Diabetes, Obesity, and Osteoporosis in an Ethnically Diverse Population of Women Receiving Osteoporosis Screening

Abstract Osteoporosis screening by bone density (BMD) testing is recommended for women aged 65-75 years. However, patients with diabetes, a risk factor for fracture, often have higher body mass index (BMI) which contributes to higher BMD. These factors may vary by race/ethnicity. The relationship of diabetes (≥2 diagnoses and treatment), obesity (BMI ≥30), and BMD-defined osteoporosis (femoral neck BMD T-score ≤ -2.5) was examined in a diverse primary care population of 44,313 non-Hispanic White, 6,103 Black, 7,777 Hispanic, and 12,634 Asian women aged 65-75 years who underwent BMD screening. Those with recent fracture, osteoporosis treatment, bone disorders, and metastatic cancer were excluded. Modified log-Poisson regression was used to examine the association of diabetes and BMD-osteoporosis. Among 70,827 women, 18% had diabetes. The prevalence of diabetes was 2-fold higher in Black, Hispanic and Asian women compared to White women. Overall, women with diabetes (versus no diabetes) were more likely to be obese and, except for Hispanic women, less likely to have BMD-osteoporosis. In unadjusted analyses, diabetes was associated with lower risk of BMD-defined osteoporosis in White, Black, and Asian women, but not Hispanic women. However, the association was attenuated or no longer evident after adjusting for BMI, suggesting that the lower burden of BMD-osteoporosis in women with diabetes is mediated in part by higher BMI. These findings support consideration of diabetes when assessing fracture risk in women undergoing osteoporosis screening. However, more studies in non-White populations with a high burden of diabetes are important since these relationships appear to differ by race/ethnicity.

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Abstract MP66: Social Determinants And Co-morbid Conditions In Women Of Child-bearing Age With Hypertension From 2001-2018

Hypertension ◽

10.1161/hyp.78.suppl_1.mp66 ◽

2021 ◽

Vol 78 (Suppl_1) ◽

Author(s):

Lara C Kovell ◽

Claire Meyerovitz ◽

Didem Ayturk ◽

Stephen P Juraschek ◽

Tiffany A Moore Simas ◽

...

Keyword(s):

Black Women ◽

Social Determinants ◽

White Women ◽

Hispanic Women ◽

Private Insurance ◽

Anthropometric Measures ◽

Mortality And Morbidity ◽

Child Bearing ◽

Race Ethnicity ◽

Morbid Conditions

Introduction: Hypertension (HTN) is the most important modifiable risk factor of serious maternal mortality and morbidity. Social determinants, including economic stability and access to healthcare, influence HTN outcomes and are critical to understanding and addressing racial and ethnic differences in HTN control. Objective: To assess social determinants and co-morbidities in US women of child-bearing age with HTN by race/ethnicity Methods: We studied women (age 20-50) with HTN in the National Health and Nutrition Examination Surveys 2001-2018. Social determinants and co-morbid conditions were examined in groups categorized by race/ethnicity - Non-Hispanic White (White), Non-Hispanic Black (Black), and Hispanic. Demographics, anthropometric measures, and co-morbid conditions were compared with White women as reference. Results: In all women with HTN, the mean (SE) age was 36.0 (0.3) years and 63% were on BP medication. Compared to white women, Black and Hispanic women had lower food security, poverty income ratio, smoking use, and private insurance (all p<0.0001, Table ). Black women had higher BP medication use, BMI, and BP compared to White women (all p<0.0001). Hispanic women had higher rates of diabetes (p=0.009) and no place to go for healthcare (p=0.005) compared to White women. Food insecurity was present in 34% of Hispanic women. Conclusions: Despite effective diagnostics and therapy, health inequity is common in women of child-bearing age with HTN, with differences by race/ethnicity in social determinants and co-morbid conditions. Each racial/ethnic group with HTN brings social determinants and comorbid conditions important for providers to recognize.

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Abstract MP046: Gestational Hypertension in Minorities: Can Racial and Ethnic Disparities Be Attributed to Socio-Economic Status?

Circulation ◽

10.1161/circ.125.suppl_10.amp046 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Alexander V Sergeev ◽

Christina M Nyirati

Keyword(s):

White Women ◽

Gestational Hypertension ◽

Economic Status ◽

Ethnic Disparities ◽

Asian Women ◽

Low Ses ◽

Racial And Ethnic Disparities ◽

Socio Economic Status ◽

Race Ethnicity ◽

Hispanic White

Background: Gestational hypertension (GHTN) remains a compelling clinical and public health problem. It can increase risks of intrauterine growth restriction, low-birth weight, and stillbirth. Little is known about whether racial and ethnic minorities and lower socio-economic status (SES) population groups are more vulnerable to GHTN. Hypothesis: We hypothesized that racial and ethnic disparities in GHTN exist beyond the scope of SES-related health disparities. Methods: A case-control study of GHTN was conducted using the data of 114,298 births in the year 2010 in Ohio. The comprehensive births data were obtained from Ohio Department of Health. Cases were identified as those with GHTN. Controls were identified as those without GHTN. Mothers utilizing Medicaid or the Federal Special Supplemental Nutrition Program for Women, Infants and Children were considered of low SES. Odds ratios of GHTN in relation to mother’s race, ethnicity, and SES were obtained using multivariable logistic regression (SAS software), adjusting for known confounders - gestational age, mother’s age, pre-pregnancy and pregnancy smoking status, pre-pregnancy or gestational diabetes, and plurality. Results: GHTN was statistically significantly associated with maternal race and ethnicity, even after adjustment for SES. Compared to non-Hispanic whites, non-Hispanic blacks were more likely to develop GHTN (adjusted OR = 1.867, 95% CI 1.663–2.096, p<0.001), while Asian women were less likely to develop GHTN (adjusted OR = 0.538, 95% CI 0.426–0.679, p<0.001). Hispanic white women were less likely to develop GHTN than non-Hispanic white women, although the difference between them did not reach a conventional p<0.05 level of statistical significance (adjusted OR = 0.651, 95% CI 0.395–1.076, p=0.09). Adjusted for maternal race, ethnicity, age, and known clinical confounders, women of lower SES were more likely to develop GHTN (adjusted OR = 1.475, 95% CI 1.32–1.647, p<0.001). Conclusions: Non-Hispanic black women are at the highest risk of developing GHTN, while Asian women are at the lowest. The Hispanic paradox phenomenon extends to the issue of GHTN. Racial and ethnic disparities cannot be attributed to low SES only; other mechanisms need to be investigated further.

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New onset of restless legs syndrome in pregnancy in a prospective multiracial cohort

Neurology ◽

10.1212/wnl.0000000000011082 ◽

2020 ◽

Vol 95 (24) ◽

pp. e3438-e3447

Author(s):

Muzi Na ◽

Jing Wu ◽

Mengying Li ◽

Stefanie N. Hinkle ◽

Cuilin Zhang ◽

...

Keyword(s):

Risk Factors ◽

Black Women ◽

Restless Legs Syndrome ◽

White Women ◽

Hispanic Women ◽

Nutritional Factors ◽

Restless Legs ◽

Relative Risks ◽

Race Ethnicity ◽

In Pregnancy

ObjectiveTo determine whether the incidence and risk factors of restless legs syndrome (RLS) in pregnancy differ by race/ethnicity, we estimated relative risks of demographic, socioeconomic, and nutritional factors in association with risk of any incident RLS in pregnancy in a cohort of 2,704 healthy pregnant women without prior RLS.MethodsUsing data from the multicenter, multiracial National Institute of Child Health and Human Development (NICHD) Fetal Growth Studies–Singletons, we examined the incidence of RLS from early pregnancy to near delivery through up to 6 assessments. Multivariable Poisson models with robust variance were applied to estimate relative risks (RRs).ResultsThe cumulative incidence of RLS in pregnancy was 18.1% for all women, 20.3% for White women, 15.4% for Black women, 17.1% for Hispanic women, and 21.1% for Asian women. Among Hispanic women, older age (RR [reference ≤25 years]: 25–35 years, 1.51; 95% confidence interval [CI] 1.05–2.16; ≥35 years, 1.58; 95% CI 0.93–2.68), anemia (RR [reference no]: yes, 2.47; 95% CI 1.31–4.64), and greater total skinfolds of the subscapular and triceps sites, independent of body mass index (RR [reference quartile 1]: quartile 5, 2.54; 95% CI 1.30–4.97; p trend = 0.01) were associated with higher risk of RLS, while multiparity was associated with a lower risk (RR [reference nulliparity]: 0.69; 95% CI 0.50–0.96). In Black women, greater skinfolds and waist circumference were associated with higher risk of pregnancy RLS, although the trends were less clear.ConclusionsThe incidence of RLS in pregnancy was high and differed by race/ethnicity, which is likely accounted for by differences in other risk factors, such as age, parity, and nutritional factors.

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Disparities at the Intersection of Race and Ethnicity: Examining Trends and Outcomes in Hispanic Women With Breast Cancer

JCO Oncology Practice ◽

10.1200/op.20.00381 ◽

2020 ◽

pp. OP.20.00381

Author(s):

Cosette D. Champion ◽

Samantha M. Thomas ◽

Jennifer K. Plichta ◽

Edgardo Parrilla Castellar ◽

Laura H. Rosenberger ◽

...

Keyword(s):

Breast Cancer ◽

Black Women ◽

Racial Differences ◽

White Women ◽

Hispanic Women ◽

Hazard Ratio ◽

Tumor Subtype ◽

Hispanic Patients ◽

Race Ethnicity ◽

Hispanic White

PURPOSE: We sought to examine tumor subtype, stage at diagnosis, time to surgery (TTS), and overall survival (OS) among Hispanic patients of different races and among Hispanic and non-Hispanic (NH) women of the same race. METHODS: Women 18 years of age or older who had been diagnosed with stage 0-IV breast cancer and who had undergone lumpectomy or mastectomy were identified in the National Cancer Database (2004-2014). Tumor subtype and stage at diagnosis were compared by race/ethnicity. Multivariable linear regression and Cox proportional hazards modeling were used to estimate associations between race/ethnicity and adjusted TTS and OS, respectively. RESULTS: A total of 44,374 Hispanic (American Indian [AI]: 79 [0.2%]; Black: 1,011 [2.3%]; White: 41,126 [92.7%]; Other: 2,158 [4.9%]) and 858,634 NH women (AI: 2,319 [0.3%]; Black: 97,206 [11.3%]; White: 727,270 [84.7%]; Other: 31,839 [3.7%]) were included. Hispanic Black women had lower rates of triple-negative disease (16.2%) than did NH Black women (23.5%) but higher rates than did Hispanic White women (13.9%; P < .001). Hispanic White women had higher rates of node-positive disease (23.2%) versus NH White women (14.4%) but slightly lower rates than Hispanic (24.6%) and NH Black women (24.5%; P < .001). Hispanic White women had longer TTS versus NH White women regardless of treatment sequence (adjusted means: adjuvant chemotherapy, 42.71 v 38.60 days; neoadjuvant chemotherapy, 208.55 v 201.14 days; both P < .001), but there were no significant racial differences in TTS among Hispanic patients. After adjustment, Hispanic White women (hazard ratio, 0.77 [95% CI, 0.74 to 0.81]) and Black women (hazard ratio, 0.75 [95% CI, 0.58 to 0.96]) had improved OS versus NH White women (reference) and Black women (hazard ratio, 1.15 [95% CI, 1.12 to 1.18]; all P < .05). CONCLUSION: Hispanic women had improved OS versus NH women, but racial differences in tumor subtype and nodal stage among Hispanic women highlight the importance of disaggregating racial/ethnic data in breast cancer research.

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Disparities in ART Live Birth and Cumulative Live Birth Outcomes for Hispanic and Asian Women Compared to White Non-Hispanic Women

Journal of Clinical Medicine ◽

10.3390/jcm10122615 ◽

2021 ◽

Vol 10 (12) ◽

pp. 2615

Author(s):

Alexander M. Kotlyar ◽

Burcin Simsek ◽

David B. Seifer

Keyword(s):

Live Birth ◽

White Women ◽

Hispanic Women ◽

Asian Women ◽

Multivariate Logistic Regression ◽

Asian Patients ◽

Prior Art ◽

Cumulative Live Birth ◽

Nulliparous Women ◽

History Of

BACKGROUND: Conflicting disparities have been seen in assisted reproductive technology (ART) outcomes for Hispanic and Asian women compared to white, non-Hispanic (WNH) women. We, therefore, sought to clarify these disparities and calculated cumulative live birth rates (CLBR) for these racial or ethnic groups using the SARTCORS database. METHODS: We performed an analysis of the 2014–2016 SARTCORS database for member clinics doing at least 50 cycles of ART each year. RESULTS: In comparison to cycles in WNH women, cycles in Hispanic and Asian patients were in older (p < 0.001), more nulliparous women, that were less likely to have a history of endometriosis compared WNH women regardless of prior ART status. ART cycles in Hispanic and Asian women, exhibited lower rates of live birth (LB) per cycle start (p < 0.001) compared to cycles in WNH women. Multivariate logistic regression demonstrated that cycles from Hispanic and Asian women were less likely to have a LB and CLBR than white women (OR 0.86; p = 0.004, OR 0.69; p < 0.001, respectively) independent of age, parity, BMI, etiology of infertility, use of ICSI or number of embryos transferred. CONCLUSIONS: Race or ethnicity continues to be an independent prognostic factor for LB and CLBR for ART. Additional analysis of trends among Hispanic and Asian women is warranted to enable addressing disparities in outcomes in ART treatment.

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Racial and Ethnic Disparities in Maternal and Infant Outcomes Among Opioid-Exposed Mother–Infant Dyads in Massachusetts (2017–2019)

American Journal of Public Health ◽

10.2105/ajph.2020.305888 ◽

2020 ◽

Vol 110 (12) ◽

pp. 1828-1836

Author(s):

Mary Peeler ◽

Munish Gupta ◽

Patrice Melvin ◽

Allison S. Bryant ◽

Hafsatou Diop ◽

...

Keyword(s):

Black Women ◽

White Women ◽

Hispanic Women ◽

Ethnic Disparities ◽

Opioid Use Disorder ◽

Opioid Use ◽

Infant Outcomes ◽

Race Ethnicity ◽

Hispanic White ◽

Maternal Race

Objectives. To examine the extent to which differences in medication for opioid use disorder (MOUD) in pregnancy and infant neonatal opioid withdrawal syndrome (NOWS) outcomes are associated with maternal race/ethnicity. Methods. We performed a secondary analysis of a statewide quality improvement database of opioid-exposed deliveries from January 2017 to April 2019 from 24 hospitals in Massachusetts. We used multivariable mixed-effects logistic regression to model the association between maternal race/ethnicity (non-Hispanic White, non-Hispanic Black, or Hispanic) and prenatal receipt of MOUD, NOWS severity, early intervention referral, and biological parental custody at discharge. Results. Among 1710 deliveries to women with opioid use disorder, 89.3% (n = 1527) were non-Hispanic White. In adjusted models, non-Hispanic Black women (AOR = 0.34; 95% confidence interval [CI] = 0.18, 0.66) and Hispanic women (AOR = 0.43; 95% CI = 0.27, 0.68) were less likely to receive MOUD during pregnancy compared with non-Hispanic White women. We found no statistically significant associations between maternal race/ethnicity and infant outcomes. Conclusions. We identified significant racial/ethnic differences in MOUD prenatal receipt that persisted in adjusted models. Research should focus on the perspectives and treatment experiences of non-Hispanic Black and Hispanic women to ensure equitable care for all mother–infant dyads.

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ETHNICITY, DEPRESSION, AND FUNCTIONAL OUTCOMES IN OLDER WOMEN

Innovation in Aging ◽

10.1093/geroni/igz038.2253 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S605-S605

Author(s):

Cassandra M Germain

Keyword(s):

Depressive Symptoms ◽

Older Women ◽

Functional Impairment ◽

Functional Outcomes ◽

White Women ◽

Hispanic Women ◽

Functional Limitations ◽

Prevalence Rates ◽

Race Ethnicity ◽

Retirement Study

Abstract Women continue to have higher prevalence rates of functional impairment and depressive symptoms than men. In addition, women from certain ethnic groups experience disproportionately higher rates of ADL limitation, and are less likely to be screened for depression. The current study examines the association between race/ethnicity and depressive symptoms on functional limitations in Black, White and Hispanic women. We examined prevalence and adjusted odds of ADL limitations by race in n=9,846 women aged 50+ with low (CESD <4) and high (CESD =>4) depressive symptoms from the 2014 wave of the Health and Retirement Study. Overall, Black and Hispanic women had significantly higher rates of depression (p <.001) and ADL limitations (p<.001) than White women. Among those with high depressive symptoms, Black OR 1.98 [1.17, 3.34] and Hispanic OR 2.82 [1.42, 5.6] women have significantly higher rates of ADL limitations as compared to White women.

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Race-Ethnicity and Medical Services for Infertility

Journal of Health and Social Behavior ◽

10.1177/0022146511418236 ◽

2011 ◽

Vol 52 (4) ◽

pp. 493-509 ◽

Cited By ~ 57

Author(s):

Arthur L. Greil ◽

Julia McQuillan ◽

Karina M. Shreffler ◽

Katherine M. Johnson ◽

Kathleen S. Slauson-Blevins

Keyword(s):

Women Of Color ◽

White Women ◽

Hispanic Women ◽

Private Insurance ◽

The United States ◽

Medical Services ◽

Reproductive Control ◽

Stratified Reproduction ◽

Race Ethnicity ◽

Levels Of Service

Evidence of group differences in reproductive control and access to reproductive health care suggests the continued existence of “stratified reproduction” in the United States. Women of color are overrepresented among people with infertility but are underrepresented among those who receive medical services. The authors employ path analysis to uncover mechanisms accounting for these differences among black, Hispanic, Asian, and non-Hispanic white women using a probability-based sample of 2,162 U.S. women. Black and Hispanic women are less likely to receive services than other women. The enabling conditions of income, education, and private insurance partially mediate the relationship between race-ethnicity and receipt of services but do not fully account for the association at all levels of service. For black and Hispanic women, social cues, enabling conditions, and predisposing conditions contribute to disparities in receipt of services. Most of the association between race-ethnicity and service receipt is indirect rather than direct.

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Variation in Attitudes toward Being a Mother by Race/Ethnicity and Education among Women in the United States

Sociological Perspectives ◽

10.1177/0731121416662452 ◽

2016 ◽

Vol 60 (3) ◽

pp. 600-619 ◽

Cited By ~ 3

Author(s):

Veronica Tichenor ◽

Julia McQuillan ◽

Arthur L. Greil ◽

Andrew V. Bedrous ◽

Amy Clark ◽

...

Keyword(s):

Black Women ◽

White Women ◽

Hispanic Women ◽

The United States ◽

Relationship Type ◽

Raising Children ◽

Number Of Children ◽

Positive Attitudes ◽

Race Ethnicity ◽

Attitudes Toward Motherhood

Do differences in experiences of motherhood (e.g., number of children, age at first child, and relationship type) by race/ethnicity and social class mean that attitudes toward motherhood also vary by social location? We examine attitudes toward being a mother among black, Hispanic, Asian, and white women of higher and lower socioeconomic status (SES, as measured by education). Results using the National Survey of Fertility Barriers ( N = 4,796) indicate that, despite fertility differences, attitudes toward being a mother differ little between groups. White and Asian women have higher positive attitudes toward being a mother than black and Hispanic women. Only black women appear to distinguish between having and raising children; surprisingly, lower educated Hispanic women are less likely to think that they would be a mother, see motherhood as fulfilling, and think that it is important to have and to raise children compared with higher educated, white women.

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Prevalence and Time of Diagnosis of Endometriosis across Racial and Ethnic Groups in the US

10.1101/2021.07.28.21261303 ◽

2021 ◽

Author(s):

Rui Li ◽

Donna A Kreher ◽

Ashley L Gubbels ◽

Amy R Benjamin

Keyword(s):

Ethnic Groups ◽

White Women ◽

Hispanic Women ◽

The Other ◽

Future Research ◽

Socioeconomic Indicators ◽

Cross Sectional ◽

The Us ◽

Race Ethnicity ◽

Hispanic White

Background: Endometriosis is associated with substantial adverse health and psychosocial consequences. However, the prevalence of endometriosis across different racial and ethnic groups in the US has not been established and to what extent the difference in prevalence might be associated with systemic barriers to receiving the diagnosis is unknown. We aimed to estimate the prevalence of endometriosis across different racial and ethnic groups and examine the association between race/ethnicity and the time of diagnosis. Methods: Using cross-sectional data from the National Health and Nutrition Examination Survey 1999-2006, we estimated race/ethnicity-specific prevalence of self-reported diagnosis of endometriosis among 5,557 women aged 20-54 years. Multivariable generalized linear regression model examined the association between race/ethnicity and the age of endometriosis diagnosis, accounting for socioeconomic indicators, health insurance, lifestyle and reproductive characteristics. Results: Endometriosis was prevalent in 9.0% overall, 11.1% among non-Hispanic white, 5.8% among non-Hispanic black, 2.7% among Hispanic, and 6.4% among the other racial and ethnic groups combined. The mean age of endometriosis diagnosis was 29.0 years (range 13-52). Compared with non-Hispanic white, non-Hispanic black women were diagnosed on average at 2.6 years older (95% confidence interval [CI], 0.5-4.6), Hispanic women 3.8 years older (95% CI, 1.5-6.2), and women in the other group 1.0 years younger (95% CI, -4.6 to 2.5). Conclusions: Prevalence of endometriosis varied across different racial and ethnic groups. Among women with a diagnosis of endometriosis, black and Hispanic women were diagnosed at older ages than non-Hispanic white women. Future research is needed to determine whether such age disparity in endometriosis diagnosis persists.

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