Racial and Ethnic Disparities in the Time to Ovarian Cancer Surgery in Patients at an Integrated Health Care Delivery System.

BACKGROUND: Disparities in ovarian cancer survival for African American women are multifactorial. We evaluated racial and ethnic differences in time to ovarian cancer surgery in members of an integrated health care system. PATIENTS AND METHODS: In this retrospective cohort study, we identified women diagnosed with invasive epithelial-type ovarian cancer between January 1, 2008, through December 31, 2014, at an integrated health care system in the United States. We extracted data on cancer-related variables and sociodemographic variables from the health care system's cancer registry and electronic health records. We included patients who received ovarian cancer surgery without neoadjuvant chemotherapy. We defined time to surgery as the number of days between diagnostic imaging study and surgery. We used Cox proportional hazards regression to evaluate crude and adjusted association of race and ethnicity with time to surgery. RESULTS: Of 872 patients included, 55.1% were non-Hispanic White (hereafter, White), 24.9% were Hispanic, 14.6% were Asian/Pacific Islander (PI)/Native American, and 5.5% were African American. Median age at diagnosis was 59.0 years. African American patients were diagnosed at an older age and were more likely to come from deprived neighborhoods than other racial and ethnic groups. Median time to surgery was longer for African American patients compared with White, Hispanic, and Asian/PI/Native American patients (median days: 27.5 vs 21.0, 24.5, and 26.0, respectively; P<.0001). In adjusted models, the likelihood of having received surgery at any given time post diagnostic imaging was 31% lower for African American patients compared with White patients (HR, 0.69; 95% CI, 0.51-0.93). This likelihood was also lower for Hispanic and Asian/PI/Native American patients, but not statistically significant. CONCLUSIONS: Our findings showed that patients with ovarian cancer from racial and ethnic minorities had a lower likelihood of having received surgery at any given time post diagnostic imaging compared with White patients, demonstrating that racial and ethnic differences exist in time to ovarian cancer surgery in patients with relatively equal access to care.

Race and Ethnicity and Clinician Linguistic Expressions of Doubt in Hospital Admission Notes.

Importance: Stigmatizing language in electronic health records (EHRs) can generate or reinforce negative stereotypes about patients from minoritized groups and erode their trust and experience. However, less is known about the use of such language to cast doubt on patient clinical history in hospital settings. Objective: To compare the prevalence of language expressing doubt about patient clinical history (eg, experiences and symptoms) in hospital admission notes by patient race and ethnicity. Design, Setting, and Participants: In this cohort study, natural language processing tools were applied to analyze 54 936 admission notes from 1249 clinicians about patients aged 18 years or older at admission and hospitalized at an academic health system in the Northeast US between January 1, 2018, and February 28, 2023. Data were analyzed from September 1, 2022, to July 31, 2023. Exposure: Patient race and ethnicity (non-Hispanic Black, non-Hispanic White, and racial and ethnic minoritized groups excluding non-Hispanic Black [includes multiple racial and ethnic groups, such as Hispanic and Asian]) as recorded in the EHR based on self-report or registrar determination. Main Outcome and Measure: Binary indicator for at least 1 term casting doubt on patient clinical history was defined using epistemic stance, a linguistic construct expressing a writer's degree of certainty in information. Terms were manually validated via iterative review of notes by the study team. Results: Among 56 325 admission notes (mean [SD] age of patients, 55.9 [19.0] years; 30 913 notes among female patients [54.9%]; 25 649 notes among non-Hispanic Black patients [45.5%], 26 442 notes among non-Hispanic White patients [46.9%], and 2985 notes among members of racial and ethnic minoritized groups excluding non-Hispanic Black patients [5.3%]), we analyzed 54 936 admission notes that had no missing data. Among all analyzed admission notes, 39 023 notes (71.0%) contained doubt language. Notes written about non-Hispanic Black patients had increased odds of containing at least 1 word or phrase of doubt (adjusted odds ratio, 1.21; 95% CI, 1.14-1.28; P < .001) compared with notes among non-Hispanic White patients. Compared with notes among non-Hispanic White patients, notes written about members of racial and ethnic minoritized groups excluding non-Hispanic Black patients had similar odds of containing at least 1 term of doubt. Conclusion and Relevance: In this study, language casting doubt on patient clinical history was more likely to be found in notes of non-Hispanic Black patients. These results suggest that with the implementation of policies allowing patients full access to their health records, examining clinical documentation standards may be associated with improved patient experience.

Hip Arthroscopy Utilization Disparities and Complications Amongst Ethnic Groups.

While hip arthroscopy (HA) has increased in recent years, limited data exists regarding utilization and outcomes among racial groups. The National Surgical Quality Improvement Program (NSQIP) database was queried for patients who underwent HA from 2006 to 2017. Patients were stratified into 6 self-reported racial/ethnic categories: White, African American, Hispanic, Asian and Pacific Islander, Native American, and Unknown. Major and minor complications in the 30-day post-operative period were identified. Data were available for 2230 patients who underwent HA. There were significant differences in the proportions of HA procedures when examining by race. White patients comprised 69% of the patient sample, African American patients 5.6%, Hispanic patients 3.9%, Asian patients 2.5%, Native American patients 0.7% and Unknown race/ethnicity patients 18.3% (P < .05). HA utilization increased significantly over time by all groups but remained low among ethnic minorities compared to the White cohort. Overall, major, and minor 30-day complication rates were 1.3%, 0.5%, and 0.9%, respectively. Although African American and Hispanic patients had higher overall complication rates than White patients, the differences were not statistically significant. Surgeons should be aware of the underutilization of HA among racial/ethnic minorities, and further studies evaluating insurance status and access to care are needed.

Changes in First and Second Births to U.S. Teenagers From 2000 to 2022.

Objectives: This study examines trends in the numbers, percentages, and rates of first and second and higher-order births to teenagers younger than age 20 and for those ages 15-17 and 18-19 by race and Hispanic origin. Methods: Data for this analysis are from the National Vital Statistics System birth data files from 2000 and 2022. Analyses are limited to births to females younger than age 20. Changes in the numbers, percentages, and rates of total, first, and second and higher-order teen births from 2000 to 2022 were calculated for all teenagers and for non-Hispanic American Indian and Alaska Native, non-Hispanic Black, non-Hispanic White, and Hispanic teenagers. Results: The number of first teen births declined 67% and the number of second and higher-order teen births declined 79%, while the population of female teenagers increased 7% from 2000 to 2022. The declines were greater for younger teenagers compared with older teenagers. First and second and higher-order teen birth rates declined 69% and 80%, respectively. Similar declines were found for each race and Hispanic-origin group. In 2000 and 2022, first and second and higher-order birth rates were lowest among White teenagers. First birth rates were highest among Hispanic teenagers in 2000 and for Hispanic and non-Hispanic American Indian and Alaska Native teenagers in 2022. In 2000, second and higher-order birth rates were highest for non-Hispanic Black and Hispanic teenagers; second and higher-order birth rates were more similar by race and Hispanic-origin group in 2022.

Infant Mortality in the United States, 2022: Data From the Period Linked Birth/Infant Death File.

Objectives: This report presents final 2022 infant mortality statistics by age at death, maternal race and Hispanic origin, maternal age, gestational age, leading causes of death, and maternal state of residence. Trends in infant mortality are also examined. Methods: Descriptive tabulations of data are presented and interpreted for infant deaths and infant mortality rates using the 2022 period linked birth/infant death file. The linked birth/infant death file is based on birth and death certificates registered in all 50 states and the District of Columbia. Results: A total of 20,577 infant deaths were reported in the United States in 2022, up 3% from 2021. The U.S. infant mortality rate was 5.61 infant deaths per 1,000 live births, a 3% increase from the rate of 5.44 in 2021. The neonatal mortality rate increased 3% from 3.49 in 2021 to 3.59 in 2022, and the postneonatal mortality rate increased 4% from 1.95 to 2.02. The overall infant mortality rate increased for infants of American Indian and Alaska Native non-Hispanic, White non-Hispanic, and Dominican women in 2022 compared with 2021; changes in rates for the other race and Hispanic-origin groups were not significant. Infants of Black non-Hispanic women had the highest mortality rate (10.90) in 2022, followed by infants of American Indian and Alaska Native non-Hispanic and Native Hawaiian or Other Pacific Islander non-Hispanic (9.06 and 8.50, respectively), Hispanic (4.89), White non-Hispanic (4.52), and Asian non-Hispanic (3.51) women. Mortality rates increased from 2021 to 2022 among preterm (less than 37 weeks of gestation) infants (33.59 to 34.78) and for infants born term (37 to 41 weeks of gestation) (2.08 to 2.18). The five leading causes of infant death in 2022 were the same as in 2021. Infant mortality rates by state for 2022 ranged from a low of 3.32 in Massachusetts to a high of 9.11 in Mississippi.

Wound Care at the Intersection of Race, Ethnicity, and Malnutrition.

ABSTRACT: Ensuring adequate nutrition is vital for maintaining skin health and promoting successful wound healing. Globally, the rise in malnutrition and diet-related diseases is contributing to increased rates of illness and disability. Populations in food deserts and those experiencing food insecurity are particularly at risk. Being at risk for or having malnutrition associated with chronic conditions such as diabetes and cardiovascular disease can increase the incidence of wounds. Healthcare disparities and varied clinical outcomes among ethnic minorities further contribute to these challenges. Research indicates that racial and ethnic minorities experience a higher prevalence and severity of wounds, including pressure injuries. Detecting early-stage wounds in individuals with darker skin tones can be difficult, adding to the disparities.Culturally appropriate nutrition interventions are essential in addressing these health inequities because tailored approaches tend to be more effective than uniform strategies. Understanding diverse dietary patterns and incorporating cultural food preferences into care plans can improve patient adherence and outcomes. Promoting equity in wound care through culturally sensitive practices helps to foster respect, dignity, and trust within healthcare settings, particularly for minority populations.In this review, the authors highlight the need for inclusive interventions that provide culturally aligned nutrition, supporting patients' clinical and holistic well-being.

Variation in Mentions of Race and Ethnicity in Notes in Intensive Care Units Across a Health Care System.

BACKGROUND: Social constructs like race can affect how patients are perceived and impact care. This study investigated whether mentions of race in notes for critically ill patients differed according to patients' race. METHODS: This retrospective cohort study included intensive care unit notes for adults (≥18 years old) admitted to any of 6 intensive care units at University of California, San Francisco, from 2012 through 2020. Notes were linked to National Provider Identifier records to obtain note writer characteristics. Logistic regression analysis with robust SEs clustered on note writers was adjusted for patient-, note- and clinician-level characteristics. Any race or ethnicity mention was the outcome of interest. RESULTS: Among 5573 patients with 292 457 notes by 9742 unique note writers, 3225 patients (57.9%) self-reported their race as White, 997 (17.9%) as Asian, 860 (15.4%) as Latinx, and 491 (8.8%) as Black. Note writers documented race/ethnicity for 20.8% of Black, 10.9% of Latinx, 9.1% of White, and 4.4% of Asian patients. Black patients were more likely than White patients to have race mentioned in notes (adjusted odds ratio, 2.05 [95% CI, 1.49-2.82]). CONCLUSIONS: Black patients were more than twice as likely as White patients to have race mentioned in notes. Note language containing information on social constructs has consequences for clinicians and patients reading notes and for algorithms trained on clinical notes.

Intersectionality of sex and race in COVID-19 mortality and vaccination inequities in Massachusetts.

BACKGROUND: Inequities in COVID-19 incidence, morbidity, and mortality between racial and ethnic groups in the United States (U.S.) have been documented since the start of the pandemic in early 2020. Similarly, disparities by sex for COVID-19 morbidity and mortality have emerged, with men dying at a higher rate than women. Little research has been done to understand how the intersection of sex and race impacts COVID-19 inequities in Massachusetts (MA). This cross-sectional study examined how COVID-19 mortality rates (February 2020- May 2023) and vaccination rates (December 2020-February 2023) varied by sex across racial groups in MA. METHODS: Using Massachusetts Department of Public Health data of all COVID-19 mortality cases and primary series vaccinations in MA from 2020 to 2023, we calculated both age-specific and age-adjusted COVID-19 mortality rates in order to account for differences in age distributions across sex-race groups. RESULTS: Overall, men across all age-race groups consistently had a higher mortality rate compared to their female counterparts. The age-standardized mortality rate difference between White men and White women is the smallest, with the rate for White men being 1.3 times higher than White women. The age-standardized mortality rate between Hispanic men and Hispanic women varies the largest, with the rate for Hispanic men being 1.7 times higher than Hispanic women. Notably, Black women and White women have similar vaccination rates, yet the age-standardized mortality rate for Black women is 1.4 times the rate of White women. CONCLUSIONS: Our findings show that there are disparities at the intersection of sex and race for COVID-19 mortality and vaccination in MA. This highlights the importance for targeted COVID-19 interventions at the intersection of sex and race and the need for detailed COVID-19 reporting by sex within race groups.

Exploring the Importance of Race and Gender Concordance Between Patients and Physical Therapists in Digital Rehabilitation for Musculoskeletal Conditions: Observational, Longitudinal Study.

BACKGROUND: Race/ethnicity and gender concordance between patients and providers is a potential strategy to improve health care interventions. In digital health, where human interactions occur both synchronously and asynchronously, the effect of concordance between patients and providers is unknown. OBJECTIVE: This study aimed to evaluate the impact of race/ethnicity or gender concordance between patients and physical therapists (PTs) in engagement and the clinical outcomes following a digital care program (DCP) in patients with musculoskeletal (MSK) conditions. METHODS: This secondary analysis of 2 prospective longitudinal studies (originally focused on assessing the acceptance, engagement, and clinical outcomes after a remote DCP) examined the impact of both race/ethnicity concordance and gender concordance between patients and PTs on outcomes for a digital intervention for MSK conditions. Outcomes included engagement (measured by the completion rate and communication, assessed by text interactions), satisfaction, and clinical outcomes (response rate, ie, percentage of patients achieving at least a minimal clinically important change in pain, measured by the Numerical Pain Rating Scale [NPRS]; anxiety, measured by the Generalized Anxiety Disorder 7-item scale [GAD-7]; depression, measured by the Patient Health Questionnaire 9-item [PHQ-9]; and daily activity impairment, measured by the Work Productivity and Activity Impairment [WPAI] questionnaire). RESULTS: Of 71,201 patients, 63.9% (n=45,507) were matched with their PT in terms of race/ethnicity, while 61.2% (n=43,560) were matched for gender. Concordant dyads showed a higher completion rate among White (adjusted odds ratio [aOR] 1.11, 95% CI 1.05-1.19, P<.001) and Hispanic (aOR 1.27, 95% CI 1.08-1.54, P=.009) groups, as well as women (aOR 1.10, 95% CI 1.06-1.18, P<.001), when compared to discordant dyads. High and similar levels of interaction between patients and PTs were observed across race/ethnicity and gender dyads, except for Asian concordant dyads (adjusted ß coefficient 5.32, 95% CI 3.28-7.36, P<.001). Concordance did not affect satisfaction, with high values (>8.52, 95% CI 8.27-8.77) reported across all dyads. Response rates for pain, anxiety, and daily activity impairment were unaffected by race/ethnicity concordance. An exception was observed for depression, with White patients reporting a higher response rate when matched with PTs from other races/ethnicities (aOR 1.20, 95% CI 1.02-1.39, P=.02). In terms of gender, men had a slightly higher pain response rate in discordant dyads (aOR 1.08, 95% CI 1.01-1.15, P=.03) and a higher depression response rate in concordant dyads (aOR 1.23, 95% CI 1.05-1.47, P=.01). CONCLUSIONS: Race/ethnicity and gender concordance between patients and PTs does not translate into higher satisfaction or improvement for most clinical outcomes, aside from a positive effect on treatment completion. These results highlight the importance of other PT characteristics, in addition to race/ethnicity or gender concordance, suggesting the potential benefit of experience, languages spoken, and cultural safety training as ways to optimize care. TRIAL REGISTRATION: ClinicalTrials.gov NCT04092946, NCT05417685; https://clinicaltrials.gov/study/NCT05417685, https://clinicaltrials.gov/study/NCT04092946.

Risk and Protective Factors for Preterm Birth Among Racial, Ethnic, and Socioeconomic Groups in California.

Importance: Preterm birth (PTB) (gestational age <37 weeks) is a major cause of infant mortality and morbidity in the US and is marked by racial and ethnic and socioeconomic inequities. Further research is needed to elucidate the association of risk and protective factors with trends in PTB rates and with related inequities. Objective: To describe the association of PTB rates with inequities as well as related risk and protective factors over the past decade in a US population-based cohort. Design, Setting, and Participants: This retrospective cohort study of singleton live births in California from January 1, 2011, to December 31, 2022, was conducted using vital statistics records and hospital records. The cohort included births with a gestational age of 22 to 44 weeks. Main Outcomes and Measures: Preterm birth rates by racial and ethnic group and by public and nonpublic insurance (considered as a proxy for socioeconomic status) were studied across years. Log-linear regression (relative risks with 95% CIs) was used to evaluate risk and protective factors within groups. Associations of PTB rates with risk and protective factors were assessed. Results: This study included 5 431 018 singleton live births to individuals who identified as American Indian or Alaska Native (0.3%), Asian (14.2%), Black (4.9%), Hispanic (47.8%), or White (27.0%). A total of 43.1% of births were to individuals with public health insurance. From 2011 to 2022, the overall PTB rate increased from 6.8% to 7.5% (change [SE], 10.6% [0.6%]; z score of 18.5; P < .001). Differences in PTB rates and associated changes were observed for racial and ethnic groups and insurance groups. For example, 2022 PTB rates ranged from 5.8% among White individuals with nonpublic insurance to 11.3% among Black individuals with public health insurance. From 2011 to 2022, PTB rates decreased from 9.1% to 8.8% (change [SE], -3.5% [4.2]; z score of -0.8; P = .42) among Black individuals with nonpublic insurance, whereas they increased from 6.4% to 9.5% (change [SE], 49.8% [16.0%]; z score of 3.1; P = .002) among American Indian or Alaska Native individuals with nonpublic insurance. Increases in some risk factors (eg, preexisting diabetes, sexually transmitted infections, mental health conditions) were observed in most groups, and decreases in some protective factors (eg, participation in the California Women, Infants, and Children program) (P for trend < .001 from 2011 to 2021) were observed mostly in low-income groups. Conclusions and Relevance: In this cohort study of singleton live births in California, PTB rates increased in many groups. Persistent racial and ethnic and socioeconomic inequities were also observed. Changes in risk and protective factors provided clues to patterns of PTB. These data point to an urgent need to address factors associated with PTB at both the individual and population levels.

Trends in 5-year cancer survival disparities by race and ethnicity in the US between 2002-2006 and 2015-2019.

Racial and ethnic disparities persist in cancer survival rates across the United States, despite overall improvements. This comprehensive analysis examines trends in 5-year relative survival rates from 2002-2006 to 2015-2019 for major cancer types, elucidating differences among racial/ethnic groups to guide equitable healthcare strategies. Data from the SEER Program spanning 2000-2020 were analyzed, focusing on breast, colorectal, prostate, lung, pancreatic cancers, non-Hodgkin lymphoma, acute leukemia, and multiple myeloma. Age-standardized relative survival rates were calculated to assess racial (White, Black, American Indian/Alaska Native, Asian/Pacific Islander) and ethnic (Hispanic, Non-Hispanic) disparities, utilizing period analysis for recent estimates and excluding cases identified solely through autopsy or death certificates. While significant survival improvements were observed for most cancers, notable disparities persisted. Non-Hispanic Blacks exhibited the largest gain in breast cancer survival, with an increase of 5.2% points (from 77.6 to 82.8%); however, the survival rate remained lower than that of Non-Hispanic Whites (92.1%). Colorectal cancer survival declined overall (64.7-64.1%), marked by a 6.2% point drop for Non-Hispanic American Indian/Alaska Natives (66.3-60.1%). Prostate cancer survival declined across all races, with Non-Hispanic American Indian/Alaska Natives showing a decrease of 7.7% points (from 96.9 to 89.2%). Lung cancer, acute leukemia, and multiple myeloma showed notable increases across groups. Substantial racial/ethnic disparities in cancer survival underscore the notable need for tailored strategies ensuring equitable access to advanced treatments, particularly addressing significant trends in colorectal and pancreatic cancers among specific minority groups. Careful interpretation of statistical significance is warranted given the large dataset.

Use of Hematopoietic Cell Transplant for Hematologic Cancers by Race, Ethnicity, and Age.

Importance: Utilization of hematopoietic cell transplantation (HCT) for hematologic cancers previously demonstrated race, ethnicity, and age-based disparities. Objective: To evaluate utilization over time by race, ethnicity, and age to determine if disparities persist in light of recent significant increases in HCT volume. Design, Setting, and Participants: This US population-based retrospective cohort study includes patients who received transplants from January 2009 to December 2018. Data collection and cleaning occurred from February 2019 to November 2021, and data analysis occurred from January 2022 to October 2023. Method 1 restricted the analysis to Surveillance, Epidemiology and End Results (SEER) reporting areas for cases and transplants. Method 2 applied SEER age-, race-, and ethnicity-specific incidence rates to corresponding US census population and included all transplants reported to the Center for International Blood and Marrow Transplant Research. Race and ethnicity groups were hierarchically defined as Hispanic (any race), non-Hispanic White, non-Hispanic Black, and non-Hispanic Other (Asian and American Indian). Exposure: Receipt of HCT. Main Outcomes and Measures: Utilization rate of autologous or allogeneic HCT for patients with hematologic cancers by age, race, and ethnicity. Results: From 2009 to 2018, 136 280 HCTs were analyzed for 6 hematologic cancers comprising 16.7% pediatric/adolescent/young adults (0-39 years), 83.3% adults (40-84 years), 58% male, 10.3% Hispanic, 11.4% non-Hispanic Black, 3.8% non-Hispanic Other, and 74.5% non-Hispanic White patients, with 49 385 allogeneic and 86 895 autologous HCTs performed. HCT utilization increased over time for all disease, age, race, and ethnic groups. From 2017 to 2018, adult (40-84 years) allogeneic transplant utilization for acute myeloid leukemia and myelodysplastic syndrome (MDS) was similar for Hispanic and non-Hispanic White or Other patients but was lower for non-Hispanic Black patients (acute myeloid leukemia: 19% vs 13%; MDS: 9%-10% vs 5%). Similarly, autologous transplant utilization for lymphoma was similar for all race and ethnicity groups; however, autologous transplant for multiple myeloma was highest for non-Hispanic White patients and lower for all other groups (31% vs 26%-27%). In patients aged 0 to 39 years, utilization of allogeneic transplant for acute lymphoblastic leukemia was highest in Hispanic patients, followed by non-Hispanic White, Black, and Other races (acute lymphoblastic leukemia: 19%, 18%, 17%, and 16%, respectively). Conclusions and Relevance: In this cohort study of autologous and allogeneic transplant utilization for hematologic cancers, disparities persisted for non-Hispanic Black patients. Hispanic, non-Hispanic Other, and younger age groups had increased utilization over time that was on par with non-Hispanic White patients in the most recent cohort.

Cardiovascular equity and health center funding: Associations of unmet hypertension and diabetes need by race/ethnicity and federal grants at federally qualified health centers, 2014-2019.

IMPORTANCE: Racial and ethnic disparities in chronic disease are a major public health priority. OBJECTIVE: To determine if the amount of federal grant funding to federally-qualified health centers (FQHCs) was associated with baseline overall prevalence of uncontrolled hypertension and uncontrolled diabetes, as well as prevalence by racial and ethnic subgroup. DESIGN: Cross-sectional multivariate regression analysis of Uniform Data System 2014-2019, which includes clinic-level data from each FQHC regarding demographics, chronic disease control by race and ethnicity, and grant funding. EXPOSURES: Our main exposure were the average values of the prevalence of uncontrolled hypertension and uncontrolled diabetes among the overall population and by racial and ethnic group from 2014-2016. MAIN OUTCOMES: Average federal grant funding per patient from 2017-2019, as measured by annual health center funding from the Bureau of Primary Health Care (BPHC) and overall federal grant funding. RESULTS: We analyzed 1,205 FQHCs from 2014-2019; the average BPHC grant per patient across all FQHCs in 2019 was $168 while the average total federal grant was $184 per patient. Increasing shares of total patients with uncontrolled hypertension or uncontrolled diabetes were not associated with increased total federal grant funding in either unadjusted or adjusted analysis. Increased shares of patients who are American Indian or Alaskan Native (AI-AN) with uncontrolled hypertension and diabetes were associated with increasing total federal grant funding in both unadjusted and adjusted analysis (adjusted beta hypertension $168.3, p <0.001; adjusted beta diabetes 59.44, p = 0.02). However, cardiovascular clinical need among other racial and ethnic groups was not significantly associated with grant funding. CONCLUSIONS: FQHCs with higher overall rates of uncontrolled hypertension or diabetes do not receive more federal funds, and there is no significant association between federal funding levels and rates of uncontrolled blood pressure or diabetes within most racial and ethnic groups, with the exception of AI-AN populations. To narrow inequities in cardiovascular disease, HRSA should consider more explicitly targeting federal grants to clinics with higher levels of clinical need.

An intersectional analysis of the health status, work conditions, and nonwork conditions of the U.S. working-classed across class, sex, race, and nativity identities.

BACKGROUND: Classism, sexism, racism, and nativism intersect to create inequitable conditions and health outcomes based on workers' social identities. This study describes the health status, work conditions, and nonwork conditions of the United States (U.S.) working-classed at the intersections of class, sex, racial, and nativity identities. METHODS: Descriptive statistics (e.g., frequencies, percentages) were calculated from the 2015 National Health Interview Survey data for the total working classed sample (N = 11,884) and 16 intersectional groupings. General and psychosocial health status, work factors, and access to resources outside of work were examined. RESULTS: Intersectional analysis revealed divisions in work and nonwork conditions despite the majority of each grouping reporting very good/excellent health. The majority of the female Latine born-outside-U.S. grouping (60%) reported not having paid sick leave. The majority of the male Latine born-outside-U.S. grouping reported having neither paid sick leave (62%) nor health insurance (55%). The majority of the female Latine (53%), male Latine (60%), and male Black (55%) born-outside-U.S. groupings reported workplaces as less safe. The majority of the female Latine born-outside-U.S. grouping (53%) was the only grouping to report being moderately/very worried about being able to afford housing costs. CONCLUSION: The health status and precarity of work and nonwork conditions of the U.S. working classed may be shaped by intersecting systems of power across class, sex, racial, and nativity identities. Intersectional analysis increases our purview to see who is most affected, how, and where, which can inform future opportunities to mitigate worker health inequities.

Association between buprenorphine capacity rates and percentages of ethnic/racial minorities at the county level in the United States.

OBJECTIVE: This study investigated the association between patient treatment capacity rates and the percentage of racial/ethnic minorities at the county level. DESIGN: Ecological study at the county level. EXPOSURE: The percentages of racial/ethnic minorities and the people living in poverty in 3,140 counties serve as the main exposure and confounder variables. MAIN OUTCOME MEASURE: "No or low patient capacity" was defined as a patient capacity rate less than or equal to the 40th percentile of the distribution. Patient capacity rates were calculated by adding the maximum number of patients X-waivered providers could potentially treat in each county. RESULT: Counties in higher racial/ethnic minority quintiles had significantly lower odds of "no or low patient capacity" than those in the lowest quintile in multiple logistic regression (adjusted odds ratio, 0.29; 95 percent CI, 0.14-0.61). CONCLUSION: Since racial/ethnic minorities continue to have limited access to buprenorphine, as shown in individual-level studies, merely increasing treatment capacity is largely insufficient.

Racism, not race: Quantitative analysis of the use of race and racism in the addiction literature.

RATIONALE: Prior research has demonstrated that medical journals rarely mention racism, potentially contributing to an incorrect understanding of and inappropriate interventions for health inequities affecting Black and Brown communities in the US. While this infrequency of mentions of racism has been documented in the general medical literature, it is unknown if this pattern extends to the addiction literature, where some have argued that structural racism has played a specific role in shaping policy and treatment. OBJECTIVE: To assess how frequently the addiction literature for the last 30 years has mentioned race and racism and if these rates vary with social movements. METHODS: We created an algorithm to download and process over 30,000 published articles published from 1990 to 2022 in five major addiction journals: Addiction, Addictive Behaviors, Drug and Alcohol Dependence, Journal of Substance Abuse and Treatment, and International Journal of Drug Policy. Using this data, we reported temporal patterns of mentioning both race and racism across journals and article types. Further, we utilized interrupted time series analysis to identify if the social movements against police violence and the murder of George Floyd in 2020 were associated with significant changes in rates of mentioning racism. RESULTS: While over 30% of the articles in addiction medicine journals included the word race, only 1.5% of articles mentioned racism. Based on an interrupted time series model, after the racial reckoning following the murder of George Floyd in 2020, mentions of racism increased in the addiction literature (OR = 3.21, 95% CI: [2.39, 4.32], P<.001). CONCLUSIONS: A large chasm remains between how often authors mention race versus racism in addiction medicine, a field with a unique history intertwined with structural racism. Addressing inequities in addiction outcomes, including burgeoning inequities in overdose deaths, will require acknowledging racism in the scientific literature.

Racial and Ethnic Representation in Food Allergen Immunotherapy Trial Participants: A Systematic Review.

Importance: The lack of inclusion of diverse population samples in food allergy immunotherapy clinical trials not only leads to decreased applicability to the general population in terms of results and treatments but can also be seen as a broader social injustice contributing to inequity within the health care system. Objectives: To investigate the racial and ethnic distribution of participants included in food allergy immunotherapy clinical trials, and determine whether the racial and ethnic representation in trials accurately reflects the patients who experience food allergy. Evidence Review: Data were collected from articles found on PubMed and ClinicalTrials.gov using key terms of food hypersensitivity, food allergy, and immunotherapy, while also incorporating specific criteria such as clinical trials conducted within the last 5 years with children aged from birth to 18 years old. Articles were selected based on their relevance to the research question. Main outcomes were totals and percentages of trial participants by race and ethnicity, stratified by pediatric trials, site of study, and National Institutes of Health funding. Findings: Thirty-five articles were initially identified, of which 34 were classified as human clinical trials. Of these trials, 26 met criteria of an original randomized clinical trial and included racial and ethnic demographics for analysis in the study. Among trials included, the majority of the 3689 participants identified as White (2640 participants [72.0%]), followed by Black or African American (293 participants [8.0%]), Asian (239 participants [6.0%]), multiple races or other (210 participants [6.0%]), Hispanic or Latino (96 participants [3.0%]), American Indian (3 participants [<1.0%]), and Native American or Pacific Islander (3 participants [<1.0%]). We observed differences in racial and ethnic inclusion by study site (US vs external to US) and funding support (National Institutes of Health vs industry or other non-National Institutes of Health sources). Conclusions and Relevance: In this systematic review of racial and ethnic diversity in food allergy immunotherapy trials, there was a lack of diversity relative to the overall food allergy burden among Black and Hispanic patients, indicating important gaps in the conduct of pediatric clinical trials, especially for treatments that are meant for use in broad populations where significant race- and ethnicity-related disparities exist. Working to correct this disparity will not only increase the usefulness of future clinical trial data but can further assist in alleviating public health inequities.

Trend of incompleteness of the race/color variable in hospitalizations due to COVID-19 whose outcome was death in Brazil, 2020-2022.

OBJECTIVE: To analyze the incompleteness and trend of incompleteness of the race/color variable in hospitalizations due to COVID-19 whose outcome was death, in Brazil, between April 2020 and April 2022. METHODS: Ecological time series study on the incompleteness of the race/color variable in hospitalizations due to COVID-19 whose outcome was death in Brazil, its macro-regions and Federative Units (FU), by joinpoint regression, calculation of Monthly Percent Change (MPC) and Average Monthly Percent Change (AMPC), based on data from the Hospital Information System of the Unified Health System (SIH/SUS). RESULTS: The incompleteness of the race/color variable in COVID-19 hospitalizations with a death outcome in Brazil was 25.85%, considered poor. All regions of the country had a poor degree of incompleteness, except for the South, which was considered regular. In the period analyzed, the joinpoint analysis revealed a stable trend in the incompleteness of the race/color variable in Brazil (AMPC = 0.54; 95%CI: -0.64 to 1.74; p = 0.37) and in the Southeast (AMPC = -0.61; 95%CI: -3.36 to 2.22; p = 0.67) and North (AMPC = 3.74; 95%CI: -0.14 to 7.78; p = 0.06) regions. The South (AMPC = 5.49; 95%CI: 2.94 to 8.11; p = 0.00002) and Northeast (AMP = 2.50; 95%CI: 0.77 to 4.25; p = 0.005) regions showed an increase in the incompleteness trend, while the Midwest (AMPC = -2.91 ; 95%CI: -5.26 to -0.51; p = 0.02) showed a downward trend. CONCLUSION: The proportion of poor completeness and the stable trend of incompleteness show that there was no improvement in the quality of filling in the race/color variable during the COVID-19 pandemic in Brazil, a fact that may have increased health inequalities for the black population and made it difficult to plan strategic actions for this population, considering the pandemic context. The results found reinforce the need to encourage discussion on the subject, given that the incompleteness of health information systems increases inequalities in access to health services and compromises the quality of health data.

Neighborhood Child Opportunity and Preterm Birth Rates by Race and Ethnicity.

Importance: In the US, infants born to non-Hispanic Black birthing parents are 50% more likely to be born preterm than those born to non-Hispanic White birthing parents, and individual-level factors do not fully account for this inequity. Neighborhood context, rooted in historic patterns of structural racism, may facilitate understanding patterns of inequity in preterm birth. Objective: To estimate the association between neighborhood opportunity level, measured by the Child Opportunity Index (COI), and preterm birth among infants in Massachusetts. Design, Setting, and Participants: In this cross-sectional, population-based study, Massachusetts birth certificates from 3 large metropolitan areas (Boston, Springfield, and Worcester) were linked to US Census tract-level data from the COI, and log binomial regression models and generalized estimating equations were fit to examine associations of different levels of opportunity with preterm birth. Singleton infants born in Massachusetts between February 1, 2011, and December 31, 2015, were included. Analyses were originally conducted in 2019 and updated in 2024. Exposure: Level of child opportunity (measured by the COI) at the US Census tract level. Race and ethnicity were ascertained from the birth certificate, as reported by the birthing parent. Main Outcomes and Measures: Live birth before 37 completed weeks' gestation. Results: The analytic dataset included 267 553 infants, of whom 18.9% were born to Hispanic, 10.1% to non-Hispanic Asian or Pacific Islander, 10.1% to non-Hispanic Black, and 61.0% to non-Hispanic White birthing parents. More than half of infants born to non-Hispanic Black and Hispanic birthing parents were born into very low opportunity neighborhoods, and in crude models, this was associated with greater prevalence of preterm birth relative to very high opportunity neighborhoods (prevalence ratio, 1.44; 95% CI, 1.37-1.52). After adjustment for covariates, infants born into very low opportunity neighborhoods still had a greater prevalence of preterm birth (prevalence ratio, 1.16; 95% CI, 1.10-1.23). Conclusions and Relevance: In this cross-sectional study of neighborhood opportunity and preterm birth, elevated risk associated with exposure to a very low opportunity neighborhood, coupled with the disproportionate exposure by race and ethnicity, points to a modifiable factor that may contribute to racial and ethnic inequities in preterm birth. Future research should investigate interventions that seek to address neighborhood opportunity.