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1.
Front Public Health ; 9: 674736, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34095075

RESUMO

Breast cancer is the most commonly experienced cancer among women. Its high rates of incidence and survival mean that a number of women will live it for periods of their lifetimes. Group differences in breast cancer incidence and mortality occur by race and ethnicity. For example, while white women are slightly more likely to be diagnosed with breast cancer, Black women are 40% more likely to die from the disease. In this article, rather than focusing the discussion on individual-level factors like health behaviors that have the potential to blame Black women and those living in poverty for their conditions, we view breast cancer disparities through the lens of Critical Race Theory, taking a historical perspective. This allows us to delve beyond individual risk factors to explore social determinants of breast cancer disparities at the population level, paying special attention to the myriad ways in which social factors, notably views of race and discriminatory public policies, over time have contributed to the disproportionate breast cancer mortality experienced by Black women. We suggest ways of addressing breast cancer disparities, including methods of training healthcare professionals and public policy directions, that include rather than marginalize Black and lower socioeconomic status women.


Assuntos
Neoplasias da Mama , Neoplasias da Mama/epidemiologia , Grupo com Ancestrais do Continente Europeu , Feminino , Disparidades nos Níveis de Saúde , Humanos , Determinantes Sociais da Saúde , Fatores Socioeconômicos
3.
J Prev Med Public Health ; 54(3): 161-165, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34092061

RESUMO

OBJECTIVES: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spreads heterogeneously, disproportionately impacting poor and minority communities. The relationship between poverty and race is complex, with a diverse set of structural and systemic factors driving higher rates of poverty among minority populations. The factors that specifically contribute to the disproportionate rates of SARS-CoV-2 infection, however, are not clearly understood. METHODS: We evaluated SARS-CoV-2 test results from community-based testing sites in Los Angeles, California, between June and December, 2020. We used tester zip code data to link those results with United States Census report data on average annual household income, rates of healthcare coverage, and employment status by zip code. RESULTS: We analyzed 2 141 127 SARS-CoV-2 test results, of which 245 154 (11.4%) were positive. Multivariable modeling showed a higher likelihood of SARS-CoV-2 test positivity among Hispanic communities than among other races. We found an increased risk for SARS-CoV-2 positivity among individuals from zip codes with an average annual household income

Assuntos
COVID-19/etnologia , Pobreza/estatística & dados numéricos , Adolescente , Adulto , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Idoso , Americanos Asiáticos/estatística & dados numéricos , COVID-19/epidemiologia , Teste para COVID-19/estatística & dados numéricos , Estudos Transversais , Emprego/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Los Angeles/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , SARS-CoV-2 , Adulto Jovem
4.
PLoS Med ; 18(6): e1003605, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34061844

RESUMO

BACKGROUND: Increased vitamin D levels, as reflected by 25-hydroxy vitamin D (25OHD) measurements, have been proposed to protect against COVID-19 based on in vitro, observational, and ecological studies. However, vitamin D levels are associated with many confounding variables, and thus associations described to date may not be causal. Vitamin D Mendelian randomization (MR) studies have provided results that are concordant with large-scale vitamin D randomized trials. Here, we used 2-sample MR to assess evidence supporting a causal effect of circulating 25OHD levels on COVID-19 susceptibility and severity. METHODS AND FINDINGS: Genetic variants strongly associated with 25OHD levels in a genome-wide association study (GWAS) of 443,734 participants of European ancestry (including 401,460 from the UK Biobank) were used as instrumental variables. GWASs of COVID-19 susceptibility, hospitalization, and severe disease from the COVID-19 Host Genetics Initiative were used as outcome GWASs. These included up to 14,134 individuals with COVID-19, and up to 1,284,876 without COVID-19, from up to 11 countries. SARS-CoV-2 positivity was determined by laboratory testing or medical chart review. Population controls without COVID-19 were also included in the control groups for all outcomes, including hospitalization and severe disease. Analyses were restricted to individuals of European descent when possible. Using inverse-weighted MR, genetically increased 25OHD levels by 1 standard deviation on the logarithmic scale had no significant association with COVID-19 susceptibility (odds ratio [OR] = 0.95; 95% CI 0.84, 1.08; p = 0.44), hospitalization (OR = 1.09; 95% CI: 0.89, 1.33; p = 0.41), and severe disease (OR = 0.97; 95% CI: 0.77, 1.22; p = 0.77). We used an additional 6 meta-analytic methods, as well as conducting sensitivity analyses after removal of variants at risk of horizontal pleiotropy, and obtained similar results. These results may be limited by weak instrument bias in some analyses. Further, our results do not apply to individuals with vitamin D deficiency. CONCLUSIONS: In this 2-sample MR study, we did not observe evidence to support an association between 25OHD levels and COVID-19 susceptibility, severity, or hospitalization. Hence, vitamin D supplementation as a means of protecting against worsened COVID-19 outcomes is not supported by genetic evidence. Other therapeutic or preventative avenues should be given higher priority for COVID-19 randomized controlled trials.


Assuntos
COVID-19/sangue , Polimorfismo de Nucleotídeo Único , Índice de Gravidade de Doença , Deficiência de Vitamina D/sangue , Vitamina D/análogos & derivados , Adulto , Idoso , COVID-19/etiologia , Estudos de Casos e Controles , Causalidade , Suplementos Nutricionais , Grupo com Ancestrais do Continente Europeu/genética , Feminino , Predisposição Genética para Doença , Estudo de Associação Genômica Ampla , Hospitalização , Humanos , Masculino , Análise da Randomização Mendeliana , Pessoa de Meia-Idade , Razão de Chances , Fatores de Risco , SARS-CoV-2 , Vitamina D/sangue , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/genética
5.
Front Public Health ; 9: 661592, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34079786

RESUMO

Older adults are most at risk of negative COVID-19 outcomes and consequences. This study applies the World Health Organization's Health Inequity Causal Model to identify different factors that may be driving the higher observed hospitalizations and deaths among older adults of color compared to non-Latinx Whites in the United States. We used multiple data sets, including the US Census American Community Survey and PULSE COVID data, along with published reports, to understand the social context of older adults, including income distributions by race and ethnicity, household composition and potential COVID-19 exposure to older adults by working family members. Our findings point to multiple social determinants of health, beyond individual health risks, which may explain why older adults of color are the most at risk of negative COVID-19 outcomes and consequences. Current health policies do not adequately address disproportionate impact; some even worsen it. This manuscript provides new data and analysis to support the call for equity-focused solutions to this pandemic and health in general in the future, focusing on meeting the needs of our most vulnerable communities.


Assuntos
COVID-19 , Equidade em Saúde , Idoso , Grupo com Ancestrais do Continente Europeu , Humanos , Pandemias , SARS-CoV-2 , Estados Unidos/epidemiologia
6.
Cardiovasc Ther ; 2021: 6667934, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34025779

RESUMO

Background: It has been suggested that the angiotensinogen (AGT) gene rs4762 (p.Thr174Met) polymorphism might be associated with myocardial infarction (MI) risk, but the study results are still debatable. Objective and Methods. In order to explore the relationship between AGT p.Thr174Met polymorphism and MI risk, the current meta-analysis involving 7657 subjects from 11 individual studies was conducted. Results: A significant association between AGT p.Thr174Met polymorphism and MI was found under recessive (OR: 2.26, 95% CI: 1.35-3.77, P = 0.002), dominant (OR: 1.131, 95% CI: 1.016-1.260, P = 0.024), codominant (OR: 2.198, 95% CI: 1.334-3.621, P = 0.002), and additive (OR: 1.363, 95% CI: 1.132-1.641, P = 0.001) genetic models. In the Asian subgroup, significantly increased MI risk was found under all genetic models (P < 0.05). No significant association between AGT p.Thr174Met polymorphism and MI was found under all genetic models in the Caucasian subgroup (P > 0.05). Conclusions: AGT p.Thr174Met variant might increase MI risk, especially within the Asian population. The Met174 allele of AGT p.Thr174Met might confer the risk for MI.


Assuntos
Angiotensinogênio/genética , Predisposição Genética para Doença , Infarto do Miocárdio/genética , Polimorfismo Genético , Alelos , Grupo com Ancestrais do Continente Asiático/genética , Grupo com Ancestrais do Continente Europeu/genética , Humanos , Infarto do Miocárdio/etnologia , Infarto do Miocárdio/etiologia , Fatores de Risco
7.
JAMA Netw Open ; 4(5): e2111629, 2021 05 03.
Artigo em Inglês | MEDLINE | ID: mdl-34042990

RESUMO

Importance: The impact of COVID-19 in the US has been far-reaching and devastating, especially in Black populations. Vaccination is a critical part of controlling community spread, but vaccine acceptance has varied, with some research reporting that Black individuals in the US are less willing to be vaccinated than other racial/ethnic groups. Medical mistrust informed by experiences of racism may be associated with this lower willingness. Objective: To examine the association between race/ethnicity and rejection of COVID-19 vaccine trial participation and vaccine uptake and to investigate whether racial/ethnic group-based medical mistrust is a potential mediator of this association. Design, Setting, and Participants: This cross-sectional survey study was conducted from June to December 2020 using a convenience sample of 1835 adults aged 18 years or older residing in Michigan. Participants were recruited through community-based organizations and hospital-academic networks. Main Outcomes and Measures: Separate items assessed whether respondents, if asked, would agree to participate in a research study to test a COVID-19 vaccine or to receive a COVID-19 vaccine. Participants also completed the suspicion subscale of the Group-Based Medical Mistrust Scale. Results: Of the 1835 participants, 1455 (79%) were women, 361 (20%) men, and 19 (1%) other gender. The mean (SD) age was 49.4 (17.9) years, and 394 participants (21%) identified as Black individuals. Overall, 1376 participants (75%) reported low willingness to participate in vaccine trials, and 945 (52%) reported low willingness to be vaccinated. Black participants reported the highest medical mistrust scores (mean [SD], 2.35 [0.96]) compared with other racial/ethnic groups (mean [SD] for the total sample, 1.83 [0.91]). Analysis of path models revealed significantly greater vaccine trial and vaccine uptake rejection among Black participants (vaccine trial: B [SE], 0.51 [0.08]; vaccine uptake: B [SE], 0.51 [0.08]; both P < .001) compared with the overall mean rejection. The association was partially mediated by medical mistrust among Black participants (vaccine trial: B [SE], 0.04 [0.01]; P = .003; vaccine uptake: B [SE], 0.07 [0.02]; P < .001) and White participants (vaccine trial: B [SE], -0.06 [0.02]; P = .001; vaccine uptake: B [SE], -0.10 [0.02]; P < .001). Conclusions and Relevance: In this survey study of US adults, racial/ethnic group-based medical mistrust partially mediated the association between individuals identifying as Black and low rates of acceptance of COVID-19 vaccine trial participation and actual vaccination. The findings suggest that partnerships between health care and other sectors to build trust and promote vaccination may benefit from socially and culturally responsive strategies that acknowledge and address racial/ethnic health care disparities and historical and contemporary experiences of racism.


Assuntos
Vacinas contra COVID-19/uso terapêutico , COVID-19/etnologia , Ensaios Clínicos como Assunto/psicologia , Grupos de Populações Continentais/psicologia , Confiança , Recusa de Vacinação/etnologia , Adolescente , Adulto , Afro-Americanos/psicologia , Afro-Americanos/estatística & dados numéricos , Idoso , Americanos Asiáticos/psicologia , Americanos Asiáticos/estatística & dados numéricos , Atitude Frente a Saúde/etnologia , COVID-19/prevenção & controle , Grupos de Populações Continentais/estatística & dados numéricos , Estudos Transversais , Grupo com Ancestrais do Continente Europeu/psicologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/psicologia , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Michigan , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Confiança/psicologia , Recusa de Vacinação/psicologia , Recusa de Vacinação/estatística & dados numéricos , Adulto Jovem
8.
BMC Musculoskelet Disord ; 22(1): 465, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34020634

RESUMO

BACKGROUND: Care continuum models (also known as care cascade models) are used by researchers and health system planners to identify potential gaps or disparities in healthcare, but these models have limited applications to complex or chronic clinical conditions. Cyclical continuum models that integrate more complex clinical information and that are displayed using circular data visualization tools may help to overcome these limitations. We performed proof-of-concept cyclical continuum modeling for one such group of conditions-musculoskeletal infections-and assessed for racial and ethnic disparities across the complex care process related to these infections. METHODS: Cyclical continuum modeling was performed in a diverse, retrospective cohort of 1648 patients with musculoskeletal infections, including osteomyelitis, septic arthritis, and/or infectious myositis, in the University of New Mexico Health System. Logistic regression was used to estimate the relative odds of each element or outcome of care in the continuum. Results were visualized using circularized, map-like images depicting the continuum of care. RESULTS: Racial and ethnic disparities differed at various phases in the care process. Hispanic/Latinx patients had evidence of healthcare disparities across the continuum, including diabetes mellitus [odds ratio (OR) 2.04, 95% confidence interval (CI): 1.61, 2.60 compared to a white non-Hispanic reference category]; osteomyelitis (OR 1.28, 95% CI: 1.01, 1.63); and amputation (OR 1.48; 95% CI: 1.10, 2.00). Native American patients had evidence of disparities early in the continuum (diabetes mellitus OR 3.59, 95% CI: 2.63, 4.89; peripheral vascular disease OR 2.50; 95% CI: 1.45, 4.30; osteomyelitis OR 1.43; 95% CI: 1.05, 1.95) yet lower odds of later-stage complications (amputation OR 1.02; 95% CI: 0.69, 1.52). African American/Black non-Hispanic patients had higher odds of primary risk factors (diabetes mellitus OR 2.70; 95% CI: 1.41, 5.19; peripheral vascular disease OR 4.96; 95% CI: 2.06, 11.94) and later-stage outcomes (amputation OR 2.74; 95% CI: 1.38, 5.45) but not intervening, secondary risk factors (osteomyelitis OR 0.79; 95% CI: 0.42, 1.48). CONCLUSIONS: By identifying different structural and clinical barriers to care that may be experienced by groups of patients interacting with the healthcare system, cyclical continuum modeling may be useful for the study of healthcare disparities.


Assuntos
Grupo com Ancestrais do Continente Europeu , Disparidades em Assistência à Saúde , Continuidade da Assistência ao Paciente , Grupos Étnicos , Humanos , México , Estudos Retrospectivos , Estados Unidos
9.
Sci Rep ; 11(1): 9905, 2021 05 10.
Artigo em Inglês | MEDLINE | ID: mdl-33972602

RESUMO

The COVID-19 pandemic has affected African American populations disproportionately with respect to prevalence, and mortality. Expression profiles represent snapshots of combined genetic, socio-environmental (including socioeconomic and environmental factors), and physiological effects on the molecular phenotype. As such, they have potential to improve biological understanding of differences among populations, and provide therapeutic biomarkers and environmental mitigation strategies. Here, we undertook a large-scale assessment of patterns of gene expression between African Americans and European Americans, mining RNA-Seq data from 25 non-diseased and diseased (tumor) tissue-types. We observed the widespread enrichment of pathways implicated in COVID-19 and integral to inflammation and reactive oxygen stress. Chemokine CCL3L3 expression is up-regulated in African Americans. GSTM1, encoding a glutathione S-transferase that metabolizes reactive oxygen species and xenobiotics, is upregulated. The little-studied F8A2 gene is up to 40-fold more highly expressed in African Americans; F8A2 encodes HAP40 protein, which mediates endosome movement, potentially altering the cellular response to SARS-CoV-2. African American expression signatures, superimposed on single cell-RNA reference data, reveal increased number or activity of esophageal glandular cells and lung ACE2-positive basal keratinocytes. Our findings establish basal prognostic signatures that can be used to refine approaches to minimize risk of severe infection and improve precision treatment of COVID-19 for African Americans. To enable dissection of causes of divergent molecular phenotypes, we advocate routine inclusion of metadata on genomic and socio-environmental factors for human RNA-sequencing studies.


Assuntos
Afro-Americanos/genética , COVID-19/genética , Grupo com Ancestrais do Continente Europeu/genética , Perfilação da Expressão Gênica/métodos , Regulação Neoplásica da Expressão Gênica , Neoplasias/genética , COVID-19/epidemiologia , COVID-19/virologia , Quimiocina CCL3/genética , Redes Reguladoras de Genes , Glutationa Transferase/genética , Humanos , Neoplasias/classificação , Neoplasias/etnologia , Proteínas Nucleares/genética , Pandemias , Prognóstico , RNA-Seq/métodos , SARS-CoV-2/isolamento & purificação , SARS-CoV-2/fisiologia , Fatores Socioeconômicos , Estados Unidos/epidemiologia
10.
Nat Commun ; 12(1): 2579, 2021 05 10.
Artigo em Inglês | MEDLINE | ID: mdl-33972514

RESUMO

Serum concentration of hepatic enzymes are linked to liver dysfunction, metabolic and cardiovascular diseases. We perform genetic analysis on serum levels of alanine transaminase (ALT), alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT) using data on 437,438 UK Biobank participants. Replication in 315,572 individuals from European descent from the Million Veteran Program, Rotterdam Study and Lifeline study confirms 517 liver enzyme SNPs. Genetic risk score analysis using the identified SNPs is strongly associated with serum activity of liver enzymes in two independent European descent studies (The Airwave Health Monitoring study and the Northern Finland Birth Cohort 1966). Gene-set enrichment analysis using the identified SNPs highlights involvement in liver development and function, lipid metabolism, insulin resistance, and vascular formation. Mendelian randomization analysis shows association of liver enzyme variants with coronary heart disease and ischemic stroke. Genetic risk score for elevated serum activity of liver enzymes is associated with higher fat percentage of body, trunk, and liver and body mass index. Our study highlights the role of molecular pathways regulated by the liver in metabolic disorders and cardiovascular disease.


Assuntos
Alanina Transaminase/genética , Fosfatase Alcalina/genética , Doenças Cardiovasculares/genética , Fígado/enzimologia , Doenças Metabólicas/genética , gama-Glutamiltransferase/genética , Idoso , Alanina Transaminase/sangue , Fosfatase Alcalina/sangue , Doenças Cardiovasculares/enzimologia , Estudos de Coortes , Bases de Dados Genéticas , Grupo com Ancestrais do Continente Europeu , Feminino , Regulação Enzimológica da Expressão Gênica/genética , Predisposição Genética para Doença , Testes Genéticos , Estudo de Associação Genômica Ampla , Humanos , Resistência à Insulina/genética , Metabolismo dos Lipídeos/genética , Fígado/metabolismo , Masculino , Análise da Randomização Mendeliana , Doenças Metabólicas/enzimologia , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único , Fatores de Risco , gama-Glutamiltransferase/sangue
11.
Front Public Health ; 9: 653498, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34046389

RESUMO

Background: Knowledge, attitudes, and beliefs are cognitive outcomes that serve as key determinants of engaging in health behaviors, likely including vaccination and other mitigation behaviors against coronavirus disease 2019 (COVID-19). Studies have begun examining people's knowledge, attitudes, and beliefs about COVID-19, but little is known about how these cognitive outcomes differ across racial/ethnic groups. Methods: An online survey was conducted with a convenience sample of adults ages 18 and older in the United States (n = 2,006) in May 2020, about 2 months after COVID-19 was declared a pandemic. Multivariable regression models were used to examine differences in knowledge, attitudes, and beliefs about COVID-19 across racial/ethnic groups (non-Latinx white, non-Latinx black, non-Latinx of another race, or Latinx). Results: Knowledge tended to be lower among non-Latinx blacks and Latinx participants compared to non-Latinx whites. For example, fewer non-Latinx blacks responded correctly that COVID-19 is not caused by the same virus that causes influenza (adjusted OR = 0.66, 95% CI: 0.49-0.90), and Latinx participants were less likely to respond correctly that people with COVID-19 do not always show symptoms of being sick (adjusted OR = 0.63, 95% CI: 0.45-0.87). For beliefs and attitudes, non-Latinx blacks (ß = -0.09) and non-Latinx participants of another race (ß = -0.05) reported lower perceived likelihood of getting COVID-19 in the future compared to non-Latinx whites, while Latinx participants reported greater perceived stigma of COVID-19 (ß = 0.08) (all p < 0.05). Conclusions: Several differences in cognitive outcomes about COVID-19 exist across racial/ethnic groups, including gaps in knowledge and varied beliefs and attitudes. Results identify modifiable targets for public health programs promoting vaccination and other mitigation behaviors against COVID-19.


Assuntos
COVID-19 , Conhecimentos, Atitudes e Prática em Saúde , Adolescente , Adulto , Grupo com Ancestrais do Continente Europeu , Humanos , Pandemias , SARS-CoV-2 , Estados Unidos/epidemiologia
12.
N Z Med J ; 134(1535): 71-77, 2021 05 21.
Artigo em Inglês | MEDLINE | ID: mdl-34012141

RESUMO

The current New Zealand Bowel Screening Programme (BSP) is inequitable. At present, just over half of bowel cancers in Maori present before the age of 60 years (58% in females and 52% in males), whereas just under a third of bowel cancers in non-Maori are diagnosed before the same age (27% in females and 29% in males). The argument for extending the bowel screening age range down to 50 years for Maori is extremely simple-in comparison to non-Maori, a greater percentage of bowel cancers in Maori occur before the age of 60 years (when screening starts). Commencing the BSP at 50 years of age for Maori with high coverage will help fix this inequity. In this paper we review the current epidemiology of colorectal cancer with respect to the age range extension for Maori.


Assuntos
Neoplasias do Colo/prevenção & controle , Detecção Precoce de Câncer , Disparidades em Assistência à Saúde , Grupo com Ancestrais Oceânicos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Neoplasias do Colo/diagnóstico , Neoplasias do Colo/epidemiologia , Neoplasias do Colo/etnologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Disparidades em Assistência à Saúde/etnologia , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Adulto Jovem
13.
Nat Commun ; 12(1): 2721, 2021 05 25.
Artigo em Inglês | MEDLINE | ID: mdl-34035248

RESUMO

Urban heat stress poses a major risk to public health. Case studies of individual cities suggest that heat exposure, like other environmental stressors, may be unequally distributed across income groups. There is little evidence, however, as to whether such disparities are pervasive. We combine surface urban heat island (SUHI) data, a proxy for isolating the urban contribution to additional heat exposure in built environments, with census tract-level demographic data to answer these questions for summer days, when heat exposure is likely to be at a maximum. We find that the average person of color lives in a census tract with higher SUHI intensity than non-Hispanic whites in all but 6 of the 175 largest urbanized areas in the continental United States. A similar pattern emerges for people living in households below the poverty line relative to those at more than two times the poverty line.


Assuntos
Exposição Ambiental/análise , Disparidades nos Níveis de Saúde , Transtornos de Estresse por Calor/etnologia , Temperatura Alta , Saúde da População Urbana/etnologia , Afro-Americanos/estatística & dados numéricos , Cidades , Exposição Ambiental/efeitos adversos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Geografia , Hispano-Americanos/estatística & dados numéricos , Humanos , Renda/estatística & dados numéricos , Maryland , Pobreza/estatística & dados numéricos , South Carolina , Estados Unidos
14.
Medicine (Baltimore) ; 100(20): e25922, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34011063

RESUMO

BACKGROUND: Numerous studies have investigated the associations between Vitamin D receptor (VDR) gene polymorphisms and risk of intervertebral disc degeneration but the results remain controversial. This study aimed to drive a more precise estimation of association between VDR gene polymorphisms and risk of intervertebral disc degeneration. METHODS: PubMed, EMBASE, Cochrane library, Web of Science and China Knowledge Resource Integrated Database for papers on VDR gene polymorphisms and risk of intervertebral disc degeneration were searched. The pooled odds ratios (ORs) with 95% confidence intervals (CIs) were used to assess the strength of association in the homozygote model, heterozygote model, dominant model, recessive model and an additive model. RESULTS: Overall, 23 articles were included in the final meta-analysis. The subgroup analyses by ethnicity showed a significant association of VDR FokI mutation with disc degeneration risk in Caucasians (recessive model, OR with 95%CI 1.301, [1.041, 1.626]; additive model, OR with 95%CI 1.119, [1.006, 1.245]). The results of subgroup analyses by ethnicity showed a significant association of VDR TaqI mutation with disc degeneration risk in Asians but not in Caucasians. There was a significant association between VDR ApaI mutation and risk of disc degeneration and subgroup analyses by ethnicity showed a significant association in Caucasians and in Asians. CONCLUSIONS: In summary, VDR FokI polymorphisms was associated with disc degeneration risk among Caucasians but not Asians, VDR TaqI polymorphisms was associated with disc degeneration risk among Asians but not Caucasians, while VDR ApaI polymorphism was associated with disc degeneration risk among Asians and Caucasians.


Assuntos
Predisposição Genética para Doença , Degeneração do Disco Intervertebral/genética , Dor Lombar/genética , Receptores de Calcitriol/genética , Grupo com Ancestrais do Continente Asiático/genética , Estudos de Casos e Controles , Grupo com Ancestrais do Continente Europeu/genética , Humanos , Degeneração do Disco Intervertebral/complicações , Degeneração do Disco Intervertebral/epidemiologia , Dor Lombar/epidemiologia , Razão de Chances , Polimorfismo de Fragmento de Restrição
15.
Medicine (Baltimore) ; 100(20): e25936, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34011069

RESUMO

ABSTRACT: In this observational study, by the use of a multiplex proteomic platform, we aimed to explore associations between 92 targeted proteins involved in cardiovascular disease and/or inflammation, and phenotypes of deteriorating vascular health, with regards to ethnicity.Proteomic profiling (92 proteins) was carried out in 362 participants from the Sympathetic activity and Ambulatory Blood Pressure in Africans (SABPA) study of black and white African school teachers (mean age 44.7 ±â€Š9.9 years, 51.9% women, 44.5% Black Africans, 9.9% with known cardiovascular disease). Three proteins with <15% of samples below detectable limits were excluded from analyses. Associations between multiple proteins and prevalence of hypertension as well as vascular health [Carotid intima-media thickness (cIMT) and pulse wave velocity (PWV)] measures were explored using Bonferroni-corrected regression models.Bonferroni-corrected significant associations between 89 proteins and vascular health markers were further adjusted for clinically relevant co-variates. Hypertension was associated with growth differentiation factor 15 (GDF-15) and C-X-C motif chemokine 16 (CXCL16). cIMT was associated with carboxypeptidase A1 (CPA1), C-C motif chemokine 15 (CCL15), chitinase-3-like protein 1 (CHI3L1), scavenger receptor cysteine-rich type 1 protein M130 (CD163) and osteoprotegerin, whereas PWV was associated with GDF15, E-selectin, CPA1, fatty acid-binding protein 4 (FABP4), CXCL16, carboxypeptidase B (CPB1), and tissue-type plasminogen activator. Upon entering ethnicity into the models, the associations between PWV and CPA1, CPB1, GDF-15, FABP4, CXCL16, and between cIMT and CCL-15, remained significant.Using a multiplex proteomic approach, we linked phenotypes of vascular health with several proteins. Novel associations were found between hypertension, PWV or cIMT and proteins linked to inflammatory response, chemotaxis, coagulation or proteolysis. Further, we could reveal whether the associations were ethnicity-dependent or not.


Assuntos
Arteriosclerose/epidemiologia , Hipertensão/epidemiologia , Proteômica/métodos , Adulto , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Arteriosclerose/sangue , Arteriosclerose/diagnóstico , Arteriosclerose/imunologia , Biomarcadores/sangue , Espessura Intima-Media Carotídea , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Fatores de Risco de Doenças Cardíacas , Humanos , Hipertensão/sangue , Hipertensão/diagnóstico , Hipertensão/imunologia , Inflamação/sangue , Inflamação/diagnóstico , Inflamação/imunologia , Masculino , Pessoa de Meia-Idade , Prevalência , Análise de Onda de Pulso , Medição de Risco/métodos , Adulto Jovem
16.
Medicine (Baltimore) ; 100(20): e25976, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34011086

RESUMO

ABSTRACT: Disparities by race/ethnicity and socioeconomic status (SES) exist in rehospitalization rates and inpatient mortality rates. Few studies have examined how length of stay (LOS, a measure of hospital efficiency/quality) differs by race/ethnicity and SES.This study's objective was to determine whether differences in risk-adjusted LOS exist by race/ethnicity and SESUsing a retrospective cohort of 1,432,683 medical and surgical discharges, we compared risk-adjusted LOS, in days, by race/ ethnicity and SES (median household income by patient ZIP code in quartiles), using generalized linear models controlling for demographic and clinical factors, and differences between hospitals and between diagnoses.White patients were on average older than both Black and Hispanic patients, had more chronic conditions, and had a higher inpatient mortality risk. In adjusted analyses, Black patients had a significantly longer LOS than White patients (0.25-day difference when discharged to home and 0.23-day difference when discharged to non-home destinations, both P<.001); there was no difference between Hispanic and White patients. Wealthier patients had a shorter LOS than poorer patients (0.16-day difference when discharged to home and 0.06-day difference when discharged to nonhome destinations, both P<.001). These differences by race/ethnicity reversed for Medicaid patients.Disparities in LOS exist based on a patient's race/ethnicity and SES. Black and poorer patients, but not Hispanic patients, have longer LOS compared to White and wealthier patients. In aggregate, these differences may be related to trust and implicit bias and have implications for use of LOS as a quality metric. Future research should examine the drivers of these disparities.


Assuntos
Disparidades em Assistência à Saúde/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Fatores Socioeconômicos , Adulto , Afro-Americanos/estatística & dados numéricos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , New York , Estudos Retrospectivos
18.
Front Public Health ; 9: 655447, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33937178

RESUMO

Analyzing the myriad ways in which structural racism systemically generates health inequities requires engaging with the profound challenges of conceptualizing, operationalizing, and analyzing the very data deployed-i. e., racialized categories-to document racialized health inequities. This essay, written in the aftermath of the January 6, 2021 vigilante anti-democratic white supremacist assault on the US Capitol, calls attention to the two-edged sword of data at play, reflecting long histories of support for and opposition to white supremacy and scientific racism. As illustrated by both past and present examples, including COVID-19, at issue are both the non-use (Edge #1) and problematic use (Edge #2) of data on racialized groups. Recognizing that structural problems require structural solutions, in this essay I propose a new two-part institutional mandate regarding the reporting and analysis of publicly-funded work involving racialized groups and health data and documentation as to why the proposed mandates are feasible. Proposal/part 1 is to implement enforceable requirements that all US health data sets and research projects supported by government funds must explicitly explain and justify their conceptualization of racialized groups and the metrics used to categorize them. Proposal/part 2 is that any individual-level health data by membership in racialized groups must also be analyzed in relation to relevant data about racialized societal inequities. A new opportunity arises as US government agencies re-engage with their work, out of the shadow of white grievance politics cast by the Trump Administration, to move forward with this structural proposal to aid the work for health equity.


Assuntos
COVID-19 , Equidade em Saúde , Racismo , Grupo com Ancestrais do Continente Europeu , Humanos , SARS-CoV-2
19.
BMC Womens Health ; 21(1): 186, 2021 05 03.
Artigo em Inglês | MEDLINE | ID: mdl-33941168

RESUMO

BACKGROUND: Tennessee women experience the 12th highest breast cancer mortality in the United States. We examined the geographic differences in breast cancer incidence in Tennessee between Appalachian and non-Appalachian counties from 2005 to 2015. METHODS: We used ArcGIS 10.7 geospatial analysis and logistic regression on the Tennessee Cancer Registry incidence data for adult women aged ≥ 18 years (N = 59,287) who were diagnosed with breast cancer from 2005 to 2015 to evaluate distribution patterns by Appalachian county designation. The Tennessee Cancer Registry is a population-based, central cancer registry serving the citizens of Tennessee and was established by Tennessee law to collect and monitor cancer incidence. The main outcome was breast cancer stage at diagnosis. Independent variables were age, race, marital status, type of health insurance, and county of residence. RESULTS: Majority of the sample were White (85.5%), married (58.6%), aged ≥ 70 (31.3%) and diagnosed with an early stage breast cancer (69.6%). More than half of the women had public health insurance (54.2%), followed by private health insurance coverage (44.4%). Over half of the women resided in non-Appalachian counties, whereas 47.6% were in the Appalachian counties. We observed a significant association among breast cancer patients with respect to marital status and type of health insurance coverage (p = < 0.0001). While the logistic regression did not show a significant result between county of residence and breast cancer incidence, the spatial analysis revealed geographic differences between Appalachian and non-Appalachian counties. The highest incidence rates of 997.49-1164.59/100,000 were reported in 6 Appalachian counties (Anderson, Blount, Knox, Rhea, Roane, and Van Buren) compared to 3 non-Appalachian counties (Fayette, Marshall, and Williamson). CONCLUSIONS: There is a need to expand resources in Appalachian Tennessee to enhance breast cancer screening and early detection. Using geospatial techniques can further elucidate disparities that may be overlooked in conventional linear analyses to improve women's cancer health and associated outcomes.


Assuntos
Neoplasias da Mama , Adulto , Região dos Apalaches/epidemiologia , Neoplasias da Mama/epidemiologia , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Incidência , Tennessee/epidemiologia , Estados Unidos
20.
PLoS One ; 16(5): e0251960, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34038459

RESUMO

Social distancing prescribed by policy makers in response to COVID-19 raises important questions as to how effectively people of color can distance. Due to inequalities from residential segregation, Hispanic and Black populations have challenges in meeting health expectations. However, segregated neighborhoods also support the formation of social bonds that relate to healthy behaviors. We evaluate the question of non-White distancing using social mobility data from Google on three sites: workplaces, grocery stores, and recreational locations. Employing hierarchical linear modeling and geographically weighted regression, we find the relation of race/ethnicity to COVID-19 distancing is varied across the United States. The HLM models show that compared to Black populations, Hispanic populations overall more effectively distance from recreation sites and grocery stores: each point increase in percent Hispanic was related to residents being 0.092 percent less likely (p< 0.05) to visit recreational sites and 0.127 percent less likely (p< 0.01) to visit grocery stores since the onset of COVID-19. However, the GWR models show there are places where the percent Black is locally related to recreation distancing while percent Hispanic is not. Further, these models show the association of percent Black to recreation and grocery distancing can be locally as strong as 1.057 percent (p< 0.05) and 0.989 percent (p< 0.05), respectively. Next, the HLM models identified that Black/White residential isolation was related to less distancing, with each point of isolation residents were 11.476 percent more likely (p< 0.01) to go to recreational sites and 7.493 percent more likely (p< 0.05) to visit grocery stores compared to before COVID-19. These models did not find a measurable advantage/disadvantage for Black populations in these places compared to White populations. COVID-19 policy should not assume disadvantage in achieving social distancing accrue equally to different racial/ethnic minorities.


Assuntos
COVID-19/epidemiologia , Grupos Étnicos/psicologia , Distanciamento Físico , Afro-Americanos/psicologia , Americanos Asiáticos/psicologia , COVID-19/patologia , COVID-19/virologia , Grupo com Ancestrais do Continente Europeu/psicologia , Hispano-Americanos/psicologia , Humanos , Recreação , SARS-CoV-2/isolamento & purificação , Supermercados , Estados Unidos/epidemiologia , Local de Trabalho
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