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1.
Law Hum Behav ; 45(3): 243-255, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34351206

RESUMO

OBJECTIVE: Although researchers, policymakers, and practitioners recognize the importance of the public's perceptions of police, few studies have examined developmental trends in adolescents and young adults' views of police. HYPOTHESES: Hypothesis 1: Perceptions of police legitimacy would exhibit a U-shaped curve, declining in adolescence before improving in young adulthood. Hypothesis 2: At all ages, Black youth would report more negative perceptions of police legitimacy than Latino youth, who would report more negative perceptions than White youth. Hypothesis 3: Perceptions of police bias would be consistently associated with worse perceptions of police legitimacy. METHOD: Utilizing longitudinal data from the Crossroads Study, this study examined within-person trends in males' perceptions of police legitimacy from ages 13 to 22, as well as whether perceptions of police bias were associated with perceptions of police legitimacy. RESULTS: Perceptions of police legitimacy followed a U-shaped curve that declined during adolescence, reached its lowest point around age 18, and improved during the transition to young adulthood. Compared with White youth, Latino and Black youth had shallower curves in perceptions of police legitimacy that exhibited less improvement during the transition to adulthood. Further, perceptions of police bias were consistently associated with more negative perceptions of police legitimacy across races and ages. CONCLUSIONS: While perceptions of police legitimacy may decline during adolescence before improving during the transition to adulthood, perceptions of police bias are consistently negatively related to youth and young adults' perceptions of police legitimacy. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Grupo com Ancestrais do Continente Africano/psicologia , Atitude/etnologia , Grupo com Ancestrais do Continente Europeu/psicologia , Hispano-Americanos/psicologia , Percepção , Polícia , Racismo/etnologia , Adolescente , Fatores Etários , Humanos , Aplicação da Lei , Estudos Longitudinais , Masculino , Estados Unidos/etnologia , Adulto Jovem
2.
Am J Health Behav ; 45(4): 665-676, 2021 07 26.
Artigo em Inglês | MEDLINE | ID: mdl-34340734

RESUMO

Objectives: The purpose of this study was to understand COVID-19 information seeking among Korean immigrant women in comparison to their flu/cold information seeking. In particular, the study aimed to examine: (1) the levels of information sought regarding both COVID-19 and the flu/cold, and (2) the content of information discussed at each level. Methods: We analyzed the posts on Missy USA--one of the largest Korean online communities for married Korean immigrant women. Two sets of data, one for COVID-19 (n=726) and the other for the flu/cold (n=50), were analyzed with codes at different levels, which were adapted from the social-ecological model. Results: Applying the social-ecological model, we found that about 80% of information regarding the flu/cold and about 60% of COVID-19 information was concentrated at individual, interpersonal, and organizational levels. Information seeking at the community level was more frequent for COVID-19 than for the flu/cold. Conclusions: Our finding that Korean immigrant women primarily sought information regarding COVID-19 serves as a theoretical contribution at the transnational level, which might be relevant for immigrant women during the unprecedented COVID-19 pandemic.


Assuntos
COVID-19 , Resfriado Comum , Informação de Saúde ao Consumidor , Emigrantes e Imigrantes , Influenza Humana , Comportamento de Busca de Informação , Mídias Sociais , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , República da Coreia/etnologia , Estados Unidos/etnologia
3.
PLoS One ; 16(7): e0255132, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34314458

RESUMO

OBJECTIVE: Limited evidence suggests that higher levels of serum vitamin D (25(OH)D) protect against SARS-CoV-2 virus (COVID-19) infection. Black women commonly experience 25(OH)D insufficiency and are overrepresented among COVID-19 cases. We conducted a prospective analysis of serum 25(OH)D levels in relation to COVID-19 infection among participants in the Black Women's Health Study. METHODS: Since 1995, the Black Women's Health Study has followed 59,000 U.S. Black women through biennial mailed or online questionnaires. Over 13,000 study participants provided a blood sample in 2013-2017. 25(OH)D assays were performed in a certified national laboratory shortly after collection of the samples. In 2020, participants who had completed the online version of the 2019 biennial health questionnaire were invited to complete a supplemental online questionnaire assessing their experiences related to the COVID-19 pandemic, including whether they had been tested for COVID-19 infection and the result of the test. We used logistic regression analysis to estimate odds ratios (OR) and 95% confidence intervals (CI) for the association of 25(OH)D level with COVID-19 positivity, adjusting for age, number of people living in the household, neighborhood socioeconomic status, and other potential confounders. RESULTS: Among 5,081 eligible participants whose blood sample had been assayed for 25(OH)D, 1,974 reported having had a COVID-19 test in 2020. Relative to women with 25(OH)D levels of 30 ng/mL (75 nmol/l) or more, multivariable-adjusted ORs for COVID-19 infection in women with levels of 20-29 ng/mL (50-72.5 nmol/l) and <20 ng/mL (<50 nmol/l) were, respectively, 1.48 (95% CI 0.95-2.30) and 1.69 (95% CI 1.04-2.72) (p trend 0.02). CONCLUSION: The present results suggest that U.S. Black women with lower levels of 25(OH)D are at increased risk of infection with COVID-19. Further work is needed to confirm these findings and determine the optimal level of 25(OH)D for a beneficial effect.


Assuntos
Afro-Americanos/estatística & dados numéricos , COVID-19/sangue , COVID-19/epidemiologia , Vitamina D/análogos & derivados , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Pandemias , Fatores de Risco , Estados Unidos/epidemiologia , Estados Unidos/etnologia , Vitamina D/sangue
4.
Neurology ; 97(8): e825-e835, 2021 08 24.
Artigo em Inglês | MEDLINE | ID: mdl-34088871

RESUMO

OBJECTIVE: The associations of Lewy bodies (LBs) with olfactory dysfunction, parkinsonism, and higher odds of dementia were assessed in Black and White community-dwelling elders and racial differences in these associations were tested. METHODS: Black decedents (n = 81) were matched 2-to-1 by age, sex, years of education, and follow-up time in the study with White decedents (n = 154) from 4 longitudinal studies of dementia and aging. Participants underwent uniform clinical examination and cognitive, motor, and olfactory testing. LBs were detected in 7 brain regions by α-synuclein immunohistochemistry and racial differences in their association with olfaction, parkinsonism, and odds of dementia were determined using regression analyses. RESULTS: The mean scores of the odor test, global parkinsonism signs, and global cognition were lower in Black than White decedents; the frequency of dementia was similar in both groups. The frequency of LBs was similar in Black and White decedents (∼25%), as was the frequency of LBs in individual brain regions, while the mean LB counts/mm2 were similar in all regions except the cingulate cortex, which showed higher mean LB counts in Black decedents. In regression analyses, LBs were associated with impaired olfaction (-2.23, 95% confidence interval [CI] -3.45 to -1.01) and higher odds of dementia (odds ratio 3.0, 95% CI 1.10-8.17) in both racial groups; an association with parkinsonism was stronger in Black than White decedents. CONCLUSIONS: The frequency, distribution, and clinical manifestations of LBs are similar in Black and White elders.


Assuntos
Afro-Americanos/etnologia , Tonsila do Cerebelo/patologia , Córtex Cerebral/patologia , Grupo com Ancestrais do Continente Europeu/etnologia , Corpos de Lewy/patologia , Doença por Corpos de Lewy/etnologia , Transtornos do Olfato/etnologia , Substância Negra/patologia , Idoso , Idoso de 80 Anos ou mais , Autopsia , Feminino , Humanos , Doença por Corpos de Lewy/complicações , Doença por Corpos de Lewy/patologia , Doença por Corpos de Lewy/fisiopatologia , Estudos Longitudinais , Masculino , Transtornos do Olfato/etiologia , Transtornos do Olfato/fisiopatologia , Índice de Gravidade de Doença , Estados Unidos/etnologia
6.
Anthropol Med ; 28(2): 223-238, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34058932

RESUMO

Opioids, a set of potent pain medications, have numerous known deleterious side effects, ranging from constipation to respiratory depression and death, and yet they are routinely prescribed and administered in biomedical settings. Situated against the backdrop of the US opioid epidemic, this paper examines how the iatrogenic and inadvertent harms and complications caused by opioid administration in clinical settings are experienced by clinicians as forms of moral injury. 'Moral injury' describes a moral agent's experience of perpetrating or being unable to prevent events that are at odds with their moral beliefs and social expectations. This concept powerfully extends Illich's notion of clinical iatrogenesis, which refers to harms experienced by patients; instead, 'moral injury' indexes forms of harm that extend beyond patients to those providing them care. Using an analytic auto-ethnographic approach based on more than a decade of clinical practice in urban hospitals in the Midwestern and Northeastern United States, the authors describe interactions with patients on opioids whose treatment trajectories are fraught with iatrogenic complications, and explore how biomedical institutions and systems further harm vulnerable patients who receive and are addicted to opioids. Though anxious to avoid harming their patients, clinicians are disempowered by hierarchical systems of medical decision-making, which hinder their ability to always act in what they feel are the patient's best interests. This paper highlights the emotional/affective distress and ambivalence experienced by physicians when making decisions about whether to administer or prescribe opioids. Ultimately, the paper demonstrates how iatrogenesis and moral injury are concomitantly produced through cascades of decision-making and local health systems, rather than individual clinical decisions alone.


Assuntos
Analgésicos Opioides , Doença Iatrogênica/etnologia , Epidemia de Opioides , Transtornos Relacionados ao Uso de Opioides/etnologia , Idoso , Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/uso terapêutico , Antropologia Médica , Tomada de Decisão Clínica , Humanos , Masculino , Pessoa de Meia-Idade , Relações Médico-Paciente , Estados Unidos/etnologia
10.
J. Am. Coll. Radiol ; 18(supl. 5): S229-S238, May 1, 2021. tab
Artigo em Inglês | BIGG - guias GRADE | ID: biblio-1255164

RESUMO

Syncope and presyncope lead to well over one million emergency room visits in the United States each year. Elucidating the cause of syncope or presyncope, which are grouped together given similar etiologies and outcomes, can be exceedingly difficult given the diverse etiologies. This becomes more challenging as some causes, such as vasovagal syncope, are relatively innocuous while others, such as cardiac-related syncope, carry a significant increased risk of death. While the mainstay of syncope and presyncope assessment is a detailed history and physical examination, imaging can play a role in certain situations. In patients where a cardiovascular etiology is suspected based on the appropriate history, physical examination, and ECG findings, resting transthoracic echocardiography is usually considered appropriate for the initial imaging. While no imaging studies are considered usually appropriate when there is a low probability of cardiac or neurologic pathology, chest radiography may be appropriate in certain clinical situations. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment


Assuntos
Humanos , Síncope/diagnóstico por imagem , Síncope/etnologia , Estados Unidos/etnologia , Radiografia Torácica , Eletrocardiografia
11.
Sci Rep ; 11(1): 8738, 2021 04 22.
Artigo em Inglês | MEDLINE | ID: mdl-33888833

RESUMO

Factors contributing to racial inequities in outcomes from coronavirus disease 2019 (COVID-19) remain poorly understood. We compared by race the risk of 4 COVID-19 health outcomes--maximum length of hospital stay (LOS), invasive ventilation, hospitalization exceeding 24 h, and death--stratified by Elixhauser comorbidity index (ECI) ranking. Outcomes and ECI scores were constructed from retrospective data obtained from the Cerner COVID-19 De-Identified Data cohort. We hypothesized that racial disparities in COVID-19 outcomes would exist despite comparable ECI scores among non-Hispanic (NH) Blacks, Hispanics, American Indians/Alaska Natives (AI/ANs), and NH Whites. Compared with NH Whites, NH Blacks had longer hospital LOS, higher rates of ventilator dependence, and a higher mortality rate; AI/ANs, higher odds of hospitalization for ECI = 0 but lower for ECI ≥ 5, longer LOS for ECI = 0, a higher risk of death across all ECI categories except ECI ≥ 5, and higher odds of ventilator dependence; Hispanics, a lower risk of death across all ECI categories except ECI = 0, lower odds of hospitalization, shorter LOS for ECI ≥ 5, and higher odds of ventilator dependence for ECI = 0 but lower for ECI = 1-4. Our findings contest arguments that higher comorbidity levels explain elevated COVID-19 death rates among NH Blacks and AI/ANs compared with Hispanics and NH Whites.


Assuntos
Afro-Americanos/estatística & dados numéricos , Nativos Estadunidenses/estatística & dados numéricos , COVID-19/epidemiologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Hispano-Americanos/estatística & dados numéricos , Adulto , Idoso , COVID-19/mortalidade , Feminino , Disparidades nos Níveis de Saúde , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos/etnologia
12.
J Clin Neurosci ; 86: 122-128, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33775315

RESUMO

Epidemiology provides an avenue for deciphering disease pathogenesis. By determining incidence across socioeconomic and demographic variables in the context of benign cerebral meningiomas (BCM), epidemiologic data may aid in elucidating and addressing healthcare inequalities. To investigate BCM incidence (per 100,000) with respect to sex, age, income, residence, and race/ethnicity, we queried the largest United States (US) administrative dataset (1997-2016), the National (Nationwide) Inpatient Sample (NIS), which surveys 20% of US discharges. Annual national BCM incidence was 5.01. Females had an incidence of 6.78, higher (p = 0.0000038) than males at 3.14. Amongst age groups incidence varied (p = 1.65 × 10-11) and was highest amongst those 65-84 (16.71) and 85+ (18.32). Individuals with middle/high income had an incidence of 5.27, higher (p = 0.024) than the 4.91 of low income patients. Depending on whether patients lived in urban, suburban, or rural communities, incidence varied (χ2 = 8.22, p = 0.016) as follows, respectively: 5.23; 4.96; 5.51. Amongst race/ethnicity (p = 8.15 × 10-14), incidence for Whites, Blacks, Asian/Pacific Islanders, Hispanics, and Native Americans were as follows, respectively: 5.05; 4.59; 4.22; 2.99; 0.55. In the US, BCM annual incidence exhibited disparities amongst socioeconomic and demographic subsets. Disproportionately, incidence was greatest for patients who were White, Black, female, 65 and older, and middle/high income.


Assuntos
Neoplasias Encefálicas/economia , Grupos Étnicos , Disparidades em Assistência à Saúde/economia , Renda , Neoplasias Meníngeas/economia , Meningioma/economia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Encefálicas/etnologia , Neoplasias Encefálicas/terapia , Feminino , Humanos , Masculino , Neoplasias Meníngeas/etnologia , Neoplasias Meníngeas/terapia , Meningioma/etnologia , Meningioma/terapia , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos/etnologia , Adulto Jovem
13.
Transl Behav Med ; 11(3): 785-792, 2021 04 07.
Artigo em Inglês | MEDLINE | ID: mdl-33769536

RESUMO

Widespread uptake of the COVID-19 vaccine is critical to halt the pandemic. At present, little is known about factors that will affect vaccine uptake, especially among diverse racial/ethnic communities that have experienced the highest burden of COVID. We administered an online survey to a Qualtrics respondent panel of women ages 27-45 years (N = 396) to assess vaccine intentions and attitudes, and trusted vaccine information sources. 56.8% intended to be vaccinated and 25.5% were unsure. In bivariate analyses, a greater percentage of non-Latina White (NLW) and Chinese women reported that they would be vaccinated, compared with Latina and non-Latina Black (NLB) women (p < 0.001). Those who were uninsured, unemployed and those with lower incomes were less likely to say that they would be vaccinated. In analyses stratified by race/ethnicity, NLB women remained significantly less likely to report that they would be vaccinated compared with NLW women (adjusted odds ratio: 0.47; 95% confidence interval: 0.23, 0.94), controlling for age, marital status, income, education, employment, and insurance status. When analyses were additionally controlled for beliefs in vaccine safety and efficacy, racial/ethnic differences were no longer significant (adjusted odds ratio: 0.64; 95% confidence interval: 0.31, 1.34). Given that NLB women were less likely to report the intention to be vaccinated, targeted efforts will be needed to promote vaccine uptake. It will be critical to emphasize that the vaccine is safe and effective; this message may be best delivered by trusted community members.


Assuntos
Afro-Americanos/etnologia , Americanos Asiáticos/estatística & dados numéricos , Vacinas contra COVID-19 , Grupo com Ancestrais do Continente Europeu/etnologia , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Hispano-Americanos/estatística & dados numéricos , Vacinação em Massa/etnologia , Adulto , Feminino , Humanos , Intenção , Pessoa de Meia-Idade , Estados Unidos/etnologia , Mulheres
14.
Biomed Environ Sci ; 34(2): 152-162, 2021 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-33685574

RESUMO

Objective: Testicular germ cell tumors (TGCT) are the most common cancer among men aged 15 to 39 years. Previous studies have considered factors related to TGCT survival rate and race/ethnicity, but histological type of the diagnosed cancer has not yet been thoroughly assessed. Methods: The data came from 42,854 eligible patients from 1992 to 2015 in the Surveillance Epidemiology and End Results 18. Frequencies and column percent by seminoma and nonseminoma subtypes were determined for each covariates. We used Cox proportional hazard regression to assess the impact of multiple factors on post-diagnostic mortality of TGCT. Results: Black males were diagnosed at a later stage, more commonly with local or distant metastases. The incidence of TGCT in black non-seminoma tumors increased most significantly. The difference in survival rates between different ethnic and histological subtypes, overall survival (OS) in patients with non-seminoma was significantly worse than in patients with seminoma. The most important quantitative predictor of death was the stage at the time of diagnosis, and older diagnostic age is also important factor affecting mortality. Conclusion: Histological type of testicular germ cell tumor is an important factor in determining the prognosis of testicular cancer in males of different ethnic groups.


Assuntos
Disparidades nos Níveis de Saúde , Neoplasias Embrionárias de Células Germinativas/etnologia , Neoplasias Embrionárias de Células Germinativas/mortalidade , Neoplasias Testiculares/etnologia , Neoplasias Testiculares/mortalidade , Adulto , Humanos , Masculino , Neoplasias Embrionárias de Células Germinativas/diagnóstico , Neoplasias Embrionárias de Células Germinativas/patologia , Prognóstico , Fatores de Risco , Programa de SEER/estatística & dados numéricos , Seminoma/diagnóstico , Seminoma/etnologia , Seminoma/mortalidade , Seminoma/patologia , Taxa de Sobrevida/tendências , Neoplasias Testiculares/diagnóstico , Neoplasias Testiculares/patologia , Estados Unidos/epidemiologia , Estados Unidos/etnologia
15.
Int J Cancer ; 148(11): 2748-2758, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-33544892

RESUMO

Breast cancer survivors have a high risk of a second primary contralateral breast cancer (CBC), but there are few studies of CBC risk in racial/ethnic minority populations. We examined whether the incidence and risk factors for CBC differed by race/ethnicity in the United States. Women with a first invasive Stage I-IIB breast cancer diagnosis at ages 20-74 years between 2000 and 2015 in the Surveillance, Epidemiology, and End Results Program (SEER) 18 registries were followed through 2016 for a diagnosis of invasive CBC ≥1 year after the first breast cancer diagnosis. We used cause-specific Cox proportional hazards models to test the association between race/ethnicity and CBC, adjusting for age, hormone receptor status, radiation therapy, chemotherapy and stage at first diagnosis, and evaluated the impact of contralateral prophylactic mastectomy, socioeconomic status, and insurance status on the association. After a median follow-up of 5.9 years, 9247 women (2.0%) were diagnosed with CBC. Relative to non-Hispanic (NH) White women, CBC risk was increased in NH Black women (hazard ratio = 1.44, 95% CI 1.35-1.54) and Hispanic women (1.11, 95% CI 1.02-1.20), with the largest differences among women diagnosed at younger ages. Adjustment for contralateral prophylactic mastectomy, socioeconomic status and health insurance did not explain the associations. Therefore, non-Hispanic Black and Hispanic women have an increased risk of CBC that is not explained by clinical or socioeconomic factors collected in SEER. Large studies of diverse breast cancer survivors with detailed data on treatment delivery and adherence are needed to inform interventions to reduce this disparity.


Assuntos
Afro-Americanos/estatística & dados numéricos , Neoplasias da Mama/epidemiologia , Hispano-Americanos/estatística & dados numéricos , Segunda Neoplasia Primária/epidemiologia , Adulto , Idoso , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Segunda Neoplasia Primária/patologia , Segunda Neoplasia Primária/cirurgia , Mastectomia Profilática , Modelos de Riscos Proporcionais , Medição de Risco , Programa de SEER , Estados Unidos/etnologia , Adulto Jovem
16.
Int J Cancer ; 148(12): 2964-2973, 2021 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-33521947

RESUMO

Family history (FH) of ovarian cancer and breast cancer are well-established risk factors for ovarian cancer, but few studies have examined this association in African American (AA) and white women by histotype. We assessed first- and second-degree FH of ovarian and breast cancer and risk of epithelial ovarian cancer in the Ovarian Cancer in Women of African Ancestry Consortium. Analyses included 1052 AA cases, 2328 AA controls, 2380 white cases and 3982 white controls. Race-specific odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using multilevel logistic regression with adjustment for covariates. Analyses were stratified by histotype (high-grade serous vs others). First-degree FH of ovarian cancer was associated with high-grade serous carcinoma in AA (OR = 2.32, 95% CI: 1.50, 3.59) and white women (OR = 2.48, 95% CI: 1.82, 3.38). First-degree FH of breast cancer increased risk irrespective of histotype in AAs, but with high-grade serous carcinoma only in white women. Associations with second-degree FH of ovarian cancer were observed for overall ovarian cancer in white women and with high-grade serous carcinoma in both groups. First-degree FH of ovarian cancer and of breast cancer, and second-degree FH of ovarian cancer is strongly associated with high-grade serous ovarian carcinoma in AA and white women. The association of FH of breast cancer with high-grade serous ovarian carcinoma is similar in white women and AA women, but may differ for other histotypes.


Assuntos
Afro-Americanos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Síndrome Hereditária de Câncer de Mama e Ovário/epidemiologia , Síndrome Hereditária de Câncer de Mama e Ovário/patologia , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Anamnese , Pessoa de Meia-Idade , Gradação de Tumores , Razão de Chances , Prevalência , Estados Unidos/epidemiologia , Estados Unidos/etnologia
17.
Int J Cancer ; 148(12): 2954-2963, 2021 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-33527405

RESUMO

Asian Americans (AAs) are heterogeneous, and aggregation of diverse AA populations in national reporting may mask high-risk groups. Gastrointestinal (GI) cancers constitute one-third of global cancer mortality, and an improved understanding of GI cancer mortality by disaggregated AA subgroups may inform future primary and secondary prevention strategies. Using national mortality records from the United States from 2003 to 2017, we report age-standardized mortality rates, standardized mortality ratios and annual percent change trends from GI cancers (esophageal, gastric, colorectal, liver and pancreatic) for the six largest AA subgroups (Asian Indians, Chinese, Filipinos, Japanese, Koreans and Vietnamese). Non-Hispanic Whites (NHWs) are used as the reference population. We found that mortality from GI cancers demonstrated nearly 3-fold difference between the highest (Koreans, 61 per 100 000 person-years) and lowest (Asian Indians, 21 per 100 000 person-years) subgroups. The distribution of GI cancer mortality demonstrates high variability between subgroups, with Korean Americans demonstrating high mortality from gastric cancer (16 per 100 000), and Vietnamese Americans demonstrating high mortality from liver cancer (19 per 100 000). Divergent temporal trends emerged, such as increasing liver cancer burden in Vietnamese Americans, which exacerbated existing mortality differences. There exist striking differences in the mortality burden of GI cancers by disaggregated AA subgroups. These data highlight the need for disaggregated data reporting, and the importance of race-specific and personalized strategies of screening and prevention.


Assuntos
Americanos Asiáticos/estatística & dados numéricos , Neoplasias Gastrointestinais/classificação , Neoplasias Gastrointestinais/mortalidade , Idoso , Idoso de 80 Anos ou mais , China/etnologia , Atestado de Óbito , Feminino , Neoplasias Gastrointestinais/etnologia , Humanos , Japão/etnologia , Masculino , Pessoa de Meia-Idade , República da Coreia/etnologia , Estados Unidos/etnologia , Vietnã/etnologia
18.
Acad Med ; 96(6): 798-801, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-33637659

RESUMO

The glaring racial inequities in the impact of the COVID-19 pandemic and the devastating loss of Black lives at the hands of police and racist vigilantes have catalyzed a global reckoning about deeply rooted systemic racism in society. Many medical training institutions in the United States have participated in this discourse by denouncing racism, expressing solidarity with people of color, and reexamining their diversity and inclusion efforts. Yet, the stagnant progress in recruiting, retaining, and supporting racial/ethnic minority trainees and faculty at medical training institutions is well documented and reflects unaddressed systemic racism along the academic pipeline. In this article, the authors draw upon their experiences as early-career physicians of color who have led and supported antiracism efforts within their institutions to highlight key barriers to achieving meaningful progress. They describe common pitfalls of diversity and inclusion initiatives and call for an antiracist approach to systems change. The authors then offer 9 recommendations that medical training institutions can implement to critically examine and address racist structures within their organizations to actualize racial equity and justice.


Assuntos
Afro-Americanos/psicologia , COVID-19/psicologia , Preceptoria/métodos , Racismo/prevenção & controle , Afro-Americanos/etnologia , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/virologia , Diversidade Cultural , Tomada de Decisões/ética , Grupos Étnicos/psicologia , Humanos , Grupos Minoritários/psicologia , Preceptoria/estatística & dados numéricos , SARS-CoV-2/isolamento & purificação , Inclusão Social , Justiça Social , Estados Unidos/etnologia
19.
Proc Natl Acad Sci U S A ; 118(8)2021 02 23.
Artigo em Inglês | MEDLINE | ID: mdl-33547252

RESUMO

Crises lay bare the social fault lines of society. In the United States, race, gender, age, and education have affected vulnerability to COVID-19 infection. Yet, consequences likely extend far beyond morbidity and mortality. Temporarily closing the economy sent shock waves through communities, raising the possibility that social inequities, preexisting and current, have weakened economic resiliency and reinforced disadvantage, especially among groups most devastated by the Great Recession. We address pandemic precarity, or risk for material and financial insecurity, in Indiana, where manufacturing loss is high, metro areas ranked among the hardest hit by the Great Recession nationally, and health indicators stand in the bottom quintile. Using longitudinal data (n = 994) from the Person to Person Health Interview Study, fielded in 2019-2020 and again during Indiana's initial stay-at-home order, we provide a representative, probability-based assessment of adverse economic outcomes of the pandemic. Survey-weighted multivariate regressions, controlling for preexisting inequality, find Black adults over 3 times as likely as Whites to report food insecurity, being laid off, or being unemployed. Residents without a college degree are twice as likely to report food insecurity (compared to some college), while those not completing high school (compared to bachelor's degree) are 4 times as likely to do so. Younger adults and women were also more likely to report economic hardships. Together, the results support contentions of a Matthew Effect, where pandemic precarity disproportionately affects historically disadvantaged groups, widening inequality. Strategically deployed relief efforts and longer-term policy reforms are needed to challenge the perennial and unequal impact of disasters.


Assuntos
Fatores Etários , COVID-19 , Grupos de Populações Continentais , Disparidades nos Níveis de Saúde , Pandemias/economia , Pobreza , SARS-CoV-2 , Adolescente , Adulto , Idoso , COVID-19/epidemiologia , COVID-19/etnologia , COVID-19/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Estados Unidos/etnologia
20.
Laryngoscope ; 131(8): 1722-1728, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33493376

RESUMO

OBJECTIVE/HYPOTHESIS: The aim of this study is to assess the ethnic and racial demographics of patients enrolled in prospective chronic rhinosinusitis (CRS) studies relative to the corresponding geographic demographics of the United States (U.S.) census data. STUDY DESIGN: Systematic Review and Population analysis. METHODS: A systematic review was performed to identify CRS clinical trials, conducted in the U.S. and published between 2010 and 2020 in which patients were prospectively enrolled. Pooled racial and ethnicity data were compared to national and corresponding regional census data. RESULTS: Eighty-three studies were included, comprising 12,027 patients. 50.4% were male and the average age was 49.2 years. 8,810 patients underwent a surgical procedure. Of the 12,027 patients, 81.67% were identified as White, 5.35% as Black, 1.27% as Asian, 0.02% as Pacific Islander, 0.12% as American Indian, and 11.57% were classified as Other. The racial and ethnic composition of the pooled study population differs significantly from the national U.S. census data with the underrepresentation of each minority population (P ≤ .0002). Regional sub-analyses yield variable results. In the Northeast and West, there was an underrepresentation of all minority populations. In the South and Midwest, Black enrollment was similar to the U.S. census data, while all other minorities were underrepresented. CONCLUSIONS: The racial and ethnic composition of patients enrolled in prospective CRS clinical trials differs significantly from the demographics of the U.S. POPULATION: The generalizability and external validity of findings derived from studies comprised of demographically mismatched populations has not been established. Future efforts to enroll more representative populations should be emphasized by the research community, funding bodies, and editorial boards. LEVEL OF EVIDENCE: NA Laryngoscope, 131:1722-1728, 2021.


Assuntos
Grupos Étnicos/estatística & dados numéricos , Disparidades em Assistência à Saúde/etnologia , Rinite/cirurgia , Sinusite/cirurgia , Doença Crônica , Ensaios Clínicos como Assunto , Demografia , Feminino , Geografia , Humanos , Masculino , Pessoa de Meia-Idade , Grupos Minoritários , Estudos Prospectivos , Rinite/complicações , Rinite/etnologia , Sinusite/complicações , Sinusite/etnologia , Classe Social , Estados Unidos/etnologia
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