Telehealth use in cystic fibrosis during COVID-19: Association with race, ethnicity, and socioeconomic factors.

BACKGROUND: Due to the COVID-19 pandemic, there was an uptake of telehealth in cystic fibrosis care. Previous studies show disparities in telehealth use based on socioeconomic status (SES). We aimed to: (1) understand telehealth use and perceptions and (2) identify the facilitators and barriers to telehealth use among people with CF and their families (PwCF) from diverse racial/ethnic and socioeconomic backgrounds. METHODS: We conducted an analysis of the 2020 Cystic Fibrosis State of Care surveys completed by PwCF (PFSoC), CF Care Programs (SoC1) and the CF Foundation Patient Registry (CFFPR). RESULTS: A total of 424 PwCF and 286 programs responded to the PFSoC and SoC1. Among PwCF, 90% self-identified as White, 6% as Hispanic/Latino, and 2% as Black. Racial/ethnic minorities were less likely to have had a telehealth visit (p=.015). This difference was pronounced among the Hispanic/Latino population (p<.01). Telehealth use did not differ by health insurance and was similarly offered independent of financial status. Compared to PwCF who denied financial constraints, those who reported financial difficulties found telehealth more difficult to use (p=.018) and were less likely to think that their concerns (p=.010) or issues that mattered most to them (p=.020) were addressed during telehealth. Programs perceived lack of technology, language barriers, and home conditions as barriers to telehealth in vulnerable populations. CONCLUSION: PFSoC and SoC1 identified differences in telehealth use and care perceptions by ethnicity, race, and socioeconomic characteristics. Further studies are needed to understand how telehealth can change access to CF care in diverse subpopulations.

Sociodemographic characteristics of women with invasive cervical cancer in British Columbia, 2004-2013: a descriptive study.

BACKGROUND: Although cancer screening has led to reductions in the incidence of invasive cervical cancer (ICC) across Canada, benefits of prevention efforts are not equitably distributed. This study investigated the sociodemographic characteristics of women with ICC in British Columbia compared with the general female population in the province. METHODS: In this descriptive study, data of individuals 18 years and older diagnosed with ICC between 2004 and 2013 were obtained from the BC Cancer Registry. Self-reported sociodemographic characteristics were derived from standardized health assessment forms (HAFs) completed upon admission in the BC Cancer Registry. Standardized ratios (SRs) were derived by dividing observed and age-adjusted expected counts by ethnicity or race, language, and marital, smoking and urban-rural status. Differences between observed and expected counts were tested using χ2 goodness-of-fit tests. General population data were derived from the 2006 Census, 2011 National Household Survey and 2011/12 Canadian Community Health Survey. RESULTS: Of 1705 total cases of ICC, 1315 were referred to BC Cancer (77.1%). Of those who were referred, 1215 (92.4%) completed HAFs. Among Indigenous women, more cases were observed (n = 85) than expected (n = 39; SR 2.16, 95% confidence interval [CI] 2.15-2.18). Among visible minorities, observed cases (n = 320) were higher than expected (n = 253; 95% CI 1.26-1.26). Elevated SRs were observed among women who self-identified as Korean (SR 1.78, 95% CI 1.76-1.80), Japanese (SR 1.77, 95% CI 1.74-1.79) and Filipino (SR 1.60, 95% CI 1.58-1.62); lower SRs were observed among South Asian women (SR 0.63, 95% CI 0.62-0.63). Elevated SRs were observed among current smokers (SR 1.34, 95% CI 1.33-1.34) and women living in rural-hub (SR 1.29, 95% CI 1.28-1.31) and rural or remote (SR 2.62, 95% CI 2.61-2.64) areas; the SR was lower among married women (SR 0.90, 95% CI 0.90-0.90). INTERPRETATION: Women who self-identified as visible minorities, Indigenous, current smokers, nonmarried and from rural areas were overrepresented among women with ICC. Efforts are needed to address inequities to ensure all women benefit from cervical cancer prevention.

Perfil clínico epidemiológico de salud oral en comunidades nativas peruanas / Clinical epidemiological profile of oral health in Peruvian native communities

Introducción: Las comunidades nativas forman uno de los grupos humanos más olvidados donde se reagudizan las inequidades y desigualdades en salud oral. Objetivo: Determinar el perfil clínico epidemiológico de salud oral en pobladores de las comunidades nativas de Potsoteni, Boca Sanibeni y Unión Puerto Ashaninka del distrito de Mazamari, provincia de Satipo, departamento de Junín, Perú. Material y Métodos: Se realizó un estudio observacional descriptivo de corte transversal. La muestra estuvo integrada por 169 adultos de las comunidades nativas, se tomaron en cuenta criterios de inclusión y exclusión, y se siguieron las normas éticas en investigación científica. Se evaluó la salud oral mediante una ficha epidemiológica con los indicadores: Índice CPOD, índice de significancia de caries dental (SIC), índice de higiene oral simplificado (IHO-S), índice de necesidad de prótesis dentales de la OMS, clasificación de maloclusión de Angle, índice de consecuencias clínicas de caries no tratadas (PUFA), la evaluación fue realizada con luz natural por observadores calibrados. Los datos se analizaron en el programa STATA v 14 mediante tablas de distribución de frecuencias y figura. Resultados: El 100 por ciento de los pacientes estudiados tenía caries dental (CPO-D = 13,23; SIC=19,01), IHO-S: 5,02 (DS=0,51), la mayoría presentó un tipo de maloclusión y consecuencias clínicas de caries no tratadas 116 (68,63 por ciento ) y 115 (68 por ciento ) respectivamente, la prótesis dental unitaria fue la que más se necesitó en ambos maxilares. Conclusiones: El estado de salud bucal fue preocupante, es necesario fomentar políticas que permitan un mejor acceso a los servicios de salud a fin de revertir estos indicadores(AU)

Introduction: Native communities are one of the most forgotten human groups where inequities and inequalities in oral health are exacerbated. Objective: To determine the epidemiological and clinical profile of oral health in residents of the native communities of Potsoteni, Boca Sanibeni and Union Puerto Ashaninka of Mazamari district, Satipo province, Junín department, Peru. Material and Methods: A cross-sectional descriptive observational study was conducted. The sample consisted of 169 adults from native communities who fulfilled inclusion and exclusion criteria, following the ethical norms in scientific research. Oral health was evaluated through an epidemiological fact sheet with the following indicators: DMFT index, Significant Caries Index (SCI), simplified oral hygiene index (OHI-S), prosthetic need WHO index, classification of Angle malocclusion, and index of clinical consequences of untreated dental caries (PUFA). The evaluation was made with natural light by calibrated observers. The data was analyzed in the STATA v 14 program by means of frequency and figure distribution tables. Results: It was determined that 100 percent of the patients studied had dental caries (DMFT = 13.23, SCI = 19.01), OHI-S: 5.02 (SD = 0.51), the majority of them presented a type of malocclusion and clinical consequences of untreated caries; 116 (68.63 percent) and 115 (68 percent), respectively. The unitary dental prosthesis was the most needed in both jaws. Conclusions: The state of oral health was worrisome; it is necessary to promote policies that allow better access to health services in order to revert these indicators(AU)

African-Americans and Indigenous Peoples Have Increased Burden of Diseases of the Exocrine Pancreas: A Systematic Review and Meta-Analysis.

Ethnic health disparity is a well-acknowledged issue in many disease settings, but not diseases of the exocrine pancreas. A systematic review and meta-analysis was conducted to explore the race- and ethnicity-specific burden of diseases of the exocrine pancreas. Studies that compared health-related endpoints between two or more ethnicities were eligible for inclusion. Proportion meta-analyses were conducted to compare burden between groups. A total of 42 studies (24 on pancreatic cancer, 17 on pancreatitis, and one on pancreatic cyst) were included in the systematic review, of which 19 studies were suitable for meta-analyses. The incidence of pancreatic cancer was 1.4-fold higher among African-Americans, while the incidence of acute pancreatitis was 4.8-fold higher among an indigenous population (New Zealand Maori) compared with Caucasians. The prevalence of post-pancreatitis diabetes mellitus was up to 3.0-fold higher among certain ethnicities, including Asians, Pacific Islanders, and indigenous populations compared with Caucasians. The burden of diseases of the exocrine pancreas differs between ethnicities, with African-Americans and certain indigenous populations being at the greatest risk of developing these diseases. Development of race- and ethnicity-specific screening as well as protocols for lifestyle modifications may need to be considered with a view to reducing the disparities in burden of diseases of the exocrine pancreas.

Indigenous health disparities: a challenge and an opportunity

Summary: Clinical Indigenous health research is sparse and often not patient-centred. Despite a broad acknowledgement that Indigenous patients have unique clinical considerations, specific interventional research in Indigenous health is lacking.

Racial Disparities in Obesity Treatment.

PURPOSE OF REVIEW: Obesity rates in the USA have reached pandemic levels with one third of the population with obesity in 2015-2016 (39.8% of adults and 18.5% of youth). It is a major public health concern, and it is prudent to understand the factors which contribute. Racial and ethnic disparities are pronounced in both the prevalence and treatment of obesity and must be addressed in the efforts to combat obesity. RECENT FINDINGS: Disparities in prevalence of obesity in racial/ethnic minorities are apparent as early as the preschool years and factors including genetics, diet, physical activity, psychological factors, stress, income, and discrimination, among others, must be taken into consideration. A multidisciplinary team optimizes lifestyle and behavioral interventions, pharmacologic therapy, and access to bariatric surgery to develop the most beneficial and equitable treatment plans. The reviewed studies outline disparities that exist and the impact that race/ethnicity have on disease prevalence and treatment response. Higher prevalence and reduced treatment response to lifestyle, behavior, pharmacotherapy, and surgery, are observed in racial and ethnic minorities. Increased research, diagnosis, and access to treatment in the pediatric and adult populations of racial and ethnic minorities are proposed to combat the burgeoning obesity epidemic and to prevent increasing disparity.

Factors Associated With Current Smoking Among Off-Reserve First Nations and Métis Youth: Results From the 2012 Aboriginal Peoples Survey.

First Nations and Métis, two of Canada's constitutionally recognized Indigenous groups, suffer from poorer overall health than non-Indigenous Canadians. Current smoking, a known predictor of chronic health conditions, is close to twice as prevalent among Indigenous youth as it is among non-Indigenous Canadian youth. However, little population-level research has examined the correlates of current smoking among this population. Guided by a health framework centered on Indigenous-specific determinants, we used data from the 2012 Aboriginal Peoples Survey to examine the correlates of current smoking among First Nations and Métis youth aged 15-17 years living outside of First Nations reserves. Using binary logistic regression, we investigated how culturally specific factors, namely knowledge of an Indigenous language, participation in traditional activities, and family members' attendance at residential schools, were correlated with current smoking. We also considered demographic, geographic, socioeconomic and health-related correlates. Overall, an estimated 20.6% of First Nations and Métis youth reported current smoking. We found no significant associations between culturally specific activities and current smoking in the multivariate analyses, although those who spoke an Indigenous language were more likely to smoke. Those who participated in sports more often were less likely to smoke, and respondents who reported heavy drinking and who were from families with lower income were more likely to smoke. Gender, body mass index, urban/rural geography and regional geography, and mother's highest level of education were not significantly correlated with smoking. The results of our study support prior research that has found a disturbingly high prevalence of current smoking among Indigenous youth, compared to their non-Indigenous counterparts. Our results highlight the importance of considering sports participation, co-occurring health-risk behaviours and socioeconomic factors when developing interventions aimed at reducing the prevalence of smoking among First Nations and Métis youth.

Vitamin D deficiency in minority populations.

OBJECTIVE: Black and Hispanic individuals synthesize less vitamin D per unit of sun exposure than white individuals. The relationship between UV radiation and vitamin D insufficiency in minorities has not been well explored. DESIGN: Prospective cohort study. SETTING: Using the National Health and Nutrition Examination Survey, we obtained serum vitamin D levels for non-Hispanic Whites, Hispanics and non-Hispanic Blacks aged ≥18 years from 2000-2006. We linked these data with the average monthly solar UV index by census tract and data on sun exposure, vitamin D supplementation, health and demographics. We used multivariable regression analyses to assess vitamin D deficiency (<15 ng/ml) and insufficiency (<20 ng/ml) in January (when the UV index was lowest) by race/ethnicity and geography. SUBJECTS: Adults (n 14,319) aged ≥18 years. RESULTS: A 1-point increase in the UV index was associated with a 0·51 ng/ml increase in vitamin D (95% CI 0·35, 0·67 ng/ml; P<0·001). Non-Hispanic Black race and Hispanic ethnicity were associated with a 7·47 and 3·41 ng/ml decrease in vitamin D, respectively (both P<0·001). In January, an estimated 65·4% of non-Hispanic Blacks were deficient in vitamin D, compared with 28·9% of Hispanics and 14·0% of non-Hispanic Whites. An estimated 84·2% of non-Hispanic Blacks were insufficient in vitamin D v. 56·3% of Hispanics and 34·8% of non-Hispanic Whites. More non-Hispanic Blacks were estimated to be deficient in vitamin D in January in the highest UV index quartile than were non-Hispanic Whites in the lowest UV index quartile (60·2% v. 25·7%). CONCLUSIONS: Wintertime vitamin D insufficiency is pervasive among minority populations, and not uncommon among non-Hispanic Whites.

Meta-analysis of operative mortality and complications in patients from minority ethnic groups.

BACKGROUND: Insight into the effects of ethnic disparities on patients' perioperative safety is necessary for the development of tailored improvement strategies. The aim of this study was to review the literature on safety differences between patients from minority ethnic groups and those from the ethnic majority undergoing surgery. METHODS: PubMed, CINAHL, the Cochrane Library and Embase were searched using predefined inclusion criteria for available studies from January 1990 to January 2013. After quality assessment, the study data were organized on the basis of outcome, statistical significance and the direction of the observed effects. Relative risks for mortality were calculated. RESULTS: After screening 3105 studies, 26 studies were identified. Nine of these 26 studies showed statistically significant higher mortality rates for patients from minority ethnic groups. Meta-analysis demonstrated a greater risk of mortality for these patients compared with patients from the Caucasian majority in studies performed both in North America (risk ratio 1·22, 95 per cent confidence interval 1·05 to 1·42) and outside (risk ratio 2·25, 1·40 to 3·62). For patients from minority groups, the length of hospital or intensive care unit stay was significantly longer in five studies, and complication rates were significantly higher in ten. Methods used to identify patient ethnicity were not described in 14 studies. CONCLUSION: Patients from minority ethnic groups, in North America and elsewhere, have an increased risk of perioperative death and complications. More insight is needed into the causes of ethnic disparities to pursue safer perioperative care for patients of minority ethnicity.

Using technology to promote postpartum weight loss in urban, low-income mothers: a pilot randomized controlled trial.

OBJECTIVE: To examine the feasibility, acceptability, and initial efficacy of a technology-based weight loss intervention for urban, low-income mothers. METHODS: Eighteen obese, ethnic minority, socioeconomically disadvantaged mothers in the first year after childbirth were randomly assigned to either: 1) technology-based intervention, which included empirically supported behavior-change strategies, daily skills, and self-monitoring text messages with personalized feedback, biweekly counseling calls from a health coach, and access to a Facebook support group, or 2) usual-care control. RESULTS: After 14 weeks of treatment, the technology-based intervention participants had significantly greater weight loss (-2.9 ± 3.6 kg) than usual care (0.5 ± 2.3 kg; adjusted mean difference: -3.2 kg, 95% confidence interval -6.2 to -0.1 kg, P = .04). One-third of intervention participants (3 of 9) and no control participants lost > 5% of their initial body weight at follow up. CONCLUSIONS AND IMPLICATIONS: Results suggest the potential for using technology to deliver a postpartum weight loss intervention among low-income racial/ethnic minorities.

A latent class analysis of cancer risk behaviors among U.S. college students.

OBJECTIVE: The purpose of this study is to understand how cancer risk behaviors cluster in U.S. college students and vary by race and ethnicity. METHODS: Using the fall 2010 wave of the National College Health Assessment (NCHA), we conducted a latent class analysis (LCA) to evaluate the clustering of cancer risk behaviors/conditions: tobacco use, physical inactivity, unhealthy diet, alcohol binge drinking, and overweight/obesity. The identified clusters were then examined separately by students' self-reported race and ethnicity. RESULTS: Among 30,093 college students surveyed, results show a high prevalence of unhealthy diet as defined by insufficient fruit and vegetable intake (>95%) and physical inactivity (>60%). The LCA identified behavioral clustering for the entire sample and distinct clustering among Black and American Indian students. CONCLUSIONS: Cancer risk behaviors/conditions appear to cluster among college students differentially by race. Understanding how risk behaviors cluster in young adults can lend insight to racial disparities in cancer through adulthood. Health behavior interventions focused on modifying multiple risk behaviors and tailored to students' racial group could potentially have a much larger effect on cancer prevention than those targeting any single behavior.

Racial disparities in survival for patients with clinically localized prostate cancer adjusted for treatment effects.

OBJECTIVE: To examine whether racial disparities in survival exist among black, Hispanic, and Asian patients compared with white patients with clinically localized prostate cancer (CLPC) after adjustment for the effects of treatment. PATIENTS AND METHODS: We performed a retrospective cohort study of patients with CLPC diagnosed from January 1, 1995, through December 31, 2003, as documented in the Surveillance, Epidemiology, and End Results registry. Treatment-stratified, risk-adjusted Cox proportional hazards models were constructed. RESULTS: During the study period, CLPC was diagnosed in 294,160 patients. Of these patients, 123,850 (42.1%) underwent surgery and 101,627 (34.5%) underwent radiotherapy, whereas 68,683 (23.3%) received no treatment. Overall 5-year and 10-year survival rates for Asians (85.6% and 67.6%, respectively), Hispanics (85.9% and 69.0%, respectively), and whites (83.9% and 65.7%, respectively) were higher than for blacks (81.5% and 61.7%, respectively) (P<.001). Prostate cancer-specific survival also varied significantly by race (P<.001). A risk-adjusted model stratified by primary treatment modality revealed that blacks had worse overall survival than whites (hazard ratio, 1.37; 95% CI, 1.33-1.41; P<.001), whereas Asians had better survival compared with whites (hazard ratio, 0.79; 95% CI, 0.76-0.83; P<.001). After the effects of treatment were accounted for, Hispanics had similar overall survival compared with whites (hazard ratio, 0.97; 95% CI, 0.94-1.01; P=.10). CONCLUSION: Blacks with CLPC have poorer survival than whites, whereas Asians have better survival, even after risk adjustment and stratification by treatment. These data may be relevant to US regions with large underserved populations that have limited access to health care.

What does state-level inpatient palliative care data tell us about service provision?

BACKGROUND: Palliative care is increasingly seen as an integral component of care for patients with advanced malignant and nonmalignant illness. Clinical audit data can provide important insights into patient care, but limited published data are available investigating statewide palliative care provision issues. OBJECTIVES: Our aim was to provide a comprehensive perspective on inpatient palliative care within a populous Australian state, and highlight potential gaps in service provision. METHODS: Descriptive analysis was conducted of the Victorian Admitted Episodes Dataset (VAED, a comprehensive database of inpatient activity from all hospitals in Victoria). Variables analyzed included overall number of separations, average length of stay, referral source, age profile, and indigenous status. RESULTS: The mean length of stay for patients in Victorian inpatient palliative care settings was 12.8 days, and there were 6004 separations reported over an 11 month period from approximately 264 designated palliative care beds in the state. The mode of separation for the majority of admissions to inpatient palliative care was death (65%). Few patients resided outside metropolitan regions, and no patients admitted identified as Aboriginal and/or Torres Strait Islander (the indigenous communities of Australia). CONCLUSION: The pooled epidemiological data reviewed identify a number of areas of interest including the lack of Aboriginal Australians identified and accessing inpatient palliative care, and variations in inpatient care across geographical areas. This highlights issues of access and equity of access to inpatient palliative care.

Socioeconomic disparities in colorectal cancer mortality in the United States, 1990-2007.

United States colorectal cancer mortality rates have declined; however, disparities by socioeconomic status and race/ethnicity persist. The objective of this study was to describe the temporal association between colorectal cancer mortality and socioeconomic status by sex and race/ethnicity. Cancer mortality rates in the United States from 1990 to 2007, which were generated by the National Center for Health Statistics, and county-level socioeconomic status, which was estimated as the proportion of county residents living below the national poverty line based on 1990 US Census Bureau data, were obtained from the Surveillance, Epidemiology, and End Results program. The Kunst-Mackenbach relative index of inequality, which considers data across all poverty levels when comparing risks in the poorest (≥ 20%) and richest counties (<10%), was calculated as the measure of association. The study found that colorectal cancer mortality rates were significantly lower in the poorest counties than the richest counties during 1990-1992 among non-Hispanic whites, non-Hispanic black women and non-Hispanic API men. Over time though the tendency was for the poorest counties to have higher mortality rates. By 2003-2007 colorectal cancer mortality rates were significantly higher in the poorest than the richest counties among all sex-race/ethnicity groups. This disparity was most noticeable and appeared to be increasing most among Hispanic men. This suggests that socioeconomic disparities in colorectal cancer mortality were apparent after stratifying by sex and race/ethnicity and reversed over time. Further studies into the causes of these disparities would provide a basis for targeted cancer control interventions and allocation of public health resources.