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Journal of Burn Care & Research :... Sep 2023Outcomes of burn survivors is a growing field of interest; however, there is little data comparing the outcomes of burn survivors by ethnicity. This study seeks to...
Outcomes of burn survivors is a growing field of interest; however, there is little data comparing the outcomes of burn survivors by ethnicity. This study seeks to identify any inequities in burn outcomes by racial and ethnic groups. A retrospective chart review of an ABA Certified burn center at a large urban safety net hospital identified adult inpatient admissions from 2015 to 2019. A total of 1142 patients were categorized by primary ethnicity: 142 black or African American, 72 Asian, 479 Hispanic or Latino, 90 white, 215 other, and 144 patients whose race or ethnicity was unrecorded. Multivariable analyses evaluated the relationship between race and ethnicity and outcomes. Covariate confounders were controlled by adjustment of demographic, social, and prehospital clinical factors to isolate differences that might not be explained by other factors. After controlling for covariates, black patients had 29% longer hospital stays (P = .043). Hispanic patients were more likely to be discharged to home or to hospice care (P = .005). Hispanic ethnicity was associated with a 44% decrease in the odds of discharge to acute care, inpatient rehabilitation, or a ward outside the burn unit (P = .022). Black and Hispanic patients had a higher relative chance of having publicly assisted insurance, versus private insurance, than their white counterparts (P = .041, P = .011 respectively). The causes of these inequities are indeterminate. They may stem from socioeconomic status not entirely accounted for, ethnic differences in comorbidity related to stressors, or inequity in health care delivery.
Topics: Adult; Humans; Burns; Ethnicity; Hispanic or Latino; Retrospective Studies; White; Black or African American; Asian; Racial Groups; Healthcare Disparities
PubMed: 36881674
DOI: 10.1093/jbcr/irad033 -
JAMA Network Open Dec 2023Representativeness of populations within neonatal clinical trials is crucial to moving the field forward. Although racial and ethnic disparities in research inclusion...
IMPORTANCE
Representativeness of populations within neonatal clinical trials is crucial to moving the field forward. Although racial and ethnic disparities in research inclusion are well documented in other fields, they are poorly described within neonatology.
OBJECTIVE
To describe the race and ethnicity of infants included in a sample of recent US neonatal clinical trials and the variability in this reporting.
EVIDENCE REVIEW
A systematic search of US neonatal clinical trials entered into Cochrane CENTRAL 2017 to 2021 was conducted. Two individuals performed inclusion determination, data extraction, and quality assessment independently with discrepancies adjudicated by consensus.
FINDINGS
Of 120 studies with 14 479 participants that met the inclusion criteria, 75 (62.5%) included any participant race or ethnicity data. In the studies that reported race and ethnicity, the median (IQR) percentage of participants of each background were 0% (0%-1%) Asian, 26% (9%-42%) Black, 3% (0%-12%) Hispanic, 0% (0%-0%) Indigenous (eg, Alaska Native, American Indian, and Native Hawaiian), 0% (0%-0%) multiple races, 57% (30%-68%) White, and 7% (1%-21%) other race or ethnicity. Asian, Black, Hispanic, and Indigenous participants were underrepresented, while White participants were overrepresented compared with a reference sample of the US clinical neonatal intensive care unit (NICU) population from the Vermont Oxford Network. Many participants were labeled as other race or ethnicity without adequate description. There was substantial variability in terms and methods of reporting race and ethnicity data. Geographic representation was heavily skewed toward the Northeast, with nearly one-quarter of states unrepresented.
CONCLUSIONS AND RELEVANCE
These findings suggest that neonatal research may perpetuate inequities by underrepresenting Asian, Black, Hispanic, and Indigenous neonates in clinical trials. Studies varied in documentation of race and ethnicity, and there was regional variation in the sites included. Based on these findings, funders and clinical trialists are advised to consider a 3-point targeted approach to address these issues: prioritize identifying ways to increase diversity in neonatal clinical trial participation, agree on a standardized method to report race and ethnicity among neonatal clinical trial participants, and prioritize the inclusion of participants from all regions of the US in neonatal clinical trials.
Topics: Humans; Infant; Infant, Newborn; Ethnicity; Clinical Trials as Topic; Racial Groups
PubMed: 38127349
DOI: 10.1001/jamanetworkopen.2023.48882 -
Genome Medicine Apr 2023Population screening for genetic risk of adult-onset preventable conditions has been proposed as an attractive public health intervention. Screening unselected...
BACKGROUND
Population screening for genetic risk of adult-onset preventable conditions has been proposed as an attractive public health intervention. Screening unselected individuals can identify many individuals who will not be identified through current genetic testing guidelines.
METHODS
We sought to evaluate enrollment in and diagnostic yield of population genetic screening in a resource-limited setting among a diverse population. We developed a low-cost, short-read next-generation sequencing panel of 25 genes that had 98.4% sensitivity and 99.98% specificity compared to diagnostic panels. We used email invitations to recruit a diverse cohort of patients in the University of Washington Medical Center system unselected for personal or family history of hereditary disease. Participants were sent a saliva collection kit in the mail with instructions on kit use and return. Results were returned using a secure online portal. Enrollment and diagnostic yield were assessed overall and across race and ethnicity groups.
RESULTS
Overall, 40,857 people were invited and 2889 (7.1%) enrolled. Enrollment varied across race and ethnicity groups, with the lowest enrollment among African American individuals (3.3%) and the highest among Multiracial or Other Race individuals (13.0%). Of 2864 enrollees who received screening results, 106 actionable variants were identified in 103 individuals (3.6%). Of those who screened positive, 30.1% already knew about their results from prior genetic testing. The diagnostic yield was 74 new, actionable genetic findings (2.6%). The addition of more recently identified cancer risk genes increased the diagnostic yield of screening.
CONCLUSIONS
Population screening can identify additional individuals that could benefit from prevention, but challenges in recruitment and sample collection will reduce actual enrollment and yield. These challenges should not be overlooked in intervention planning or in cost and benefit analysis.
Topics: Adult; Humans; Genetic Testing; Risk Factors; Racial Groups; Black or African American; Ethnicity
PubMed: 37069702
DOI: 10.1186/s13073-023-01174-7 -
The Journal of Pediatrics Aug 2023To examine the associations between race and ethnicity and length of stay (LOS) for US children with acute osteomyelitis. (Comparative Study)
Comparative Study
OBJECTIVE
To examine the associations between race and ethnicity and length of stay (LOS) for US children with acute osteomyelitis.
STUDY DESIGN
Using the Kids' Inpatient Database, we conducted a cross-sectional study of children <21 years old hospitalized in 2016 or 2019 with acute osteomyelitis. Using survey-weighted negative binomial regression, we modeled LOS by race and ethnicity, adjusting for clinical and hospital characteristics and socioeconomic status. Secondary outcomes included prolonged LOS, defined as LOS of >7 days (equivalent to LOS in the highest quartile).
RESULTS
We identified 2388 children discharged with acute osteomyelitis. The median LOS was 5 days (IQR, 3-7). Compared with White children, children of Black race (adjusted incidence rate ratio [aIRR] 1.15; 95% CI, 1.05-1.27), Hispanic ethnicity (aIRR 1.11; 95% CI, 1.02-1.21), and other race and ethnicity (aIRR 1.12; 95% CI, 1.01-1.23) had a significantly longer LOS. The odds of Black children experiencing prolonged LOS was 46% higher compared with White children (aOR, 1.46; 95% CI, 1.01-2.11).
CONCLUSIONS
Children of Black race, Hispanic ethnicity, and other race and ethnicity with acute osteomyelitis experienced longer LOS than White children. Elucidating the mechanisms underlying these race- and ethnicity-based differences, including social drivers such as access to care, structural racism, and bias in provision of inpatient care, may improve management and outcomes for children with acute osteomyelitis.
Topics: Adolescent; Child; Humans; Young Adult; Acute Disease; Black or African American; Cross-Sectional Studies; Ethnicity; Hispanic or Latino; Hospitalization; Length of Stay; Osteomyelitis; United States; White; Racial Groups
PubMed: 37084849
DOI: 10.1016/j.jpeds.2023.113424 -
The Journals of Gerontology. Series B,... Jan 2022Later adult work attachments and exits are in flux, suggesting the need for understanding both the range of contemporary population-level pathways of work and nonwork...
OBJECTIVES
Later adult work attachments and exits are in flux, suggesting the need for understanding both the range of contemporary population-level pathways of work and nonwork and variations by overlapping social locations. We document patterned continuity and change in monthly work attachments and analyze the intersecting effects of age, gender, education, and race/ethnicity.
METHODS
We capitalize on massive microlevel 16-month panel data from the Current Population Survey from 2008 through 2016 to empirically identify patterned pathways of monthly states: working full-time, long hours, part-time; being self-employed or unemployed; not working because of a disability, due to family care or other reasons, or because one defines oneself as retired.
RESULTS
Analyses of 346,488 American women and men aged 50-75 years reveal patterned elasticity in the timing and nature of work attachments in the form of six distinctive pathways. Our intersectional analyses illustrate divergences and disparities: advantages for educated White men, disadvantages for low-educated Black men and women through their early 60s, and intersecting effects of gender, education, and race/ethnicity during the later work course across age groups. We find convergence across social markers by the 70s.
DISCUSSION
This research highlights the importance of intersectional analysis, recasting the gendered work course in later adulthood into a framework of even greater complexities within mutually shaping categories of race/ethnicity, class, and age. Older Americans experience patterned, uneven pathways around work and nonwork. We recommend additional scholarship on the dynamics of constrained and disparate choices unfolding across multiple intersecting social locations.
Topics: Age Factors; Aged; Disabled Persons; Educational Status; Employment; Ethnicity; Female; Humans; Male; Middle Aged; Racial Groups; Sex Factors; Socioeconomic Factors; United States
PubMed: 33687059
DOI: 10.1093/geronb/gbab039 -
JAMA Pediatrics Jul 2023Although inequitable care due to racism and bias is well documented in health care, the impact on health care-associated infections is less understood.
IMPORTANCE
Although inequitable care due to racism and bias is well documented in health care, the impact on health care-associated infections is less understood.
OBJECTIVE
To determine whether disparities in first central catheter-associated bloodstream infection (CLABSI) rates existed for pediatric patients of minoritized racial, ethnic, and language groups and to evaluate the outcomes associated with quality improvement initiatives for addressing these disparities.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study retrospectively examined outcomes of 8269 hospitalized patients with central catheters from October 1, 2012, to September 30, 2019, at a freestanding quaternary care children's hospital. Subsequent quality improvement interventions and follow-up were studied, excluding catheter days occurring after the outcome and episodes with catheters of indeterminate age through September 2022.
EXPOSURES
Patient self-reported (or parent/guardian-reported) race, ethnicity, and language for care as collected for hospital demographic purposes.
MAIN OUTCOMES AND MEASURES
Central catheter-associated bloodstream infection events identified by infection prevention surveillance according to National Healthcare Safety Network criteria were reported as events per 1000 central catheter days. Cox proportional hazards regression was used to analyze patient and central catheter characteristics, and interrupted time series was used to analyze quality improvement outcomes.
RESULTS
Unadjusted infection rates were higher for Black patients (2.8 per 1000 central catheter days) and patients who spoke a language other than English (LOE; 2.1 per 1000 central catheter days) compared with the overall population (1.5 per 1000 central catheter days). Proportional hazard regression included 225 674 catheter days with 316 infections and represented 8269 patients. A total of 282 patients (3.4%) experienced a CLABSI (mean [IQR] age, 1.34 [0.07-8.83] years; female, 122 [43.3%]; male, 160 [56.7%]; English-speaking, 236 [83.7%]; LOE, 46 [16.3%]; American Indian or Alaska Native, 3 [1.1%]; Asian, 14 [5.0%]; Black, 26 [9.2%]; Hispanic, 61 [21.6%]; Native Hawaiian or Other Pacific Islander, 4 [1.4%]; White, 139 [49.3%]; ≥2 races, 14 [5.0%]; unknown race and ethnicity or refused to answer, 15 [5.3%]). In the adjusted model, a higher hazard ratio (HR) was observed for Black patients (adjusted HR, 1.8; 95% CI, 1.2-2.6; P = .002) and patients who spoke an LOE (adjusted HR, 1.6; 95% CI, 1.1-2.3; P = .01). Following quality improvement interventions, infection rates in both subgroups showed statistically significant level changes (Black patients: -1.77; 95% CI, -3.39 to -0.15; patients speaking an LOE: -1.25; 95% CI, -2.23 to -0.27).
CONCLUSIONS AND RELEVANCE
The study's findings show disparities in CLABSI rates for Black patients and patients who speak an LOE that persisted after adjusting for known risk factors, suggesting that systemic racism and bias may play a role in inequitable hospital care for hospital-acquired infections. Stratifying outcomes to assess for disparities prior to quality improvement efforts may inform targeted interventions to improve equity.
Topics: Child; Female; Humans; Infant; Male; Cross Infection; Ethnicity; Hispanic or Latino; Retrospective Studies; Sepsis; Healthcare Disparities; Catheter-Related Infections; Ethnic and Racial Minorities; Language; Quality Improvement; Catheterization, Central Venous; Black or African American; Racial Groups; Communication Barriers; Child, Preschool; American Indian or Alaska Native; Systemic Racism; Asian; Native Hawaiian or Other Pacific Islander; White
PubMed: 37252746
DOI: 10.1001/jamapediatrics.2023.1379 -
Sleep Health Feb 2018Sleep is essential for optimal health, well-being, and cognitive functioning, and yet nationwide, youth are not obtaining consistent, adequate, or high-quality sleep. In... (Review)
Review
Sleep is essential for optimal health, well-being, and cognitive functioning, and yet nationwide, youth are not obtaining consistent, adequate, or high-quality sleep. In fact, more than two-thirds of US adolescents are sleeping less than 8 hours nightly on school nights. Racial and ethnic minority children and adolescents are at an increased risk of having shorter sleep duration and poorer sleep quality than their white peers. In this review, we critically examined and compared results from 23 studies that have investigated racial/ethnic sleep disparities in American school-aged children and adolescents ages 6-19 years. We found that White youth generally had more sufficient sleep than minority youth, Hispanics had more than Blacks, and there was inconclusive evidence for Asians and other minorities. Recommendations for researchers include the following: (1) explore underlying causes of the disparities of these subpopulations, with a particular interest in identifying modifiable causes; (2) examine factors that may be impacted by racial/ethnic sleep disparities; (3) use a multidimensional approach to measuring sleep disparities; and (4) examine how beliefs about sleep are patterned by race/ethnicity. Understanding sleep disparities can inform interventions, policies, and educational programs to minimize sleep disparities and their impact on health, psychological, and educational outcomes.
Topics: Adolescent; Child; Ethnicity; Health Status Disparities; Humans; Racial Groups; Sleep; United States
PubMed: 29332684
DOI: 10.1016/j.sleh.2017.09.005 -
Obstetrics and Gynecology Nov 2020To evaluate the associations between the number of chronic conditions and maternal race and ethnicity (race) with the risk of severe maternal morbidity.
OBJECTIVE
To evaluate the associations between the number of chronic conditions and maternal race and ethnicity (race) with the risk of severe maternal morbidity.
METHODS
Using the National Inpatient Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality, years 2016-2017, we examined risk of severe maternal morbidity among 1,480,925 delivery hospitalizations among women of different races and with different numbers of comorbid conditions using multivariable logistic regression.
RESULTS
The rate of severe maternal morbidity was 139.7 per 10,000 deliveries. Compared with women with no comorbidities (rate 48.5/10,000), there was increased risk of severe maternal morbidity among women with one comorbidity (rate 238.6; odds ratio [OR] 5.0, 95% CI 4.8-5.2), two comorbidities (rate 379.9; OR 8.1, 95% CI 7.8-8.5), or three or more comorbidities (rate 560; OR 12.1, 95% CI 11.5-12.7). In multivariable regressions, similar associations were noted for women with one (adjusted odds ratio [aOR] 4.4, 95% CI 4.2-4.6), two (aOR 6.6, 95% CI 6.3-6.9), or three or more comorbidities (aOR 9.1, 95% CI 8.7-9.6). Black women had higher rates of comorbid conditions than all other racial and ethnic groups, with 55% (95% CI 54-56%) of Black women having no comorbidities, compared with 67% (95% CI 67-68%) of White women, 68% (95% CI 67-69%) of Hispanic women, and 72% (95% CI 71-73%) of Asian women.
CONCLUSION
We found a dose-response relationship between number of comorbidities and risk of severe maternal morbidity, with the highest rates of severe maternal morbidity among women with three or more comorbidities. Focusing on the prevention and treatment of chronic conditions among women of childbearing age may have the potential to improve maternal outcomes across races and ethnicities.
Topics: Adult; Black or African American; Asian; Chronic Disease; Comorbidity; Delivery, Obstetric; Ethnicity; Female; Health Status Disparities; Hispanic or Latino; Hospitalization; Humans; Odds Ratio; Pregnancy; Pregnancy Complications; Racial Groups; United States; White People
PubMed: 33030867
DOI: 10.1097/AOG.0000000000004057 -
Sleep Medicine Reviews Aug 2013Sleep duration in America has gradually declined over the last four decades and appears to have reached a plateau for the last six years, with recent studies reporting... (Review)
Review
Sleep duration in America has gradually declined over the last four decades and appears to have reached a plateau for the last six years, with recent studies reporting that the population's current average sleep duration is approximately 6 h. In this paper, we examine epidemiologic and community-based data on sleep complaints reported by American adults, specifically addressing the role of race/ethnicity in the subjective report of sleep problems. Subjective and objective findings indicate that black (throughout the text, we use the term black in lieu of African American for there are instances where we refer to individuals with self-ascribed race/ethnicity as black, African American, African, or Caribbean American; the term white is used to denote individuals of European descent). Americans have higher rates of long (≥9 h) and short (≤5 h) sleep than their white counterparts, and this may mediate a higher risk of cardiovascular disease, obesity and diabetes among blacks. In addition, studies show mixed results on sleep complaints among blacks compared to those among other ethnicities. This paper explores factors that may contribute to racial/ethnic differences in sleep including intra-ethnic variation, cultural biases, genetics and psychosocial factors.
Topics: Adult; Ethnicity; Humans; Middle Aged; Racial Groups; Risk Factors; Sleep; Sleep Wake Disorders; Time Factors; United States
PubMed: 23348004
DOI: 10.1016/j.smrv.2012.07.002 -
Trauma, Violence & Abuse Oct 2023Children in foster care face heightened risk of adverse psychosocial and economic outcomes compared with children in the general population. Yet, the effects of foster... (Review)
Review
Children in foster care face heightened risk of adverse psychosocial and economic outcomes compared with children in the general population. Yet, the effects of foster care as an intervention are heterogeneous. Heterogeneity outcomes by race and ethnicity are of particular interest, given that Black and Indigenous youth experience foster care at higher rates than other racial/ethnic groups and experience group differences in setting, duration, and exits to permanency. This meta-regression explores racial disparities in education, employment, mental health, and behavioral outcomes during and following foster care. A systematic search of PsycINFO, ERIC, and Academic Search Complete using a series of search terms for studies published between January 2000 and June 2021 found 70 articles and 392 effect sizes that provided outcomes of US-based foster care by race/ethnicity. Findings reveal that Black foster care impacted persons (FCIPs) have 20% lower odds (95% CI: .68-.93) of achieving employment or substantial financial earnings and have 18% lower odds (95% CI: .68-1.00) of mental health concerns compared to White FCIPs. Hispanic FCIPs have 10% lower odds (95% CI: .84-.97) of achieving stable housing compared to non-Hispanic FCIPs. Moderator analyses revealed certain study features (i.e. publication type, timing of the study, location of the study, and placement status of the participants) have a significant impact on the gap between Black and non-Black and Hispanic and non-Hispanic FCIPs. The findings provide important implications for racial disparities in foster care outcomes, as well as highlight important gaps and missing information from published studies.
Topics: Adolescent; Child; Humans; Ethnicity; Foster Home Care; Hispanic or Latino; Housing; Mental Health; Psychological Well-Being; Health Status Disparities; Racial Groups; Black or African American; White
PubMed: 35773632
DOI: 10.1177/15248380221111481