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1.
MMWR Morb Mortal Wkly Rep ; 70(7): 236-239, 2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33600382

RESUMO

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease with manifestations that vary widely in severity. Although minority populations are at higher risk for SLE and have more severe outcomes (1), population-based estimates of mortality by race and ethnicity are often lacking, particularly for Asian and Hispanic/Latino persons. Among 812 patients in the California Lupus Surveillance Project (CLSP) during 2007-2009 (2,3), who were matched to the 2007-2017 National Death Index (NDI), 16.6% had died by 2017. This proportion included persons of White (14.4%), Black (25%), Asian (15.3%), and Hispanic/Latino (15.5%) race/ethnicity. Standardized mortality ratios (SMRs) of observed-to-expected deaths among persons with SLE within each racial/ethnic group were 2.3, 2.0, 3.8, and 3.9, respectively. These findings provide the first population-based estimates of mortality among Asian and Hispanic/Latino persons with SLE. Coordination of robust care models between primary care providers and rheumatologists could ensure that persons with SLE receive a timely diagnosis and appropriate treatments that might help address SLE-associated mortality.


Assuntos
Americanos Asiáticos/estatística & dados numéricos , Hispano-Americanos/estatística & dados numéricos , Lúpus Eritematoso Sistêmico/etnologia , Lúpus Eritematoso Sistêmico/mortalidade , Grupos Minoritários/estatística & dados numéricos , Adolescente , Adulto , Idoso , California/epidemiologia , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade/etnologia , Adulto Jovem
2.
Medicine (Baltimore) ; 100(3): e24136, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33546026

RESUMO

ABSTRACT: Currently, the wide-spread use of screening mammography has led to dramatic increases in ductal carcinoma in situ (DCIS). However, DCIS of Chinese Americans, the largest Asian subgroup in American, has rarely been comprehensively studied over the past decade. This work compared the DCIS characteristics and prognosis of Chinese American patients with White Americans in the USA to determine the characteristics and prognosis of DCIS patients of Chinese Americans.The data were obtained using the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) data. The diagnosis and treatment variables between the two groups were compared by means of Chi-square tests. Survival was determined with the use of the Kaplan-Meier method and the multivariable Cox proportional hazard regression model.From 1975 to 2016, 81,745 White Americans and 2069 Chinese Americans were diagnosed with ductal carcinoma in situ. Compared with the white patients, the Chinese Americans were younger (P < .001) with smaller tumors (P < .001) and higher family income (P < .001). DCIS patients of Chinese American group accounted for a higher percentage of all breast cancers than the whites (P < .001). In the multivariable Cox proportional hazard regression analysis, Chinese American was an independent favorable prognostic factor in terms of overall survival (OS) (HR, 0.684; 95% CI, 0.593-0.789; P < .001) compared with the white group.In conclusion, DCIS characteristics of the Chinese group, which exhibited a higher proportion of younger age, a higher DCIS ratio, and a better prognosis, were distinct from those of the White Americans.


Assuntos
Neoplasias da Mama/etnologia , Carcinoma Intraductal não Infiltrante/etnologia , Adulto , Idoso , Americanos Asiáticos/estatística & dados numéricos , Mama/patologia , Neoplasias da Mama/mortalidade , Neoplasias da Mama/patologia , Carcinoma Intraductal não Infiltrante/mortalidade , Carcinoma Intraductal não Infiltrante/patologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Programa de SEER , Estados Unidos/epidemiologia
3.
J Surg Res ; 257: 246-251, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32862052

RESUMO

BACKGROUND: Training diverse house staff, including those who are underrepresented in medicine, is vital to provide high-quality patient care for the communities that we serve. In 2018, the Accreditation Council for Graduate Medical Education announced new common program requirements for systematic efforts to recruit and retain a diverse workforce. However, questions remain about how to implement such efforts. MATERIALS AND METHODS: Electronic Residency Application Service (ERAS) data from eight residency programs spanning two recruitment cycles (2017-2018, 2018-2019) was reviewed. The number of candidates at each stage in the process (applicant, invited to interview, interviewed, and matched) was examined by self-identified race or ethnicity. These data were presented to residency program directors at our Graduate Medical Education committee meeting before the next recruitment cycle. Data were analyzed following the 2019-20 residency match. Odds ratios and Pearson's chi-squared test were used to assess statistical significance. RESULTS: A total of 10,445 and 10,982 medical students applied to our 8 core residency programs in 2017 and 2018, respectively. Medical students who applied and self-identified as Asian, Black or African American, and Hispanic or Latino or Spanish origin had lower odds of being invited to interview than those who self-identified as White. After data presentation, the odds of inviting Black or African American applicants to interview increased significantly. The odds of attending an interview once invited were the same across groups. CONCLUSIONS: Sharing ERAS data patterns with residency program directors was associated with a significant year over year change in interviewee diversity. Structured analysis of institutional ERAS data can provide insight into the resident selection process and may be a useful tool to improve house staff diversity.


Assuntos
Diversidade Cultural , Mão de Obra em Saúde/organização & administração , Internato e Residência/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Seleção de Pessoal/organização & administração , Estudantes de Medicina/estatística & dados numéricos , Afro-Americanos/estatística & dados numéricos , Americanos Asiáticos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Estudos de Viabilidade , Mão de Obra em Saúde/estatística & dados numéricos , Hispano-Americanos/estatística & dados numéricos , Humanos , Internato e Residência/organização & administração , Candidatura a Emprego , Seleção de Pessoal/estatística & dados numéricos , Estados Unidos
4.
Am J Surg ; 221(1): 155-161, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32758359

RESUMO

BACKGROUND: The purpose of this study was to determine whether racial or other demographic characteristics were associated with declining surgery for early stage gastric cancer. METHODS: Patients with clinical stage I-II gastric adenocarcinoma were identified from the NCDB. Multivariable logistic models identified predictors for declining resection. Patients were stratified based on propensity scores, which were modeled on the probability of declining. Overall survival was evaluated using the Kaplan-Meier method. RESULTS: Of 11,326 patients, 3.68% (n = 417) declined resection. Patients were more likely to refuse if they were black (p < 0.001), had Medicaid or no insurance (p < 0.001), had shorter travel distance to the hospital (p < 0.001) or were treated at a non-academic center (p = 0.001). After stratification, patients who declined surgery had worse overall survival (all strata, p < 0.001). CONCLUSIONS: Racial and sociodemographic disparities exist in the treatment of potentially curable gastric cancer, with patients who decline recommended surgery suffering worse overall survival.


Assuntos
Adenocarcinoma/cirurgia , Afro-Americanos/estatística & dados numéricos , Americanos Asiáticos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Neoplasias Gástricas/cirurgia , Recusa do Paciente ao Tratamento/estatística & dados numéricos , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Demografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Fatores Socioeconômicos , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/patologia , Taxa de Sobrevida , Estados Unidos
5.
Epidemiology ; 32(2): 157-161, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33323745

RESUMO

BACKGROUND: Black, Hispanic, and Indigenous persons in the United States have an increased risk of SARS-CoV-2 infection and death from COVID-19, due to persistent social inequities. However, the magnitude of the disparity is unclear because race/ethnicity information is often missing in surveillance data. METHODS: We quantified the burden of SARS-CoV-2 notification, hospitalization, and case fatality rates in an urban county by racial/ethnic group using combined race/ethnicity imputation and quantitative bias analysis for misclassification. RESULTS: The ratio of the absolute racial/ethnic disparity in notification rates after bias adjustment, compared with the complete case analysis, increased 1.3-fold for persons classified Black and 1.6-fold for those classified Hispanic, in reference to classified White persons. CONCLUSIONS: These results highlight that complete case analyses may underestimate absolute disparities in notification rates. Complete reporting of race/ethnicity information is necessary for health equity. When data are missing, quantitative bias analysis methods may improve estimates of racial/ethnic disparities in the COVID-19 burden.


Assuntos
Afro-Americanos/estatística & dados numéricos , Hispano-Americanos/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Povos Indígenas/estatística & dados numéricos , Mortalidade/etnologia , Americanos Asiáticos/estatística & dados numéricos , Coleta de Dados , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Georgia/epidemiologia , Disparidades nos Níveis de Saúde , Humanos , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Estatística como Assunto , Estados Unidos/epidemiologia
6.
J Med Internet Res ; 22(11): e21684, 2020 11 06.
Artigo em Inglês | MEDLINE | ID: mdl-33108307

RESUMO

BACKGROUND: Media coverage and scholarly research have reported that Asian people who reside in the United States have been the targets of racially motivated incidents during the COVID-19 pandemic. OBJECTIVE: This study aimed to examine the types of discrimination and worries experienced by Asians and Asian Americans living in the United States during the pandemic, as well as factors that were associated with everyday discrimination experience and concerns about future discrimination that the Asian community may face. METHODS: A cross-sectional online survey was conducted. A total of 235 people who identified themselves as Asian or Asian American and resided in the United States completed the questionnaire. RESULTS: Our study suggested that up to a third of Asians surveyed had experienced some type of discrimination. Pooling the responses "very often," "often," and "sometimes," the percentages for each experienced discrimination type ranged between 14%-34%. In total, 49%-58% of respondents expressed concerns about discrimination in the future. The most frequently experienced discrimination types, as indicated by responses "very often" and "often," were "people act as if they think you are dangerous" (25/235, 11%) and "being treated with less courtesy or respect" (24/235, 10%). About 14% (32/235) of individuals reported very often, often, or sometimes being threatened or harassed. In addition, social media use was significantly associated with a higher likelihood of experiencing discrimination (ß=.18, P=.01) and having concerns about future episodes of discrimination the community may face (ß=.20, P=.005). Use of print media was also positively associated with experiencing discrimination (ß=.31, P<.001). CONCLUSIONS: Our study provided important empirical evidence regarding the various types of discrimination Asians residing in the United States experienced or worried about during the COVID-19 pandemic. The relationship between media sources and the perception of racial biases in this group was also identified. We noted the role of social media in reinforcing the perception of discrimination experience and concerns about future discrimination among Asians during this outbreak. Our results indicate several practical implications for public health agencies. To reduce discrimination against Asians during the pandemic, official sources and public health professionals should be cognizant of the possible impacts of stigmatizing cues in media reports on activating racial biases. Furthermore, Asians or Asian Americans could also be informed that using social media to obtain COVID-19 information is associated with an increase in concerns about future discrimination, and thus they may consider approaching this media source with caution.


Assuntos
Americanos Asiáticos/psicologia , Americanos Asiáticos/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Meios de Comunicação de Massa/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Racismo/psicologia , Racismo/estatística & dados numéricos , Inquéritos e Questionários , Adolescente , Adulto , Idoso , Grupos de Populações Continentais/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Saúde Pública , Mídias Sociais/estatística & dados numéricos , Estados Unidos/epidemiologia , Adulto Jovem
7.
Obstet Gynecol ; 136(5): 892-901, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33030867

RESUMO

OBJECTIVE: To evaluate the associations between the number of chronic conditions and maternal race and ethnicity (race) with the risk of severe maternal morbidity. METHODS: Using the National Inpatient Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality, years 2016-2017, we examined risk of severe maternal morbidity among 1,480,925 delivery hospitalizations among women of different races and with different numbers of comorbid conditions using multivariable logistic regression. RESULTS: The rate of severe maternal morbidity was 139.7 per 10,000 deliveries. Compared with women with no comorbidities (rate 48.5/10,000), there was increased risk of severe maternal morbidity among women with one comorbidity (rate 238.6; odds ratio [OR] 5.0, 95% CI 4.8-5.2), two comorbidities (rate 379.9; OR 8.1, 95% CI 7.8-8.5), or three or more comorbidities (rate 560; OR 12.1, 95% CI 11.5-12.7). In multivariable regressions, similar associations were noted for women with one (adjusted odds ratio [aOR] 4.4, 95% CI 4.2-4.6), two (aOR 6.6, 95% CI 6.3-6.9), or three or more comorbidities (aOR 9.1, 95% CI 8.7-9.6). Black women had higher rates of comorbid conditions than all other racial and ethnic groups, with 55% (95% CI 54-56%) of Black women having no comorbidities, compared with 67% (95% CI 67-68%) of White women, 68% (95% CI 67-69%) of Hispanic women, and 72% (95% CI 71-73%) of Asian women. CONCLUSION: We found a dose-response relationship between number of comorbidities and risk of severe maternal morbidity, with the highest rates of severe maternal morbidity among women with three or more comorbidities. Focusing on the prevention and treatment of chronic conditions among women of childbearing age may have the potential to improve maternal outcomes across races and ethnicities.


Assuntos
Doença Crônica/epidemiologia , Grupos de Populações Continentais/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Complicações na Gravidez/epidemiologia , Adulto , Afro-Americanos/estatística & dados numéricos , Americanos Asiáticos/estatística & dados numéricos , Doença Crônica/etnologia , Comorbidade , Parto Obstétrico/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Disparidades nos Níveis de Saúde , Hispano-Americanos/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Razão de Chances , Gravidez , Complicações na Gravidez/etnologia , Estados Unidos/epidemiologia
8.
Pediatrics ; 146(4)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32883808

RESUMO

BACKGROUND: Children with isolated neutropenia (absolute neutrophil count [ANC] <1500/µL) are frequently referred to pediatric hematology and oncology clinics for further diagnostic evaluation. Scant literature exists on interventions and outcomes for isolated neutropenia. We hypothesized that children will have resolution of their neutropenia without the need for intervention(s) by a pediatric hematologist and oncologist. METHODS: We performed a 5.5-year institutional review board-approved retrospective chart review of children referred to our pediatric hematology and oncology clinics for isolated neutropenia. Neutropenia was categorized as mild (ANC of 1001-1500/µL), moderate (ANC of 500-1000 µL), severe (ANC of 201-500/µL), or very severe (ANC of ≤200/µL). RESULTS: Among 155 children referred with isolated neutropenia, 45 (29%) had mild neutropenia, 65 (42%) had moderate neutropenia, 30 (19%) had severe neutropenia, and 15 (10%) had very severe neutropenia. Only 29 (19%) children changed to an ANC category lower than their initial referral category. At a median follow-up of 12 months, 101 children had resolution of neutropenia, 40 children had mild neutropenia, 10 children had moderate neutropenia, 3 children had severe neutropenia, and 1 patient had very severe neutropenia. A specific diagnosis was not identified in most (54%) children. The most common etiologies were viral suppression (16%), autoimmune neutropenia (14%), and drug-induced neutropenia (8%). Black children had a 3.5 higher odds of having persistent mild neutropenia. Six (4%) children received granulocyte colony-stimulating factor therapy. CONCLUSIONS: Most children referred for isolated neutropenia do not progress in severity and do not require subspecialty interventions or hospitalizations.


Assuntos
Neutropenia/epidemiologia , Encaminhamento e Consulta/estatística & dados numéricos , Adolescente , Afro-Americanos/estatística & dados numéricos , Anticorpos Antinucleares/análise , Americanos Asiáticos/estatística & dados numéricos , Doenças Autoimunes/complicações , Neutropenia Febril Induzida por Quimioterapia/epidemiologia , Criança , Pré-Escolar , Progressão da Doença , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Seguimentos , Fator Estimulador de Colônias de Granulócitos/uso terapêutico , Hematologia , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , Oncologia , Neutropenia/diagnóstico , Neutropenia/tratamento farmacológico , Neutropenia/etiologia , Remissão Espontânea , Estudos Retrospectivos , Viroses/complicações
9.
Artigo em Inglês | MEDLINE | ID: mdl-32858944

RESUMO

The primary purpose of this study was to describe obesity, body composition, convenience food consumption, physical activity, and muscle strength among Asian American youth compared to other racial/ethnic groups. The secondary purpose was to examine whether obesity, body composition, convenience food consumption, physical activity, and muscle strength differed by acculturation levels among Asian American youth. A secondary analysis was conducted using data from 12,763 children aged 2 to 17 years that participated in the 2011-2018 US National Health and Nutrition Examination Survey (NHANES). In the NHANES interview, acculturation, dietary behavior, and physical activity questionnaires were administered. The acculturation level was indicated by the language spoken at home. In the NHANES examination, anthropometry, dual-energy X-ray absorptiometry (DXA), and muscle strength assessments were conducted. Compared to non-Hispanic White American boys, Asian American boys had similar levels of obesity, central obesity, and fat mass. Among the five racial/ethnic groups examined, lean body mass, muscle mass, convenience food consumption, and daily physical activity were the lowest in the Asian group. More acculturated Asian American boys, but not girls, were more likely to be obese (OR = 3.28 (1.63, 6.60)). More acculturated Asian American youth more frequently consumed convenience food (1.4 more meals/month (1.2, 1.6)). This study highlights the obesity problem among Asian American boys, which worsens with acculturation to America. The study results also suggest that although Asian American youth consume less convenience food overall than non-Hispanic White American youth, increasing acculturation may negatively influence food choices.


Assuntos
Aculturação , Americanos Asiáticos/estatística & dados numéricos , Composição Corporal/fisiologia , Exercício Físico , Fast Foods/estatística & dados numéricos , Comportamento Alimentar/etnologia , Obesidade/prevenção & controle , Adolescente , Americanos Asiáticos/psicologia , Criança , Pré-Escolar , Fast Foods/efeitos adversos , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Inquéritos Nutricionais , Obesidade/etnologia , Fatores Socioeconômicos , Estados Unidos/epidemiologia
10.
JAMA Netw Open ; 3(6): e205867, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32515797

RESUMO

Importance: As health information transparency increases, patients more often seek their health data. More than 44 million patients in the US can now readily access their ambulatory visit notes online, and the practice is increasing abroad. Few studies have assessed documentation errors that patients identify in their notes and how these may inform patient engagement and safety strategies. Objective: To assess the frequency and types of errors identified by patients who read open ambulatory visit notes. Design, Setting, and Participants: In this survey study, a total of 136 815 patients at 3 US health care organizations with open notes, including 79 academic and community ambulatory care practices, received invitations to an online survey from June 5 to October 20, 2017. Patients who had at least 1 ambulatory note and had logged onto the portal at least once in the past 12 months were included. Data analysis was performed from July 3, 2018, to April 27, 2020. Exposures: Access to ambulatory care open notes through patient portals for up to 7 years (2010-2017). Main Outcomes and Measures: Proportion of patients reporting a mistake and how serious they perceived the mistake to be, factors associated with finding errors characterized by patients as serious, and categories of patient-reported errors. Results: Of 136 815 patients who received survey invitations, 29 656 (21.7%) responded and 22 889 patients (mean [SD] age, 55.16 [15.96] years; 14 447 [63.1%] female; 18 301 [80.0%] white) read 1 or more notes in the past 12 months and completed error questions. Of these patients, 4830 (21.1%) reported a perceived mistake and 2043 (42.3%) reported that the mistake was serious (somewhat serious: 1563 [32.4%]; very serious: 480 [9.9%]). In multivariable analysis, female patients (relative risk [RR], 1.79; 95% CI, 1.72-1.85), more educated patients (RR, 1.38; 95% CI, 1.29-1.48), sicker patients (RR, 1.89; 95% CI, 1.84-1.94), those aged 45 to 64 years (RR, 2.23; 95% CI, 2.06-2.42), those 65 years or older (RR, 2.00; 95% CI, 1.73-2.32), and those who read more than 1 note (2-3 notes: RR, 1.82; 95% CI, 1.34-2.47; ≥4 notes: RR, 3.09; 95% CI, 2.02-4.73) were more likely to report a mistake that they found to be serious compared with their reference groups. After categorization of patient-reported very serious mistakes, those specifically mentioning the word diagnosis or describing a specific error in current or past diagnoses were most common (98 of 356 [27.5%]), followed by inaccurate medical history (85 of 356 [23.9%]), medications or allergies (50 of 356 [14.0%]), and tests, procedures, or results (30 of 356 [8.4%]). A total of 23 (6.5%) reflected notes reportedly written on the wrong patient. Of 433 very serious errors, 255 (58.9%) included at least 1 perceived error potentially associated with the diagnostic process (eg, history, physical examination, tests, referrals, and communication). Conclusions and Relevance: In this study, patients who read ambulatory notes online perceived mistakes, a substantial proportion of which they found to be serious. Older and sicker patients were twice as likely to report a serious error compared with younger and healthier patients, indicating important safety and quality implications. Sharing notes with patients may help engage them to improve record accuracy and health care safety together with practitioners.


Assuntos
Confiabilidade dos Dados , Documentação/normas , Registros Eletrônicos de Saúde/estatística & dados numéricos , Registros Eletrônicos de Saúde/normas , Adolescente , Adulto , Afro-Americanos/estatística & dados numéricos , Fatores Etários , Idoso , Assistência Ambulatorial , Americanos Asiáticos/estatística & dados numéricos , Testes Diagnósticos de Rotina , Escolaridade , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Anamnese , Reconciliação de Medicamentos , Pessoa de Meia-Idade , Gravidade do Paciente , Fatores Sexuais , Inquéritos e Questionários , Adulto Jovem
11.
South Med J ; 113(6): 311-319, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32483642

RESUMO

OBJECTIVES: Prevalence and trends in all cardiovascular disease (CVD) risk factors among young adults (18-39 years) have not been evaluated on a large scale stratified by sex and race. The aim of this study was to establish the prevalence and temporal trend of CVD risk factors in US inpatients younger than 40 years of age from 2007 through 2014 with racial and sex-based distinctions. In addition, the impact of these risk factors on inpatient outcomes and healthcare resource utilization was explored. METHODS: A cross-sectional nationwide analysis of all hospitalizations, comorbidities, and complications among young adults from 2007 to 2014 was performed. The primary outcomes were frequency, trends, and race- and sex-based differences in coexisting CVD risk factors. Coprimary outcomes were trends in all-cause mortality, acute myocardial infarction, arrhythmia, stroke, and venous thromboembolism in young adults with CVD risk factors. Secondary outcomes were demographics and resource utilization in young adults with versus without CVD risk factors. RESULTS: Of 63 million hospitalizations (mean 30.5 [standard deviation 5.9] years), 27% had at least one coexisting CVD risk factor. From 2007 to 2014, admission frequency with CVD risk factors increased from 42.8% to 55.1% in males and from 16.2% to 24.6% in females. Admissions with CVD risk were higher in male (41.4% vs 15.9%) and white (58.4% vs 53.8%) or African American (22.6% vs 15.9%) patients compared with those without CVD risk. Young adults in the Midwest (23.9% vs 21.1%) and South (40.8% vs 37.9%) documented comparatively higher hospitalizations rates with CVD risk. Young adults with CVD risk had higher all-cause in-hospital mortality (0.4% vs. 0.3%) with a higher average length of stay (4.3 vs 3.2 days) and charges per admission ($30,074 vs $20,124). CONCLUSIONS: Despite modern advances in screening, management, and interventional measures for CVD, rising trends in CVD risk factors across all sex and race/ethnic groups call for attention by preventive cardiologists.


Assuntos
Diabetes Mellitus/epidemiologia , Dislipidemias/epidemiologia , Hipertensão/epidemiologia , Obesidade/epidemiologia , Doenças Vasculares Periféricas/epidemiologia , Fumar/epidemiologia , Adolescente , Adulto , Afro-Americanos/estatística & dados numéricos , Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/etnologia , Americanos Asiáticos/estatística & dados numéricos , Bases de Dados Factuais , Diabetes Mellitus/etnologia , Dislipidemias/etnologia , Grupos Étnicos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Mortalidade Hospitalar , Hospitalização , Humanos , Hipertensão/etnologia , Índios Norte-Americanos/estatística & dados numéricos , Masculino , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/etnologia , Obesidade/etnologia , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Doenças Vasculares Periféricas/etnologia , Prevalência , Fatores de Risco , Fatores Sexuais , Fumar/etnologia , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etnologia , Estados Unidos/epidemiologia , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/etnologia , Adulto Jovem
12.
J Public Health (Oxf) ; 42(3): 470-478, 2020 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-32490519

RESUMO

BACKGROUND: Recent reports indicate racial disparities in the rates of infection and mortality from the 2019 novel coronavirus (coronavirus disease 2019 [COVID-19]). The aim of this study was to determine whether disparities exist in the levels of knowledge, attitudes and practices (KAPs) related to COVID-19. METHODS: We analyzed data from 1216 adults in the March 2020 Kaiser Family Foundation 'Coronavirus Poll', to determine levels of KAPs across different groups. Univariate and multivariate regression analysis was used to identify predictors of KAPs. RESULTS: In contrast to White respondents, Non-White respondents were more likely to have low knowledge (58% versus 30%; P < 0.001) and low attitude scores (52% versus 27%; P < 0.001), but high practice scores (81% versus 59%; P < 0.001). By multivariate regression, White race (odds ratio [OR] 3.06; 95% confidence interval [CI]: 1.70-5.50), higher level of education (OR 1.80; 95% CI: 1.46-2.23) and higher income (OR 2.06; 95% CI: 1.58-2.70) were associated with high knowledge of COVID-19. Race, sex, education, income, health insurance status and political views were all associated with KAPs. CONCLUSIONS: Racial and socioeconomic disparity exists in the levels of KAPs related to COVID-19. More work is needed to identify educational tools that tailor to specific racial and socioeconomic groups.


Assuntos
Afro-Americanos/estatística & dados numéricos , Americanos Asiáticos/estatística & dados numéricos , Infecções por Coronavirus/psicologia , Grupos Étnicos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Hispano-Americanos/estatística & dados numéricos , Pneumonia Viral/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Pandemias , Pneumonia Viral/epidemiologia , Fatores Raciais , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
14.
Am J Public Health ; 110(8): 1205-1207, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32552026

RESUMO

Objectives. To study the impact on mortality in Hawaii from the revoked state Medicaid program coverage in March 2015 for most Compact of Free Association (COFA) migrants who were nonblind, nondisabled, and nonpregnant.Methods. We computed quarterly crude mortality rates for COFA migrants, Whites, and Japanese Americans from March 2012 to November 2018. We employed a difference-in-difference research design to estimate the impact of the Medicaid expiration on log mortality rates.Results. We saw larger increases in COFA migrant mortality rates than White mortality rates after March 2015. By 2018, the increase was 43% larger for COFA migrants (P = .003). Mortality trends over this period were similar for Whites and Japanese Americans, who were not affected by the policy.Conclusions. Mortality rates of COFA migrants increased after Medicaid benefits expired despite the availability of state-funded premium coverage for private insurance and significant outreach efforts to reduce the impact of this coverage change.


Assuntos
Cobertura do Seguro , Seguro Saúde , Medicaid/estatística & dados numéricos , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Mortalidade , Migrantes/estatística & dados numéricos , Adulto , Americanos Asiáticos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Hawaii , Acesso aos Serviços de Saúde , Humanos , Pessoas sem Cobertura de Seguro de Saúde/etnologia , Pessoa de Meia-Idade , Mortalidade/etnologia , Mortalidade/tendências , Estados Unidos
15.
JAMA Netw Open ; 3(6): e205824, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32589228

RESUMO

Importance: Increased work requirements have been proposed throughout federal safety net programs, including the Supplemental Nutrition Assistance Program (SNAP). Participation in SNAP is associated with reduced food insecurity and improved health. Objectives: To determine whether SNAP work requirements are associated with lower rates of program participation and to examine whether there are racial/ethnic disparities or spillover effects for people with disabilities, who are not intended to be affected by work requirements. Design, Setting, and Participants: This nationally representative, pooled cross-sectional study examined how changes in SNAP work requirements at state and local levels in the US are associated with changes in food voucher program participation. The study combined information on state and local SNAP work requirements with repeated cross-sections from the 2012 through 2017 American Community Survey (with outcomes covering 2013 to 2017). The analytical approaches were based on difference-in-difference and triple-difference methods, after controlling for other economic and social factors. The sample included low-income adults without dependents, stratified by racial/ethnic group and disability status. The study also included parents who would otherwise meet work requirement criteria as a comparison group to estimate triple-difference models. This accounted for otherwise unobserved factors affecting trends in SNAP participation within local areas. Data were analyzed from January 2019 through March 2020. Exposure: Residence in areas where SNAP work requirements apply. Main Outcomes and Measures: The primary outcome is SNAP participation measured by whether anyone in the household received food vouchers at any point over the prior 12 months. Results: The final analytical sample included 866 000 low-income adults (weighted mean [SE] age, 33.6 [0.01] years; 42.5% [SE, 0.07%] men). The racial/ethnic breakdown was 56.5% (SE, 0.07%) non-Hispanic white respondents, 19.4% (SE, 0.06%) non-Hispanic black respondents, 17.7% (SE, 0.06%) Hispanic respondents, 2.5% (SE, 0.02%) Asian respondents, and 3.9% (SE, 0.03%) respondents of other or multiple races. In final triple-difference models, work requirements were associated with a 4.0 percentage point decrease in participation (95% CI, -0.048 to -0.032; P < .001) for childless adults without disability, equivalent to a 21.2% reduction in SNAP participation (95% CI, -25.5% to -17.0%). For childless adults with disability, work requirements were associated with a 4.0 percentage point reduction (95% CI, -0.058 to -0.023; P < .001), equivalent to 7.8% fewer SNAP participants with disability (95% CI, -11.2% to -4.4%). When the final models were stratified by race/ethnicity, benefit reductions were larger for non-Hispanic black adults (7.2 percentage points; 95% CI, -0.092 to -0.051; P < .001) and Hispanic adults (5.5 percentage points; 95% CI, -0.072 to -0.038; P < .001) than for non-Hispanic white adults (2.6 percentage points; 95% CI, -0.035 to -0.016; P < .001). Conclusions and Relevance: Because of the association of SNAP with food security and health, work requirements that lead to benefit loss may create nutritional and health harm for low-income Americans. These findings suggest that there may be racially disparate consequences and unintended harm for those with disability.


Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Emprego/legislação & jurisprudência , Emprego/estatística & dados numéricos , Assistência Alimentar/estatística & dados numéricos , Assistência Alimentar/tendências , Adulto , Afro-Americanos/estatística & dados numéricos , Americanos Asiáticos/estatística & dados numéricos , Estudos Transversais , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Características da Família , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Pobreza , Inquéritos e Questionários , Estados Unidos
16.
AIDS Educ Prev ; 32(2): 117-136, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32539477

RESUMO

Very few studies have been conducted to investigate HIV risk and protective behaviors in relation to psychosocial factors among Asian and Pacific Islander (API) MSM whose HIV/AIDS prevalence is lower than those of other racial/ethnic groups. This study, based on an online survey targeting API MSM in California revealed that API MSM often met sex partners online and that psychosocial factors (e.g., homophobia and identity with API gay community) were correlated with condomless receptive anal sex (RAS) with casual partners. In particular, an Asian cultural construct, interdependency, was correlated with condom use for RAS; that is, those who consider sex partners' health and value harmony tend to engage in safe sex. This finding sheds light on re-thinking the current over-emphasis on assertiveness and self-responsibility to keep free from HIV/STIs during negotiation with partners. Future STI prevention programs for API MSM should incorporate Asian cultural constructs and target specific risk groups.


Assuntos
Americanos Asiáticos/estatística & dados numéricos , Infecções por HIV/epidemiologia , Homossexualidade Masculina/psicologia , Internet , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Sexo Seguro/estatística & dados numéricos , Doenças Sexualmente Transmissíveis/epidemiologia , Adolescente , Adulto , Americanos Asiáticos/psicologia , California/epidemiologia , Infecções por HIV/psicologia , Homossexualidade Masculina/etnologia , Humanos , Masculino , Pessoa de Meia-Idade , Grupo com Ancestrais Oceânicos/psicologia , Prevalência , Assunção de Riscos , Sexo Seguro/psicologia , Parceiros Sexuais , Doenças Sexualmente Transmissíveis/psicologia , Inquéritos e Questionários , Adulto Jovem
17.
JAMA Netw Open ; 3(6): e204945, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32530471

RESUMO

Importance: New-onset diabetes after the age of 50 years is a potential indicator of pancreatic cancer. Understanding the associations between hyperglycemia, diabetes, and pancreatic cancer, including pancreatic ductal adenocarcinoma, is key to developing an approach to early detection. Objective: To assess the association of elevation in glycated hemoglobin (HbA1c) with the risk of pancreatic cancer. Design, Setting, and Participants: This cohort study was conducted using data collected from an integrated health care system in California. A total of 851 402 patients aged 50 to 84 years who had HbA1c measurements taken between 2010 and 2014 were identified as the base cohort, with 12 contemporaneous cohorts created based on varying HbA1c thresholds (ie, 6.1%, 6.3%, 6.5%, and 6.7%) and prior diabetes status. Data analysis was conducted from August 2018 to September 2019. Main Outcomes and Measures: New cases of pancreatic cancer identified through cancer registry and California death files during a 3-year period. Three-year risk, incidence rate, sensitivity, number of patients needed to screen to detect 1 case, timing, and stage at diagnosis were determined. Results: Among 851 402 patients in the base cohort, 447 502 (52.5%) were women, 255 441 (30.0%) were Hispanic participants, 383 685 (45.1%) were non-Hispanic white participants, 100 477 (11.8%) were Asian participants, and 88 969 (10.4%) were non-Hispanic black participants, with a median (interquartile range) age of 62 (56-69) years and a median (interquartile range) HbA1c level of 6.0% (5.7%-6.6%). The incidence rate of pancreatic cancer was 0.45 (95% CI, 0.43-0.49) per 1000 person-years. After excluding prior diabetes as well as confirmation of new-onset hyperglycemia based on an HbA1c level of 6.5%, a total of 20 012 patients remained, with 74 of 1041 pancreatic ductal adenocarcinoma cases (7.1%) from the base cohort included. The rate of pancreatic cancer was 0.72 (95% CI, 0.32-1.42) per 1000 person-years among Asian patients, 0.83 (95% CI, 0.35-1.71) per 1000 person-years among non-Hispanic black patients, 0.84 (95% CI, 0.48-1.37) per 1000 person-years among Hispanic patients, and 2.37 (95% CI, 1.75-3.14) per 1000 person-years among non-Hispanic white patients. Overall, 42 of 74 cancers (56.8%) were diagnosed within 1 year of the index laboratory test. Among 1041 total cases, 708 (68.0%) had staging information available, of whom 465 (65.7%) had stage III or IV disease at diagnosis. In the base cohort, the number needed to undergo evaluation to identify a single case of pancreatic ductal adenocarcinoma was 818 (95% CI, 770-869), with estimates ranging from 206 (95% CI, 160-264) to 600 (95% CI, 540-666) in the subcohorts. Conclusions and Relevance: The findings of this study suggest that screening patients for pancreatic cancer based solely on elevation in HbA1c level is unlikely to represent an effective strategy. Future efforts to identify a high-risk population based on changes in glycemic parameters should account for racial/ethnic differences.


Assuntos
Carcinoma Ductal Pancreático/epidemiologia , Diabetes Mellitus/sangue , Hemoglobina A Glicada/metabolismo , Neoplasias Pancreáticas/epidemiologia , Afro-Americanos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Americanos Asiáticos/estatística & dados numéricos , California/epidemiologia , Carcinoma Ductal Pancreático/etnologia , Carcinoma Ductal Pancreático/patologia , Diabetes Mellitus/diagnóstico , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Pancreáticas/etnologia , Neoplasias Pancreáticas/patologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
18.
Arch Phys Med Rehabil ; 101(8): 1383-1388, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32416150

RESUMO

OBJECTIVE: To examine demographic, psychiatric symptom, and neuropsychological performance factors associated with duration of unemployment in Iraq/Afghanistan Veterans with a history of mild-to-moderate traumatic brain injury (TBI). DESIGN: Cross-sectional, secondary data analysis of baseline measures in a supported employment study. SETTING: VA medical center. PARTICIPANTS: Participants (N=50) were veterans with a history of mild-to-moderate TBI who were unemployed, stating a goal of returning to work, and had documented impairment in at least 1 neuropsychological domain. Participants were referred from VA vocational and assessment-based clinics. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Duration of unemployment, neuropsychological, and psychiatric symptom assessments. RESULTS: Bivariate correlations revealed that longer duration of unemployment was associated with greater posttraumatic stress disorder (P<.10) and depressive (P<.05) symptom severity, worse executive functioning (P<.05), and racial/ethnic minority status (P<.05). A multiple linear regression analysis including these independent variables explained 26.5% of the variance in duration of unemployment. Worse executive functioning, specifically reasoning and set-shifting, and minority status were each associated with longer duration of unemployment in the context of multiple independent variables. CONCLUSIONS: Our results underscore the importance of objective assessment of cognitive functioning in job-seeking Veterans with TBI histories. It may be useful to target aspects of executive functioning in vocational rehabilitation interventions and to provide additional assistance to Veterans from racial/ethnic minority groups.


Assuntos
Concussão Encefálica/psicologia , Função Executiva , Grupos Minoritários/estatística & dados numéricos , Desemprego/estatística & dados numéricos , Veteranos/psicologia , Veteranos/estatística & dados numéricos , Adulto , Americanos Asiáticos/estatística & dados numéricos , Estudos Transversais , Depressão/psicologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Masculino , Escalas de Graduação Psiquiátrica , Transtornos de Estresse Pós-Traumáticos/psicologia , Fatores de Tempo , Adulto Jovem
19.
BMC Neurol ; 20(1): 163, 2020 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-32354354

RESUMO

BACKGROUND: Research is needed to examine differences in multiple sclerosis (MS) prevalence by race-ethnicity. The goal of this study was to quantify MS prevalence in a health care system in Northern California and examine differences in prevalence and phenotype by race-ethnicity. METHODS: We conducted a retrospective, observational cohort study of adults (2010-2016). MS prevalence estimates were standardised to distributions of gender and race-ethnicity for the underlying geographic region and stratified by gender and race-ethnicity with age adjustment. We performed a chart review of a racial-ethnic stratified sample of patients to examine disease phenotypes. RESULTS: 1,058,102 patients were identified, of which 3286 had MS. The overall direct-standardised prevalence was 288.0 cases per 100,000 population (95% confidence interval: 276.3-299.8). Age-adjusted prevalence ranged from 677.0 per 100,000 among non-Hispanic black women to 49.7 per 100,000 among non-Hispanic Asian men. Non-Hispanic blacks compared with other groups more often had primary-progressive (10.0% vs. 0.0-4.0%) or progressive-relapsing MS (6.0% vs. 0.0-2.0%). CONCLUSIONS: In this Northern Californian Cohort, between 2010 and 2016 the direct-standardised MS prevalence was estimated at 288.0 per 100,000 population, and increased over time. Non-Hispanic blacks, especially women, were disproportionately affected and had less common, earlier progressive MS phenotypes.


Assuntos
Grupos Étnicos/estatística & dados numéricos , Esclerose Múltipla/epidemiologia , Adulto , Afro-Americanos/estatística & dados numéricos , Fatores Etários , Americanos Asiáticos/estatística & dados numéricos , California/epidemiologia , Estudos de Coortes , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Fenótipo , Prevalência , Estudos Retrospectivos , Fatores Sexuais
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