RATES OF DISENROLLMENT FROM MEDICARE MANAGED CARE PLANS ARE HIGHER AMONG RACIAL, ETHNIC, AND LINGUISTIC MINORITIES

Abstract Voluntary disenrollment from Medicare managed care (Medicare Advantage; MA) plans is related to beneficiaries’ negative experiences with their plan, disrupts continuity of care, and conflicts with goals to reduce Medicare costs. Information on associated factors may help illuminate the dynamics that drive decisions to disenroll. We used data from 17,517,852 beneficiaries enrolled in 736 MA plans in 2015 to investigate differences in rates of disenrollment by race, ethnicity, and preferred language. Disenrollment data came from Medicare’s enrollment system. Social Security Administration data on race and ethnicity were augmented with surname, address, and other Medicare administrative data to calculate probabilities of membership in seven race/ethnicity/language-preference groups: White, Black, English-preferring Hispanic, Spanish-preferring Hispanic, Asian or Pacific Islander (API), American Indian or Alaska Native, and multiracial. We summarized disparities across groups using regression models with and without plan intercepts, controlling for gender, disability, and Medicaid eligibility. Adjusted rates of disenrollment were significantly higher for Spanish-preferring Hispanics (19.1%), Blacks (10.2%), and APIs (9.4%) than for Whites (7.7%), and significantly lower for English-preferring Hispanics (7.4%, p’s<0.001). Within-plan disparities accounted for only a small fraction of overall disparities, indicating that Spanish-preferring Hispanics, Blacks, and APIs tended to be enrolled in plans with higher disenrollment than plans in which Whites were enrolled, whereas English-preferring Hispanics tended to be enrolled in plans with lower disenrollment. These between-plan differences may indicate that high-minority-enrollment plans less effectively inform beneficiaries about the cost and coverage of care or that racial/ethnic/linguistic minorities more often select plans that raise rates or restrict coverage.

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A Systematic Review of Parenting Scales Measurement Invariance/Equivalence of by Race and Ethnicity: Recommendations for Inclusive Parenting Research

Assessment ◽

10.1177/10731911211038630 ◽

2021 ◽

pp. 107319112110386

Author(s):

Violeta J. Rodriguez ◽

Dominique L. La Barrie ◽

Miriam C. Zegarac ◽

Anne Shaffer

Keyword(s):

Systematic Review ◽

Measurement Invariance ◽

Ethnic Minorities ◽

Race And Ethnicity ◽

Parenting Practices ◽

The United States ◽

Weak Evidence ◽

Race Ethnicity ◽

Development And Validation ◽

Racial Ethnic

The limited inclusion of racial/ethnic minorities in the development and validation of parenting measures limits our understanding of whether parenting constructs are valid in racial and ethnic minorities. Tests of measurement invariance/equivalence (MI/E) of parenting measures can help evaluate the validity of parenting constructs among racial/ethnic minorities. This systematic review summarized studies on MI/E of parenting constructs by race/ethnicity and evaluated the strength of the evidence. A literature search was conducted using various databases and references to retrieve studies from the United States. Indeed, 10 studies were identified that tested for MI/E of eight parenting scales by race/ethnicity. Only one scale showed moderate evidence of MI/E, five showed weak evidence of MI/E, and two showed no evidence of MI/E. Most studies (80%) used factor analytic methods to test for MI/E, but only two studies (20%) examined all levels of invariance. These findings show that differences exist in how racial/ethnic minorities perceive parenting constructs. Further research is needed to develop more inclusive parenting measures, to protect against the ways in which biased measures may pathologize or misrepresent parenting practices among racial/ethnic minorities.

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How Administrative Data Collection and Analysis Can Better Reflect Racial and Ethnic Identities

Review of Research in Education ◽

10.3102/0091732x20903321 ◽

2020 ◽

Vol 44 (1) ◽

pp. 301-331

Author(s):

Samantha Viano ◽

Dominique J. Baker

Keyword(s):

Data Collection ◽

Administrative Data ◽

Race And Ethnicity ◽

Ethnic Disparities ◽

Ethnic Identities ◽

Birth Certificates ◽

Data Sets ◽

Race Ethnicity ◽

Equivalent Sources ◽

Racial Ethnic

Measuring race and ethnicity for administrative data sets and then analyzing these data to understand racial/ethnic disparities present many logistical and theoretical challenges. In this chapter, we conduct a synthetic review of studies on how to effectively measure race/ethnicity for administrative data purposes and then utilize these measures in analyses. Recommendations based on this synthesis include combining the measure of Hispanic ethnicity with the broader racial/ethnic measure and allowing individuals to select more than one race/ethnicity. Data collection should rely on self-reports but could be supplemented using birth certificates or equivalent sources. Collecting data over time, especially for young people, will help identify multiracial and American Indian populations. For those with more complex racial/ethnic identities, including measures of country of origin, language, and recency of immigration can be helpful in addition to asking individuals which racial/ethnic identity they most identify with. Administrative data collection could also begin to incorporate phenotype measures to facilitate the calculation of disparities within race/ethnicity by skin tone. Those analyzing racial/ethnic disparities should understand how these measures are created and attempt to develop fieldwide terminology to describe racial/ethnic identities.

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Race and ethnicity on MS presentation and disease course

Multiple Sclerosis Journal ◽

10.1177/1352458519887328 ◽

2020 ◽

Vol 26 (5) ◽

pp. 561-567

Author(s):

Lilyana Amezcua ◽

Jacob L McCauley

Keyword(s):

African Americans ◽

Race And Ethnicity ◽

Ethnic Disparities ◽

European Ancestry ◽

Mortality Trends ◽

Ethnic Populations ◽

Specific Mortality ◽

Future Challenges ◽

Race Ethnicity ◽

Racial Ethnic

Multiple sclerosis (MS) has a strong racial and ethnic component and disproportionately affects whites of European background. Recent incidence reports suggest an increasing rate of MS among African Americans compared with whites. Despite this recent increase in MS in African Americans, Hispanics and Asians are significantly less likely to develop MS than whites of European ancestry. MS-specific mortality trends demonstrate distinctive disparities by race/ethnicity and age, suggesting that there is an unequal burden of disease. Inequalities in health along with differences in clinical characteristics that may be genetic, environmental, and social in origin may be contributing to disease variability and be suggestive of endophenotypes. The overarching goal of this review was to summarize the current understanding on the variability of disease that we observe in selected racial and ethnic populations: Hispanics and African Americans. Future challenges will be to unravel the genetic, environmental, and social determinants of the observed racial/ethnic disparities.

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Judicial Diversity in France: The Unspoken and the Unspeakable

Law & Social Inquiry ◽

10.1111/lsi.12331 ◽

2018 ◽

Vol 43 (04) ◽

pp. 1542-1573 ◽

Cited By ~ 4

Author(s):

Mathilde Cohen

Keyword(s):

Race And Ethnicity ◽

Qualitative Data ◽

The United States ◽

Future Research ◽

Sexual Diversity ◽

Legal Professionals ◽

The Third ◽

Race Ethnicity ◽

Racial Ethnic ◽

Shed Light

Despite the importance of judicial diversity for litigants and the broader public, no previous study has examined this issue within the French judiciary. This article begins to fill this gap by using original, qualitative data that shed light on judges’, prosecutors', and other legal actors' discourses on racial, ethnic, and sexual diversity. Its main contribution is to show that these legal professionals deploy three strategies—linguistic, institutional, and geographic—to dodge or downplay the relevance of race, ethnicity, and sexual orientation. The first, linguistic, form of avoidance lies in refusing to name and discuss race and ethnicity explicitly; the second, institutional, in denying that the judiciary has a diversity problem or that the problem lies within its power; and the third, geographic, consists in relegating the issue of diversity to distant places—the United States and overseas France. The article concludes by discussing key directions for future research.

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Latinx children’s race- and ethnicity-related identities, beliefs, and preferences

Group Processes & Intergroup Relations ◽

10.1177/13684302211050553 ◽

2021 ◽

pp. 136843022110505

Author(s):

Amber D. Williams ◽

Rebecca S. Bigler ◽

M. Chantal Ramirez

Keyword(s):

Social Distance ◽

Race And Ethnicity ◽

Theoretical Models ◽

Policy Recommendations ◽

White Children ◽

Best Friends ◽

Positive Attitudes ◽

Age Related ◽

Race Ethnicity ◽

Racial Ethnic

The study of Latinx children’s race- and ethnicity-related identity, beliefs, and preferences has the potential to contribute to theoretical models and policy recommendations concerning intergroup attitudes and relations. We examined a host of such constructs among Latinx children ( N = 61; 72% girls) living in the Southwest US, ranging from 6 to 11 years ( M = 8.45, SD = 1.39). With the goal of assessing individual, group, and age-related variation within—and relations across—measures, we assessed racial/ethnic: (a) identity (i.e., self-categorization, centrality), (b) beliefs (stereotypes, perceived parental social distance), and (c) preferences (friendship choices, social distance). Results indicated that children held more positive attitudes toward Latinx and White children than toward Black children. Children who felt more comfortable around Latinx individuals had more Latinx best friends, and those children who felt that race/ethnicity was an important part of their identity were more likely to report having no Black best friends, suggesting that parents and teachers should discuss race/ethnicity in ways that dispel potential anti-Black prejudice and encourage cross-race/ethnicity friendship.

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The problematization of racial/ethnic minority student participation in U.S. study abroad

Applied Linguistics Review ◽

10.1515/applirev-2013-0016 ◽

2013 ◽

Vol 4 (2) ◽

pp. 365-390 ◽

Cited By ~ 12

Author(s):

M'Balia Thomas

Keyword(s):

Study Abroad ◽

Language Learning ◽

Ethnic Minority ◽

Minority Students ◽

Race And Ethnicity ◽

Minority Student ◽

Study Abroad Programs ◽

Ethnic Minority Students ◽

Race Ethnicity ◽

Racial Ethnic

AbstractWithin U.S. higher education, there has been concern expressed about the underrepresentation of racial/ethnic minority students in U.S. study abroad programs. Though as a whole these students participate in study abroad at lower rates than their Caucasian counterparts, the fact that study abroad participation is even problematized by race/ethnicity (rather than other social categories such as gender, socioeconomic status or field of study) and the manner by which this is done warrant critical investigation. Drawing upon Foucault's concept of problematization (1984, 1988), this paper examines the discourses and practices (both discursive and nondiscursive) that mark current study abroad literature in which participation by U.S. undergraduates is tracked, categorized and ranked by race and ethnicity. It further problematizes the taken-for-granted assumptions that masquerade as truths and inhabit the methodological and analytical practices that govern research on racial and ethnic minority students, and in the process, uncovers an overarching code of thought that permeates the literature. Ultimately, this paper seeks to challenge the “truths” and counter the assumptions upon which this code of thought is based by highlighting those voices only marginally recognized in study abroad participation literature. These voices provide a local and contextualized perspective on the factors contributing to the lower rates of participation among one racial/ethnic minority category: African Americans. Although the paper does not take up the topic of language learning in study abroad contexts, it does present the real world challenge of language-in-use. It addresses the material and subject effects that a problematization of study abroad participation by race/ethnicity has on students, research practices, institutional and governmental policies, and the allocation of resources related to language study and the promotion and support of study abroad.

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Exploring Bias in Student Evaluations: Gender, Race, and Ethnicity

Political Science and Politics ◽

10.1017/s1049096519001744 ◽

2019 ◽

Vol 53 (2) ◽

pp. 270-274 ◽

Cited By ~ 2

Author(s):

Kerry Chávez ◽

Kristina M.W. Mitchell

Keyword(s):

Race And Ethnicity ◽

Online Courses ◽

Student Evaluations ◽

Student Evaluations Of Teaching ◽

Gender And Race ◽

White Males ◽

Quasi Experimental ◽

Race Ethnicity ◽

And Gender ◽

Racial Ethnic

ABSTRACTResearch continues to accumulate showing that in instructor evaluations students are biased against women. This article extends these analyses by examining the dynamics between evaluations and gender and race/ethnicity. In a quasi-experimental design, faculty members teaching identical online courses recorded welcome videos that were presented to students at the course onset, constituting the sole exposure to perceived gender and race/ethnicity. This enables exploration of whether and to what degree the instructors’ characteristics influenced student evaluations, even after holding all other course factors constant. Findings show that instructors who are female and persons of color receive lower scores on ordinal student evaluations than those who are white males. Overall, we add further evidence to a growing literature calling for student evaluations of teaching (SETs) reform and extend it to encompass the effects on racial/ethnic minorities in addition to women.

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232 COVID stress and sleep disturbance among a racially/ethnically diverse sample of adolescents: Analysis from the NESTED study

SLEEP ◽

10.1093/sleep/zsab072.231 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A92-A93

Author(s):

Azizi Seixas ◽

Sarah Honaker ◽

Amy Wolfson ◽

Kyla Wahlstrom ◽

Judith Owens ◽

...

Keyword(s):

Sleep Disturbance ◽

Ethnic Groups ◽

Alaska Native ◽

Social Vulnerability ◽

Online Survey ◽

Social Vulnerability Index ◽

Race Ethnicity ◽

Related Stress ◽

Chi Square Analysis ◽

Racial Ethnic

Abstract Introduction Using data from the Nationwide Education and Sleep in TEens During COVID (NESTED) study (N=6,578), we investigated if race/ethnicity (64.6% were White and 35.4% identified as a racial/ethnic minority, mixed, or “other”) and community social vulnerability affected the association between COVID stress and sleep disturbance. Methods Data on sociodemographic factors (age, race, sex, grade, zip code [for neighborhood social vulnerability index, SVI]), COVID-related stress, depression, anxiety, instructional format (online, in-person, or hybrid), and sleep disturbance (PROMIS Pediatric Sleep Disturbance) were captured through an online survey. Descriptive and inferential analyses (Hierarchical Binary Logistic Regression (HBLR), SPSS v. 25) in 4171 adolescents examined associations between sleep disturbance and COVID-related stress, adjusting for race, sex, SVI, grade level, learning format, household density, and mental health factors. Results Sleep disturbance was prevalent among adolescents (89% above average, T-score >50); about two-thirds (64.4%) reported greater stress due to the pandemic. Compared to White (88.5%) adolescents, sleep disturbance was more common in Black (91.2%), Hispanic (90.5%), American Indian/Alaska native (95.1%), and Mixed (92.3%) and less common in Asian (83.9%) adolescents. Chi-square analysis indicated that both race/ethnicity (□2 = 14.96, p<.05) and SVI (□2 = 8.34, p<.05) had an effect on sleep disturbance. HBLR analysis indicated that compared to pre-pandemic, adolescents reporting “little stress” (OR=.70, 95% CI= .49-.99, p=.04) or “the “same amount of stress” (OR=.64, 95% CI= .47-.89, p=.007) had lower odds of sleep disturbance. Higher depression (OR=1.06, 95% CI=1.04-1.07, p<.001) and anxiety (OR=1.05, 95% CI=1.04-1.07, p<.001) symptoms increased odds of sleep disturbance, while male gender lowered odds of sleep disturbance (OR=.11, 95% CI=.015-.86, p<.05). Overall, race/ethnicity (p=.44) and SVI (p=.45) did not independently predict sleep disturbance. Race/ethnicity stratified analyses indicated that for Black and Hispanic adolescents, being in grades 11/ 12 and depression predicted sleep disturbance; and for Asian adolescents SVI and anxiety predicted sleep disturbance. Conclusion COVID-related stress and symptoms of depression and anxiety are associated with sleep disturbance. We observed differences in sleep disturbance across racial/ethnic groups and neighborhood social vulnerability strata, for specific racial/ethnic groups. Support (if any) AS was supported by funding from the NIH (K01HL135452, R01HL152453)

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Characteristics and Factors Associated with COVID-19 Infection, Hospitalization, and Mortality Across Race and Ethnicity

10.1101/2020.10.14.20212803 ◽

2020 ◽

Author(s):

Chengzhen L. Dai ◽

Sergey A. Kornilov ◽

Ryan T. Roper ◽

Hannah Cohen-Cline ◽

Kathleen Jade ◽

...

Keyword(s):

Mechanical Ventilation ◽

Hospital Mortality ◽

Health System ◽

Alaska Native ◽

Clinical Characteristics ◽

Hospital Death ◽

Increased Risk ◽

Hispanic Patients ◽

Race Ethnicity ◽

Racial Ethnic

BackgroundData on the characteristics of COVID-19 patients disaggregated by race/ethnicity remain limited. We evaluated the sociodemographic and clinical characteristics of patients across the major racial/ethnic groups and assessed their associations with COVID-19 outcomes.MethodsThis retrospective cohort study analyzed patients who were tested for SARS-CoV-2 in a large, integrated health system spanning California, Oregon, and Washington between March 1 and August 30, 2020. Sociodemographic and clinical characteristics were obtained from electronic health records. Odds of SARS-CoV-2 infection, COVID-19 hospitalization, and in-hospital death were assessed with multivariate logistic regression.Findings289,294 patients with known race/ethnicity were tested for SARS-CoV-2 by PCR, of whom 27.5% were non-White minorities. 15,605 persons tested positive, with minorities representing 58.0%. Disparities were widest among Hispanics, who represented 40.5% of infections but 12.8% of those tested. Hispanics were generally younger and had fewer comorbidities except diabetes than White patients. Of the 3,197 patients hospitalized, 58.9% were non-White. 459 patients died, of whom 49.8% were minorities. Racial/ethnic distributions of outcomes across the health system tracked with state-level statistics. Increase odds of testing positive and hospitalization were associated with all minority races/ethnicities except American Indian/Alaska Native. Highest odds of testing SARS-CoV-2 positive was for Hispanic patients (OR [95% CI]: 3.68 [3.52-3.84]) and highest odds of COVID-19 hospitalization was for Native Hawaiian/Pacific Islander patients (2.13 [1.48 - 3.06]). Hispanic patients also exhibited increased morbidity including need for mechanical ventilation. In multivariate modeling, Hispanic race/ethnicity was associated with increased odds of hospital mortality (1.75 [1.15-2.67]) among patients over age 70, but hospital mortality was not increased for any race/ethnicity sub-population in the multivariate model.InterpretationMajor healthcare disparities were evident, especially among Hispanics who tested positive at a higher rate, and despite younger in age, required excess hospitalization and need for mechanical ventilation compared to their expected demographic proportions. As characteristics of patients varying between race/ethnicity, targeted, culturally-responsive interventions are needed to address the increased risk of poor outcomes among minority populations with COVID-19.FundingBiomedical Advanced Research and Development Authority; National Center for Advancing Translational Sciences

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Analysis of potential disparities by race, ethnicity, and age in adult accruals to NCI National Clinical Trials Network (NCTN) breast, lung, prostate, and colorectal trials.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e18072 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e18072-e18072

Author(s):

Grace Mishkin ◽

Sarah Madhu Temkin ◽

Andrea Denicoff ◽

Elise C. Kohn ◽

Holly A. Massett ◽

...

Keyword(s):

Colorectal Cancer ◽

Elderly Patients ◽

Cancer Patients ◽

Alaska Native ◽

Group Treatment ◽

Race And Ethnicity ◽

Colorectal Cancers ◽

Treatment Trials ◽

Race Ethnicity ◽

Cancer Trials

e18072 Background: Previous studies have raised concerns about disparities in patient accrual to NCI cancer trials and how this could impact the generalizability of trial results. This study compared the demographics of patients enrolled in NCTN cancer trials to the incident US population. Methods: We analyzed US adult accruals aged 40 or older to NCTN breast, lung, prostate, and colorectal cancer treatment trials between the launch of the NCTN on 3/1/14 and 12/31/16. Accruals were compared to the proportion of patients with these cancers by race, ethnicity, and age in the US population estimated using census-adjusted SEER incidence data for 2010-2013. Results: There were 14,247 accruals across 56 NCTN group treatment trials in breast (39.7% of accruals), prostate (25.9%), lung (23.9%), and colorectal cancers (10.5%). Hispanic and black patients were underrepresented in prostate, lung, and colorectal trials, but overrepresented in breast trials (see table). American Indian/Alaska Native populations were slightly overrepresented in 3 of 4 disease areas, and Asian populations in 2 of 4. Elderly patients were underrepresented in breast, lung, and colorectal cancers, with the greatest disparities in colorectal cancer patients over age 70 (19% of accruals versus 48% of incident patients). However, prostate cancer patients aged 65 to 84 were overrepresented (46% versus 36%). Conclusions: Disparities in race and ethnicity between patients accrued to NCTN studies and the incident population were smaller than seen in previous studies. However, challenges remain in certain diseases, and particularly in enrollment of elderly patients. Improvement efforts should focus on key disparities. [Table: see text]

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