Diabetes Mellitus, Race, and Effects of Omega-3 Fatty Acids on Incidence of Heart Failure Hospitalization.

OBJECTIVES: The primary aim was to evaluate whether prevalent type 2 diabetes (T2D) modifies the effects of omega-3 supplementation on heart failure (HF) hospitalization. The secondary aim was to examine if race modifies the effects of omega-3 supplements on HF risk. BACKGROUND: It is unclear whether race and T2D modify the effects of omega-3 supplementation on the incidence of HF. METHODS: In this ancillary study of the parent VITAL (Vitamin D and Omega-3 Trial)-a completed randomized trial testing the efficacy of vitamin D and omega-3 fatty acids on cardiovascular diseases and cancer, we assessed the role of T2D and race on the effects of omega-3 supplements on the incidence of HF hospitalization (adjudicated by a review of medical records and supplemented with a query of Centers for Medicare and Medicaid Services data). RESULTS: When omega-3 supplements were compared with placebo, the HR for first HF hospitalization was 0.69 (95% CI: 0.50-0.95) in participants with prevalent T2D and 1.09 (95% CI: 0.88-1.34) in those without T2D (P for interaction = 0.019). Furthermore, prevalent T2D modified the effects of omega-3 fatty acids on the incidence of recurrent HF hospitalization (HR: 0.53; 95% CI: 0.41-0.69 in participants with prevalent T2D vs HR: 1.07; 95% CI: 0.89-1.28 in those without T2D; P interaction <0.0001). In our secondary analysis, omega-3 supplementation reduced recurrent HF hospitalization only in Black participants (P interaction race × omega-3 = 0.0497). CONCLUSIONS: Our data show beneficial effects of omega-3 fatty acid supplements on incidence of HF hospitalization in participants with T2D but not in those without T2D, and such benefit appeared to be stronger in Black participants with T2D. (Intervention With Vitamin D and Omega-3 Supplements and Incident Heart Failure; NCT02271230; Vitamin D and Omega-3 Trial [VITAL]; NCT01169259 [parent study]).

Association of Race and Ethnicity With Incidence of Dementia Among Older Adults.

Importance: The racial and ethnic diversity of the US, including among patients receiving their care at the Veterans Health Administration (VHA), is increasing. Dementia is a significant public health challenge and may have greater incidence among older adults from underrepresented racial and ethnic minority groups. Objective: To determine dementia incidence across 5 racial and ethnic groups and by US geographical region within a large, diverse, national cohort of older veterans who received care in the largest integrated health care system in the US. Design, Setting, and Participants: Retrospective cohort study within the VHA of a random sample (5% sample selected for each fiscal year) of 1 869 090 participants aged 55 years or older evaluated from October 1, 1999, to September 30, 2019 (the date of final follow-up). Exposures: Self-reported racial and ethnic data were obtained from the National Patient Care Database. US region was determined using Centers for Disease Control and Prevention (CDC) regions from residential zip codes. Main Outcomes and Measures: Incident diagnosis of dementia (9th and 10th editions of the International Classification of Diseases). Fine-Gray proportional hazards models were used to examine time to diagnosis, with age as the time scale and accounting for competing risk of death. Results: Among the 1 869 090 study participants (mean age, 69.4 [SD, 7.9] years; 42 870 women [2%]; 6865 American Indian or Alaska Native [0.4%], 9391 Asian [0.5%], 176 795 Black [9.5%], 20 663 Hispanic [1.0%], and 1 655 376 White [88.6%]), 13% received a diagnosis of dementia over a mean follow-up of 10.1 years. Age-adjusted incidence of dementia per 1000 person-years was 14.2 (95% CI, 13.3-15.1) for American Indian or Alaska Native participants, 12.4 (95% CI, 11.7-13.1) for Asian participants, 19.4 (95% CI, 19.2-19.6) for Black participants, 20.7 (95% CI, 20.1-21.3) for Hispanic participants, and 11.5 (95% CI, 11.4-11.6) for White participants. Compared with White participants, the fully adjusted hazard ratios were 1.05 (95% CI, 0.98-1.13) for American Indian or Alaska Native participants, 1.20 (95% CI, 1.13-1.28) for Asian participants, 1.54 (95% CI, 1.51-1.57) for Black participants, and 1.92 (95% CI, 1.82-2.02) for Hispanic participants. Across most US regions, age-adjusted dementia incidence rates were highest for Black and Hispanic participants, with rates similar among American Indian or Alaska Native, Asian, and White participants. Conclusions and Relevance: Among older adults who received care at VHA medical centers, there were significant differences in dementia incidence based on race and ethnicity. Further research is needed to understand the mechanisms responsible for these differences.

Lung Cancer Screening by Race and Ethnicity in an Integrated Health System in Hawaii.

Importance: Racial and ethnic differences in lung cancer screening (LCS) completion and follow-up may be associated with lung cancer incidence and mortality rates among high-risk populations. Aggregation of Asian American, Native Hawaiian, and Pacific Islander racial and ethnic groups may mask the true underlying disparities in screening uptake and diagnostic follow-up, creating barriers for targeted, preventive health care. Objective: To examine racial and ethnic differences in LCS completion and follow-up rates in a multiethnic population. Design, Setting, and Participants: This population-based cohort study was conducted at a health maintenance organization in Hawaii. LCS program participants were identified using electronic medical records from January 1, 2015, to December 31, 2019. Study eligibility requirements included being aged 55 to 79 years, a 30 pack-year smoking history, a current smoker or having quit within the past 15 years, at least 5 years past any lung cancer diagnosis and treatment, and cancer free. Data analysis was performed from June 2019 to October 2020. Exposure: Eligible for LCS. Main Outcomes and Measures: Screening rates were analyzed by self-reported race and ethnicity and completion of a low-dose computed tomography (LDCT) test. Diagnostic follow-up results were based on the Lung Imaging Reporting and Data System (Lung-RADS) staging system. Results: A total of 1030 eligible LCS program members had an order placed; their mean (SD) age was 65.5 (5.8) years, and 633 (61%) were men. The largest racial and ethnic groups were non-Hispanic White (381 participants [37.0%]), Native Hawaiian or part Native Hawaiian (186 participants [18.1%]), and Japanese (146 participants [14.2%]). Men and Filipino, Chinese, Japanese, and non-Hispanic White individuals had a higher proportion of screen orders for LDCT compared with women and individuals of the other racial and ethnic groups. The overall LCS completion rate was 81% (838 participants). There was a 14% to 15% screening completion rate gap among groups. Asian individuals had the highest screening completion rate (266 participants [86%]) followed by Native Hawaiian (149 participants [80%]) and non-Hispanic White individuals (305 participants [80%]), Pacific Islander (50 participants [79%]) individuals, and individuals of other racial and ethnic groups (68 participants [77%]). Within Asian subgroups, Korean (31 participants [94%]) and Japanese (129 participants [88%]) individuals had the highest completion rates followed by Chinese individuals (28 participants [82%]) and Filipino individuals (78 participants [79%]). Of the 54 participants with Lung-RADS stage 3 disease, 93% (50 participants) completed a 6-month surveillance LDCT test; of 37 individuals with Lung-RADS stage 4 disease, 35 (97%) were followed-up for additional procedures. Conclusions and Relevance: This cohort study found racial and ethnic disparities in LCS completion rates after disaggregation of Native Hawaiian, Pacific Islander, and Asian individuals and their subgroups. These findings suggest that future research is needed to understand factors that may be associated with LCS completion and follow-up behaviors among these racial and ethnic groups.

Coffee, Tea, and Mammographic Breast Density in Premenopausal Women.

Studies have investigated the associations of coffee and tea with mammographic breast density (MBD) in premenopausal women with inconsistent results. We analyzed data from 375 premenopausal women who attended a screening mammogram at Washington University School of Medicine, St. Louis, MO in 2016, and stratified the analyses by race (non-Hispanic White (NHW) vs. Black/African American). Participants self-reported the number of servings of coffee, caffeinated tea, and decaffeinated tea they consumed. Volpara software was used to determine volumetric percent density (VPD), dense volume (DV), and non-dense volume (NDV). We used generalized linear regression models to quantify the associations of coffee and tea intake with MBD measures. Coffee: ≥1 time/day (ß = 1.06; 95% CI = 0.93-1.21; p-trend = 0.61) and caffeinated tea: ≥1 time/day (ß = 1.01; 95% CI = 0.88-1.17; p-trend = 0.61) were not associated with VPD. Decaffeinated tea (≥1 time/week) was positively associated with VPD in NHW women (ß = 1.22; 95% CI = 1.06-1.39) but not in African American women (ß = 0.93; 95% CI = 0.73-1.17; p-interaction = 0.02). Coffee (≥1 time/day) was positively associated with DV in African American women (ß = 1.52; 95% CI = 1.11-2.07) but not in NHW women (ß = 1.10; 95% CI = 0.95-1.29; p-interaction = 0.02). Our findings do not support associations of coffee and caffeinated tea intake with VPD in premenopausal women. Positive associations of decaffeinated tea with VPD, with suggestions of effect modification by race, require confirmation in larger studies with diverse study populations.

COVID-19 Vaccination Coverage Among Insured Persons Aged ≥16 Years, by Race/Ethnicity and Other Selected Characteristics - Eight Integrated Health Care Organizations, United States, December 14, 2020-May 15, 2021.

COVID-19 vaccination is critical to ending the COVID-19 pandemic. Members of minority racial and ethnic groups have experienced disproportionate COVID-19-associated morbidity and mortality (1); however, COVID-19 vaccination coverage is lower in these groups (2). CDC used data from CDC's Vaccine Safety Datalink (VSD)* to assess disparities in vaccination coverage among persons aged ≥16 years by race and ethnicity during December 14, 2020-May 15, 2021. Measures of coverage included receipt of ≥1 COVID-19 vaccine dose (i.e., receipt of the first dose of the Pfizer-BioNTech or Moderna COVID-19 vaccines or 1 dose of the Janssen COVID-19 vaccine [Johnson & Johnson]) and full vaccination (receipt of 2 doses of the Pfizer-BioNTech or Moderna COVID-19 vaccines or 1 dose of Janssen COVID-19 vaccine). Among 9.6 million persons aged ≥16 years enrolled in VSD during December 14, 2020-May 15, 2021, ≥1-dose coverage was 48.3%, and 38.3% were fully vaccinated. As of May 15, 2021, coverage with ≥1 dose was lower among non-Hispanic Black (Black) and Hispanic persons (40.7% and 41.1%, respectively) than it was among non-Hispanic White (White) persons (54.6%). Coverage was highest among non-Hispanic Asian (Asian) persons (57.4%). Coverage with ≥1 dose was higher among persons with certain medical conditions that place them at higher risk for severe COVID-19 (high-risk conditions) (63.8%) than it was among persons without such conditions (41.5%) and was higher among persons who had not had COVID-19 (48.8%) than it was among those who had (42.4%). Persons aged 18-24 years had the lowest ≥1-dose coverage (28.7%) among all age groups. Continued monitoring of vaccination coverage and efforts to improve equity in coverage are critical, especially among populations disproportionately affected by COVID-19.

Racial/Ethnic Disparities in the Performance of Prediction Models for Death by Suicide After Mental Health Visits.

Importance: Clinical prediction models estimated with health records data may perpetuate inequities. Objective: To evaluate racial/ethnic differences in the performance of statistical models that predict suicide. Design, Setting, and Participants: In this diagnostic/prognostic study, performed from January 1, 2009, to September 30, 2017, with follow-up through December 31, 2017, all outpatient mental health visits to 7 large integrated health care systems by patients 13 years or older were evaluated. Prediction models were estimated using logistic regression with LASSO variable selection and random forest in a training set that contained all visits from a 50% random sample of patients (6 984 184 visits). Performance was evaluated in the remaining 6 996 386 visits, including visits from White (4 031 135 visits), Hispanic (1 664 166 visits), Black (578 508 visits), Asian (313 011 visits), and American Indian/Alaskan Native (48 025 visits) patients and patients without race/ethnicity recorded (274 702 visits). Data analysis was performed from January 1, 2019, to February 1, 2021. Exposures: Demographic, diagnosis, prescription, and utilization variables and Patient Health Questionnaire 9 responses. Main Outcomes and Measures: Suicide death in the 90 days after a visit. Results: This study included 13 980 570 visits by 1 433 543 patients (64% female; mean [SD] age, 42 [18] years. A total of 768 suicide deaths were observed within 90 days after 3143 visits. Suicide rates were highest for visits by patients with no race/ethnicity recorded (n = 313 visits followed by suicide within 90 days, rate = 5.71 per 10 000 visits), followed by visits by Asian (n = 187 visits followed by suicide within 90 days, rate = 2.99 per 10 000 visits), White (n = 2134 visits followed by suicide within 90 days, rate = 2.65 per 10 000 visits), American Indian/Alaskan Native (n = 21 visits followed by suicide within 90 days, rate = 2.18 per 10 000 visits), Hispanic (n = 392 visits followed by suicide within 90 days, rate = 1.18 per 10 000 visits), and Black (n = 65 visits followed by suicide within 90 days, rate = 0.56 per 10 000 visits) patients. The area under the curve (AUC) and sensitivity of both models were high for White, Hispanic, and Asian patients and poor for Black and American Indian/Alaskan Native patients and patients without race/ethnicity recorded. For example, the AUC for the logistic regression model was 0.828 (95% CI, 0.815-0.840) for White patients compared with 0.640 (95% CI, 0.598-0.681) for patients with unrecorded race/ethnicity and 0.599 (95% CI, 0.513-0.686) for American Indian/Alaskan Native patients. Sensitivity at the 90th percentile was 62.2% (95% CI, 59.2%-65.0%) for White patients compared with 27.5% (95% CI, 21.0%-34.7%) for patients with unrecorded race/ethnicity and 10.0% (95% CI, 0%-23.0%) for Black patients. Results were similar for random forest models, with an AUC of 0.812 (95% CI, 0.800-0.826) for White patients compared with 0.676 (95% CI, 0.638-0.714) for patients with unrecorded race/ethnicity and 0.642 (95% CI, 0.579-0.710) for American Indian/Alaskan Native patients and sensitivities at the 90th percentile of 52.8% (95% CI, 50.0%-55.8%) for White patients, 29.3% (95% CI, 22.8%-36.5%) for patients with unrecorded race/ethnicity, and 6.7% (95% CI, 0%-16.7%) for Black patients. Conclusions and Relevance: These suicide prediction models may provide fewer benefits and more potential harms to American Indian/Alaskan Native or Black patients or those with undrecorded race/ethnicity compared with White, Hispanic, and Asian patients. Improving predictive performance in disadvantaged populations should be prioritized to improve, rather than exacerbate, health disparities.

Mortality, Health, and Substance Abuse by Religious Attendance Among HIV Infected Patients from the Veterans Aging Cohort Study.

Religion and spirituality have been associated with higher survival and improved biological markers among people living with HIV/AIDS (PLWH). Prior results have largely been among small cohort studies. We examined the association using a larger sample and longitudinal data from the Veterans Aging Cohort Study (VACS) years 2002-2012 (n = 3,685). Attending services at least monthly was associated with higher social support (80% vs 75%, p = 0.002), less unhealthy alcohol use (35% vs 39%, p = 0.006), less marijuana use in the past year (23% vs 32%, p < 0.001), less overall drug use within the past year (27% vs 31%, p = 0.01), and lower depression (20% vs 24%, p = 0.004). Attending services monthly was associated with a reduced mortality risk adjusting for age, race, gender, education, MSM, HCV, VL, CD4, and adherence to ARV (adjusted HazardRatio [aHR] = 0.89, 0.80-0.99). However, after controlling for smoking status, this association of mortality and religious attendance became non-significant (aHR = 0.93, 0.84-1.04).

RESUMEN: La religión y la espiritualidad se han asociado con una mayor supervivencia y mejores marcadores biológicos entre las personas que viven con VIH / SIDA (PLWH). Los resultados anteriores han sido en gran parte entre estudios de cohortes pequeñas. Examinamos la asociación utilizando una muestra más grande y datos longitudinales del Estudio de cohorte de envejecimiento de veteranos (VACS) años 2002­2012 (n = 3,685). Asistir a los servicios al menos mensualmente se asoció con un mayor apoyo social (80% frente a 75%, p = 0.002), menos consumo de alcohol no saludable (35% frente a 39%, p = 0.006), menos consumo de marihuana en el último año (23% vs 32%, p < 0.001), menos consumo total de drogas en el último año (27% vs 31%, p = 0.01) y depresión más baja (20% vs 24%, p = 0.004). La asistencia mensual a los servicios se asoció con una reducción del riesgo de mortalidad ajustada por edad, raza, sexo, educación, HSH, VHC, VL, CD4 y adherencia al ARV (HazardRatio ajustado [aHR] = 0.89, 0.80­0.99). Sin embargo, después de controlar el tabaquismo, esta asociación de mortalidad y asistencia religiosa se volvió no significativa (aHR = 0.93, 0.84­1.04).

Admissions Is Not Enough: The Racial Achievement Gap in Medical Education.

The achievement gap is a disparity in academic and standardized test performance that exists between White and underrepresented minority (URM) students that begins as early as preschool and worsens as students progress through the educational system. Medical education is not immune to this inequality. URM medical students are more likely to experience delayed graduation and course failure, even after accounting for science grade point average and Medical College Admission Test performance. Moreover, URM students are more likely to earn lower scores on licensing examinations, which can have a significant impact on their career trajectory, including specialty choice and residency competitiveness. After the release of preliminary recommendations from the Invitational Conference on USMLE Scoring (InCUS) and public commentary on these recommendations, the National Board of Medical Examiners and Federation of State Medical Boards announced that the United States Medical Licensing Examination (USMLE) Step 1 would transition from a 3-digit numeric score to pass/fail scoring. Given that another of InCUS's recommendations was to "minimize racial demographic differences that exist in USMLE performance," it is paramount to consider the impact of this scoring change on URM medical students specifically. Holistic admissions are a step in the right direction of acknowledging that URM students often travel a further distance to reach medical school. However, when residency programs emphasize USMLE performance (or any standardized test score) despite persistent test score gaps, medical education contributes to the disproportionate harm URM students face and bolsters segregation across medical specialties. This Perspective provides a brief explanation of the achievement gap, its psychological consequences, and its consequences in medical education; discusses the potential effect of the Step 1 scoring change on URM medical students; and provides a review of strategies to redress this disparity.

Lethality and characteristics of deaths due to COVID-19 in Rondônia: an observational study. / Letalidade e características dos óbitos por COVID-19 em Rondônia: estudo observacional.

OBJECTIVE: To describe the characteristics of deaths due to COVID-19 in the state of Rondônia. METHODS: This was a descriptive study, with data from the Brazilian National Health System Epidemiological Surveillance System Computerization Strategy (E-SUS-VE, notified between January 1 and August 20, 2020. Statistical tests (Chi-square and Marascuilo procedure) were applied, where differences were considered to be significant when p< 0.05. RESULTS: 184,146 suspected cases were reported, of which 49,804 were confirmed as COVID-19, and 1,020 died (lethality 2.1%). Statistically significant differences were observed between age groups and lethality (p-value <0.001); lethality was greater as age increased (Marascuilo procedure, significant in the comparison between the over 60s and the other age groups); death was higher among males (2.7% lethality); and lethality was higher among Black people (3.0%). CONCLUSION: Lethality was greater among the elderly, males and people of brown and black skin color in Rondônia.

Racial and ethnic disparities in care for health system-affiliated physician organizations and non-affiliated physician organizations.

OBJECTIVE: To assess racial and ethnic disparities in care for Medicare fee-for-service (FFS) beneficiaries and whether disparities differ between health system-affiliated physician organizations (POs) and nonaffiliated POs. DATA SOURCES: We used Medicare Data on Provider Practice and Specialty (MD-PPAS), Medicare Provider Enrollment, Chain, and Ownership System (PECOS), IRS Form 990, 100% Medicare FFS claims, and race/ethnicity estimated using the Medicare Bayesian Improved Surname Geocoding 2.0 algorithm. STUDY DESIGN: Using a sample of 16 007 POs providing primary care in 2015, we assessed racial/ethnic disparities on 12 measures derived from claims (2 cancer screenings; diabetic eye examinations; continuity of care; two medication adherence measures; three measures of follow-up visits after acute care; all-cause emergency department (ED) visits, all-cause readmissions, and ambulatory care-sensitive admissions). We decomposed these "total" disparities into within-PO and between-PO components using models with PO random effects. We then pair-matched 1853 of these POs that were affiliated with health systems to similar nonaffiliated POs. We examined differences in within-PO disparities by affiliation status by interacting each nonwhite race/ethnicity with an affiliation indicator. DATA COLLECTION/EXTRACTION METHODS: Medicare Data on Provider Practice and Specialty identified POs billing Medicare; PECOS and IRS Form 990 identified health system affiliations. Beneficiaries age 18 and older were attributed to POs using a plurality visit rule. PRINCIPAL FINDINGS: We observed total disparities in 12 of 36 comparisons between white and nonwhite beneficiaries; nonwhites received worse care in 10. Within-PO disparities exceeded between-PO disparities and were substantively important (>=5 percentage points or>=0.2 standardized differences) in nine of the 12 comparisons. Among these 12, nonaffiliated POs had smaller disparities than affiliated POs in two comparisons (P < .05): 1.6 percentage points smaller black-white disparities in follow-up after ED visits and 0.6 percentage points smaller Hispanic-white disparities in breast cancer screening. CONCLUSIONS: We find no evidence that system-affiliated POs have smaller racial and ethnic disparities than nonaffiliated POs. Where differences existed, disparities were slightly larger in affiliated POs.

Complementary and alternative medicine use in Australian children with acute respiratory tract infection - A cross-sectional survey of parents.

BACKGROUND: Acute respiratory tract infection (ARTI) is a prevalent condition associated with serious health and economic implications. A range of strategies is used to manage ARTI in children, including complementary and alternative medicines (CAM). There has been little investigation into this area, and this study aims to address this knowledge gap. METHODS: Primary carers of children aged from 0 to 12 years that utilised CAM for ARTI were invited to participate in the online survey in 2019. Survey data were analysed descriptively. RESULTS: The 246 surveyed parents specified the types of CAM frequently used to manage ARTI in their children were home-remedies. Reasons parents reported using CAM were personal-beliefs and positive past-experience with CAM practitioners. Information sources that parents consulted when decision-making were education, naturopaths, and journals. CONCLUSION: Parents utilised diverse interventions, with home-remedies dominating the choice. Parents were most likely well-informed. Notably, parents indicated a preference for an integrative healthcare approach.

Nutritional rickets under 16 years: UK surveillance results.

OBJECTIVE: The UK national incidence of nutritional rickets is unknown. We aimed to describe the incidence, presentation and clinical management of children under 16 years with nutritional rickets in the UK presenting to secondary care. METHODS: Prospective data were collected monthly between March 2015 and March 2017 from 3500 consultant paediatricians using British Paediatric Surveillance Unit methodology. Clinicians completed online clinical questionnaires for cases fitting the surveillance case definition. RESULTS: 125 cases met the case definition, an annual incidence of 0.48 (95% CI 0.37 to 0.62) per 100 000 children under 16 years. 116 children were under 5 years (annual incidence of 1.39 (95% CI 1.05 to 1.81) per 100 000. Boys (70%) were significantly more affected than girls (30%) (OR 2.17, 95% CI 1.25 to 3.78). The majority were of Black (43%) or South Asian (38%) ethnicity. 77.6% of children were not taking vitamin D supplements despite being eligible. Complications included delayed gross motor development (26.4%), fractures (9.6%), hypocalcaemic seizures (8%) and dilated cardiomyopathy (3%). Two children died (1.6%). In eight cases, rickets was confirmed radiologically and biochemically [raised serum alkaline phosphatase (ALP) and parathyroid hormone (PTH) levels ] but were excluded from the incidence analysis for not meeting the case definition of 25-hydroxyvitamin D of <25 nmol/L. CONCLUSION: The incidence of nutritional rickets in the UK is lower than expected. Serious complications and unexpected deaths, particularly in Black and South Asian children under 5 years, occurred. Both vitamin D deficiency and dietary calcium deficiency are role players in pathogenesis. Uptake of vitamin D supplementation remains low.

Racial and Socioeconomic Factors Associated with the Use of Complementary and Alternative Modalities for Pain in Cancer Outpatients: An Integrative Review.

OBJECTIVES: Racial and ethnic disparities in pain management are widely documented in the United States. The 2016 Centers for Disease Control and Prevention (CDC) guidelines for opioid prescribing have generated new imperatives for using complementary and alternative medicine approaches (CAM) to manage chronic pain, including cancer pain. This review's purpose was to explore the prevalence of CAM use for cancer-related pain among racial and ethnic minorities and to organize these findings according to the CAM modalities proposed by the National Center for Complementary and Integrative Health (NCCIH). DESIGN: An integrative review of the literature published between 2007 and 2017. DATA SOURCES: PubMed and SCOPUS databases (2007-2017). REVIEW/ANALYSIS METHODS: Articles were included if they engaged in explicit analysis of racial or ethnic differences in CAM use for cancer pain in the outpatient setting, yielding 13 articles for final analysis. RESULTS AND CONCLUSIONS: Overall, CAM use for any modality ranged from 51% to 83%. Mind-body therapies were reported most, and energy therapies the least. Differences in CAM use were most often attributable to socioeconomic status (SES), with those of higher SES associated with greater use of practitioner-assisted CAM therapies and those of lower SES with greater use of free therapies. This difference has implications for achieving adequate and consistent pain relief among subgroups of patients with cancer. This review also identifies a literature gap regarding racial/ethnic disparities in access to CAM for cancer pain, and a need for validated measures to assess CAM use.

Disparities in Donor Human Milk Supplementation Among Well Newborns.

BACKGROUND: Donor human milk supplementation for healthy newborns has increased. Racial-ethnic disparities in supplementation have been described in the neonatal intensive care unit but not in the well newborn setting. RESEARCH AIM: The aim of this study was to identify maternal characteristics associated with donor human milk versus formula supplementation in the well newborn unit. METHODS: This retrospective cohort study includes dyads of well newborns and their mothers (N = 678) who breastfed and supplemented with formula (n = 372) or donor human milk (n = 306) during the birth hospitalization at a single hospital in the midwestern United States. Maternal characteristics and infant feeding type were extracted from medical records. Chi-square and logistic regression were used to examine associations between maternal characteristics and feeding type. RESULTS: Nonwhite women were less likely to use donor human milk. Compared to non-Hispanic white women, the largest disparity was with Hispanic (adjusted odds ratio [OR] = 0.28, 95% CI [0.12, 0.65]), then non-Hispanic black (adjusted OR = 0.32, 95% CI [0.13, 0.76]) and Asian women (adjusted OR = 0.34, 95% CI [0.16, 0.74]). Lower donor human milk use was associated with primary language other than English and public versus private insurance. CONCLUSION: The goal of improving public health through breastfeeding promotion may be inhibited without targeting donor human milk programs to these groups. Identifying the drivers of these disparities is necessary to inform person-centered interventions that address the needs of women with diverse backgrounds.

Differences in Function and Comorbidities Between Older Adult Users and Nonusers of Chiropractic and Osteopathic Manipulation: A Cross-sectional Analysis of the 2012 National Health Interview Survey.

OBJECTIVE: The purpose of this cross-sectional study was to compare functional limitations and comorbidity prevalence between older adult users and nonusers of chiropractic and osteopathic (DC/DO) manipulation to inform provider training. METHODS: We conducted a secondary analysis of the 2012 National Health Interview Survey data. Adults age 65 or older who responded to the survey were included. Descriptive statistics are reported for adults who used DC/DO manipulation (vs nonusers) regarding function, comorbidities, musculoskeletal complaints, and medical services. Weighted percentages were derived using SAS and compared with χ2 tests. RESULTS: The DC/DO users were more often female, overweight or obese, and of white race than nonusers. More DC/DO users reported arthritis (55.3% vs 47.0%, <0.01) or asthma (15.0% vs 10.0%, P < .01) than nonusers; hypertension (61.9% vs 55.5%, P = .02) and diabetes (20.3% vs 15.7%, P = .02) were more prevalent in nonusers; and other comorbidities were comparable. The DC/DO users reported more joint pain/stiffness (55.7% vs 44.8%), chronic pain (19.8% vs 14.2%), low back pain (27.8% vs 18.4%), low back with leg pain (18.8% vs 10.6%), and neck pain (24.2% vs 13.1%) than nonusers (all P < .01). Functional limitations affected two-thirds overall, but DC/DO users reported more difficulties stooping and bending; other limitations were comparable. One in 9 reported activities of daily living or instrumental activities of daily living limitations; nonusers were more affected. Surgery was more common among DC/DO users (26.1% vs 19.3%, <0.01); emergency room visits were comparable. CONCLUSION: Differences existed between older adult manipulation users and nonusers, especially surgical utilization, musculoskeletal complaints, and comorbidities; functional differences were modest. Our findings highlight areas for provider training and awareness regarding comorbidity burden and management needs in older patients who may simultaneously use manipulation and medical care for musculoskeletal complaints.

Perceived Benefits of Using Complementary and Alternative Medicine by Race/Ethnicity Among Midlife and Older Adults in the United States.

Objective: To describe, for a national sample of midlife and older adults, the types of complementary and alternative medicine (CAM) used for health and wellness and the perceived benefits of CAM use by race/ethnicity. Method: Using data from the 2012 National Health Interview Survey, we ran multiple logistic regression models to estimate the odds of each perceived benefit among adults ages 50 and older. Results: More than 38% of midlife and older adults used CAM in the past year. For six of seven perceived benefits examined, we found significant differences by race/ethnicity, with each group having higher odds of two or more perceived benefits compared with non-Hispanic Whites. Discussion: Although racial/ethnic minority groups are less likely to use CAM compared with non-Hispanic Whites, those who use CAM perceive great benefit. Future research should examine the potential contribution of evidence-based CAM to promoting health and well-being in a diverse aging population.

Patients' adoption of and feature access within electronic patient portals.

OBJECTIVES: We describe online portal account adoption and feature access among subgroups of patients who traditionally have been disadvantaged or represent those with high healthcare needs. STUDY DESIGN: Retrospective cohort study of insured primary care patients 18 years and older (N = 20,282) receiving care from an integrated health system. METHODS: Using data from an electronic health record repository, portal adoption was defined by 1 or more online sessions. Feature access (ie, messaging, appointment management, visit/admission summaries, and medical record access and management) was defined by user-initiated "clicks." Multivariable regression methods were used to identify patient factors associated with portal adoption and feature access among adopters. RESULTS: One-third of patients were portal adopters, with African Americans (odds ratio [OR], 0.50; 95% CI, 0.46-0.56), Hispanics (OR, 0.63; 95% CI, 0.47-0.84), those 70 years and older (OR, 0.48; 95% CI, 0.44-0.52), and those preferring a language other than English (OR, 0.43; 95% CI, 0.31-0.59) less likely to be adopters. On the other hand, the likelihood of portal adoption increased with a higher number of comorbidities (OR, 1.04; 95% CI, 1.02-1.07). Among adopters, record access and management features (95.9%) were accessed most commonly. The majority of adopters also accessed appointment management (76.6%) and messaging (59.1%) features. Similar race and age disparities were found in feature access among adopters. CONCLUSIONS: The diversity of portal features accessed may bode well for the ability of portals to engage some patients, but without purposeful intervention, reliance on portals alone for patient engagement may exacerbate known social disparities-even among those with an activated portal account.

Use of Yoga, Meditation, and Chiropractors Among U.S. Adults Aged 18 and Over.

Complementary health is the use of holistic or unconventional medicine with mainstream Western medicine for health and wellness (1,2). Past research has identified yoga, meditation, and seeing a chiropractor as some of the most commonly used approaches (3). This report examines changes over time in the percentage of adults who used yoga, meditation, and chiropractors in the past 12 months, as well as variation by sex, age, and race and Hispanic origin.