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Hawai'i Journal of Health & Social... Oct 2023Federal race and ethnicity data standards are commonly applied within the state of Hawai'i. When a multiracial category is used, Native Hawaiians are disproportionately... (Review)
Review
Federal race and ethnicity data standards are commonly applied within the state of Hawai'i. When a multiracial category is used, Native Hawaiians are disproportionately affected since they are more likely than any other group to identify with an additional race or ethnicity group. These data conventions contribute to a phenomenon known as data genocide - the systematic erasure of Indigenous and marginalized peoples from population data. While data aggregation may be unintentional or due to real or perceived barriers, the obstacles to disaggregating data must be overcome to advance health equity. In this call for greater attention to relevant social determinants of health through disaggregation of race and ethnicity data, the history of data standards is reviewed, the implications of aggregation are discussed, and recommended disaggregation strategies are provided.
Topics: Humans; Ethnicity; Hawaii; Health Status Disparities; Native Hawaiian or Other Pacific Islander; Data Analysis; Racial Groups; Social Determinants of Health; Health Disparate Minority and Vulnerable Populations; Health Equity
PubMed: 37901675
DOI: No ID Found -
The Pediatric Infectious Disease Journal May 2023Racial inequities influence health outcomes in the United States, but their impact on sepsis outcomes among children is understudied. We aimed to evaluate for racial...
BACKGROUND
Racial inequities influence health outcomes in the United States, but their impact on sepsis outcomes among children is understudied. We aimed to evaluate for racial inequities in sepsis mortality using a nationally representative sample of pediatric hospitalizations.
METHODS
This population-based, retrospective cohort study used the 2006, 2009, 2012 and 2016 Kids' Inpatient Database. Eligible children 1 month to 17 years old were identified using sepsis-related International Classification of Diseases, Ninth Revision or International Classification of Diseases, Tenth Revision codes. We used modified Poisson regression to evaluate the association between patient race and in-hospital mortality, clustering by hospital and adjusting for age, sex and year. We used Wald tests to assess for modification of associations between race and mortality by sociodemographic factors, geographic region and insurance status.
RESULTS
Among 38,234 children with sepsis, 2555 (6.7%) died in-hospital. Compared with White children, mortality was higher among Hispanic (adjusted relative risk: 1.09; 95% confidence interval: 1.05-1.14), Asian/Pacific Islander (1.17, 1.08-1.27) and children from other racial minority groups (1.27, 1.19-1.35). Black children had similar mortality to White children overall (1.02, 0.96-1.07), but higher mortality in the South (7.3% vs. 6.4%; P < 0.0001). Hispanic children had higher mortality than White children in the Midwest (6.9% vs. 5.4%; P < 0.0001), while Asian/Pacific Islander children had higher mortality than all other racial categories in the Midwest (12.6%) and South (12.0%). Mortality was higher among uninsured children than among privately insured children (1.24, 1.17-1.31).
CONCLUSIONS
Risk of in-hospital mortality among children with sepsis in the United States differs by patient race, geographic region and insurance status.
Topics: Child; Humans; Hispanic or Latino; Hospital Mortality; Racial Groups; Retrospective Studies; Sepsis; United States; Health Status Disparities; Black or African American; White; Asian
PubMed: 36795560
DOI: 10.1097/INF.0000000000003842 -
JAMA Network Open Jul 2020Racial bias is associated with the allocation of advanced heart failure therapies, heart transplants, and ventricular assist devices. It is unknown whether gender and...
IMPORTANCE
Racial bias is associated with the allocation of advanced heart failure therapies, heart transplants, and ventricular assist devices. It is unknown whether gender and racial biases are associated with the allocation of advanced therapies among women.
OBJECTIVE
To determine whether the intersection of patient gender and race is associated with the decision-making of clinicians during the allocation of advanced heart failure therapies.
DESIGN, SETTING, AND PARTICIPANTS
In this qualitative study, 46 US clinicians attending a conference for an international heart transplant organization in April 2019 were interviewed on the allocation of advanced heart failure therapies. Participants were randomized to examine clinical vignettes that varied 1:1 by patient race (African American to white) and 20:3 by gender (women to men) to purposefully target vignettes of women patients to compare with a prior study of vignettes of men patients. Participants were interviewed about their decision-making process using the think-aloud technique and provided supplemental surveys. Interviews were analyzed using grounded theory methodology, and surveys were analyzed with Wilcoxon tests.
EXPOSURE
Randomization to clinical vignettes.
MAIN OUTCOMES AND MEASURES
Thematic differences in allocation of advanced therapies by patient race and gender.
RESULTS
Among 46 participants (24 [52%] women, 20 [43%] racial minority), participants were randomized to the vignette of a white woman (20 participants [43%]), an African American woman (20 participants [43%]), a white man (3 participants [7%]), and an African American man (3 participants [7%]). Allocation differences centered on 5 themes. First, clinicians critiqued the appearance of the women more harshly than the men as part of their overall impressions. Second, the African American man was perceived as experiencing more severe illness than individuals from other racial and gender groups. Third, there was more concern regarding appropriateness of prior care of the African American woman compared with the white woman. Fourth, there were greater concerns about adequacy of social support for the women than for the men. Children were perceived as liabilities for women, particularly the African American woman. Family dynamics and finances were perceived to be greater concerns for the African American woman than for individuals in the other vignettes; spouses were deemed inadequate support for women. Last, participants recommended ventricular assist devices over transplantation for all racial and gender groups. Surveys revealed no statistically significant differences in allocation recommendations for African American and white women patients.
CONCLUSIONS AND RELEVANCE
This national study of health care professionals randomized to clinical vignettes that varied only by gender and race found evidence of gender and race bias in the decision-making process for offering advanced therapies for heart failure, particularly for African American women patients, who were judged more harshly by appearance and adequacy of social support. There was no associated between patient gender and race and final recommendations for allocation of advanced therapies. However, it is possible that bias may contribute to delayed allocation and ultimately inequity in the allocation of advanced therapies in a clinical setting.
Topics: Adult; Female; Healthcare Disparities; Heart Failure; Heart Transplantation; Humans; Male; Middle Aged; Qualitative Research; Racial Groups; Resource Allocation; Sexism; Socioeconomic Factors; Surveys and Questionnaires
PubMed: 32692370
DOI: 10.1001/jamanetworkopen.2020.11044 -
Associations Between State and Local Government Spending and Pregnancy-Related Mortality in the U.S.American Journal of Preventive Medicine Apr 2023There is limited evidence on how government spending is associated with maternal death. This study investigates the associations between state and local government...
INTRODUCTION
There is limited evidence on how government spending is associated with maternal death. This study investigates the associations between state and local government spending on social and healthcare services and pregnancy-related mortality among the total, non-Hispanic Black, Hispanic, and non-Hispanic White populations.
METHODS
State-specific total population and race/ethnicity-specific 5-year (2015-2019) pregnancy-related mortality ratios were estimated from annual natality and mortality files provided by the National Center for Health Statistics. Data on state and local government spending and population-level characteristics were obtained from U.S. Census Bureau surveys. Generalized linear Poisson regression models with robust SEs were fitted to estimate adjusted rate ratios and 95% CIs associated with proportions of total spending allocated to social services and healthcare domains, adjusting for state-level covariates. All analyses were completed in 2021-2022.
RESULTS
State and local government spending on transportation was associated with 11% lower overall pregnancy-related mortality (adjusted rate ratio=0.89, 95% CI=0.83, 0.96) and 9%-12% lower pregnancy-related mortality among the racial/ethnic groups. Among spending subdomains, expenditures on higher education, highways and roads, and parks and recreation were associated with lower pregnancy-related mortality rates in the total population (adjusted rate ratio=0.90, 95% CI=0.86, 0.94; adjusted rate ratio=0.87, 95% CI=0.81, 0.94; and adjusted rate ratio=0.68, 95% CI=0.49, 0.95, respectively). These results were consistent among the racial/ethnic groups, but patterns of associations with pregnancy-related mortality and other spending subdomains differed notably between racial/ethnic groups.
CONCLUSIONS
Investing more in local- and state-targeted spending in social services may decrease the risk for pregnancy-related mortality, particularly among Black women.
Topics: Female; Humans; Pregnancy; Ethnicity; Hispanic or Latino; Local Government; Racial Groups; United States; Maternal Mortality; Black or African American; White; Financing, Government; State Government
PubMed: 36658021
DOI: 10.1016/j.amepre.2022.10.022 -
Alcohol Research : Current Reviews 2021Mutual help groups are a ubiquitous component of the substance abuse treatment system in the United States, showing demonstrated effectiveness as a treatment adjunct;... (Review)
Review
Mutual help groups are a ubiquitous component of the substance abuse treatment system in the United States, showing demonstrated effectiveness as a treatment adjunct; so, it is paramount to understand whether they are as appealing to, and as effective for, racial or ethnic minority groups as they are for Whites. Nonetheless, no known comprehensive reviews have examined whether there are racial/ethnic disparities in mutual help group participation. Accordingly, this study comprehensively reviewed the U.S. literature on racial/ethnic disparities in mutual help participation among adults and adolescents with substance use disorder treatment need. The study identified 19 articles comparing mutual help participation across specific racial/ethnic minority groups and Whites, including eight national epidemiological studies and 11 treatment/community studies. Most compared Latinx and/or Black adults to White adults, and all but two analyzed 12-step participation, with others examining "self-help" attendance. Across studies, racial/ethnic comparisons yielded mostly null ( = 17) and mixed ( = 9) effects, though some findings were consistent with a racial/ethnic disparity ( = 6) or minority advantage ( = 3). Findings were weakly suggestive of disparities for Latinx populations (especially immigrants, women, and adolescents) as well as for Black women and adolescents. Overall, data were sparse, inconsistent, and dated, highlighting the need for additional studies in this area.
Topics: Adolescent; Adult; Black People; Child; Ethnicity; Female; Health Services Accessibility; Healthcare Disparities; Hispanic or Latino; Humans; Male; Minority Groups; Racial Groups; Self-Help Groups; Substance-Related Disorders; United States; White People; Young Adult; American Indian or Alaska Native
PubMed: 33717774
DOI: 10.35946/arcr.v41.1.03 -
Attention, Perception & Psychophysics Apr 2018Other-race faces are discriminated and recognized less accurately than own-race faces. Despite a wealth of research characterizing this other-race effect (ORE), little...
Other-race faces are discriminated and recognized less accurately than own-race faces. Despite a wealth of research characterizing this other-race effect (ORE), little is known about the nature of the representations of own-race versus other-race faces. This is because traditional measures of this ORE provide a binary measure of discrimination or recognition (correct/incorrect), failing to capture potential variation in the quality of face representations. We applied a novel continuous-response paradigm to independently measure the number of own-race and other-race face representations stored in visual working memory (VWM) and the precision with which they are stored. Participants reported target own-race or other-race faces on a circular face space that smoothly varied along the dimension of identity. Using probabilistic mixture modeling, we found that following ample encoding time, the ORE is attributable to differences in the probability of a face being maintained in VWM. Reducing encoding time, a manipulation that is more sensitive to encoding limitations, caused a loss of precision or an increase in variability of VWM for other-race but not own-race faces. These results suggest that the ORE is driven by the inefficiency with which other-race faces are rapidly encoded in VWM and provide novel insights about how perceptual experience influences the representation of own-race and other-race faces in VWM.
Topics: Adult; Facial Recognition; Female; Humans; Male; Memory, Short-Term; Racial Groups
PubMed: 29344908
DOI: 10.3758/s13414-017-1467-6 -
BMC Health Services Research Jul 2020Patient satisfaction is increasingly being used to assess, and financially reward, provider performance. Previous studies suggest that race/ethnicity (R/E) may impact...
BACKGROUND
Patient satisfaction is increasingly being used to assess, and financially reward, provider performance. Previous studies suggest that race/ethnicity (R/E) may impact satisfaction, yet few practices adjust for patient R/E. The objective of this study is to examine R/E differences in patient satisfaction ratings and how these differences impact provider rankings.
METHODS
Patient satisfaction survey data linked to electronic health records from two large outpatient centers in northern California - a non-profit organization of community-based clinics (Site A) and an academic medical center (Site B) - was collected and analyzed. Participants consisted of adult patients who received outpatient care at Site A from December 2010 to November 2014 and Site B from March 2013 to August 2014, and completed Press-Ganey Medical Practice Survey questionnaires (Nā=ā216,392 (Site A) and 30,690 (Site B)). Self-reported non-Hispanic white (NHW), Black, Latino, and Asian patients were studied. For six questions each representing a survey subdomain, favorable ratings were defined as top-box ("very good") compared to all other categories ("very poor," "poor," "fair," and "good"). Using multivariable logistic regression with provider random effects, we assessed whether the likelihood of giving favorable ratings differed by patient R/E, adjusting for patient age and sex.
RESULTS
Asian, younger and female patients provided less favorable ratings than other R/E, older and male patients. After adjustment, Asian patients were less likely than NHW patients to provide top-box ratings to the overall assessment question "likelihood of recommending this practice to others" (Site A: Asian predicted probability (PP) 0.680, 95% confidence interval (CI): 0.675-0.685 compared to NHW PP 0.820, 95% CI: 0.818-0.822; Site B: Asian PP 0.734, 95% CI: 0.733-0.736 compared to NHW PP 0.859, 95% CI: 0.859-0.859). The effect sizes for Asian R/E were greater than the effect sizes for older age and female sex. An absolute 3% decrease in mean composite score between providers serving different percentages of Asian patients translated to an absolute 40% drop in national ranking.
CONCLUSIONS
Patient satisfaction scores may need to be adjusted for patient R/E, particularly for providers caring for high panel percentages of Asian patients.
Topics: Academic Medical Centers; Adolescent; Adult; Aged; Ambulatory Care; Asian People; California; Community Health Centers; Ethnicity; Female; Health Care Surveys; Humans; Male; Middle Aged; Patient Satisfaction; Racial Groups; Young Adult
PubMed: 32698825
DOI: 10.1186/s12913-020-05534-6 -
Schizophrenia Research Mar 2023Few empirical studies have examined whether exposure to major racial discrimination explains ethnoracial disparities in psychosis outcomes and none to our knowledge have...
Few empirical studies have examined whether exposure to major racial discrimination explains ethnoracial disparities in psychosis outcomes and none to our knowledge have done so in the U.S. or have examined the role of other forms of racism such as racial microaggressions. The present study examined ethnoracial differences in self-reported psychotic experiences (PE) among 955 college students in an urban environment in the Northeastern U.S., and the degree to which major experiences of racial discrimination and racial microaggressions explains ethnoracial differences in PE. Mean scores on self-report inventories of PE and distressing PE (i.e., Prodromal Questionnaire (PQ)), major experiences of racial discrimination (EOD), and racial and ethnic microaggressions (REMS) were compared across 4 ethnoracial groups (White, Black, Asian, and Latina/o). Results from parallel mediation linear regression models adjusted for immigrant status, age, gender, and family poverty using the Hayes PROCESS application indicated ethnoracial differences in PE were explained independently by both forms of racism. Specifically, Black young people reported higher mean levels of PE, and distressing PE than both White and Latina/o people and the difference in PE between Black and White and Black and Latino/a young people was significantly explained by both greater exposure to racial microaggressions and major racial discriminatory experiences among Black people. This study re-emphasizes the explanatory role of racism, in its multiple forms, for psychosis risk among Black young populations in the US. Anti-racism interventions at both structural and interpersonal levels are necessary components of public health efforts to improve mental health in Black populations.
Topics: Humans; Hispanic or Latino; Microaggression; Racial Groups; Racism; White; Asian; Black or African American; Universities; New England
PubMed: 34750038
DOI: 10.1016/j.schres.2021.10.014 -
PloS One 2022This paper introduces a series of high resolution (100-meter) population grids for eight different sociodemographic variables across the state of California using data...
This paper introduces a series of high resolution (100-meter) population grids for eight different sociodemographic variables across the state of California using data from the 2020 census. These layers constitute the 'CA-POP' dataset, and were produced using dasymetric mapping methods to downscale census block populations using fine-scale residential tax parcel boundaries and Microsoft's remotely-sensed building footprint layer as ancillary datasets. In comparison to a number of existing gridded population products, CA-POP shows good concordance and offers a number of benefits, including more recent data vintage, higher resolution, more accurate building footprint data, and in some cases more sophisticated but parsimonious and transparent dasymetric mapping methodologies. A general accuracy assessment of the CA-POP dasymetric mapping methodology was conducted by producing a population grid that was constrained by population observations within block groups instead of blocks, enabling a comparison of this grid's population apportionment to block-level census values, yielding a median absolute relative error of approximately 30% for block group-to-block apportionment. However, the final CA-POP grids are constrained by higher-resolution census block-level observations, likely making them even more accurate than these block group-constrained grids over a given region, but for which error assessments of population disaggregation is not possible due to the absence of observational data at the sub-block scale. The CA-POP grids are freely available as GeoTIFF rasters online at github.com/njdepsky/CA-POP, for total population, Hispanic/Latinx population of any race, and non-Hispanic populations for the following groups: American Indian/Alaska Native, Asian, Black/African-American, Native Hawaiian and other Pacific Islander, White, other race or multiracial (two or more races) and residents under 18 years old (i.e. minors).
Topics: Adolescent; California; Censuses; Hispanic or Latino; Humans; Native Hawaiian or Other Pacific Islander; Racial Groups
PubMed: 35834564
DOI: 10.1371/journal.pone.0270746 -
Demography Feb 2017A person's racial or ethnic self-identification can change over time and across contexts, which is a component of population change not usually considered in studies...
A person's racial or ethnic self-identification can change over time and across contexts, which is a component of population change not usually considered in studies that use race and ethnicity as variables. To facilitate incorporation of this aspect of population change, we show patterns and directions of individual-level race and Hispanic response change throughout the United States and among all federally recognized race/ethnic groups. We use internal U.S. Census Bureau data from the 2000 and 2010 censuses in which responses have been linked at the individual level (N = 162 million). Approximately 9.8 million people (6.1 %) in our data have a different race and/or Hispanic-origin response in 2010 than they did in 2000. Race response change was especially common among those reported as American Indian, Alaska Native, Native Hawaiian, Other Pacific Islander, in a multiple-race response group, or Hispanic. People reported as non-Hispanic white, black, or Asian in 2000 usually had the same response in 2010 (3 %, 6 %, and 9 % of responses changed, respectively). Hispanic/non-Hispanic ethnicity responses were also usually consistent (13 % and 1 %, respectively, changed). We found a variety of response change patterns, which we detail. In many race/Hispanic response groups, we see population churn in the form of large countervailing flows of response changes that are hidden in cross-sectional data. We find that response changes happen across ages, sexes, regions, and response modes, with interesting variation across racial/ethnic categories. Researchers should address the implications of race and Hispanic-origin response change when designing analyses and interpreting results.
Topics: Black or African American; Asian; Censuses; Cross-Sectional Studies; Ethnicity; Hispanic or Latino; Humans; Indians, North American; Native Hawaiian or Other Pacific Islander; Racial Groups; United States; White People
PubMed: 28105578
DOI: 10.1007/s13524-016-0544-0