Black-White Racial Disparities in Disabilities Among Older Americans Between 2008 and 2017: Improvements in Cognitive Disabilities but no Progress in Activities of Daily Living or Functional Limitations.

The objectives of this study were to examine the prevalence of race-based disparities in cognitive problems, functional limitations (FLs), and activity of daily living (ADL) limitations between US Black and White older adults in 2008 and 2017, to explore how age, sex, income, and education attenuate these racial disparities, and to determine if Black-White health disparities are narrowing. Secondary analysis of the nationally representative American Community Surveys including 423,066 respondents aged ≥65 (388,602 White, 34,464 Black) in 2008 and 536,984 (488,483 White, 48,501 Black) in 2017. Findings indicate that Black-White racial disparities were apparent for all three outcomes in 2008 and 2017. Approximately half of the racial disparities was attenuated when adjustments were made for education and income. Racial disparities in cognition declined between 2008 and 2017 (p < .001) but persisted unabated in FLs and ADL limitations. Further exploration on the mechanisms of racial disparities is warranted.

An examination of racial and ethnic disparities in mental health during the Covid-19 pandemic in the U.S. South.

BACKGROUND: The mental health of racial/ethnic minority groups in the United States may be disproportionately impacted by the COVID-19 pandemic due to greater experience of peri-pandemic stressors. Yet, few studies have systematically examined racial/ethnic differences in mental health outcomes in this context. METHODS: Data came from the COVID-19 Southern Cities Study, a probability-based, cross-sectional study conducted in May/June 2020 among adults living in the metropolitan statistical areas of Atlanta, Austin, Dallas, Houston, and New Orleans. Unadjusted and adjusted associations between racial/ethnic identity and past-week depression and/or anxiety symptoms (Patient Health Questionnaire-2 score ≥ 3 or Generalized Anxiety Disorder-2 score ≥ 3), trouble sleeping, physical reactions when thinking about COVID-19, and self-rated worsened mental health due to the pandemic were estimated in separate logistic regression models. RESULTS: Over 30% of respondents reported depression and/or anxiety symptoms, 21% reported physical reactions, 25% had trouble sleeping, and 33% worsened mental health since the pandemic began. Adjusting for sociodemographic and health-related characteristics and pandemic-related stressors, odds of anxiety symptoms (odds ratio (OR) 0.53, 95% confidence interval (CI) 0.30-0.95) and worsened mental health (OR 0.58, 95% CI 0.36-0.94) were lower among non-Hispanic Black vs. non-Hispanic white respondents. LIMITATIONS: No diagnostic assessments were used, and results may not be generalizable to later phases of the pandemic and the entire U.S. South. CONCLUSIONS: Despite greater pandemic-related stressor experience, poor mental health outcomes were not more common among racial/ethnic minority individuals. However, interventions to reduce disparities in stressor experience and promote mental health are needed.

High fructose corn syrup, excess-free-fructose, and risk of coronary heart disease among African Americans- the Jackson Heart Study.

BACKGROUND: Researchers have sought to explain the black-white coronary heart disease (CHD) mortality disparity that increased from near parity to ~ 30% between 1980 and 2010. Contributing factors include cardiovascular disease prevention and treatment disparities attributable to disparities in insurance coverage. Recent research suggests that dietary/environmental factors may be contributors to the disparity. Unabsorbed/luminal fructose alters gut bacterial load, composition and diversity. There is evidence that such microbiome disruptions promote hypertension and atherosclerosis. The heart-gut axis may, in part, explain the black-white CHD disparity, as fructose malabsorption prevalence is higher among African Americans. Between 1980 and 2010, consumption of excess-free-fructose-the fructose type that triggers malabsorption-exceeded dosages associated with fructose malabsorption (~ 5 g-10 g), as extrapolated from food availability data before subjective, retroactively-applied loss adjustments. This occurred due to an industrial preference shift from sucrose to high-fructose-corn-syrup (HFCS) that began ~ 1980. During this period, HFCS became the main sweetener in US soda. Importantly, there has been more fructose in HFCS than thought, as the fructose-to-glucose ratio in popular sodas (1.9-to-1 and 1.5-to-1) has exceeded generally-recognized-as-safe levels (1.2-to-1). Most natural foods contain a ~ 1-to-1 ratio. In one recent study, ≥5 times/wk. consumers of HFCS sweetened soda/fruit drinks/and apple juice-high excess-free-fructose beverages-were more likely to have CHD, than seldom/never consumers. METHODS: Jackson-Heart-Study data of African Americans was used to test the hypothesis that regular relative to low/infrequent intake of HFCS sweetened soda/fruit drinks increases CHD risk, but not orange juice-a low excess-free-fructose juice. Cox proportional hazards models were used to calculate hazard ratios using prospective data of 3407-3621 participants, aged 21-93 y (mean 55 y). RESULTS: African Americans who consumed HFCS sweetend soda 5-6x/wk. or any combination of HFCS sweetened soda and/or fruit drinks ≥3 times/day had ~ 2 (HR 2.08, 95% CI 1.03-4.20, P = 0.041) and 2.5-3 times higher CHD risk (HR 2.98, 95% CI 1.15-7.76; P = 0.025), respectively, than never/seldom consumers, independent of confounders. There were no associations with diet-soda or 100% orange-juice, which has a similar glycemic profile as HFCS sweetened soda, but contains a ~ 1:1 fructose-to-glucose ratio. CONCLUSION: The ubiquitous presence of HFCS in the food supply may pre-dispose African Americans to increased CHD risk.

Desimportância da raça/cor e responsabilidade médico-legal no preenchimento da declaração de óbito / Un-importance of race/colour and medical-legal responsibility in the fill out of the death certification / Desimportância de la raza/ color y la responsabilidad de la medicina forense al completar la declaración de muerte

O Nordeste possui a pior qualidade de informação de mortalidade por raça-cor. Uma vez que o morto não pode autodeclarar sua raça ou cor, cabe ao médico legista definir esse atributo da vítima de morte violenta. O objetivo deste trabalho é avaliar a importância dada pelos médicos legistas ao preenchimento da declaração de óbito e, em especial, ao quesito raça/cor, enquanto instrumentos de informação em saúde. O estudo exploratório foi realizado no Instituto Médico da Legal de Feira de Santana, Bahia, por meio de entrevistas semiestruturadas com profissionais médicos e não médicos envolvidos no processo. As entrevistas foram analisadas segundo a técnica de análise de conteúdo. Os resultados apontam que, apesar de os médicos legistas considerarem a declaração de óbito um instrumento importante, eles atêm-se ao preenchimento do campo da causa mortis. Em relação ao quesito raça/cor, observou-se que não existe uma consciência maior sobre a importância da sua determinação nos indivíduos necropsiados enquanto informação essencial para a saúde da população negra.

The Northeast has the worst quality of data on race- skin color mortality. Since the dead can not self-declare his/her race or skin color, the professional of Legal Medicine is the professional in charge of defining this feature from the victim of violent death. The aim of this study is to evaluate the importance given by the coroner (or forensic surgeon) to the filling out of a death certificate?s particularly, the race/ skin color?s query, as tools of health information. This exploratory study was conducted at the Legal Medical Institute of Feira de Santana, Bahia, through semi-structured interviews with medical and non-medical professionals involved in the process. The interviews were analyzed by Content Analysis. The results show that although the doctors consider the death certificate an important tool, they are concerned only with the cause of death. In relation to the filling out of the race/ skin color issue one observed that there is no awareness about the importance of its register as essential information to the health of the black population.

El Noreste tiene la peor calidad de información sobre mortalidad por raza/color. Puesto que los muertos no pueden autodeclarar su raza o color, cabe al médico forense establecer ese atributo de la víctima por muerte violenta. El objetivo de este estudio es evaluar la importancia dada por los médicos forenses al completar el certificado de defunción y, en particular, al asunto raza/color, en cuanto instrumento de información en salud. El estudio exploratorio se llevó a cabo en el Instituto de Medicina Legal de Feira de Santana, Bahia, mediante entrevistas semiestructuradas con profesionales médicos y no médicos involucrados en el proceso. Las entrevistas fueron analizadas utilizando la técnica del análisis de contenido. Los resultados indican que, aunque los médicos forenses tienen en cuenta el certificado de defunción como una herramienta importante, ellos se preocupan en completar el campo referente a causamortis. En relación con la raza/color, se observó que no existe una mayor 886 conciencia sobre la importancia de su determinación en los individuos sometidos a la autopsia, en cuanto información esencial para la salud de la población de color negro.