scholarly journals Incidence of Mild Cognitive Impairment, Conversion to Probable Dementia, and Mortality

2021 ◽  
Vol 36 ◽  
pp. 153331752110122
Author(s):  
Yun Zhang ◽  
Ginny Natale ◽  
Sean Clouston
Keyword(s):  
Cognitive Impairment ◽  
Ethnic Disparities ◽  
Community Dwelling ◽  
High Rate ◽  
Survival Models ◽  
Racial And Ethnic Disparities ◽  
Older Americans ◽  
Cognitively Normal ◽  
Beneficial Impact ◽  
Hispanic White

Background: Few studies have jointly estimated incidence of MCI, conversion to probable dementia, and mortality in a nationally representatie sample. Methods: We used data from six waves of the National Health and Aging Trends Study (2011-2016). Multivariable-adjusted multi-state survival models (MSMs) were used to model incidence upon accounting for misclassification. Results: A total of 6,078 eligible NHATS participants were included (average age: 77.49 ± 7.79 years; 58.42% females; 68.99% non-Hispanic white). The incidence of MCI was estimated to be 41.0 [35.5, 47.3]/1,000 person-years (PY). Participants converted to probable dementia at a high rate of 241.3 [189.6, 307.0]/1,000 PY, though a small number also reverted from MCI to cognitively normal. Education was associated with lower incidence of MCI and conversion to probable dementia, but increased mortality in those with MCI. There were also substantial racial and ethnic disparities in the incidence of MCI and dementia. Conclusions: Our results underscore the relatively common incidence of and conversions between MCI and dementia in community-dwelling older Americans and uncover the beneficial impact of education to withstand cognitive impairment before death.

scholarly journals Incidence of Mild Cognitive Impairment, Conversion to Probable Dementia, and Mortality

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 648-648
Author(s):  
Yun Zhang ◽  
Ginny Natale ◽  
Sean Clouston
Keyword(s):  
Cognitive Impairment ◽  
Ethnic Disparities ◽  
Community Dwelling ◽  
High Rate ◽  
Survival Models ◽  
Racial And Ethnic Disparities ◽  
Older Americans ◽  
Cognitively Normal ◽  
Beneficial Impact ◽  
Hispanic White

Abstract Background Few studies have jointly estimated incidence of MCI, conversion to probable dementia, and mortality. Methods We used data from six waves of the National Health and Aging Trends Study (2011-2016). Multivariable-adjusted multi-state survival models (MSMs) were used to model incidence upon accounting for misclassification. Results A total of 6,078 eligible NHATS participants 65 years of age and older were included (average age: 77.49 ±7.79 years; 58.42% females; 68.99% non-Hispanic White). Incidence of MCI was estimated to be 41.0 [35.5, 47.3]/1,000 person-years (PY). Participants converted to probable dementia at a high rate of 241.3 [189.6, 307.0]/1,000 PY, though a small number also reverted from MCI to cognitively normal. Education was associated with lower incidence of MCI and probable dementia, but increased mortality in those with MCI. There were also substantial racial and ethnic disparities in the incidence of MCI and dementia. Conclusions Our results underscore the relatively common incidence of and conversions between MCI and dementia in community-dwelling older Americans and uncover the beneficial impact of education to withstand cognitive impairment before death.

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

Circulation ◽  
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.

Racial and Ethnic Disparities in Cesarean Morbidity

2021 ◽  
Author(s):  
Adina R. Kern-Goldberger ◽  
Whitney Booker ◽  
Alexander Friedman ◽  
Cynthia Gyamfi-Bannerman
Keyword(s):  
Cesarean Section ◽  
Cesarean Delivery ◽  
Race And Ethnicity ◽  
Primary Outcome ◽  
Ethnic Disparities ◽  
Neonatal Morbidity ◽  
Secondary Outcome ◽  
Racial And Ethnic Disparities ◽  
Hispanic White ◽  
Maternal Race

Background Maternal race and ethnicity have been identified as significant independent predictors of obstetric morbidity and mortality in the United States. An appreciation of the clinical contexts in which maternal racial and ethnic disparities are most pronounced can better target efforts to alleviate these disparities and improve outcomes. It remains unknown whether cesarean delivery precipitates these divergent outcomes. Objective This study assessed the association between maternal race and ethnicity and cesarean complications. Study Design We conducted a retrospective cohort study from a multicenter observational cohort of women undergoing cesarean delivery. Nulliparous women with non-anomalous singleton gestations who underwent primary cesarean section were included. Race/ethnicity was categorized as non-Hispanic White, non-Hispanic Black, Hispanic, Asian, Native American, or unknown. The primary outcome was a composite of maternal cesarean complications including hysterectomy, uterine atony, blood transfusion, surgical injury, arterial ligation, infection, wound complication, and ileus. A composite of neonatal morbidity was evaluated as a secondary outcome. We created a multivariable logistic regression model adjusting for selected demographic and obstetric variables that may influence the likelihood of the primary outcome. Results A total of 14,570 women in the parent trial met inclusion criteria with an 18.8% incidence of the primary outcome (2,742 women). After adjusting for potential confounding variables, maternal surgical morbidity was found to be significantly higher for non-Hispanic Black (adjusted odds ratios [aORs] 1.96, 95% confidence intervals [CIs] 1.63–2.35) and Hispanic (aOR 1.66, 95% CI 1.37–2.01) women as compared with non-Hispanic white women. Neonatal morbidity was similarly found to be significantly associated with the Black race and Hispanic ethnicity. Conclusion In this cohort, the odds of cesarean-related maternal and neonatal morbidity were significantly higher for non-Hispanic Black and Hispanic women. These findings suggest race as a distinct risk factor for cesarean complications, and efforts to alleviate disparities should highlight cesarean section as an opportunity for improvement in outcomes. Key Points

Have Racial and Ethnic Disparities in Juvenile Justice Declined Over Time? An Empirical Assessment of the DMC Mandate

2020 ◽  
pp. 154120402096216
Author(s):  
Steven N. Zane
Keyword(s):  
Juvenile Justice ◽  
Ethnic Disparities ◽  
Criminal Court ◽  
Racial And Ethnic Disparities ◽  
Implementation Failure ◽  
Theory Failure ◽  
Hispanic White ◽  
Final Disposition ◽  
Over Time ◽  
Research And Policy

The present study examines whether racial and ethnic disparities in juvenile justice declined significantly in a state that has made substantial reform efforts in compliance with the Disproportionate Minority Contact (DMC) mandate. Using a sample of all referrals in Connecticut with final disposition in 2000 (N = 18,458) or 2010 (N = 12,265), the study employed multilevel modeling with cross-level interactions to assess whether disparities changed over time for five outcomes: detention, petition, adjudication, commitment, and waiver to criminal court. Findings indicated that Black-White disparities in detention decreased over time, while Black-White disparities increased for petition, adjudication, and waiver. Findings also indicated that Hispanic-White disparities increased for adjudication (while not changing for other outcomes). The limited success of the DMC mandate may be explained by implementation failure or theory failure. Adjudicating between these alternative explanations is needed to guide future reform efforts. Several implications for research and policy are discussed, including whether reform efforts should focus on overall harm reduction rather than proportional representation.

scholarly journals Racial and Ethnic Disparities in Maternal Mortality in the United States Using Enhanced Vital Records, 2016‒2017

2021 ◽  
pp. e1-e9
Author(s):  
Marian F. MacDorman ◽  
Marie Thoma ◽  
Eugene Declcerq ◽  
Elizabeth A. Howell
Keyword(s):  
Black Women ◽  
Maternal Mortality ◽  
Cause Of Death ◽  
Maternal Death ◽  
White Women ◽  
Ethnic Disparities ◽  
The United States ◽  
Mortality Data ◽  
Racial And Ethnic Disparities ◽  
Hispanic White

Objectives. To better understand racial and ethnic disparities in US maternal mortality. Methods. We analyzed 2016–2017 vital statistics mortality data with cause-of-death literals (actual words written on the death certificate) added. We created a subset of confirmed maternal deaths that had pregnancy mentions in the cause-of-death literals. Primary cause of death was identified and recoded using cause-of-death literals. We examined racial and ethnic disparities both overall and by primary cause. Results. The maternal mortality rate for non-Hispanic Black women was 3.55 times that for non-Hispanic White women. Leading causes of maternal death for non-Hispanic Black women were eclampsia and preeclampsia and postpartum cardiomyopathy with rates 5 times those for non-Hispanic White women. Non-Hispanic Black maternal mortality rates from obstetric embolism and obstetric hemorrhage were 2.3 to 2.6 times those for non-Hispanic White women. Together, these 4 causes accounted for 59% of the non-Hispanic Black‒non-Hispanic White maternal mortality disparity. Conclusions. The prominence of cardiovascular-related conditions among the leading causes of confirmed maternal death, particularly for non-Hispanic Black women, necessitates increased vigilance for cardiovascular problems during the pregnant and postpartum period. Many of these deaths are preventable. (Am J Public Health. Published online ahead of print August 12, 2021: e1–e9. https://doi.org/10.2105/AJPH.2021.306375 )

scholarly journals Racial and ethnic disparities in maternal mental health during COVID-19

2021 ◽  
Author(s):  
Ananya Suresh Iyengar ◽  
Tsachi Ein-Dor ◽  
Emily Xujia Zhang ◽  
Sabrina Josephine Chan ◽  
Anjali Joann Kaimal ◽  
...  
Keyword(s):  
Mental Health ◽  
Traumatic Stress ◽  
Maternal Mental Health ◽  
Minority Group ◽  
Ethnic Disparities ◽  
Racial And Ethnic Disparities ◽  
Black African ◽  
Clinically Significant ◽  
Skin To Skin ◽  
Hispanic White

Knowledge of childbirth outcomes of Black and Latinx individuals during the coronavirus pandemic is limited. Black/African American and Latinx/Hispanic individuals were matched to non-Hispanic white individuals on socio-demographics. Minority individuals were nearly three times more likely to have clinically significant traumatic stress in response to childbirth and two times more likely to report postpartum depression. Unplanned Cesarean rates were higher and incidences of skin-to-skin and breastfeeding were lower in the minority group. Racial and ethnic maternal disparities exist during COVID-19.

scholarly journals Racial and ethnic disparities in rates of continuous glucose monitor initiation and continued use in children with type 1 diabetes

2020 ◽  
Author(s):  
Charlene W. Lai ◽  
Terri H. Lipman ◽  
Steven M. Willi ◽  
Colin P. Hawkes
Keyword(s):  
Type 1 Diabetes ◽  
Ethnic Disparities ◽  
Racial And Ethnic Disparities ◽  
Continuous Glucose Monitor ◽  
Sustained Use ◽  
Continued Use ◽  
One Year ◽  
Racial Ethnic ◽  
Hispanic White

<b>Background: </b>Racial/ethnic disparities in continuous glucose monitor (CGM) use exist among children with type 1 diabetes. It is not known if differential rates of device initiation or sustained use drive this disparity.<b></b> <p><b>Objective: </b>To compare CGM initiation rates and continued use among non-Hispanic white (NHW), non-Hispanic black (NHB) and Hispanic children. </p> <p><b>Methods: </b>Retrospective review including children with type 1 diabetes attending Children’s Hospital of Philadelphia between 1/1/15 and 12/31/18. <b></b></p> <p><b>Results:</b> Of 1509 eligible children, 726 (48%) started CGM during the study period. More NHW (54%) than NHB (31%) and Hispanic (33%) children started CGM (p < 0.001). One-year after starting, fewer NHB (61%) than NHW (86%) and Hispanic (85%) children were using CGM (p<0.001). </p> <p><b>Conclusions:</b> Lower CGM use in NHB children was due to lower rates of device initiation and higher rates of discontinuation. Interventions to address these barriers are needed to reduce disparities in CGM use.</p>

scholarly journals Achieving Healthcare Equity: Disparities in Diagnosis, Quality of Care, and Outcomes Among People With Dementia

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 665-666
Author(s):  
Maricruz Rivera-Hernandez ◽  
Amit Kumar ◽  
Amit Kumar
Keyword(s):  
Older Adults ◽  
Quality Of Care ◽  
Ethnic Groups ◽  
Racial Differences ◽  
Ethnic Disparities ◽  
Public Health Problem ◽  
The United States ◽  
Community Dwelling ◽  
Racial And Ethnic Disparities

Abstract Alzheimer’s disease and Related Dementia (ADRD) is a significant public health problem and improving the quality and efficiency of care for older adults with ADRD is a national priority. Approximately five million older adults in the United States, including 50% of nursing home residents and 20% of community-dwelling elderly, have ADRD or probable dementia. Although, the number of minorities affected by ADRD growing at an alarming rate, the diagnosis of ADRD and supportive care for this condition are more likely to be delayed among racial/ethnic minority groups. Given the need to ensure equity of care among racial and ethnic groups, there is a pressing need to understand disparities in diagnosis, access and quality of care among racial and ethnic groups with ADRD, specifically using nationally representative data. This symposium will feature four presentations that provide novel insight regarding racial disparities among people with ADRD in the community-, institution-based post-acute, and long-term settings. Individual presentations will describe 1) racial and ethnic differences in risk and protective factors of dementia and cognitive impairment without dementia; 2) racial and ethnic disparities in high-quality home health use among persons with dementia; 3) Within- and between-nursing homes racial and ethnic disparities in resident’s outcomes for people with ADRD; and 4) racial differences in transition to post-acute care and rehab utilization following hip fracture related hospitalization in patients with ADRD. Finally, there will be a discussion regarding policy and clinical implications, as well directions for future research.

Racial and Ethnic Disparities in Birth Outcomes and Labor and Delivery Charges Among Massachusetts Women With Intellectual and Developmental Disabilities

2020 ◽  
Vol 58 (2) ◽  
pp. 126-138
Author(s):  
Ilhom Akobirshoev ◽  
Monika Mitra ◽  
Susan L. Parish ◽  
Anne Valentine ◽  
Tiffany A. Moore Simas
Keyword(s):  
Black Women ◽  
Developmental Disabilities ◽  
Birth Outcomes ◽  
Ethnic Differences ◽  
Ethnic Disparities ◽  
Intellectual And Developmental Disabilities ◽  
Labor And Delivery ◽  
Racial And Ethnic Disparities ◽  
Racial And Ethnic Differences ◽  
Hispanic White

Abstract Understanding the pregnancy experiences of racial and ethnic minority women with intellectual and developmental disabilities (IDD) is critical to ensuring that policies can effectively support these women. This research analyzed data from the 1998–2013 Massachusetts Pregnancy to Early Life Longitudinal (PELL) data system to examine the racial and ethnic disparities in birth outcomes and labor and delivery charges of U.S. women with IDD. There was significant preterm birth disparity among non-Hispanic Black women with IDD compared to their non-Hispanic White peers. There were also significant racial and ethnic differences in associated labor and delivery-related charges. Further research, examining potential mechanisms behind the observed racial and ethnic differences in labor and delivery-related charges in Massachusetts' women with IDD is needed.

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