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There are two dominant approaches to implementing permanent supportive housing (PSH), namely place-based (PB) and scattered-site (SS). Formal guidance does not distinguish between these two models and only specifies that PSH should be reserved for those who are most vulnerable with complex health needs. To consider both system- and self-selection factors that may affect housing assignment, this study applied the Gelberg-Anderson behavioral model for vulnerable populations to compare predisposing, enabling, and need factors among people experiencing homelessness (PE) by whether they were assigned to PB-PSH (n = 272) or SS-PSH (n = 185) in Los Angeles County during the COVID-19 pandemic. This exploratory, observational study also included those who were approved but did not receive PSH (n = 94). Results show that there are notable differences between (a) those who received PSH versus those who did not, and (b) those in PB-PSH versus SS-PSH. Specifically, PEH who received PSH were more likely to be white, US-born, have any physical health condition, and have lower health activation scores. PEH who received PB- versus SS-PSH were more likely to be older, Black, have any alcohol use disorder, and have higher health activation scores. These findings suggest that homeless service systems may consider PB-PSH more appropriate for PEH with higher needs but also raises important questions about how race may be a factor in the type of PSH that PEH receive and whether PSH is received at all.

INTRODUCTION: Criminal convictions may be imperfect markers of criminalized behavior, in part because of criminal legal system processes (e.g., plea bargaining). In this retrospective cohort study of individuals convicted of misdemeanors, authors compared the risk of subsequent criminal charges for a violent crime among those initially charged with a felony with that among those initially charged with only misdemeanors, overall and by defendant race and ethnicity. METHODS: The study population included individuals aged ≥18 years who were convicted of a misdemeanor in Washington Superior Courts from January 1, 2015 to December 31, 2019. Those with and without initial felony charges were age/gender matched in a 4:1 ratio. The primary outcome was the first subsequent violent crime charge in Washington Superior Courts through December 31, 2020. Data were analyzed with Fine-Gray hazard models from June 2022 to November 2023. RESULTS: There were 3,841 individuals with initial felony charges and 956 with initial misdemeanor charges only. Median follow-up was 2.4 years for both groups. During follow-up, there were 166 new violent crime charges. In multivariable models, White defendants with initial felony charges had a greater risk of subsequent violent crime charges (subdistribution hazard ratio=2.58; 95% CI=1.24, 5.36) than White defendants with initial misdemeanor charges only. Among Black and Hispanic/Latinx defendants, initial felony versus misdemeanor charges were not associated with subsequent violent crime charges (subdistribution hazard ratio=0.93; 95% CI=0.44, 1.97 among Black defendants; subdistribution hazard ratio=0.49; 95% CI=0.15, 1.57 among Hispanic/Latinx defendants). CONCLUSIONS: Findings suggest differential associations between downgrading of felony charges to misdemeanor convictions and future violent crime charges by defendant race and ethnicity, with implications for inequitable collateral consequences of criminal convictions.

PurposeWe investigated racial disparities in survival by histology in cervical cancer and examined the factors contributing to these disparities.MethodsNon-Hispanic Black and non-Hispanic White (hereafter known as Black and White) patients with stage I-IV cervical carcinoma diagnosed between 2004 and 2017 in the National Cancer Database were studied. Survival differences were compared using Cox modeling to estimate hazard ratio (HR) or adjusted HR (AHR) and 95% confidence interval (CI). The contribution of demographic, socioeconomic and clinical factors to the Black vs White differences in survival was estimated after applying propensity score weighting in patients with squamous cell carcinoma (SCC) or adenocarcinoma (AC).ResultsThis study included 10,111 Black and 43,252 White patients with cervical cancer. Black patients had worse survival than White cervical cancer patients (HR = 1.40, 95% CI = 1.35-1.45). Survival disparities between Black and White patients varied significantly by histology (HR = 1.20, 95% CI = 1.15-1.24 for SCC; HR = 2.32, 95% CI = 2.12-2.54 for AC, interaction p

Many educators in California are unaware of just how harmful out of school suspensions can be. When suspended students are barred from attending school, more often than not, the rule broken was some form of minor misconduct. This update of "Lost Instruction Time in California Schools" demonstrates that despite the important efforts by the state of California to reduce suspensions, those efforts are seriously insufficient.

BackgroundDeep-rooted racial residential segregation and housing discrimination have given rise to housing disparities among low-income Black young adults in the US. Most studies have focused on single dimensions of housing instability, and thus provide a partial view of how Black young adults experience multiple, and perhaps overlapping, experiences of housing instability including homelessness, frequent moves, unaffordability, or evictions. We aimed to illuminate the multiple forms of housing instability that Black young adults contend with and examine relationships between housing instability and mental health outcomes.MethodsUsing baseline data from the Black Economic Equity Movement (BEEM) guaranteed income trial with 300 urban low-income Black young adults (aged 18-24), we conducted a three-stage latent class analysis using nine housing instability indicators. We identified distinct patterns by using fit indices and theory to determine the optimal number of latent classes. We then used multinomial logistic regression to identify subpopulations disproportionately represented within unstable housing patterns. Finally, we estimated associations between housing experience patterns and mental health outcomes: depression, anxiety, and hope.ResultsWe found high prevalence of housing instability with 27.3% of participants reporting experiences of homelessness in the prior year and 39.0% of participants reporting multiple measures of housing instability. We found the 4-class solution to be the best fitting model for the data based on fit indices and theory. Latent classes were characterized as four housing experience patterns: 1) more stably housed, 2) unaffordable and overcrowded housing, 3) mainly unhoused, and 4) multiple dimensions of housing instability. Those experiencing unaffordable and overcrowded housing and being mainly unhoused were more than four times as likely to have symptoms of depression (Unaffordable: aOR = 4.57, 95% CI: 1.64, 12.72; Unhoused: aOR = 4.67, 95% CI:1.18, 18.48) and more than twice as likely to report anxiety (Unaffordable: aOR = 2.28, 95% CI: 1.03, 5.04; Unhoused: aOR = 3.36, 95% CI: 1.12, 10.05) compared to the more stably housed pattern. We found that hope scores were similarly high across patterns.ConclusionsHigh prevalence of housing instability and mental health challenges among low-income Black young adults demands tailored interventions to reduce instability, given widening racial disparities and implications for future well-being into adulthood.

BACKGROUND: Black-White racial disparities in cancer mortality are well-documented in the US. Given the estimated shortage of oncologists over the next decade, understanding how access to oncology care might influence cancer disparities is of considerable importance. We aim to examine the association between oncology provider density in a county and Black-White cancer mortality disparities. METHODS: An ecological study of 1048 US counties was performed. Oncology provider density was estimated using the 2013 National Plan and Provider Enumeration System data. Black:White cancer mortality ratio was calculated using 2014-2018 age-standardized cancer mortality rates from State Cancer Profiles. Linear regression with covariate adjustment was constructed to assess the association of provider density with (1) Black:White cancer mortality ratio, and (2) cancer mortality rates overall, and separately among Black and White persons. RESULTS: The mean Black:White cancer mortality ratio was 1.12, indicating that cancer mortality rate among Black persons was on average 12% higher than that among White persons. Oncology provider density was significantly associated with greater cancer mortality disparities: every 5 additional oncology providers per 100 000 in a county was associated with a .02 increase in the Black:White cancer mortality ratio (95% CI: .007 to .03); however, the unexpected finding may be explained by further analysis showing that the relationship between oncology provider density and cancer mortality was different by race group. Every 5 additional oncologists per 100 000 was associated with a 1.6 decrease per 100 000 in cancer mortality rates among White persons (95% CI: -3.0 to -.2), whereas oncology provider density was not associated with cancer mortality among Black persons. CONCLUSION: Greater oncology provider density was associated with significantly lower cancer mortality among White persons, but not among Black persons. Higher oncology provider density alone may not resolve cancer mortality disparities, thus attention to ensuring equitable care is critical.

OBJECTIVE: We sought to examine trends in diagnosed behavioral health (BH) conditions [mental health (MH) disorders or substance use disorders (SUD)] among pregnant and postpartum individuals between 2008-2020. We then explored the relationship between BH conditions and race/ethnicity, acknowledging race/ethnicity as a social construct that influences health disparities. METHODS: This study included delivering individuals, aged 15-44 years, and continuously enrolled in a single commercial health insurance plan for 1 year before and 1 year following delivery between 2008-2020. We used BH conditions as our outcome based on relevant ICD 9/10 codes documented during pregnancy or the postpartum year. RESULTS: In adjusted analyses, white individuals experienced the highest rates of BH conditions, followed by Black, Hispanic, and Asian individuals, respectively. Asian individuals had the largest increase in BH rates, increasing 292%. White individuals had the smallest increase of 192%. The trend remained unchanged even after adjusting for age and Bateman comorbidity score, the trend remained unchanged. CONCLUSIONS: The prevalence of diagnosed BH conditions among individuals in the perinatal and postpartum periods increased over time. As national efforts continue to work toward improving perinatal BH, solutions must incorporate the needs of diverse populations to avert preventable morbidity and mortality.

Cognitive impairment and decreased executing functioning represent common symptoms of both ADHD and pregnancy. This study aimed to characterize temporal trends and racial/ethnic disparities in ADHD diagnosis during the perinatal period. In this serial cross-sectional study, we used administrative claims to create a cohort of commercially insured women with a documented live birth between 2008 and 2020 and identified those with an ADHD diagnosis in the year before or after delivery. We applied logistic regression to assess the probability of ADHD diagnosis adjusting for race/ethnicity, age, and comorbid conditions. We used this model to calculate the predicted probability of ADHD diagnosis by racial/ethnic group for each year. We identified 736,325 deliveries from 2008 to 2020. Overall, 16,801 (2.28 %) of deliveries had an ADHD diagnosis in the year before or after delivery. ADHD rates increased 290 % from 101 (95%CI: 92–111) per 10,000 deliveries in 2008 to 394 (95%CI: 371–419) per 10,000 deliveries in 2020. White women experienced the highest rates followed by Black, Hispanic, and Asian, respectively. Increasing ADHD diagnosis rates during the perinatal period may reflect improved detection but racial disparities persist. Additional research is needed to develop equitable outreach strategies to better support women experiencing ADHD during the perinatal period. • Deficits in cognition and executing functioning are common complaints of pregnancy. • ADHD diagnoses among delivering women increased 290 % between 2008 and 2020. • Women of color were less likely to have a perinatal ADHD diagnosis than white women. • Increasing diagnosis may reflect improved detection but racial disparities persist. [ABSTRACT FROM AUTHOR]

Ovarian cancer has poor 5-year survival, particularly among non-Hispanic (NH) Black patients. Efforts to identify patients at high-risk of functional limitations and frailty may improve outcomes. In this study, we examined how healthcare access (HCA) and race/ethnicity relate to frailty among patients with ovarian cancer. We identified Hispanic, NH Black, and NH White patients diagnosed at ages ≥6 5 years with ovarian cancer between 2009 and 2015 using SEER-Medicare. Log-binomial regression was used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for the association between HCA and race/ethnicity with pre- or post-diagnosis frailty, adjusting for age and comorbidities. A total of 6041 patients with ovarian cancer were included, including 91.8% NH White, 6.6% NH Black, and 1.7% Hispanic. Pre-diagnosis, 14.7% of patients were defined as frail (NH White: 14.3%; NH Black: 17.9%; Hispanic: 20.8%). Post-diagnosis, frailty prevalence increased to 58.8% (NH White: 58.2%; NH Black: 65.2%; Hispanic: 70.2%). No statistically significant associations were observed between race/ethnicity and pre- or post-diagnosis frailty in fully adjusted models. After adjustment for patient characteristics and healthcare accessibility and availability, higher healthcare affordability was associated with a decreased prevalence of pre-diagnosis frailty (PR: 0.91, 95% CI: 0.8 5, 0.98). Patients with ovarian cancer have a high prevalence of frailty after diagnosis, particularly NH Black and Hispanic patients. Improving healthcare affordability may prevent or help manage frailty in Medicare patients, improve receipt of cancer treatment, and increase cancer survival. • This study examined how healthcare access and race/ethnicity are related to frailty in ovarian cancer patients. • Prior to diagnosis, about 15% of patients were defined as frail, which increased to nearly 60% in the year after diagnosis. • Higher healthcare affordability was associated with a reduced prevalence of frailty prior to diagnosis. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic exacerbated health disparities among immigrant communities. Delivering accurate information and addressing misinformation on protective measures and vaccination to linguistically disadvantaged groups was critical for mitigating the effects of the pandemic. One group that was especially vulnerable to miscommunication about COVID-19 was non–native English-speaking immigrants. To address these disparities, the Asian American Studies Center and the Fielding School of Public Health at the University of California, Los Angeles, partnered to create a multilingual resource hub, TranslateCovid.org, to disseminate credible and reliable information about COVID-19 safety measures, the science behind the vaccines, and vaccine safety. We identified >1300 verified resources in 60 languages from government, academic, and nonprofit organizations and reposted them on the TranslateCovid website. We also developed public service announcement videos on handwashing, use of face masks, and social distancing in 10 languages and a fact sheet for frequently asked questions in 20 languages. We used a participatory approach to develop strategies for disseminating these resources. We discuss lessons learned, including strategies for forming government, community, and academic partnerships to support the timely development and dissemination of information. We conclude with a discussion on the unique role of universities in promoting equitable access to public health resources among immigrant communities in times of crisis. [ABSTRACT FROM AUTHOR]

Youth interpersonal firearm violence disproportionately affects Black youth, with residential racial segregation as a key determinant. Racially segregated neighborhoods, which are economically isolated (e.g., neighborhood disadvantage), are linked to increased exposure to violence. This exposure, in turn, is a determinant of youth firearm aggression (i.e., using a gun on someone else). Mechanisms from residential racial segregation to firearm aggression, however, have not been evaluated. Therefore, we tested neighborhood disadvantage and exposure to violence as mediators in the association between residential racial segregation and youth firearm aggression. Participants were 338 Black youth who had used drugs in the past 6 months and sought care in an urban emergency department. Using serial mediation analysis, residential racial segregation was indirectly associated with youth firearm aggression via neighborhood disadvantage and then exposure to violence. While researchers have documented the association between structural racism and firearm violence injury and incidents, our study assessed multiple socioecological mechanisms simultaneously. Identifying the downstream socioecological consequences of residential segregation can guide the development of firearm aggression prevention programs addressing the consequences of racism. [ABSTRACT FROM AUTHOR]

Introduction: Despite considerable national attention, racial disparities in surgical outcomes persist. We sought to consider whether race-based inequities in outcomes following major elective surgery have improved in the contemporary era. Methods: All adult hospitalization records for elective coronary artery bypass grafting, abdominal aortic aneurysm repair, colectomy, and hip replacement were tabulated from the 2016-2020 National Inpatient Sample. Patients were stratified by Black or White race. To consider the evolution in outcomes, we included an interaction term between race and year. We designated centers in the top quartile of annual procedural volume as high-volume hospitals (HVH). Results: Of -2,838,485 patients, 245,405 (8.6%) were of Black race. Following risk-adjustment, Black race was linked with similar odds of in-hospital mortality, but increased likelihood of major complications (Adjusted Odds Ratio [AOR] 1.41, 95%Confidence Interval [CI] 1.36-1.47). From 2016-2020, overall risk-adjusted rates of major complications declined (patients of White race: 9.2% to 8.4%; patients of Black race 11.8% to 10.8%, both P < .001). Yet, the delta in risk of adverse outcomes between patients of White and Black race did not significantly change. Of the cohort, 158,060 (8.4%) were treated at HVH. Following adjustment, Black race remained associated with greater odds of morbidity (AOR 1.37, CI 1.23-1.52; Ref:White). The race-based difference in risk of complications at HVH did not significantly change from 2016 to 2020. Conclusion: While overall rates of complications following major elective procedures declined from 2016 to 2020, patients of Black race faced persistently greater risk of adverse outcomes. Novel interventions are needed to address persistent racial disparities and ensure acceptable outcomes for all patients. [ABSTRACT FROM AUTHOR]

To investigate the association between race and route of hysterectomy among patients undergoing hysterectomy for abnormal uterine bleeding (AUB) in the absence of uterine myoma disease and excluding malignancy. A cross-sectional cohort study utilizing the Healthcare Cost and Utilization Project Nationwide Inpatient Sample and National Ambulatory Surgical databases to compare abdominal to minimally invasive routes of hysterectomy. Hospitals and hospital-affiliated ambulatory surgical centers participating in the Healthcare Cost and Utilization Project in 2019. A total of 75 838 patients who had undergone hysterectomy for AUB, excluding uterine myoma and malignancy. n/a Of the 75 838 hysterectomies performed for AUB in the absence of uterine myomas and malignancy, 10.1% were performed abdominally and 89.9% minimally invasively. After adjusting for confounders, Black patients were 38% more likely to undergo abdominal hysterectomy compared to White patients (OR 1.38, CI 1.12–1.70 p =.002). Black race, thus, is independently associated with open surgery. Despite excluding uterine myomas as a risk factor for an abdominal route of hysterectomy, Black race remained an independent predictor for abdominal versus minimally invasive hysterectomy, and Black patients were found to undergo a disproportionately higher rate of abdominal hysterectomy compared to White patients. [ABSTRACT FROM AUTHOR]

Management of lower extremity (LE) wounds has evolved with the establishment of specialized limb preservation services. Although clinical factors contribute to limb outcomes, socioeconomic status and community factors also influence the risk for limb loss. The Distressed Community Index (DCI) score is a validated index of social deprivation created to provide an objective measure of economic well-being in United States communities. Few studies have examined the influence of geographic deprivation on outcomes in patients with LE wounds. We examined relationships between socioeconomic deprivation and outcomes of inpatients evaluated by a dedicated limb preservation service (Functional Limb Extremity Service [FLEX]). Inpatients referred to FLEX over a 5-year period were included. Wound, Ischemia, foot Infection (WIfI) staging was collected. DCI scores were determined using seven indices based on ZIP Code. Outcomes included any minor or major amputations, any endovascular or open LE revascularization, or wound care procedures. Disease etiology, demographic, and anthropometric data were collected. Associations between neighborhood deprivation and limb-specific outcomes were evaluated in models for the DCI and each of its components separately. A total of 677 patients were included. Thirty-eight percent were female, with a mean age of 64 years. Sixty percent had WIfI stage 3 or 4 risk of amputation, and 43% had WIfI stage 3 or 4 risk of revascularization. Mean ankle-brachial index and toe pressure were 0.96 (standard deviation [SD], 0.43) and 80 (SD, 57) mmHg. Thirty-five percent were non-White. Amputation was performed in 31% of patients, whereas 17% underwent revascularization. The mean distress score was 64 (SD, 24). Mean DCI scores did not differ across WIfI scores. Likewise, overall DCI distress score was not related to any of the outcomes in univariable or multivariable linear regression models. In univariable linear regression models for amputation, higher poverty rate (odds ratio for SD increase 1.20; 95% confidence interval, 1.02-1.42; P =.025) was significantly associated with the outcome. In multivariable models, neither DCI distress score nor any of its components remained significantly associated with the outcome. Despite known racial disparities in limb-specific outcomes, an aggregate measure of community level distress was not found to be related to outcomes. Although the poverty rate demonstrated a significant relationship with amputation in univariable analysis, this association was not found in multivariable models. Notably, non-White race emerged as a predictor of amputation, underscoring the importance of addressing racial disparities in LE outcomes. Further investigation of potential determinants of LE outcomes is needed, particularly the interaction of such factors with race. [ABSTRACT FROM AUTHOR]

Purpose of Review: Gestational diabetes mellitus (GDM) is one of the most common pregnancy complications worldwide and the prevalence is continuously rising globally. Importantly, GDM is not an isolated complication of pregnancy. Growing evidence suggests that individuals with GDM, compared to those without GDM, have an increased risk of subsequent type 2 diabetes (T2D) and cardiovascular diseases (CVD). Substantial racial and ethnic disparities exist in the risk of GDM. However, the role of race and ethnicity in the progression from GDM to T2D and CVD remains unclear. The purpose of the current review is to summarize recent research about GDM and its life-course impacts on cardiometabolic health, including 1) the peak time of developing T2D and CVD risks after GDM, 2) the racial and ethnic disparities in the risk cardiometabolic diseases after GDM, 3) the biological plausibility and underlying mechanisms, and 4) recommendations for screening and prevention of cardiometabolic diseases among individuals with GDM, collectively to provide an updated review to guide future research. Recent Findings: Growing evidence has indicated that individuals with GDM had greater risks of T2D (7.4 to 9.6 times), hypertension (78% higher), and CDV events (74% higher) after GDM than their non-GDM counterparts. More recently, a few studies also suggested that GDM could slightly increase the risk of mortality. Available evidence suggests that key CVD risk factors such as blood pressure, plasma glucose, and lipids levels are all elevated as early as < 1 year postpartum in individuals with GDM. The risk of T2D and hypertension is likely to reach a peak between 3–6 years after the index pregnancy with GDM compared to normal glycemia pregnancy. Cumulative evidence also suggests that the risk of cardiometabolic diseases including T2D, hypertension, and CVD events after GDM varies by race and ethnicity. However, whether the risk is higher in certain racial and ethnic groups and whether the pattern may vary by the postpartum cardiometabolic outcome of interest remain unclear. The underlying mechanisms linking GDM and subsequent T2D and CVD are complex, often involving multiple pathways and their interactions, with the specific mechanisms varying by individuals of different racial and ethnic backgrounds. Diabetes and CVD risk screening among individuals with GDM should be initiated early during postpartum and continue, if possible, frequently. Unfortunately, adherence to postpartum glucose testing with either obstetrician or primary care providers remained poor among individuals with GDM. Summary: A life-course perspective may provide critical information to address clinical and public health gaps in postpartum screening and interventions for preventing T2D and CVD risks in individuals with GDM. Future research investigating the racial- and ethnic-specific risk of progression from GDM to cardiometabolic diseases and the role of multi-domain factors including lifestyle, biological, and socio-contextual factors are warranted to inform tailored and culture-appropriate interventions for high-risk subpopulations. Further, examining the barriers to postpartum glucose testing among individuals with GDM is crucial for the effective prevention of cardiometabolic diseases and for enhancing life-long health. [ABSTRACT FROM AUTHOR]

Introduction: Financial toxicity negatively affects clinical outcomes in breast cancer. Underrepresented demographics may be at higher risk for financial toxicity. We characterized disparities on the basis of age and other factors. Patients and Methods: Surveys completed by women with stage 0–IV breast cancer treated at Memorial Sloan Kettering Cancer Center between 06/2022 and 05/2023 were analyzed. The comprehensive score for financial toxicity (COST) scale was used to assess financial toxicity. Descriptive statistics were calculated for differences in financial toxicity/related factors, and outcomes by age and race. Associations between variables of interest and COST scores were analyzed using linear regression. Results: Of 8512 respondents (75% white, 9.3% Asian, 8.4% Black), most (68%) had clinical stage 0/I disease. Stratified by age, young Black women had higher financial toxicity than young white or Asian women (p < 0.001). On multivariable analysis, women age < 45 years experienced higher financial toxicity than older women (coefficient − 2.0, 95% CI − 2.8 to − 1.1, p < 0.001). Compared with white women, financial toxicity was greater among Black (coefficient − 6.8, 95% CI − 7.8 to − 5.8) and Asian women (coefficient − 3.5, 95% CI − 4.4 to − 2.5). Cost-related medication non-adherence was more frequent among Black and Asian women (p < 0.001). Asian women more often paid for treatment with savings than white and Black women (p < 0.001). Young women reported using savings for treatment-related costs more than older (45% vs. 32%); p < 0.001). Conclusions: Racial minorities and young patients are disproportionately affected by financial toxicity. Further studies are planned to determine how financial toxicity evolves over time and whether referral to financial services effectively reduces toxicity. [ABSTRACT FROM AUTHOR]

Background: Despite mandated insurance coverage since 2006 and robust health infrastructure in urban settings with high concentrations of minority patients, race‐based disparities in prostate cancer (PCa) treatment persist in Massachusetts. In this qualitative study, the authors sought to identify factors driving inequities in PCa treatment in Massachusetts. Methods: Four hospitals offering PCa treatment in Massachusetts were selected using a case‐mix approach. Purposive sampling was used to conduct semistructured interviews with hospital stakeholders. Additional interviews were conducted with representatives from grassroots organizations providing PCa education. Two study staff coded the interviews to identify major themes and recurrent patterns. Results: Of the 35 informants invited, 25 participated in the study. Although national disparities in PCa outcomes were readily discussed, one half of the informants were unaware that PCa disparities existed in Massachusetts. Informants and grassroots organization representatives acknowledged that patients with PCa are willing to face transportation barriers to receive treatment from trusted and accommodating institutions. Except for chief equity officers, most health care providers lacked knowledge on accessing or using metrics regarding racial disparities in cancer outcomes. Although community outreach was recognized as a potential strategy to reduce treatment disparities and engender trust, informants were often unable to provide a clear implementation plan. Conclusions: This statewide qualitative study builds on existing quantitative data on the nature and extent of disparities. It highlights knowledge gaps in recognizing and addressing racial disparities in PCa treatment in Massachusetts. Improved provider awareness, the use of disparity metrics, and strategic community engagement may ensure equitable access to PCa treatment. Plain Language Summary: Despite mandated insurance and urban health care access, racial disparities in prostate cancer treatment persist in Massachusetts.This qualitative study revealed that, although national disparities were acknowledged, awareness about local disparities are lacking.Stakeholders highlighted the importance of ancillary services, including translators, rideshares, and navigators, in the delivery of care.In addition, whereas hospital stakeholders were aware of collected equity outcomes, they were unsure whether and who is monitoring equity metrics.Furthermore, stakeholders agreed that community outreach showed promise in ensuring equitable access to prostate cancer treatment.Nevertheless, most interviewed stakeholders lacked clear implementation plans. To understand the drivers of racial disparities in prostate cancer treatment in Massachusetts, this statewide qualitative study was conducted through interviews with stakeholders at treating hospitals. Abstracted themes highlight the significance of provider awareness, the importance of overcoming transportation barriers, the accommodation of care through translators and navigators, and strategic community engagement for ensuring equitable access to care. [ABSTRACT FROM AUTHOR]

Background: Despite Medicare coverage, financial hardship is a prevalent issue among those diagnosed with cancer at age 65 years and older, particularly among those belonging to a racial or ethnic minority group. Sociodemographic, clinical, and area‐level factors may mediate this relationship; however, no studies have assessed the extent to which these factors contribute to the racial/ethnic disparities in financial hardship. Methods: Surveys assessing financial hardship were completed by 721 White (84%) or Black (16%) patients (aged 65 years and older) who were diagnosed with breast (34%), prostate (27%), lung (17%), or colorectal (14%) cancer or lymphoma (9%) at the University of Alabama at Birmingham between 2000 and 2019. Financial hardship included material, psychological, and behavioral domains. Nonlinear Blinder–Oaxaca effect decomposition methods were used to evaluate the extent to which individual and area‐level factors contribute to racial disparities in financial hardship. Results: Black patients reported lower income (65% vs. 34% earning <$50,000) and greater scores on the Area Deprivation Index (median, 93.0 vs. 55.0). Black patients reported significantly higher rates of overall (39% vs. 18%), material (29% vs. 11%), and psychological (27% vs. 11%) hardship compared with White patients. Overall, the observed characteristics explained 51% of racial differences in financial hardship among cancer survivors, primarily because of differences in income (23%) and area deprivation (11%). Conclusions: The current results identify primary contributors to racial disparities in financial hardship among older cancer survivors, which can be used to develop targeted interventions and allocate resources to those at greatest risk for financial hardship. Racial disparities in financial hardship among older cancer survivors are attributable to the downstream effects of structural racism. Interventions aimed at reducing the Black–White disparity in financial hardship should be targeted toward factors associated with historical racial discrimination. [ABSTRACT FROM AUTHOR]

Background: The National Health Interview Survey (NHIS) is a comprehensive health survey conducted by the National Center for Health Statistics (NCHS) in the U.S., providing valuable insights into the health status of the population. This study focuses on the NHIS child survey between 2019 and 2021, exploring developmental disabilities in U.S. children, including autism spectrum disorder (ASD), attention deficit/hyperactivity disorder or attention-deficit disorder (ADHD/ADD), intellectual disability (ID), other developmental delay (other DD), and learning disability (LD). Objective: Leveraging NHIS data, our primary objective is to investigate the latest trends and disparities in the prevalence of developmental disabilities among various racial-ethnic groups. Methods: Employing a repeated cross-sectional design, we analyzed NHIS data from 2019 to 2021, focusing on children aged 3-17. The survey employed a meticulous stratified multi-stage sampling design. We utilized SAS version 9.4 for data analysis, calculating race-ethnicity-specific prevalence rates and employing weighted linear regression and the Rao-Scott chi-square test for trend analysis. Results: Among 19,490 children, prevalence rates varied: ASD (3.11%), ADHD/ADD (9.50%), ID (1.85%), other DD (5.66%), and LD (7.49%). Non-Hispanic black children exhibited higher rates of ID and LD, while non-Hispanic white children had the highest ADHD/ADD prevalence. Disparities persisted across sociodemographic subgroups, with variations in prevalence rates. Conclusion: Our study reveals an increase in ASD prevalence and persistent disparities among racial-ethnic groups. Non-Hispanic black children face elevated risks of ID and LD, while non-Hispanic white children exhibit higher rates of ADHD/ADD. [ABSTRACT FROM AUTHOR]

The sociological literature on race operates under the progressive ideological assumption that systemic racism is the predominant cause of racial disparities. This assumption has become "paradigmatic," shaping the selection of research questions and the interpretation of research results. Consequently, the literature offers a rather narrow "Overton window" concerning what we, as sociologists, know about: (1) the causes of racial disparities, (2) the accuracy and motivation behind the public's views on race-related issues, and (3) race-related policy preferences. A paradigm shift is needed to improve our understanding of racial disparities and devise more effective ways to address them. To achieve this end, sociologists should broaden their perspectives beyond attributing all racial disparities to systemic racism and consider additional hypotheses. From a policy perspective, to reduce racial disparities we should reconsider addressing social class and related factors early in life. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic officially started in March 2020 and ended in May 2023. Preventive behaviors have been proven to be one of the most effective strategies for preventing COVID-19 transmission. Common preventive behaviors against COVID-19 include but are not limited to wearing a face mask, washing and sanitizing one's hands frequently, avoiding crowds, and avoiding traveling. Underserved communities and racial/ethnic minorities across the U.S. have been disproportionately affected by the COVID-19 pandemic. Using a three-wave longitudinal survey conducted from early 2021 to late 2022, the present study investigated changes in the adoption of COVID-19-preventive behaviors among residents living in Delaware's most underserved communities. We also examined whether changes in COVID-19-preventive behaviors differed by race. Our results indicated that fewer people adopted preventive behaviors as the pandemic progressed, and this finding is applicable to both Black people and White people. However, Black people had a consistently greater likelihood of adopting preventive behaviors compared to White people from early 2021 to late 2022. Scientific and policy implications are discussed. [ABSTRACT FROM AUTHOR]

Background: Heterogeneous Black populations encounter significant obstacles in accessing cancer care, yet research on lung cancer treatment disparities remains limited. This study investigates whether the disparity in receiving curative‐intent treatment (curative‐intent surgery and/or stereotactic body radiation therapy [SBRT]) for early‐stage non‐small cell lung cancer (NSCLC) between non‐Hispanic Whites (NHWs) and total Blacks extends to diverse Black populations, including US‐born, Afro‐Haitian, West Indian Black, and Hispanic Black individuals. Methods: This cross‐sectional study included all Florida cancer registry early‐stage NSCLC cases 2005–2017, linked to individual‐level discharge data containing comorbidity and specific treatment details (surgery and/or SBRT). Multivariable logistic regression assessed the association between race/ethnicity and the receipt of curative‐intent treatment, while accounting for sociodemographic factors (poverty, age, insurance, and smoking status) and clinical variables. Results: Among 55,655 early‐stage NSCLC patients, 71.1% received curative‐intent treatment: 72.1% NHW and 59.7% Black (non‐Hispanic and Hispanic) individuals. Black patients had 35% lower odds (ORadj, 0.65; 95% CI, 0.59–0.70) of receiving curative‐intent treatment compared to NHW patients. ORs varied from 0.57 (95% CI, 0.59–0.70) for Hispanic Black to 0.76 (95% CI, 0.56–1.02) for West Indian Black. Remarkably, Black‐White disparities persisted despite the availability of curative treatment options (SBRT) for both high Charlson Comorbidity Index (CCI) observed among US‐born Blacks and surgery for low CCI patients among all other Black subgroups. Conclusions: Pronounced disparities in accessing curative‐intent treatments for early‐stage NSCLC were evident across all Black subgroups, regardless of treatment availability and comorbidity profile. These findings underscore the need to address Black heterogeneity and prompt further research to rectify treatment disparities in early‐stage NSCLC. [ABSTRACT FROM AUTHOR]

Racial/ethnic disparities in the association between short-term (eg, days, weeks), ambient fine particulate matter (PM2.5) and temperature exposures and stillbirth in the United States have been understudied. A time-stratified, case-crossover design using a distributed lag nonlinear model (0- to 6-day lag) was used to estimate stillbirth odds due to short-term increases in average daily PM2.5 and temperature exposures among 118 632 Medicaid recipients from 2000 to 2014. Disparities by maternal race/ethnicity (Black, White, Hispanic, Asian, American Indian) and zip code–level socioeconomic status (SES) were assessed. In the temperature-adjusted model, a 10 μg m−3 increase in PM2.5 concentration was marginally associated with increased stillbirth odds at lag 1 (0.68%; 95% CI, −0.04% to 1.40%) and lag 2 (0.52%; 95% CI, −0.03 to 1.06) but not lag 0-6 (2.80%; 95% CI, −0.81 to 6.45). An association between daily PM2.5 concentrations and stillbirth odds was found among Black individuals at the cumulative lag (0-6 days: 9.26% 95% CI, 3.12%-15.77%) but not among other races or ethnicities. A stronger association between PM2.5 concentrations and stillbirth odds existed among Black individuals living in zip codes with the lowest median household income (lag 0-6: 14.13%; 95% CI, 4.64%-25.79%). Short-term temperature increases were not associated with stillbirth risk among any race/ethnicity. Black Medicaid enrollees, and especially those living in lower SES areas, may be more vulnerable to stillbirth due to short-term increases in PM2.5 exposure. This article is part of a Special Collection on Environmental Epidemiology. [ABSTRACT FROM AUTHOR]

Introduction: Racial and ethnic disparities remain a major problem in orthopedic surgery, driving inequitable resource distribution, disparate clinical outcomes, and increased healthcare costs. The objective of this study was to investigate potential racial/ethnic disparities in the incidence and injury patterns of orthopedic lower extremity trauma (LET) in the United States over the past 10 years, as well as differences in final disposition outcomes. Materials and Methods: The National Electronic Injury Surveillance System database was queried for all orthopedic LET presenting to U.S. emergency departments from 2010 to 2020. Incidence rate ratios (IRR) were used to compare incidence rates between racial/ethnic groups. Multivariate logistic regression was performed to compare disposition outcomes. Results: Black/African Americans (Black/AAs) consistently experienced the highest incidence of LET over the 10-year period analyzed (709.108 per 100,000 person-years), followed by Whites (547.159 per 100,000 person-years). Furthermore, Black/AAs had the highest incidence of polytrauma (114.19 per 100,000 person-years), over 1.7x greater than Whites (IRR: 1.73 [95% confidence interval (CI): 1.72–1.75]). Black/AAs had over 2-fold higher odds of death after LET compared to Whites (adjusted odds ratio [aOR] 2.15 [95% CI: 1.78–2.59]). By 2019 to 2020, the incidence of deaths among Black/AAs reached more than triple that of Whites (IRR: 3.50 [95% CI: 2.74–4.46]). Black/AAs were also the most likely to be discharged against medical advice (AMA) (aOR: 1.94 [95% CI: 1.92–1.96]), and the least likely to be admitted as inpatients (aOR: 0.683 [95% CI: 0.679–0.688]). Conclusions: Despite Black/AAs experiencing a disproportionately higher incidence of LET and over 2-fold greater odds of death compared to Whites, they were also the most likely to be discharged AMA and least likely to be admitted as inpatients. Understanding the effects of conscious/unconscious biases and the importance of effective communication and patient education may help physicians ensure that injuries in this patient population are not prematurely discharged, potentially improving clinical outcomes, and reducing mortality. Level of Evidence: III. [ABSTRACT FROM AUTHOR]

Introduction/Aims: Given the importance of early diagnosis and treatment of myasthenia gravis (MG), it is critical to understand disparities in MG care. We aimed to determine if there are any differences in testing, treatment, and/or access to neurologists for patients of varying sex and race/ethnicity with MG. Methods: We used a nationally representative healthcare claims database of privately insured individuals (2001–2018) to identify incident cases of MG using a validated definition. Diagnostic testing, steroid‐sparing agents, intravenous immunoglobulin (IVIG), plasma exchange (PLEX), and thymectomy were defined using drug names or CPT codes. Steroid use was defined using AHFS class codes. We also determined whether an individual had a visit to a neurologist and the time between primary care and neurologist visits. Logistic regression determined associations between sex and race/ethnicity and testing, treatments, and access to neurologists. Results: Female patients were less likely to get a computed tomography (CT) chest (odds ratio (OR) 0.73, 95% confidence interval (CI): 0.64–0.83), receive steroids (OR: 0.85, 95% CI: 0.75–0.97), steroid‐sparing agents (OR: 0.84, 95% CI: 0.72–0.97), and IVIG or PLEX (OR: 0.80, 95% CI: 0.67–0.95). Black patients were less likely to receive steroids (OR: 0.78, 95% CI: 0.63–0.96). No significant disparities were seen in access to neurologists. Discussion: We found healthcare disparities in MG treatment with female and Black patients receiving less treatment than men and those of other races/ethnicities. Further research and detailed assessments accounting for individual patient factors are needed to confirm these apparent disparities. [ABSTRACT FROM AUTHOR]

Diffuse large B‐cell Lymphoma (DLBCL) is an aggressive subtype of non‐Hodgkin lymphoma (NHL). The disease generally occurs in older patients. Although at a lower prevalence, the disease also occurs in the adolescent and young adult group (AYA). There is paucity of data in the literature on racial and ethnic disparities in the incidence and survival outcomes of DLBCL in the AYA group. The objective of our study is to demonstrate the disparities in these outcomes. Utilizing SEER, we obtained data on patient demographics, incidence, and survival from 2000 to 2020. We observed statistically significant reduced incidence of DLBCL in all racial groups, except the non‐Hispanic Asian and Pacific Islander group (NHAPI). The non‐Hispanic Black group (NHB) had one of the lowest survival despite showing the largest decrease in incidence in DLBCL. The differences in the survival could be secondary to socioeconomic factors, however other reasons need to be explored. The increased incidence among the NHAPI group mirrors that of large population‐based studies in East Asian countries, however, underlying reasons have not been elucidated. [ABSTRACT FROM AUTHOR]

Background: It is unknown whether 5‐year overall survival (OS) differs and to what extent between the American Joint Committee on Cancer stage III non‐seminoma testicular germ cell tumor (NS‐TGCT) patients and simulated age‐matched male population‐based controls, according to race/ethnicity groups. Methods: We identified newly diagnosed (2004–2014) stage III NS‐TGCT patients within the Surveillance Epidemiology and End Results database 2004–2019. For each case, we simulated an age‐matched male control (Monte Carlo simulation), relying on Social Security Administration (SSA) Life Tables with 5 years of follow‐up. We compared OS rates between stage III NS‐TGCT patients and simulated age‐matched male population‐based controls, according to race/ethnicity groups (Caucasian, Hispanic, Asian/Pacific Islander and African American). Both, cancer‐specific mortality (CSM) and other‐cause mortality (OCM) were computed. Results: Of 2054 stage III NS‐TGCT patients, 60% were Caucasians versus 33% Hispanics versus 4% Asians/Pacific Islanders versus 3% African Americans. The 5‐year OS difference between stage III NS‐TGCT patients versus simulated age‐matched male population‐based controls was highest in Asians/Pacific Islanders (64 vs. 99%, Δ = 35%), followed by African Americans (66 vs. 97%, Δ = 31%), Hispanics (72 vs. 99%, Δ = 27%), and Caucasians (76 vs. 98%, Δ = 22%). The 5‐year CSM rate was highest in Asians/Pacific Islanders (32%), followed by African Americans (26%), Hispanics (25%), and Caucasians (20%). The 5‐year OCM rate was highest in African Americans (8%), followed by Caucasians (4%), Asians/Pacific Islanders (4%), and Hispanics (2%). Conclusion: Relative to SSA Life Tables, the highest 5‐year OS disadvantage applied to stage III NS‐TGCT Asian/Pacific Islander race/ethnicity group, followed by African American, Hispanic and Caucasian, in that order. [ABSTRACT FROM AUTHOR]

Objective While there are known racial disparities in cesarean delivery (CD) rates, the exact etiologies for these disparities are multifaceted. We aimed to determine if differences in induction of labor (IOL) management contribute to these disparities. Study Design This retrospective cohort study evaluated all nulliparous patients with an unfavorable cervix and intact membranes who underwent IOL of a term, singleton gestation at a single institution from October 1, 2018, to September 30, 2020. IOL management was at clinician discretion. Patients were classified as Black, Indigenous, and People of Color (BIPOC) or White based on self-report. Overall rates of CD were compared for BIPOC versus White race. Chart review then evaluated various IOL management strategies as possible contributors to differences in CD by race. Results Of 1,261 eligible patients, 915 (72.6%) identified as BIPOC and 346 (27.4%) as White. BIPOC patients were more likely to be younger (26 years interquartile range (IQR): [22–30] vs. 32 years IQR: [30–35], p < 0.001) and publicly insured (59.1 vs. 9.9%, p < 0.001). Indication for IOL and modified Bishop score also differed by race (p < 0.001; p = 0.006). There was 40% increased risk of CD for BIPOC patients, even when controlling for confounders (30.7 vs. 21.7%, p = 0.001; adjusted relative risk (aRR) = 1.41, 95% confidence interval (CI): [1.06–1.86]). Despite this difference in CD, there were no identifiable differences in IOL management prior to decision for CD by race. Specifically, there were no differences in choice of cervical ripening agent, cervical dilation at or time to amniotomy, use and maximum dose of oxytocin, or dilation at CD. However, BIPOC patients were more likely to undergo CD for fetal indications and failed IOL. Conclusion BIPOC nulliparas are 40% more likely to undergo CD during IOL than White patients within our institution. These data suggest that the disparity is not explained by differences in IOL management prior to cesarean, indicating that biases outside of induction management may be important to target to reduce CD disparities. Key Points The etiologies for racial disparities in cesarean are likely multifaceted. In this work, there were no differences by race in measures of labor induction management. Biases outside of induction management during labor may be targeted to reduce CD disparities. [ABSTRACT FROM AUTHOR]

Improving postsecondary educational attainment has been prioritized as a national imperative by policymakers, foundations, and advocacy groups with the goal of significantly increasing the share of college graduates. To achieve this imperative, individual states have developed college-level attainment policies and plans to reach target milestones by years 2025, 2030, and beyond. Although states have taken on the challenge of college completion, there has been little attention placed on the racial disparities that exist in attainment and the ways they are potentially addressed through these efforts. Of all racial and ethnic groups, the Latinx community faces the lowest attainment rate in 34 of 50 states. Knowing these wide disparities exist, we studied state-level attainment plans and the discourse around addressing Latinx disparities. Using critical policy analysis, we found little evidence that attainment plans acknowledge or address racial disparities in general or the glaring gaps for the Latinx community specifically. Our findings reveal that the primary discourse around improving attainment is an economic one, focused on improving rates to sustain and achieve workforce demands. Across attainment plans, we found three patterns of discourse—deficit-oriented, race-evasive, or race-conscious—that attempt to acknowledge inequities and take action to improve rates for the Latinx community. Our findings suggest that without explicit language in attainment efforts, racial inequities will persist and the goals of improved attainment cannot be achieved. [ABSTRACT FROM AUTHOR]

Purpose of Review: Prostate cancer (PCa) represents a significant health burden globally, ranking as the most diagnosed cancer among men and a leading cause of cancer-related mortality. Conventional treatment methods such as radiation therapy or radical prostatectomy have significant side effects which often impact quality of life. As our understanding of the natural history and progression of PCa has evolved, so has the evolution of management options. Recent Findings: Active surveillance (AS) has become an increasingly favored approach to the management of very low, low, and properly selected favorable intermediate risk PCa. AS permits ongoing observation and postpones intervention until definitive treatment is required. There are, however, challenges with selecting patients for AS, which further emphasizes the need for more precise tools to better risk stratify patients and choose candidates more accurately. Tissue-based biomarkers, such as ProMark, Prolaris, GPS (formerly Oncotype DX), and Decipher, are valuable because they improve the accuracy of patient selection for AS and offer important information on the prognosis and severity of disease. By enabling patients to be categorized according to their risk profiles, these biomarkers help physicians and patients make better informed treatment choices and lower the possibility of overtreatment. Even with their potential, further standardization and validation of these biomarkers is required to guarantee their broad clinical utility. Summary: Active surveillance has emerged as a preferred strategy for managing low-risk prostate cancer, and tissue-based biomarkers play a crucial role in refining patient selection and risk stratification. Standardization and validation of these biomarkers are essential to ensure their widespread clinical use and optimize patient outcomes. [ABSTRACT FROM AUTHOR]

Objectives: Guided by a life course perspective and fundamental cause theory, this study aims to visualize co-trajectories of health between partners and examine how changes in one spouse's cognitive status can cohesively impact the health of the other spouse along three dimensions (functional, mental, and cognitive). Methods: Drawing longitudinal data from the Health and Retirement Study 2000–2016 (N = 3582), we measure women's health profiles by functional limitation (physical health), depression (mental health), and cognitive function (cognitive health). We use multivariate linear mixed models to summarize these paths in the same visual representation. Results: The approach provides a visualization tool that depicts data and model in the same spatial representation allowing assessment of model fit and comparison. This study advances the traditional life course studies by representing underlying processes as a multidimensional time vector of health outcomes. Discussion: The described approach provides a blueprint for studying complex health profiles or trajectories. [ABSTRACT FROM AUTHOR]

AbstractMost older adults aspire to age in their homes and communities; they often face challenges due to functional limitations. The demand for home and community-based services (HCBS) has steadily increased to address these challenges. This scoping review explores the relationship between HCBS and the health outcomes of older adults. A total of 11,317 peer-reviewed articles published between January 1, 2005, and August 1, 2023, were identified from major electronic databases, with 12 articles selected for the final sample. The findings indicate that HCBS are consistently associated with better health outcomes, including improvements in physical and mental health and reduced hospitalizations. However, Black and Asian older adults reported lower accessibility to HCBS and poorer self-rated health compared to their White counterparts. Additionally, low density and lack of HCBS in neighborhoods were linked to poorer health outcomes among older adults. Policymakers should prioritize improving HCBS accessibility in neighborhoods, consider the demographic characteristics of older adults, and address their diverse needs to tailor HCBS effectively. [ABSTRACT FROM AUTHOR]

Health disparities are ongoing challenges in the United States, with one of the underlying factors being the variation in health risk behaviors across different socioeconomic and demographic communities. In this cross-sectional ecological study, utilizing data from 26,781 US zip codes provided by the Centers for Disease Control and Prevention (CDC), we conducted generalized linear model regressions to explore the associations between race, poverty, education, and urban/rural status in areas. Our analysis indicated that areas with a higher prevalence of Black population and higher poverty levels are associated with a more significant number of unique health risk behaviors. Conversely, other racial groups were associated with fewer unique health risk behaviors, although they may still engage in higher levels of specific behaviors. These insights underscore the need for tailored public health strategies to address the disparities in health risk behaviors across different sub-populations. Additionally, we employed Finite Mixture Modeling (FMM) to identify distinct sub-populations in the United States based on health risk behaviors, specifically binge drinking, smoking, sleep deprivation, and physical inactivity, which are essential risk factors for chronic diseases such as cancer, diabetes, and cardiovascular diseases. We identified four clusters and conducted an in-depth analysis of the demographics and socioeconomic characteristics of the identified clusters. Our findings reveal that one cluster, characterized by the worst health risk behaviors, exhibited the highest poverty rate, the least favorable health insurance profile, and the lowest frequencies of post-secondary education attainment compared to the other three clusters. This cluster, therefore, warrants targeted public health interventions. [ABSTRACT FROM AUTHOR]

As adiposity increases in youth, so does the prevalence of cardiometabolic risk factors (CMRFs). The etiology of adiposity-based chronic disease and CMRFs includes ethnoracial disparities that are rarely considered in current treatment approaches. Precision interventions require further characterization of these disparities among high-risk youth. The objective of this study was to characterize differences in CMRF among African American (AA) and Hispanic (H) adolescents with varying levels of adiposity. A cross-sectional analysis of 2284 adolescents aged 12–17 was conducted using 3-year clinical data from Lifedoc Health. CMRF prevalence were compared using χ2, with logistic regression models (LRM) applied to explore the relationships between exposures (age, sex, ethnoracial group, adiposity) and CMRF outcomes. Prevalence of CMRF rose with increasing adiposity, which was the strongest determinant of risk overall. However, individual risk profiles differed between the two groups, with H having higher prevalence of metabolic syndrome (MetS), higher triglycerides and liver enzymes, and low high-density lipoprotein cholesterol (HDL-c). Meanwhile, AA had higher prevalence of elevated blood pressure (BP) in the overweight category, prediabetes in overweight to severe obesity, and type 2 diabetes in obesity. LRM showed 3.0-fold greater chance of impaired glucose metabolism in AA than H, who were 1.7, 5.9, and 8.3 times more likely to have low HDL-c, high liver enzymes, and high triglycerides, respectively. Overweight/obesity prevalence was very high among AA and H adolescents. Excess adiposity was associated with an increased prevalence of CMRF, with individual risk factors differing between groups as adiposity increased. Research within routine clinical settings is required to better characterize these discrepancies and ameliorate their adverse impact on health in the transition to adulthood. [ABSTRACT FROM AUTHOR]

Aim Design, setting and participants Measurements Findings Conclusion This study: (1) estimated the effect of early discontinuation of medication for opioid use disorder (MOUD) on overdose probability and (2) measured the relationship between patient characteristics and early discontinuation probability for each MOUD type.This was a retrospective cohort using electronic health record data from the US Veterans Healthcare Administration. Participants were veterans initiating MOUD with buprenorphine (BUP), methadone (MET) or extended‐release naltrexone (XR‐NTX) from fiscal years 2012–19. A total of 39 284 veterans met eligibility with 22 721 (57.8%) initiating BUP, 12 652 (32.2%) initiating MET and 3911 (10.0%) initiating XR‐NTX.Measurements (1) determined whether the veteran experienced an overdose in the 365 days after MOUD initiation (primary) and (2) early discontinuation of MOUD, defined as discontinuation before 180 days (secondary). We assumed that unobserved patient characteristics would jointly influence the probability of discontinuation and overdose. and estimated the joint distribution with a bivariate probit model.We found that 9.0% of BUP initiators who experienced an overdose above the predicted 3.9% had no veteran‐discontinued BUP early; findings for XR‐NTX were similar, with 12.2% of initiators overdosing above the predicted 4.5%, but this was statistically inconclusive. We found no relationship between early discontinuation and overdose for MET initiators, probably due to the high risk of both events. The patient characteristics included in our post‐estimation exploratory analysis of early discontinuation varied by MOUD type, with between 14 (XR‐NTX) and 25 (BUP) tested. The only characteristics with at least one level showing a statistically significant change in probability of early discontinuation for all three MOUD types were geography and prior‐year exposure to psychotherapy, although direction and magnitude varied.Early discontinuation of buprenorphine, and probably extended‐release naltrexone, appears to be associated with a greater probability of experiencing a fatal or non‐fatal overdose among US veterans receiving medication for opioid use disorder (MOUD); methadone does not show the same association. There is no consistent set of characteristics among early discontinuers by MOUD type. [ABSTRACT FROM AUTHOR]

Racial and ethnic disparities in emergency general surgery (EGS) patients have been well described in the literature. Nonetheless, the burden of these disparities, specifically within the more vulnerable older adult population, is relatively unknown. This study aims to investigate racial and ethnic disparities in clinical outcomes among older adult patients undergoing EGS. This retrospective analysis used data from 2013 to 2019 American College of Surgeons National Surgery Quality Improvement Program database. EGS patients aged 65 y or older were included. Patients were categorized based on their self-reported race and ethnicity. The primary outcomes evaluated were in-hospital mortality, 30-d mortality, and overall morbidity. Multivariable logistic regression was performed to examine the relationship between race/ethnicity and postoperative outcomes while adjusting for relevant factors including age, comorbidities, functional status, preoperative conditions, and surgical procedure. A total of 54,132 patients were included, of whom 79.8% identified as non-Hispanic White, 9.5% as non-Hispanic Black (NHB), 5.8% as Hispanic, and 4.2% as non-Hispanic Asian. After risk adjustment, compared to non-Hispanic White patients, NHB, non-Hispanic Asian, and Hispanic patients had decreased odds of 30-d mortality. For 30-d readmission and reoperation, differences among groups were comparable. However, NHB patients had significantly increased odds of overall morbidity (adjusted odds ratio, 1.18; 95% confidence interval: 1.10-1.26; P < 0.001) and postoperative complications including sepsis, venous thromboembolism, and unplanned intubation. Hispanic ethnicity was associated with lower odds of postoperative myocardial infarction and stroke. Among older adult patients undergoing emergency general surgery, minority patients experienced higher morbidity rates, but paradoxical disparities in mortality were detected. Further research is necessary to identify the cause of these disparities and develop targeted interventions to eliminate them. [ABSTRACT FROM AUTHOR]

Currently, there is no mandatory standard for reporting race and ethnicity in medical journals, presenting significant barriers to studying disparities in medical outcomes. We seek to investigate whether greater recent awareness of diversity and inclusion reflects in reporting of race and ethnicity by peer-reviewed cardiothoracic articles. Pubmed was queried for clinical outcomes articles published from January 2017 to June 2023 in the Journal of Thoracic and Cardiovascular Surgery, Annals of Thoracic Surgery, Journal of Heart and Lung Transplantation, and CHEST Journal. Basic science, translational studies, and international studies were excluded. SAS Studio was used for statistical analysis. 817 papers were reviewed, 378 reported race/ethnicity with 354 (93%) reporting White, 267 (71%) reporting Black, 128 (34%) reporting Hispanic, and 119 (31%) reporting Asian. Over 8-y, there were no statistically significant changes in percent of articles that included White (odds ratio 0.808 95% confidence interval [0.624-1.047], P = 0.1068), Black (1.125 [0.984-1.288], P = 0.0857), or Asian (1.096 [0.960-1.250], P = 0.1751) groups. Hispanics were more likely to be reported in recent years (1.147 [1.006-1.307], P = 0.0397). Subset analysis was performed on cardiac (n = 157) and thoracic articles (n = 157) with no significant trends for race reporting in these subsets. Minorities remain underrepresented in reported patient populations in peer-reviewed cardiothoracic journals. Future efforts should prioritize accurately representing these populations in the literature. Inaccurate data and exclusion of minority populations can contribute to disparities observed in overall outcomes. [ABSTRACT FROM AUTHOR]

Background: Throughout the COVID-19 pandemic, the practice of preventative health behaviours had been used disparately across different racial groups. This study seeks to identify any differences in preventative health behaviours across racial groups, controlling for other socio-demographic factors. Methods: A US national survey study was electronically conducted from July through November 2020, to measure racial/ethnic differences in health preventive behaviours about COVID-19. We performed 2-part regression models to assess whether preventive health behaviours differed by race and ethnicity. Specifically, we employed generalized logistic regressions for investigating the predictors of the use of complementary or alternative medicine (CAM), or stay-at-home strategy, then performed ordinal logistic regression to examine the predictors of social distancing, face mask wearing, and hand hygiene strategy practice. Results: The results show that non-White respondents were more likely to practice social distancing, mask wearing, and hand hygiene strategy to prevent COVID-19, compared to their White counterparts. Additionally, the findings indicate that individuals who experienced COVID-19-related racial abuse or depression had a higher likelihood of practicing preventive health behaviours. Discussion: We found ethnicity can be a predictor of health preventive behaviours, in accordance with previous research. The causes of these disparities will require further investigation in order to be addressed. [ABSTRACT FROM AUTHOR]

This article provides an overview of the multifaceted landscape of mental health among Black men, shedding light on the unique challenges they face. Black men in the United States confront a complex interplay of sociocultural, historical, and economic factors that influence their mental well-being. This article synthesizes existing research and explores the disparities in mental health outcomes among Black men, delving into the stigmatization of mental health within this community. It also examines the role of systemic racism, socioeconomic factors, and cultural norms in shaping the mental health experiences of Black men. The abstract highlights the importance of culturally competent and community-driven interventions, offering insights into potential strategies to address these disparities. By recognizing the specific issues affecting mental health among Black men, this research contributes to the broader discourse on mental health equity. It underscores the imperative of tailored approaches to support the well-being of this demographic. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic increased the mortality rate in the U.S. and exposed many to the unexpected death of someone close. No prior research has assessed whether the COVID-19 pandemic was followed by an increase in bereavement during pregnancy, and whether patterns varied by race and ethnicity. Using data from the Pregnancy Risk Assessment Monitoring System from 2017–2021 across 23 U.S. sites (N = 107,226), we assessed trends in the odds of experiencing the death of someone close before and after the onset of the COVID-19 pandemic. Findings revealed an increased percentage of women who reported having someone close to them die in the year prior to childbirth after the start of the COVID-19 pandemic (March 2020 or later) (aPR=1.121, 95 % CI (1.079 – 1.165). Analysis by mother's race and ethnicity showed death of someone close increased significantly after the COVID-19 pandemic for Hispanic (aPR = 1.192, 95 % CI = 1.062, 1.337), non-Hispanic Black (aPR = 1.115, 95 % CI = 1.015 – 1.225), and American Indian-Alaskan Native pregnant women (aPR = 1.391, 1.023 – 1.891) compared to White, Non-Hispanic pregnant women. Increased bereavement among pregnant women during the COVID-19 pandemic warrants routine grief screening and response training in prenatal care. [ABSTRACT FROM AUTHOR]

Nighttime blood pressure (BP) and BP dipping (daytime–nighttime BP) are prognostic for cardiovascular disease. When compared with other racial/ethnic groups, Black Americans exhibit elevated nighttime BP and attenuated BP dipping. Neighborhood deprivation may contribute to disparities in cardiovascular health, but its effects on resting and ambulatory BP patterns in young adults are unclear. Therefore, we examined associations between neighborhood deprivation with resting and nighttime BP and BP dipping in young Black and White adults. We recruited 19 Black and 28 White participants (23 males/24 females, 21 ± 1 yr, body mass index: 26 ± 4 kg/m2) for 24-h ambulatory BP monitoring. We assessed resting BP, nighttime BP, and BP dipping (absolute dip and nighttime:daytime BP ratio). We used the area deprivation index (ADI) to assess average neighborhood deprivation during early and mid-childhood and adolescence. When compared with White participants, Black participants exhibited higher resting systolic and diastolic BP (Ps ≤ 0.029), nighttime systolic BP (114 ± 9 vs. 108 ± 9 mmHg, P = 0.049), diastolic BP (63 ± 8 vs. 57 ± 7 mmHg, P = 0.010), and attenuated absolute systolic BP dipping (12 ± 5 vs. 9 ± 7 mmHg, P = 0.050). Black participants experienced greater average ADI scores compared with White participants [110 (10) vs. 97 (22), P = 0.002], and select ADI scores correlated with resting BP and some ambulatory BP measures. Within each race, select ADI scores correlated with some BP measures for Black participants, but there were no ADI and BP correlations for White participants. In conclusion, our findings suggest that neighborhood deprivation may contribute to higher resting BP and impaired ambulatory BP patterns in young adults warranting further investigation in larger cohorts. NEW & NOTEWORTHY: We demonstrate that young Black adults exhibit higher resting blood pressure, nighttime blood pressure, and attenuated systolic blood pressure dipping compared with young White adults. Black adults were exposed to greater neighborhood deprivation, which demonstrated some associations with resting and ambulatory blood pressure. Our findings add to a growing body of literature indicating that neighborhood deprivation may contribute to increased blood pressure. [ABSTRACT FROM AUTHOR]

There are two dominant approaches to implementing permanent supportive housing (PSH), namely place-based (PB) and scattered-site (SS). Formal guidance does not distinguish between these two models and only specifies that PSH should be reserved for those who are most vulnerable with complex health needs. To consider both system- and self-selection factors that may affect housing assignment, this study applied the Gelberg-Anderson behavioral model for vulnerable populations to compare predisposing, enabling, and need factors among people experiencing homelessness (PE) by whether they were assigned to PB-PSH (n = 272) or SS-PSH (n = 185) in Los Angeles County during the COVID-19 pandemic. This exploratory, observational study also included those who were approved but did not receive PSH (n = 94). Results show that there are notable differences between (a) those who received PSH versus those who did not, and (b) those in PB-PSH versus SS-PSH. Specifically, PEH who received PSH were more likely to be white, US-born, have any physical health condition, and have lower health activation scores. PEH who received PB- versus SS-PSH were more likely to be older, Black, have any alcohol use disorder, and have higher health activation scores. These findings suggest that homeless service systems may consider PB-PSH more appropriate for PEH with higher needs but also raises important questions about how race may be a factor in the type of PSH that PEH receive and whether PSH is received at all. [ABSTRACT FROM AUTHOR]

Racial and ethnic disparities in gynecologic cancer care have been documented. Treatment at academic facilities is associated with improved survival, yet no study has examined independent associations between race and ethnicity with facility type among gynecologic cancer patients. We used the National Cancer Database and identified 484,455 gynecologic cancer (cervix, ovarian, uterine) patients diagnosed between 2004 and 2020. Facility type was dichotomized as academic vs. non-academic, and we used logistic regression to estimate multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) between race and ethnicity and facility type. Secondarily, we examined joint effects of race and ethnicity and facility type on overall survival using Cox proportional hazards regression. We observed higher odds of treatment at academic (vs. non-academic) facilities among American Indian/Alaska Native (OR = 1.42, 95% CI = 1.28–1.57), Asian (OR = 1.64, 95% CI = 1.59–1.70), Black (OR = 1.69, 95% CI = 1.65–1.72), Hispanic (OR = 1.70, 95% CI = 1.66–1.75), Native Hawaiian/Pacific Islander (OR = 1.74, 95% CI = 1.57–1.93), and other race (OR = 1.29, 95% CI = 1.20–1.40) patients compared with White patients. In the joint effects survival analysis with White, academic facility-treated patients as the reference group, Asian, Hispanic, and other race patients treated at academic or non-academic facilities had improved overall survival. Conversely, Black patients treated at academic facilities [Hazard Ratio (HR) = 1.10, 95% CI = 1.07–1.12] or non-academic facilities (HR = 1.19, 95% CI = 1.16–1.21) had worse survival. Minoritized gynecologic cancer patients were more likely than White patients to receive treatment at academic facilities. Importantly, survival outcomes among patients receiving care at academic institutions differed by race, requiring research to investigate intra-facility survival disparities. • Minoritized gynecologic cancer patients were more likely than White patients to receive treatment at an academic facility. • Compared with White, academic facility-treated patients, Asian and Hispanic patients had improved overall survival. • Black patients had worse survival, regardless of treatment facility, when compared with White, academic facility-treated patients. [ABSTRACT FROM AUTHOR]

Introduction Racial minorities have been found to have worse health care outcomes, including perioperative adverse events. We hypothesized that these racial disparities may be mitigated in a military treatment facility, where all patients have a military service connection and are universally insured. Materials and Methods This is a single institution retrospective review of American College of Surgeons National Surgical Quality Improvement Program data for all procedures collected from 2017 to 2020. The primary outcome analyzed was risk-adjusted 30-day postoperative complications compared by race. Results There were 6,941 patients included. The overall surgical complication rate was 6.9%. The complication rate was 7.3% for White patients, 6.5% for Black patients, 12.6% for Asian patients, and 3.4% for other races. However, after performing patient and procedure level risk adjustment using multivariable logistic regression, race was not independently associated with surgical complications. Conclusions Risk-adjusted surgical complication rates do not vary by race at this military treatment facility. This suggests that postoperative racial disparities may be mitigated within a universal health care system. [ABSTRACT FROM AUTHOR]

Objective: To examine case logs reported by general surgery residents and identify potential disparities in operative experience. Background: A recent study of 21 institutions noted significant differences between the number of cases reported during general surgery residency by trainees who are underrepresented in medicine (URiM) versus trainees who are not URiM (non-URiM). This study also identified differences between female residents and male residents. We partnered with the Accreditation Council for Graduate Medical Education to examine case logs reported from all accredited general surgery programs in the United States. This is the first time these data have been examined nationally. Methods: We examined total case logs submitted by graduating residents between 2017 and 2022. Group differences in mean reported case logs were examined using paired t tests for female versus male and URiM versus non-URiM overall case numbers. Results: A total of 6458 residents submitted case logs from 319 accredited programs. Eight-hundred fifty-four (13%) were URiM and 5604 (87%) were non-URiM. Over the 5-year study period, URM residents submitted 1096.95 (SD ± 160.57) major cases versus 1115.96 (±160.53) for non-URiM residents (difference = 19 cases, P = 0.001). Case logs were submitted by 3833 (60.1%) male residents and 2625 (39.9%) female residents over the 5-year study period. Male residents reported 1128.56 (SD ± 168.32) cases versus 1091.38 (±145.98) cases reported by females (difference = 37.18, P < 0.001). When looking at surgeon chief and teaching assistant cases, there was no significant difference noted between cases submitted by URiM versus non-URiM residents. However, male residents reported significantly more in both categories than their female peers (P < 0.001). Conclusions: Overall, URiM residents submitted fewer cases in the 5-year study period than their non-URiM peers. The gap in submitted cases between male and female residents was more pronounced, with male residents submitting significantly more cases than their female counterparts. This finding was consistent and statistically significant throughout the entire study period, in most case categories, and without narrowing of difference over time. A difference of 30 to 40 cases can amount to 1 to 3 months of surgical training and is a concerning national trend deserving the attention of every training program and our governing institutions. [ABSTRACT FROM AUTHOR]

Background: Heart failure (HF) and breast cancer are major health concerns with overlapping risk factors. This study investigated the impact of breast cancer on in-hospital mortality, length of stay, and health care charges in patients with HF. Methods: A retrospective cohort study was conducted using data from the National Inpatient Sample, focusing on female patients diagnosed with both breast cancer and HF. A control group of patients with HF without breast cancer was also analyzed. Main outcomes included in-hospital mortality, length of stay, and health care charges. Statistical analysis involved logistic and linear regression models. Results: The study included 17,551 unweighted cases of breast cancer, corresponding to 87,755 weighted cases. Breast cancer, particularly metastatic, was associated with increased in-hospital mortality across various types of HF. Patients with breast cancer and HF had longer hospital stays, which was more pronounced in metastatic cases. However, the impact on hospital charges was not consistent across the different HF types. Racial disparities were evident, with Native Americans showing the highest mortality risk in acute HF. Conclusion: Breast cancer significantly increases the in-hospital mortality risk and length of hospital stay in patients with HF. These findings highlight the need for integrated cardiovascular and oncological care, especially in the presence of metastatic breast cancer. The study underscores the importance of tailored management strategies for patients with HF with concurrent breast cancer and points toward the necessity for addressing racial disparities in health care. [ABSTRACT FROM AUTHOR]

Aims/hypothesis: Both short and long sleep durations have been linked to higher diabetes risk. However, sleep duration may vary over time, and there has been limited research focusing on individual sleep trajectories and diabetes risk. There are substantial racial disparities in both sleep health and diabetes risk in the USA. Thus, it is important to understand the role of suboptimal sleep patterns in diabetes risk in different racial groups. Methods: We assessed long-term trajectories of sleep duration and incident diabetes in 22,285 Black adults (mean age ± SD, 51.1 ± 8.2 years; 64.8% women) and 13,737 White adults (mean age ± SD, 54.4 ± 9.0 years; 63.8% women) enrolled in the Southern Community Cohort Study. Nine sleep trajectories were derived based on self-reported sleep duration at baseline and after a mean of 5 years of follow-up: normal–normal (reference), short–normal, normal–short, short–short, long–normal, normal–long, long–long, long–short and short–long. Diabetes was reported using a validated questionnaire. Multivariable-adjusted logistic regression was used to determine relationships between sleep trajectories and incident diabetes. Results: When compared with the normal–normal trajectory, suboptimal sleep trajectories were associated with higher likelihoods of developing diabetes (OR; 95% CI: short–normal 1.19; 1.09, 1.31; normal–short 1.14; 1.02, 1.27; short–short 1.17; 1.07, 1.28; long–normal 1.13; 0.98, 1.30; normal–long 1.16; 1.00, 1.34; long–long 1.23; 1.02, 1.48; long–short 1.45; 1.19, 1.77; short–long 1.51; 1.28, 1.77). Stratified analyses by race and socioeconomic status (i.e. education and household income) showed that most suboptimal sleep trajectories were consistently associated with incident diabetes in all sociodemographic subgroups. We also noted potential interaction with race and education for several sleep trajectories (i.e. short–long and normal–short with race; long–long and short–short with education). Conclusions/interpretation: Adults with suboptimal sleep duration trajectories are more likely to develop incident diabetes. Future research is needed to study how sociodemographic factors modulate this relationship. [ABSTRACT FROM AUTHOR]

Conflicting clinical trial results on omega-3 highly unsaturated fatty acids (n-3 HUFA) have prompted uncertainty about their cardioprotective effects. While the VITAL trial found no overall cardiovascular benefit from n-3 HUFA supplementation, its substantial African American (AfAm) enrollment provided a unique opportunity to explore racial differences in response to n-3 HUFA supplementation. The current observational study aimed to simulate randomized clinical trial (RCT) conditions by matching 3766 AfAm and 15,553 non-Hispanic White (NHW) individuals from the VITAL trial utilizing propensity score matching to address the limitations related to differences in confounding variables between the two groups. Within matched groups (3766 AfAm and 3766 NHW), n-3 HUFA supplementation's impact on myocardial infarction (MI), stroke, and cardiovascular disease (CVD) mortality was assessed. A weighted decision tree analysis revealed belonging to the n-3 supplementation group as the most significant predictor of MI among AfAm but not NHW. Further logistic regression using the LASSO method and bootstrap estimation of standard errors indicated n-3 supplementation significantly lowered MI risk in AfAm (OR 0.17, 95% CI [0.048, 0.60]), with no such effect in NHW. This study underscores the critical need for future RCT to explore racial disparities in MI risk associated with n-3 HUFA supplementation and highlights potential causal differences between supplementation health outcomes in AfAm versus NHW populations. [ABSTRACT FROM AUTHOR]