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Health Services Research Oct 2005Veterans Affairs (VA) patient populations are becoming increasingly diverse in race and ethnicity. The purpose of this paper is to (1) document the importance of using... (Review)
Review
OBJECTIVES
Veterans Affairs (VA) patient populations are becoming increasingly diverse in race and ethnicity. The purpose of this paper is to (1) document the importance of using consistent standards of conceptualizing and categorizing race and ethnicity in health services research, (2) provide an overview of different methods currently used to assess race and ethnicity in health services research, and (3) suggest assessment methods that could be incorporated into health services research to ensure accurate assessment of disease prevalence and incidence, as well as accounts of appropriate health services use, in patients with different racial and ethnic backgrounds.
DESIGN
A critical review of published literature was used.
PRINCIPAL FINDINGS
Race is a complex, multidimensional construct. For some individuals, institutionalized racism and internalized racism are intertwined in the effects of race on health outcomes and health services use. Ethnicity is most commonly used as a social-political construct and includes shared origin, shared language, and shared cultural traditions. Acculturation appears to affect the strength of the relationships among ethnicity, health outcomes, and health services use.
CONCLUSIONS
Improved and consistent methods of data collection need to be developed for use by VA researchers across the country. VA research sites with patients representing specific population groups could use a core set of demographic items in addition to expanded modules designed to assess the ethnic diversity within these population groups. Improved and consistent methods of data collection could result in the collection of higher-quality data, which could lead to the identification of race- and ethnic-specific health services needs. These investigations could in turn lead to the development of interventions designed to reduce or eliminate these disparities.
Topics: Acculturation; Censuses; Data Collection; Ethnicity; Health Services Research; Humans; Psychometrics; Racial Groups; Socioeconomic Factors; United States
PubMed: 16179001
DOI: 10.1111/j.1475-6773.2005.00449.x -
Forensic Science International. Genetics Nov 2023The assignment of individuals to a population can be of importance for the identification of mass disaster victims or criminal offenders in the field of forensic...
The assignment of individuals to a population can be of importance for the identification of mass disaster victims or criminal offenders in the field of forensic genetics. This assignment is based on biostatistical methods that process data of ancestry informative markers (AIMs), which are selected based on large allele frequency differences between the populations of interest. However, population assignments of individuals with an admixed genetic background are challenging. Admixed individuals are genetic mosaics of chromosomal segments from the parental populations, which may lead to ambiguous or no population assignment. This is problematic since admixture events are a substantial part of human history. In this study, we present challenges of interpreting the evidential weight of population assignments. We used Genogeographer for likelihood ratio (LR) calculations and Brazilians as examples of admixed individuals. Brazilians are a very heterogenous population representing a three-way admixture between Native Americans, Europeans, and Africans. Ancestry informative markers were typed in a total of 589 individuals from Brazil using the Precision ID Ancestry Panel. The Brazilians were assigned to six metapopulations (East Asia, Europe, Middle East, North Africa, South-Central Asia, Sub-Saharan Africa) defined in the Genogeographer software and LRs were calculated if the AIM profile was not an outlier in all metapopulations and simulated two-way (1:1) admixtures of the six metapopulations. Population assignments failed for 55% of the samples. These samples had significantly higher genetic contributions from East Asia, South-Central Asia and Sub-Saharan Africa, and significantly lower genetic contributions from Europe. Most of the individuals with population assignments were assigned to the metapopulations of Middle East (58%) or North Africa (36%), followed by Europe (4%), South-Central Asia (1%), and Sub-Saharan Africa (1%). For 8% of the samples, population assignments were only possible when assignments to simulated two-way (1:1) admixtures of the six metapopulations were considered. Most of these individuals were assigned to two-way admixtures of North Africa, South-Central Asia, or Sub-Saharan Africa. Relatively low median likelihood ratios (LRs<1000) were observed when comparing population likelihoods for Europe, Middle East, North Africa, South-Central Asia, or simulated 1:1 admixtures of these metapopulations. Comparisons including East Asian or Sub-Saharan African populations resulted in larger median LRs (LR>10). The results suggested that the Precision ID Ancestry Panel provided too little information and that additional markers specifically selected for sub-continental differentiation may be required for accurate population assignment of admixed individuals. Furthermore, a Genogeographer database with additional populations including admixed populations would be advantageous for interpretation of admixed AIM profiles. It would likely increase the number of population assignments and illustrate alternatives to the most likely population, which would be valuable information for the case officer when writing the case report.
Topics: Humans; Brazil; Gene Frequency; Genetics, Population; Polymorphism, Single Nucleotide; Population Groups
PubMed: 37713981
DOI: 10.1016/j.fsigen.2023.102934 -
Preventing Chronic Disease Jun 2023Although current cigarette smoking among US adults decreased from 42.4% in 1965 to 12.5% in 2020, prevalence is higher among certain racial and ethnic groups, including...
INTRODUCTION
Although current cigarette smoking among US adults decreased from 42.4% in 1965 to 12.5% in 2020, prevalence is higher among certain racial and ethnic groups, including non-Hispanic American Indian and Alaska Native (AIAN) adults.
METHODS
We examined trends in current cigarette smoking prevalence, population estimates, and relative disparity among US adults (aged ≥18 y) between 2011 and 2020 by using data from the National Health Interview Survey. SAS-callable SUDAAN was used to obtain prevalence and population estimates, and relative disparity was calculated on the basis of findings in the literature. Trends were significant at P < .05.
RESULTS
From 2011 to 2020, linear decreases in prevalence and population estimates were observed for non-Hispanic White (20.6% to 13.3%; 32.1 million to 20.7 million), non-Hispanic Black (19.4% to 14.4%; 5.1 million to 4.0 million), and Hispanic (12.9% to 8.0%; 4.2 million to 3.3 million) adults. For non-Hispanic AIAN adults, prevalence remained around 27%, and a linear increase in the population estimate was observed from 400,000 to 510,000. Relative disparity did not change across racial and ethnic categories.
CONCLUSION
Linear decreases have occurred between 2011 and 2020 for non-Hispanic White, non-Hispanic Black, and Hispanic adults who smoke, but the number of non-Hispanic AIAN adults who currently smoke has increased by 110,000, and relative disparities persist. To reduce racial and ethnic disparities in smoking, understanding how factors at multiple socioecologic levels impact smoking and helping to inform paths to equitable reach and implementation of tobacco control interventions for all population groups are needed.
Topics: Adult; Humans; Black or African American; Cigarette Smoking; Ethnicity; Hispanic or Latino; United States; White; Health Status Disparities; American Indian or Alaska Native
PubMed: 37262328
DOI: 10.5888/pcd20.220375 -
Systematic Reviews Apr 2021Appropriate search strategies are essential to ensure the integrity and reproducibility of systematic and scoping reviews, as researchers seek to capture as many...
BACKGROUND
Appropriate search strategies are essential to ensure the integrity and reproducibility of systematic and scoping reviews, as researchers seek to capture as many relevant resources as possible. In the case of Indigenous health reviews, researchers are met with the special challenge of creating a search strategy that can encompass this large, diverse population group with no universally agreed upon identification criteria.
MAIN BODY
With an aim to promote improved review methodologies that uphold standards of justice, autonomy, and equity for Indigenous peoples and other heterogeneous populations, we describe critical gaps and approaches to close them. We report organizational and transparency issues around how Indigenous populations are indexed in several major databases, and draw on examples of published reviews and protocols to demonstrate the challenges inherent to creating a comprehensive search strategy.
CONCLUSIONS
The conduct and communication of results from health literature research on global Indigenous populations are compromised by challenges of methodology that are rooted in the complexities inherent to defining Indigenous peoples. These challenges must be urgently addressed to improve this important field of inquiry moving forward.
Topics: Humans; Indigenous Peoples; Population Groups; Reproducibility of Results; Review Literature as Topic
PubMed: 33874997
DOI: 10.1186/s13643-021-01664-y -
BMJ Open May 2022To explore the barriers to and options for improving access to quality healthcare for the urban poor in Nairobi, Kenya.
OBJECTIVE
To explore the barriers to and options for improving access to quality healthcare for the urban poor in Nairobi, Kenya.
DESIGN AND PARTICIPANTS
This was a qualitative approach. In-depth interviews (n=12), focus group discussions with community members (n=12) and key informant interviews with health providers and policymakers (n=25) were conducted between August 2019 and September 2020. Four feedback and validation workshops were held in December 2019 and April-June 2021.
SETTING
Korogocho and Viwandani urban slums in Nairobi, Kenya.
RESULTS
The socioe-conomic status of individuals and their families, such as poverty and lack of health insurance, interact with community-level factors like poor infrastructure, limited availability of health facilities and insecurity; and health system factors such as limited facility opening hours, health providers' attitudes and skills and limited public health resources to limit healthcare access and perpetuate health inequities. Limited involvement in decision-making processes by service providers and other key stakeholders was identified as a major challenge with significant implications on how limited health system resources are managed.
CONCLUSION
Despite many targeted interventions to improve the health and well-being of the urban poor, slum residents are still unable to obtain quality healthcare because of persistent and new barriers due to the COVID-19 pandemic. In a devolved health system, paying attention to health services managers' abilities to assess and respond to population health needs is vital. The limited use of existing accountability mechanisms requires attention to ensure that the mechanisms enhance, rather than limit, access to health services for the urban slum residents. The uniqueness of poor urban settings also requires in-depth and focused attention to social determinants of health within these contexts. To address individual, community and system-level barriers to quality healthcare in this and related settings and expand access to health services for all, multisectoral strategies tailored to each population group are needed.
Topics: COVID-19; Health Facilities; Health Services Accessibility; Humans; Kenya; Pandemics; Population Groups; Qualitative Research
PubMed: 35523490
DOI: 10.1136/bmjopen-2021-057484 -
BMC Medical Research Methodology Jan 2022Ensuring fair comparisons of cancer survival statistics across population groups requires careful consideration of differential competing mortality due to other causes,...
BACKGROUND
Ensuring fair comparisons of cancer survival statistics across population groups requires careful consideration of differential competing mortality due to other causes, and adjusting for imbalances over groups in other prognostic covariates (e.g. age). This has typically been achieved using comparisons of age-standardised net survival, with age standardisation addressing covariate imbalance, and the net estimates removing differences in competing mortality from other causes. However, these estimates lack ease of interpretability. In this paper, we motivate an alternative non-parametric approach that uses a common rate of other cause mortality across groups to give reference-adjusted estimates of the all-cause and cause-specific crude probability of death in contrast to solely reporting net survival estimates.
METHODS
We develop the methodology for a non-parametric equivalent of standardised and reference adjusted crude probabilities of death, building on the estimation of non-parametric crude probabilities of death. We illustrate the approach using regional comparisons of survival following a diagnosis of rectal cancer for men in England. We standardise to the covariate distribution and other cause mortality of England as a whole to offer comparability, but with close approximation to the observed all-cause region-specific mortality.
RESULTS
The approach gives comparable estimates to observed crude probabilities of death, but allows direct comparison across population groups with different covariate profiles and competing mortality patterns. In our illustrative example, we show that regional variations in survival following a diagnosis of rectal cancer persist even after accounting for the variation in deprivation, age at diagnosis and other cause mortality.
CONCLUSIONS
The methodological approach of using standardised and reference adjusted metrics offers an appealing approach for future cancer survival comparison studies and routinely published cancer statistics. Our non-parametric estimation approach through the use of weighting offers the ability to estimate comparable survival estimates without the need for statistical modelling.
Topics: Cause of Death; Humans; Male; Models, Statistical; Population Groups; Probability; Rectal Neoplasms
PubMed: 34991487
DOI: 10.1186/s12874-021-01465-w -
Genetics Sep 2018A classic problem in population genetics is the characterization of discrete population structure in the presence of continuous patterns of genetic differentiation....
A classic problem in population genetics is the characterization of discrete population structure in the presence of continuous patterns of genetic differentiation. Especially when sampling is discontinuous, the use of clustering or assignment methods may incorrectly ascribe differentiation due to continuous processes (, geographic isolation by distance) to discrete processes, such as geographic, ecological, or reproductive barriers between populations. This reflects a shortcoming of current methods for inferring and visualizing population structure when applied to genetic data deriving from geographically distributed populations. Here, we present a statistical framework for the simultaneous inference of continuous and discrete patterns of population structure. The method estimates ancestry proportions for each sample from a set of two-dimensional population layers, and, within each layer, estimates a rate at which relatedness decays with distance. This thereby explicitly addresses the "clines versus clusters" problem in modeling population genetic variation, and remedies some of the overfitting to which nonspatial models are prone. The method produces useful descriptions of structure in genetic relatedness in situations where separated, geographically distributed populations interact, as after a range expansion or secondary contact. We demonstrate the utility of this approach using simulations and by applying it to empirical datasets of poplars and black bears in North America.
Topics: Animals; Cluster Analysis; Data Interpretation, Statistical; Gene Flow; Genetic Variation; Genetics, Population; Humans; Models, Genetic; North America; Population Groups; Populus; Ursidae
PubMed: 30026187
DOI: 10.1534/genetics.118.301333 -
Pediatrics Jul 2014Our understanding of the influence of maternal race/ethnicity and nativity and childhood autistic disorder (AD) in African Americans/blacks, Asians, and Hispanics in the...
OBJECTIVE
Our understanding of the influence of maternal race/ethnicity and nativity and childhood autistic disorder (AD) in African Americans/blacks, Asians, and Hispanics in the United States is limited. Phenotypic differences in the presentation of childhood AD in minority groups may indicate etiologic heterogeneity or different thresholds for diagnosis. We investigated whether the risk of developing AD and AD phenotypes differed according to maternal race/ethnicity and nativity.
METHODS
Children born in Los Angeles County with a primary AD diagnosis at ages 3 to 5 years during 1998-2009 were identified and linked to 1995-2006 California birth certificates (7540 children with AD from a cohort of 1,626,354 births). We identified a subgroup of children with AD and a secondary diagnosis of mental retardation and investigated heterogeneity in language and behavior.
RESULTS
We found increased risks of being diagnosed with AD overall and specifically with comorbid mental retardation in children of foreign-born mothers who were black, Central/South American, Filipino, and Vietnamese, as well as among US-born Hispanic and African American/black mothers, compared with US-born whites. Children of US African American/black and foreign-born black, foreign-born Central/South American, and US-born Hispanic mothers were at higher risk of exhibiting an AD phenotype with both severe emotional outbursts and impaired expressive language than children of US-born whites.
CONCLUSIONS
Maternal race/ethnicity and nativity are associated with offspring's AD diagnosis and severity. Future studies need to examine factors related to nativity and migration that may play a role in the etiology as well as identification and diagnosis of AD in children.
Topics: Black or African American; Asian; California; Child Development Disorders, Pervasive; Child, Preschool; Female; Hispanic or Latino; Humans; Male; Mothers; Racial Groups; White People
PubMed: 24958588
DOI: 10.1542/peds.2013-3928 -
International Journal of Environmental... Jul 2019Solastalgia is a relatively new concept for understanding the links between human and ecosystem health, specifically, the cumulative impacts of climatic and...
Solastalgia is a relatively new concept for understanding the links between human and ecosystem health, specifically, the cumulative impacts of climatic and environmental change on mental, emotional, and spiritual health. Given the speed and scale of climate change alongside biodiversity loss, pollution, deforestation, unbridled resource extraction, and other environmental challenges, more and more people will experience solastalgia. This study reviewed 15 years of scholarly literature on solastalgia using a scoping review process. Our goal was to advance conceptual clarity, synthesize the literature, and identify priorities for future research. Four specific questions guided the review process: (1) How is solastalgia conceptualized and applied in the literature?; (2) How is solastalgia experienced and measured in the literature?; (3) How is 'place' understood in the solastalgia literature?; and (4) Does the current body of literature on solastalgia engage with Indigenous worldviews and experiences? Overall, we find there is a need for additional research employing diverse methodologies, across a greater diversity of people and places, and conducted in collaboration with affected populations and potential knowledge, alongside greater attention to the practical implications and applications of solastalgia research. We also call for continued efforts to advance conceptual clarity and theoretical foundations. Key outcomes of this study include our use of the landscape construct in relation to solastalgia and a call to better understand Indigenous peoples' lived experiences of landscape transformation and degradation in the context of historical traumas.
Topics: Climate Change; Ecosystem; Health Status; Humans; Population Groups
PubMed: 31349659
DOI: 10.3390/ijerph16152662 -
Journal of the National Cancer Institute Nov 2022
Topics: Humans; Patient Selection; Population Groups; Drug Development; Eligibility Determination
PubMed: 36047853
DOI: 10.1093/jnci/djac155