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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.

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.

Background: Deep-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. Methods: Using 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. Results: We 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. Conclusions: High 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. [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]

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]

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]

Purpose: Smoking is a modifiable lifestyle factor that has not been established as a prostate cancer risk factor, nor emphasized in prostate cancer prevention. Studies have shown that African American (AA) smokers have a poorer cancer prognosis than European Americans (EAs), while having a lower prevalence of heavy smoking. We examined the relationship between cigarette smoking and prostate cancer aggressiveness and assessed racial differences in smoking habits on the probability of high-aggressive prostate cancer. Methods: Using data from the North Carolina-Louisiana Prostate Cancer Project (n = 1,279), prostate cancer aggressiveness was defined as high or low based on Gleason scores, serum prostate-specific antigen levels, and tumor stage. Cigarette smoking was categorized as current, former, or never smokers. Multivariable logistic regression was used to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI). Results: Self-reported current (OR = 1.99; 95% CI 1.30–3.06) smoking was associated with high-aggressive prostate cancer relative to never smokers. When stratified by self-reported race, the odds of having high-aggressive cancer increased among AA current (OR = 3.58; 95% CI 2.04–6.28) and former smokers (OR = 2.21; 95% CI 1.38–3.53) compared to AA never smokers, but the odds were diminished among the EA stratum (Pself-reported race x smoking status = 0.003). Conclusion: Cigarette smoking is associated with prostate cancer aggressiveness, a relationship modulated by self-reported race. Future research is needed to investigate types of cigarettes smoked and metabolic differences that may be contributing to the racial disparities observed. [ABSTRACT FROM AUTHOR]

Purpose: Chordomas are rare malignant neoplasms primarily treated surgically. Disparities related to race and socioeconomic status, may affect patient outcomes. This study aims to identify prognostic factors for access to care and survival in patients with spinal chordomas. Methods: The NCDB database was queried between the years 2004 and 2017. Kaplan-Meier curves were constructed to compare survival probabilities among different groups, based on race and socioeconomic determinents. Results: 1769 patients were identified, with 87% being White, 5% Hispanic, 4% Black, and Asian each. The mean age was 61.3 years. Most patients received care at academic/research centers and lived in a large metropolitan area, with no difference between races. A significantly higher percentage of Black patients did not undergo surgery (p < 0.001), with no statistically significant difference in survival between races (p = 0.97). A higher survival probability was seen in patients with other government insurances (p < 0.0001), in higher income quartiles (p < 0.0001), in metropolitan areas (p = 0.023), and at an academic/research center (p < 0.0001). A lower survival probability was seen in patients who are uninsured, in rural areas, and at community cancer programs (p < 0.0001). Conclusion: This study highlights disparities in access to surgical intervention for patients with spinal chordomas, especially among Black individuals. It emphasizes the significant impact of insurance status and income on access to surgical care and highlights geographical and institutional variations in survival rates. Addressing socioeconomic differences is crucial for fostering equity in neurosurgical outcomes. [ABSTRACT FROM AUTHOR]

Objective: Using a sample of U.S. college students, the authors evaluated whether barriers to mental health treatment varied by race and ethnicity. Methods: Data were drawn from a large multicampus study conducted across 26 U.S. colleges and universities. The sample (N=5,841) included students who screened positive for at least one mental disorder and who were not currently receiving psychotherapy. Results: The most prevalent barriers to treatment across the sample were a preference to deal with issues on one's own, lack of time, and financial difficulties. Black and Hispanic/Latine students reported a greater willingness to seek treatment than did White students. However, Black and Hispanic/Latine students faced more financial barriers to treatment, and Hispanic/Latine students also reported lower perceived importance of mental health. Asian American students also reported financial barriers and preferred to handle their issues on their own or with support from family or friends and had lower readiness, willingness, and intentionality to seek help than did White students. Conclusions: Disparities in unmet treatment needs may arise from both distinct and common barriers and point to the potential benefits of tailored interventions to address the specific needs of students of color from various racial and ethnic backgrounds. The findings further underscore the pressing need for low-cost and brief treatment models that can be used or accessed independently to address the most prevalent barriers for students. [ABSTRACT FROM AUTHOR]

Purpose: Integrative medicine (IM) has received the American Society of Clinical Oncology's endorsement for managing cancer treatment-related side effects. Little is known about racial differences in familiarity, interest, and use of IM among patients with breast cancer. Methods: Patients with breast cancer enrolled in the Chicago Multiethnic Epidemiologic Breast Cancer Cohort were surveyed regarding familiarity, interest, and use of acupuncture, massage, meditation, music therapy, and yoga. Familiarity and interest, measured by a 5-point Likert scale, was modeled using proportional odds. Use was self-reported, and modeled using binary logistic regression. Results: Of 1,300 respondents (71.4% White and 21.9% Black), Black patients were less likely than White patients to be familiar with acupuncture (aOR 0.60, 95% CI 0.41–0.87); there were no racial differences in familiarity with massage, meditation, music therapy, and yoga. While there were no differences in interest in acupuncture between Black and White patients (aOR 1.12, 95% CI 0.76–1.65), Black patients were more interested in massage (aOR 1.86, 95% CI 1.25–2.77), meditation (aOR 2.03, 95% CI 1.37–3.00), music therapy (aOR 2.68, 95% CI 1.80–3.99), and yoga (aOR 2.10, 95% CI 1.41–3.12). Black patients were less likely than White patients to have used acupuncture (aOR 0.49, 95% CI 0.29–0.84); but there were no racial differences in use of massage, meditation, music therapy, and yoga. Conclusion: Black patients expressed more interest in IM than their White counterparts; there were no racial differences in IM use, except lower acupuncture use among Black patients. A breast program focused on equity should provide access to these services for patients with breast cancer. [ABSTRACT FROM AUTHOR]

Purpose: Osteoporosis, the most prevalent metabolic bone disease, significantly impacts global public health by increasing fracture risks, particularly among post-menopausal women and the elderly. Osteoporosis is characterized by decreased bone mineral density (BMD) and deterioration of bone tissue, which leads to enhanced fragility. The disease is predominantly diagnosed using dual X-ray absorptiometry (DXA) and is significantly influenced by demographic factors such as age and hormonal changes. This chapter delves into the condition's complex nature, emphasizing the pervasive gender and racial disparities in its screening, diagnosis, and treatment. Recent Findings: Recent findings highlight a substantial gap in the management of osteoporosis, with many individuals remaining under-screened and under-treated. Factors contributing to this include the asymptomatic early stages of the disease, lack of awareness, economic barriers, and inconsistent screening practices, especially in under-resourced areas. These challenges are compounded by disparities that affect different genders and races unevenly, influencing both the prevalence of the disease and the likelihood of receiving adequate healthcare services. Summary: The summary of this chapter underscores the urgent need for targeted strategies to overcome these barriers and improve health equity in osteoporosis care. Proposed strategies include enhancing public and healthcare provider awareness of osteoporosis, broadening access to diagnostic screenings, and integrating personalized treatment approaches. These efforts aim to align with global health objectives to mitigate the impacts of osteoporosis and ensure equitable health outcomes across all demographic groups. [ABSTRACT FROM AUTHOR]

Objective Background Method Results Conclusion Implications This research project aims to (a) investigate the association between sandwich caregiving and midlife women's health and (b) ask how this relationship differs by race.Although researchers consistently find that physical health declines substantially during midlife for women, much about what produces this trend is unexplored. One notable gap in prior literature is the impact of simultaneously providing care to both aging parents and young children (i.e., sandwich caregiving) on the health and well‐being of midlife women.This study analyzes six consecutive waves of nationally representative data from the National Longitudinal Survey of Youth 1979 (NLSY79) between 2008 and 2018 with growth curve models.The analysis illustrates that sandwich caregiving does not have a significant relationship with self‐reported physical health among White and Black mothers but has a negative association with fair or poor self‐rated physical health among Hispanic mothers.This study contributes to previous scholarship by specifying the heterogeneous consequences of sandwich caregiving for the health and well‐being of White, Black, and Hispanic women during midlife. Moreover, this work highlights the importance of exploring the complex implications of sandwich caregiving, as more and more midlife adults begin to provide care to dual generations.This study underscores the relevance of the life course perspective and the stress process model in understanding sandwich caregiving. Furthermore, my findings emphasize the significance of the family as a social institution in shaping social inequality and the need for race‐specific interventions to mitigate the adverse health outcomes of sandwich caregiving. [ABSTRACT FROM AUTHOR]

With rapid population aging in the U.S. a greater number of older adults now experience economic insecurity, a situation disproportionately affecting older people of color. The COVID pandemic, rising inflation, and increasing economic inequality have reduced the purchasing power of both wages and fixed incomes. Compared with prior cohorts, the current cohort of adults at or nearing retirement age faces higher levels of secured and unsecured debt burden from mortgages, home equity loans, student loans, credit cards, and out-of-pocket medical costs. Long-standing disparities in opportunities and generational wealth have resulted in more outstanding debt for Black older adults than their white counterparts. This “financial fragility” may result in older people foregoing proper nutrition, doctor’s visits, needed medications, or home or car repairs, while stress about finances may contribute to chronic health and mental health conditions. Along with programs to educate and advise older adults on their pressing financial concerns, practitioners who interact with older people in many settings should incorporate needed financial assessment and referrals into their work with this population. Professional and continuing education should ensure financial literacy and awareness of financial fragility for those working with older adults. [ABSTRACT FROM AUTHOR]

Background: Racial and ethnic disparities in mortality persist among US cancer survivors, with social determinants of health (SDoH) may have a significant impact on these disparities. Methods: A population-based cohort study of a nationally representative sample of adult cancer survivors, who participated in the US National Health and Nutrition Examination Survey from 1999 to 2018 was included. Sociodemographic characteristics and SDoH were self-reported using standardized questionnaires in each survey cycle. The SDoH was examined by race and estimated for associations with primary outcomes, which included all-cause and cancer-specific mortality. Multiple mediation analysis was performed to assess the contribution of each unfavorable SDoH to racial disparities to all-cause and cancer-specific mortality. Results: Among 5163 cancer survivors (2724 [57.7%] females and 3580 [69.3%] non-Hispanic White individuals), only 881 (24.9%) did not report an unfavorable SDoH. During the follow-up period of up to 249 months (median 81 months), 1964 deaths were recorded (cancer, 624; cardiovascular, 529; other causes, 811). Disparities in all-cause and cancer-specific mortality were observed between non-Hispanic Black and White cancer survivors. Unemployment, lower economic status, education less than high school, government or no private insurance, renting a home or other arrangements, and social isolation were significantly and independently associated with worse overall survival. Unemployment, lower economic status, and social isolation were significantly associated with cancer-specific mortality. Compared to patients without an unfavorable SDoH, the risk of all-cause mortality was gradually increased in those with a cumulative number of unfavorable SDoHs (1 unfavorable SDoH: hazard ratio [HR] = 1.54, 95% CI 1.25–1.89; 2 unfavorable SDoHs: HR = 1.81, 95% CI 1.46–2.24; 3 unfavorable SDoHs: HR = 2.42, 95% CI 1.97–2.97; 4 unfavorable SDoHs: HR = 3.22, 95% CI 2.48–4.19; 5 unfavorable SDoHs: HR = 3.99, 95% CI 2.99–5.33; 6 unfavorable SDoHs: HR = 6.34 95% CI 4.51–8.90). A similar trend existed for cancer-specific mortality. Conclusions: In this cohort study of a nationally representative sample of US cancer survivors, a greater number of unfavorable SDoH was associated with increased risks of mortality from all causes and cancer. Unfavorable SDoH levels were critical risk factors for all-cause and cancer-specific mortality, as well as the underlying cause of racial all-cause mortality disparities among US cancer survivors. [ABSTRACT FROM AUTHOR]

Background: Racial disparities in sleep are well‐documented. However, evidence‐based options for addressing these disparities are lacking in cancer populations. To inform future research on sleep interventions, this study aims to understand racial differences in treatment responses to acupuncture and cognitive behavioral therapy for insomnia (CBT‐I) among Black and White cancer survivors. Methods: We conducted a secondary analysis of a comparative effectiveness trial evaluating acupuncture versus CBT‐I for insomnia in cancer survivors. We compared insomnia severity, sleep characteristics, and co‐morbid symptoms, as well as treatment attitudes, adherence, and responses among Black and White participants. Results: Among 156 cancer survivors (28% Black), Black survivors reported poorer sleep quality, longer sleep onset latency, and higher pain at baseline, compared to White survivors (all p < 0.05). Black survivors demonstrated lower adherence to CBT‐I than White survivors (61.5% vs. 88.5%, p = 0.006), but their treatment response to CBT‐I was similar to white survivors. Black survivors had similar adherence to acupuncture as white survivors (82.3% vs. 93.4%, p = 0.16), but they had greater reduction in insomnia severity with acupuncture (−3.0 points, 95% CI −5.4 to 0.4, p = 0.02). Conclusion: This study identified racial differences in sleep characteristics, as well as treatment adherence and responses to CBT‐I and acupuncture. To address racial disparities in sleep health, future research should focus on improving CBT‐I adherence and confirming the effectiveness of acupuncture in Black cancer survivors. [ABSTRACT FROM AUTHOR]

Background: Placement of peripheral intravenous catheters (PIVC) is a routine procedure in hospital settings. The primary objective is to explore the relationship between healthcare inequities and PIVC outcomes. Methods: This study was a multicenter, observational analysis of adults with PIVC access established in the emergency department requiring inpatient admission between January 1st, 2021, and January 31st, 2023, in metro Detroit, Michigan, United States. Epidemiological, demographic, therapeutic, clinical, and outcomes data were collected. Health disparities were defined by the National Institute on Minority Health and Health Disparities. The primary outcome was the proportion of PIVC dwell time to hospitalization length of stay, expressed as the proportion of dwell time (hours) to hospital stay (hours) x 100%. Multivariable linear regression and a machine learning model were used for variable selection. Subsequently, a multivariate linear regression analysis was utilized to adjust for confounders and best estimate the true effect of each variable. Results: Between January 1st, 2021, and January 31st, 2023, our study analyzed 144,524 ED encounters, with an average patient age of 65.7 years and 53.4% female. Racial demographics showed 67.2% White, and 27.0% Black, with the remaining identifying as Asian, American Indian Alaska Native, or other races. The median proportion of PIVC dwell time to hospital length of stay was 0.88, with individuals identifying as Asian having the highest ratio (0.94) and Black individuals the lowest (0.82). Black females had a median dwell time to stay ratio of 0.76, significantly lower than White males at 0.93 (p < 0.001). After controlling for confounder variables, a multivariable linear regression demonstrated that Black males and White males had a 10.0% and 19.6% greater proportion of dwell to stay, respectively, compared to Black females (p < 0.001). Conclusions: Black females face the highest risk of compromised PIVC functionality, resulting in approximately one full day of less reliable PIVC access than White males. To comprehensively address and rectify these disparities, further research is imperative to improve understanding of the clinical impact of healthcare inequities on PIVC access. Moreover, it is essential to formulate effective strategies to mitigate these disparities and ensure equitable healthcare outcomes for all individuals. [ABSTRACT FROM AUTHOR]

Objectives: To determine whether life expectancy (LE) changes between 2000 and 2019 were associated with race, rural status, local economic prosperity, and changes in local economic prosperity, at the county level. Methods: Between 12/1/22 and 2/28/23, we conducted a retrospective analysis of 2000 and 2019 data from 3,123 United States counties. For Total, White, and Black populations, we compared LE changes for counties across the rural-urban continuum, the local economic prosperity continuum, and for counties in which local economic prosperity dramatically improved or declined. Results: In both years, overall, across the rural-urban continuum, and for all studied populations, LE decreased with each progression from the most to least prosperous quintile (all p < 0.001); improving county prosperity between 2000-2019 was associated with greater LE gains (p < 0.001 for all). Conclusion: At the county level, race, rurality, and local economic distress were all associated with LE; improvements in local economic conditions were associated with accelerated LE. Policymakers should appreciate the health externalities of investing in areas experiencing poor economic prosperity if their goal is to improve population health. [ABSTRACT FROM AUTHOR]

Background: Black individuals in the U.S. face increasing racial disparities in drug overdose related to social determinants of health, including place-based features. Mobile outreach efforts work to mitigate social determinants by servicing geographic areas with low drug treatment and overdose prevention access but are often limited by convenience-based targets. Geographic information systems (GIS) are often used to characterize and visualize the overdose crisis and could be translated to community to guide mobile outreach services. The current study examines the initial acceptability and appropriateness of GIS to facilitate data-driven outreach for reducing overdose inequities facing Black individuals. Methods: We convened a focus group of stakeholders (N = 8) in leadership roles at organizations conducting mobile outreach in predominantly Black neighborhoods of St. Louis, MO. Organizations represented provided adult mental health and substance use treatment or harm reduction services. Participants were prompted to discuss current outreach strategies and provided feedback on preliminary GIS-derived maps displaying regional overdose epidemiology. A reflexive approach to thematic analysis was used to extract themes. Results: Four themes were identified that contextualize the acceptability and utility of an overdose visualization tool to mobile service providers in Black communities. They were: 1) importance of considering broader community context; 2) potential for awareness, engagement, and community collaboration; 3) ensuring data relevance to the affected community; and 4) data manipulation and validity concerns. Conclusions: There are several perceived benefits of using GIS to map overdose among mobile providers serving Black communities that are overburdened by the overdose crisis but under resourced. Perceived potential benefits included informing location-based targets for services as well as improving awareness of the overdose crisis and facilitating collaboration, advocacy, and resource allocation. However, as GIS-enabled visualization of drug overdose grows in science, public health, and community settings, stakeholders must consider concerns undermining community trust and benefits, particularly for Black communities facing historical inequities and ongoing disparities. [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]

Research Summary: We conducted a group randomized‐controlled trial of an internal dashboard system deployed by the Michigan State Police to determine its effectiveness in reducing traffic stop racial disparities. Informed by a difference‐in‐differences design, analyses of traffic stop data from 2019–2022 indicated that the dashboard had no impact on traffic stop racial disparities. Additional analyses of traffic stops, crashes, and crime revealed that the dashboard had no "de‐policing" effect on traffic patrols, nor were there any significant changes in traffic safety or crime in treatment patrol areas relative to control patrol areas. Qualitative analyses of interview data from more than 40 troopers in the agency revealed unique barriers to program implementation and opportunities for future improvement. Policy Implications: In an era of policing where the capacity and demand for data‐driven decision‐making is on the rise, evidence‐based policy and practice can provide police agencies with informed solutions for addressing traffic stop racial disparities. Yet, the increased demand for evidence‐based reform is fueled by a relatively low supply of evidence‐based research. This study adds to this evidence base by providing unique insights into the effectiveness of a program built specifically to reduce racial disparities in traffic stops, while also highlighting implementation challenges. [ABSTRACT FROM AUTHOR]

Although molecular biomarkers have significantly advanced precision oncology in glioblastoma, the prevalence of these biomarkers by race remains underexplored. This study aims to characterize the genomic alterations in glioblastoma across Asian, Black, and White patients, offering insights into racial disparities that may influence treatment outcomes and disease progression. Analyzing data from the American Association for Cancer Research Project Genomics Evidence Neoplasia Information Exchange database V13.0, this study examined 2390 primary glioblastoma samples from unique patients. Genomic alterations in 566 cancer-related genes were assessed using targeted next-generation sequencing panels from 3 large cancer institutes. The patient cohort included 112 Asians, 67 Blacks, and 2211 Whites. Statistical significance of associations between genomic alterations and race was evaluated using the chi-squared test, with the Benjamini–Hochberg method applied to control for multiple testing adjustments. Significant racial differences were observed in the frequency of genomic alterations. Asians exhibited a higher frequency of TP53 alterations (52.68%, P < 0.001), Blacks showed more frequent alterations in NRAS (7.46%, P < 0.001), MTOR (10.45%, P = 0.039), and TET2 (8.96%, P = 0.039), and Whites had a higher occurrence of PTEN alterations (48.67%, P = 0.045). Additionally, Black patients had an elevated rate of RET deletions (14.29%, P < 0.001). This study identifies significant racial disparities in the alteration frequencies of 6 key glioblastoma genes: NRAS, TP53, MTOR, TET2, PTEN, and RET. These findings underscore the need for racial considerations in glioblastoma treatment strategies and highlight potential avenues for targeted therapeutic interventions. Further research is needed to explore the clinical implications of these genomic disparities. [ABSTRACT FROM AUTHOR]

This study aims to assess race as an independent risk factor for postoperative complications after surgical fixation of traumatic thoracolumbar fractures for African American and Asian American patients compared with White patients. The 2011–2021 American College of Surgeons - National Surgical Quality Improvement Program (ACS-NSQIP) dataset was used to identify patients undergoing fusion surgeries for thoracolumbar spine fractures. Patient comorbidity burden was assessed using a modified 5-item frailty index score (mFI-5). Chi-squared and ANOVA tests were used to compare baseline clinical characteristics between groups. Multivariate analysis was performed to compare African American and Asian American patients with White patients controlling for age, BMI, and American Society of Anesthesiologists (ASA) score. African American patients experienced longer operative times compared to Asian American and White patients (3.74 ± 1.87 hours vs. 3.04 ± 1.71 hours and 3.48 ± 1.81 hours, P < 0.001). African American and Asian American patients demonstrated higher comorbidity burden with mFI-5>2 compared to White patients (30.7% and 25.6% vs. 19.9%, P < 0.001). African American and Asian American patients had a higher risk of postoperative complications than White patients (22.4% and 20% vs. 19.7%, P < 0.001). African American race was an independent risk factor of postoperative 30-day morbidity (OR 1.19, CI 1.11–1.28, P < 0.001). African American and Asian American patients undergoing thoracolumbar fusion surgeries exhibit disproportionate comorbidity burden, longer LOS, and greater postoperative complications compared with White patients. Furthermore, the African American race was associated with an increased rate of 30-day postoperative complications. [ABSTRACT FROM AUTHOR]

Introduction: Alcoholic hepatitis (AH) is a serious complication of alcohol consumption with high morbidity and mortality, particularly in the United States where alcohol-related liver diseases rank as one of the leading causes of preventable death. Our study aims to analyze the morbidity and mortality of AH across racial groups and project hospitalization trends up to 2028, thereby informing public health initiatives. Methods: We conducted a cross-sectional study utilizing data from the Nationwide Inpatient Sample (NIS) spanning 2012 to 2021. The study population comprised hospitalizations identified using specific ICD-9-CM and ICD-10-CM codes for AH. We assessed hospitalizations, in-hospital mortality rates, length of stay (LOS), and morbidities related to alcoholic hepatitis adjusting for sociodemographic factors and hospital characteristics. Statistical analyses were performed using Stata and R software, employing logistic and linear regression analyses, and SARIMA models for forecasting. Results: Our results indicated a predominantly White cohort (68%), with a notable increase in AH hospitalizations among Hispanics (129.1% from 2012 to 2021). Racial disparities were observed in inpatient mortality, liver transplant accessibility, and the occurrence of in-hospital complications. The study forecasts a continued rise in hospitalizations across all racial groups, with Hispanics experiencing the sharpest increase. Conclusion: Our study reveals a disproportionate rise in the AH burden among Hispanics with projections indicating a persistent upward trend through 2028. These findings highlight the need for targeted public health strategies and improved healthcare access to mitigate the increasing AH burden and address disparities in care and outcomes. [ABSTRACT FROM AUTHOR]

Objective: Analyze the association between race and surgery performed for uterine fibroids during the coronavirus disease 2019 (COVID-19) pandemic. Methods: Retrospective exploratory cross-sectional study of patients with fibroids who underwent surgery during the COVID-19 pandemic. We compared the type of surgery performed (minimally invasive hysterectomy [MIH], uterine-sparing procedure [USP], or total abdominal hysterectomy [TAH]) by White versus non-White patients. Absolute percentage differences were estimated with multinomial logistic regression adjusting for age, body mass index (BMI), parity, comorbidities, and maximum fibroid diameter. Results: Of 350 subjects, the racial composition was 1.7% Asian, 23.4% Black, and 74.9% White. Non-White patients had greater fibroid burden by mean maximum fibroid diameter, mean uterine weight, and mean fibroid weight. Although MIH occurred more frequently among White patients (7.5% points higher [95% confidence interval (CI) = −3.1 to 18.2]), USP and TAH were more commonly conducted for non-White patients (3.4% points higher [95% CI = −10.4 to 3.6] and 4.2% points higher [95% CI = −13.2 to 4.8], respectively). The overall complication rate was 18.6%, which was 6% points lower (95% CI = −15.8 to 3.7) among White patients. Conclusion: During the COVID-19 pandemic at a single-site institution, non-White patients were more likely to undergo a uterine-sparing procedure for surgical treatment of uterine fibroids, abdominal procedures, including both hysterectomy and myomectomy, and experience surgery-related complications. [ABSTRACT FROM AUTHOR]

Simple Summary: Head and neck cancer disparities in outcomes for Black Americans have been well recognized. However, the specific drivers of the inferior outcomes remain poorly understood. We investigated the biologic features of patient oral cancers and performed a follow-up study of the patient post-surgery recurrences and metastases aiming to explore potential mechanisms that might underpin the poorer outcomes among Black American patients. It was found that high levels of tumor stemness and tumor-promoting stromal characteristics were linked to patient recurrence and metastasis. There were more cases of Black American than White American exhibiting high stemness traits and strong tumor-promoting stromal features associated with tumor recurrences and metastases, although the investigated cases displayed comparable clinical diagnoses. Our findings revealed that the differences in tumor stemness and stromal property among cancers with similar diagnoses contribute to patient outcome disparities. Black Americans (BAs) with head and neck cancer (HNC) have worse survival outcomes compared to the White patients. While HNC disparities in patient outcomes for BAs have been well recognized, the specific drivers of the inferior outcomes remain poorly understood. Here, we investigated the biologic features of patient tumor specimens obtained during the surgical treatment of oral cancers and performed a follow-up study of the patients' post-surgery recurrences and metastases with the aim to explore whether tumor biologic features could be associated with the poorer outcomes among BA patients compared with White American (WA) patients. We examined the tumor stemness traits and stromal properties as well as the post-surgery recurrence and metastasis of oral cancers among BA and WA patients. It was found that high levels of tumor self-renewal, invasion, tumorigenesis, metastasis, and tumor-promoting stromal characteristics were linked to post-surgery recurrence and metastasis. There were more BA than WA patients demonstrating high stemness traits and strong tumor-promoting stromal features in association with post-surgery tumor recurrences and metastases, although the investigated cases displayed clinically comparable TNM stages and histological grades. These findings demonstrated that the differences in tumor stemness and stromal property among cancers with comparable clinical diagnoses contribute to the outcome disparity in HNCs. More research is needed to understand the genetic and molecular basis of the biologic characteristics underlying the inferior outcomes among BA patients, so that targeting strategies can be developed to reduce HNC disparity. [ABSTRACT FROM AUTHOR]

Prior investigations assessing the impact of race/ethnicity on outcomes after mitral valve (MV) surgery have reported conflicting findings. This analysis aimed to examine the association between race/ethnicity and operative presentation and outcomes of patients undergoing MV and tricuspid valve (TV) surgery. We retrospectively analyzed 5984 patients (2730 female, median age 63 y) who underwent MV (n = 4,534, 76%), TV (n = 474, 8%) or both MV and TV (n = 976, 16%) surgery in a statewide collaborative from 2012 to 2021. The influence of race/ethnicity on preoperative characteristics, MV and TV repair rates, and postoperative outcomes was assessed for White (n = 4,244, 71%), Black (n = 1,271, 21%), Hispanic (n = 144, 2%), Asian (n = 171, 3%), and mixed/other race (n = 154, 3%) patients. Black patients, compared to White patients, had higher Society of Thoracic Surgeons predicted risk of morbidity/mortality (24.5% versus 13.1%; P < 0.001) and more comorbid conditions. Compared to White patients, Black and Hispanic patients were less likely to undergo an elective procedure (White 71%, Black 55%, Hispanic 58%; P < 0.001). Degenerative MV disease was more prevalent in White patients (White 62%, Black 41%, Hispanic 43%, Asian 51%, mixed/other 45%; P < 0.05), while rheumatic disease was more prevalent in non–White patients (Asian 28%, Hispanic 26%, mixed/other 25%, Black 17%, White 10%; P < 0.05). After multivariable adjustment, repair rates and adverse postoperative outcomes, including mortality, did not differ by racial/ethnic group. Patient race/ethnicity is associated with a higher burden of comorbidities at operative presentation and MV disease etiology. Strategies to improve early detection of valvular heart disease and timely referral for surgery may improve outcomes. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Substantial racial and ethnic disparities in hypertension and dementia exist in the United States. We evaluated the effect of maintaining systolic blood pressure (SBP) below clinical thresholds on dementia incidence. METHODS: We included 6806 Multi‐Ethnic Study of Atherosclerosis participants (44 to 84 years old). We implemented the parametric g‐formula to simulate the hypothetical interventions to reduce SBP below 120 and 140 mmHg over time, accounting for time‐varying confounding. We estimated risk ratios (RRs) and risk differences for dementia incidence at 19 years. RESULTS: The RRs (95% confidence intervals [CIs]) comparing an intervention reducing SBP below 120 mmHg to no intervention were 0.93 (0.87 to 0.99) for total sample, 0.95 (0.88 to 1.02) for White, 0.90 (0.79 to 1.02) for Black, 0.90 (0.78 to 1.05) for Latino, and 1.16 (0.83 to 1.55) for Chinese American participants. Results for lowering SBP below 140 mmHg and with death as competing event were attenuated. DISCUSSION: The reduction of SBP below 120 mmHg over time has modest effects on reducing dementia incidence. More work is needed to understand the heterogeneity across racial and ethnic groups. Highlights: There is a potential beneficial effect in lowering SBP to reduce the risk of dementia, which may vary by race and ethnicity.The percentage of participants who would need intervention on blood pressure to meet clinical thresholds is greater for Black and Latino communities.Results are sensitive to the way that death is specified in the research question and analysis. [ABSTRACT FROM AUTHOR]

Contemporary school racial segregation is a manifestation of structural racism shown to harm Black children's health. Yet, evidence on its long-term impacts throughout life, as well as effects among children of other racial backgrounds, is sparse. Data on Black and White children were drawn from the National Longitudinal Study of Adolescent to Adult Health. Using multilevel models, we estimated associations between district-level school segregation and measures of short-term and long-term health, including self-reported outcomes and biomarkers. Models were run separately for Black and White children, adjusting for individual- and district-level covariates. We further carried out subgroup analyses by school racial composition (i.e., majority White vs. majority non-White schools). School segregation was associated with worsened short- and long-term risk factors of chronic disease among both Black and White students in terms of exercise and body mass index, but only in majority non-White schools. Moreover, Black students in these schools demonstrated less adolescent drinking and smoking with increased racial segregation and better self-reported health in young adulthood. Our findings suggest that segregated majority non-White schools may be targets of systemic disinvestment and may therefore lack sufficient resources for physical education or nutrition. Improvements in some outcomes among Black children may reflect peer influence (i.e., Black adolescents generally drink less than White adolescents), reduced exposure to interpersonal racism from White peers, or positive health fostered by feelings of belonging in Black community. Ensuring all students go to schools with the resources they need to thrive may have positive spillovers for population health. [ABSTRACT FROM AUTHOR]

Background Mechanisms underlying racial and ethnic disparities in robot-assisted radical prostatectomy (RARP) vs open radical prostatectomy (ORP) are unclear. We sought to test 2 physician-level hypotheses: 1) Segregated Treatment and 2) Differential Treatment. Methods This observational study used the New York State Cancer Registry linked to discharge records and included patients undergoing radical prostatectomy for localized prostate cancer from October 1, 2008 to December 31, 2018. For hypothesis 1, we examined the association between patient race and ethnicity and treating surgeon RARP use (high-use surgeons, low-use surgeons, and surgeons at non-RARP facilities). For hypothesis 2, we determined the association between patient race and ethnicity and receipt of RARP when matching on treating surgeon, age, year of procedure, and Gleason group. We explored the role of insurance in both analyses. Results This study included 18 926 patients (8.0% Hispanic, 16.9% non-Hispanic Black, 75.1% non-Hispanic White), with a mean age of 60.4 ± 7.1 years. Compared with non-Hispanic White patients, Hispanic and non-Hispanic Black patients had higher odds of being treated by low-RARP-use surgeons (odds ratio [OR] = 2.16, 95% confidence interval [CI] = 1.20 to 3.88; OR = 1.76, 95% CI = 1.06 to 2.94, respectively) and by surgeons at non-RARP facilities (OR = 4.19, 95% CI = 2.18 to 8.07; OR = 4.60, 95% CI = 2.58 to 8.23, respectively). In the matched cohorts, Hispanic and non-Hispanic Black patients were less likely to receive RARP than non-Hispanic White patients (OR = 0.78, 95% CI = 0.62 to 0.98; OR = 0.75, 95% CI = 0.57 to 1.00, respectively). These associations were partially attenuated after accounting for insurance. Conclusions Racial and ethnic disparities in RARP use are related to patients being treated by different surgeons and treated differently by the same surgeons. Identifying and addressing multilevel barriers to equitable surgical treatment is needed to reduce disparities among prostate cancer patients. [ABSTRACT FROM AUTHOR]

BACKGROUND Nearly half of all Americans have hypertension, and Black adults experience a disproportionate burden. Hypercoagulability may relate to hypertension risk, and higher levels of factor VIII increase thrombosis risk. Black adults have higher factor VIII and more hypertension than other groups. Whether higher factor VIII associates with incident hypertension is unknown. METHODS The Biomarkers as Mediators of Racial Disparities in Risk Factors (BioMedioR) study measured certain biomarkers in a sex-race stratified sample of 4,400 REGARDS participants who attended both visits. We included BioMedioR participants, excluding those with prevalent hypertension, missing factor VIII level, or covariates of interest. Modified Poisson regression estimated risk ratios (RR) for incident hypertension by higher log-transformed factor VIII level per SD (SD of log-transformed factor VIII, 0.33). Weighting was applied to take advantage of REGARDS sampling design. RESULTS Among the 1,814 participants included (55% female, 24% Black race), the median follow-up was 9.5 years and 35% (2,146/6,138) developed hypertension. Black participants had a higher median (IQR) factor VIII level (105.6%; 87.1%–126.9%) than White participants (95.6%; 79.8%–115.9%; P  < 0.001). The age- and sex-adjusted Black–White hypertension RR was 1.45 (95% CI 1.28, 1.63). Higher factor VIII was not associated with more hypertension (final model RR 1.01; 95% CI 0.94, 1.07). CONCLUSIONS In a prospective study of Black and White adults without prevalent hypertension, factor VIII was not associated with greater hypertension risk. [ABSTRACT FROM AUTHOR]

Background: Currently, racial disparities exist in access to genetic testing. Recent developments have helped narrow the gap in accessibility. The purpose of this study was to determine whether racial disparities in genetic consultation attendance and completion of genetic testing persist, and, if so, factors that contribute to under-utilization of these resources. Methods: A single-institution retrospective review of breast patients referred for genetic counseling between 2017 and 2019 was performed. Univariate and multivariate logistic regression evaluated factors associated with genetic counseling attendance and genetic testing. Results: A total of 596 patients were referred for genetic counseling: 433 (72.7%) white; 138 (23.2%) black; and 25 (4.2%) other or unknown. In multivariate analysis, black patients, patients without breast cancer family history, and patients without a current cancer diagnosis, classified as high risk, were significantly less likely to attend their genetics appointment (p = 0.010, p = 0.007, p = 0.005, respectively). Age, insurance type, distance from facility, and need for chemotherapy did not significantly impact consult completion rate. Of the patients who completed a genetic consult, 84.4% (n = 248) had genetic testing and 17.7% (n = 44) had a pathogenic variant. For patients who attended counseling, there were no significant factors that were predictive with receipt of genetic testing. Conclusions: In this study, there was a significant association between race and attending genetic counseling. Once counseled, most patients went on to receive genetic testing, and racial disparities in testing disappeared, emphasizing the value of providing additional education about the importance and purpose of genetic testing. [ABSTRACT FROM AUTHOR]

Objective: There is growing attention toward the implications of race and ethnicity on health disparities within otolaryngology. While race is an established predictor of adverse head and neck oncologic outcomes, there is paucity in the literature on studies employing national, multi‐institutional data to assess the impact of race and ethnicity on head and neck autograft surgery. Methods: Using the National Surgical Quality Improvement Program (NSQIP) database, trends in 30 days outcomes were assessed. Patients with ICD‐10 codes for malignant head and neck neoplasms were isolated. Autograft surgeries were selected using Current Procedural Terminology (CPT) codes for free flap and pedicled flap reconstruction. Primary outcomes included surgical complications, reoperation, readmission, extended length of stay and operation time. Each binary categorical variable was compared to racial/ethnic identity via binary logistic regression. Results: The study cohort consisted of 2447 patients who underwent head and neck autograft surgery (80.71% free flap reconstruction and 19.39% pedicled flap reconstruction). Black patients had significantly higher odds of overall surgical complications (odds ratio [OR] 1.583, 95% confidence interval [CI] 1.091, 2.298, p = 0.016) with much higher odds of perioperative blood transfusions (OR 2.291, 95% CI 1.532, 3.426, p = <.001). Hispanic patients were more likely to undergo reoperation within 30 days after surgery and were more likely to be hospitalized for more than 30 days post‐operatively (OR 1.566, 95% CI 1.015, 2.418, p = 0.043 and OR 12.224, 95% CI 2.698, 55.377, p = 0.001, respectively). Conclusions: Race and ethnicity serve as independent predictors of complications in the post‐operative period following head and neck autograft surgery. Level of Evidence: 3 Laryngoscope, 134:3595–3603, 2024 [ABSTRACT FROM AUTHOR]

Despite a developing literature on the consequences of parental incarceration, its effects on childhood obesity are not evident. Our research project fills this knowledge gap by describing the relationship between parental incarceration and childhood obesity among children aged 3–15 and determining if and how this association differs across race. We use four consecutive waves of data on 3,302 children from the Fragile Families and Child Wellbeing Study. Our analysis finds little evidence that parental incarceration influences the probability of obesity among all children as a group. Moreover, our findings reveal critical racial disparities in the relationship between parental incarceration and childhood obesity. In particular, parental lifetime incarceration is not associated with risks of obesity for White or Hispanic children but is associated with a significantly decreased chance of obesity for Black children. This research effort can initiate an interdisciplinary conversation on the important intersection of family and corrections in order to alleviate the intergenerational erosion of physical health and well-being. [ABSTRACT FROM AUTHOR]

Purpose: Cardiovascular risk factors (CVRFs) are associated with increased risk for cognitive impairment and decline in the general population, but less is known about how CVRFs might influence cognitive aging among older cancer survivors. We aimed to determine how CVRFs prior to a cancer diagnosis affect post-cancer diagnosis memory aging, compared to cancer-free adults, and by race/ethnicity. Methods: Incident cancer diagnoses and memory (immediate and delayed recall) were assessed biennially in the US Health and Retirement Study (N = 5,736, 1998–2018). CVRFs measured at the wave prior to a cancer diagnosis included self-reported cigarette smoking, obesity, diabetes, heart disease, hypertension, and stroke. Multivariable-adjusted linear mixed-effects models evaluated the rate of change in standardized memory score (SD/decade) post-cancer diagnosis for those with no, medium, and high CVRFs, compared to matched cancer-free adults, overall and stratified by sex and race/ethnicity. Results: Higher number of CVRFs was associated with worse baseline memory for both men and women, regardless of cancer status. Cancer survivors with medium CVRFs had slightly slower rates of memory decline over time relative to cancer-free participants (0.04 SD units/decade [95% CI: 0.001, 0.08]). Non-Hispanic Black (NHB) and Hispanic cancer-free participants and cancer survivors had worse baseline memory than their Non-Hispanic White (NHW) counterparts. Conclusions: CVRFs were associated with worse baseline memory function, but not decline, for cancer-free adults and cancer survivors. Racial disparities were largely similar between cancer survivors and cancer-free adults. Implications for Cancer Survivors: These findings may inform hypotheses about pre-diagnosis multimorbidity and cognitive aging of cancer survivors from diverse groups. [ABSTRACT FROM AUTHOR]

Introduction/Aims Methods Results Discussion 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.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.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.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]

Triple negative breast cancer (TNBC) is a heterogenous disease that disproportionately affects Black women. TNBC outcomes among Black women are dismal secondary to multiple factors, such as poor healthcare accessibility resulting in delays in diagnosis, and aggressive disease biology in addition to a pro-tumor immune microenvironment (TME). Black women with breast cancer exhibit elevated levels of serum pro-inflammatory cytokines, and a pro-tumorigenic TME with higher immunosuppressive regulatory T cells (Tregs), M2 macrophages and exhausted CD8+ T cells. We have shown that the combined use of toll-like receptor 3 (TLR3) ligands with interferon-α (chemokine modulation: CKM) is able to enrich the tumor with CD8+ T cells, while not increasing immunosuppressive cells. Recent clinical trials have revealed the efficacy of immune checkpoint inhibitors (ICI) in rejuvenizing exhausted CD8+ T cells. We hypothesize that strategies to modulate the TME by enriching chemokines that attract CD8+T cells followed by reversal of CD8+ T cell exhaustion (ICI), when added to standard treatment, could potentially improve clinical outcomes, and mitigate the racial disparities in TNBC outcomes between Black and White Women. [ABSTRACT FROM AUTHOR]

Background: Blacks/African American (BAA) patients diagnosed with head and neck squamous cell carcinoma (HNSCC) have worse survival outcomes than White patients. However, the mechanisms underlying racial disparities in HNSCC have not been thoroughly characterized. Methods: Data on gene expression, copy number variants (CNVs), gene mutations, and methylation were obtained from 6 head and neck cancer datasets. Comparative bioinformatics analysis of the above genomic features was performed between BAAs and Whites. The expression pattern of GSTM1 was validated by immunohistochemistry using tumor tissue microarray (TMA). Effect of GSTM1 knockdown were assessed by cell proliferation, colony formation, and tumor development in an orthotopic mouse model. The changes in protein kinases were determined using the Proteome Profiler Human Phospho-Kinase Array Kit in HNSCC cells with or without GSTM1 knockdown. Results: We identified ancestry-related differential genomic profiles in HNSCC. Specifically, in BAA HNSCC, FAT1 mutations were associated with its gene expression, SALL3 gene expression correlated with its gene CNVs, and RTP4 gene expression showed an inverse correlation with its methylation. Notably, GSTM1 emerged as a prognostic risk factor for BAA HNSCC, with high gene CNVs and expression levels correlating with poor overall survival in BAA patients. Immunohistochemistry results from newly developed in-house TMA validated the expression pattern of GSTM1 between BAA HNSCC and White HNSCC. In an orthotopic mouse model, GSTM1 knockdown significantly inhibited malignant progression in tumors derived from BAAs. In contrast, loss of GSTM1 did not affect the development of HNSCC originating in Whites. Mechanistically, GSTM1 knockdown suppressed HSP27 phosphorylation and β-catenin in BAA HNSCC cells, but not in White HNSCC cells. This differential effect at least partially contributes to tumor development in BAA patients. Conclusion: This study identifies GSTM1 as a novel molecular determinant of survival in HNSCC patients of African descent. It also provides a molecular basis for future research focused on identifying molecular determinants and developing therapeutic interventions to improve outcomes for BAA patients with HNSCC. [ABSTRACT FROM AUTHOR]

Background and Aim Methods Results Conclusions Esophageal cancer significantly contributes to US cancer mortality, with notable racial disparities. This study aims to provide updated esophageal cancer mortality trends among Black and White adults from 1999 to 2020.CDC‐WONDER was used to identify Black and White adults in the United States from 1999 to 2020. We calculated age‐standardized mortality rates, absolute rate differences, and rate ratios to compare the mortality differences between these populations.From 1999 to 2020 in the United States, there were 303 267 esophageal cancer deaths, with significant racial disparities. The age‐adjusted mortality rate for Black adults fell from 6.52 to 2.62 per 100 000, while for White adults, it declined from 4.19 to 3.97 per 100 000, narrowing the racial mortality gap. Gender‐wise, the study showed a decrease in the mortality rate from 3.31 to 2.29 per 100 000 in Black women, but an increase from 1.52 to 1.99 per 100 000 in White women. Among young men, the rate dropped in Black men from 12.82 to 6.26 per 100 000 but rose in White men from 9.90 to 10.57 per 100 000. Regionally, Black adults in the Midwest and South initially had higher mortality rates than Whites, but this gap reduced over time. By 2020, Black men had lower mortality rates across all regions.Over the last two decades, age‐adjusted esophageal cancer mortality decreased in Black adults but stabilized in White adults, reflecting distinct cancer trends and risk factors. The study highlights the importance of tailored public health strategies for healthcare access and risk factor management. [ABSTRACT FROM AUTHOR]