Aleitamento materno e consumo de ultraprocessados pela ótica da desigualdade racial: um delineamento ecológico / Breastfeeding and consumption of ultra-processed foods from the perspective of racial inequality: an ecological outline / Lactancia materna y consumo de alimentos ultraprocesados desde la perspectiva de la desigualdad racial: un panorama ecológico

Este artigo objetivou avaliar as informações acerca do consumo alimentar e aleitamento materno de crianças do município de Alfenas (MG) e, ainda, verificar fatores relacionados, como cor da pele e faixa etária. Trata-se de um estudo epidemiológico ecológico longitudinal, com coleta de dados pelo Sistema de Vigilância Alimentar e Nutricional Web e análise por meio de proporções e contagens medianas mensais. Admitiu-se um nível de confiança de 95% (p<0,05) para as análises realizadas com apoio do pacote computacional estatístico R. Foram totalizados 2.377 registros para os marcadores de consumo alimentar, apresentando 25% (IC95%: 16,67-36,06) de ausência de aleitamento materno exclusivo e 50% (IC95%: 50,00-66,67) para o consumo de alimentos ultraprocessados. Ainda, os marcadores estavam associados à cor da pele, sendo não branca a com maior risco à saúde, na proporção de 63,9% para a ausência de aleitamento materno exclusivo e de 77,5% para o maior consumo de alimentos ultraprocessados. Os resultados, referentes ao consumo de ultraprocessados e à ausência de aleitamento materno exclusivo para o município de Alfenas (MG), são positivamente superiores às médias nacionais, enfatizando o comportamento alimentar inadequado em relação à questão racial.

This article aimed to evaluate information about the food consumption and breastfeeding of children in the municipality of Alfenas, Minas Gerais, and to verify related factors such as ethnicity and age group. Longitudinal ecological epidemiological study, with data collected by the Web Food and Nutrition Surveillance System (SISVAN Web) and analyzed using proportions and monthly median counts. A confidence level of 95% (p<0.05) was accepted for the analyses carried out with the support of the statistical computational package R. There were 2,377 records for the food consumption markers, with 25% (95%CI: 16.67­36.06) absence of exclusive breastfeeding and 50% (95%CI: 50.00­66.67) consumption of ultra-processed foods. Furthermore, the markers were associated with ethnicity, with non-white ethnicity having the highest health risk, in the proportion of 63.9% for the absence of exclusive breastfeeding and 77.5% for the highest consumption of ultra-processed foods. The results regarding the consumption of ultra-processed foods and the absence of exclusive breastfeeding for the municipality of Alfenas, Minas Gerais, are positively higher than the national averages, emphasizing the inadequate eating behavior in relation to the racial issue.

Este artículo tiene por objetivo evaluar información sobre el consumo de alimentos y la lactancia materna de niños en la ciudad de Alfenas, Minas Gerais (Brasil), así como identificar los factores relacionados, como el color de la piel y el grupo de edad. Se trata de un estudio epidemiológico ecológico longitudinal, con recolección de datos en el Sistema de Vigilancia Alimentaria y Nutricional Web y análisis mediante proporciones y conteos medianos mensuales. Se utilizó un nivel de confianza del 95% en los análisis (p<0,05) realizados con apoyo del paquete computacional estadístico R. Hubo un total de 2.377 registros en los marcadores de consumo de alimentos, con un 25% (IC95%: 16,67-36,06) para ausencia de lactancia materna exclusiva y el 50% (IC95%: 50,00-66,67) para el consumo de alimentos ultraprocesados. Además, los marcadores estuvieron asociados con el color de la piel, en el cual el color de piel no blanco presentó un mayor riesgo para la salud, en la proporción del 63,9% para ausencia de lactancia materna exclusiva y del 77,5% para el mayor consumo de alimentos ultraprocesados. Los resultados sobre el consumo de alimentos ultraprocesados y la ausencia de lactancia materna exclusiva en el municipio de Alfenas son positivamente superiores a los promedios nacionales, destacando la conducta alimentaria inadecuada por cuestiones raciales.

Implementation Science to Achieve Equity in Heart Failure Care: A Scientific Statement From the American Heart Association.

Guideline-directed medical therapies and guideline-directed nonpharmacological therapies improve quality of life and survival in patients with heart failure (HF), but eligible patients, particularly women and individuals from underrepresented racial and ethnic groups, are often not treated with these therapies. Implementation science uses evidence-based theories and frameworks to identify strategies that facilitate uptake of evidence to improve health. In this scientific statement, we provide an overview of implementation trials in HF, assess their use of conceptual frameworks and health equity principles, and provide pragmatic guidance for equity in HF. Overall, behavioral nudges, multidisciplinary care, and digital health strategies increased uptake of therapies in HF effectively but did not include equity goals. Few HF studies focused on achieving equity in HF by engaging stakeholders, quantifying barriers and facilitators to HF therapies, developing strategies for equity informed by theory or frameworks, evaluating implementation measures for equity, and titrating strategies for equity. Among these HF equity studies, feasibility was established in using various educational strategies to promote organizational change and equitable care. A couple include ongoing randomized controlled pragmatic trials for HF equity. There is great need for additional HF implementation trials designed to promote delivery of equitable guideline-directed therapy.

Evaluating Racial Disparities in Implementation and Monitoring of a Remote Blood Pressure Program in a Pregnant Population-A Retrospective Cohort Study.

Background: Whether remote blood pressure (BP) monitoring can decrease racial disparities in BP measurement during pregnancy and the postpartum period remains unclear. This study evaluated whether Black and White patients enrolled in the Connected Maternity Online Monitoring (CMOM) program showed improvements in BP ascertainment and interval. Methods: A retrospective cohort of 3,976 pregnant patients enrolled in CMOM were compared to matched usual care patients between January 2016 and September 2022 using electronic health record data. The primary outcomes were BP ascertainment (number of BP measurements) and BP interval (time between BP measurements) during pregnancy and the postpartum period. The proportion of patients with a hypertensive disorder of pregnancy who checked their BP within 7 days of discharge following delivery was also assessed. Results: Enrollment in CMOM was lower among Black patients than White patients (42.1% vs 54.7%, P<0.0001). Patients in the CMOM group had more BP measurements than patients in the usual care group during pregnancy (rate ratio=1.78, 95% CI 1.74-1.82) and the postpartum period (rate ratio=1.30, 95% CI 1.23-1.37), with significant improvements for both Black and White patients enrolled in CMOM compared to patients in usual care. The CMOM intervention did not result in an improvement in 7-day postpartum adherence to checking BP for Black patients (risk ratio=1.03, 95% CI 0.94-1.11) as it did for White patients (risk ratio=1.09, 95% CI 1.01-1.17). Conclusion: Remote BP monitoring programs are a helpful tool to improve the frequency of BP measurements and shorten intervals between measurements during the prenatal and postpartum periods for all patients. Future evaluation is needed to determine the barriers to offering the program to and enrolling Black patients.

Racial disparities among mild stroke survivors: predictors of home discharge from a retrospective analysis.

BACKGROUND: Half of all strokes are classified as mild, and most mild stroke survivors are discharged home after their initial hospitalization without any post-acute rehabilitation despite experiencing cognitive, psychosocial, motor, and mobility impairments. OBJECTIVES: To investigate the demographic and clinical characteristics of mild stroke survivors and their association with discharge location. METHODS: This is a retrospective analysis of mild stroke survivors from 2015-2023 in an academic medical center. Demographic characteristics, clinical measures, and discharge locations were obtained from the electronic health record. The Social Vulnerability Index was used to measure the community vulnerability. Associations between variables and discharge location were examined using bivariate logistic regression analysis. RESULTS: There were 2,953 mild stroke survivors included in this study. The majority of participants were White (65.46%), followed by Black (19.40%). Black stroke survivors and individuals with higher social vulnerability had a higher proportion of discharges to skilled nursing facilities (p = 0.001). Black patients and patients with high vulnerability in housing type and transportation were less likely to be discharged home. CONCLUSIONS: Mild stroke survivors have a high rate of home discharge, potentially because less severe stroke symptoms have a reduced need for intensive care. Racial disparities in discharge location were evident, with Black stroke survivors experiencing higher rates of institutionalized care and lower likelihood of being discharged home compared to White counterparts, emphasizing the importance of addressing these disparities for equitable healthcare delivery and optimal outcomes.

Racial Inequalities in the Health Establishment Access to the Treatment of COVID-19 in Brazil in 2020.

The Brazilian health system simultaneously allows for the existence of the public and private sectors, which often imposes financial barriers to access to services and affects the health of exposed groups. Studies have shown evidence of higher lethality risks among Black/Biracial and Indigenous People admitted to hospitals due to COVID-19 during the pandemic when compared to White People. This paper evaluated the association between access to treatment for COVID-19, race, and COVID-19-related deaths among the five macro-regions of Brazil in 2020. We conducted a retrospective, cross-sectional observational, and population-wide study. Logistical models were used including first-order interactions between race and the health establishment administration sector using deaths as outcome, adjusted for covariates. The lethality risk, defined as the percentage of deaths among hospitalized patients, of Black/Biracial and Indigenous People was up to 78% (in the Midwest) and 29% (in the South) higher when compared to White People, respectively. The association of the race/access interaction with COVID-19-related deaths suggested the possibility of institutional racism in health establishments. The results highlight the need to guarantee adequate funding to the public health sector to improve equity in access to healthcare and the constant development of educational activities and increased participation of racialized minorities in the healthcare workforce at influential positions for health workers on topics such as racism.

Can stepped collaborative care interventions improve post-traumatic stress disorder symptoms for racial and ethnic minority injury survivors?

Objectives: No large-scale randomized clinical trial investigations have evaluated the potential differential effectiveness of early interventions for post-traumatic stress disorder (PTSD) among injured patients from racial and ethnic minority backgrounds. The current investigation assessed whether a stepped collaborative care intervention trial conducted at 25 level I trauma centers differentially improved PTSD symptoms for racial and ethnic minority injury survivors. Methods: The investigation was a secondary analysis of a stepped wedge cluster randomized clinical trial. Patients endorsing high levels of distress on the PTSD Checklist (PCL-C) were randomized to enhanced usual care control or intervention conditions. Three hundred and fifty patients of the 635 randomized (55%) were from non-white and/or Hispanic backgrounds. The intervention included care management, cognitive behavioral therapy elements and, psychopharmacology addressing PTSD symptoms. The primary study outcome was PTSD symptoms assessed with the PCL-C at 3, 6, and 12 months postinjury. Mixed model regression analyses compared treatment effects for intervention and control group patients from non-white/Hispanic versus white/non-Hispanic backgrounds. Results: The investigation attained between 75% and 80% 3-month to 12-month follow-up. The intervention, on average, required 122 min (SD=132 min). Mixed model regression analyses revealed significant changes in PCL-C scores for non-white/Hispanic intervention patients at 6 months (adjusted difference -3.72 (95% CI -7.33 to -0.10) Effect Size =0.25, p<0.05) after the injury event. No significant differences were observed for white/non-Hispanic patients at the 6-month time point (adjusted difference -1.29 (95% CI -4.89 to 2.31) ES=0.10, p=ns). Conclusion: In this secondary analysis, a brief stepped collaborative care intervention was associated with greater 6-month reductions in PTSD symptoms for non-white/Hispanic patients when compared with white/non-Hispanic patients. If replicated, these findings could serve to inform future American College of Surgeon Committee on Trauma requirements for screening, intervention, and referral for PTSD and comorbidities. Level of evidence: Level II, secondary analysis of randomized clinical trial data reporting a significant difference. Trial registration number: NCT02655354.

Racial disparities in low-risk cesarean birth rates across hospitals.

BACKGROUND: We compared low-risk cesarean birth rates for Black and White women across hospitals serving increasing proportions of Black women and identified hospitals where Black women had low-risk cesarean rates less than or equal to White women. METHODS: In this cross-sectional analysis of secondary data from four states, we categorized hospitals by their proportion of Black women giving birth from "low" to "high". We analyzed the odds of low-risk cesarean for Black and White women across hospital categories. RESULTS: Our sample comprised 493 hospitals and the 65,524 Black and 251,426 White women at low risk for cesarean who birthed in them. The mean low-risk cesarean rate was significantly higher for Black, compared with White, women in the low (20.1% vs. 15.9%) and medium (18.1% vs. 16.9%) hospital categories. In regression models, no hospital structural characteristics were significantly associated with the odds of a Black woman having a low-risk cesarean. For White women, birthing in a hospital serving the highest proportion of Black women was associated with a 21% (95% CI: 1.01-1.44) increase in the odds of having a low-risk cesarean. DISCUSSION: Black women had higher odds of a low-risk cesarean than White women and were more likely to access care in hospitals with higher low-risk cesarean rates. The existence of hospitals where low-risk cesarean rates for Black women were less than or equal to those of White women was notable, given a predominant focus on hospitals where Black women have poorer outcomes. Efforts to decrease the low-risk cesarean rate should focus on (1) improving intrapartum care for Black women and (2) identifying differentiating organizational factors in hospitals where cesarean birth rates are optimally low and equivalent among racial groups as a basis for system-level policy efforts to improve equity and reduce cesarean birth rates.

Addressing racial differences in the management of atrial fibrillation: Focus on black patients.

Atrial fibrillation (AF) is the most common sustained arrhythmia, affecting between 3 and 6 million people in the United States. It is associated with a reduced quality of life and increased risk of stroke, cognitive decline, heart failure and death. Black patients have a lower prevalence of AF than White patients but are more likely to suffer worse outcomes with the disease. It is important that stakeholders understand the disproportionate burden of disease and management gaps that exists among Black patients living with AF. Appropriate treatments, including aggressive risk factor control, early referral to cardiovascular specialists and improving healthcare access may bridge some of the gaps in management and improve outcomes.

Inequities in Definitive Treatment for Localized Prostate Cancer Among Those With Clinically Significant Mental Health Disorders.

INTRODUCTION: Patients with mental health disorders are at risk for receiving inequitable cancer treatment, likely resulting from various structural, social, and health-related factors. This study aims to assess the relationship between mental health disorders and the use of definitive treatment in a population-based cohort of those with localized, clinically significant prostate cancer. METHODS: We conducted a cohort study analysis in SEER (Surveillance, Epidemiology, and End Results)-Medicare (2004-2015). History of a mental health disorder was defined as presence of specific ICD (International Classification of Diseases)-9 or ICD-10 diagnostic codes in the 2 years preceding cancer diagnosis. Descriptive statistics were performed using Wilcoxon rank-sum and χ2 testing. Multivariable logistic regression was used to evaluate the relationship between mental health disorders and definitive treatment utilization (defined as surgery or radiation). RESULTS: Of 101,042 individuals with prostate cancer, 7,945 (7.8%) had a diagnosis of a mental health disorder. They were more likely to be unpartnered, have a lower socioeconomic status, and less likely to receive definitive treatment (61.8% vs 68.2%, P < .001). Definitive treatment rates were >66%, 62.8%, 60.3%, 58.2%, 54.3%, and 48.1% for post-traumatic stress disorder, depressive disorder, bipolar disorder, anxiety disorder, substance abuse disorder, and schizophrenia, respectively. After adjusting for age, race and ethnicity, marital status and socioeconomic status, history of a mental health disorder was associated with decreased odds of receiving definitive treatment (OR 0.74, 95% CI 0.66-0.83). CONCLUSIONS: Individuals with mental health disorders and prostate cancer represent a vulnerable population; careful attention to clinical and social needs is required to support appropriate use of beneficial treatments.

Performance of Fracture Risk Assessment Tools by Race and Ethnicity: A Systematic Review for the ASBMR Task Force on Clinical Algorithms for Fracture Risk.

The American Society of Bone and Mineral Research (ASBMR) Professional Practice Committee charged an ASBMR Task Force on Clinical Algorithms for Fracture Risk to review the evidence on whether current approaches for differentiating fracture risk based on race and ethnicity are necessary and valid. To help address these charges, we performed a systematic literature review investigating performance of calculators for predicting incident fractures within and across race and ethnicity groups in middle-aged and older US adults. We included English-language, controlled or prospective cohort studies that enrolled US adults aged >40 years and reported tool performance predicting incident fractures within individual race and ethnicity groups for up to 10 years. From 4838 identified references, six reports met eligibility criteria, all in women. Just three, all from one study, included results in non-white individuals. In these three reports, non-white women experienced relatively few major osteoporotic fractures (MOFs), especially hip fractures, and risk thresholds for predicting fractures in non-white women were derived from risks in the overall, predominantly white study population. One report suggested the Fracture Risk Assessment Tool (FRAX) without bone mineral density (BMD) overestimated hip fracture similarly across race and ethnicity groups (black, Hispanic, American Indian, Asian, white) but overestimated MOF more in non-white than White women. However, these three reports were inconclusive regarding whether discrimination of FRAX or the Garvan calculator without BMD or of FRAX with BMD for MOF or hip fracture differed between white versus black women. This uncertainty was at least partly due to imprecise hip fracture estimates in black women. No reports examined whether ratios of observed to predicted hip fracture risks within each race or ethnicity group varied across levels of predicted hip fracture risk. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR). This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.

Historical Redlining, Socioeconomic Distress, and Risk of Heart Failure Among Medicare Beneficiaries.

BACKGROUND: The association of historical redlining policies, a marker of structural racism, with contemporary heart failure (HF) risk among White and Black individuals is not well established. METHODS: We aimed to evaluate the association of redlining with the risk of HF among White and Black Medicare beneficiaries. Zip code-level redlining was determined by the proportion of historically redlined areas using the Mapping Inequality Project within each zip code. The association between higher zip code redlining proportion (quartile 4 versus quartiles 1-3) and HF risk were assessed separately among White and Black Medicare beneficiaries using generalized linear mixed models adjusted for potential confounders, including measures of the zip code-level Social Deprivation Index. RESULTS: A total of 2 388 955 Medicare beneficiaries (Black n=801 452; White n=1 587 503; mean age, 71 years; men, 44.6%) were included. Among Black beneficiaries, living in zip codes with higher redlining proportion (quartile 4 versus quartiles 1-3) was associated with increased risk of HF after adjusting for age, sex, and comorbidities (risk ratio, 1.08 [95% CI, 1.04-1.12]; P<0.001). This association remained significant after further adjustment for area-level Social Deprivation Index (risk ratio, 1.04 [95% CI, 1.002-1.08]; P=0.04). A significant interaction was observed between redlining proportion and Social Deprivation Index (Pinteraction<0.01) such that higher redlining proportion was significantly associated with HF risk only among socioeconomically distressed regions (above the median Social Deprivation Index). Among White beneficiaries, redlining was associated with a lower risk of HF after adjustment for age, sex, and comorbidities (risk ratio, 0.94 [95% CI, 0.89-0.99]; P=0.02). CONCLUSIONS: Historical redlining is associated with an increased risk of HF among Black patients. Contemporary zip code-level social determinants of health modify the relationship between redlining and HF risk, with the strongest relationship between redlining and HF observed in the most socioeconomically disadvantaged communities.

Impact of the use of dental services on dental pain according to adolescents' skin colour: a 10-year cohort.

OBJECTIVE: Evaluate the association of the interaction between the use of dental services and the skin colour on the occurrence of dental pain over time. MATERIAL AND METHODS: This study is a cohort with 10 years of follow-up, started in 2010 with a sample of 639 preschool children (1-5 years old). The use of dental services, race and the presence of dental pain were self-reported by the individuals according to predefined criteria. Multilevel logistic regression analysis was performed to assess the interaction between skin colour and use of dental services in the occurrence of dental pain over time. RESULTS: About 449 and 429 were reassessed in 2017 and 2020, respectively. The occurrence of dental pain across the cohort was 60.7%. Caucasian individuals who used dental services throughout the cohort had a 51% lower chance of having a dental pain than those who used dental services but were non-white (OR 0.49; 95% IC 0.27-0.90). CONCLUSION: There was a racial inequity in the occurrence of dental pain among individuals who managed to make use of dental services throughout the follow-ups. CLINICAL RELEVANCE: The differences found should serve as a warning to the way how individuals with different characteristics are treated and must be used to combat this inequity. Individuals should receive resolute and personalized treatments according to their clinical condition and not according to their socioeconomic characteristics.

Racial-Ethnic Disparities in Benzodiazepine Prescriptions for Anxiety in US Emergency Departments.

BACKGROUND/OBJECTIVES: Benzodiazepines are commonly used to treat anxiety and panic disorders. White patients are more likely to receive a benzodiazepine prescription than non-White patients in different medical settings. Racial-ethnic disparities have also been found in prescription of opioids from the emergency room. It is not known whether racial disparities in benzodiazepine prescriptions exist at the emergency department level. This study aims to analyze the relationship between benzodiazepine prescriptions for anxiety in an emergency department setting. DESIGN: Data for this cross-sectional study was obtained from the National Hospital Ambulatory Medical Care Survey (NHAMCS) Years 2009-2018. Patients ≥ 18 years of age presenting to the emergency department with anxiety were identified. Adjusted survey logistic regression was conducted to evaluate the patient characteristics and receipt of benzodiazepines. RESULTS: This study analyzed 1,174,556,119 emergency department (ED) visits out of which 2.8% had a diagnosis of anxiety disorder. Prevalence of anxiety was higher in the following groups: females, younger age range (18-34 years old), and non-Hispanic (NH) White. Rates of benzodiazepine prescription for patients with anxiety were higher for NH-White and Hispanic patients at 29% and 28% respectively than for NH-Black and NH-Other (24% and 21% respectively). Compared to NH-White patients, NH-Black patients were 36% less likely to be prescribed a benzodiazepine (prevalence ratio (PR) = 0.64; 95% confidence interval (CI) = 0.54-0.76) and Hispanic patients were 19% less likely to be prescribed a benzodiazepine (PR = 0.81; 95% CI = 0.68-0.96). Age, sex, or type of insurance did not show a statistically significant influence in the prescription of benzodiazepines. CONCLUSIONS: These findings reveal that NH-Black and Hispanic patients with anxiety are significantly less likely to be prescribed benzodiazepines than their NH-White counterparts in the ED. Further studies are needed to determine the root causes of these health disparities and strategies to combat them.

Differences in food consumption of the Brazilian population by race/skin color in 2017-2018 / Diferenças no consumo alimentar da população brasileira por raça/cor da pele em 2017-2018

ABSTRACT OBJECTIVE To evaluate food consumption in Brazil by race/skin color of the population. METHODS Food consumption data from the Pesquisa de Orçamentos Familiares (POF - Household Budget Survey) 2017-2018 were analyzed. Food and culinary preparations were grouped into 31 items, composing three main groups, defined by industrial processing characteristics: 1 - in natura/minimally processed, 2 - processed, and 3 - ultra-processed. The percentage of calories from each group was estimated by categories of race/skin color - White, Black, Mixed-race, Indigenous, and Yellow- using crude and adjusted linear regression for gender, age, schooling, income, macro-region, and area. RESULTS In the crude analyses, the consumption of in natura/minimally processed foods was lower for Yellow [66.0% (95% Confidence Interval 62.4-69.6)] and White [66.6% (95%CI 66.1-67.1)] groups than for Blacks [69.8% (95%CI 68.9-70.8)] and Mixed-race people [70.2% (95%CI 69.7-70.7)]. Yellow individuals consumed fewer processed foods, with 9.2% of energy (95%CI 7.2-11.1) whereas the other groups consumed approximately 13%. Ultra-processed foods were less consumed by Blacks [16.6% (95%CI 15.6-17.6)] and Mixed-race [16.6% (95%CI 16.2-17.1)], with the highest consumption among White [20.1% (95%CI 19.6-20.6)] and Yellow [24.5% (95%CI 20.0-29.1)] groups. The adjustment of the models reduced the magnitude of the differences between the categories of race/skin color. The difference between Black and Mixed-race individuals from the White ones decreased from 3 percentage points (pp) to 1.2 pp in the consumption of in natura/minimally processed foods and the largest differences remained in the consumption of rice and beans, with a higher percentage in the diet of Black and Mixed-race people. The contribution of processed foods remained approximately 4 pp lower for Yellow individuals. The consumption of ultra-processed products decreased by approximately 2 pp for White and Yellow groups; on the other hand, it increased by 1 pp in the consumption of Black, Mixed-race, and Indigenous peoples. CONCLUSION Differences in food consumption according to race/skin color were found and are influenced by socioeconomic and demographic conditions.

RESUMO OBJETIVO Avaliar o consumo alimentar no Brasil por raça/cor da pele da população. MÉTODOS Foram analisados dados de consumo alimentar da Pesquisa de Orçamentos Familiares 2017-2018. Alimentos e preparações culinárias foram agrupados em 31 itens, compondo três grupos principais, definidos por características do processamento industrial: 1 - in natura/minimamente processados, 2 - processados e 3 - ultraprocessados. O percentual de calorias de cada grupo foi estimado por categorias de raça/cor da pele - branca, preta, parda, indígena e amarela -, utilizando-se regressão linear bruta e ajustada para sexo, idade, escolaridade, renda, macrorregião e área. RESULTADOS Nas análises brutas, o consumo de alimentos in natura/minimamente processados foi menor para amarelos [66,0% (Intervalo de Confiança 95% 62,4-69,6)] e brancos [66,6% (IC95% 66,1-67,1)] que para pretos [69,8% (IC95% 68,9-70,8)] e pardos [70,2% (IC95% 69,7-70,7)]. Amarelos consumiram menos alimentos processados, com 9,2% das calorias (IC95% 7,2-11,1) enquanto os demais consumiram aproximadamente 13%. Ultraprocessados foram menos consumidos por pretos [16,6% (IC95% 15,6-17,6)] e pardos [16,6% (IC95% 16,2-17,1)], e o maior consumo ocorreu entre brancos [20,1% (IC95% 19,6-20,6)] e amarelos [24,5% (IC95% 20,0-29,1)]. O ajuste dos modelos reduziu a magnitude das diferenças entre as categorias de raça/cor da pele. A diferença entre pretos e pardos em relação aos brancos diminuiu, de 3 pontos percentuais (pp), para 1,2 pp no consumo de alimentos in natura/minimamente processados e as maiores diferenças remanescentes foram no consumo de arroz e feijão, com maior percentual na alimentação de pretos e pardos. A participação de alimentos processados permaneceu aproximadamente 4 pp menor para amarelos. O consumo de ultraprocessados diminuiu aproximadamente 2 pp para brancos e amarelos; por outro lado, aumentou 1 pp no consumo de pretos, pardos e indígenas. CONCLUSÃO Diferenças no consumo alimentar segundo raça/cor da pele foram encontradas e são influenciadas por condições socioeconômicas e demográficas.

Desigualdade racial na assistência à saúde do adulto internado por COVID-19 / Desigualdad racial en la atención a la salud de adultos hospitalizados por COVID-19 / Racial inequality in health care of adults hospitalized with COVID-19

Resumo: O objetivo deste artigo foi analisar a associação entre raça/cor e assistência à saúde, em adultos hospitalizados pela síndrome respiratória aguda grave (SRAG)/COVID-19 no Brasil, entre março de 2020 e setembro de 2022. Trata-se de estudo transversal, que utilizou o banco de dados do Sistema de Informação de Vigilância Epidemiológica da Gripe (SIVEP-Gripe) e contou com uma população composta por adultos (≥ 18 anos). A classificação final foi SRAG por COVID-19 ou SRAG não especificada. O efeito direto do aspecto cor na mortalidade intra-hospitalar foi estimado por meio de regressão logística ajustada por idade, sexo, escolaridade, sistema de saúde e período, estratificado por situação vacinal. Esse mesmo modelo foi utilizado também para avaliar o efeito do quesito cor nas variáveis de acesso aos serviços de saúde: unidade de terapia intensiva (UTI), tomografia, radiografia de tórax e suporte ventilatório. Os resultados evidenciam que pretos, pardos e indígenas morreram mais, independentemente do grau de escolaridade e da quantidade de comorbidades, com maiores chances de óbito em 23%, 32% e 80%, respectivamente, ao serem submetidos ao suporte ventilatório. Foram observadas diferenças raciais no uso de serviços de saúde e nos desfechos de morte por COVID-19 ou SRAG não especificada, em que minorias étnicas tiveram maiores taxas de mortalidade intra-hospitalar e os recursos hospitalares foram utilizados com menos frequência. Tais resultados sugerem que as populações negra e indígena têm severas desvantagens em relação à branca, enfrentando barreiras de acesso aos serviços de saúde no contexto da pandemia de COVID-19.

Resumen: Se pretende analizar la asociación entre raza/color en la atención de la salud de adultos hospitalizados por síndrome respiratorio agudo severo (SARS)/COVID-19 en el período entre marzo de 2020 y septiembre de 2022, tomando Brasil como unidad de análisis. Se trata de un estudio transversal, en que se utilizó la base de datos del Sistema de Información de Vigilancia Epidemiológica de la Gripe (SIVEP-Gripe) y tuvo una muestra compuesta por adultos (≥ 18 años) y la clasificación final fue SARS por COVID-19 o SARS no especificado. El efecto directo de la pregunta color sobre la mortalidad intrahospitalaria se estimó mediante la regresión logística ajustada según edad, sexo, nivel de estudios, sistema de salud y período, estratificada por estado de vacunación. Este modelo también se utilizó para evaluar el efecto de la pregunta color en las variables de acceso a los servicios de salud: unidades de cuidado intensivo (UCI), tomografía, radiografía de tórax y soporte ventilatorio. Los resultados muestran que negros, pardos e indígenas murieron más, independientemente del nivel de estudios y el número de comorbilidades, y cuando fueron sometidos a soporte ventilatorio, tuvieron mayores probabilidades de muerte con el 23%, 32% y 80%, respectivamente. Se observaron diferencias raciales en el uso de los servicios de salud y los resultados de muerte por COVID-19 o SARS no especificado, en los que las minorías étnicas tuvieron una mayor mortalidad intrahospitalaria y los recursos hospitalarios se utilizaron con menos frecuencia. Estos resultados evidencian que las poblaciones negra e indígena tienen graves desventajas en comparación con la población blanca, afrontando dificultades de acceso a los servicios de salud en el contexto de la pandemia del COVID-19.

Abstract: The objective was to analyze the association of race/skin color in health care, in adults hospitalized with severe acute respiratory syndrome (SARS)/COVID-19, between March 2020 and September 2022, with Brazil as the unit of analysis. This is a cross-sectional study that used the Influenza Epidemiological Surveillance Information System (SIVEP-Gripe) database and had a population composed of adults (≥ 18 years) and the final classification was SARS by COVID-19 or unspecified SARS. The direct effect of skin color on in-hospital mortality was estimated through logistic regression adjusted for age, gender, schooling level, health care system and period, stratified by vaccination status. This same model was also used to assess the effect of skin color on the variables related to access to health care services: intensive care unit (ICU), tomography, chest X-ray and ventilatory support. The results show that black, brown and indigenous people died more, regardless the schooling level and number of comorbidities, with 23%, 32% and 80% higher chances of death, respectively, when submitted to ventilatory support. Racial differences were observed in the use of health care services and in outcomes of death from COVID-19 or unspecified SARS, in which ethnic minorities had higher in-hospital mortality and lower use of hospital resources. These results suggest that black and indigenous populations have severe disadvantages compared to the white population, facing barriers to access health care services in the context of the COVID-19 pandemic.

Racial/Ethnic Disparities and Determinants of Sufficient Physical Activity Levels.

Introduction: Adequate physical activity is an integral requirement for achieving cardiovascular health. Physical inactivity is the fourth leading cause of death worldwide. Hence, it is important to identify racial/ethnic groups that are less likely to achieve sufficient physical activity levels, and to address barriers to meeting physical activity requirements. Methods: Cross-sectional data from the 2006-2015 National Health Interview Survey (NHIS) were used to compare self-reported sufficient physical activity among different racial/ethnic groups: non-Hispanic (NH) Whites, NH Blacks, NH Asians, and Hispanics in the United States. Sufficient physical activity was defined as ≥ 150 minutes per week of moderate-intensity physical activity, ≥ 75 minutes per week of vigorous-intensity physical activity, or ≥ 150 minutes per week of moderate and vigorous physical activity. Results: The study sample consisted of 296,802 individuals, mean age ± standard error age 46.4 ± 0.10 years, 52% women, 70% NH White, 12% NH Black, 5% NH Asian, and 14% Hispanic. The prevalence of sufficient physical activity in the overall population was 46%, while it was 48% among NH Whites, 39% among NH Blacks, 45% among NH Asians, and 40% among Hispanics. In multivariable-adjusted models (odds ratio; 95% confidence interval), NH Blacks (0.79; 0.64,0.97), NH Asians (0.72; 0.62,0.85) and Hispanics (0.71; 0.61,0.82) were significantly less likely to engage in sufficient physical activity compared with NH Whites. Older age, women, and low income were inversely associated with sufficient physical activity, while a college education or higher was associated directly with it. Conclusions: NH Black and Asian Americans and Hispanic adults were less likely to engage in sufficient physical activity levels compared with Whites. It is important to address barriers to meeting physical activity thresholds to help achieve optimal cardiovascular health.

Employment Industry and Occupational Class in Relation to Serious Psychological Distress in the United States.

Occupational characteristics may influence serious psychological distress (SPD) and contribute to health inequities; yet, few studies have examined multiple employment industries and occupational classes in a large, racially diverse sample of the United States. Using data from the National Health Interview Survey, we investigated employment industry and occupational class in relation to SPD in the overall population and by race/ethnicity, gender, age, household income, and health status. We created eight employment industry categories: professional/administrative/management, agricultural/manufacturing/construction, retail trade, finance/information/real estate, educational services, health care/social assistance, accommodation/food services, and public administration/arts/other services. We also created three occupational class categories: professional/management, support services, and laborers. SPD was measured using the Kessler Psychological Distress Scale and scores ≥13 indicated SPD. We adjusted for confounders and used Poisson regression to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs). Among the 245,038 participants, the mean age was 41.7 ± 0.1 years, 73% were Non-Hispanic (NH)-White, and 1.5% were categorized as having SPD. Compared to the professional/administrative/management industry, working in other industries (e.g., manufacturing/construction (PR = 0.82 [95% CI: 0.70-0.95]) and educational services (PR = 0.79 [95% CI: 0.66-0.94])) was associated with lower SPD. Working in support services and laborer versus professional/management positions were both associated with 19% higher prevalence of SPD (95% CI: 1.04-1.35; 95% CI: 1.04-1.38, respectively). Furthermore, working in a support services or laborer versus professional/management position was associated with higher SPD in most employment industries. Industry-specific workplace interventions to equitably improve mental health are warranted.