Racial and Ethnic Differences in Subjective Cognitive Decline - United States, 2015-2020.

Subjective cognitive decline (SCD), the self-reported experience of worsening or more frequent memory loss or confusion, might be a symptom of early-stage dementia or future serious cognitive decline such as Alzheimer disease* or a related dementia (ADRD) (1). Established modifiable risk factors for ADRD include high blood pressure, inadequate physical activity, obesity, diabetes, depression, current cigarette smoking, and hearing loss (2). An estimated 6.5 million persons aged ≥65 years in the United States live with Alzheimer disease, the most common dementia (1). This number is projected to double by 2060, with the largest increase among non-Hispanic Black or African American (Black), and Hispanic or Latino (Hispanic) adults (1,3). Using data from the Behavioral Risk Factor Surveillance System (BRFSS), CDC assessed racial and ethnic, select demographic, and geographical differences in SCD prevalence, and prevalence of health care professional conversations among those reporting SCD. The age-adjusted prevalence of SCD during 2015-2020 was 9.6% among adults aged ≥45 years (5.0% of Asian or Pacific Islander [A/PI] adults, 9.3% of non-Hispanic White [White] adults, 10.1% of Black adults, 11.4% of Hispanic adults, and 16.7% of non-Hispanic American Indian or Alaska Native [AI/AN] adults). College education was associated with a lower prevalence of SCD among all racial and ethnic groups. Only 47.3% of adults with SCD reported that they had discussed confusion or memory loss with a health care professional. Discussing changes in cognition with a physician can allow for the identification of potentially treatable conditions, early detection of dementia, promotion of dementia risk reduction behaviors, and establishing a treatment or care plan to help adults remain healthy and independent for as long as possible.

Dementia Caregiving Experiences and Health Across Geographic Contexts by Race and Ethnicity.

OBJECTIVES: Few studies have examined how the intersectionality of geographic context and race/ethnicity influences dementia caregiving. Our objectives were to determine whether caregiver experiences and health (a) differed across metro and nonmetro areas and (b) differed by caregiver race/ethnicity and geography. METHODS: We used data from the 2017 National Health and Aging Trends Study and National Study of Caregiving. The sample included caregivers (n = 808) of care recipients ages 65 and older with "probable" dementia (n = 482). The geographic context was defined as the care recipient's residence in metro or nonmetro counties. Outcomes included caregiving experiences (care situation, burden, and gains) and health (self-rated anxiety, depression symptoms, and chronic health conditions). RESULTS: Bivariate analyses indicated that nonmetro dementia caregivers were less racially/ethnically diverse (82.7% White, non-Hispanic) and more were spouses/partners (20.2%) than their metro counterparts (66.6% White, non-Hispanic; 13.3% spouses/partners). Among racial/ethnic minority dementia caregivers, nonmetro context was associated with more chronic conditions (p < .01), providing less care (p < .01), and not coresiding with care recipients (p < .001). Multivariate analyses demonstrated that nonmetro minority dementia caregivers had 3.11 times higher odds (95% confidence interval [CI] = 1.11-9.00) of reporting anxiety in comparison to metro minority dementia caregivers. DISCUSSION: Geographic context shapes dementia caregiving experiences and caregiver health differently across racial/ethnic groups. Findings are consistent with previous studies that have shown that feelings of uncertainty, helplessness, guilt, and distress are more prevalent among people providing caregiving from a distance. Despite higher rates of dementia and dementia-related mortality in nonmetro areas, findings suggest both positive and negative aspects of caregiving among White and racial/ethnic minority caregivers.

"We (still) charge genocide": A systematic review and synthesis of the direct and indirect health consequences of police violence in the United States.

Building on historical and contemporary efforts to eliminate police and other forms of state violence, and on the understanding that police violence is a social determinant of health, we conducted a systematic review in which we synthesize the existing literature around 1) racial disparities in police violence; 2) health impacts of direct exposure to police violence; and 3) health impacts of indirect exposure to police violence. We screened 336 studies and excluded 246, due to not meeting our inclusion criteria. Forty-eight additional studies were excluded during the full text review, resulting in a study sample size of 42 studies. Our review showed that Black people in the US are far more likely than white people to experience a range of forms of police violence: from fatal and nonfatal shootings, to assault and psychological violence. Exposure to police violence increases risk of multiple adverse health outcomes. Moreover, police violence may operate as a vicarious and ecological exposure, producing consequences beyond those directly assaulted. In order to successfully eliminate police violence, scholars must work in alignment with social justice movements.

Race-Based Care and Beliefs Regarding the Etiology of Racial Differences in Health Outcomes.

INTRODUCTION: Physicians' perspectives regarding the etiology of racial health differences may be associated with their use of race in clinical practice (race-based practice). This study evaluates whether attributing racial differences in health to genetics, culture, or social conditions is associated with race-based practice. METHODS: This is a cross-sectional analysis, conducted in 2022, of the Council of Academic Family Medicine Education Research Alliance 2021 general membership survey. Only actively practicing U.S. physicians were included. The survey included demographic questions; the Racial Attributes in Clinical Evaluation (RACE) scale (higher scores imply greater race-based practice); and 3 questions regarding beliefs that racial differences in genetics, culture (e.g., health beliefs), or social conditions (e.g., education) explained racial differences in health. Three multivariable linear regressions were used to evaluate the relationship between RACE scores and beliefs regarding the etiology of racial differences in health. RESULTS: Of the 4,314 survey recipients, 949 (22%) responded, of whom 689 were actively practicing U.S. physicians. In multivariable regressions controlling for age, gender, race, ethnicity, and practice characteristics, a higher RACE score was associated with a greater belief that differences in genetics (ß=3.57; 95% CI=3.19, 3.95) and culture (ß=1.57; 95% CI=0.99, 2.16)-in but not social conditions-explained differences in health. CONCLUSIONS: Physicians who believed that genetic or cultural differences between racial groups explained racial differences in health outcomes were more likely to use race in clinical care. Further research is needed to determine how race is differentially applied in clinical care on the basis of the belief in its genetic or cultural significance.

Racial/ethnic disparities in sleep-disordered breathing during pregnancy in the nuMoM2b study.

OBJECTIVE: The aim of this study was to assess the prevalence and severity of sleep-disordered breathing (SDB) across racial/ethnic groups in 3702 pregnant people at 6 to 15 and 22 to 31 weeks gestational age, examine whether BMI modifies the association between race/ethnicity and SDB, and investigate whether interventions to reduce weight might reduce racial/ethnic disparities in SDB. METHODS: Differences by race/ethnicity in SDB prevalence and severity were quantified via linear, logistic, or quasi-Poisson regression. Controlled direct effect was used to estimate whether intervening on BMI would remove/diminish differences by race/ethnicity in SDB severity. RESULTS: This study comprised 61.2% non-Hispanic White (nHW), 11.9% non-Hispanic Black (nHB), 18.5% Hispanic, and 3.7% Asian people. SDB prevalence was higher for nHB compared with nHW pregnant people at 6 to 15 weeks (odds ratio [OR] 1.81, 95% CI [1.07, 2.97]), whereas at 21 to 32 weeks, Asian pregnant people had a higher SDB prevalence than nHW (OR 2.2, 95% CI [1.1, 4.0]). The severity of SDB differed across racial/ethnic groups in early pregnancy, with nHB pregnant people having a higher apnea-hypopnea index (AHI) (OR 1.35, 95% CI [1.07, 1.69]) compared with nHW. Having overweight/obesity was associated with a higher AHI (ß = 2.36, 95% CI [1.97, 2.84]). Controlled direct effect analyses indicated that in early pregnancy, nHB and Hispanic pregnant people would have a lower AHI compared with nHW people had they had normal weight. CONCLUSIONS: This study extends knowledge on racial/ethnic disparities in SDB to a pregnant population.

Have racial disparities in home dialysis utilization changed over time?

OBJECTIVES: The Medicare end-stage kidney disease (ESKD) prospective payment system (PPS) for maintenance dialysis, implemented in 2011, resulted in modestly increased access to both home-based peritoneal dialysis (PD) and home hemodialysis (HHD) treatment modalities, but it is unclear whether regional disparities in home dialysis (PD and HHD) were affected. We compared regional home dialysis use by White and non-White individuals over time. STUDY DESIGN: Retrospective cohort study of dialysis facilities offering home dialysis in 2006-2016 and of 1,098,579 patients with prevalent ESKD in 2006-2016. METHODS: We compared hospital referral region (HRR) utilization rates of home dialysis between White and non-White patients over time using a generalized estimating equation model with a negative binomial distribution adjusting for regional characteristics. RESULTS: The mean number of facilities offering home dialysis operating in each HRR increased from 15.6 in 2006 to 22.1 in 2016. Observed mean HRR home dialysis rates increased overall, but White patients maintained greater home dialysis use than non-White patients: 19.7% in 2006 and 26.2% in 2016 among White patients vs 13.0% in 2006 and 17.8% in 2016 among non-White patients. In adjusted analysis, there was no evidence of changes in White/non-White disparities in home dialysis use over time (P = .84) or after the Medicare ESKD PPS in 2011 (incidence rate ratio, 0.97; 95% CI, 0.92-1.02; P = .29). CONCLUSIONS: Even after modest increases in dialysis facility availability and patient utilization after the implementation of the Medicare ESKD PPS in 2011, significant racial disparities in home dialysis remain.

Introduction to special section: Addressing racism, anti-blackness, and racial trauma in psychotherapy.

This article introduces the special section on "Addressing Racism, Anti-Blackness, and Racial Trauma in Psychotherapy." The special section was organized to highlight research and clinical practices on addressing racism, anti-Blackness, and racial trauma in psychotherapy. We provide an overview of the special section with attention to future research to continue to advance practice and scholarship on addressing racism, anti-Blackness, and racial trauma in psychotherapy. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A test for implicit bias in discretionary criminal justice decisions.

OBJECTIVE: Our goal was to develop a framework to test for implicit racial bias in discretionary decisions made by community supervision agents in conditions with increasing information ambiguity. HYPOTHESES: We reasoned that as in-person contact decreases, community supervision officers' specific knowledge of clients would be replaced by heuristics that lead to racially disproportionate outcomes in higher discretion events. Officers' implicit biases would lead to disproportionately higher technical violation rates among Black community corrections' clients when they have less personal contact, but we expected no analogous increase in nondiscretionary decisions. METHOD: Using data from Black and White clients entering probation and postrelease supervision in North Carolina from 2012 through 2016, we estimated the difference in racial disparities in discretionary versus nondiscretionary decisions across five levels of supervision. We evaluated the robustness of our main fixed-effects model using an alternative regression discontinuity design. RESULTS: Racial disparities in discretionary decisions grew as supervision intensity decreased, and the bias was larger for women than men. There was no similar pattern of increased disparity for nondiscretionary decisions. CONCLUSIONS: Criminal justice system actors have a great deal of discretion, particularly in how they deal with less serious criminal behavior. Although decentralized decisions are foundational to the function of the criminal justice system, they provide an opportunity for implicit bias to seep in. Shortcuts and mental heuristics are more influential when the decision-maker's mental resources are already strained-for instance, if someone is tired, distracted, or overworked. Therefore, limiting discretion and increasing oversight and accountability may reduce the impact of implicit bias on criminal justice system outcomes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Psychosocial outcomes and peer influences among multiracial adolescents in the United States.

Objective: To examine racial and ethnic self-identification among adolescents and explore psychosocial outcomes and peer treatment for multiracial adolescents in the United States. Methods: Data are from the 2014 Child Development Supplement, a subsample of the Panel Study of Income Dynamics. Data were weighted to be nationally representative. Descriptive statistics were used to describe the population and to explore family and parent demographics. Multivariable regressions tested for differences in psychosocial outcomes and peer treatment and group behaviors for multiracial youth in comparison to their single race peers. Results: Black multiracial youth had significantly lower scores on the children's depression index compared to single race Black youth, and White multiracial youth reported significantly higher rates of peer mistreatment in comparison to White single race youth. Black multiracial and White multiracial adolescents reported similar positive and negative peer group behaviors. Conclusions: Complex patterns emerge when examining the psychosocial and peer treatment variables presented in this analysis for multiracial adolescents and their single-race peers. The findings regarding depressive symptoms and peer bullying point to signs of different relationships between multiracial groups. White multiracial adolescents report worse outcomes than their White single-race peers, but Black multiracial adolescents reporting better outcomes than their Black single-race peers.

Telomere length associates with chronological age and mortality across racially diverse pulmonary fibrosis cohorts.

Pulmonary fibrosis (PF) is characterized by profound scarring and poor survival. We investigated the association of leukocyte telomere length (LTL) with chronological age and mortality across racially diverse PF cohorts. LTL measurements among participants with PF stratified by race/ethnicity were assessed in relation to age and all-cause mortality, and compared to controls. Generalized linear models were used to evaluate the age-LTL relationship, Cox proportional hazards models were used for hazard ratio estimation, and the Cochran-Armitage test was used to assess quartiles of LTL. Standardized LTL shortened with increasing chronological age; this association in controls was strengthened in PF (R = -0.28; P < 0.0001). In PF, age- and sex-adjusted LTL below the median consistently predicted worse mortality across all racial groups (White, HR = 2.21, 95% CI = 1.79-2.72; Black, HR = 2.22, 95% CI = 1.05-4.66; Hispanic, HR = 3.40, 95% CI = 1.88-6.14; and Asian, HR = 2.11, 95% CI = 0.55-8.23). LTL associates uniformly with chronological age and is a biomarker predictive of mortality in PF across racial groups.

Racial and Ethnic Disparities in Research and Clinical Trials.

Clinical trials are an essential component of research for determining the safety and efficacy of treatments for medical diseases. In order for the results of clinical trials to be generalizable to diverse populations, they must include participants at ratios that are reflective of national and global populations. A significant number of dermatology studies not only lack racial/ethnic diversity but also fail to report data on minority recruitment and enrollment. Reasons for this are multifold and are discussed in this review. Although steps have been implemented to improve this issue, greater efforts are needed for sustained and meaningful change.

Neighborhood social organization exposures and racial/ethnic disparities in hypertension risk in Los Angeles.

Despite a growing evidence base documenting associations between neighborhood characteristics and the risk of developing high blood pressure, little work has established the role played by neighborhood social organization exposures in racial/ethnic disparities in hypertension risk. There is also ambiguity around prior estimates of neighborhood effects on hypertension prevalence, given the lack of attention paid to individuals' exposures to both residential and nonresidential spaces. This study contributes to the neighborhoods and hypertension literature by using novel longitudinal data from the Los Angeles Family and Neighborhood Survey to construct exposure-weighted measures of neighborhood social organization characteristics-organizational participation and collective efficacy-and examine their associations with hypertension risk, as well as their relative contributions to racial/ethnic differences in hypertension. We also assess whether the hypertension effects of neighborhood social organization vary across our sample of Black, Latino, and White adults. Results from random effects logistic regression models indicate that adults living in neighborhoods where people are highly active in informal and formal organizations have a lower probability of being hypertensive. This protective effect of exposure to neighborhood organizational participation is also significantly stronger for Black adults than Latino and White adults, such that, at high levels of neighborhood organizational participation, the observed Black-White and Black-Latino hypertension differences are substantially reduced to nonsignificance. Nonlinear decomposition results also indicate that almost one-fifth of the Black-White hypertension gap can be explained by differential exposures to neighborhood social organization.

The impact of county-level fees & fines as exploitative revenue generation on US birth outcomes 2011-2015.

Fees and fines collected through courts and law enforcement can comprise a considerable proportion of revenue for local governments. Law enforcement, as agents of revenue generation, change policing behavior to increase revenue, at times targeting Black and brown neighborhoods to bolster municipal budgets. This structural racism in revenue generation has not yet been assessed as an exposure for adverse health. Using the 2012 Census of Governments, and 2011-2015 vital statistics from the National Center of Health Statistics, we examine the relationship between countyaverage fees and fines as a percent of total own-source revenue and county-level characteristics, and risk of preterm birth and low birthweight across the United States. Mothers residing in counties with the greatest reliance on fees and fines had 1.08 (95% CI: 1.03-1.12) times the odds of preterm birth and 1.07 (95% CI: 1.02-1.11) times the odds of low birthweight than mothers residing in counties with the least reliance on fees and fines, controlling for individual- and county-level covariates. The addition of countylevel racial composition, and the Index of Concentration at the Extremes (ICE), reduced these associations yet remained statistically significant. Future studies should continue to examine how racist, exploitative revenue generation through police and court activities influences the health of residents.

Redressing the Harms of Race-Based Kidney Function Estimation.

This Viewpoint emphasizes the urgency of abolishing race-based medical practices and explains how they have unjustly contributed to racial inequities in clinical care and health outcomes.