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1.
Rev Bras Epidemiol ; 22: e190036, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31038617

RESUMO

INTRODUCTION: Racial density has not yet been explored in studies of racial inequalities in Brazil. Thisstudy identified categories of racial density in Brazilian cities and described the living and health context in these categories in 2000 and 2010, when demographic censuses were conducted. METHOD: Ecological study which used skin color or race information from the last two censuses to calculate racial density (the ratio of people aggregated to the same racial group) of the Brazilian cities each year. Four categories of racial density (Brown; Mixed-race, predominantly black; White/Caucasian; and Mixed-race, predominantly white). Socioeconomic, demographic and health indicators were described to each category. RESULTS: The categories of racial density captured important inequalities throughout the census and also indicated the continuance of worse living and health conditions in the cities composed by Browns and mixed-race people, predominantly Black; better conditions were indicated in cities where White/Caucasians are predominant. The cities, composed mainly of Browns and mixed-race people, predominantly Black, presented younger age structure, worse human development indexes, greater social vulnerability, income concentration, infant and premature mortality (<65 years) and lower life expectancy in both censuses, as compared to other cities. DISCUSSION: Similarly to other countries, the racial density reflected inequalities in the Brazilian living and health context as well as a time lag among the cities. CONCLUSION: The categories of racial density may contribute to social epidemiology and race relations studies in Brazil.


Assuntos
Grupos de Populações Continentais/estatística & dados numéricos , Nível de Saúde , Densidade Demográfica , Fatores Raciais/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Brasil/etnologia , Criança , Pré-Escolar , Cidades/etnologia , Feminino , Humanos , Lactente , Expectativa de Vida/etnologia , Masculino , Pessoa de Meia-Idade , Características de Residência , Distribuição por Sexo , Fatores Socioeconômicos , Análise Espaço-Temporal , Fatores de Tempo , Adulto Jovem
2.
Medicina (Kaunas) ; 55(2)2019 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-30781893

RESUMO

Background and objectives: Smoking is associated with a lower health-related quality of life (HRQOL). However, there is little information about the association between HRQOL in relation to race, income, and smoking status. The present study aimed to assess the association between HRQOL and smoking status for those of different races and income levels. Materials and Methods: This study applied a cross-sectional design using data from the 2017 patient survey of the Louisiana Tobacco Control Initiative. We obtained 1108 responses from patients at eight Louisiana public hospitals. The EuroQol (EQ-5D) US index score assessed HRQOL. Smoking status was classified into four groups: never smoked, former smoker, current smoker with a quit attempt, and current smoker without a quit attempt. Multivariate linear regression analyses were used to estimate the HRQOL for black or African Americans and whites. Results: The patients were predominantly black or African American (58.9%) with lower-income (71.2%). Bivariate analyses showed that there were differences in income levels between black or African Americans and whites (p = 0.006). Moreover, black or African Americans (median = 0.80) had a higher mean of HRQOL than whites (median = 0.76). Among lower-income black or African Americans, current smokers with a quit attempt had a lower HRQOL than current smokers (coefficient = -0.12; p < 0.01). Conclusions: Racial and income disparities were evident with regards to HRQOL, with lower-income black or African Americans who were current smokers with a quit attempt having a lower HRQOL. Intervention programs for smoking cessation should target lower-income black or African American smokers who have a prior quit attempt and provide effective cessation services to help them quit smoking and improve their HRQOL.


Assuntos
Renda/estatística & dados numéricos , Qualidade de Vida , Fatores Raciais/estatística & dados numéricos , Fumantes/estatística & dados numéricos , Abandono do Hábito de Fumar/estatística & dados numéricos , Fumar/epidemiologia , Adolescente , Adulto , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Idoso , Estudos Transversais , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hospitais Públicos , Humanos , Modelos Lineares , Louisiana/epidemiologia , Masculino , Pessoa de Meia-Idade , Fumar/efeitos adversos , Inquéritos e Questionários/normas , Adulto Jovem
3.
Matern Child Health J ; 23(3): 346-355, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30712089

RESUMO

Objectives Severe maternal morbidity (SMM) is an important indicator for identifying and monitoring efforts to improve maternal health. Studies have identified independent risk factors, including race/ethnicity; however, there has been limited investigation of the modifying effect of socioeconomic factors. Study aims were to quantify SMM risk factors and to determine if socioeconomic status modifies the effect of race/ethnicity on SMM risk. Methods We used 2008-2012 NYC birth certificates matched with hospital discharge records for maternal deliveries. SMM was defined using an algorithm developed by the Centers for Disease Control and Prevention. Mixed-effects logistic regression models estimated SMM risk by demographic, socioeconomic, and health characteristics. The final model was stratified by Medicaid status (as a proxy for income), education, and neighborhood poverty. Results Of 588,232 matched hospital deliveries, 13,505 (229.6 per 10,000) had SMM. SMM rates varied by maternal age, birthplace, education, income, pre-existing chronic conditions, pre-pregnancy weight status, trimester of prenatal care entry, plurality, and parity. Race/ethnicity was consistently and significantly associated with SMM. While racial differences in SMM risk persisted across all socioeconomic groupings, the risk was exacerbated among Latinas and Asian-Pacific Islanders with lower income when compared to white non-Latinas. Similarly, living in the poorest neighborhoods exacerbated SMM risk among both black non-Latinas and Latinas. Conclusions for Practice SMM determinants in NYC mirror national trends, including racial/ethnic disparities. However, these disparities persisted even in the highest income and educational groups suggesting other pathways are needed to explain racial/ethnic differences.


Assuntos
Morbidade , Mães/estatística & dados numéricos , Determinantes Sociais da Saúde/etnologia , Adolescente , Adulto , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/etnologia , Feminino , Disparidades em Assistência à Saúde/etnologia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Modelos Logísticos , Cidade de Nova Iorque/epidemiologia , Cidade de Nova Iorque/etnologia , Obesidade/epidemiologia , Obesidade/etnologia , Vigilância da População/métodos , Gravidez , Fatores Raciais/estatística & dados numéricos , Fatores de Risco , Fatores Socioeconômicos
4.
Medicina (Kaunas) ; 55(1)2019 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-30621205

RESUMO

Background and objectives: Glial brain cancers affect nearly 20,000 individuals in the United States (USA) annually. SEER database data exploring the relationship between race and gliomas is now available and have shown that cerebral gliomas occur at a higher frequency in Caucasian men. However, such analyses did not include demographic data specific to the state of Florida. This study assessed the association between race and glial vs. non-glial Central Nervous System (CNS) cancers in Florida, USA. Materials and Methods: This case-control study utilized the Florida Cancer Data Registry (FCDS), in which race was considered the exposure and development of glioma as the measured outcome. The sample was comprised of patients in Florida diagnosed with brain tumors from 1981 to 2013. Relative racial frequencies were compared between patients with glial brain tumors and those with other CNS tumors. Data was analyzed using logistic regression in order to determine any associations between race and frequency of diagnosis adjusting for several confounders (age, sex, smoking status, year of diagnosis, and insurance status). Results: Between 1981 and 2013 a total of 14,092 patients meeting the inclusion and exclusion criteria were diagnosed in Florida with a primary brain tumor. Being of non-white race was associated with 60% decreased odds of glioma diagnosis compared to the reference white population (adjusted OR 0.4, 95% CI 0.34⁻0.47). Secondary findings include associations between increasing age and male sex with increased odds of glioma diagnosis. Decreased adjusted odds of glioma diagnosis were found with former smoking status (reference non-smokers), diagnosis between 2001 and 2010 (reference 1981⁻1990), and Medicaid or Medicare insurance (reference private insurance). Hispanic ethnicity, current smoking status, no insurance/self-pay, and geographical location (urban vs. rural) all had no association with glioma diagnosis. Conclusions: These findings are consistent with and help reinforce previous studies utilizing national databases (SEER) which also showed increasing odds of glioma diagnosis in older white males. Various potential explanations for these findings include genetic predisposition, lifestyle and behavioral factors, and socioeconomic status, including access to healthcare. Future research aims at identifying potential genetic etiologies.


Assuntos
Neoplasias Encefálicas/epidemiologia , Glioma/epidemiologia , Adulto , Fatores Etários , Idoso , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/genética , Estudos de Casos e Controles , Demografia , Grupo com Ancestrais do Continente Europeu , Feminino , Florida/epidemiologia , Predisposição Genética para Doença , Glioma/diagnóstico , Glioma/genética , Humanos , Incidência , Modelos Logísticos , Masculino , Medicaid , Pessoa de Meia-Idade , Fatores Raciais/estatística & dados numéricos , Sistema de Registros , Fatores Sexuais , Fumar/epidemiologia , Fatores Socioeconômicos , Estados Unidos , População Urbana/estatística & dados numéricos
5.
Rev Bras Epidemiol ; 21(suppl 1): e180003, 2018 Nov 29.
Artigo em Português, Inglês | MEDLINE | ID: mdl-30517454

RESUMO

INTRODUCTION: Knowing the profile of individuals who demand health services or professionals could help in the improvement and reorganization of services. However, this subject is still underexplored among adolescents. This study aimed to describe and identify characteristics related to the demand for health services or professionals by Brazilian students. METHODS: Using data from the 2015 National School Health Survey, the prevalence and respective 95% confidence intervals (95%CI) of the demand for health services or professionals among students were estimated, and Poisson regression adjusted by age and region of residence was used to identify the associated factors. RESULTS: More than half of the students demanded for health services or professionals in the last year, with a higher demand among females. The characteristics associated with the outcome were sociodemographic (female, white, private school), family (maternal schooling of 12 years or more, having meals with parents/guardians and parents' knowledge of the adolescent's activities in their free time), risk behaviors (alcohol consumption and sexual intercourse without a condom) and health-related issues (physical violence, wheezing, toothache, hygiene habits, and attitude to one's own weight). CONCLUSION: Organizing health services in a way that takes the particularities of this population into account may provide a space to deal with subjects related to the risks to which it is exposed.


Assuntos
Comportamento do Adolescente/psicologia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Inquéritos Epidemiológicos/estatística & dados numéricos , Adolescente , Atitude Frente a Saúde , Brasil , Estudos Transversais , Comportamento Perigoso , Relações Familiares/psicologia , Comportamento Alimentar/psicologia , Feminino , Humanos , Masculino , Relações Pais-Filho , Prevalência , Fatores Raciais/estatística & dados numéricos , Instituições Acadêmicas/estatística & dados numéricos , Distribuição por Sexo
6.
BMC Pediatr ; 18(1): 363, 2018 11 21.
Artigo em Inglês | MEDLINE | ID: mdl-30463543

RESUMO

BACKGROUND: Pediatric pain is associated to patient weight and demographics in specialized settings, but pain prevalence and its associated patient attributes in general pediatric outpatient care are unknown. Our objective was to determine the rate of positive pain screenings in pediatric primary care and evaluate the relationship between reported pain and obesity, demographics, and exam findings during routine pediatric encounters. METHODS: Cross-sectional observational study of 26,180 patients ages 2 to 19 seen in five urban pediatric primary care clinics between 2009 and 2016. Data were collected from systematic screening using a computerized clinical decision support system. Multivariable logistic regressions were used to analyze the association between pain reporting and obesity (body mass index), age, sex, race, season, insurance status, clinic site, prior pain reporting, pain reporting method, and exam findings. RESULTS: Pain was reported by the patient or caregiver in 14.9% of visits. In adjusted models, pain reporting was associated with obesity (Odds Ratio (OR) 1.23, 95% Confidence Intervals (CI) 1.11-1.35) and severe obesity (OR 1.32, CI 1.17-1.49); adolescents (OR 1.47, CI 1.33-1.61); and females (OR 1.21, CI 1.12-1.29). Pain reported at the preceding visit increased odds of pain reporting 2.67 times (CI 2.42-2.95). Abnormal abdominal, extremity, ear, nose, throat, and lymph node exams were associated with pain reporting. Pain reporting increased in minority races within clinics that predominantly saw a concordant race. CONCLUSIONS: Pain is common in general pediatric encounters, and occurs more frequently in obese children and those who previously reported pain. Pain reporting may be influenced by seasonal variation and clinic factors. Future pediatric pain screening may be guided by associated risk factors to improve identification and targeted healthcare interventions.


Assuntos
Índice de Massa Corporal , Dor/epidemiologia , Obesidade Pediátrica/epidemiologia , Adolescente , Distribuição por Idade , Criança , Pré-Escolar , Comorbidade , Estudos Transversais , Feminino , Humanos , Indiana/epidemiologia , Cobertura do Seguro , Masculino , Obesidade Pediátrica/etnologia , Exame Físico , Prevalência , Atenção Primária à Saúde , Fatores Raciais/estatística & dados numéricos , Estações do Ano , Distribuição por Sexo , Classe Social , Adulto Jovem
7.
J Hum Lact ; 34(3): 485-493, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29787690

RESUMO

BACKGROUND: Breastfeeding is an active area in public health advocacy. Despite documented benefits for infants and mothers, exclusive breastfeeding is not universal. Ethnicity, among other variables, has been shown to influence breastfeeding practice. Research aim: Our study aimed to determine which variables are associated with infant feeding patterns at the postpartum visit; compare the sociodemographic variables associated with infant feeding patterns between Hispanic and non-Hispanic mothers; and determine the odds of exclusive breastfeeding, mixed feeding, and exclusive formula feeding associated with sociodemographic characteristics. METHODS: A retrospective, cross-sectional two-group comparison design was used. Hispanic and non-Hispanic women's ( N = 666) infant feeding patterns at 6-week postpartum were analyzed. Group comparisons were made of the demographic characteristics and infant feeding practice. RESULTS: Thirty-four percent of Hispanic participants reported exclusive breastfeeding compared with 59% of non-Hispanic White participants. Language and body mass index were significantly associated with infant feeding patterns among Hispanic participants. Compared with non-Hispanic White participants, Hispanic participants had increased odds of reporting mixed feeding and exclusive formula feeding. CONCLUSION: Breastfeeding initiatives should target English-speaking Hispanic mothers and obese Hispanic mothers to align breastfeeding rates with medical recommendations. Healthcare providers may benefit from additional training to address barriers to breastfeeding among obese women and to provide culturally sensitive support that encourages continued breastfeeding in this population.


Assuntos
Aleitamento Materno/métodos , Comportamento Alimentar/psicologia , Cuidado Pós-Natal/normas , Fatores Raciais/estatística & dados numéricos , Adulto , Índice de Massa Corporal , Aleitamento Materno/etnologia , Aleitamento Materno/estatística & dados numéricos , California/etnologia , Barreiras de Comunicação , Estudos Transversais , Comportamento Alimentar/etnologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Lactente , Recém-Nascido , Cuidado Pós-Natal/estatística & dados numéricos , Fatores Raciais/métodos , Estudos Retrospectivos
8.
Cancer Med ; 7(5): 2160-2171, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29601662

RESUMO

Significant racial disparities in prostate cancer (PCa) outcomes have been reported, with African-American men (AAM) more likely to endure adverse oncologic outcomes. Despite efforts to dissipate racial disparities in PCa, a survival gap persists and it remains unclear to what extent this disparity can be explained by known clinicodemographic factors. In this study, we leveraged our large institutional database, spanning over 25 years, to investigate whether AAM continued to experience poor PCa outcomes and factors that may contribute to racial disparities in PCa. A total of 7307 patients diagnosed with PCa from 1989 through 2015 were included. Associations of race and clinicodemographic characteristics were analyzed using chi-square for categorical and Mann-Whitney U-test for continuous variables. Racial differences in prostate cancer outcomes were analyzed using competing risk analysis methods of Fine and Gray. Median follow-up time was 106 months. There were 2304 deaths recorded, of which 432 resulted from PCa. AAM were more likely to be diagnosed at an earlier age (median 60 vs. 65 years, P = <0.001) and were more likely to have ≥1 comorbidities (13.6% vs. 7.5%, P < 0.001). In a multivariate competing risk model, adjusted for baseline covariates, AAM experienced significantly higher risk of PCSM compared to NHW men (HR, 1.62, 95% CI, 1.02-2.57, P = 0.03) NHW. Among men diagnosed at an older age (>60 years), racial differences in PCSM were more pronounced, with AAM experiencing higher rates of PCSM (HR, 2.05, 95% CI, 1.26-3.34, P = 0.003). After adjustment of clinicodemographic and potential risk factors, AAM continue to experience an increased risk of mortality from PCa, especially older AAM. Furthermore, AAM are more likely to be diagnosed at an early age and more likely to have higher comorbidity indices.


Assuntos
Afro-Americanos/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Neoplasias da Próstata/epidemiologia , Neoplasias da Próstata/mortalidade , Fatores Raciais/estatística & dados numéricos , Fatores Etários , Idoso , Detecção Precoce de Câncer/estatística & dados numéricos , Humanos , Seguro Saúde/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Prognóstico , Neoplasias da Próstata/diagnóstico , Estados Unidos/epidemiologia
9.
J Urban Health ; 95(1): 13-20, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29204842

RESUMO

Race disparities in self-rated health in the USA are well-documented, such that African Americans rate their health more poorly than whites. However, after adjusting for health status, socioeconomic status (SES), and health behaviors, residual race differences are observed. This suggests the importance of unmeasured variables. Because African Americans and whites tend to live in differing social contexts, it is possible that accounting for social and environmental conditions may reduce racial disparities in self-rated health. Differences in self-rated health among whites and African Americans were assessed in a low-income, urban integrated community (Exploring Health Disparities in Integrated Communities (EHDIC)) and compared with a national sample (National Health Interview Survey (NHIS)). Controlling for demographics, SES, health insurance, status, and behaviors, African Americans in NHIS had higher odds of reporting fair or poor health (odds ratio [OR] = 1.40, 95% confidence interval [CI] = 1.18-1.66) than whites. In EHDIC, there was no race difference in self-rated health (OR = 0.83, 95% CI = 0.63-1.11). These results demonstrate the importance of social context in understanding race disparities in self-rated health.


Assuntos
Afro-Americanos/psicologia , Grupo com Ancestrais do Continente Europeu/psicologia , Disparidades nos Níveis de Saúde , Nível de Saúde , Pobreza/psicologia , Autoavaliação , Adulto , Afro-Americanos/estatística & dados numéricos , Estudos Transversais , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Pobreza/estatística & dados numéricos , Fatores Raciais/estatística & dados numéricos , Classe Social , Meio Social , Fatores Socioeconômicos , Estados Unidos , População Urbana/estatística & dados numéricos
10.
J Urol ; 198(5): 1033-1038, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-28655530

RESUMO

PURPOSE: We sought to determine whether race, gender and number of bladder cancer risk factors are significant predictors of hematuria evaluation. MATERIALS AND METHODS: We used self-reported data from SCCS (Southern Community Cohort Study) linked to Medicare claims data. Evaluation of subjects diagnosed with incident hematuria was considered complete if imaging and cystoscopy were performed within 180 days of diagnosis. Exposures of interest were race, gender and risk factors for bladder cancer. RESULTS: Of the 1,412 patients evaluation was complete in 261 (18%). On our adjusted analyses African American patients were less likely than Caucasian patients to undergo any aspect of evaluation, including urology referral (OR 0.72, 95% CI 0.56-0.93), cystoscopy (OR 0.67, 95% CI 0.50-0.89) and imaging (OR 0.75, 95% CI 0.59-0.95). Women were less likely than men to be referred to a urologist (OR 0.59, 95% CI 0.46-0.76). Also, although all patients with 2 or 3 risk factors had 31% higher odds of urology referral (OR 1.31, 95% CI 1.02-1.69), adjusted analyses indicated that this effect was only apparent among men. CONCLUSIONS: Only 18% of patients with an incident hematuria diagnosis underwent complete hematuria evaluation. Gender had a substantial effect on referral to urology when controlling for socioeconomic factors but otherwise it had an unclear role on the quality of evaluation. African American patients had markedly lower rates of thorough evaluation than Caucasian patients. Number of risk factors predicted referral to urology among men but it was otherwise a poor predictor of evaluation. There is opportunity for improvement by increasing the completion of hematuria evaluations, particularly in patients at high risk and those who are vulnerable.


Assuntos
Disparidades em Assistência à Saúde/estatística & dados numéricos , Hematúria/etiologia , Neoplasias da Bexiga Urinária/diagnóstico , Neoplasias da Bexiga Urinária/epidemiologia , Cistoscopia/estatística & dados numéricos , Diagnóstico por Imagem/estatística & dados numéricos , Humanos , Medicare/estatística & dados numéricos , Fatores Raciais/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Fatores de Risco , Autorrelato , Fatores Sexuais , Estados Unidos/epidemiologia , Neoplasias da Bexiga Urinária/diagnóstico por imagem , Urologia/estatística & dados numéricos
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