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Associations of Race/Ethnicity and Food Insecurity With COVID-19 Infection Rates Across US Counties.JAMA Network Open Jun 2021Food insecurity is prevalent among racial/ethnic minority populations in the US. To date, few studies have examined the association between pre-COVID-19 experiences of...
IMPORTANCE
Food insecurity is prevalent among racial/ethnic minority populations in the US. To date, few studies have examined the association between pre-COVID-19 experiences of food insecurity and COVID-19 infection rates through a race/ethnicity lens.
OBJECTIVE
To examine the associations of race/ethnicity and past experiences of food insecurity with COVID-19 infection rates and the interactions of race/ethnicity and food insecurity, while controlling for demographic, socioeconomic, risk exposure, and geographic confounders.
DESIGN, SETTING, AND PARTICIPANTS
This cross-sectional study examined the associations of race/ethnicity and food insecurity with cumulative COVID-19 infection rates in 3133 US counties, as of July 21 and December 14, 2020. Data were analyzed from November 2020 through March 2021.
EXPOSURES
Racial/ethnic minority groups who experienced food insecurity.
MAIN OUTCOMES AND MEASURES
The dependent variable was COVID-19 infections per 1000 residents. The independent variables of interest were race/ethnicity, food insecurity, and their interactions.
RESULTS
Among 3133 US counties, the mean (SD) racial/ethnic composition was 9.0% (14.3%) Black residents, 9.6% (13.8%) Hispanic residents, 2.3% (7.3%) American Indian or Alaska Native residents, 1.7% (3.2%) Asian American or Pacific Islander residents, and 76.1% (20.1%) White residents. The mean (SD) proportion of women was 49.9% (2.3%), and the mean (SD) proportion of individuals aged 65 years or older was 19.3% (4.7%). In these counties, large Black and Hispanic populations were associated with increased COVID-19 infection rates in July 2020. An increase of 1 SD in the percentage of Black and Hispanic residents in a county was associated with an increase in infection rates per 1000 residents of 2.99 (95% CI, 2.04 to 3.94; P < .001) and 2.91 (95% CI, 0.39 to 5.43; P = .02), respectively. By December, a large Black population was no longer associated with increased COVID-19 infection rates. However, a 1-SD increase in the percentage of Black residents in counties with high prevalence of food insecurity was associated with an increase in infections per 1000 residents of 0.90 (95% CI, 0.33 to 1.47; P = .003). Similarly, a 1-SD increase in the percentage of American Indian or Alaska Native residents in counties with high levels of food insecurity was associated with an increase in COVID-19 infections per 1000 residents of 0.57 (95% CI, 0.06 to 1.08; P = .03). By contrast, a 1-SD increase in Hispanic populations in a county remained independently associated with a 5.64 (95% CI, 3.54 to 7.75; P < .001) increase in infection rates per 1000 residents in December 2020 vs 2.91 in July 2020. Furthermore, while a 1-SD increase in the proportion of Asian American or Pacific Islander residents was associated with a decrease in infection rates per 1000 residents of -1.39 (95% CI, -2.29 to 0.49; P = .003), the interaction with food insecurity revealed a similar association (interaction coefficient, -1.48; 95% CI, -2.26 to -0.70; P < .001).
CONCLUSIONS AND RELEVANCE
This study sheds light on the association of race/ethnicity and past experiences of food insecurity with COVID-19 infection rates in the United States. These findings suggest that the channels through which various racial/ethnic minority population concentrations were associated with COVID-19 infection rates were markedly different during the pandemic.
Topics: Adult; Black or African American; Aged; Asian; COVID-19; Cross-Sectional Studies; Ethnicity; Female; Food Insecurity; Health Status Disparities; Hispanic or Latino; Humans; Male; Middle Aged; Minority Groups; Native Hawaiian or Other Pacific Islander; Pandemics; Prevalence; Racial Groups; SARS-CoV-2; United States; White People; American Indian or Alaska Native
PubMed: 34100936
DOI: 10.1001/jamanetworkopen.2021.12852 -
Scientific Reports Jan 2017Body language is a powerful indicator of others' emotions in social interactions, with positive signals triggering approach and negative ones retreat and defensiveness....
Body language is a powerful indicator of others' emotions in social interactions, with positive signals triggering approach and negative ones retreat and defensiveness. Intergroup and interracial factors can influence these interactions, sometimes leading to aggressive or even violent behaviour. Despite its obvious social relevance however, the interaction between body expression and race remains unexplored, with explanations of the impact of race being almost exclusively based on the role of race in face recognition. In the current fMRI study we scanned white European participants while they viewed affective (angry and happy) body postures of both same race (white) and other race (black) individuals. To assess the difference between implicit and explicit recognition participants performed either an explicit emotion categorisation task, or an irrelevant shape judgement task. Brain activity was modulated by race in a number of brain regions across both tasks. Race-related activity appeared to be task- as well as emotion- specific. Overall, the other-race effects appeared to be driven by positive emotions, while same-race effects were observed for negative emotions. A race specific effect was also observed in right amygdala reflecting increased activation for explicit recognition of angry white body expressions. Overall, these results provide the first clear evidence that race influences affective body perception.
Topics: Behavior; Brain; Emotions; Female; Humans; Male; Online Systems; Perception; Racial Groups; Task Performance and Analysis; Young Adult
PubMed: 28128279
DOI: 10.1038/srep41349 -
International Journal For Equity in... Jul 2023The challenges presented by multimorbidity continue to rise in the United States. Little is known about how the relative contribution of individual chronic conditions to...
BACKGROUND
The challenges presented by multimorbidity continue to rise in the United States. Little is known about how the relative contribution of individual chronic conditions to multimorbidity has changed over time, and how this varies by race/ethnicity. The objective of this study was to describe trends in multimorbidity by race/ethnicity, as well as to determine the differential contribution of individual chronic conditions to multimorbidity in hospitalized populations over a 20-year period within the United States.
METHODS
This is a serial cross-sectional study using the Nationwide Inpatient Sample (NIS) from 1993 to 2012. We identified all hospitalized patients aged ≥ 18 years old with available data on race/ethnicity. Multimorbidity was defined as the presence of 3 or more conditions based on the Elixhauser comorbidity index. The relative change in the proportion of hospitalized patients with multimorbidity, overall and by race/ethnicity (Black, White, Hispanic, Asian/Pacific Islander, Native American) were tabulated and presented graphically. Population attributable fractions were estimated from modified Poisson regression models adjusted for sex, age, and insurance type. These fractions were used to describe the relative contribution of individual chronic conditions to multimorbidity over time and across racial/ethnic groups.
RESULTS
There were 123,613,970 hospitalizations captured within the NIS between 1993 and 2012. The prevalence of multimorbidity increased in all race/ethnic groups over the 20-year period, most notably among White, Black, and Native American populations (+ 29.4%, + 29.7%, and + 32.0%, respectively). In both 1993 and 2012, Black hospitalized patients had a higher prevalence of multimorbidity (25.1% and 54.8%, respectively) compared to all other race/ethnic groups. Native American populations exhibited the largest overall increase in multimorbidity (+ 32.0%). Furthermore, the contribution of metabolic diseases to multimorbidity increased, particularly among Hispanic patients who had the highest population attributable fraction values for diabetes without complications (15.0%), diabetes with complications (5.1%), and obesity (5.8%).
CONCLUSIONS
From 1993 to 2012, the secular increases in the prevalence of multimorbidity as well as changes in the differential contribution of individual chronic conditions has varied substantially by race/ethnicity. These findings further elucidate the racial/ethnic gaps prevalent in multimorbidity within the United States.
PRIOR PRESENTATIONS
Preliminary finding of this study were presented at the Society of General Internal Medicine (SGIM) Annual Conference, Washington, DC, April 21, 2017.
Topics: Adolescent; Humans; Cross-Sectional Studies; Ethnicity; Hispanic or Latino; Multimorbidity; United States; Hospitalization; Young Adult; Adult; Middle Aged; Aged; Aged, 80 and over; Racial Groups
PubMed: 37488549
DOI: 10.1186/s12939-023-01950-2 -
JAMA Oncology Aug 2016Although poorly understood, there is heterogeneity in the molecular biology of cancer across race and ethnicities. The representation of racial minorities in large...
IMPORTANCE
Although poorly understood, there is heterogeneity in the molecular biology of cancer across race and ethnicities. The representation of racial minorities in large genomic sequencing efforts is unclear, and could have an impact on health care disparities.
OBJECTIVE
To determine the racial distribution among samples sequenced within The Cancer Genome Atlas (TCGA) and the deficit of samples needed to detect moderately common mutational frequencies in racial minorities.
DESIGN, SETTING, AND PARTICIPANTS
This was a retrospective review of individual patient data from TCGA data portal accessed in July 2015. TCGA comprises samples from a wide array of institutions primarily across the United States. Samples from 10 of the 31 currently available tumor types were analyzed, comprising 5729 samples from the approximately 11 000 available.
MAIN OUTCOMES AND MEASURES
Using the estimated median somatic mutational frequency, the samples needed beyond TCGA to detect a 10% and 5% mutational frequency over the background somatic mutation frequency were calculated for each tumor type by racial ethnicity.
RESULTS
Of the 5729 samples, 77% (n = 4389) were white, 12% (n = 660) were black, 3% (n = 173) were Asian, 3% (n = 149) were Hispanic, and less than 0.5% combined were from patients of Native Hawaiian, Pacific Islander, Alaskan Native, or American Indian decent. This overrepresents white patients compared with the US population and underrepresents primarily Asian and Hispanic patients. With a somatic mutational frequency of 0.7 (prostate cancer) to 9.9 (lung squamous cell cancer), all tumor types from white patients contained enough samples to detect a 10% mutational frequency. This is in contrast to all other racial ethnicities, for which group-specific mutations with 10% frequency would be detectable only for black patients with breast cancer. Group-specific mutations with 5% frequency would be undetectable in any racial minority, but detectable in white patients for all cancer types except lung (adenocarcinoma and squamous cell carcinoma) and colon cancer.
CONCLUSIONS AND RELEVANCE
It is probable, but poorly understood, that ethnic diversity is related to the pathogenesis of cancer, and may have an impact on the generalizability of findings from TCGA to racial minorities. Despite the important benefits that continue to be gained from genomic sequencing, dedicated efforts are needed to avoid widening the already pervasive gap in health care disparities.
Topics: Black or African American; Alaska Natives; Asian; Databases, Genetic; Ethnicity; Genomics; Healthcare Disparities; Hispanic or Latino; Humans; Minority Groups; Mutation Rate; Native Hawaiian or Other Pacific Islander; Neoplasms; Racial Groups; Retrospective Studies; United States; White People
PubMed: 27366979
DOI: 10.1001/jamaoncol.2016.1854 -
Other-race faces are given more weight than own-race faces when assessing the composition of crowds.Vision Research Apr 2019In two experiments we examined the performance of Asian and Caucasian participants as they were asked to estimate the ethnic composition of arrays of 16 concurrently...
In two experiments we examined the performance of Asian and Caucasian participants as they were asked to estimate the ethnic composition of arrays of 16 concurrently presented faces. Across trials we systematically varied the physical proportion of Asian and Caucasian faces presented in the arrays using the method of constant stimuli. The task was to explicitly indicate which group was in the majority. The position of the 16 faces within the array were continuously shuffled using a 4 × 4 moving grid to block explicit enumeration. Measures of bias and sensitivity were estimated by fitting cumulative normal distributions to individual response data. Consistent with recent findings on "ensemble" face processing, all participants were able to make group estimates quite accurately. This was true using both full-colour, non-normalised, headshots (Exp1) and centre-apertured, normalised, grey-scale images (Exp2). However, the main finding was that performance estimates from the two groups of participants did not overlap. Specifically, patterns of bias suggest that other-race faces are weighted more heavily than own-race faces (Exps 1 & 2), while sensitivity is better for groups instructed to decide if the other-race, rather than own-race, is more numerous (Exp 2). To our knowledge, these are the first demonstrations of other-race biases affecting decisions that have to be made about groups of faces.
Topics: Adult; Analysis of Variance; Bias; Facial Recognition; Female; Humans; Male; Racial Groups; Reaction Time; Recognition, Psychology; Young Adult
PubMed: 29555300
DOI: 10.1016/j.visres.2018.02.008 -
Journal of Racial and Ethnic Health... Aug 2021There are health concerns associated with unhealthy sleep duration. A growing body of evidence indicates that there are disparities in sleep duration based upon...
Effects of Race and Poverty on Sleep Duration: Analysis of Patterns in the 2014 Native Hawaiian and Pacific Islander National Health Interview Survey and General National Health Interview Survey Data.
BACKGROUND
There are health concerns associated with unhealthy sleep duration. A growing body of evidence indicates that there are disparities in sleep duration based upon race/ethnicity and socioeconomic status. Prior studies have suffered from inadequate measures of poverty and have not included Native Hawaiians and Pacific Islanders (NHPI).
METHODS
Using the 2014 National Health Interview Survey (NHIS) and the 2014 NHPI-NHIS, the effect of race/ethnicity and poverty was examined for associations with sleep duration.
RESULTS
Significant differences among race/ethnicity groups and sleep duration were found in adjusted associations. Compared with Whites, NHPIs and Blacks were twice as likely to experience very short sleep; NHPI, Hispanic, and Blacks were more likely to experience short sleep; Blacks were also more likely to experience long sleep. Asians were less likely to experience unhealthy sleep (very short, short, or long sleep). Persons living in poverty were significantly more likely to experience very short sleep compared with persons not living in poverty.
CONCLUSION
This is the first population-based study that has examined the relationship between sleep duration and poverty with a large sample that included NHPI in relation to other races/ethnicities. The difference in sleep duration between NHPI and Asians provides a strong rationale for not aggregating Asian and NHPI data in population-based studies.
Topics: Female; Health Surveys; Humans; Male; Middle Aged; Native Hawaiian or Other Pacific Islander; Poverty; Race Factors; Racial Groups; Sleep; Time Factors; United States
PubMed: 32815121
DOI: 10.1007/s40615-020-00841-4 -
Social Science & Medicine (1982) Jun 2024Despite the general consensus that there is no biological basis to race, racial categorization is still used by clinicians to guide diagnosis and treatment plans for...
Despite the general consensus that there is no biological basis to race, racial categorization is still used by clinicians to guide diagnosis and treatment plans for certain diseases. In medicine, race is commonly used as a rough proxy for unmeasured social, environmental, and genetic factors. The American College of Cardiology's Eighth Joint National Committee's (JNC 8) guidelines for the treatment of hypertension provide race-specific medication recommendations for Black versus non-Black patients, without strong evidence for race-specific physiological differences in drug response. Clinicians practicing family or geriatric medicine (n = 21) were shown a video of a mock hypertensive patient with genetic ancestry test results that could be viewed as discordant with their phenotype and self-identified race. After viewing the videos, we conducted in-depth interviews to examine how clinicians value and prioritize different cues about race -- namely genetic ancestry data, phenotypic appearance, and self-identified racial classifications - when making treatment decisions in the context of race-specific guidelines, particularly in situations when patients claim mixed-race or complex racial identities. Results indicate that clinicians inconsistently follow the race-specific guidelines for patients whose genetic ancestry test results do not match neatly with their self-identified race or phenotypic features. However, many clinicians also emphasized the importance of clinical experience, side effects, and other factors in their decision making. Clinicians' definitions of race, categorization of the patient's race, and prioritization of racial cues greatly varied. The existence of the race-specific guidelines clearly influences treatment decisions, even as clinicians' express uncertainty about how to incorporate consideration of a patient's genetic ancestry. In light of widespread debate about removal of race from medical diagnostics, researchers should revisit the clinical justification for maintaining these race-specific guidelines. Based on our findings and prior studies indicating a lack of convincing evidence for biological differences by race in medication response, we suggest removing race from the JNC 8 guidelines to avoid risk of perpetuating or exacerbating health disparities in hypertension.
Topics: Humans; Hypertension; Female; Male; Practice Guidelines as Topic; Middle Aged; Racial Groups; Adult; Qualitative Research; Attitude of Health Personnel; Antihypertensive Agents
PubMed: 38735272
DOI: 10.1016/j.socscimed.2024.116938 -
Health Affairs (Project Hope) Jan 2023The US physician workforce does not reflect the racial and ethnic makeup of the country's population, despite efforts to promote diversity. Becoming a physician requires...
The US physician workforce does not reflect the racial and ethnic makeup of the country's population, despite efforts to promote diversity. Becoming a physician requires significant time and financial investment, and populations that are underrepresented in medicine have also been excluded from building wealth. Understanding the differential burden of debt by race and ethnicity may inform strategies to improve workforce diversity. We used 2014-19 data on postgraduate resident trainees from the Association of American Medical Colleges to examine the association between race and ethnicity and debt independent of other demographics and residency characteristics. Black trainees were significantly more likely to have every type of debt than the overall sample and all other racial and ethnic groups (96 percent of Black trainees had any debt versus 83 percent overall; 60 percent had premedical education loans versus 35 percent overall, and 50 percent had consumer debt versus 25 percent overall). American Indian/Alaska Native, Hispanic, and Native Hawaiian/Pacific Islander trainees were more likely to have debt compared with White and Asian trainees. Overall, debt prevalence decreased over time and varied by specialty; however, for Black trainees, debt decreased minimally over time and was stable across specialties. Scholarships, debt relief, and financial guidance should be explored to improve diversity and inclusion in medicine across specialties.
Topics: Humans; Asian; Ethnicity; Hispanic or Latino; Internship and Residency; Minority Groups; United States; Black or African American; American Indian or Alaska Native; Native Hawaiian or Other Pacific Islander
PubMed: 36623219
DOI: 10.1377/hlthaff.2022.00446 -
European Urology Jan 2021In the USA, it is unknown whether metastatic prostate cancer incidence has continued to increase and whether racial differences have persisted. (Comparative Study)
Comparative Study Observational Study
BACKGROUND
In the USA, it is unknown whether metastatic prostate cancer incidence has continued to increase and whether racial differences have persisted.
OBJECTIVE
Combining multiple imputation with age and delay adjustment, we provide an up-to-date, comprehensive assessment of US prostate cancer incidence trends by stage and race.
DESIGN, SETTING, AND PARTICIPANTS
From Surveillance Epidemiology and End Results (SEER)-18, 774 240 prostate cancer cases were diagnosed during 2004-2017.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
Multiple imputation assigned prostate cancer stage to the 4.7% of cases with missing stage, which varied by year and race-ethnicity. SEER delay factors adjusted case counts to anticipated future data corrections. Twenty datasets were imputed, and Rubin's rules were used for summary estimation. Overall and stage-specific rates were estimated and stratified by race and age group. Joinpoint software identified significant temporal changes and estimated annual percentage changes. We compared these estimates without multiple imputation and delay adjustment.
RESULTS AND LIMITATIONS
Metastatic prostate cancer incidence increased during 2011-2017, with an annual percentage change of 5.5. This was followed by increases in localized and regional disease since 2014. Non-Hispanic black men continued to have the highest incidence, especially for metastatic disease. The increasing rate of metastatic prostate cancer in non-Hispanic white men aged 50-74 yr accelerated recently, and the incidence was 56% higher in 2017 than in 2004. Rates without multiple imputation and delay adjustment were quantitatively and qualitatively different. This observational study is unable to assign causes to observed changes in prostate cancer incidence.
CONCLUSIONS
Multiple imputation and delay adjustment are essential for portraying accurately stage- and race-specific prostate cancer incidence as clinical practice evolves.
PATIENT SUMMARY
In the USA, diagnosis of prostate cancer that has spread to distant sites (metastatic disease) continues to increase. Black men continue to have higher risks of being diagnosed with metastatic prostate cancer than other race-ethnicities.
Topics: Age Distribution; Humans; Incidence; Male; Neoplasm Staging; Prostatic Neoplasms; Racial Groups; Time Factors; United States
PubMed: 33092896
DOI: 10.1016/j.eururo.2020.09.041 -
American Journal of Public Health Mar 2013To investigate the possibility of a Hispanic mortality advantage, we conducted a systematic review and meta-analysis of the published longitudinal literature reporting... (Meta-Analysis)
Meta-Analysis Review
To investigate the possibility of a Hispanic mortality advantage, we conducted a systematic review and meta-analysis of the published longitudinal literature reporting Hispanic individuals' mortality from any cause compared with any other race/ethnicity. We searched MEDLINE, PubMed, EMBASE, HealthSTAR, and PsycINFO for published literature from January 1990 to July 2010. Across 58 studies (4 615 747 participants), Hispanic populations had a 17.5% lower risk of mortality compared with other racial groups (odds ratio = 0.825; P < .001; 95% confidence interval = 0.75, 0.91). The difference in mortality risk was greater among older populations and varied by preexisting health conditions, with effects apparent for initially healthy samples and those with cardiovascular diseases. The results also differed by racial group: Hispanics had lower overall risk of mortality than did non-Hispanic Whites and non-Hispanic Blacks, but overall higher risk of mortality than did Asian Americans. These findings provided strong evidence of a Hispanic mortality advantage, with implications for conceptualizing and addressing racial/ethnic health disparities.
Topics: Hispanic or Latino; Humans; Longitudinal Studies; Mortality; Racial Groups; United States
PubMed: 23327278
DOI: 10.2105/AJPH.2012.301103