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1.
Eur J Public Health ; 34(1): 176-180, 2024 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-37713471

RESUMO

BACKGROUND: The E.U.'s lack of racially disaggregated data impedes the formulation of effective interventions, and crises such as Covid-19 may continue to impact minorities more severely. Our predictive model offers insight into the disparate ways in which Covid-19 has likely impacted E.U. minorities and allows for the inference of differences in Covid-19 infection and death rates between E.U. minority and non-minority populations. METHODS: Data covering Covid-19, social determinants of health and minority status were included from 1 March 2020 to 28 February 2021. A systematic comparison of US and E.U. states enabled the projection of Covid-19 infection and death rates for minorities and non-minorities in E.U. states. RESULTS: The model predicted Covid-19 infection rates with 95-100% accuracy for 23 out of 28 E.U. states. Projections for Covid-19 infection and mortality rates among E.U. minority groups illustrate parallel trends to US rates. CONCLUSIONS: Disparities in Covid-19 infection and death rates by minority status likely exist in patterns similar to those observed in US data. Policy Implications: Collecting data by race/ethnicity in the E.U. would help document health disparities and craft more targeted health interventions and mitigation strategies.


Assuntos
COVID-19 , Etnicidade , União Europeia , Humanos , Negro ou Afro-Americano , COVID-19/epidemiologia , COVID-19/etnologia , COVID-19/mortalidade , Etnicidade/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Grupos Minoritários/estatística & dados numéricos , Estados Unidos/epidemiologia , União Europeia/estatística & dados numéricos
2.
Glob Public Health ; 18(1): 2273425, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-37902041

RESUMO

Racial/ethnic minority individuals in the U.S. experience numerous health disparities versus Whites, often due to differences in social determinants. Yet, limited large-scale research has examined these differences at the neighbourhood level. We merged 2021 PLACES Project and 2020 American Community Survey data across 3,211 census tracts (neighbourhoods) defined as majority (>50%) Black, Latina/o, Asian or White. T-tests and hierarchical linear regressions were used to examine differences and associations between neighbourhoods on key health (general health, mental health, obesity, diabetes, cancer, coronary heart disease, chronic obstructive pulmonary disease, stroke), and social outcomes (income, unemployment, age, population density). Results indicated that minority neighbourhoods in California exhibited stark health and social disparities versus White neighbourhoods, displaying worse outcomes on nearly every social and health variable/condition examined; particularly for Black and Latina/o neighbourhoods. Moreover, regression findings revealed that, after considering income, unemployment, and population density, (1) fair/poor mental health and higher percentages of Black, Latina/o and Asian residents in neighbourhoods independently associated with greater neighbourhood fair/poor physical health, and (2) fair/poor mental health significantly associated with greater prevalence of obesity and COPD. This study thus underscores the need to address the profound health and social disparities experienced by minority neighbourhoods for more equitable neighbourhoods.


Assuntos
Doença Crônica , Saúde , Características da Vizinhança , Determinantes Sociais da Saúde , Humanos , California/epidemiologia , Doença Crônica/epidemiologia , Doença Crônica/etnologia , Etnicidade/estatística & dados numéricos , Hispânico ou Latino/estatística & dados numéricos , Saúde Mental/etnologia , Saúde Mental/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Obesidade/epidemiologia , Características de Residência/estatística & dados numéricos , Determinantes Sociais da Saúde/etnologia , Determinantes Sociais da Saúde/estatística & dados numéricos , Características da Vizinhança/estatística & dados numéricos , Saúde/etnologia , Saúde/estatística & dados numéricos , Negro ou Afro-Americano/estatística & dados numéricos , Asiático/estatística & dados numéricos , Brancos/estatística & dados numéricos , Populações Vulneráveis/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/etnologia
3.
JAMA ; 330(14): 1325-1326, 2023 10 10.
Artigo em Inglês | MEDLINE | ID: mdl-37721764

RESUMO

This Viewpoint discusses a pathway toward individual, institutional, professional, and societal actions to increase the number of underrepresented individuals in medicine within the medical workforce in a "post­affirmative action" landscape.


Assuntos
Diversidade Cultural , Medicina , Grupos Minoritários , Política Pública , Grupos Minoritários/estatística & dados numéricos , Estados Unidos/epidemiologia , Medicina/estatística & dados numéricos , Política Pública/legislação & jurisprudência
6.
JAMA ; 329(21): 1848-1858, 2023 06 06.
Artigo em Inglês | MEDLINE | ID: mdl-37278814

RESUMO

Importance: The culture of academic medicine may foster mistreatment that disproportionately affects individuals who have been marginalized within a given society (minoritized groups) and compromises workforce vitality. Existing research has been limited by a lack of comprehensive, validated measures, low response rates, and narrow samples as well as comparisons limited to the binary gender categories of male or female assigned at birth (cisgender). Objective: To evaluate academic medical culture, faculty mental health, and their relationship. Design, Setting, and Participants: A total of 830 faculty members in the US received National Institutes of Health career development awards from 2006-2009, remained in academia, and responded to a 2021 survey that had a response rate of 64%. Experiences were compared by gender, race and ethnicity (using the categories of Asian, underrepresented in medicine [defined as race and ethnicity other than Asian or non-Hispanic White], and White), and lesbian, gay, bisexual, transgender, queer (LGBTQ+) status. Multivariable models were used to explore associations between experiences of culture (climate, sexual harassment, and cyber incivility) with mental health. Exposures: Minoritized identity based on gender, race and ethnicity, and LGBTQ+ status. Main Outcomes and Measures: Three aspects of culture were measured as the primary outcomes: organizational climate, sexual harassment, and cyber incivility using previously developed instruments. The 5-item Mental Health Inventory (scored from 0 to 100 points with higher values indicating better mental health) was used to evaluate the secondary outcome of mental health. Results: Of the 830 faculty members, there were 422 men, 385 women, 2 in nonbinary gender category, and 21 who did not identify gender; there were 169 Asian respondents, 66 respondents underrepresented in medicine, 572 White respondents, and 23 respondents who did not report their race and ethnicity; and there were 774 respondents who identified as cisgender and heterosexual, 31 as having LGBTQ+ status, and 25 who did not identify status. Women rated general climate (5-point scale) more negatively than men (mean, 3.68 [95% CI, 3.59-3.77] vs 3.96 [95% CI, 3.88-4.04], respectively, P < .001). Diversity climate ratings differed significantly by gender (mean, 3.72 [95% CI, 3.64-3.80] for women vs 4.16 [95% CI, 4.09-4.23] for men, P < .001) and by race and ethnicity (mean, 4.0 [95% CI, 3.88-4.12] for Asian respondents, 3.71 [95% CI, 3.50-3.92] for respondents underrepresented in medicine, and 3.96 [95% CI, 3.90-4.02] for White respondents, P = .04). Women were more likely than men to report experiencing gender harassment (sexist remarks and crude behaviors) (71.9% [95% CI, 67.1%-76.4%] vs 44.9% [95% CI, 40.1%-49.8%], respectively, P < .001). Respondents with LGBTQ+ status were more likely to report experiencing sexual harassment than cisgender and heterosexual respondents when using social media professionally (13.3% [95% CI, 1.7%-40.5%] vs 2.5% [95% CI, 1.2%-4.6%], respectively, P = .01). Each of the 3 aspects of culture and gender were significantly associated with the secondary outcome of mental health in the multivariable analysis. Conclusions and Relevance: High rates of sexual harassment, cyber incivility, and negative organizational climate exist in academic medicine, disproportionately affecting minoritized groups and affecting mental health. Ongoing efforts to transform culture are necessary.


Assuntos
Cyberbullying , Docentes de Medicina , Incivilidade , Cultura Organizacional , Assédio Sexual , Local de Trabalho , Feminino , Humanos , Masculino , Etnicidade/psicologia , Etnicidade/estatística & dados numéricos , Incivilidade/estatística & dados numéricos , Minorias Sexuais e de Gênero/psicologia , Minorias Sexuais e de Gênero/estatística & dados numéricos , Assédio Sexual/psicologia , Assédio Sexual/estatística & dados numéricos , Local de Trabalho/organização & administração , Local de Trabalho/psicologia , Local de Trabalho/estatística & dados numéricos , Centros Médicos Acadêmicos/organização & administração , Centros Médicos Acadêmicos/estatística & dados numéricos , Cyberbullying/psicologia , Cyberbullying/estatística & dados numéricos , Condições de Trabalho/organização & administração , Condições de Trabalho/psicologia , Condições de Trabalho/estatística & dados numéricos , Marginalização Social/psicologia , Grupos Minoritários/psicologia , Grupos Minoritários/estatística & dados numéricos , Saúde Mental/estatística & dados numéricos , Docentes de Medicina/organização & administração , Docentes de Medicina/psicologia , Docentes de Medicina/estatística & dados numéricos , Medicina/organização & administração , Medicina/estatística & dados numéricos , Estados Unidos/epidemiologia , Asiático/psicologia , Asiático/estatística & dados numéricos , Brancos/psicologia , Brancos/estatística & dados numéricos , Inquéritos e Questionários , Racismo/psicologia , Racismo/estatística & dados numéricos , Sexismo/psicologia , Sexismo/estatística & dados numéricos , Preconceito/etnologia , Preconceito/psicologia , Preconceito/estatística & dados numéricos
8.
Drug Alcohol Depend ; 248: 109894, 2023 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-37167795

RESUMO

OBJECTIVE: Polysubstance use among adolescents is a significant public health concern, yet most studies on adolescent substance use focus on a singular substance. This study is one of the first to investigate the association between perceived racial discrimination (PRD) in school and polysubstance use among racial/ethnic minority adolescents using a nationally representative sample. METHODS: Data was from the 2021 Adolescent Behaviors and Experiences Survey. The sample included 4145 racial/ethnic minority adolescents (52.8% female). Hierarchical binary logistic regression was used to examine the association between PRD in school and polysubstance use among racial/ethnic minority adolescents. RESULTS: About 12% of racial/ethnic minority adolescents engaged in polysubstance use and 23.4% reported experiencing PRD in school sometimes/most of the time/always. Controlling for other factors, experiencing PRD in school sometimes/most of the time/always was associated with 1.52 times higher odds of polysubstance use when compared to adolescents who never experienced PRD in school (OR=1.52, p=.044, 95% CI=1.01-2.30). Cyberbullying victimization, symptoms of depression, and being emotionally abused by a parent during COVID-19 were also associated with polysubstance use. CONCLUSION: Controlling for demographic characteristics and psychosocial stressors, PRD in school was significantly associated with higher odds of polysubstance use among racial/ethnic minority adolescents. The findings of this study could inform clinicians and policymakers of the association between PRD in school and polysubstance use, which could contribute to early identification of polysubstance use among racial/ethnic minority adolescents.


Assuntos
Etnicidade , Grupos Minoritários , Grupos Raciais , Racismo , Transtornos Relacionados ao Uso de Substâncias , Estados Unidos/epidemiologia , Grupos Minoritários/psicologia , Grupos Minoritários/estatística & dados numéricos , Etnicidade/psicologia , Etnicidade/estatística & dados numéricos , Grupos Raciais/psicologia , Grupos Raciais/estatística & dados numéricos , Racismo/psicologia , Racismo/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Humanos , Masculino , Feminino , Adolescente , Comportamento do Adolescente , Inquéritos e Questionários , Depressão/epidemiologia , Depressão/psicologia , Cyberbullying/estatística & dados numéricos , Abuso Emocional/estatística & dados numéricos
9.
JAMA ; 329(19): 1682-1692, 2023 05 16.
Artigo em Inglês | MEDLINE | ID: mdl-37191700

RESUMO

Importance: Health inequities exist for racial and ethnic minorities and persons with lower educational attainment due to differential exposure to economic, social, structural, and environmental health risks and limited access to health care. Objective: To estimate the economic burden of health inequities for racial and ethnic minority populations (American Indian and Alaska Native, Asian, Black, Latino, and Native Hawaiian and Other Pacific Islander) and adults 25 years and older with less than a 4-year college degree in the US. Outcomes include the sum of excess medical care expenditures, lost labor market productivity, and the value of excess premature death (younger than 78 years) by race and ethnicity and the highest level of educational attainment compared with health equity goals. Evidence Review: Analysis of 2016-2019 data from the Medical Expenditure Panel Survey (MEPS) and state-level Behavioral Risk Factor Surveillance System (BRFSS) and 2016-2018 mortality data from the National Vital Statistics System and 2018 IPUMS American Community Survey. There were 87 855 survey respondents to MEPS, 1 792 023 survey respondents to the BRFSS, and 8 416 203 death records from the National Vital Statistics System. Findings: In 2018, the estimated economic burden of racial and ethnic health inequities was $421 billion (using MEPS) or $451 billion (using BRFSS data) and the estimated burden of education-related health inequities was $940 billion (using MEPS) or $978 billion (using BRFSS). Most of the economic burden was attributable to the poor health of the Black population; however, the burden attributable to American Indian or Alaska Native and Native Hawaiian or Other Pacific Islander populations was disproportionately greater than their share of the population. Most of the education-related economic burden was incurred by adults with a high school diploma or General Educational Development equivalency credential. However, adults with less than a high school diploma accounted for a disproportionate share of the burden. Although they make up only 9% of the population, they bore 26% of the costs. Conclusions and Relevance: The economic burden of racial and ethnic and educational health inequities is unacceptably high. Federal, state, and local policy makers should continue to invest resources to develop research, policies, and practices to eliminate health inequities in the US.


Assuntos
Escolaridade , Estresse Financeiro , Iniquidades em Saúde , Acesso aos Serviços de Saúde , Determinantes Sociais da Saúde , Adulto , Humanos , Etnicidade/estatística & dados numéricos , Estresse Financeiro/epidemiologia , Estresse Financeiro/etnologia , Estresse Financeiro/etiologia , Grupos Minoritários/estatística & dados numéricos , Estados Unidos/epidemiologia , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Determinantes Sociais da Saúde/economia , Determinantes Sociais da Saúde/etnologia , Determinantes Sociais da Saúde/estatística & dados numéricos , Efeitos Psicossociais da Doença , Indígena Americano ou Nativo do Alasca/estatística & dados numéricos , Nativo Asiático-Americano do Havaí e das Ilhas do Pacífico/estatística & dados numéricos , Hispânico ou Latino/estatística & dados numéricos , Negro ou Afro-Americano/estatística & dados numéricos
10.
J Sch Psychol ; 97: 101-122, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-36914361

RESUMO

Diversity approaches in school may affect students' interethnic relations but are often only assessed through students' perceptions. We related teacher-reported diversity approaches (i.e., assimilationism, multiculturalism, color-evasion, and intervening with discrimination) to ethnic majority and minority students' ethnic attitudes as well as to their experiences or perceptions of ethnic discrimination. We also explored students' perceptions of teacher approaches as hypothetical mediators of teacher effects on interethnic relations. We coupled survey data from 547 teachers (Mage = 39.02 years, 70% female) in 64 schools in Belgium with large-scale longitudinal survey data from their students, including 1287 Belgian majority students (Mage = 15.52, 51% female) and 696 Turkish- or Moroccan-origin minority students (Mage = 15.92, 58% female) enrolled in the same schools (Phalet et al., 2018). Longitudinal multilevel models revealed that over time, teacher-reported assimilationism predicted (even) more positive attitudes towards Belgian majority members, and multiculturalism predicted less highly positive attitudes towards Belgian majority members among Belgian majority students. Teacher-reported intervening with discrimination predicted more perceived discrimination of ethnic minority students over time among Belgian majority students. We did not find significant longitudinal effects of teachers' diversity approaches with Turkish- or Moroccan-origin minority students' ethnic attitudes, nor with their discrimination experiences or perceptions. We conclude that teachers' multiculturalism and anti-discrimination approaches reduced interethnic bias and raised awareness of discrimination among ethnic majority students. However, different perceptions by teachers and students suggest the need for schools to better communicate inclusive diversity approaches.


Assuntos
Diversidade Cultural , Etnicidade , Grupos Minoritários , Professores Escolares , Estudantes , Adolescente , Adulto , Feminino , Humanos , Masculino , Atitude/etnologia , Etnicidade/psicologia , Etnicidade/estatística & dados numéricos , Grupos Minoritários/psicologia , Grupos Minoritários/estatística & dados numéricos , Racismo/psicologia , Professores Escolares/psicologia , Professores Escolares/estatística & dados numéricos , Instituições Acadêmicas , Estudantes/psicologia , Estudantes/estatística & dados numéricos , Hierarquia Social , Bélgica
11.
Sleep Health ; 9(2): 128-135, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-36858835

RESUMO

OBJECTIVE: Examine the association between race and time to pharmacologic treatment of insomnia in a large multi-institutional cohort. METHODS: Retrospective analysis of electronic medical records from a regional health information exchange. Eligible patients included adults with at least one healthcare visit per year from 2010 to 2019, a new insomnia diagnosis code during the study period, and no prior insomnia diagnosis codes or medications. A Cox frailty model was used to examine the association between race and time to an insomnia medication after diagnosis. RESULTS: In total, 9557 patients were analyzed, 7773 (81.3%) of whom where White, 1294 (13.5%) Black, 238 (2.5%) Other, and 252 (2.6%) unknown race. About 6.2% of Black and 8% of Other race patients received an order for a Food and Drug Administration-approved insomnia medication after diagnosis compared with 13.5% of White patients. Black patients were significantly less likely to have an order for a Food and Drug Administration-approved insomnia medication at all time points (adjusted hazard ratio [aHR] range: 0.37-0.73), and patients reporting Other race were less likely to have received an order at 2 (aHR 0.51, 95% confidence interval [CI] 0.28-0.94), 3 (aHR 0.33, 95% CI 0.13-0.79), and 4 years (aHR 0.21, 95% CI 0.06-0.71) of follow-up. Similar results were observed in a sensitivity analysis including off-label medications. CONCLUSIONS: Patients belonging to racial minority groups are less likely to be prescribed an insomnia medication than White patients after accounting for sociodemographic and clinical factors. Further research is needed to determine the extent to which patient preferences and physician perceptions affect these prescribing patterns and investigate potential disparities in nonpharmacologic treatment.


Assuntos
Disparidades em Assistência à Saúde , Hipnóticos e Sedativos , Padrões de Prática Médica , Grupos Raciais , Distúrbios do Início e da Manutenção do Sono , Tempo para o Tratamento , Adulto , Humanos , População Negra/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Grupos Raciais/estatística & dados numéricos , Estudos Retrospectivos , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Disparidades em Assistência à Saúde/etnologia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Hipnóticos e Sedativos/administração & dosagem , Hipnóticos e Sedativos/uso terapêutico , Padrões de Prática Médica/estatística & dados numéricos , Tempo para o Tratamento/estatística & dados numéricos , Brancos/estatística & dados numéricos , Estados Unidos/epidemiologia
12.
Ann Plast Surg ; 90(5S Suppl 3): S281-S286, 2023 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-36752557

RESUMO

BACKGROUND: Racial/ethnic and gender disparities persist in plastic surgery at nearly all levels of training, becoming more pronounced at each stage. Recent studies have demonstrated that the proportion of female plastic surgery residents has increased to nearly 40%, yet only 11% of full professors of plastic surgery are female. Other studies have identified severe declines in underrepresented minority plastic surgery representation between plastic surgery residents and academicians with only 1.6% of Black/African American and 4.9% of Hispanic/Latinx full professors of plastic surgery. Often, residents seek fellowship for advanced training before seeking an academic professorship. This study aims to describe the racial/ethnic and gender representation of microsurgery and craniofacial fellows. METHODS: Names and photos of graduated fellows for the past 10 years (2012-2021) were extracted from microsurgery and craniofacial fellowship Web sites. Using a 2-person evaluation method, race/ethnicity and gender were primarily determined by photographic and surname and verified, when possible, through online confirmation methods (articles, social media). Distributions were analyzed with descriptive statistics and compared with the US population. RESULTS: Among 30 microsurgery fellowships, 180 graduated fellows (52.7%) were identified, resulting in 66 female fellows (36.7%) and the following racial/ethnic distribution: 113 (62.8%) White, 49 (27.2%) Asian, 12 (6.7%) Hispanic/Latinx, and 6 (3.3%) Black/African American. Among 31 craniofacial fellowships, 136 graduated fellows (45.0%) were identified, resulting in 38 female fellows (27.9%) and the following racial/ethnic distribution: 75 (55.1%) White, 45 (33.1%) Asian, 8 (5.9%) Hispanic/Latinx, and 8 (5.9%) Black/African American. The intersection between race/ethnicity and gender revealed the most disproportionately low representation among Black women. Relative to the US population, Hispanic/Latinx (0.31-fold) and Black/African American (0.48-fold) fellows were underrepresented, White (0.90-fold) fellows were nearly equally represented, and Asian (5.42-fold) fellows are overrepresented relative to the US population. Furthermore, despite pursuing fellowships at a greater rate, Asian and Black fellows are not reaching adequate representation among academic plastic surgeons. CONCLUSION: This study demonstrates that female racial/ethnic minorities are disproportionately underrepresented among microsurgery and craniofacial fellowships. Efforts should be made to improve the recruitment of fellows of underrepresented backgrounds and thus improve the pipeline into academic careers.


Assuntos
Bolsas de Estudo , Disparidades em Assistência à Saúde , Microcirurgia , Grupos Minoritários , Cirurgia Plástica , Feminino , Humanos , Masculino , Asiático/educação , Asiático/estatística & dados numéricos , Negro ou Afro-Americano/educação , Negro ou Afro-Americano/estatística & dados numéricos , Etnicidade/estatística & dados numéricos , Face , Bolsas de Estudo/estatística & dados numéricos , Disparidades em Assistência à Saúde/etnologia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Hispânico ou Latino/educação , Hispânico ou Latino/estatística & dados numéricos , Homens/educação , Microcirurgia/educação , Microcirurgia/estatística & dados numéricos , Grupos Minoritários/educação , Grupos Minoritários/estatística & dados numéricos , Fatores Sexuais , Crânio , Cirurgia Plástica/educação , Cirurgia Plástica/estatística & dados numéricos , Estados Unidos/epidemiologia , Brancos/educação , Brancos/estatística & dados numéricos , Mulheres/educação
13.
Plast Reconstr Surg ; 152(2): 281-290, 2023 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-36728197

RESUMO

BACKGROUND: Given the national attention to disparities in health care, understanding variation provided to minorities becomes increasingly important. This study will examine the effect of race on the rate and cost of unplanned hospitalizations after breast reconstruction procedures. METHODS: The authors performed an analysis comparing patients undergoing implant-based and autologous breast reconstruction in the Healthcare Cost and Utilization Project. The authors evaluated the rate of unplanned hospitalizations and associated expenditures among patients of different races. Multivariable analyses were performed to determine the association among race and readmissions and health care expenditures. RESULTS: The cohort included 17,042 patients. The rate of an unplanned visit was 5%. The rates of readmissions among black patients (6%) and Hispanic patients (7%) in this study are higher compared with white patients (5%). However, after controlling for patient-level characteristics, race was not an independent predictor of an unplanned visit. In our expenditure model, black patients [adjusted cost ratio, 1.35 (95% CI, 1.11 to 1.66)] and Hispanic patients [adjusted cost ratio, 1.34 (95% CI, 1.08 to 1.65)] experienced greater cost for their readmission compared with white patients. CONCLUSIONS: Although race is not an independent predictor of an unplanned hospital visit after surgery, racial minorities bear a higher cost burden after controlling for insurance status, further stimulating health care disparities. Adjusted payment models may be a strategy to reduce disparities in surgical care. In addition, direct and indirect measures of disparities should be used when examining health care disparities to identify consequences of inequities more robustly.


Assuntos
Disparidades em Assistência à Saúde , Hospitalização , Mamoplastia , Grupos Minoritários , Readmissão do Paciente , Humanos , Disparidades em Assistência à Saúde/economia , Disparidades em Assistência à Saúde/etnologia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Hispânico ou Latino/estatística & dados numéricos , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Mamoplastia/efeitos adversos , Mamoplastia/economia , Mamoplastia/métodos , Mamoplastia/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Estudos Retrospectivos , Fatores Raciais/economia , Fatores Raciais/estatística & dados numéricos , Readmissão do Paciente/economia , Readmissão do Paciente/estatística & dados numéricos , Brancos/estatística & dados numéricos , Negro ou Afro-Americano/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos
14.
J Natl Med Assoc ; 115(2): 101-118, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-36775786

RESUMO

The purpose of our study is to examine the barriers and facilitators for urban African American students interested in pursuing health professions careers in the Midwest. In our analysis of the key informant interviews and focus groups, we identified four barriers (lack of preparation, lack of funding, lack of support/isolation, and perceived discrimination) and three facilitators (early preparation, support/mentorship, funding). We provide recommendations for how to leverage these facilitators and address the barriers to increase the representation of African Americans in the healthcare workforce. Novel future directions for this work should include comprehensive interventions tailored to URM students that span the health professions education pipeline and begin as early as elementary school. Interventions that engage mentors should take place at high school, undergraduate, and graduate health professions school levels.


Assuntos
Negro ou Afro-Americano , Escolha da Profissão , Diversidade, Equidade, Inclusão , Ocupações em Saúde , Estudantes , Humanos , Negro ou Afro-Americano/psicologia , Negro ou Afro-Americano/estatística & dados numéricos , Ocupações em Saúde/educação , Ocupações em Saúde/estatística & dados numéricos , Grupos Minoritários/educação , Grupos Minoritários/psicologia , Grupos Minoritários/estatística & dados numéricos , Estudantes/psicologia , Estudantes/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Meio-Oeste dos Estados Unidos/epidemiologia
15.
Clin Lymphoma Myeloma Leuk ; 23(5): 379-384, 2023 05.
Artigo em Inglês | MEDLINE | ID: mdl-36813625

RESUMO

BACKGROUND: Advances in treatment for patients with Diffuse Large B-Cell Lymphoma (DLBCL) have led to improved patient outcomes but the magnitude of these disparities remains understudied with regards to improved survival outcomes. We sought to describe changes in DLBCL survival trends over time and explore potential differential survival patterns by patients' race/ethnicity and age. METHODS: We utilized the Surveillance, Epidemiology, and End Results (SEER) database to identify patients diagnosed with DLBCL from 1980 to 009 and determined 5-year survival outcomes for all patients, categorizing patients by year of diagnosis. We used descriptive statistics and logistic regression, adjusting for stage and year of diagnosis, to describe changes in 5-year survival rates over time by race/ethnicity and age. RESULTS: We identified 43,564 patients with DLBCL eligible for this study. Median age was 67 years (ages: 18-64 = 44.2%, 65-79 = 37.1%, 80 + = 18.7%). Most patients were male (53.4%) and had advanced stage III/IV disease (40.0%). Most patients were White race (81.4%), followed by Asian/Pacific Islander (API) (6.3%), Black (6.3%), Hispanic (5.4%), and American Indian/Alaska Native (AIAN) (0.05%). Overall, the 5-year survival rate improved from 35.1% in 1980 to 52.4% in 2009 across all races and age groups (odds ratio [OR] for 5-year survival with increasing year of diagnosis = 1.05, P < .001). Patients in racial/ethnic minority groups (API: OR = 0.86, P < .0001; Black: OR = 0.57, P < .0001; AIAN: OR = 0.51, P = .008; Hispanic: 0.76, P = 0.291) and older adults (ages 65-79: OR = 0.43, P < .0001; ages 80+: OR = 0.13, P < .0001) had lower 5-year survival rates after adjusting for race, age, stage, and diagnosis year. We found consistent improvement in the odds of 5-year survival for year of diagnosis across all race and ethnicity groups (White: OR = 1.05, P < .001; API: OR = 1.04, P < .001; Black: OR = 1.06, p<.001; AIAN: OR = 1.05, P < .001; Hispanic: OR = 1.05, P < .005) and age groups (ages 18-64: OR = 1.06, P < .001; ages 65-79: OR = 1.04, P < .001; ages 80+: OR = 1.04, P < .001). CONCLUSION: Patients with DLBCL experienced improvements in 5-year survival rates from 1980 to 2009, despite persistently lower survival among patients in racial/ethnic minority groups and older adults.


Assuntos
Etnicidade , Disparidades nos Níveis de Saúde , Linfoma Difuso de Grandes Células B , Grupos Minoritários , Grupos Raciais , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Fatores Etários , Etnicidade/estatística & dados numéricos , Linfoma Difuso de Grandes Células B/etnologia , Linfoma Difuso de Grandes Células B/mortalidade , Linfoma Difuso de Grandes Células B/patologia , Linfoma Difuso de Grandes Células B/terapia , Grupos Minoritários/estatística & dados numéricos , Fatores Raciais , Grupos Raciais/estatística & dados numéricos , Programa de SEER , Taxa de Sobrevida/tendências
16.
Psychol Med ; 53(2): 458-467, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-34011424

RESUMO

BACKGROUND: Black, Asian and minority ethnicity groups may experience better health outcomes when living in areas of high own-group ethnic density - the so-called 'ethnic density' hypothesis. We tested this hypothesis for the treatment outcome of compulsory admission. METHODS: Data from the 2010-2011 Mental Health Minimum Dataset (N = 1 053 617) was linked to the 2011 Census and 2010 Index of Multiple Deprivation. Own-group ethnic density was calculated by dividing the number of residents per ethnic group for each lower layer super output area (LSOA) in the Census by the LSOA total population. Multilevel modelling estimated the effect of own-group ethnic density on the risk of compulsory admission by ethnic group (White British, White other, Black, Asian and mixed), accounting for patient characteristics (age and gender), area-level deprivation and population density. RESULTS: Asian and White British patients experienced a reduced risk of compulsory admission when living in the areas of high own-group ethnic density [odds ratios (OR) 0.97, 95% credible interval (CI) 0.95-0.99 and 0.94, 95% CI 0.93-0.95, respectively], whereas White minority patients were at increased risk when living in neighbourhoods of higher own-group ethnic concentration (OR 1.18, 95% CI 1.11-1.26). Higher levels of own-group ethnic density were associated with an increased risk of compulsory admission for mixed-ethnicity patients, but only when deprivation and population density were excluded from the model. Neighbourhood-level concentration of own-group ethnicity for Black patients did not influence the risk of compulsory admission. CONCLUSIONS: We found only minimal support for the ethnic density hypothesis for the treatment outcome of compulsory admission to under the Mental Health Act.


Assuntos
Etnicidade , Internação Involuntária , Transtornos Mentais , Serviços de Saúde Mental , Densidade Demográfica , Atenção Secundária à Saúde , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Povo Asiático/psicologia , Povo Asiático/estatística & dados numéricos , População Negra/psicologia , População Negra/estatística & dados numéricos , Censos , Inglaterra , Etnicidade/psicologia , Etnicidade/estatística & dados numéricos , Internação Involuntária/legislação & jurisprudência , Transtornos Mentais/etnologia , Transtornos Mentais/terapia , Saúde Mental/legislação & jurisprudência , Serviços de Saúde Mental/estatística & dados numéricos , Grupos Minoritários/psicologia , Grupos Minoritários/estatística & dados numéricos , Medição de Risco , Atenção Secundária à Saúde/estatística & dados numéricos , Resultado do Tratamento , Conjuntos de Dados como Assunto
17.
J Racial Ethn Health Disparities ; 10(4): 1783-1789, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-35802253

RESUMO

BACKGROUND: Numerous studies have shown a disproportionate impact of COVID-19 infection on Black and Hispanic Americans in the adult patient population. However, few studies have been done with pediatric populations. The aim of this study is to identify the prevalence and distribution of COVID-19 cases among pediatric patients in Miami-Dade and Broward counties and identify any sociodemographic disparities. METHODS: A total of 10,087 children/adolescents ages zero years-old to 20 years-old were tested from July 1, 2020, to December 31, 2020. ArcGIS was used to map cases and obtain sociodemographic data. SPSS software was used to determine significance of data trends and create a predictive model. RESULTS: There were 1,161 pediatric COVID-19 cases detected. White Hispanics and Black Hispanics had statically significantly higher cases when compared to White non-Hispanics and Black non-Hispanics. Percentage of households on food stamps, percentage of households below the poverty line, percentage of minority populations, and percentage of Hispanic population showed a positive correlation with detected pediatric COVID-19 cases. Alternatively, areas with higher median household incomes and higher educational status were negatively correlated with COVID-19. Percentage of Hispanic population and percentage of households below the poverty line were predictive of pediatric COVID-19 cases. CONCLUSION: There was a disproportionate impact of pediatric COVID-19 infection on zip codes of lower socioeconomic status and increased racial/ethnic minority populations. This study demonstrates the need for public health policies that prioritize testing children/adolescents in these communities.


Assuntos
COVID-19 , Disparidades nos Níveis de Saúde , Pobreza , Adolescente , Criança , Humanos , Recém-Nascido , COVID-19/epidemiologia , COVID-19/etnologia , Etnicidade/estatística & dados numéricos , Florida/epidemiologia , Hispânico ou Latino/etnologia , Hispânico ou Latino/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Estados Unidos/epidemiologia , Lactente , Pré-Escolar , Adulto Jovem , Negro ou Afro-Americano/etnologia , Negro ou Afro-Americano/estatística & dados numéricos , Brancos/etnologia , Brancos/estatística & dados numéricos , Fatores Socioeconômicos , Pobreza/etnologia , Pobreza/estatística & dados numéricos , Pobreza Infantil/etnologia , Pobreza Infantil/estatística & dados numéricos
18.
J Racial Ethn Health Disparities ; 10(4): 1527-1532, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-35710858

RESUMO

OBJECTIVE: To estimate the prevalence of dementia among American Indian and Alaska Native (AIAN) Medicare beneficiaries and compare the prevalence of dementia in AIANs and other racial and ethnic minority groups-non-Hispanic Blacks (NHBs) and Hispanics-with non-Hispanic Whites (NHWs) Medicare beneficiaries. METHODS: We used survey data from Round 5 of the National Health and Aging Trends Study (NHATS, 2015) (N = 7,449), a nationally representative study of Medicare beneficiaries ages 65 years and older. We used logistic regression to estimate the age- and sex-adjusted prevalence of dementia with 95% confidence intervals by race/ethnicity as well as prevalence differences between groups. RESULTS: The majority of participants were between 65 and 74 years old. Approximately half of them were female. NHWs had a prevalence of 5% for dementia, and AIAIs had a prevalence of 9%, four percentage points higher than NHWs (95%CI 1%, 11%). We estimated a similar difference in the prevalence of dementia in AIAN Medicare beneficiaries compared to NHBs. CONCLUSION: While previous research has reported that AIANs share a similar or lower prevalence of dementia than NHWs, our findings suggest a potentially higher prevalence of dementia among AIAN Medicare beneficiaries. A relatively small number of AIAN resulted in wide confidence intervals for many of our associations. Future research should focus on recruiting a larger sample and on dementia prevalence and unique risk factors within and among AIAN tribes.


Assuntos
Indígena Americano ou Nativo do Alasca , Demência , Índios Norte-Americanos , Medicare , Idoso , Feminino , Humanos , Masculino , Envelhecimento , Indígena Americano ou Nativo do Alasca/estatística & dados numéricos , Demência/epidemiologia , Demência/etnologia , Etnicidade/estatística & dados numéricos , Índios Norte-Americanos/estatística & dados numéricos , Medicare/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Prevalência , Estados Unidos/epidemiologia , Brancos/estatística & dados numéricos , Negro ou Afro-Americano/estatística & dados numéricos , Hispânico ou Latino/estatística & dados numéricos
19.
Health Serv Res ; 58(3): 705-732, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-36307983

RESUMO

OBJECTIVE: To examine the factors that account for differences in dentist earnings between White and minoritized dentists. DATA SOURCES: We used data from the American Dental Association's Survey of dental practice, which includes information on 2001-2018 dentist net income, practice ZIP code, patient mix between private and public insurance, and dentist gender, age, and year of dental school graduation. We merged the data on dentist race and ethnicity and school of graduation from the American Dental Association masterfile. Based on practice ZIP code, we also merged the data on local area racial and ethnic composition from the American Community Survey. STUDY DESIGN: We used a linear Blinder-Oaxaca decomposition to assess observable characteristics that explain the gap in earnings between White and minoritized dentists. To assess differences in earnings between White and minoritized dentists at different points of the income distribution, we used a re-centered influence function and estimated an unconditional quantile Blinder-Oaxaca decomposition. DATA EXTRACTION METHODS: We extracted data for 22,086 dentists ages 25-85 who worked at least 8 weeks per year and 20 hours per week. PRINCIPAL FINDINGS: Observable characteristics accounted for 58% of the earnings gap between White and Asian dentists, 55% of the gap between White and Hispanic dentists, and 31% of the gap between White and Black dentists. The gap in earnings between White and Asian dentists narrowed at higher quantiles of the income distribution. CONCLUSIONS: Compared to other minoritized dentists, Black dentists have the largest earnings disparities relative to White dentists. While the level of the explained component of the disparity for Black dentists is comparable to the explained part of the disparities for other minoritized dentists, the excess percentage of the unexplained component for Black dentists accounts for the additional amount of disparity that Black dentists experienced. Persistent income disparities could discourage minoritized dentists from entering the profession.


Assuntos
Odontólogos , Renda , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Pessoa de Meia-Idade , Odontólogos/economia , Etnicidade , Hispânico ou Latino/estatística & dados numéricos , Renda/estatística & dados numéricos , Estados Unidos/epidemiologia , Brancos/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Asiático/estatística & dados numéricos , Negro ou Afro-Americano/estatística & dados numéricos , Economia em Odontologia/estatística & dados numéricos , Fatores Econômicos , Minorias Étnicas e Raciais/estatística & dados numéricos
20.
Clin Child Psychol Psychiatry ; 28(4): 1305-1320, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36210796

RESUMO

INTRODUCTION AND AIMS: Despite growing evidence demonstrating the negative mental health effects of racism-related experiences, racial/ethnic discrimination is seldom examined in youth suicide risk. The present study tested the association between racial/ethnic discrimination and well-supported correlates of suicide-related risk including emotion reactivity and dysregulation, and severity of psychiatric symptoms in a sample of ethnoracially minoritized adolescents receiving outpatient psychiatric services. METHODS: Participants were adolescents (N = 46; 80.4% female; 65.2% Latinx) who ranged in age from 13-20 years old (M=15.42; SD=1.83) recruited from a child outpatient psychiatry clinic in a low-resourced community in Northeast US. Youth completed a clinical interview and a battery of surveys. RESULTS: Findings from separate linear regression models show that increases in frequency of racial/ethnic discrimination were associated with increases in severity of suicidal ideation (SI), independent of emotion reactivity and dysregulation, and symptoms of PTSD and depression. Discriminatory experiences involving personal insults, witnessing family being discriminated, and school-based contexts were uniquely associated with SI. DISCUSSION AND CONCLUSION: Preliminary findings support the association between racial/ethnic discrimination and increased severity of suicide-related risk in ethnoracially minoritized adolescents. Accounting for racial/ethnic discrimination may improve the cultural responsiveness of youth suicide prevention strategies within outpatient psychiatric care.


Assuntos
Aceitação pelo Paciente de Cuidados de Saúde , Racismo , Suicídio , Adolescente , Feminino , Humanos , Masculino , Adulto Jovem , Etnicidade/psicologia , Etnicidade/estatística & dados numéricos , Hispânico ou Latino/psicologia , Racismo/etnologia , Racismo/prevenção & controle , Racismo/psicologia , Racismo/estatística & dados numéricos , Ideação Suicida , Suicídio/etnologia , Suicídio/psicologia , Suicídio/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Grupos Minoritários/psicologia , Grupos Minoritários/estatística & dados numéricos , New England/epidemiologia , Pobreza/etnologia , Pobreza/psicologia , Pobreza/estatística & dados numéricos
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