Health Equity最新文献

{"title":"Accuracy of Race and Ethnicity Data in the Pediatric Electronic Health Record: A Concordance and System Adequacy Study.","authors":"John D Cowden, Rachel Drake, Jessi Johnson, Katiana Kelty, Mehwish Ahmed","doi":"10.1089/heq.2024.0188","DOIUrl":"https://doi.org/10.1089/heq.2024.0188","url":null,"abstract":"<p><strong>Introduction: </strong>Conventional race and ethnicity categories and analysis are reductive and prone to inaccuracy. Because race and ethnicity data validity is essential to health equity efforts, we measured the accuracy of race and ethnicity data in a pediatric electronic health record (EHR) to identify areas for improvement in data collection and use.</p><p><strong>Methods: </strong>Patients and their caregivers reported patient race and ethnicity via in-person survey in four pediatric settings (inpatient, emergency room, urgent care, and primary care). Race and ethnicity data from the EHR were compared with survey data to calculate four measures of EHR data accuracy. The U.S. Census Bureau's novel categorization scheme was used to analyze racial and ethnic identities \"alone\" and \"in combination\" with ≥1 other identity.</p><p><strong>Results: </strong>Caregivers for 561 patients completed the survey; 116 patients aged ≥12 years completed a patient version. For consolidated race and ethnicity fields, overall concordance between survey and EHR was 74.6%. Concordance differed by race and ethnicity category when alone (Black or African American 96.1%, Hispanic 90.6%, and White 92.5%) and in combination with another category (Black or African American 93.9%, Hispanic 88.6%, and White 84.4%). The EHR had low accuracy for patients with multiple racial or ethnic identities (overall sensitivity 35%). Such patients' identities were often oversimplified due to EHR design. Using \"alone\" and \"in combination\" analysis for race and ethnicity categories allowed all patient identities to be visible across categories, unlike in conventional race and ethnicity analysis.</p><p><strong>Discussion: </strong>Identifying and eliminating health disparities depend on accurate race and ethnicity data, but current EHR design provides an unreliable data foundation for needed analyses. Conventional categorization used in race and ethnicity analysis is problematic, hiding identities in a reductive set of groupings. New approaches to validation, categorization, and analysis, as explored in this study, are urgently needed to advance health equity goals.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"9 1","pages":"256-265"},"PeriodicalIF":2.6,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12270523/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"System-Level Factors Contributing to Burnout and Professional Well-Being Among Transgender and Gender-Diverse Nurses.","authors":"Hyunmin Yu, Celsea Tibbitt, J Margo Brooks Carthon, Karen B Lasater, José A Bauermeister, Matthew D McHugh","doi":"10.1089/heq.2024.0196","DOIUrl":"https://doi.org/10.1089/heq.2024.0196","url":null,"abstract":"<p><strong>Introduction: </strong>Transgender and gender-diverse (TGD) health care professionals face significant burnout, yet evidence on system-level factors such as workplace discrimination that contribute to this issue among TGD nurses is limited. Responding to the U.S. Department of Health and Human Services' call for research on burnout among health care staff from diverse demographic backgrounds, this study aimed to examine the system-level factors affecting burnout and professional well-being among TGD nurses and identify strategies to enhance their well-being.</p><p><strong>Methods: </strong>This qualitative descriptive study employed directed content analysis of responses of 6 different open-text survey questions from 66 TGD nurses, utilizing 2 nurse survey datasets collected pre-pandemic (December 2019-February 2020) and during the pandemic (April 2021-June 2021). To identify the system-level factors influencing burnout and well-being, the themes were developed using both inductive and deductive analytic approaches, guided by the Systems Model of Clinical Burnout and Professional Well-being.</p><p><strong>Results: </strong>Three themes related to the system-level factors affecting burnout and professional well-being among TGD nurses were: (1) <i>poor working conditions</i> characterized by inadequate staffing and insufficient protective measures, (2) <i>lack of leadership support and a non-inclusive culture</i> highlighted by unsupportive leadership and workplace discrimination, and (3) <i>non-patient-centered U.S. health care and LGBTQ+ stigma</i> that create barriers to providing quality care for marginalized groups and receiving care for themselves. Recommendations from participants to enhance their professional well-being are also presented.</p><p><strong>Conclusion: </strong>To support the well-being of TGD nurses and improve the quality of care for all patients, health care organizations should implement system-level changes that create a physically and psychologically safe and inclusive work environment.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"9 1","pages":"245-255"},"PeriodicalIF":2.6,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12270527/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing Health Equity for American Indian and Alaska Native People Through Inclusion in Clinical Trials: Anti-SARS-CoV-2 Monoclonal Antibody Treatment and COVID-19 Outcomes Among Ambulatory Cherokee Nation Health Services Patients.","authors":"Jorge Mera, Whitney Essex, Elizabeth Menstell Coyle, Ashley Comiford, Molly A Feder","doi":"10.1089/heq.2024.0185","DOIUrl":"https://doi.org/10.1089/heq.2024.0185","url":null,"abstract":"<p><strong>Background: </strong>Racial/ethnic minority groups are underrepresented in clinical trials with American Indian and Alaska Native (AI/AN) people having the lowest representation. This article aims to contribute to the literature to address that gap by sharing the results of the use of anti-SARS-CoV-2 monoclonal antibodies among AI/AN people at risk for severe COVID-19.</p><p><strong>Methods: </strong>This retrospective cohort study assessed data from ambulatory AI/AN patients enrolled in Cherokee Nation Health Services in Northeastern Oklahoma, who had a positive test for SARS-CoV-2, high risk for progression, and were offered anti-SARS-CoV-2 monoclonal antibody treatment active against the circulating SARS-CoV-2 strain from December 1, 2020, to April 16, 2021. The outcomes of interest were all-cause and COVID-19-related emergency department visits, hospitalizations, intensive care admissions, and deaths within 28 days of being offered treatment.</p><p><strong>Results: </strong>Among 1,447 participants, 813 (56.2%) were treated and 634 (43.8%) were not. When adjusted for potential confounders, there was a significant difference in the odds of treated versus untreated patients experiencing a COVID-19-related emergency department visit (OR, 0.42; 95% CI, 0.27-0.63) and hospitalization (OR, 0.10; 95% CI, 0.03-0.31).</p><p><strong>Discussion: </strong>Anti-SARS-CoV-2 monoclonal antibody treatment was associated with lower odds of COVID-19-related emergency department visits and hospitalization among high-risk AI/AN patients.</p><p><strong>Health equity implications: </strong>To advance health equity, it is critical to have representation of AI/AN in clinical trials and other research. This project is an example of how community partnerships with AI/AN health systems can strengthen the evidence for new and emerging treatments, address past harm, and advance equity.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"9 1","pages":"235-244"},"PeriodicalIF":2.6,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12270532/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racial and Ethnic Disparities in Reproductive Health Care and Outcomes Among Female Veterans: A Scoping Review.","authors":"Katrina S Nietsch, Samantha L Estevez, Nichole Goodsmith, Kristin O Haeger, Jill Inderstrodt, Sabra S Inslicht, Katherine A Kosman, Qiyan Mu, Yael I Nillni, Deirdre Quinn, Adriana Rodriguez, Lauren Siff, Krysttel C Stryczek, Erica V Tartaglione, Jodie G Katon","doi":"10.1089/heq.2024.0168","DOIUrl":"https://doi.org/10.1089/heq.2024.0168","url":null,"abstract":"<p><strong>Introduction: </strong>Female veterans are the fastest growing group of new Veterans Health Administration (VA) users, and 40% identify as belonging to a racialized group. It is unclear if racial/ethnic disparities in reproductive health care and outcomes observed among nonveterans are present among veterans. The purpose of this scoping review was to characterize patterns of racial/ethnic disparities in reproductive health care and outcomes among female veterans.</p><p><strong>Methods: </strong>A structured PubMed search was performed to extend a prior systematic review (from 2008-2017 to 2018-2023). We included original research on reproductive health care and outcomes in female veterans that also included a measure of association to race or ethnicity. Four hundred thirty-eight articles were identified for potential inclusion. Following PRISMA guidelines, titles and abstracts were screened in duplicate, and full articles were reviewed using a standardized abstraction form. Articles were sorted into six categories by topic (contraception, infertility, pregnancy, reproductive health screenings, gynecology, and menopause) and outcomes characterized as structural (e.g., organization of care), process (e.g., access to services), or clinical/behavioral (e.g., low birthweight) measures per Donabedian's model.</p><p><strong>Results: </strong>After title and abstract screening, 53 articles were reviewed in full. Four additional articles were excluded for a final sample of 49 articles. All articles described results from observational studies, which were almost exclusively focused on veterans using VA care (94%, <i>n</i> = 46). Topics with the greatest number of articles included pregnancy (43%, <i>n</i> = 21) and contraception (24%, <i>n</i> = 12). Racial/ethnic disparities were detected more frequently for clinical and behavioral outcome measures than for process measures.</p><p><strong>Conclusion: </strong>Consistent with literature regarding other types of VA care, racial/ethnic disparities were more prevalent for clinical and behavioral outcome measures versus process measures, highlighting that access is necessary but not sufficient for reaching health equity. Understanding the racial/ethnic health disparities and their relationships with different measures of health care quality is essential for achieving health equity for female veterans.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"9 1","pages":"203-228"},"PeriodicalIF":2.6,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12270534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health in Harmony: Integrating Community Strengths to Bridge Disparities.","authors":"Lauren Anderson, Caison Black, Rochelle H Holm, Michael O Emerson, Ted Smith","doi":"10.1089/heq.2024.0198","DOIUrl":"https://doi.org/10.1089/heq.2024.0198","url":null,"abstract":"<p><p>There is a need to shift from deficit-based environmental health approaches toward a more balanced framework that also considers community strengths at a granular level. The Universal Basic Neighborhood Framework integrates both qualitative and quantitative data across 35 health-supportive elements within topics of environmental, housing, social, and transportation domains, promoting an understanding of health as emerging from a range of environmental factors. The framework provides a more balanced approach by presenting both negative and positive health determinants, promotes leveraging community strengths and voice in public health interventions, and enables better understanding of community health needs and assets.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"9 1","pages":"229-234"},"PeriodicalIF":2.6,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12270525/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"No-Test Screening Protocols May Disproportionately Exclude Structurally Oppressed Communities Who Could Benefit from Accessing Medication Abortion.","authors":"M Antonia Biggs, Lauren Ralph, Katherine Ehrenreich, Shelly Kaller, Kelly Blanchard, Deb Hauser, Nathalie Kapp, Tammi Kromenaker, Ghazaleh Moayedi, Jamila Perritt, Elizabeth Raymond, Kari White, Daniel Grossman","doi":"10.1089/heq.2024.0128","DOIUrl":"https://doi.org/10.1089/heq.2024.0128","url":null,"abstract":"<p><strong>Objective: </strong>To explore disparities in ineligibility for medication abortion using no-test screening criteria compared with assessment with testing including ultrasound.</p><p><strong>Methods: </strong>From June 2021 to December 2022, we surveyed patients ages ≥15 seeking abortion at nine recruitment facilities in eight U.S. states before ultrasound; clinicians assessed patients' eligibility for medication abortion with ultrasound and other testing. Using clinical guidelines and the no-test protocol criteria, we estimated (1) the proportion ineligible by no-test assessment (pregnancy duration and ectopic pregnancy risk factors as reported in patient surveys and clinician-reported assessment of other contraindications) and (2) the proportion ineligible using no-test criteria yet eligible with testing (false positives). We assessed associations between participant characteristics and ineligibility for medication abortion and reasons for ineligibility.</p><p><strong>Results: </strong>We approached 2,846 people, of whom 1,591 were eligible for the study. Of the 1,386 who consented and had complete clinician data, 21.1% (306/1,386) were ineligible with testing, 71.5% (<i>n</i> = 991/1,386) were ineligible using no-test criteria, and 51.4% (<i>n</i> = 713/1,386) screened false positive. In adjusted analyses, ineligibility using no-test criteria was significantly greater among people ages 15-19 (86.8% [105/121] vs. 71.5% for full sample, <i>p</i> < 0.001) and experiencing food or housing insecurity (75.8% [525/690] vs. 67.2%[464/693], <i>p</i> < 0.01); people ages 20-24 were more likely to screen false positive (56.1% [263/469] vs. 51.4% for full sample [713/1,386], <i>p</i> = 0.03). Moderate/severe pelvic pain was the most common (614/1,386) patient-reported reason for ineligibility and reported significantly more by people ages 15-19, who were nulliparous, and experienced food or housing insecurity.</p><p><strong>Conclusions: </strong>Screening criteria for no-test medication abortion may exclude many people who are eligible, disproportionately excluding certain population groups from getting the care they seek. More research is needed to improve screening criteria to ensure equitable access to no-test medication abortion.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"9 1","pages":"189-200"},"PeriodicalIF":2.6,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12270530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Ongoing Incorrect Use of Caucasian in Medical Research.","authors":"Jamila K Picart, Sidra N Bonner, Gurjit Sandhu","doi":"10.1089/heq.2025.0014","DOIUrl":"https://doi.org/10.1089/heq.2025.0014","url":null,"abstract":"<p><p>As medical research continues to promise the advancement of health equity, it is called to address its incorrect and ongoing use of the term \"Caucasian.\" The term \"Caucasian\" has persisted in medical research despite its entanglement with beliefs of race as a biological factor. To continue to advance efforts in addressing health disparities and achieving health equity, researchers are called to use accurate racial and ethnic terminology.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"9 1","pages":"186-188"},"PeriodicalIF":2.6,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12270528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Importance of Recruitment of Low-Income Pregnant Persons in Interdisciplinary Research to Understand the Impact of Social and Environmental Determinants: Lessons Learned About Implementation and Recruitment.","authors":"Erika Marquez, Amanda Haboush-Deloye, Elizabeth Lawrence, Selam Ayele, Courtney Coughenour, Nora Doyle, Wynona Dizon, Lizbeth Perez Rodriguez, Chloe Bombara","doi":"10.1089/heq.2024.0112","DOIUrl":"https://doi.org/10.1089/heq.2024.0112","url":null,"abstract":"<p><strong>Background: </strong>Prior research indicates that enrolling underrepresented populations in clinical research is challenging. Although research has identified some barriers to participation and strategies to overcome them, studies have made little progress in being inclusive and representative. There remains a great need for including racial/ethnic minorities, low-income families, and pregnant women in research. The purpose of this article is to describe the implementation of enrollment strategies used in our study to understand the feasibility of building a maternal cohort and better understand the relationship between environmental and social impacts on maternal exposure and child outcomes.</p><p><strong>Methods: </strong>Working across multiple academic units, our team implemented equity-focused team science strategies to recruit diverse populations into a research study. The phases included development, conceptualization, implementation, and translation.</p><p><strong>Results: </strong>Our interdisciplinary team study used intentionality and commitment to deploy effective strategies including clearly defining the problem, selecting the correct team members to leverage expertise, clearly defining the study, establishing roles and responsibilities, representation, and clear and constant communication. A total of 100 pregnant women enrolled in our study using a team science interdisciplinary model.</p><p><strong>Discussion: </strong>Building interdisciplinary teams can help us understand complex problems, increase innovation, and develop effective solutions in policy and practice. More specifically, interdisciplinary teams can advance our ability to recruit diverse populations into research. Future studies should consider how to harness the strengths of the different research team members to achieve more inclusive participation.</p><p><strong>Health equity implications: </strong>This work has the potential to improve representation in research findings, enhance understanding of health disparities, and promote inclusive research practices.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"9 1","pages":"175-182"},"PeriodicalIF":2.6,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12270524/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Training Doctoral Students to Advance Health Equity Through Policy Leadership: An Overview of the Health Policy Research Scholars Program.","authors":"Keshia M Pollack Porter, Attia Goheer, Jessica Harrington, Shannon Frattaroli","doi":"10.1089/heq.2024.0159","DOIUrl":"https://doi.org/10.1089/heq.2024.0159","url":null,"abstract":"<p><p>Health Policy Research Scholars (HPRS) is an innovative, equity-focused leadership program for doctoral students from marginalized backgrounds and identities. HPRS trains scholars from various disciplines to apply their research while engaging in policy to advance health equity. The HPRS logic model illustrates that training will lead to short-term changes including increased knowledge and skills; an interdisciplinary mindset; and increased sense of belonging, confidence, and self-awareness to advance health equity in the longterm. This article provides an overview of HPRS, including the logic model, curriculum, and implications for training doctoral students to become health equity leaders.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"9 1","pages":"170-174"},"PeriodicalIF":2.6,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12270519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Should I Buy Groceries or Get a Diagnostic Scan?","authors":"Brad Isaacson, Emma Greally","doi":"10.1089/heq.2024.0111","DOIUrl":"https://doi.org/10.1089/heq.2024.0111","url":null,"abstract":"<p><p>The economic burden of medical care is shared (often disproportionately) between patients, health care systems, and payers. Diagnostic scans in particular provide valuable information for providers; however, imaging is often performed in high-cost settings. Independent Diagnostic Testing Facilities have emerged as viable options for patients, but care is often fragmented and may lack sufficient quality standards. To change health care, bold steps are needed to maximize value-based care, enhance access, and ensure affordability for communities. If this fails to occur, for many more years, we will unfortunately hear \"should I buy groceries or get a diagnostic scan?\".</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"9 1","pages":"183-185"},"PeriodicalIF":2.6,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12270521/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}