Racial Disparities in Disability Among Older Adults

Objective: Persistent and consistently observed racial disparities in physical functioning likely stem from racial differences in social resources and environmental conditions. Method: We examined the association between race and reported difficulty performing instrumental activities of daily living (IADL) in 347 African American (45.5%) and Whites aged 50 or above in the Exploring Health Disparities in Integrated Communities–Southwest Baltimore, Maryland Study (EHDIC-SWB). Results: Contrary to previous studies, African Americans had lower rates of disability (women: 25.6% vs. 44.6%, p = .006; men: 15.7% vs. 32.9%; p = .017) than Whites. After adjusting for sociodemographics, health behaviors, and comorbidities, African American women (odds ratio [OR] = 0.32, 95% confidence interval [CI] = [0.14, 0.70]) and African American men (OR = 0.34, 95% CI = [0.13, 0.90]) retained their functional advantage compared with White women and men, respectively. Conclusion: These findings within an integrated, low-income urban sample support efforts to ameliorate health disparities by focusing on the social context in which people live.

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Race-Specific Association of Caesarean-Section Delivery with Body Size at Age 2 Years

Ethnicity & Disease ◽

10.18865/ed.26.1.61 ◽

2016 ◽

Vol 26 (1) ◽

pp. 61 ◽

Cited By ~ 1

Author(s):

Andrea E Cassidy-Bushrow ◽

Ganesa Wegienka ◽

Suzanne Havstad ◽

Albert M. Levin ◽

Susan V. Lynch ◽

...

Keyword(s):

African American ◽

Caesarean Section ◽

African American Women ◽

Birth Cohort ◽

Racial Differences ◽

White Women ◽

Specific Effect ◽

Delivery Mode ◽

Font Size ◽

African American Mothers

Objectives: African American children are at higher risk of obesity than White children and African American women are more likely to undergo caesarean-section (CS) delivery than White women. CS is associated with childhood obesity, however, little is known whether this relationship varies by race.We examined if the association of CS with obesity at age 2 years varied by race. Design: Longitudinal birth cohort.Setting: Birth cohort conducted in a health care system in metropolitan Detroit, Michigan with follow-up at age 2 years.Participants: 639 birth cohort participants; 367 children (57.4%) were born to African American mothers and 230 (36.0%) children were born via CS.Main Outcome Measure: Obesity defined as body mass index ≥95th percentile at age 2 years.Results: Slightly more children of African American (n=37; 10.1%) than non-African American mothers (n=18; 6.6%) were obese (P=.12). There was evidence of effect modification between race and delivery mode with obesity at age 2 years (interaction P=.020). In children of African-American mothers, CS compared to vaginal birth was associated with a significantly higher odds of obesity (aOR=2.35 (95% CI: 1.16, 4.77), P=.017). In contrast, delivery mode was not associated with obesity at age 2 years in children of non-African-American mothers (aOR=.47 (95% CI: .13, 1.71), P=.25). Conclusions: There is evidence for a race-specific effect of CS on obesity at age 2 years; potential underlying mechanisms may be racial differences in the developing gut microbiome or in epigenetic programming. Future research is needed to determine if this racial difference persists into later childhood. Ethn Dis. 2016;26(1):61-68; doi:10.18865/ed.26.1.61

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Cardiovascular and Metabolic Risk in Women in the First Year Postpartum: Allostatic Load as a Function of Race, Ethnicity, and Poverty Status

American Journal of Perinatology ◽

10.1055/s-0038-1675618 ◽

2018 ◽

Vol 36 (10) ◽

pp. 1079-1089 ◽

Cited By ~ 6

Author(s):

Madeleine U. Shalowitz ◽

Christine Dunkel Schetter ◽

Marianne M. Hillemeier ◽

Vernon M. Chinchilli ◽

Emma K. Adam ◽

...

Keyword(s):

African American ◽

Child Health ◽

African American Women ◽

Low Income ◽

Allostatic Load ◽

White Women ◽

Disease Risk ◽

Community Sample ◽

Density Lipoprotein ◽

First Year

Objective Allostatic load (AL) represents multisystem physiological “wear-and-tear” reflecting emerging chronic disease risk. We assessed AL during the first year postpartum in a diverse community sample with known health disparities. Study Design The Eunice Kennedy Shriver National Institute for Child Health and Human Development Community Child Health Network enrolled 2,448 predominantly low-income African-American, Latina, and White women immediately after delivery of liveborn infants at ≥20 weeks' gestation, following them over time with interviews, clinical measures, and biomarkers. AL at 6 and 12 months postpartum was measured by body mass index, waist:hip ratio, blood pressure, pulse, hemoglobin A1c, high-sensitive C-reactive protein, total cholesterol and high-density lipoprotein, and diurnal cortisol slope. Results Adverse AL health-risk profiles were significantly more prevalent among African-American women compared with non-Hispanic Whites, with Latinas intermediate. Breastfeeding was protective, particularly for White women. Complications of pregnancy were associated with higher AL, and disparities persisted or worsened through the first year postpartum. Conclusion Adverse AL profiles occurred in a substantial proportion of postpartum women, and disparities did not improve from birth to 1 year. Breastfeeding was protective for the mother.

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Does Universal Coverage Mitigate Racial Disparities in Potentially Avoidable Maternal Complications?

American Journal of Perinatology ◽

10.1055/s-0040-1701195 ◽

2020 ◽

Author(s):

Anju Ranjit ◽

Tomas Andriotti ◽

Cathaleen Madsen ◽

Tracey Koehlmoos ◽

Barton Staat ◽

...

Keyword(s):

African American ◽

Racial Disparities ◽

African American Women ◽

White Women ◽

Racial Group ◽

Direct Care ◽

Health Coverage ◽

African American Mothers ◽

Maternal Complications ◽

American Women

Abstract Objective Potentially avoidable maternity complications (PAMCs) have been validated as an indicator of access to quality prenatal care. African-American mothers have exhibited a higher incidence of PAMCs, which has been attributed to unequal health coverage. The objective of this study was to assess if racial disparities in the incidence of PAMCs exist in a universally insured population. Study Design PAMCs in each racial group were compared relative to White mothers using multivariate logistic regression. Stratified subanalyses assessed for adjusted differences in the odds of PAMCs for each racial group within direct versus purchased care. Results A total of 675,553 deliveries were included. Among them, 428,320 (63%) mothers were White, 112,170 (17%) African-American, 37,151 (6%) Asian/Pacific Islanders, and 97,912 (15%) others. African-American women (adjusted odds ratio [aOR]: 1.05, 95% CI: 1.02–1.08) were more likely to have PAMCs compared with White women, and Asian women (aOR: 0.92, 95% CI: 0.89–0.95) were significantly less likely to have PAMCs compared with White women. On stratified analysis according to the system of care, equal odds of PAMCs among African-American women compared with White women were realized within direct care (aOR: 1.03, 95% CI: 1.00–1.07), whereas slightly higher odds among African-American persisted in purchased (aOR: 1.05, 95% CI: 1.01–1.10). Conclusion Higher occurrence of PAMCs among minority women sponsored by a universal health coverage was mitigated compared with White women. Protocol-based care as in the direct care system may help overcome health disparities.

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Differences in Treatment and Outcome Between African-American and White Women With Endometrial Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2003.01.218 ◽

2003 ◽

Vol 21 (22) ◽

pp. 4200-4206 ◽

Cited By ~ 77

Author(s):

Thomas C. Randall ◽

Katrina Armstrong

Keyword(s):

African American ◽

Endometrial Cancer ◽

African American Women ◽

Racial Differences ◽

White Women ◽

Sociodemographic Characteristics ◽

Histologic Type ◽

American Women ◽

Epithelial Cancers ◽

Primary Surgery

Purpose: To investigate disparities in treatment and outcomes between African-American and white women with endometrial cancer. Patients and Methods: We analyzed 1992 to 1998 Surveillance, Epidemiology, and End Results data for 21,561 women with epithelial cancers of the endometrium. Sequential Cox proportional hazard models were used to determine the association between tumor characteristics (stage, grade, and histologic type), sociodemographic characteristics (age and marital status), and treatment (surgery and radiation therapy) and the racial difference in mortality. Results: The unadjusted hazard ratio (HR) for death from endometrial cancer for African-American women compared with white women was 2.57. However, African-American women were significantly more likely to present with advanced-stage disease and have poorly differentiated tumors or tumors with an unfavorable histologic type and were significantly less likely to undergo definitive surgery at all stages of disease. Adjusting for tumor and sociodemographic characteristics lowered the HR for African-American women to 1.80. Further adjustment for the use of surgery reduced the HR to 1.51. The association between surgery and survival was stronger among white women (HR, 0.26) than among African-American women (HR, 0.44). Conclusion: African-American women with endometrial cancer are significantly less likely to undergo primary surgery and have significantly shorter survival than white women with endometrial cancer. Racial differences in treatment are associated with racial differences in survival. The association between use of surgery and survival is weaker among African-American than white women, raising questions about potential racial differences in the effectiveness of surgery.

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Gender Differences in Negative Affect During Acute Tobacco Abstinence Differ Between African American and White Adult Cigarette Smokers

Nicotine & Tobacco Research ◽

10.1093/ntr/nty122 ◽

2018 ◽

Vol 21 (8) ◽

pp. 1072-1078 ◽

Cited By ~ 3

Author(s):

Raina D Pang ◽

Mariel S Bello ◽

Madalyn M Liautaud ◽

Andrea H Weinberger ◽

Adam M Leventhal

Keyword(s):

Gender Differences ◽

African American ◽

Negative Affect ◽

African American Women ◽

White Women ◽

African American Men ◽

Self Report ◽

Women Smokers ◽

Tobacco Withdrawal ◽

Hispanic White

Abstract Introduction Prior studies have found heightened negative affect following tobacco abstinence in women compared to men. However, experimental work addressing whether these findings generalize across racial groups is scarce. This study investigated whether race (non-Hispanic White vs. non-Hispanic African American) moderated gender differences in abstinence-induced negative affect and smoking behavior. Methods Data were collected from 2010 to 2017 from two separate laboratory studies investigating experimentally manipulated tobacco abstinence. Following a baseline session, adult daily smokers (≥10 cigarettes/day; women: n = 297, 83.8% non-Hispanic African American; men: n = 492, 86.2% non-Hispanic African American) attended two counterbalanced lab sessions (16 hours abstinent vs. non-abstinent) and completed self-report measures of negative affect followed by a laboratory analogue smoking reinstatement task. Results We found a gender × race interaction for several negative affect states and composite negative affect (βs = −.12 to −.16, Ps < .05). Analyses stratified by race showed that non-Hispanic White women compared to non-Hispanic White men exhibited greater abstinence-induced increases in anger, anxiety, and composite negative affect (βs = −.20 to −.29, Ps < .05). No significant gender differences in abstinence-induced negative affect were found for non-Hispanic African American smokers (βs = .00 to − .04, Ps > .05). Conclusion These findings suggest that negative affect during acute tobacco abstinence may be a clinically important and intervenable factor that can inform cessation interventions specifically for non-Hispanic White women smokers. Further empirical exploration of mechanisms underlying interactions of gender and race in tobacco addiction may benefit smoking cessation efforts in non-Hispanic African American women smokers. Implications This study contributes to a scant body of research examining the intersectional influence of race and gender on abstinence-induced negative affect—a central, motivationally prepotent feature of tobacco withdrawal. Using a laboratory-based design to experimentally manipulate abstinence, we provide evidence of a gender × race interaction on negative affect–related withdrawal. Our findings suggest that gender differences in abstinence-induced negative affect observed among non-Hispanic White smokers may not generalize to non-Hispanic African American smokers, highlighting the need for future work to address potential mechanisms underlying the racially discrepant impact of gender on affective tobacco withdrawal.

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Racial Differences in Weight Loss Mediated by Engagement and Behavior Change

Ethnicity & Disease ◽

10.18865/ed.28.1.43 ◽

2018 ◽

Vol 28 (1) ◽

pp. 43 ◽

Cited By ~ 6

Author(s):

Loneke T. Blackman Carr ◽

Carmen Samuel-Hodge ◽

Dianne Stanton Ward ◽

Kelly R. Evenson ◽

Shrikant I. Bangdiwala ◽

...

Keyword(s):

Weight Loss ◽

African American ◽

African American Women ◽

Racial Differences ◽

White Women ◽

Controlled Trial ◽

Face To Face ◽

Weight Control Behaviors ◽

Group Sessions ◽

Hispanic White

Objective: We set out to determine if a primarily Internet-delivered behavioral weight loss intervention produced differential weight loss in African American and non-Hispanic White women, and to identify possible mediators.Design: Data for this analysis were from a randomized controlled trial, collected at baseline and 4-months.Setting: The intervention included monthly face-to-face group sessions and an Internet component that participants were recommended to use at least once weekly.Participants: We included overweight or obese African American and non-Hispanic White women (n=170), with at least weekly Internet access, who were able to attend group sessions.Intervention: Monthly face-to-face group sessions were delivered in large or small groups. The Internet component included automated tailored feedback, self-monitoring tools, written lessons, video resources, problem solving, exercise action planning tools, and social support through message boards.Main outcome measure: Multiple linear regression was used to evaluate race group differences in weight change.Results: Non-Hispanic White women lost more weight than African American women (-5.03% vs.-2.39%, P=.0002). Greater website log-ins and higher change in Eating Behavior Inventory score in non-Hispanic White women partially mediated the race-weight loss relationship.Conclusions: The weight loss disparity may be addressed through improved website engagement and adoption of weight control behaviors. Ethn Dis. 2018;28(1):43-48; doi:10.18865/ed.28.1.43.

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The role of work in gender identity, stress and health in low-income, middle-aged African-American men

Health Promotion International ◽

10.1093/heapro/daaa144 ◽

2020 ◽

Author(s):

Dean Robinson ◽

Luis Valdez ◽

Lamont Scott ◽

David Buchanan

Keyword(s):

African American ◽

Health Disparities ◽

Low Income ◽

Minority Stress ◽

African American Men ◽

Sense Of Self ◽

Research Approach ◽

Middle Aged ◽

Structural Problems ◽

Sense Of Identity

Summary Although progress has been made in reducing disparities in life expectancy, addressing the persistence of health inequities by race remains a high priority for public health professionals. The purpose of this research was to refine a minority stress model (MSM) by identifying previously unrecognized factors contributing to stress and chronic disease health disparities among low-income middle-aged African-American men. Using a Community-Based Participatory Research approach, we conducted semi-structured individual health interviews with 42 low-income middle-aged African-American men in a mid-size New England city. The interviews focused on the participants’ perceptions of the causes of health disparities. Four major themes emerged from the analysis: the positive aspects of work, both financial and symbolic; and the negative repercussions of not working, both financial and symbolic in terms of a sense of self-respect. On an instrumental level, working men can support their family, be physically active and find social support. Symbolically, work provides a positive sense of identity as a man; it offers both social- and self-respect; it provides discipline and a sense of gratitude. Conversely, the lack of work is a significant source of stress, stemming both from the inability to support one’s family and from having nothing to do, which lead to depression, low self-esteem, suicidal ideation and anger. With no perceived viable routes to socially approved roles, many low-income men of color succumb to internalizing a negative identity. This research demonstrates a clear link between structural problems with the US economy and harms to sense of identity among low-income, middle-aged African-American men.

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Racial, ethnic, and gender diversity of applicants and matriculants to neurological surgery residency programs

Journal of Neurosurgery ◽

10.3171/2021.7.jns21906 ◽

2021 ◽

pp. 1-7

Author(s):

Edwin Nieblas-Bedolla ◽

Fatima El-ghazali ◽

Saman Qadri ◽

John R. Williams ◽

Nabiha Quadri ◽

...

Keyword(s):

African American ◽

African American Women ◽

White Women ◽

African American Men ◽

White Men ◽

Residency Programs ◽

Asian Men ◽

And Gender ◽

Neurological Surgery ◽

Ethnicity And Gender

OBJECTIVE The aim of this study was to identify trends in the demographic constitution of applicants and matriculants to neurological surgery based on race, ethnicity, and gender. METHODS The authors conducted a cross-sectional study using compiled demographic data obtained from the Association of American Medical Colleges. Trends analyzed included proportional changes in race, ethnicity, and gender of applicants and matriculants to neurosurgical residency programs from academic years 2010–2011 to 2018–2019. RESULTS A total of 5100 applicants and 2104 matriculants to neurosurgical residency programs were analyzed. No significant change in the percentage of overall women applicants (+0.3%, 95% CI −0.7% to 1.3%; p = 0.77) or in the percentage of women matriculants (+0.3%, 95% CI −2.2% to 2.9%; p = 0.71) was observed. For applicants, no change over time was observed in the percentages of American Indian or Alaska Native (AI/AN) men (0.0%, 95% CI −0.3% to 0.3%; p = 0.65); Asian men (−0.1%, 95% CI −1.2% to 1.1%; p = 0.97); Black or African American men (−0.2%, 95% CI −0.7% to 0.4%; p = 0.91); Hispanic, Latino, or of Spanish Origin men (+0.4%, 95% CI −0.8% to 1.7%; p = 0.26); White men (+0.5%, 95% CI −2.1% to 3.0%; p = 0.27); Asian women (+0.1,% 95% CI −0.9% to 1.1%; p = 0.73); Black or African American women (0.0%, 95% CI −0.6% to 0.5%; p = 0.30); Hispanic, Latino, or of Spanish Origin women (0.0%, 95% CI −0.4% to 0.4%; p = 0.71); and White women (+0.3%, 95% CI −1.1% to 1.7%; p = 0.34). For matriculants, no change over time was observed in the percentages of AI/AN men (0.0%, 95% CI −0.6% to 0.6%; p = 0.56); Asian men (0.0%, 95% CI −2.7% to 2.7%; p = 0.45); Black or African American men (−0.3%, 95% CI −1.4% to 0.8%; p = 0.52); Hispanic, Latino, or of Spanish Origin men (+0.6%, 95% CI −0.8 to 2.0%; p = 0.12); White men (−1.0%, 95% CI −5.3% to 3.3%; p = 0.92); Asian women (+0.1%, 95% CI −1.3% to 1.5%; p = 0.85); Black or African American women (0.0%, 95% CI −0.6% to 0.7%; p = 0.38); Hispanic, Latino, or of Spanish Origin women (−0.1%, 95% CI −0.7% to 0.5%; p = 0.46); and White women (+0.3%, 95% CI −2.4% to 3.0%; p = 0.70). CONCLUSIONS Despite efforts to diversify the demographic constitution of incoming neurosurgical trainees, few significant advances have been made in recent years. This study suggests that improved strategies for recruitment and cultivating early interest in neurological surgery are required to further increase the diversification of future cohorts of neurosurgical trainees.

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Patient Involvement in Surgery Treatment Decisions for Breast Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2005.06.217 ◽

2005 ◽

Vol 23 (24) ◽

pp. 5526-5533 ◽

Cited By ~ 228

Author(s):

Steven J. Katz ◽

Paula M. Lantz ◽

Nancy K. Janz ◽

Angela Fagerlin ◽

Kendra Schwartz ◽

...

Keyword(s):

Breast Cancer ◽

Decision Making ◽

African American ◽

Surgical Treatment ◽

Los Angeles ◽

African American Women ◽

Racial Differences ◽

Patient Involvement ◽

White Women ◽

Treatment Decisions

Purpose High rates of mastectomy and marked regional variations have motivated lingering concerns about overtreatment and failure to involve women in treatment decisions. We examined the relationship between patient involvement in decision making and type of surgical treatment for women with breast cancer. Methods All women with ductal carcinoma-in-situ and a 20% random sample of women with invasive breast cancer aged 79 years and younger who were diagnosed in 2002 and reported to the Detroit and Los Angeles Surveillance, Epidemiology, and End Results registries were identified and surveyed shortly after receipt of surgical treatment (response rate, 77.4%; n = 1,844). Results Mean age was 60.1 years; 70.2% of the women were white, 18.0% were African American, and 11.8% were from other ethnic groups. Overall, 30.2% of women received mastectomy as initial treatment. Most women reported that they made the surgical decision (41.0%) or that the decision was shared (37.1%); 21.9% of patients reported that their surgeon made the decision with or without their input. Among white women, only 5.3% of patients whose surgeon made the decision received mastectomy compared with 16.8% of women who shared the decision and 27.0% of women who made the decision (P < .001, adjusted for clinical factors, predisposing factors, and number of surgeons visited). However, this association was not observed for African American women (Wald test 10.0, P = .041). Conclusion Most women reported that they made or shared the decision about surgical treatment. More patient involvement in decision making was associated with greater use of mastectomy. Racial differences in the association of involvement with receipt of treatment suggest that the decision-making process varies by racial groups.

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A Critical Review on the Use of Race in Understanding Racial Disparities in Preeclampsia

The Journal of Applied Laboratory Medicine ◽

10.1093/jalm/jfaa149 ◽

2020 ◽

Author(s):

Henrietta O Fasanya ◽

Chu J Hsiao ◽

Kendra R Armstrong-Sylvester ◽

Stacy G Beal

Keyword(s):

African American ◽

Black Women ◽

Racial Disparities ◽

African American Women ◽

Racial Differences ◽

Lower Risk ◽

Morbidity And Mortality ◽

International Studies ◽

Placental Perfusion ◽

Risk Of Preeclampsia

Abstract Background Preeclampsia is a significant cause of maternal morbidity and mortality, affecting up to 8% of pregnancies globally. Although the precise etiology is still under study, the literature suggests that vascular changes reduce placental perfusion and affect the remodeling of spiral arteries to create the hallmark feature of preeclampsia: elevated blood pressure. Screening for preeclampsia is currently recommended for all pregnant women, particularly if risk factors exist. A noted risk factor codified in guidelines is “African-American race.” Content We summarize the racial disparities in preeclampsia incidence, morbidity, and mortality. We consider the limitations of using race to understand disparities by also examining multiethnic, immigration, and international studies. We then critically evaluate laboratory analytes associated with racial disparities of preeclampsia and explore other mechanisms of action, such as socioeconomic status, stress, and access to care. Summary Black and African-American women are consistently at higher risk of preeclampsia incidence, morbidity, and mortality than their white counterparts. Asian women are consistently at lower risk of preeclampsia, whereas the association for Hispanic women remains unclear. When these broad racial categories are subdivided by geographic or cultural origin, preeclampsia disparities within racial groups are identified. The limited literature suggests that sub-Saharan African immigrants tend to have a higher risk of preeclampsia than US-born white populations but a lower risk than US-born Black women. Existing studies seeking to identify racial differences in analytes have limited research designs and tend to operationalize race as a proxy for biologically inherent (i.e., genetic) differences between races despite a plethora of other possible explanatory mechanisms.

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