Ethnicity & Disease最新文献

{"title":"Advancing the Science of Implementation for Resource-Limited Settings through Bidirectional Learning Around Cervical Cancer Screening.","authors":"Prajakta Adsul, Roopa Hariprasad, Breanne E Lott, Melissa Lopez Varon","doi":"10.18865/ed.32.4.269","DOIUrl":"10.18865/ed.32.4.269","url":null,"abstract":"<p><p>In 2020, the highest rates of cervical cancer incidence and mortality were reported in Asian and African regions of the world. Across the globe, growing evidence confirms cancer disparities among racial and ethnic minorities, low socioeconomic status groups, sexual and gender minorities, uninsured individuals, and rural residents. Recognition of these stark disparities has led to increased global efforts for improving screening rates overall and, in medically underserved populations, highlighting the urgent need for research to inform the successful implementation of cervical cancer screening. Implementation science, defined as the study of methods to promote the integration of research evidence into health care practice, is well-suited to address this challenge. With a multilevel, implementation focus, we present key research directions that can help address cancer disparities in resource-limited settings. First, we describe several global feasibility studies that acknowledge the effectiveness of self-sampling as a strategy to improve screening coverage. Second, we highlight Project ECHO as a strategy to improve providers' knowledge through an extended virtual learning community, thereby building capacity for health care settings to deliver screening. Third, we consider community health workers, who are a cornerstone of implementing public health interventions in global communities. Finally, we see tremendous learning opportunities that use contextually relevant strategies to advance the science of community engagement and adaptations that could further enhance the uptake of screening in resource-limited settings. These opportunities provide future directions for bidirectional exchange of knowledge between local and global resource-limited settings to advance implementation science and address disparities.</p>","PeriodicalId":50495,"journal":{"name":"Ethnicity & Disease","volume":"32 4","pages":"269-274"},"PeriodicalIF":3.4,"publicationDate":"2022-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9590597/pdf/ethndis-32-269.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9524040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knowledge Sharing to Reduce Toxin Exposure Risks from Harmful Algal Blooms: Global Networks and Political Barriers.","authors":"Hugh B Roland, Christopher Whitehead, Lora E Fleming, Elisa Berdalet, Henrik Oksfeldt Enevoldsen, Matthew O Gribble","doi":"10.18865/ed.32.4.285","DOIUrl":"10.18865/ed.32.4.285","url":null,"abstract":"<p><p>Harmful algal blooms (HABs) are a significant global environmental management challenge, especially with respect to microalgae that produce dangerous natural toxins. Examples of HAB toxin diseases with major global health impact include: ciguatera poisoning, paralytic shellfish poisoning (PSP), amnesic shellfish poisoning (ASP), diarrhetic shellfish poisoning (DSP), and neurotoxic (brevetoxin) shellfish poisoning (NSP). Such diseases affect communities globally and contribute to health inequalities within the United States and beyond. Sharing data and lessons learned about the factors determining bloom occurrence and associated exposure to contaminated seafood across locations can reduce public health risks. Knowledge sharing is particularly important as ongoing global environmental changes seem to alter the intensity, location, and timing of toxic HAB events, reducing the reliability of conventional guidance where toxin risks have been endemic and leading to emerging challenges in new settings. Political changes that disrupt membership in knowledge-sharing networks may impede efforts to share scientific expertise and best practices. In this commentary, we stress the importance of community and expert knowledge sharing for reducing HAB risks, both for vulnerable communities in the United States and globally. Considering the impacts of political changes, we note the indirect engagement sometimes required for continued participation in international coordination programs. As an example, we highlight how lessons learned from a Native-led toxin monitoring and testing program (the Southeast Alaska Tribal Ocean Research partnership) can inform programs in other settings. We also describe how international knowledge is mutually valuable for this program in Southeast Alaska.</p>","PeriodicalId":50495,"journal":{"name":"Ethnicity & Disease","volume":"32 4","pages":"285-292"},"PeriodicalIF":3.4,"publicationDate":"2022-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9590605/pdf/ethndis-32-285.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9327809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Skin Tone, Race/Ethnicity, and Gender Differences in BMI among New US Immigrants.","authors":"Matthew A Painter, Jennifer Tabler","doi":"10.18865/ed.32.4.315","DOIUrl":"10.18865/ed.32.4.315","url":null,"abstract":"<p><p>Scholars have been interested in the relationship between skin tone and health since at least the 1970s; however, no study, to our knowledge, has analyzed a diverse immigrant sample. In this study, we use the New Immigrant Survey and interactions to examine how skin tone and race/ethnicity - alongside gender - jointly pattern BMI among Legal Permanent Residents. Our approach allows for the analysis of BMI among multiple racial/ethnic immigrant groups, while considering skin tone. Our results document that darker skin shades are associated with higher BMI, but only for women. Further, we also tease out the relationship between gender and race/ethnicity for BMI, which allows us to better understand this critical connection for new immigrants' health in the United States. Together, our results highlight that BMI jointly varies by skin tone and race/ethnicity, which emphasizes the importance of an intersectional approach, especially for new immigrant women of color.</p>","PeriodicalId":50495,"journal":{"name":"Ethnicity & Disease","volume":"32 4","pages":"315-324"},"PeriodicalIF":3.4,"publicationDate":"2022-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9590606/pdf/ethndis-32-315.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9327810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship Between Neighborhood Socioeconomic Disadvantage and Severe Maternal Morbidity and Maternal Mortality.","authors":"Meghan Tipre, Bolanle Bolaji, Christina Blanchard, Alex Harrelson, Jeff Szychowski, Rachel Sinkey, Zoe Julian, Alan Tita, Monica L Baskin","doi":"10.18865/ed.32.4.293","DOIUrl":"10.18865/ed.32.4.293","url":null,"abstract":"<p><strong>Background: </strong>Rates of severe maternal morbidity and maternal mortality (SMM/MM) in the United States are rising. Disparities in SMM/MM persist by race, ethnicity and geography, and could partially be attributed to social determinants of health.</p><p><strong>Purpose: </strong>Utilizing data from the largest, statewide referral hospital in Alabama, we investigated the relationship between residence in disadvantaged neighborhoods and SMM/MM.</p><p><strong>Methods: </strong>Data on all pregnancies between 2010 and 2020 were included; SMM/MM cases were identified using CDC definitions. Area deprivation index (ADI) available at the census-block group was geographically linked to individual records and categorized using quintile cutoffs; higher ADI score indicated higher socioeconomic disadvantage. Generalized estimating equation models were used to adjust for spatial autocorrelation and ORs were computed to evaluate the relationship between ADI and SMM/MM, adjusted for covariates including age, race, insurance, residence in medically underserved areas/population (MUAP), and urban/rural residence.</p><p><strong>Results: </strong>Overall, 32,909 live-birth deliveries were identified, with a prevalence of 9.8% deliveries with SMM/MM with blood transfusion and 5.3% without blood transfusion, respectively. Increased levels of ADI were associated with increased odds of SMM/MM. Compared to women in the lowest quintile, the adjusted OR for SMM/MM among women in highest quintile was 1.78 (95%CI, 1.22-2.59, P=.0027); increasing age, non-Hispanic Black, government insurance and residence in MUAP were also significantly associated with increased odds of SMM/MM.</p><p><strong>Conclusion: </strong>Our results suggest that residence within disadvantaged neighborhoods may contribute to SMM/MM even after adjusting for patient-level factors. Measures such as ADI can help identify the most vulnerable populations and provide points to intervene.</p>","PeriodicalId":50495,"journal":{"name":"Ethnicity & Disease","volume":"32 4","pages":"293-304"},"PeriodicalIF":3.4,"publicationDate":"2022-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9590600/pdf/ethndis-32-293.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9399432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glucometabolic State Transitions: The Jackson Heart Study.","authors":"Trudy Gaillard, Haiying Chen, Valery S Effoe, Adolfo Correa, Mercedes Carnethon, Rita R Kalyani, Justin B Echouffo-Tcheugui, Joshua J Joseph, Alain G Bertoni","doi":"10.18865/ed.32.3.203","DOIUrl":"10.18865/ed.32.3.203","url":null,"abstract":"<p><strong>Background: </strong>Diabetes and prediabetes are common among African Americans (AA), but the frequency and predictors of transition between normal, impaired glucose metabolism, and diabetes are not well-described. The aim of this study was to examine glucometabolic transitions and their association with the development of type 2 diabetes (T2D).</p><p><strong>Methods: </strong>AA participants of the Jackson Heart Study who attended baseline exam (2000-2004) and at least one of two subsequent exams (2005-2008 and 2009-2013, ~8 years) were classified according to glycemic status. Transitions were defined as progression (deterioration) or remission (improvement) of glycemic status. Multinomial logistic regression models with repeated measures were used to estimate the odds ratios (OR) for remission and progression with adjustment for demographic, anthropometric, behavioral, and biochemical factors.</p><p><strong>Results: </strong>Among 3353 participants, (mean age 54.6±12.3 years), 43% were normoglycemic, 32% were prediabetes, and 25% had diabetes at baseline. For those with normal glucose at a visit, the probability at the next visit (~4years) of having prediabetes or diabetes was 38.5% and 1.8%, respectively. For those with prediabetes, the probability was 9.9% to improve to normal and 19.9% to progress to diabetes. Progression was associated with baseline BMI, diabetes status, triglycerides, family history of diabetes, and weight gain (OR 1.04 kg, 95% CI:1.03-1.06, P=<.0001). Remission was strongly associated with weight loss (OR .97 kg, 95%CI: .95-.98, P<.001).</p><p><strong>Conclusions: </strong>In AAs, glucometabolic transitions were frequent and most involved deterioration. From a public health perspective additional emphasis should be placed on weight control to preserve glucometabolic status and prevent progression to T2D.</p>","PeriodicalId":50495,"journal":{"name":"Ethnicity & Disease","volume":"32 3","pages":"203-212"},"PeriodicalIF":3.2,"publicationDate":"2022-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9311302/pdf/ethndis-32-203.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9103834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Introduction to the Summer 2022 Issue of the RACE Series.","authors":"C. L. Ford","doi":"10.18865/ed.32.3.239","DOIUrl":"https://doi.org/10.18865/ed.32.3.239","url":null,"abstract":"Ethn Dis. 2022;32(3):239-242; doi:10.18865/ed.32.3.239","PeriodicalId":50495,"journal":{"name":"Ethnicity & Disease","volume":"32 3 1","pages":"239-242"},"PeriodicalIF":3.2,"publicationDate":"2022-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43264900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racial and Ethnic Disparities in COVID-19-Like Illness and Impacts of Social Distancing and Working from Home.","authors":"Sungwoo Lim, C. Dominianni, Karen A. Alroy, Maria Baquero, A. Crossa, L. Gould","doi":"10.18865/ed.32.2.123","DOIUrl":"https://doi.org/10.18865/ed.32.2.123","url":null,"abstract":"Objectives\u0000To examine racial and ethnic disparities in COVID-19-like illness (CLI) during March - August 2020 in New York City, and to test effect modification by age, nativity, and working from home vs outside the home, and mediation via social distancing behavior.\u0000\u0000\u0000Design\u0000Analysis of the monthly Community Health Survey datasets.\u0000\u0000\u0000Setting\u0000New York City.\u0000\u0000\u0000Participants\u00005,305 adults living in New York City.\u0000\u0000\u0000Main Outcome Measures\u0000A binary indicator of having new onset of CLI in the past 30 days.\u0000\u0000\u0000Methods\u0000Prevalence of having CLI was compared among racial and ethnic groups using multivariable log-linear regression. Stratified and causal mediation analyses were conducted to test effect modification and mediation, respectively.\u0000\u0000\u0000Results\u0000Overall percentage of CLI decreased from 25% during March-May to 14% during June-August. In both periods, there was no increased prevalence of CLI among Black or Latino New Yorkers compared with White New Yorkers. However, in stratified analyses, Latino vs White New Yorkers had 2.05 times (95%CI=1.09, 3.83) higher prevalence of CLI among adults working outside the home. Mediation via social distancing was not statistically significant.\u0000\u0000\u0000Conclusions\u0000Excess burden of CLI among Latino adults working outside the home underscores inequitable impacts of COVID-19 in New York City.","PeriodicalId":50495,"journal":{"name":"Ethnicity & Disease","volume":"32 2 1","pages":"123-130"},"PeriodicalIF":3.2,"publicationDate":"2022-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43843850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating Population Health Strategies into Primary Care: Impact on Outcomes and Hospital Use for Low-Income Adults.","authors":"H. Kitzman, Kristen Tecson, Abdullah Mamun, Briget da Graca, Samrat Yeramaneni, Kenneth Halloran, Donald Wesson","doi":"10.18865/ed.32.2.91","DOIUrl":"https://doi.org/10.18865/ed.32.2.91","url":null,"abstract":"Objective\u0000Our objectives were two-fold: 1) To evaluate the benefits of population health strategies focused on social determinants of health and integrated into the primary care medical home (PCMH) and 2) to determine how these strategies impact diabetes and cardiovascular disease outcomes among a low-income, primarily minority community. We also investigated associations between these outcomes and emergency department (ED) and inpatient (IP) use and costs.\u0000\u0000\u0000Design\u0000Retrospective cohort.\u0000\u0000\u0000Setting\u0000Community-based PCMH: Baylor Scott & White Health and Wellness Center (BSW HWC).\u0000\u0000\u0000Patients/Participants\u0000All patients who attended at least two primary care visits at BSW HWC within a 12-month time span from 2011-2015.\u0000\u0000\u0000Methods\u0000Outcomes for patients participating in PCMH only (PCMH) as compared to PCMH plus population health services (PCMH+PoPH) were compared using electronic health record data.\u0000\u0000\u0000Main Outcomes\u0000Diastolic and systolic blood pressure, hemoglobin A1c, ED visits and costs, and IP hospitalizations and costs were examined.\u0000\u0000\u0000Results\u0000From 2011-2015, 445 patients (age=46±12 years, 63% African American, 61% female, 69.5% uninsured) were included. Adjusted regression analyses indicated PCMH+PoPH had greater improvement in diabetes outcomes (prediabetes HbA1c= -.65[SE=.32], P=.04; diabetes HbA1c= -.74 [SE=.37], P<.05) and 37% lower ED costs than the PCMH group (P=.01). Worsening chronic disease risk factors was associated with 39% higher expected ED visits (P<.01), whereas improved chronic disease risk was associated with 32% fewer ED visits (P=.04).\u0000\u0000\u0000Conclusions\u0000Integrating population health services into the PCMH can improve chronic disease outcomes, and impact hospital utilization and cost in un- or under-insured populations.","PeriodicalId":50495,"journal":{"name":"Ethnicity & Disease","volume":"32 2 1","pages":"91-100"},"PeriodicalIF":3.2,"publicationDate":"2022-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41640643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Poverty, Comorbidity, and Ethnicity: COVID-19 Outcomes in a Safety Net Health System.","authors":"Joseph P Smith, Amy B Kressel, Randall W Grout, Bree Weaver, Megan Cheatham, Wanzhu Tu, Ruohong Li, David W Crabb, Lisa E Harris, William G Carlos","doi":"10.18865/ed.32.2.113","DOIUrl":"10.18865/ed.32.2.113","url":null,"abstract":"<p><strong>Objective: </strong>To determine if race-ethnicity is correlated with case-fatality rates among low-income patients hospitalized for COVID-19.</p><p><strong>Research design: </strong>Observational cohort study using electronic health record data.</p><p><strong>Patients: </strong>All patients assessed for COVID-19 from March 2020 to January 2021 at one safety net health system.</p><p><strong>Measures: </strong>Patient demographic and clinical characteristics, and hospital care processes and outcomes.</p><p><strong>Results: </strong>Among 25,253 patients assessed for COVID-19, 6,357 (25.2%) were COVID-19 positive: 1,480 (23.3%) hospitalized; 334 (22.6%) required intensive care; and 106 (7.3%) died. More Hispanic patients tested positive (51.8%) than non-Hispanic Black (31.4%) and White patients (16.7%, P<.001]. Hospitalized Hispanic patients were younger, more often uninsured, and less likely to have comorbid conditions. Non-Hispanic Black patients had significantly more diabetes, hypertension, obesity, chronic kidney disease, and asthma (P<.05). Non-Hispanic White patients were older and had more cigarette smoking history, COPD, and cancer. Non-Hispanic White patients were more likely to receive intensive care (29.6% vs 21.1% vs 20.8%, P=.007) and more likely to die (12% vs 7.3% vs 3.5%, P<.001) compared with non-Hispanic Black and Hispanic patients, respectively. Length of stay was similar for all groups. In logistic regression models, Medicaid insurance status independently correlated with hospitalization (OR 3.67, P<.001) while only age (OR 1.076, P<.001) and cerebrovascular disease independently correlated with in-hospital mortality (OR 2.887, P=.002).</p><p><strong>Conclusions: </strong>Observed COVID-19 in-hospital mortality rate was lower than most published rates. Age, but not race-ethnicity, was independently correlated with in-hospital mortality. Safety net health systems are foundational in the care of vulnerable patients suffering from COVID-19, including patients from under-represented and low-income groups.</p>","PeriodicalId":50495,"journal":{"name":"Ethnicity & Disease","volume":"32 2 1","pages":"113-122"},"PeriodicalIF":3.4,"publicationDate":"2022-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9037656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43508708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Intersection of Social Behavior, Population Health, and Inherited Traits.","authors":"Roland J. Thorpe, Jr., H. Jones","doi":"10.18865/ed.32.2.73","DOIUrl":"https://doi.org/10.18865/ed.32.2.73","url":null,"abstract":"Ethn Dis. 2022;32(2):73-74; doi:10.18865/ed.32.2.73","PeriodicalId":50495,"journal":{"name":"Ethnicity & Disease","volume":"32 2 1","pages":"73-74"},"PeriodicalIF":3.2,"publicationDate":"2022-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46847161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}