Search

ObjectiveThe primary objective of this study was to evaluate whether the COVID-19 pandemic altered the racial and ethnic composition of patients receiving cardiac procedural care.DesignThis was a retrospective observational study.SettingThis study was conducted at a single tertiary-care university hospital.ParticipantsA total of 1,704 adult patients undergoing transcatheter aortic valve replacement (TAVR) (n=413), coronary artery bypass grafting (CABG) (n=506), or atrial fibrillation (AF) ablation (n=785) from March 2019 through March 2022 were included in this study.InterventionsNo interventions were performed as this was a retrospective observational study.Measurements and main resultsPatients were grouped based on the date of their procedure: pre-COVID (March 2019 to February 2020), COVID Year 1 (March 2020 to February 2021), and COVID Year 2 (March 2021 to March 2022). Population-adjusted procedural incidence rates during each period were examined and stratified based on race and ethnicity. The procedural incidence rate was higher for White patients versus Black, and non-Hispanic patients versus Hispanic patients for every procedure and every period. For TAVR, the difference in procedural rates between White patients versus Black patients decreased between the pre-COVID and COVID Year 1 (12.05-6.34 per 1,000,000 persons). For CABG, the difference in procedural rates between White patients versus Black, and non-Hispanic patients versus Hispanic patients did not change significantly. For AF ablations, the difference in procedural rates between White patients versus Black patients increased over time (13.06 to 21.55 to 29.64 per 1,000,000 persons in the pre-COVID, COVID Year 1, and COVID Year 2, respectively).ConclusionRacial and ethnic disparities in access to cardiac procedural care were present throughout all study time periods at the authors' institution. Their findings reinforce the continuing need for initiatives to reduce racial and ethnic disparities in healthcare. Further studies are needed to fully elucidate the effects of the COVID-19 pandemic on healthcare access and delivery.

No abstract available.

IntroductionRacial-ethnic disparities in COVID-19 vaccination are well documented. The extent to which racism, manifested at the individual and ZIP code levels, explains disparities in early vaccination uptake remains unclear.MethodsData from a statewide poll of California registered voters (N=10,256), conducted between April 29 and May 5, 2021, linked to area-level resource data, were analyzed. Weighted multivariable logistic regression models examined racial disparities in COVID-19 vaccination. Decomposition analyses quantified how much of the observed racial disparities in vaccination were explained by racial discrimination and social disadvantage (i.e., educational attainment, 2019 household income, and ZIP code social vulnerability).ResultsLatinx (64.6%) and Black (66.7%) adults were less likely to have at least 1 COVID-19 vaccine dose by April or May 2021 than White adults (74.7%). In adjusted analyses, Latinx (AOR=0.69, 95% CI=0.57, 0.84) and Black (AOR=0.51, 95% CI=0.37, 0.70) adults had a lower likelihood of being vaccinated than Whites. Social disadvantage accounted for 77.4% (p

Introduction The objective of this study was to explore race-based differences in 30-day complication rates following total joint arthroplasty (TJA) using a large national database. Methods Patients undergoing primary, elective THA and TKA between 2012 and 2018 were retrospectively reviewed using the ACS-NSQIP. We compared Black and Hispanic patients with non-Hispanic White patients using multivariate statistical models adjusting for demographic, operative, and medical characteristics. Results A total of 324,795 and 200,023 patients undergoing THA and TKA, respectively, were identified. After THA, compared to White patients, Black and Hispanic patients were more likely to be diagnosed with VTE (p p p p p = 0.008, respectively), be diagnosed with VTE (p p Conclusions Our findings indicate higher rates of VTE, blood transfusions, and discharge to an inpatient facility for Black and Hispanic patients when compared to White patients following TJA, though we are unable to comment on the etiology of these disparities. These results may contribute to a growing divide with respect to outcomes and access to TJA for these at-risk patient populations.

How are improvements in healthcare being pursued? How can a textile-based soft exoskeleton be used to maintain the activities of daily living (ADL) of patients with amyotrophic lateral sclerosis (ALS)? The creation of fully soft, upper-limb exoskeletons for rehabilitation of patients with neuromuscular disorders, such as ALS, is an emerging field of study and industry. Of the millions debilitated by these diseases, few can use such robots due to insufficient research. The research team designed a fully soft wearable robotic device that will be able to assist patients with ALS. With IMU and EMG sensors, a cable actuator, and computer programming, the team developed such a device. How do interest groups, advocacies, and others strive to lessen the racial disparities in healthcare in the United States? Public health agencies report health data and fund health services. To fight for health equity, advocacies in health, civil rights and racial justice have established community health centers, free clinics, and demonstration projects. Insurance companies, hospitals and professional associations have influenced such efforts, in part to protect their own interests. In the US, racial disparities in healthcare reflect systemic inequalities that contribute to comparable disparities in education, housing, and criminal justice. Despite improvements in some communities within the US there are still millions without the necessary healthcare they need.

Over the years, breast cancer has persisted as the most common type of cancer diagnosed in women while also being the second leading cause of cancer-related mortality in the United States. However, mortality rates differ greatly amongst women of different racial backgrounds, namely African-American women versus Caucasian women, due to a variety of factors such as accessibility to cancer screening services, lack of clinics present in economically disadvantaged regions, etc. These effects compound greatly as early diagnosis is often crucial for successful treatment of cancer, and the underuse of such services by certain social groups increases the chances of mortalities. Currently, there are not many systemic options available that can help combat this inequality, and this issue continues to impact women in disparate rates throughout the nation. Researching and testing various novel treatments for breast cancer typically involves the usage of breast cancer cell lines in mice. A major problem that persists, however, is the unnatural growth of blood vessels around a tumor and how this diminishes the effects of drug delivery. One promising avenue involves the usage of anti-angiogenic drug delivery which reduces the abnormal proliferation of blood vessels around a tumor, thus allowing for more efficient delivery of subsequent chemotherapeutic agents. In turn, this could make current chemotherapy options more effective and cheaper while also increasing accessibility. However, at present, there are very few modeling techniques available which can effectively visualize the surrounding blood vessels of a tumor, and the subsequent normalization observed from drug delivery. The technical paper and tightly coupled STS research project were intended to directly address both issues discussed above. The goal of the former was to improve current treatment options for breast cancer by aiding in the development of pulsing sequences for anti-angiogenic treated tumors compared to regular tumors. This was accomplished by improving upon a pre-existing imaging software to allow for better visualization of the network of blood vessels. Furthermore, a 3D modeling procedure was established whereby cross-sectional images of a tumor’s vasculature can be taken and modeled to provide a clearer physical view of the tumor and aid in further research of vasculature normalization. However, developing such a technology does not mean that it will necessarily be equally available to all women. As already discussed, the racial backgrounds of women heavily impact the level of access they will have to such treatment options. As such, the paired STS project was intended to analyze the socio-technical system in which different social groups interpret and adopt screening technologies in varying ways, thus leading to disparate mortality rates. After investigating the endogenous and exogenous factors that were contributing to this, a wide range of solutions were proposed that will aid in mitigating these factors. By removing barriers and increasing trust in these social groups, screening technologies will come to be perceived in a more positive light which will lead to increased usage and thus lessened mortalities as time goes on.

Researchers have long used end-of-year discipline rates to identify punitive schools, explore sources of inequitable treatment, and evaluate interventions designed to stem both discipline and racial disparities in discipline. Yet, this approach leaves us with a “static view”—with no sense of how disciplinary responses fluctuate throughout the year. What if daily discipline rates, and daily discipline disparities, shift over the school year in ways that could inform when and where to intervene? This research takes a “dynamic view” of discipline. It leverages 4 years of atypically detailed data regarding the daily disciplinary experiences of 46,964 students from 61 middle schools in one of the nation’s largest school districts. Reviewing these data, we find that discipline rates are indeed dynamic. For all student groups, the daily discipline rate grows from the beginning of the school year to the weeks leading up to the Thanksgiving break, falls before major breaks, and grows following major breaks. During periods of escalation, the daily discipline rate for Black students grows significantly faster than the rate for White students—widening racial disparities. Given this, districts hoping to stem discipline and disparities may benefit from timing interventions to precede these disciplinary spikes. In addition, early-year Black–White disparities can be used to identify the schools in which Black–White disparities are most likely to emerge by the end of the school year. Thus, the results reported here provide insights regarding not only when to intervene, but where to intervene to reduce discipline rates and disparities.

Background Colorectal cancer is a leading cause of morbidity and mortality across U.S. racial/ethnic groups. Existing studies often focus on a particular race/ethnicity or single domain within the care continuum. Granular exploration of disparities among different racial/ethnic groups across the entire colon cancer care continuum is needed. We aimed to characterize differences in colon cancer outcomes by race/ethnicity across each stage of the care continuum. Methods We used the 2010–2017 National Cancer Database to examine differences in outcomes by race/ethnicity across six domains: clinical stage at presentation; timing of surgery; access to minimally invasive surgery; post-operative outcomes; utilization of chemotherapy; and cumulative incidence of death. Analysis was via multivariable logistic or median regression, with select demographics, hospital factors, and treatment details as covariates. Results 326,003 patients (49.6% female, 24.0% non-White, including 12.7% Black, 6.1% Hispanic/Spanish, 1.3% East Asian, 0.9% Southeast Asian, 0.4% South Asian, 0.3% AIAE, and 0.2% NHOPI) met inclusion criteria. Relative to non-Hispanic White patients: Southeast Asian (OR 1.39, p p p p p = 0.05), Hispanic/Spanish (OR 1.05 p = 0.02), and Black (OR 1.05, p p p p p p = 0.05). Black patients had significantly higher cumulative incidence of death at every pathologic stage relative to non-Hispanic White patients when adjusting for non-modifiable patient factors (p Conclusions Non-White patients disproportionately experience advanced stage at presentation. Disparities for Black patients are seen across the entire colon cancer care continuum. Targeted interventions may be appropriate for some groups; however, major system-level transformation is needed to address disparities experienced by Black patients.

Context: Segregation has been linked to unequal life chances. Individuals from marginalized communities experience more crime, higher levels of poverty, poorer health, and less civic engagement. In addition, segregated metropolitan regions have been found to display inequality in access to basic services. This article builds on these findings by linking segregation to infection and deaths from COVID-19. Methods: Using census data matched to COVID infection and death statistics at the county level, this article offers a theoretical basis for the researchers' choice of segregation measures and predictions for different racial groups. It analyzes the relationship between two dimensions of segregation—racial isolation and racial unevenness—and COVID outcomes for different racial and ethnic groups. Findings: In counties where Black and Latino residents lived in more racially isolated neighborhoods, they were much more likely to contract COVID-19. This pattern was exacerbated in counties with a high proportion of frontline workers. In addition, racial segregation increased COVID-19 death rates for Black, Latino, and white residents. Conclusions: These findings suggest that devastating outcomes of the coronavirus pandemic were linked to a long history of racial marginalization and entrenched discrimination produced by structural inequalities embedded in our geographies. This knowledge should be used to inform public health planning.

To define the incidence of clinically detected coronavirus disease 2019 (COVID-19) in people with HIV (PWH) in the United States and evaluate how racial and ethnic disparities, comorbidities, and HIV-related factors contribute to risk of COVID-19.Observational study within the CFAR Network of Integrated Clinical Systems cohort in seven cities during 2020.We calculated cumulative incidence rates of COVID-19 diagnosis among PWH in routine care by key characteristics including race/ethnicity, current and lowest CD4+ cell count, and geographic area. We evaluated risk factors for COVID-19 among PWH using relative risk regression models adjusted with disease risk scores.Among 16 056 PWH in care, of whom 44.5% were black, 12.5% were Hispanic, with a median age of 52 years (IQR 40-59), 18% had a current CD4+ cell count less than 350 cells/μl, including 7% less than 200; 95.5% were on antiretroviral therapy (ART), and 85.6% were virologically suppressed. Overall in 2020, 649 PWH were diagnosed with COVID-19 for a rate of 4.94 cases per 100 person-years. The cumulative incidence of COVID-19 was 2.4-fold and 1.7-fold higher in Hispanic and black PWH respectively, than non-Hispanic white PWH. In adjusted analyses, factors associated with COVID-19 included female sex, Hispanic or black identity, lowest historical CD4+ cell count less than 350 cells/μl (proxy for CD4+ nadir), current low CD4+ : CD8+ ratio, diabetes, and obesity.Our results suggest that the presence of structural racial inequities above and beyond medical comorbidities increased the risk of COVID-19 among PWH. PWH with immune exhaustion as evidenced by lowest historical CD4+ cell count or current low CD4+ : CD8+ ratio had greater risk of COVID-19.

BackgroundThe COVID-19 pandemic has exacerbated health and social disparities among US Pacific Islanders (PI). Historically, PIs have experienced a high burden of mental illness yet have underutilized mental health services. These already large treatment gaps in mental health care among PIs may worsen during the COVID-19 pandemic. In the face of pre-existing challenges, little is known about the impacts of the COVID-19 pandemic on mental health outcomes among PIs.MethodsA community-based, cross-sectional survey was administered to members of 13 PI churches across the San Francisco Bay Area. We assessed the burden of psychological distress among PIs and its associations with demographic, sociocultural, and health factors.Key resultsAmong 439 PI respondents, nearly half reported moderate or severe psychological distress. Only about one-tenth took prescription medication for mental health and less than half utilized a mental health provider in the past year. Most trusted PI churches to provide health and social services. Respondents reporting moderate or severe psychological distress were less likely to utilize a mental health provider in the past year and more likely to feel marginalized, excluded, isolated, or alienated from society "most of the time" or "always." Psychological distress was also associated with "fair" or "poor" health status, female gender, older adults, low trust in PI churches to provide health and social services, and concern over household finances.ConclusionPartnerships with faith-based and community-based organizations are essential to address unmet mental health needs and promote support-seeking behaviors among PIs during this ongoing pandemic and beyond.

The project pertains to a scoping examining the racial disparities in health services access and healthcare utilization amongst children in the U.S child welfare system.

BackgroundThe COVID-19 pandemic has affected the well-being of nursing professionals, especially long-term and acute care nurses, many of whom are nurses of color.PurposeWe examine the evidence and gaps in the literature addressing psychological well-being of racial/ethnic minority RNs in the United States during COVID-19.MethodsWe searched eight databases during March 2022 and used Joanna Briggs' Scoping Review Methodology and PRISMA-ScR reporting standards.DiscussionSeven studies met inclusion criteria. Two exclusively examined nurses; five reported findings from heterogeneous samples of health care workers. No significant racial/ethnic differences in well-being were reported among health care workers. Among nurses, if a difference existed, White nurses reported decreased psychological well-being relative to ethnic and racial minority nurses. Two studies report modest racial/ethnic differences in nurses' psychological well-being.ConclusionSignificant gaps in the literature remain; future studies should analyze groups of health care workers separately, clearly identify racial and ethnic groups, and examine the role of respondents' work setting.

Behavioral weight loss interventions are denoted as the gold standard for obesity treatment. However, research has continuously demonstrated that Black adults enrolled in standard behavioral weight loss treatment achieve significantly lower weight losses compared to White participants. Additionally, culturally-tailored interventions have not been successful in addressing this racial gap in outcomes. However, preliminary research has demonstrated that enhancing behavioral weight loss treatment (SBT) with acceptance-based components (ABT) may be able to reduce the disparities seen in standard treatment. In three of our earlier studies, three secondary analyses found that when Black adults received weight loss treatments that included acceptance-based components, weight losses were 2.7%-4.7% greater compared to standard behavioral treatment. One key limitation in these studies was the small sample size which greatly impacted the power and generalizability of the results. To address this limitation, we have combined participants from five large, randomized control trials that include SBT and ABT interventions to create a large racially diverse sample. Using this large sample, we aim to compare weight loss outcomes for participants in the acceptance-based and standard conditions to investigate if acceptance-based interventions can improve weight loss outcomes for Black adults with overweight and obesity.

This scoping review will explore the effects of race in the self-reporting of psychoneurophysical (PNP) symptoms in adult patients with four chronic diseases (cardiovascular diseases, respiratory diseases, cancers, and diabetes. The PNP symptoms of interest include depressive symptoms, fatigue, anxiety, pain, cognitive impairment, sleep impairment, mood impairment, irritability, and shortness of breath.

The COVID-19 pandemic’s disproportionate impact on people from some racial and ethnic groups in the U.S. persisted throughout 2021. Black, Latinx, and American Indian persons have been hospitalized and died at a higher rate than White persons consistently from the start of the pandemic. Early data show that hospitalization and mortality rates for Black, Latinx, and American Indian children are higher than White children in a worrying trend. The pandemic has likely worsened the gaps in wealth, employment, housing, and access to health care: the social determinants of health that caused the disparities in the first place. School closures will have a long-lasting impact on the widening achievement gaps between Black and Latinx students and White students. In the earlier vaccination phase, Black and Latinx persons were being vaccinated at a lower rate than their proportion of cases due to vaccine hesitancy, misinformation, and barriers to access. Vaccine hesitancy rates among these groups have since decreased and are now comparable to White persons. Aggregated data make it challenging to paint a picture of the actual impact of COVID-19 on Asian Americans as they are a diverse group with significant disparities. All of this highlights that we have much work to do in dismantling systemic racism, engaging communities we serve, and advancing health equity to prepare us for future pandemics and a more just healthcare system.

Coronavirus Disease 2019 disproportionately affects Black and Hispanic/Latino populations. Racial disparities inherently exist in dermatology because of underrepresentation of skin of color populations in literature, reduced access to care for minority populations, and low diversity within the specialty of dermatology itself. Lack of imagery in dermatology can have detrimental consequences for patients of color. Dermatologists should note and disseminate cutaneous manifestations of patients of color to combat current racial imbalances.

Approximately 90% of colorectal cancer (CRC) develop over the age of 50, highlighting the important role of aging in CRC risk. African Americans (AAs) shoulder a greater CRC burden than European Americans (EA) and are more likely to develop CRC at a younger age. The effects of aging in AA and EA normal rectal tissue have yet to be defined. Here, we performed epigenome-wide DNA methylation analysis in the first, large-scale biracial cohort of normal rectum (n = 140 samples). We identified increased epigenetic age acceleration in EA than AA rectum (p = 3.91 × 10−4) using linear regression. We also identified differentially methylated regions (DMRs) associated with chronological aging in AA and EA, separately using DMRcate. Next, a consensus set of regions associated with cancer was identified through DMR analysis of two rectal cancer cohorts. The vast majority of AA DMRs were present in our analysis of aging in rectum of EA subjects, though rates of epigenetic drift were significantly greater in AA (p = 1.94 × 10−45). However, 3.66-fold more DMRs were associated with aging in rectum of EA subjects, many of which were also associated with rectal cancer. Our findings reveal a novel relationship between race, age, DNA methylation and rectal cancer risk that warrants further investigation.

As research documenting disparate impacts of COVID-19 by race and ethnicity grows, little attention has been given to dynamics in mortality disparities during the pandemic and whether changes in disparities persist. We estimate age-standardized monthly all-cause mortality in the United States from January 2018 through February 2022 for seven racial/ethnic populations. Using joinpoint regression, we quantify trends in race-specific rate ratios relative to non-Hispanic White mortality to examine the magnitude of pandemic-related shifts in mortality disparities. Prepandemic disparities were stable from January 2018 through February 2020. With the start of the pandemic, relative mortality disadvantages increased for American Indian or Alaska Native (AIAN), Native Hawaiian or other Pacific Islander (NHOPI), and Black individuals, and relative mortality advantages decreased for Asian and Hispanic groups. Rate ratios generally increased during COVID-19 surges, with different patterns in the summer 2021 and winter 2021/2022 surges, when disparities approached prepandemic levels for Asian and Black individuals. However, two populations below age 65 fared worse than White individuals during these surges. For AIAN people, the observed rate ratio reached 2.25 (95% CI = 2.14, 2.37) in October 2021 vs. a prepandemic mean of 1.74 (95% CI = 1.62, 1.86), and for NHOPI people, the observed rate ratio reached 2.12 (95% CI = 1.92, 2.33) in August 2021 vs. a prepandemic mean of 1.31 (95% CI = 1.13, 1.49). Our results highlight the dynamic nature of racial/ethnic disparities in mortality and raise alarm about the exacerbation of mortality inequities for Indigenous groups due to the pandemic.

BACKGROUND As the coronavirus disease 2019 (COVID‐19) pandemic continues to spread, it remains unclear how vulnerable populations with preexisting health conditions like cancer have been affected. METHODS Between July and September of 2020, the authors conducted a cross‐sectional study that surveyed 2661 patients with breast cancer who were registered in the Chicago Multiethnic Epidemiologic Breast Cancer Cohort and received 1300 responses (71.5% White patients and 22.4% Black patients). The survey measured the psychosocial well‐being of participants before and during the COVID‐19 pandemic and examined whether they experienced any type of financial challenges or treatment disruption. RESULTS The results indicated that feelings of isolation increased significantly during the pandemic. Meanwhile, the overall median isolation/stress score was 1.2 on a scale from 0 (never) to 4 (always), which was not significantly different between White patients and Black patients. One‐third of patients experienced some type of financial challenge during this time. Medicaid recipients, of whom almost 80% were Black, were more likely to experience financial challenges. In addition, approximately one‐fourth of patients experienced difficulty getting treatment. CONCLUSIONS This study indicates that the quality of life of patients with breast cancer and their scheduled treatments have been adversely affected during the COVID‐19 pandemic. These findings suggest that more support should be provided by hospital centers and the medical research community to patients with cancer during this challenging pandemic. LAY SUMMARY The authors surveyed patients with breast cancer in Chicago using a questionnaire to examine how their lives have been affected during the coronavirus disease 2019 (COVID‐19) pandemic.The results indicate that the lives of patients with breast cancer and their scheduled treatments have been adversely affected during the pandemic.In addition, patients who were covered by Medicaid, most of whom were Black, were more likely to experience financial challenges.The findings suggest that hospital centers and the medical research community should reach out and provide more information to support patients with cancer during this challenging pandemic., The quality of life of patients with breast cancer and their scheduled treatments have been adversely affected during the coronavirus disease 2019 pandemic. The findings also suggest that more support should be provided by hospital centers and the medical research community to patients with cancer during this challenging pandemic.

Background Health systems have targeted hospital readmissions to promote health equity as there may be racial and ethnic disparities across different patient groups. However, 7-day readmissions have been understudied in adult hospital medicine. Design This is a retrospective study. We performed multivariable logistic regression between patient race/ethnicity and 7-day readmission. Mediation analysis was performed for limited English proficiency (LEP) status. Subgroup analyses were performed for patients with initial admissions for congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and cancer. Patients We identified all adults discharged from the adult hospital medicine service at UCSF Medical Center between July 2016 and June 2019. Main Measures The primary outcome was 7-day all-cause readmission back to the discharging hospital. Results There were 18,808 patients in our dataset who were discharged between July 2016 and June 2019. A total of 1,297 (6.9%) patients were readmitted within 7 days. Following multivariable regression, patients who identified as Black (OR 1.35, 95% CI 1.15–1.58, p Conclusions Black patients and Asian patients experienced higher rates of 7-day readmission than patients who identified as white, confirmed on adjusted analysis.

Background Pacific Islanders (PIs), an indigenous, diverse population in the USA, have endured generational burdens of Western colonization and institutional racism that placed this population at socioeconomic and health disadvantages, such as in poverty, chronic disease, and now COVID-19. However, little is known about the impact of COVID-19 on this historically disadvantaged population. This study assessed the extent US PIs have been adversely affected by COVID-19 across the 50 states. Methods Using state-level national data as of September 9th, 2020, we conducted a secondary-data analysis of COVID-19 cases and deaths in PIs relative to their population representation and other racial groups, case odds ratios, and age-adjusted standard mortality ratios. Key Results Only 46% of states reported PI cases and 36% of states reported PI deaths. Of 23 states with available data on PIs, PIs were overrepresented in COVID-19 cases and deaths relative to their population representation in 21 and 14 states, respectively. The proportion of COVID-19 cases and deaths to the PI population was highest among all racial groups in 15 and 9 states, respectively. PIs had higher odds of exposure to COVID-19 than Whites in 21 of 23 states, and higher number of observed deaths than expected in 6 of 7 states with available PI data. Conclusions Engaging PI community-based and faith-based organizations in medical and public health outreach efforts, health workforce employment and training programs, along with granular data collection and reporting, are vital to mitigate the disproportionate effects of COVID-19 on this population.

A growing body of research has documented racial disparities in depressive symptoms in the United States, although the precise magnitude on these differences is less well understood. This issue has important implications for informing public health policy, and developing and administering prevention and intervention strategies. In this protocol, we propose a systematic review and meta-analysis of individual participant data from nationally representative studies from the United States drawn from Inter-university Consortium for Political and Social Research (ICPSR). Our three aims are to: 1) Estimate the overall average difference of depressive symptoms between Whites and minorities, as well as between- (e.g., African-Americans, Latinos) and within- (e.g., Latinos: Mexican-Americans, Cuban-Americans) minority groups; 2) Determine if age, sex, education, income, socioeconomic status, and other variables account for these differences; 3) Test the cultural differences and similarities hypotheses.

OSA is a sleep breathing disorder that is implicated in the development and exacerbation of many chronic conditions (1,2). It has also come to light that racial disparities exist in the prevalence, diagnosis, treatment, severity, and symptomatology of OSA between Black and White patients (3). Many explanations have been theorized and tested for the discrepancy in OSA characteristics between races, including things such as obesity, existing comorbid conditions, and exposure to smoke, however one factor we hope to further investigate is the impact of psychosocial factors (loneliness, depression, stress) on OSA severity. We also plan to look at the effects of psychosocial factors on OSA symptomatology to investigate claims from the literature that Black OSA patients tend to have more daytime symptoms than White patients (3).

In this study, participants see one of four one-minute videos. In the video, an actor describes breaking their arm and needing opioid medication. Each video has the same script. In condition one, a white man performs the script, and in condition two, a Black man performs the script. In conditions three and four, the same actors perform the same script, but there is an implicit bias poster in the background of the video. We will compare how likely the participants would be to prescribe opioid medications to the actor in the video. We will also include a survey about explicit racial bias and other constructs. Finally, participants will perform the racial bias IAT.

Despite the demonstrated potential of artificial intelligence (AI) in breast cancer risk assessment for personalizing screening recommendations, further validation is required regarding AI model bias and generalizability. We performed external validation on a U.S. screening cohort of a mammography-derived AI breast cancer risk model originally developed for European screening cohorts. We retrospectively identified 176 breast cancers with exams 3 months to 2 years prior to cancer diagnosis and a random sample of 4963 controls from women with at least one-year negative follow-up. A risk score for each woman was calculated via the AI risk model. Age-adjusted areas under the ROC curves (AUCs) were estimated for the entire cohort and separately for White and Black women. The Gail 5-year risk model was also evaluated for comparison. The overall AUC was 0.68 (95% CIs 0.64–0.72) for all women, 0.67 (0.61–0.72) for White women, and 0.70 (0.65–0.76) for Black women. The AI risk model significantly outperformed the Gail risk model for all women p < 0.01 and for Black women p < 0.01, but not for White women p = 0.38. The performance of the mammography-derived AI risk model was comparable to previously reported European validation results; non-significantly different when comparing White and Black women; and overall, significantly higher than that of the Gail model.

BackgroundThe purpose of our study was to investigate the association of race and ethnicity with the use of the newest technology and postoperative outcomes in total hip arthroplasty (THA) using the American Academy of Orthopaedic Surgeons (AAOS) American Joint Replacement Registry (AJRR).MethodsAdult THA procedures were queried from the AJRR from 2012 to 2020. A mixed-effects multivariate regression model was used to evaluate the association of race and ethnicity with the use of the newest technology (ceramic femoral head, dual-mobility implant, and robotic assist) at 30-day, and 90-day readmission. A proportional subdistribution hazard model was used to model a risk of revision THA.ResultsThere were 85,188 THAs with complete data for an analysis of outcomes and 103,218 for an analysis of ceramic head usage. The median length of follow-up was 37.9 months (interquartile range [IQR] 21.6 to 56.3 months). In multivariate models, compared to White non-Hispanic patients, Black (odds ratio [OR] 0.79, 95% confidence interval [CI] 0.69-0.92, P < .001), Hispanic (OR 0.76, CI 0.59-0.99, P= .037), Asian (OR 0.74, CI 0.55-1.00, P= .045), and Native American (OR 0.52, CI 0.30-0.87, P= .004) patients all had significantly lower rates of ceramic head use in THA. Compared to White non-Hispanic patients, Asian (hazard ratio [HR] 0.39, CI 0.18-0.86, P= .008) and Hispanic (HR 0.43, CI 0.19-0.98, P= .043) patients had significantly lower rates of revision. No differences in 30-day or 90-day readmission rates were seen.ConclusionBlack, Hispanic, Native American, and Asian patients had lower rates of ceramic head use in THA when compared to White patients. These differences did not translate into worse clinical outcomes on a short-term follow-up. In fact, Asian patients had lower revision rates compared to non-Hispanic White patients. Additional study is necessary to evaluate the long-term consequence of lower ceramic head use in non-White patients in the United States.

Background Sepsis affects 1.7 million patients in the US annually, is one of the leading causes of mortality, and is a major driver of US healthcare costs. African American/Black and LatinX populations experience higher rates of sepsis complications, deviations from standard care, and readmissions compared with Non-Hispanic White populations. Despite clear evidence of structural racism in sepsis care and outcomes, there are no prospective interventions to mitigate structural racism in sepsis care, nor are we aware of studies that report reductions in racial inequities in sepsis care as an outcome. Therefore, we will deliver and evaluate a coalition-based intervention to equip health systems and their surrounding communities to mitigate structural racism, driving measurable reductions in inequities in sepsis outcomes. This paper presents the theoretical foundation for the study, summarizes key elements of the intervention, and describes the methodology to evaluate the intervention. Methods Our aims are to: (1) deliver a coalition-based leadership intervention in eight U.S. health systems and their surrounding communities; (2) evaluate the impact of the intervention on organizational culture using a longitudinal, convergent mixed methods approach, and (3) evaluate the impact of the intervention on reduction of racial inequities in three clinical outcomes: a) early identification (time to antibiotic), b) clinical management (in-hospital sepsis mortality) and c) standards-based follow up (same-hospital, all-cause sepsis readmissions) using interrupted time series analysis. Discussion This study is aligned with calls to action by the NIH and the Sepsis Alliance to address inequities in sepsis care and outcomes. It is the first to intervene to mitigate effects of structural racism by developing the domains of organizational culture that are required for anti-racist action, with implications for inequities in complex health outcomes beyond sepsis.

Concerns about systemic racism at academic and research institutions have increased over the past decade. Here, we investigate data from the National Science Foundation (NSF), a major funder of research in the United States, and find evidence for pervasive racial disparities. In particular, white principal investigators (PIs) are consistently funded at higher rates than most non-white PIs. Funding rates for white PIs have also been increasing relative to annual overall rates with time. Moreover, disparities occur across all disciplinary directorates within the NSF and are greater for research proposals. The distributions of average external review scores also exhibit systematic offsets based on PI race. Similar patterns have been described in other research funding bodies, suggesting that racial disparities are widespread. The prevalence and persistence of these racial disparities in funding have cascading impacts that perpetuate a cumulative advantage to white PIs across all of science, technology, engineering, and mathematics.

ObjectivesTo define the incidence of clinically detected coronavirus disease 2019 (COVID-19) in people with HIV (PWH) in the United States and evaluate how racial and ethnic disparities, comorbidities, and HIV-related factors contribute to risk of COVID-19.DesignObservational study within the CFAR Network of Integrated Clinical Systems cohort in seven cities during 2020.MethodsWe calculated cumulative incidence rates of COVID-19 diagnosis among PWH in routine care by key characteristics including race/ethnicity, current and lowest CD4+ cell count, and geographic area. We evaluated risk factors for COVID-19 among PWH using relative risk regression models adjusted with disease risk scores.ResultsAmong 16 056 PWH in care, of whom 44.5% were black, 12.5% were Hispanic, with a median age of 52 years (IQR 40-59), 18% had a current CD4+ cell count less than 350 cells/μl, including 7% less than 200; 95.5% were on antiretroviral therapy (ART), and 85.6% were virologically suppressed. Overall in 2020, 649 PWH were diagnosed with COVID-19 for a rate of 4.94 cases per 100 person-years. The cumulative incidence of COVID-19 was 2.4-fold and 1.7-fold higher in Hispanic and black PWH respectively, than non-Hispanic white PWH. In adjusted analyses, factors associated with COVID-19 included female sex, Hispanic or black identity, lowest historical CD4+ cell count less than 350 cells/μl (proxy for CD4+ nadir), current low CD4+ : CD8+ ratio, diabetes, and obesity.ConclusionOur results suggest that the presence of structural racial inequities above and beyond medical comorbidities increased the risk of COVID-19 among PWH. PWH with immune exhaustion as evidenced by lowest historical CD4+ cell count or current low CD4+ : CD8+ ratio had greater risk of COVID-19.

We hope this report will help to renew attention to the problem of excessive discipline. In keeping with this aim, we compare the projected full-year suspension rate for 2019-2020 to rates from prior years. We provide these projected suspension rates for the overall student population in California, and for every racial/ethnic subgroup at the state and district levels. We encourage education policymakers at the state and district levels to use the projections we provide in this report to distinguish districts that were on the path toward lower suspension rates from those on a path toward an increase or that showed no change.

Joshua Brady,1 Reem Kashlan,1 Julie Ruterbusch,2 Mehdi Farshchian,3 Meena Moossavi3 1Wayne State University School of Medicine, Detroit, MI, USA; 2Department of Oncology, Wayne State University, Detroit, MI, USA; 3Department of Dermatology, Wayne State University, Detroit, MI, USACorrespondence: Mehdi FarshchianDepartment of Dermatology, Wayne State University, 18100 Oakwood Blvd., Suite 300, Dearborn, MI, 48124 Email mfarshch@med.wayne.eduPurpose: As the most common cause of skin cancer death, incidence and mortality of melanoma vary widely between ethnic and racial groups.Methods: Surveillance, Epidemiology, and End Results (SEER) data were used to examine the incidence and survival in patients with melanoma concerning race and ethnicity in Wayne County, Michigan between 2000 and 2016.Results: Analysis of data revealed significantly higher melanoma-specific death in non-Hispanic black patients compared to their non-Hispanic white counterparts (p < 0.001). However, no increased risk of death due to melanoma was observed following adjustment of data for the stage, age, and sex (H.R. = 1.00, 95% CI 0.64– 1.56).Conclusion: Non-Hispanic black patients have the highest percentage of late-stage melanoma. Increased incidence of melanoma mortality in non-Hispanic black patients is likely a consequence of late-stage diagnosis.Keywords: melanoma, racial disparities, epidemiology, clinical research, skin of color

Background Covid-19 toll is disproportionate in Blacks although the mechanisms remain incompletely understood. From a biological perspective, several host proteins have received most attention as logical susceptibility targets. Specifically, angiotensin-converting enzyme 2 (ACE2) serves as the epithelial cell receptor and acts in concert with transmembrane protease serine 2 (TMPRSS2). Intriguingly, ACE2 can also suppress the inflammatory response and therefore may impact the severity of Covid-19 infections (from the exuberant immune response a.k.a. “cytokine storm”). We, therefore, assessed expression of ACE2 and TMPRSS2 in Blacks versus Whites. Methods Archived mucosal biopsies from colonoscopic biopsies of visually normal rectal mucosa without concurrent neoplasia or inflammation were used for this study. Total mRNA was isolated and subjected to real-time polymerase chain reaction for ACE2, and TMPRSS2 was assessed from non-Hispanic Blacks (n = 45) and non-Hispanic Whites (n = 38). GAPDH and beta-actin were used for normalization. Multivariable analysis was performed using Analyse-IT software. Results ACE2 and TMPRSS2 levels were not altered by gender, BMI, or age. ACE2 levels were lower in Blacks than Whites achieving statistical significance in multivariable (0.51-fold, p = 0.03) but not quite in univariable (p = 0.07) analysis. This downregulation was mirrored in TMRPSS2 in both univariable (p = 0.03) and multivariable analyses (0.41-fold, p = 0.02). Moreover, there was a strong correlation between ACE2 and TMPRSS2 levels (r-squared = 0.78). Conclusions To our knowledge, this is the first report on racial differences inACE2 and TMPRSS2 mucosal expression. This may provide potential biological underpinnings for the disproportionately higher mortality of Covid-19 in Blacks and should spur future studies.

A total of one in ten infants is born preterm in the U.S. with large racial disparities. Recent data suggest that neighborhood exposures may play a role. Walkability—how easily individuals can walk to amenities–may encourage physical activity. We hypothesized that walkability would be associated with a decreased risk of preterm birth (PTB) and that associations would vary by PTB phenotype. PTB can be spontaneous (sPTB) from conditions such as preterm labor and preterm premature rupture of membranes, or medically indicated (mPTB) from conditions such as poor fetal growth and preeclampsia. We analyzed associations of neighborhood walkability (quantified by their Walk Score® ranking) with sPTB and mPTB in a Philadelphia birth cohort (n = 19,203). Given racial residential segregation, we also examined associations in race-stratified models. Walkability (per 10 points of Walk Score ranking) was associated with decreased odds of mPTB (aOR 0.90, 95% CI: 0.83, 0.98), but not sPTB (aOR 1.04, 95% CI: 0.97, 1.12). Walkability was not protective for mPTB for all patients; there was a non-significant protective effect for White (aOR 0.87, 95% CI: 0.75, 1.01), but not Black patients (aOR 1.05, 95% CI: 0.92, 1.21) (interaction p = 0.03). Measuring health effects of neighborhood characteristics across populations is key for urban planning efforts focused on health equity.

Background. The 2019 overall breastfeeding initiation rate in the US was 84.1%, yet only 76.6% of American Indian (AI) women initiated breastfeeding. In North Dakota (ND), AI women have greater exposure to interpersonal violence than other racial/ethnic groups. Stress associated with interpersonal violence may interfere with processes important to breastfeeding. We explored whether interpersonal violence partially explains racial/ethnic disparities in breastfeeding in ND. Methods. Data for 2161 women were drawn from the 2017–2019 ND Pregnancy Risk Assessment Monitoring System. Breastfeeding questions in PRAMS have been tested among diverse populations. Breastfeeding initiation was self-report to “Did you ever breastfeed or pump breast milk to feed your new baby, even for a short period?” (yes/no). Breastfeeding duration (2 months; 6 months) was self-reported how many weeks or months of breastmilk feeding. Interpersonal violence for both 12 months before and during pregnancy based on self-report (yes/no) of violence from a husband/partner, family member, someone else, or ex-husband/partner. An “Any violence” variable was created if participants reported “yes” to any violence. Logistic regression models estimated crude and adjusted odds ratios (OR) and 95% confidence intervals (95% CI) for breastfeeding outcomes among AI and Other Race women compared to White women. Sequential models were adjusted for interpersonal violence (husband/partner, family member, someone else, ex-husband/partner, or any). Results. AI women had 45% reduced odds of initiating breastfeeding (OR: 0.55, 95% CI: 0.36, 0.82) compared to white women. Including interpersonal violence during pregnancy did not change results. Similar patterns were observed for all breastfeeding outcomes and all interpersonal violence exposures. Discussion. Interpersonal violence does not explain the disparity in breastfeeding in ND. Considering cultural ties to the tradition of breastfeeding and the role of colonization may provide a better understanding of breastfeeding among AI populations.

Background: Racial/ethnic (R/E) minorities with head and neck squamous cell carcinoma (HNSCC) have worse survival outcomes compared to White patients. While disparities in patient outcomes for R/E minorities have been well documented, the specific drivers of the inferior outcomes remain poorly understood. Patients and Methods: This was a population-based retrospective cohort study that analyzed HNSCC patients using the National Cancer Database (NCDB) from 2000–2016. Patient outcomes were stratified by R/E groups including White, Black, Hispanic, Native American/Other, and Asian. The main outcome in this study was overall survival (OS). Univariate time-to-event survival analyses were performed using the Kaplan–Meier product limit estimates and the log-rank test to evaluate the differences between strata. Results: There were 304,138 patients with HNSCC identified in this study, of which 262,762 (86.3%) were White, 32,528 (10.6%) were Black, 6191 were Asian (2.0%), and 2657 were Native American/Other (0.9%). Black R/E minorities were more likely to be uninsured (9% vs. 5%, p < 0.0001), have Medicaid insurance (22% vs. 8%, p < 0.0001), be in a lower income quartile (

Louisiana ranks among the bottom five states for air pollution and mortality. Our objective was to investigate associations between race and Coronavirus Disease 2019 (COVID-19) hospitalizations, intensive care unit (ICU) admissions, and mortality over time and determine which air pollutants and other characteristics may mediate COVID-19-associated outcomes. In our cross-sectional study, we analyzed hospitalizations, ICU admissions, and mortality among positive SARS-CoV-2 cases within a healthcare system around the Louisiana Industrial Corridor over four waves of the pandemic from 1 March 2020 to 31 August 2021. Associations between race and each outcome were tested, and multiple mediation analysis was performed to test if other demographic, socioeconomic, or air pollution variables mediate the race–outcome relationships after adjusting for all available confounders. Race was associated with each outcome over the study duration and during most waves. Early in the pandemic, hospitalization, ICU admission, and mortality rates were greater among Black patients, but as the pandemic progressed, these rates became greater in White patients. However, Black patients were disproportionately represented in these measures. Our findings imply that air pollution might contribute to the disproportionate share of COVID-19 hospitalizations and mortality among Black residents in Louisiana.

Racial disparities have been observed in the impacts of COVID-19 in the USA. In the present paper, we used a representative sample of adults in Michigan to examine differences in COVID-19 impacts on Blacks and Whites in four domains: direct, perceived, political, and behavioral. We found that in the initial wave of the outbreak in May 2020, Blacks experienced more severe direct impacts: they were more likely to be diagnosed or know someone who was diagnosed, and more likely to lose their job compared to Whites. In addition, Blacks differed significantly from Whites in their assessment of COVID-19’s threat to public health and the economy, the adequacy of government responses to COVID-19, and the appropriateness of behavioral changes to mitigate COVID-19’s spread. Although in many cases these views of COVID-19 were also associated with political ideology, this association was significantly stronger for Whites than Blacks. Continued investigation of racial disparities in COVID-19’s impact is necessary; however, these preliminary findings of a race-by-ideology interaction are important because they suggest some racial disparities are restricted to conservatives, while more liberal Whites and Blacks exhibit few differences.

When health professions learners’ primary pedagogical experience of Black people and how they become patients is through statistics, it becomes very easy for learners to think of Black people as data points rather than as individuals whose health is often at the mercy of racist institutions. When the human dimension of Black people’s health is ignored, specifically the ways that poor health affects individual wellbeing, one of the barriers to proper health for Black patients is how to be seen and considered as a part of a larger problem of systemic racism and institutional injustices as well as individuals whose personal lives are affected by such larger problems. I propose an approach to health professions pedagogy—the experiential race testimonies (ERT) approach—that can change the way health professions learners understand and treat Black patients, thus changing the future of Black health. The ERT approach pairs population data analysis with analysis of personal testimonies and the experiences they convey.

Background African American and Hispanic postmenopausal women have the highest risk for heart failure compared with other races, but heart failure prevalence is lower than expected in some national cohorts. It is unknown whether psychosocial factors are associated with lower risk of incident heart failure hospitalization among high-risk postmenopausal minority women. Methods and Results Using the Women's Health Initiative Study, African American and US Hispanic women were classified as high-risk for incident heart failure hospitalization with 1 or more traditional heart failure risk factors and the highest tertile heart failure genetic risk scores. Positive psychosocial factors (optimism, social support, religion) and negative psychosocial factors (living alone, social strain, depressive symptoms) were measured using validated survey instruments at baseline. Adjusted subdistribution hazard ratios of developing heart failure hospitalization were determined with death as a competing risk. Positive deviance indicated not developing incident heart failure hospitalization with 1 or more risk factors and the highest tertile for genetic risk. Among 7986 African American women (mean follow-up of 16 years), 27.0% demonstrated positive deviance. Among high-risk African American women, optimism was associated with modestly reduced risk of heart failure hospitalization (subdistribution hazard ratio 0.94, 95% confidence interval 0.91–0.99), and social strain was associated with modestly increased risk of heart failure hospitalization (subdistribution hazard ratio 1.07, 95% confidence interval 1.02–1.12) in the initial models; however, no psychosocial factors were associated with heart failure hospitalization in fully adjusted analyses. Among 3341 Hispanic women, 25.1% demonstrated positive deviance. Among high-risk Hispanic women, living alone was associated with increased risk of heart failure hospitalization (subdistribution hazard ratio 1.97, 95% confidence interval 1.06–3.63) in unadjusted analyses; however, no psychosocial factors were associated with heart failure hospitalization in fully adjusted analyses. Conclusions Among postmenopausal African American and Hispanic women, a significant proportion remained free from heart failure hospitalization despite having the highest genetic risk profile and 1 or more traditional risk factors. No observed psychosocial factors were associated with incident heart failure hospitalization in high-risk African Americans and Hispanics. Additional investigation is needed to understand protective factors among high-risk African American and Hispanic women.

Heart failure is a leading cause of readmissions in the United States, although treatment has come along away, palliative care is often not appropriately offered in advanced heart failure. The purpose of this study was to use a large database of national in-patient sample to find out the use of palliative care in acute heart failure admissions. Data from 2002 to 2017 was used for analysis. Simple linear regression was used for trend analysis over the years. Variables that were statistically significant in univariate analysis were used in single-step (entry method) multiple logistic analysis. The use of palliative care was found to be low at 4.1%, although recent trends have shown an increase (from 0.4% in 2002 to 6.2% in 2017). Women (0.3% in 2002 to 6.5% in 2017) and Caucasians (0.6% in 2002 to 6.9% in 2017) had a higher proportion of PC encounters as compared to men (0.5% in 2002 to 5.9% in 2017) and other racial minorities, increasing age (OR, 1.04[CI; 1.03-1.04], p&nbsp

This study sought to describe racial disparities in food insecurity, food pantry use, and barriers to and experiences with food pantries during the first year of the COVID-19 pandemic. We surveyed 2928 adults in Massachusetts regarding food access in the year before and during the first year of the pandemic. Weighted multivariable logistic regression models assessed racial differences in barriers to and experiences with pantry use during the pandemic. Black and Latino adults experienced the highest prevalence of food insecurity and pantry use. Additionally, Black and Latino adults reported more barriers to, but less stigma around, pantry use compared to White adults. Latino adults were less likely to know about pantry hours/locations and encounter staff who spoke their language. Black and Latino adults were also more likely to find pantry hours/locations inconvenient and have difficulty with transportation. The COVID-19 pandemic resulted in increased food insecurity, and food access inequities persisted. Programmatic policies to improve pantry access in communities of color could include increasing the hours/days that pantries are open, increasing bilingual staff, providing transportation or delivery, and creating multilingual public awareness campaigns on how to locate pantries.

ObjectiveTo assess differences in anal cancer incidence between racial/ethnic groups among a clinical cohort of men with HIV who have sex with men.DesignClinical cohort study.MethodsWe studied men who have sex with men (MSM) in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) who initiated antiretroviral therapy (ART) under HIV care in CNICS. We compared anal cancer incidence between Black and non-Black men and calculated hazard ratios controlling for demographic characteristics (age, CNICS site, year of ART initiation), HIV disease indicators (nadir CD4+, peak HIV RNA), and co-infection/behavioral factors including hepatitis B virus (HBV), hepatitis C virus (HCV), tobacco smoking and alcohol abuse.ResultsWe studied 7473 MSM with HIV who contributed 41 810 person-years of follow-up after initiating ART between 1996 and 2014 in CNICS. Forty-one individuals had an incident diagnosis of anal cancer under observation. Crude rates of anal cancer were 204 versus 61 per 100 000 person-years among Black versus non-Black MSM. The weighted hazard ratio for anal cancer in Black MSM (adjusting for demographics, HIV disease factors, and co-infection/behavioral factors) was 2.37 (95% confidence interval: 1.17, 4.82) compared to non-Black MSM.ConclusionsIn this large multicenter cohort, Black MSM were at significantly increased risk for anal cancer compared to non-Black MSM. Further detailed studies evaluating factors impacting anal cancer incidence and outcomes in Black men with HIV are necessary. Inclusion of more diverse study cohorts may elucidate modifiable factors associated with increased anal cancer risk experienced by Black MSM.

Background Among patients with type 2 diabetes, minority racial/ethnic groups have a higher burden of cardiovascular disease, chronic kidney disease, and hypoglycaemia. These groups may especially benefit from newer diabetes medication classes, but high cost may limit access. We examined the association of race/ethnicity with the initiation of newer diabetes medications (GLP-1 receptor agonists, DPP-4 inhibitors, SGLT-2 inhibitors). Methods We conducted a secondary analysis of the Look AHEAD (Action for Health in Diabetes) trial including participants with at least one study visit after April 28, 2005. Cox proportional hazards models were used to estimate the association between race/ethnicity and socioeconomic factors with time to initiation of any newer diabetes medication from April 2005 to February 2020. Models were adjusted for demographic and clinical characteristics. Findings Among 4,892 participants, 63.6%, 15.7%, 12.6%, 5.2%, and 2.9% were White, Black, Hispanic, American Indian or Alaskan Native (AI/AN), or other race/ethnicity, respectively. During a median follow-up of 8.3 years, 2,180 (45.2%) participants were initiated on newer diabetes medications. Race/ethnicity was associated with newer diabetes medication initiation (p=.019). Specifically, initiation was lower among Black (HR 0.81, 95% CI 0.70–0.94) and AI/AN participants (HR 0.51, 95% CI 0.26–0.99). Yearly family income was inversely associated with initiation of newer diabetes medications (HR 0.78, 95% CI 0.62–0.98) comparing the lowest and highest income groups. Findings were mostly driven by GLP-1 receptor agonists. Interpretation These findings provide evidence of racial/ethnic disparities in the initiation of newer diabetes medications, independent of socioeconomic factors, which may contribute to worse health outcomes. Funding source NIDDK, NIH

Background Health disparities are prevalent in many areas of medicine. We aimed to investigate the impact of the COVID-19 pandemic on racial/ethnic groups in the United States (US) and to assess the effects of social distancing, social vulnerability metrics, and medical disparities. Methods A cross-sectional study was conducted utilizing data from the COVID-19 Tracking Project and the Centers for Disease Control and Prevention (CDC). Demographic data were obtained from the US Census Bureau, social vulnerability data were obtained from the CDC, social distancing data were obtained from Unacast, and medical disparities data from the Center for Medicare and Medicaid Services. A comparison of proportions by Fisher’s exact test was used to evaluate differences between death rates stratified by age. Negative binomial regression analysis was used to predict COVID-19 deaths based on social distancing scores, social vulnerability metrics, and medical disparities. Results COVID-19 cumulative infection and death rates were higher among minority racial/ethnic groups than whites across many states. Older age was also associated with increased cumulative death rates across all racial/ethnic groups on a national level, and many minority racial/ethnic groups experienced significantly greater cumulative death rates than whites within age groups ≥ 35 years. All studied racial/ethnic groups experienced higher hospitalization rates than whites. Older persons (≥ 65 years) also experienced more COVID-19 deaths associated with comorbidities than younger individuals. Social distancing factors, several measures of social vulnerability, and select medical disparities were identified as being predictive of county-level COVID-19 deaths. Conclusion COVID-19 has disproportionately impacted many racial/ethnic minority communities across the country, warranting further research and intervention.

Background Although early‐onset colorectal cancer (EOCRC) incidence rates (IRs) are increasing, geographic and intra‐racial IR disparities are not well defined. Methods 2000‐2015 Surveillance, Epidemiology, and End Results (SEER) program CRC IR Analysis (170,434 cases) was performed from ages 30 to 60 in four US regions, 18 individual registries, metropolitan and nonmetropolitan locations and stratified by race. Analyses were conducted in 1‐year and 5‐year age increments. Results Wide US regional EOCRC IR variations exist: For example, age 45 IRs in the south are 26.8/100,000, 36.0% higher than the West, 19.7/100,000 (p, This analysis of SEER 18 early‐onset colorectal cancer data reveals marked disparities by geography and within racial groups (intra‐racial) across the United States. This data can be used to target public health interventions and guide future studies on etiology.

Background Racial disparities in New York City (NYC) breast cancer incidence and mortality rates have previously been demonstrated. Disease stage at diagnosis and mortality‐to‐incidence ratio (MIR) may present better measures of differences in screening and treatment access. Racial/ethnic trends in NYC MIR have not previously been assessed. Methods Mammogram rates were compared using the NYC Community Health Survey, 2002‐2014. Breast cancer diagnosis, stage, and mortality were from the New York State Cancer Registry, 2000‐2016. Primary outcomes were MIR, the ratio of age‐adjusted mortality to incidence rates, and stage at diagnosis. Joinpoint regression analysis identified significant trends. Results Mammogram rates in 2002‐2014 among Black and Latina women ages 40 and older (79.9% and 78.4%, respectively) were stable and higher than among White (73.6%) and Asian/Pacific‐Islander women (70.4%) (P, Lower incidence of local stage breast cancer at diagnosis and slower decrease in mortality rates among Black and Latina women in NYC as compared to White women raises great concern about unequal access to quality care including quality screening and improvements in therapy. These differences were especially prominent among Black women, who merit additional public health focus.

BACKGROUND Non-alcoholic fatty liver disease (NAFLD) has a heterogeneous distribution across racial and ethnic groups, with a disproportionate burden among Hispanics. Although there are currently no approved therapies for treatment of NAFLD, several therapies have been investigated in clinical trials. AIM To analyze the inclusion of racial and ethnic minority groups in clinical trials for NAFLD. METHODS We performed a systematic review of North American, English-language, prospective studies for NAFLD therapies published from 2005 to 2019. Racial and ethnic enrollment data were recorded for each eligible study. Meta-analysis was performed to compute pooled prevalence of different racial and ethnic groups, followed by further subgroup analyses. These analyses were based on diagnosis of non-alcoholic steatohepatitis (NASH) and timing of study on enrollment by ethnicity. Descriptive statistics were performed to compare racial and ethnic study enrollment to previously reported NAFLD population prevalence. RESULTS Thirty-eight studies met criteria for inclusion in the systematic review. When reported, median age of enrolled subjects was 49 years (range 41.5-58) with 56% female participants. NAFLD was defined through biopsy findings in 79% (n = 30) of the studies. Of the included articles, treatment modalities ranged from medications (n = 28, 74%), lifestyle interventions (n = 5, 13%), bariatric surgery (n = 4, 11%) and phlebotomy (n = 1, 2%). Twenty-eight studies (73%) included racial and/or ethnic demographic information, while only 17 (45%) included information regarding Hispanic participation. Of the 2983 patients enrolled in all eligible trials, a total of only 346 (11.6%) Hispanic participants was reported. Meta-analysis revealed a pooled Hispanic prevalence of 24.3% (95% confidence interval 16.6-32.0, I2 94.6%) among studies documenting Hispanic enrollment. Hispanic enrollment increased over time from 15% from 2005-2014 to 37% from 2015-2019. CONCLUSION In a meta-analysis of NAFLD trials, documentation of racial/ethnic demographic data occurred in less than half of studies. Standardization of reporting of race/ethnicity and targeted interventions toward minority recruitment are needed to improve diversity of enrollment.

The Robson Ten-Group Classification System is widely considered to be the gold standard for comparing cesarean section (CS) delivery rates, despite limited adoption in the United States (US). When reporting overall CS rates, Blacks and other minorities are typically reported to have high CS rates but comparing overall CS rates may be misleading as CS may be more common in some higher risk populations. Improved understanding of how CS rates differ by race among standardized groups could highlight differences in care and areas for improvement. The current study examines racial differences in cesarean section delivery rates using the Robson Ten-Group Classification System in a nationwide sample. Data from US vital statistics live birth certificates were used to identify 3,906,088 births which were each classified into one of the ten groups based on five obstetric characteristics identifiable on presentation for delivery including parity, onset of labor, gestational age, fetal presentation, and number of fetuses. Results indicated that Black and Asian mothers had the highest CS rates in groups 1–4 which all contain single, cephalic pregnancies at term with no prior CS and are only differentiated by parity and onset of labor. Black mothers also had the lowest CS rates for groups 6 and 7, containing women with nulliparous and multiparous breech births. Black and Asian mothers show differences in CS rates among groups that could indicate lack of appropriate care. Efforts should be made to prevent unnecessary primary CS among low-risk mothers.

Purpose The Coronavirus pandemic has exposed substantial racial and ethnic health and healthcare disparities. Black breast cancer patients face significant disparities in stage of presentation, surgical management, and mortality. The objective of this editorial is to examine the possible implications of the surgical delay imposed by the pandemic on black breast cancer patients. Methods The American College of Surgeons, the Society of Surgical Oncology, and the American Society of Breast Surgeons recommendations for surgical delay during the Coronavirus Disease 2019 (COVID-19) were evaluated and discussed. Results Guidelines by major surgical organizations on surgical delay for breast cancer patients may inadvertently exacerbate disparities in time to surgery for black breast cancer patients. Our recommendations to better characterize the impact of these guidelines on surgical delay among vulnerable populations include the following: (1) track time from biopsy-proven diagnosis to surgery by race and ethnicity, (2) document patient and institution-related reasons for surgical delay, (3) record patient and disease-related variables/reasons for the selection of breast conservation surgery, mastectomy, and reconstruction by race and ethnicity, and (4) collect data on impactful social determinants of health such as financial reserve, housing conditions, stress, and transportation. Conclusions The COVID-19 pandemic may exacerbate delays in time to surgery among black breast cancer patients. Surgeons should incorporate collection of social determinants of health into their clinical practice to better understand the impact of COVID-19 on racial and ethnic disparities in surgical management.