RESUMO
PURPOSE: The objective of this study is to identify how predisposing characteristics, enabling factors, and health needs are jointly and individually associated with epidemiological patterns of outpatient healthcare utilization for patients who already interact and engage with a large healthcare system. METHODS: We retrospectively analyzed electronic medical record data from 1,423,166 outpatient clinic visits from 474,674 patients in a large healthcare system from June 2018-March 2019. We evaluated patients who exclusively visited rural clinics versus patients who exclusively visited urban clinics using Chi-square tests and the generalized estimating equation Poisson regression methodology. The outcome was healthcare use defined by the number of outpatient visits to clinics within the healthcare system and independent variables included age, gender, race, ethnicity, smoking status, health status, and rural or urban clinic location. Supplementary analyses were conducted observing healthcare use patterns within rural and urban clinics separately and within primary care and specialty clinics separately. FINDINGS: Patients in rural clinics vs. urban clinics had worse health status [χ2 = 935.1, df = 3, p<0.0001]. Additionally, patients in rural clinics had lower healthcare utilization than patients in urban clinics, adjusting for age, race, ethnicity, gender, smoking, and health status [2.49 vs. 3.18 visits, RR = 0.61, 95%CI = (0.55,0.68), p<0.0001]. Further, patients in rural clinics had lower utilization for both primary care and specialty care visits. CONCLUSIONS: Within the large healthcare system, patients in rural clinics had lower outpatient healthcare utilization compared to their urban counterparts despite having potentially elevated health needs reflected by a higher number of unique health diagnoses documented in their electronic health records after adjusting for multiple factors. This work can inform future studies exploring the roots and ramifications of rural-urban healthcare utilization differences and rural healthcare disparities.
Assuntos
Disparidades em Assistência à Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Saúde da População Rural/etnologia , Adulto , Idoso , Estudos Transversais , Atenção à Saúde/etnologia , Feminino , Disparidades em Assistência à Saúde/etnologia , Humanos , Masculino , Pessoa de Meia-Idade , Meio-Oeste dos Estados Unidos/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Distribuição de Poisson , Estudos Retrospectivos , Fatores de Risco , Saúde da População Urbana/etnologia , Adulto JovemRESUMO
Urban heat stress poses a major risk to public health. Case studies of individual cities suggest that heat exposure, like other environmental stressors, may be unequally distributed across income groups. There is little evidence, however, as to whether such disparities are pervasive. We combine surface urban heat island (SUHI) data, a proxy for isolating the urban contribution to additional heat exposure in built environments, with census tract-level demographic data to answer these questions for summer days, when heat exposure is likely to be at a maximum. We find that the average person of color lives in a census tract with higher SUHI intensity than non-Hispanic whites in all but 6 of the 175 largest urbanized areas in the continental United States. A similar pattern emerges for people living in households below the poverty line relative to those at more than two times the poverty line.
Assuntos
Exposição Ambiental/análise , Disparidades nos Níveis de Saúde , Transtornos de Estresse por Calor/etnologia , Temperatura Alta , Saúde da População Urbana/etnologia , Negro ou Afro-Americano/estatística & dados numéricos , Cidades , Exposição Ambiental/efeitos adversos , Geografia , Hispânico ou Latino/estatística & dados numéricos , Humanos , Renda/estatística & dados numéricos , Maryland , Pobreza/estatística & dados numéricos , South Carolina , Estados Unidos , População Branca/estatística & dados numéricosAssuntos
Doenças Cardiovasculares/mortalidade , Diabetes Mellitus/mortalidade , Disparidades em Assistência à Saúde/etnologia , Saúde da População Rural/etnologia , Saúde da População Urbana/etnologia , Adulto , População Negra/estatística & dados numéricos , Causas de Morte , Feminino , Acessibilidade aos Serviços de Saúde/tendências , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Mortalidade , Saúde Pública/normas , Estados Unidos/epidemiologia , População Branca/estatística & dados numéricosRESUMO
OBJECTIVE: To determine the influence of socioeconomic parameters on urinary stone surgeries. METHODS: A retrospective cohort study analyzed patients undergoing urolithiasis surgery in our community network hospital in North Carolina from 2005-2018. RESULTS: Of 7731 patients, 2160 (28%), 5,174 (67%), and 397 (5%) underwent SWL, URS, and PCNL, respectively. A higher proportion of Whites underwent URS (67%) and SWL (74%) than PCNL (56%); whereas a larger percentage of Blacks underwent PCNL (24%) than URS (20%) and SWL (15%) groups (P <.001). Private insurance payers were greater in the SWL (95%) group than URS (80%) and PCNL (81%) (P <.001). The distribution of median income was significantly different amongst the 3 surgeries with higher income classes overutilizing SWL and underutilizing PCNL compared to lower income classes (P <.001). In linear regression modeling, the proportion of SWL in a postal code was positively associated with median income (R2=0.55, P <.001); URS and PCNL were negatively associated with median income (R2=0.40, P <.001 and R2=0.41, P <.001, respectively). On multivariate logistic regression modeling, Blacks were significantly more likely to undergo PCNL than Whites (aOR 1.32, 95% CI 1.01-1.74 P <.050). Private insurance payers were more likely to undergo SWL (aOR 11.0, 95% CI 7.26-16.8, P <.0001) than public insurance payers. Patients in higher median income brackets are significantly less likely to undergo PCNL than those in the <$40,000 income bracket (P <.0001). CONCLUSION: Our study suggests that socioeconomic status impacts urolithiasis surgical management, underscoring disparity recognition importance in endourologic care and ensuring appropriate surgical care regardless of socioeconomic status.
Assuntos
Litotripsia , Aceitação pelo Paciente de Cuidados de Saúde , Administração dos Cuidados ao Paciente , Saúde da População Urbana , Urolitíase , Procedimentos Cirúrgicos Urológicos , Demografia , Feminino , Necessidades e Demandas de Serviços de Saúde , Disparidades em Assistência à Saúde/normas , Humanos , Revisão da Utilização de Seguros/estatística & dados numéricos , Litotripsia/métodos , Litotripsia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , North Carolina/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Administração dos Cuidados ao Paciente/métodos , Administração dos Cuidados ao Paciente/estatística & dados numéricos , Determinantes Sociais da Saúde , Fatores Socioeconômicos , Saúde da População Urbana/etnologia , Saúde da População Urbana/normas , Saúde da População Urbana/estatística & dados numéricos , Urolitíase/epidemiologia , Urolitíase/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Procedimentos Cirúrgicos Urológicos/estatística & dados numéricosRESUMO
AIMS/HYPOTHESIS: This study explored the impact of ethnicity on time-to-clinic, time-to-treatment and rates of vision loss in people referred to hospital with diabetic eye disease. METHODS: A survival analysis was performed on all referrals from an inner-city diabetic eye screening programme to a tertiary hospital eye service between 1 October 2013 and 31 December 2017. Exclusion criteria were failure to attend hospital, distance visual acuity in both eyes too low to quantify with the Early Treatment Diabetic Retinopathy Study (ETDRS) letter chart and treatment received prior to referral. Demographic and screening grade data were collected at the point of referral. Small-area statistics and census data were used to calculate indices of multiple deprivation. The main outcome measures were time taken from the date of referral for an individual to achieve the following: (1) attend the first hospital clinic appointment; (2) receive the first macular laser, intravitreal anti-vascular endothelial growth factor injection or pan-retinal photocoagulation treatment, in either eye; and (3) lose at least ten ETDRS letters of distance visual acuity, in either eye. RESULTS: Of 2062 referrals, 1676 individuals were included. Mean age (± SD) was 57.6 ± 14.7 years, with 52% male sex and 86% with type 2 diabetes. The ethnicity profile was 52% Black, 30% White, 10% Asian and 9% mixed/other, with similar disease severity at the time of referral. Time-to-clinic was significantly longer for Asian people than for Black people (p = 0.03) or White people (p = 0.001). Time-to-treatment was significantly longer for Black people than for White people (p = 0.02). Social deprivation did not significantly influence time-to-treatment. There were no significant differences in the rates of vision loss between ethnic groups. CONCLUSIONS/INTERPRETATION: Black people wait longer for hospital eye treatment compared with their White counterparts. The reasons for this delay in treatment warrant further investigation.
Assuntos
Povo Asiático , População Negra , Retinopatia Diabética/etnologia , Retinopatia Diabética/terapia , Tempo para o Tratamento , Transtornos da Visão/etnologia , Transtornos da Visão/terapia , População Branca , Adulto , Idoso , Retinopatia Diabética/mortalidade , Retinopatia Diabética/fisiopatologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/etnologia , Humanos , Londres/epidemiologia , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Prevalência , Encaminhamento e Consulta , Medição de Risco , Fatores de Risco , Determinantes Sociais da Saúde/etnologia , Fatores Socioeconômicos , Fatores de Tempo , Resultado do Tratamento , Saúde da População Urbana/etnologia , Transtornos da Visão/mortalidade , Transtornos da Visão/fisiopatologia , Acuidade VisualRESUMO
Identifying areas with low access to testing and high case burden is necessary to understand risk and allocate resources in the COVID-19 pandemic. Using zip code level data for New York City, we analyzed testing rates, positivity rates, and proportion positive. A spatial scan statistic identified clusters of high and low testing rates, high positivity rates, and high proportion positive. Boxplots and Pearson correlations determined associations between outcomes, clusters, and contextual factors. Clusters with less testing and low proportion positive tests had higher income, education, and white population, whereas clusters with high testing rates and high proportion positive tests were disproportionately black and without health insurance. Correlations showed inverse associations of white race, education, and income with proportion positive tests, and positive associations with black race, Hispanic ethnicity, and poverty. We recommend testing and health care resources be directed to eastern Brooklyn, which has low testing and high proportion positives.
Assuntos
Doenças Transmissíveis Emergentes/epidemiologia , Infecções por Coronavirus/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Disparidades em Assistência à Saúde/etnologia , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Saúde da População Urbana/etnologia , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19 , Teste para COVID-19 , Técnicas de Laboratório Clínico/estatística & dados numéricos , Análise por Conglomerados , Infecções por Coronavirus/diagnóstico , Feminino , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/economia , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Pneumonia Viral/diagnóstico , Medição de Risco , Análise Espacial , Saúde da População Urbana/economia , População UrbanaRESUMO
Objectives: Despite improvements in infant mortality rates (IMR) in the United States, racial gaps in IMR remain and may be driven by both structural racism and place. This study assesses the relationship between structural racism and race-specific IMR and the role of urban-rural classification on race-specific IMR and Black/White racial gaps in IMR. Methods: We conducted an analysis of variance tests using 2019 County Health Rankings Data to determine differences in structural racism indicators, IMR and other co-variates by urban-rural classification. We used linear regressions to determine the associations between measures of structural racism and county-level health outcomes. Results: Study results suggest that racial inequities in education, work, and homeownership negatively impact Black IMR, especially in large fringe, medium, and small metro counties, and positively impact White IMR. Structural racism is also associated with Black-White gaps in IMR. Conclusions: Factors related to structural racism may not be homogenous or have the same impacts on overall IMR, race-specific IMR, and racial differences in IMR across places. Understanding these differential impacts can help public health professionals and policymakers improve Black infant health and eliminate racial inequities in IMR.
Assuntos
Equidade em Saúde/organização & administração , Mortalidade Infantil/etnologia , Racismo , Saúde da População Rural/etnologia , Saúde da População Urbana/etnologia , População Negra/estatística & dados numéricos , Humanos , Lactente , Racismo/etnologia , Racismo/prevenção & controle , Classe Social , Determinantes Sociais da Saúde , Estados Unidos/epidemiologia , População Branca/estatística & dados numéricosRESUMO
Background Cardiovascular disease incidence, prevalence, morbidity, and mortality have declined in the past several decades; however, disparities persist among subsets of the population. Notably, blacks have not experienced the same improvements on the whole as whites. Furthermore, frequent reports of relatively poorer health statistics among the black population have led to a broad assumption that black race reliably predicts relatively poorer health outcomes. However, substantial intraethnic and intraracial heterogeneity exists; moreover, individuals with similar risk factors and environmental exposures are often known to experience vastly different cardiovascular health outcomes. Thus, some individuals have good outcomes even in the presence of cardiovascular risk factors, a concept known as resilience. Methods and Results The MECA (Morehouse-Emory Center for Health Equity) Study was designed to investigate the multilevel exposures that contribute to "resilience" in the face of risk for poor cardiovascular health among blacks in the greater Atlanta, GA, metropolitan area. We used census tract data to determine "at-risk" and "resilient" neighborhoods with high or low prevalence of cardiovascular morbidity and mortality, based on cardiovascular death, hospitalization, and emergency department visits for blacks. More than 1400 individuals from these census tracts assented to demographic, health, and psychosocial questionnaires administered through telephone surveys. Afterwards, ≈500 individuals were recruited to enroll in a clinical study, where risk biomarkers, such as oxidative stress, and inflammatory markers, endothelial progenitor cells, metabolomic and microRNA profiles, and subclinical vascular dysfunction were measured. In addition, comprehensive behavioral questionnaires were collected and ideal cardiovascular health metrics were assessed using the American Heart Association's Life Simple 7 measure. Last, 150 individuals with low Life Simple 7 were recruited and randomized to a behavioral mobile health (eHealth) plus health coach or eHealth only intervention and followed up for improvement. Conclusions The MECA Study is investigating socioenvironmental and individual behavioral measures that promote resilience to cardiovascular disease in blacks by assessing biological, functional, and molecular mechanisms. REGISTRATION URL: https://www.cliniâcaltrâials.gov. Unique identifier: NCT03308812.
Assuntos
Negro ou Afro-Americano , Doenças Cardiovasculares/etnologia , Disparidades nos Níveis de Saúde , Determinantes Sociais da Saúde/etnologia , Saúde da População Urbana/etnologia , Adulto , Negro ou Afro-Americano/psicologia , Idoso , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/prevenção & controle , Doenças Cardiovasculares/psicologia , Feminino , Georgia/epidemiologia , Comportamentos Relacionados com a Saúde/etnologia , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Fatores de Risco de Doenças Cardíacas , Humanos , Estilo de Vida/etnologia , Masculino , Pessoa de Meia-Idade , Prevalência , Serviços Preventivos de Saúde , Prognóstico , Fatores Raciais , Projetos de Pesquisa , Medição de Risco , Fatores SocioeconômicosRESUMO
INTRODUCTION: This study examined the prevalence of pre-hypertension (PHT) and hypertension (HT) in urban youth, and assessed the effects of sodium intake and obesity on blood pressure (BP) by ethnicity. METHODS: A convenience sample of 557 multiethnic youth, aged 11-23 years, was recruited from 12 schools and institutions in Edmonton, Alberta, Canada. Participants were divided by self-identified ethnicity into four groups (Indigenous, African and Middle Eastern (AME), Asian, and European). RESULTS: Between October 2013 and March 2014, one-on-one interviews were conducted to collect data on demographics, physical activity, diet, and Body Mass Index (BMI). BP was obtained at two different times during the interview and measured a third time in cases of high variability. The standard deviation scores (SDS) of systolic BP (SBP) and diastolic BP (DBP) were used to estimate associations with sodium intake (per 1000 mg/day). Overall, 18.2% and 5.4% of the participants had PHT and HT, respectively. Indigenous and AME participants showed the highest rates of PHT (23.1%). Indigenous and European participants showed higher rates of HT (8.3% and 5.3%, respectively) than other ethnic groups (AME = 4.4%, Asian = 3.9%). There was a positive association between 1000 mg/day increase in sodium intake and SDS of SBP by 0.041 (95% CI 0.007-0.083; p = 0.04) among pre-hypertensive participants. Over 85% of participants exceeded the recommended dietary sodium intake. Mean BMI and dietary sodium intake were higher among pre-hypertensive participants (4219 mg/day) than normotensive (3475 mg/day). CONCLUSIONS: The prevalence of HT varied by ethnicity. High dietary sodium intake was of concern. There is a need for culturally-tailored, population-based interventions to reduce sodium intake.
Assuntos
Pressão Sanguínea , Hipertensão/etnologia , Estilo de Vida/etnologia , Pré-Hipertensão/etnologia , Sódio na Dieta/efeitos adversos , Saúde da População Urbana/etnologia , Adolescente , Fatores Etários , Alberta/epidemiologia , Povo Asiático , População Negra , Criança , Estudos Transversais , Dieta Hipossódica/etnologia , Exercício Físico , Feminino , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Inquéritos Epidemiológicos , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Hipertensão/prevenção & controle , Indígenas Norte-Americanos , Masculino , Obesidade Infantil/diagnóstico , Obesidade Infantil/etnologia , Pré-Hipertensão/diagnóstico , Pré-Hipertensão/fisiopatologia , Pré-Hipertensão/prevenção & controle , Prevalência , Fatores Raciais , Recomendações Nutricionais , Medição de Risco , Fatores de Risco , Comportamento de Redução do Risco , População Branca , Adulto JovemRESUMO
OBJECTIVE: Primary amputation (ie, without attempted revascularization) is a devastating complication of peripheral artery disease. Racial disparities in primary amputation have been described; however, rural disparities have not been well investigated. The purpose of this study was to examine the impact of rurality on risk of primary amputation and to explore the effect of race on this relationship. METHODS: The national Vascular Quality Initiative amputation data set was used for analyses (N = 6795). The outcome of interest was primary amputation. Independent variables were race/ethnicity (non-Latinx whites vs nonwhites) and rural residence. Multivariable logistic regression examined impact of rurality and race/ethnicity on primary amputation after adjustment for relevant covariates and included an interaction for race/ethnicity by rural status. RESULTS: Primary amputation occurred in 49% of patients overall (n = 3332), in 47% of rural vs 49% of urban patients (P = .322), and in 46% of whites vs 53% of nonwhites (P < .001). On multivariable analysis, nonwhites had a 21% higher odds of undergoing primary amputation overall (adjusted odds ratio [AOR], 1.21; 95% confidence interval [CI], 1.05-1.39). On subgroup analysis, rural nonwhites had two times higher odds of undergoing primary amputation than rural whites (AOR, 2.06; 95% CI, 1.53-2.78) and a 52% higher odds of undergoing primary amputation than urban nonwhites (AOR, 1.52; 95% CI, 1.19-1.94). In the urban setting, nonwhites had a 21% higher odds of undergoing primary amputation than urban whites (AOR, 1.21; 95% CI, 1.05-1.39). CONCLUSIONS: In these analyses, rurality was associated with greater odds for primary amputation in nonwhite patients but not in white patients. The effect of race on primary amputation was significant in both urban and rural settings; however, the effect was significantly stronger in rural settings. These findings suggest that race/ethnicity has a compounding effect on rural health disparities and that strategies to improve health of rural communities need to consider the particular needs of nonwhite residents to reduce disparities.
Assuntos
Amputação Cirúrgica , Disparidades em Assistência à Saúde/etnologia , Doença Arterial Periférica/etnologia , Doença Arterial Periférica/cirurgia , Serviços de Saúde Rural , Saúde da População Rural/etnologia , Saúde da População Urbana/etnologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico , Fatores Raciais , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Serviços Urbanos de SaúdeRESUMO
BACKGROUND: Suboptimal sleep has been documented in at-risk groups such as urban minority children, particularly those with asthma. It is therefore critical to examine differences in sleep outcomes across specific racial and ethnic groups and to identify factors that contribute to such variations in sleep outcomes to inform tailored interventions to improve sleep health. OBJECTIVES: The objectives were to examine racial/ethnic differences in sleep outcomes among urban children with and without asthma and to evaluate the extent to which asthma status and aspects of sleep hygiene and the sleep environment contribute to racial/ethnic differences in sleep outcomes in this sample. METHODS: Two hundred and sixteen African American, Latino, or non-Latino white (NLW) urban children, ages 7-9â¯years, with (nâ¯=â¯216) and without asthma (nâ¯=â¯130) and their primary caregivers were included. Objective sleep duration and efficiency were assessed via actigraphy. Asthma status was assessed by a study clinician. Caregiver-reported sleep hygiene and exposure to noise were assessed using a questionnaire. RESULTS: Minority children in the sample had, on average, shorter sleep duration compared to NLW children during the monitoring period (mean difference Latino vs NLWâ¯=â¯-22.10, SEâ¯=â¯5.02; mean difference AA vs NLWâ¯=â¯-18.69, SEâ¯=â¯5.28) Additionally, several racial/ethnic group differences in sleep outcomes emerged and were dependent on whether or not children had asthma. Specifically, Latinos had lower mean number of awakenings compared to NLWs but only among control participants with no asthma. Furthermore, specific aspects of sleep hygiene and exposure to nighttime noise in the home and neighborhood contributed to racial/ethnic differences in sleep outcomes. CONCLUSION: Considering urban stressors and asthma status when treating pediatric populations is important, as factors related to urban stress and asthma management may influence sleep hygiene practices and sleep outcomes.
Assuntos
Asma/etnologia , Negro ou Afro-Americano/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Hispânico ou Latino/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Sono , Saúde da População Urbana/etnologia , Cuidadores , Criança , Feminino , Humanos , Masculino , New England , Higiene do Sono , Inquéritos e Questionários , Fatores de Tempo , População Branca/estatística & dados numéricosRESUMO
We examined the interactive associations of poor diet quality and Alzheimer's Disease (AD) genetic risk with cognitive performance among 304 African American adults (mean age~57 years) from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study. In this cross-sectional study, selected participants had complete predictors and covariate data with 13 cognitive test scores as outcomes. Healthy Eating Index-2010 (HEI-2010), Dietary Approaches to Stop Hypertension (DASH), and mean adequacy ratio (MAR) were measured. A genetic risk score for AD in HANDLS (hAlzScore) was computed from 12 selected single nucleotide polymorphisms (SNPs). Our key hypotheses were tested using linear regression models. The hAlzScore was directly associated with poor performance in verbal memory (-0.4 ± 0.2, 0.01) and immediate visual memory (0.4 ± 0.2, 0.03) measured in seconds, in women only. The hAlzScore interacted synergistically with poorer diet quality to determine lower cognitive performance on a test of verbal fluency. Among numerous SNP × diet quality interactions for models of cognitive performance as outcomes, only one passed correction for multiple testing, namely verbal fluency. Our results suggest that improved diet quality can potentially modify performance on cognitive tests of verbal fluency among individuals with higher AD genetic risk.
Assuntos
Doença de Alzheimer/etnologia , Negro ou Afro-Americano , Cognição , Dieta/etnologia , Valor Nutritivo/etnologia , Polimorfismo de Nucleotídeo Único , Saúde da População Urbana/etnologia , Adulto , Negro ou Afro-Americano/genética , Negro ou Afro-Americano/psicologia , Doença de Alzheimer/diagnóstico , Doença de Alzheimer/genética , Doença de Alzheimer/psicologia , Baltimore/epidemiologia , Estudos Transversais , Feminino , Interação Gene-Ambiente , Predisposição Genética para Doença , Humanos , Masculino , Pessoa de Meia-Idade , Fenótipo , Fatores de RiscoRESUMO
BACKGROUND: There is global concern for the overuse of obstetric interventions during labour and birth. Of particular concern is the increasing amount of mothers and babies experiencing morbidity and mortality associated with caesarean section compared to vaginal birth. In high-income settings, emerging evidence suggests that overuse of obstetric intervention is more prevalent among wealthier mothers with no medical need of it. In Australia, the rates of caesarean section and other obstetric interventions are rising. These rising rates of intervention have been mirrored by a decreasing rate of unassisted non-instrumental vaginal deliveries. In the context of rising global concern about rising caesarean section rates and the known health effects of caesarean section on mothers and children, we aim to better characterise the use of obstetric intervention in the state of Queensland, Australia by examining the characteristics of mothers receiving obstetric intervention. Identifying whether there is overuse of obstetric interventions within a population is critical to improving the quality, value and appropriateness of maternity care. METHODS: The association between demographic characteristics (at birth) and birth delivery type were compared with chi-square. The percentage of mothers based on their socioeconomic characteristics were reported and differences in percentages of obstetric interventions were compared. Multivariate analysis was undertaken using multiple logistic regression to assess the likelihood of receiving obstetric intervention and having a vaginal (non-instrumental) delivery after accounting for key clinical characteristics. RESULTS: Indigenous mothers, mothers in major cities and mothers in the wealthiest quintile all had higher percentages of all obstetric interventions and had the lowest percentages of unassisted (non-instrumental) vaginal births. These differences remained even after adjusting for other key sociodemographic and clinical characteristics. CONCLUSIONS: Differences in obstetric practice exist between economic, ethnic and geographical groups of mothers that are not attributable to medical or lifestyle risk factors. These differences may reflect health system, organisational and structural conditions and therefore, a better understanding of the non-clinical factors that influence the supply and demand of obstetric interventions is required.
Assuntos
Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Uso Excessivo dos Serviços de Saúde/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Adulto , Parto Obstétrico/economia , Feminino , Disparidades em Assistência à Saúde/economia , Disparidades em Assistência à Saúde/etnologia , Humanos , Modelos Logísticos , Uso Excessivo dos Serviços de Saúde/economia , Padrões de Prática Médica/economia , Gravidez , Queensland , Saúde da População Rural/economia , Saúde da População Rural/etnologia , Saúde da População Rural/estatística & dados numéricos , Fatores Socioeconômicos , Saúde da População Urbana/economia , Saúde da População Urbana/etnologia , Saúde da População Urbana/estatística & dados numéricosRESUMO
BACKGROUND: There is evidence of a greater incidence of stroke in native populations and minorities. A total of 34% of the population in the Araucanía Region is indigenous. The association between Mapuche ethnicity and stroke is unknown. The aim of the study was to estimate the magnitude of the association between Mapuche ethnicity and stroke occurrence in patients admitted to the Dr. Hernán Henríquez Aravena Hospital (HHHA) in Temuco, Chile. METHODS: We performed an incident case-control-paired study with patients hospitalized with an acute stroke in the internal medicine service and controls from other medical services at the HHHA. One control was selected for each case, matched by gender and age (±5 years). RESULTS: A total of 104 nonconsecutive cases of stroke were included. The proportion of Mapuche individuals was similar between cases and controls (27.9% and 32.7%, respectively, P = .45). Hypertension and overweight-obesity were associated with stroke. Low socioeconomic status, rurality, diabetes, and smoking were associated with Mapuche ethnicity. In the conditional logistic regression model, Mapuche ethnicity was not associated with stroke. The odds ratio was .75 (P = .47, 95% confidence intervals: .35-1.62). CONCLUSIONS: There is no statistically significant evidence in the study to support the hypothesis of an association between Mapuche ethnicity and stroke. None of the control variables modified the effect of ethnicity on stroke.
Assuntos
Indígenas Sul-Americanos , Acidente Vascular Cerebral/etnologia , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Chile/epidemiologia , Comorbidade , Diabetes Mellitus/etnologia , Feminino , Humanos , Hipertensão/etnologia , Incidência , Masculino , Pessoa de Meia-Idade , Obesidade/etnologia , Medição de Risco , Fatores de Risco , Saúde da População Rural/etnologia , Fumar/efeitos adversos , Fumar/etnologia , Classe Social , Determinantes Sociais da Saúde/etnologia , Acidente Vascular Cerebral/diagnóstico , Saúde da População Urbana/etnologiaRESUMO
BACKGROUND: With the implementation of Chinese economic reform and rapid urbanization, policies and values surrounding migration have changed and given rise to unprecedented population mobility. This study is designed to examine the effect of Hukou origin on establishment of health records among internal migrants in China. METHODS: The data used for this study are from the 2015 National Internal Migrant Population Dynamic Monitoring Survey, covering 112,782 migrants nationwide. For continuous variables, the p value is calculated using Student t test; for categorical variables, the p value is calculated using chi-square test. Binary logistic regression with an enter method is employed to assess the association of establishment of health records with origin residence. RESULTS: About 35.1% of the migrant population has established health records in their inflow communities, with 37.4% established among those of urban origin and 34.8% established among those of rural origin. The establishment of health records is significantly higher among migrants of urban origin than among migrants of rural origin (OR = 1.057; 1.017-1.098). Our results also show that among populations of both rural and urban origin, inter-province migrants, along with migrants who are employers, have no plans for long-term residence, have no insurance, and have more family income less likely to establish health records. CONCLUSIONS: This study demonstrates that residence is associated with establishment of health records among the migrant population in China. Targeted policies should be made to improve the establishment of health records among migrants of both rural and urban origins.
Assuntos
Emigração e Imigração/estatística & dados numéricos , Prontuários Médicos/estatística & dados numéricos , Migrantes/estatística & dados numéricos , Adolescente , Adulto , Idoso , China/epidemiologia , China/etnologia , Coleta de Dados , Emprego , Feminino , Humanos , Renda , Masculino , Pessoa de Meia-Idade , Dinâmica Populacional/estatística & dados numéricos , Saúde da População Rural/etnologia , População Rural/estatística & dados numéricos , Saúde da População Urbana/etnologia , Adulto JovemRESUMO
Although changes in Brazilian diet have occurred over the last decades, there is no evidence about differences in food portion sizes (FPS) over time. Therefore, we aimed to evaluate the association of FPS with excess body weight (EBW), and to monitor differences in the population from São Paulo, Brazil, from 2003 to 2015. Data came from three cross-sectional population-based studies with 5270 individuals aged ≥12 years in 2003, 2008, and 2015. Dietary data were obtained from 24-h recalls. Logistic regression models were used to evaluate the association between FPS and EBW. Over the years, there was a diverse variation in FPS, with an increase in some groups (white meat, salted snacks, coffee/tea, eggs) and decrease in others (rice, red meat, sweets, pasta, sandwiches, cold cuts). The percentage of people reporting the intake of six food groupings (rice, white meat, sweets, fruits, commercial juices, toasts/biscuits) increased in the period. In this population, EBW was associated with larger FPS of 11 of the 30 food groupings investigated (cold cuts, fried snacks, fruit and commercial juices, pizza, red meat, rice, salted snacks, soft drinks, soups, sugar). These findings could support future interventions and policies for optimal food intake in Brazil.
Assuntos
Transição Epidemiológica , Obesidade/etiologia , Sobrepeso/etiologia , Obesidade Infantil/etiologia , Tamanho da Porção , Saúde da População Urbana , Adolescente , Adulto , Idoso , Índice de Massa Corporal , Brasil/epidemiologia , Estudos Transversais , Ingestão de Energia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Obesidade/epidemiologia , Obesidade/etnologia , Sobrepeso/epidemiologia , Sobrepeso/etnologia , Obesidade Infantil/epidemiologia , Obesidade Infantil/etnologia , Tamanho da Porção/etnologia , Tamanho da Porção/tendências , Prevalência , Saúde da População Urbana/etnologia , Saúde da População Urbana/tendências , Aumento de Peso , Adulto JovemRESUMO
The study explores the dietary acculturation process among first-generation immigrant families from sub-Saharan Africa or the Caribbean living in Ottawa (Canada). In-depth qualitative interviews were conducted with 12 mothers. The interaction between accelerating factors and other mediating factors resulted in a spiral of dietary changes triggered by immigration. The spiral evolved at different paces from traditional to acculturated and toward healthy or unhealthy diets and was hard to stop or to change in its direction once it started. Findings call for enhancing immigrant mothers' food access, food literacy and nutrition-related parenting skills, and their children's school food environment.
Assuntos
Aculturação , Dieta Saudável , Dieta Ocidental/efeitos adversos , Emigrantes e Imigrantes , Características da Família , Cooperação do Paciente , Saúde da População Urbana , Adulto , África Subsaariana/etnologia , Região do Caribe/etnologia , Países Desenvolvidos , Dieta Saudável/etnologia , Dieta Saudável/psicologia , Dieta Ocidental/etnologia , Dieta Ocidental/psicologia , Características da Família/etnologia , Feminino , Assistência Alimentar , Preferências Alimentares/etnologia , Abastecimento de Alimentos/economia , Humanos , Pessoa de Meia-Idade , Mães , Avaliação das Necessidades , Ontário , Cooperação do Paciente/etnologia , Pesquisa Qualitativa , Fatores Socioeconômicos , Saúde da População Urbana/etnologiaRESUMO
BACKGROUND: High salt intake increases blood pressure (BP) and hypertension risk. This study aimed to examine association of urinary sodium excretion with BP and hypertension correlates among Cameroonian pygmies under hunter-gatherer subsistence mode and Bantus, living in urban area under unhealthy behavioral habits. METHODS: In this cross-sectional cluster sampling study, we randomly enrolled rural pygmies living in Lolodorf and urban Bantus living in Douala. The World Health Organization steps questionnaire was used to collect socio-demographic and lifestyle data. Height, weight, BP and single overnight spot urine samples were obtained in all participants. BP was measured in triplicate. Urinary sodium and potassium excretion was determined by flame photometry. Data were recorded and analyzed using SPSS 16.0. RESULTS: We included 150 Pygmies and 150 Bantus aged 38 ± 12 years and 33 ± 11 years, respectively (p < 0.0001). Compare to Bantus, pygmy's height and weight were respectively: 1.54 ± 0.09 m vs 1.72 ± 0.12 m; and 54.4 ± 9.2 kg vs 77.2 ± 14.8 kg, all p < 0.0001. Age-standardized prevalence of hypertension was 3.3% among Pygmies and 28% among Bantus (p < 0.0001). Age-adjusted systolic and diastolic BP were lower in Pygmies than in Bantus (107 ± 12 vs 119 ± 17 mmHg and 71 ± 11 vs 78 ± 13 mmHg respectively, all P < 0.0001). BP increased with age but to a lesser extent in Pygmies (all p < 0.01). Urinary sodium excretion was lower in Pygmies than in Bantus (46.9 ± 32.4 vs 121.5 ± 61.0 mmol/l, p < 0.0001). Systolic and diastolic BP were positively associated with urinary sodium excretion in Bantus (all p < 0.05). In the two groups, urinary potassium excretion was similar, and was not related to blood pressure. In the total study group and in Bantus taken separately, urinary sodium excretion was higher in hypertensive than in normotensive subjects. Multivariable logistic regression showed that urinary sodium excretion, Bantu status and age emerged as independent determinants of hypertension in the whole study group (OR (95%CI): 1.012 (1.005-1.018); 11.408 (3.599-36.165); 1.095 (1.057-1.135) respectively, p < 0.0001). CONCLUSION: Hunter-gatherer pygmies exhibit low level of urinary sodium excretion related to low rate of hypertension and slower BP increase with age. Salt intake was a major driver of hypertension in our study population. Our findings highlight the need of efforts to implement nationwide prevention programs promoting risk factor screening and healthier lifestyles including reduction of dietary salt intake in Cameroonian.
Assuntos
População Negra , Pressão Sanguínea , Hipertensão/etnologia , Hipertensão/fisiopatologia , Natriurese , Cloreto de Sódio na Dieta/efeitos adversos , Sódio/urina , Adulto , Distribuição por Idade , Fatores Etários , Biomarcadores/urina , Camarões/epidemiologia , Estudos Transversais , Comportamento Alimentar/etnologia , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/urina , Masculino , Pessoa de Meia-Idade , Potássio/urina , Prevalência , Fatores de Risco , Saúde da População Rural/etnologia , Cloreto de Sódio na Dieta/urina , Migrantes , Saúde da População Urbana/etnologia , Adulto JovemRESUMO
The study's objective was to determine whether variations in the 2013 American College of Cardiology/American Heart Association 10-year risk for atherosclerotic cardiovascular disease (ASCVD) were associated with differences in food consumption and diet quality. Findings from the baseline wave of Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study 2004-2009, revealed participants consumed a Western diet. Diet quality measures, specifically the Healthy Eating Index (HEI)-2010, Dietary Approaches to Stop Hypertension (DASH) diet and the Mean Adequacy Ratio (MAR), based on two 24-h recalls collected during follow-up HANDLS studies from 2009-2013, were used. Reported foods were assigned to 27 groups. In this cross-sectional analysis, the participants (n = 2140) were categorized into tertiles based on their 10-year ASCVD risk. Lower and upper tertiles were used to determine significantly different consumption rates among the food groups. Ten groups were used in hierarchical case clustering to generate four dietary patterns (DPs) based on group energy contribution. The DP with the highest HEI-2010 score included sandwiches along with vegetables and cheese/yogurt. This DP, along with the pizza/sandwiches DP, had significantly higher DASH and MAR scores and a lower 10-year ASCVD risk, compared to the remaining two DPs-meats/sandwiches and sandwiches/bakery products; thus, Western dietary patterns were associated with different levels of ASCVD 10-year risk.
Assuntos
Aterosclerose/etnologia , Negro ou Afro-Americano , Dieta Ocidental/etnologia , Abordagens Dietéticas para Conter a Hipertensão/etnologia , Comportamento Alimentar/etnologia , Saúde da População Urbana/etnologia , População Branca , Adulto , Aterosclerose/diagnóstico , Aterosclerose/prevenção & controle , Baltimore/epidemiologia , Estudos Transversais , Dieta Ocidental/efeitos adversos , Abordagens Dietéticas para Conter a Hipertensão/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Valor Nutritivo , Prognóstico , Estudos Prospectivos , Fatores de Proteção , Fatores de Risco , Fatores de TempoRESUMO
SCOPE: Whether dietary fish consumption is linked to mortality remains unclear. We aim to investigate the association of fish consumption with mortality in Chinese and US nationwide populations. METHODS AND RESULTS: We utilize data from China Health and Nutrition Survey (CHNS, n = 14 117) and National Health and Nutrition Examination Survey (NHANES, n = 33 221) including NHANES III conducted in 1988-1994 and continuous NHANES 1999-2010. Cox proportional hazards regression is used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). During a median follow-up of 14 and 9.8 years for CHNS and NHANES, 1007 and 5209 deaths are documented, respectively. Among Chinese adults, increased fish intake is significantly associated with decreased total mortality. The multivariable-adjusted HRs (95% CIs) across increasing categories of fish intake are 0.45 (0.36-0.56), 0.72 (0.60-0.86), and 0.70 (0.59-0.85) (p trend < 0.0001). However, fish intake is not associated with total mortality among US adults (p trend = 0.21). We only detected a borderline inverse association between fish intake and stroke mortality (p trend = 0.05), whereas a positive association with diabetes mortality in the third category of fish intake in NHANES. CONCLUSION: In these two nationwide cohort studies, fish consumption is associated with a reduced risk of total mortality for Chinese but not US populations.