A study of racial/ethnic differences in treatment preferences among lupus patients.

OBJECTIVES: To determine whether there are racial/ethnic differences in the willingness of SLE patients to receive CYC or participate in clinical trials, and whether demographic, psychosocial and clinical characteristics contribute to these differences. METHODS: Data from 120 African-American and 62 white lupus patients were evaluated. Structured telephone interviews were conducted to determine treatment preferences, as well as to study characteristics and beliefs that may affect these preferences. Data were analysed using serial hierarchical multivariate logistic regression and deviances were calculated from a saturated model. RESULTS: Compared with their white counterparts, African-American SLE patients expressed less willingness to receive CYC (67.0% vs 84.9%, P = 0.02) if their lupus worsened. This racial/ethnic difference remained significant after adjusting for socioeconomic and psychosocial variables. Logistic regression analysis showed that African-American race [odds ratio (OR) 0.29, 95% CI 0.10, 0.80], physician trust (OR 1.05, 95% CI 1.00, 1.12) and perception of treatment effectiveness (OR 1.40, 95% CI 1.22, 1.61) were the most significant determinants of willingness to receive CYC. A trend in difference by race/ethnicity was also observed in willingness to participate in a clinical trial, but this difference was not significant. CONCLUSION: This study demonstrated reduced likelihood of accepting CYC in African-American lupus patients compared with white lupus patients. This racial/ethnic variation was associated with belief in medication effectiveness and trust in the medical provider, suggesting that education about therapy and improved trust can influence decision-making among SLE patients.

Social and economic inequality in coronavirus disease 2019 vaccination coverage across Illinois counties.

Prior research has well established the association of ethno-racial and economic inequality with COVID-19 incidence and mortality rates across counties in the US. In this ecological study, a similar association was found between ethno-racial and economic inequality and COVID-19 full vaccination rates across the 102 counties in the American state of Illinois in the early months of vaccination. Among the counties with income inequality below the median, a county's poverty rate had a negative association with the proportion of population fully vaccinated. However, among the counties with income inequality above the median, a higher percentage of Black or Hispanic population was persistently associated with a lower proportion of fully vaccinated population over the two-month period from early February to early April of 2021.

"The street will drive you crazy": why homeless psychotic women in the institutional circuit in the United States often say no to offers of help.

Many people who struggle with psychotic disorder often refuse offers of help, including housing, extended by mental health services. This article uses the ethnographic method to examine the reasons for such refusal among women who are homeless and psychiatrically ill in the institutional circuit in an urban area of Chicago. It concludes that such refusals arise not only from a lack of insight but also from the local culture's ascription of meaning to being "crazy." These data suggest that offers of help-specifically, diagnosis-dependent housing-to those on the street may be more successful when explicit psychiatric diagnosis is downplayed.

Child strengths and placement stability among racial/ethnic minority youth in the child welfare system.

While all children deserve a stable living environment, national data illustrate that many states struggle to achieve placement stability for youth in the child welfare system as a significant number of children in foster care continue to experience multiple placements while in state custody. Prior research has not considered the impact of youth protective factors or strengths on the frequency of placement changes that youth experience while in the child welfare system. This study examined the association between strengths measured at multiple levels (i.e., individual, family, and community) and placement stability among 4022 minority youth (aged 10-18) using administrative and clinical data from the Illinois child welfare system. Negative binomial regressions at the family level revealed that youth with at least one loving and supportive family member experienced 16% fewer placement changes than youth without family strengths. At the community level, youth attending schools that work to create an environment that meets its students' needs experienced 13% fewer placement changes than youth without educational supports. These findings can inform the quality of treatment and services provided to minority youth in the child welfare system.

Association Between Family History and Early-Onset Atrial Fibrillation Across Racial and Ethnic Groups.

Importance: There is a genetic predisposition to early-onset atrial fibrillation (EOAF) in European American individuals. However, the role of family history in the pathogenesis of EOAF in racial and ethnic minorities remains unclear. Objective: To determine whether probands with EOAF across racial and ethnic groups have a higher rate of AF in first-degree family members than racially and ethnically matched control patients with non-early-onset AF (non-EOAF). Design, Setting, and Participants: In this cohort study, patients prospectively enrolled in a clinical and genetic biorepository were administered baseline questionnaires that included questions about family history of AF. Early-onset AF was defined as AF occurring in probands aged 60 years or younger in the absence of structural heart disease. All other forms were categorized as non-EOAF. Recruitment took place from July 2015 to December 2017. Analysis was performed in January 2018. Main Outcomes and Measures: Primary analysis of reported family history of AF in first-degree relatives with sensitivity analysis restricted to those in whom a family history was confirmed by medical record review and electrocardiogram. Results: Of 664 patients enrolled (mean [SD] age, 62 [12] years; 407 [61%] male), 267 (40%) were European American; 258 (39%), African American; and 139 (21%), Hispanic/Latino. There was a family history of AF in 36 probands with EOAF (49%) compared with 128 patients with non-EOAF (22%) (difference, 27%; 95% CI, 14%-40%; P < .001). On multivariable analysis, the adjusted odds of a proband with EOAF who was of African descent (odds ratio [OR], 2.69; 95% CI, 1.06-6.91; P < .001) or Hispanic descent (OR, 9.25; 95% CI, 2.37-36.23; P = .002) having a first-degree relative with AF were greater than those of European descent (OR, 2.51; 95% CI, 1.29-4.87; P = .006). Overall, probands with EOAF were more likely to have a first-degree relative with AF compared with patients with non-EOAF (adjusted OR, 3.02; 95% CI, 1.82-4.95; P < .001) across the 3 racial and ethnic groups. Atrial fibrillation in a first-degree family member was confirmed in 32% of probands with EOAF vs 11% of those with non-EOAF (difference, 21%; 95% CI, 11%-33%; P < .001). Furthermore, African American (28% vs 5%; difference, 23%; 95% CI, 4%-43%; P = .001), European American (35% vs 20%; difference, 15%; 95% CI, 1%-30%; P = .03), and Hispanic/Latino (30% vs 5%; difference, 25%; 95% CI, 4%-54%; P = .02) probands with EOAF were more likely to have a first-degree relative with confirmed AF vs racially and ethnically matched control patients with non-EOAF. The positive and negative predictive values for a family history of confirmed AF were both 89%. Conclusions and Relevance: Probands of African or Hispanic/Latino descent with EOAF were more likely to have a first-degree relative with AF when compared with European American individuals. These findings support genetic predisposition to EOAF across all 3 races.

Racial and socioeconomic disparities in bone density testing before and after hip fracture.

BACKGROUND: Racial and socioeconomic disparities have been identified in osteoporosis screening. OBJECTIVE: To determine whether racial and socioeconomic disparities in osteoporosis screening diminish after hip fracture. DESIGN: Retrospective cohort study of female Medicare patients. SETTING: Entire states of Illinois, New York, and Florida. PARTICIPANTS: Female Medicare recipients aged 65-89 years old with hip fractures between January 2001 and June 2003. MEASUREMENTS: Differences in bone density testing by race/ethnicity and zip-code level socioeconomic characteristics during the 2-year period preceding and the 6-month period following a hip fracture. RESULTS: Among all 35,681 women with hip fractures, 20.7% underwent bone mineral density testing in the 2 years prior to fracture and another 6.2% underwent testing in the 6 months after fracture. In a logistic regression model adjusted for age, state, and comorbidity, women of black race were about half as likely (RR 0.52 [0.43, 0.62]) and Hispanic women about 2/3 as likely (RR 0.66 [0.54, 0.80]) as white women to undergo testing before their fracture. They remained less likely (RR 0.66 [0.50, 0.88] and 0.58 [0.39, 0.87], respectively) to undergo testing after fracture. In contrast, women residing in zip codes in the lowest tertile of income and education were less likely than those in higher-income and educational tertiles to undergo testing before fracture, but were no less likely to undergo testing in the 6 months after fracture. CONCLUSIONS: Racial, but not socioeconomic, differences in osteoporosis evaluation continued to occur even after Medicare patients had demonstrated their propensity to fracture. Future interventions may need to target racial/ethnic and socioeconomic disparities differently.

Outcome Disparities in Caucasian and Non-Caucasian Patients With Myeloproliferative Neoplasms.

BACKGROUND: The Philadelphia chromosome-negative myeloproliferative neoplasms (MPNs) are characterized by an increased risk of thrombotic and hemorrhagic complications. Large retrospective studies have demonstrated racial disparities in MPN outcomes and attributed this to differences in access to health care. Utilizing a single institution experience, we report outcomes in patients with polycythemia vera (PV), essential thrombocythemia (ET), and myelofibrosis in relation to ethno-racial background. PATIENTS AND METHODS: A total of 127 Caucasian (56%) and non-Caucasian (44%) adult patients with MPNs consecutively treated at the University of Illinois between 1990 and 2012 were examined in this retrospective study. Relationships between ethno-racial background and vascular complications, and disease transformation were evaluated using multivariate logistic regression models. RESULTS: Non-Caucasian PV patients had an increased risk of vascular complications including cardiovascular thrombosis and hemorrhagic events, while Caucasian patients with PV and ET had a higher risk of progression to myelofibrosis. In a Cox proportional hazard regression analysis, Caucasian race emerged as an independent prognostic factor protective against cardiovascular thrombosis in PV and ET patients (hazard ratio, 0.2; 95% confidence interval, 0.03-0.9; P = .04) while age > 60 years and prior thrombosis were significant risk factors in univariate analysis. Non-Caucasian race was also a significant risk factor in univariate analysis of hemorrhagic complications of PV and ET, and this was largely driven by African American ethnicity. CONCLUSION: This study shows for the first time that race can influence clinical outcomes in myeloproliferative neoplasms. Our findings highlight the need for greater representation of non-Caucasian patients in studies investigating vascular risk factors in MPNs.

The Illinois Forest Preserve District Act of 1913 and the emergence of metropolitan park system planning in the USA.

In 1913, the Illinois Legislature enacted the Forest Preserve District Act. After adoption of the Act by voters in Cook County, the Chicago metropolitan area became among the first in the USA to establish a park system with an outer ring of nature preserves. This article chronicles the story of how the Cook County Forest Preserve District was established, its historical context and its influence on planning practice. It contends that although Chicago was not the originator of the idea of outer parks, it added significantly to development of the concept of comprehensive park system planning. The article contends that the paradigm of park management changed from conservation of the native landscape to multiple use management during the 20-year struggle to establish the district, and that passage of the Act was largely the result of the efforts of two individuals - Dwight Perkins and Jens Jensen.

Patterns of movement in foster care: an optimal matching analysis.

Placement instability remains a vexing problem for child welfare agencies across the country. This study uses child welfare administrative data to retrospectively follow the entire placement histories (birth to age 17.5) of 474 foster youth who reached the age of majority in the state of Illinois and to search for patterns in their movement through the child welfare system. Patterns are identified through optimal matching and hierarchical cluster analyses. Multiple logistic regression is used to analyze administrative and survey data in order to examine covariates related to patterns. Five distinct patterns of movement are differentiated: Late Movers, Settled with Kin, Community Care, Institutionalized, and Early Entry. These patterns suggest high but variable rates of movement. Implications for child welfare policy and service provision are discussed.