Abstract 217: Racial Disparities in Echocardiography Use Within The Veterans Administration and Medicare Systems

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Sheeva Rajaei ◽  
Peter Groeneveld ◽  
John Teerlink ◽  
Mary Whooley ◽  
Mintu Turakhia ◽  
...  
Keyword(s):  
Heart Failure ◽  
Native American ◽  
Native Americans ◽  
Racial Disparities ◽  
Veterans Administration ◽  
Limited Data ◽  
Medicare Data ◽  
Veterans Healthcare Administration ◽  
The Impact ◽  
To Receive

Background: There is increasing interest in understanding the factors that influence the use of diagnostic imaging in heart failure in US health systems. However, there is limited data examining overall use and the impact of racial disparities in the VA and Medicare. Methods: We analyzed Veterans Healthcare Administration (VA) and Medicare data from 2002 to 2009 to identify veteran patients above the age of sixty-five with a diagnosis of heart failure for at least 1 year. Patients receiving care in both systems were excluded. We examined patients undergoing echocardiography and scintigraphy each year by race and system of care. Multivariate logistic regression analyses were performed adjusting for age, gender and comorbidities. Results: A total of 2,917,307 veteran patients were included (263,778 in VA and 1,698,497 in Medicare). Overall use of echocardiography each year was 45.6% for Whites, 51.9% for Asians, 43.2% for Blacks, 39.7% for Hispanics, 42.0% for Pacific Islanders, 40.9% for Native-American and 48.1% for Other. The adjusted odds ratio of undergoing echocardiography was higher for Asians in both systems compared to Whites (Figure). In Medicare, use was lower for Native Americans, Blacks and Hispanics compared to Whites. In the VA, use among Blacks and Hispanics was higher than Whites. Conclusion: There are significant differences in echocardiography use between the VA and Medicare systems by race for veterans with heart failure. Whites were more likely to receive echocardiography compared to most races in Medicare but not in the VA.

Abstract 13466: Gender and Racial Disparities in Clinical Outcomes Among Patients With Preserved Ejection Fraction Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Chiamaka S Diala ◽  
Vivian Chukwuma ◽  
Abdulkareem Lukan ◽  
Habeeb Sanni ◽  
Keziah Aibangbee ◽  
...  
Keyword(s):  
Heart Failure ◽  
Native American ◽  
Native Americans ◽  
Ejection Fraction ◽  
Racial Disparities ◽  
Clinical Outcomes ◽  
Hospital Cost ◽  
Pacific Islanders ◽  
Preserved Ejection Fraction ◽  
Asian Pacific

Background: Heart failure is a chronic cardiovascular condition with associated high morbidity, mortality and health-related costs. The disparities of varying sociodemographic factors associated with clinical outcomes in patients with preserved ejection fraction heart failure (HFpEF) is yet to be extensively studied. Aim: To evaluate gender and racial disparities in length of hospital stay (LOS), cost of hospitalization, and in-hospital (IH) mortality in patients with HFpEF. Method: Adults (>18 years) with a primary diagnosis of Acute on Chronic Diastolic dysfunction were identified from the 2016 and 2017 National Inpatient Sample using ICD 10 codes. The relationship between gender or racial groups (Non-Hispanic Whites (NHW)-Ref, Non-Hispanic Blacks (NHB), Hispanics, Asian/Pacific Islanders and Native Americans and study clinical outcomes were assessed using weighted multivariable logistic and linear regression models as appropriate. Results: Among patients with HFpEF (n=595,936), 59.8% were females; 73.4%, 15.6%, 6.6%, 1.9%, and 2.5% were NHW, NHB, Hispanics, Native Americans, and Asians/Pacific Islanders respectively. Females had lower IH mortality [adjusted OR (aOR) 0.9; 95% CI: 0.87 - 0.92) compared to males. Compared to NHW, NHB (aOR 0.81; 95%CI: 0.77 - 0.84) and Hispanics (aOR 0.91; 95%CI: 0.86 - 0.96) had lower odds of IH mortality, while IH mortality in Asian/Pacific Islander and Native American was not significantly different from NHW. Females had lower LOS (mean difference(mD) -0.34 days; 95%CI -0.38 to -0.30) and lower hospital cost (mD -$1967; 95%CI: -2097 to -1838) than males. NHB had similar rates of LOS (mD 0.04days; 95%CI: -0.02 - 0.11) and hospital cost (mD -$176; 95%CI: -412 - 60) compared to NHW. Hispanics had similar rates of LOS but higher hospital cost (mD 0.07 days; 95%CI -0.04 - 0.18; mD $1182; 95%CI: 754 - 1609), Asians/Pacific Islander (mD 0.32 days; 95%CI: 0.14 - 0.49, mD $2846; 95%CI 2173 - 3519) and Native American had a higher LOS and hospital cost compared to NHW (mD 0.49 days; 95%CI: 0.33 - 0.64, mD $2793; 95%CI: 2048 - 3539). Conclusion: Our study highlights racial and gender disparities in important clinical outcomes among patients with HFpEF, buttressing the need to tailor intervention to higher risk groups.

Prejudicial reactions to the removal of Native American mascots

2021 ◽  
pp. 136843022110408
Author(s):  
Tyler Jimenez ◽  
Jamie Arndt ◽  
Peter J. Helm
Keyword(s):  
Native American ◽  
Native Americans ◽  
Intergroup Relations ◽  
Psychological Impact ◽  
Geographical Location ◽  
Population Level ◽  
Location Study ◽  
Chief Illiniwek ◽  
The Impact ◽  
Chief Wahoo

As Native American mascots are discontinued, research is needed to understand the impact on intergroup relations. Such discontinuations may be threatening to some and increase prejudice against Native Americans. In Study 1 ( N = 389), exposure to information about a Native American mascot removal increased punitive judgments against a Native American in a hypothetical legal scenario, particularly among those high in racial colorblindness and those residing in the implicated geographical location. Study 2 ( N = 358,644) conceptually replicated and extended these findings, using population-level implicit bias data to perform a natural quasi-experiment. Prejudice against Native Americans increased in the year following the removal of two Native American mascots: “Chief Illiniwek” and “Chief Wahoo.” However, in the case of Chief Illiniwek, the effect diminished after 6 years. Together, the studies contribute to understanding the psychological impact of Native American mascots, offering a first look at how their removal influence intergroup relations.

scholarly journals Sociodemographic Characteristics as Predictors of Outcomes in Hepatocellular Carcinoma: A Retrospective Cohort Study

2020 ◽  
Vol 27 (1) ◽  
pp. 107327482095661
Author(s):  
Bryce D. Beutler ◽  
Mark B. Ulanja ◽  
Rohee Krishan ◽  
Vijay Aluru ◽  
Munachismo L. Ndukwu ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Cohort Study ◽  
Native American ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Private Insurance ◽  
Insurance Status ◽  
The Impact ◽  
To Receive

Background: Race, gender, insurance status, and income play important roles in predicting health care outcomes. However, the impact of these factors has yet to be fully elucidated in the setting of hepatocellular carcinoma (HCC). Methods: We designed a retrospective cohort study utilizing data from the Surveillance, Epidemiology, and End Results (SEER) program to identify patients diagnosed with resectable HCC (N = 28,518). Demographic factors of interest included race (Asian/Pacific Islander [API], African American [AA], Native American/Alaska Native [NA], or White [WH]) and gender (male [M] or female [F]). Insurance classifications included those having Medicare/Private Insurance [ME/PI], Medicaid [MAID], or No Insurance [NI]. Median household income was estimated for all diagnosed with HCC. Endpoints included: (1) overall survival; (2) likelihood of receiving a recommendation for surgery; and (3) specific surgical intervention performed. Multivariate multinomial logistic regression for relative risk ratio (RRR) and Cox regression models were used to identify pertinent associations. Results: Race, gender, insurance status, and income had statistically significant effects on the likelihood of surgical recommendation and overall survival. API were more likely to receive a recommendation for hepatic resection (RRR = 1.45; 95% CI: 1.31-1.61; Reference Race: AA) and exhibited prolonged overall survival (HR = 0.77; 95% CI: 0.73-0.82; Reference Race: AA) as compared to members of any other ethnic group; there was no difference in these endpoints between AA, NA, or WH individuals. Gender also had a significant effect on survival: Females exhibited superior overall survival (HR = 0.89; 95% CI: 0.85-0.93; Reference Gender: M) as compared to males. Patients who had ME/PI were more likely than those with MAID or NI to receive a surgical recommendation. ME/PI was also associated with superior overall survival. Conclusions: Race, gender, insurance status, and income have measurable effects on HCC management and outcomes. The underlying causes of these disparities warrant further investigation.

The Impact of the California Civil Rights Initiative (CCRI) on University and Professional School Admissions and the Implications for the California Economy

1996 ◽  
Vol 25 (1) ◽  
pp. 13-59 ◽  
Author(s):  
Cecilia A. Conrad ◽  
Rhonda V. Sharpe
Keyword(s):  
Native American ◽  
Native Americans ◽  
Affirmative Action ◽  
Civil Rights ◽  
Mexican Americans ◽  
Health Care Services ◽  
Negative Impact ◽  
Professional School ◽  
Preliminary Evaluation ◽  
The Impact

Using data from the University of California and results from previously published research on the returns to higher education, this article presents a preliminary evaluation of the impact of ending affirmative action in admissions at a large, publicly funded university. At the undergraduate level, eliminating race as a factor in the admissions process will redistribute African Americans, Mexican Americans, and Native Americans away from the most competitive campuses (UC-Berkeley, UCLA, UC-San Diego) towards the less competitive campuses in the California State University system. This redistribution will lower the returns to schooling for those affected groups and could have a negative impact on the educational environment for all students. Affirmative action will, in the short run, reduce the number of African American, Mexican American, and Native American students admitted and, in the long run, will have an adverse effect on the delivery of legal and health care services to those racial and ethnic groups.

Abstract P161: Drug-Eluting Stent Utilization and Post-Coronary Revascularization Procedure Mortality: Do Racial Disparities Matter?

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Alexander V Sergeev
Keyword(s):  
Native American ◽  
Hospital Mortality ◽  
Racial Disparities ◽  
Coronary Revascularization ◽  
Multivariable Analysis ◽  
Drug Eluting Stents ◽  
Drug Eluting Stent ◽  
Hospital Death ◽  
Drug Eluting ◽  
To Receive

Background: Besides being a major risk factor for coronary artery disease (CAD), diabetes mellitus (DM) also worsens CAD patients’ prognosis. Percutaneous coronary intervention (PCI) with stenting is an effective treatment procedure for certain categories of CAD patients with DM (CAD-DM). Newer drug-eluting stents (DES) were developed to minimize the occurrence of restenosis known to hinder PCI with older non-drug-eluting stents (non-DES). We hypothesized that disparities in DES utilization and post-procedure mortality would exist in CAD-DM patients. Methods: We conducted a retrospective cohort study of in-hospital mortality in 132,934 CAD-DM patients [mean+SD age: 65.3+11.4 years; 62.7% (83,409 of 132,934) males] after PCI with DES and non-DES in the years 2007,2009. Patient race was classified as white, black, or other Asian, Pacific Islander, Native American). Due to short length of stay, in-hospital death was defined as a binary variable (discharged alive vs. deceased). Multivariable logistic regression was used to obtain adjusted odds ratios (ORs) for in-hospital death after DES and non-DES PCI in relation to patients’ race, adjusting for confounders: age, gender, comorbidities, number of stents inserted, number of vessels treated, socio-economic status, emergency department (ED) admission, rural/urban area status. Results: Blacks were less likely to receive newer DES stent than any other racial group: 75.7% blacks, 76.9% whites, 79.0% other (p<0.04). Blacks were more likely to undergo an emergency rather than planned procedure: 45.7% blacks, 39.8% whites, and 42.7% other were ED-admitted (p<0.01). In adjusted multivariable analysis, controlling for the type of stent and confounding factors, post-PCI mortality in blacks was similar to whites (adjusted OR 0.824, 95% CI: 0.672-1.010, p=0.06), but in other was higher than in whites (adjusted OR 1.284, 95% CI: 1.151-1.434, p<0.001). Conclusions: Racial disparities exist in DES utilization by CAD-DM patients and in post-PCI in-hospital mortality: blacks are least likely to receive DES, but patients of other racial groups are more likely to die after PCI. Further studies investigating the mechanisms responsible for these disparities are warranted.

Abstract 242: Impact of Hospitalists on Heart Failure Outcomes in Hawaii

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Santhosh R Mannem ◽  
Ayeong Jun Ahn ◽  
Jill Miyamura ◽  
Deborah Juarez ◽  
John Chen ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Heart Failure ◽  
Length Of Stay ◽  
Hospital Discharge ◽  
Hospital Medicine ◽  
Inhospital Mortality ◽  
Limited Data ◽  
The Us ◽  
The Impact ◽  
Discharge Database

Background: Hospital Medicine is the fastest growing subspecialty in the US. However, limited data compare care provided by Hospitalists (H) with Non-Hospitalists (NH) (ie, internal medicine, family practice). Because much of heart failure (HF) care is provided by non-cardiologists, we examined HF outcomes among pts treated by H and NH. Methods: All pts discharged with primary dx of HF from 2009-11 were identified from a statewide all-payer database in Hawaii (n=6,581). We categorized pts by specialty of discharging physician and examined length of stay (LOS), 30-day readmission and inhospital mortality comparing H and NH. Because pts discharged by cardiologists accounted for a minority of cases (345/6,581 or 5.2%) and may substantially differ from other pts, they were excluded from our study. Results: There were slight differences between pts cared by H and NH, while disease severity (Charlson Index) was similar. Readmissions were similar for H and NH, although inhospital mortality was significantly lower for H. These differences persisted after adjusting for potential confounders (readmission: OR=1.08, 95% CI: 0.96-1.20; mortality: OR=0.59, 95% CI: 0.46-0.75). Conclusions: In a statewide, all-payer hospital discharge database H care for the majority of HF pts. Compared with NH, 30-day readmission was similar but inhospital mortality was lower. Further research is needed to study the impact of cardiologists, who often serve as consultants for this population.

Gi-gikinomaage-min (we are all teachers): using history to give voice to urban native American communities

2017 ◽  
Vol 13 (2) ◽  
pp. 98-105 ◽  
Author(s):  
Melanie Shell-Weiss ◽  
Belinda Bardwell
Keyword(s):  
Native American ◽  
Native Americans ◽  
Best Practices ◽  
Critical Pedagogy ◽  
Predominantly White ◽  
Oral History ◽  
Metropolitan Area ◽  
Collaborative Effort ◽  
Grand Rapids ◽  
The Impact

This article explores one developing model for framing ethical, mutually beneficial collaborations between a predominantly White, non-tribal serving university and urban Native American communities. Called Gi-gikinomaage-min (We are all teachers): Defend our History, Unlock Your Spirit, this oral history documentation initiative is informed by the developing literature on best practices for archiving Native American resources as well as by revolutionary critical pedagogy. Focusing on the impact of federal Urban Relocation Programs, the project is the first collaborative effort to focus on documenting experiences of Native Americans in the Grand Rapids, Michigan metropolitan area to create a publicly accessible archive of material that can be used for teaching, research, and other educational purposes. By reflecting on the work of this project to date, we aim for these efforts to become part of the larger, international conversation.

Abstract 107: Home Health Care After Discharge is Associated With Less Early Readmissions for Patients With Acute Myocardial Infarction

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Muhammad A Sheikh ◽  
David Ngendahimana ◽  
Salil V Deo ◽  
Sajjad Raza ◽  
Salah Altarabsheh ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Health Care ◽  
Acute Myocardial Infarction ◽  
Logistic Regression ◽  
Regression Model ◽  
Home Health Care ◽  
Home Health ◽  
The Impact ◽  
To Receive

Objective: Home health care (HHC) is a support tool to transition patients after discharge and acute myocardial infarction (AMI) is a significant cause of morbidity and mortality in the U.S. However, little is known regarding the impact of HHC on AMI patients. We sought to identify predictors of readmissions among AMI patients, characteristics of those who receive HHC and investigate the association of HHC with readmission. Methods: We queried the National Readmission Database (NRD) (January 2012 - December 2014), to identify patients discharged after AMI and selected patients who were discharged home with (HHC+) and without HHC (HHC-). We reported national estimates with survey methods with weights provided in our data. After univariate exploratory analyses, we developed a regression model to identify the probability of each patient to receive HHC. From the propensity score, we calculated average treatment on the treated (ATT) weights. These ATT weights were included in the logistic regression model to determine the impact of HHC on readmission after adjusting for available clinical confounders. We considered post-weighting standardized differences <10% as appropriate for our ATT model. To determine clinical factors associated with readmission, we also performed a multi-variable logistic regression with readmission as the end-point. All results were reported as risk ratios (RR) with their 95% confidence intervals (CI). Results: Between January 2012 to December 2014, 406,237 patients were treated for AMI and discharged home with or without HHC. Among these 9.4% (38,215) received HHC. HHC+ patients were older (mean age 77 ± 11 vs 60 ±12 years p<0.001), more likely to be female (53.6% vs. 26.9%, p <0.001), and have cancer (3.7% vs 1.3%, p <0.001), congestive heart failure (5.7% vs. 0.5%, p <0.001), chronic pulmonary disease (23.2% vs. 12.7%, p <0.001), chronic kidney disease (26.9% vs 6.9%, p <0.001), diabetes (35.6% vs. 26.7%, p <0.001), hypertension (70.7% vs. 64.8%, p <0.001) and peripheral vascular disease (14.6% vs 6.4%, p <0.001). Patients readmitted after MI were more likely to be older and have diabetes (RR 1.42, 95% CI 1.37-1.48), CHF (RR 5.89, CI 5.55-6.26) or COPD (RR 1.59, 1.52-1.65). Unadjusted 30-day readmission rate was 20.9% for HHC+ and 8.2% for HHC- patients. Propensity-weighted adjustment for covariates yielded 36,979 HHC+ patients and 37,785 HHC- patients. Adjusted risk rations (RR) for 30-day readmission were computed using ATT weights, and HHC+ patients had significantly lower readmission risk (RR 0.89, 95% CI 0.82 - 0.96) compared to HHC- (RR 1.12, 95% CI 1.04 - 1.21; p < 0.001) Conclusion: In the United States, a small proportion of patients receive home health care after discharge post-AMI. Older, females and those with diabetes or heart failure are more likely to receive home health care. Use of home health care may be associated with lower 30-day readmission rates after AMI.

Joseph Johnson's Lost Gamuts: Native Hymnody, Materials of Exchange, and the Colonialist Archive

2019 ◽  
Vol 13 (4) ◽  
pp. 482-507
Author(s):  
GLENDA GOODMAN
Keyword(s):  
Native American ◽  
Native Americans ◽  
Sacred Music ◽  
Intercultural Relations ◽  
Native Community ◽  
Legal Documents ◽  
Land Transfer ◽  
Short Period ◽  
The Impact

AbstractIn the winter of 1772–1773, Joseph Johnson (Mohegan/Brothertown) copied musical notation into eight books for Christian Native Americans in Farmington, Connecticut, a town established by English settler colonists on the land known as Tunxis Sepus. Johnson did so because, as he wrote in his diary, “The indians are all desireous of haveing Gamuts.” Johnson's “gamuts” have not survived, but their erstwhile existence reveals hymnody's important role within the Native community in Farmington as well as cross-culturally with the English settler colonists. In order to reconstruct the missing music books and assess their sociocultural significance, this article proposes a surrogate bibliography, gathering a constellation of sources among which Johnson's books would have circulated and gained meaning for Native American Christians and English colonists (including other printed and manuscript music, wampum, and legal documents pertaining to land transfer). By bringing together this multi-modal network of materials, this essay seeks to redress the material and epistemological effects of a colonialist archive. On one level, this is a case study that focuses on a short period of time in order to document the impact on sacred music of conversion, literacy, shifting intercultural relations, and a drive to preserve sovereignty. On another, this article presents a methodological intervention for dealing with lost materials and colonialist archives without recourse to discourses of recovery or discovery, the latter of which is considered through the framework of what I term “archival orientalism.”

Partisanship and Non-Partisanship Among American Indians

2016 ◽  
Vol 45 (4) ◽  
pp. 673-691 ◽  
Author(s):  
Jeffrey W. Koch
Keyword(s):  
Native American ◽  
Native Americans ◽  
American Indians ◽  
Political Party ◽  
Republican Party ◽  
Democratic Party ◽  
Social Groups ◽  
Minority Population ◽  
American Society ◽  
The Impact

This research examines the partisan inclinations of American Indians, a minority population with a complicated history with the U.S. government and American society. The empirical analyses identify Native Americans as preferring the Democratic Party over the Republican Party. The impact of being Native American on identification with the Democratic Party is sizable, equivalent to the effect for being Hispanic, Asian, or female. In addition, American Indians demonstrate a pronounced tendency to not affiliate with a major American political party. The higher incidence of non-identification among Native Americans likely results from the importance of their claims for sovereignty and, relatedly, living separate from much of American society. Unlike other broad-based social groups in American politics, Native Americans disseminate cues that reduce the tendency of their members to affiliate with a major political party.

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