Racial/ethnic differences in HIV testing: An application of the health services utilization model

This study applying the health services utilization model examined the importance of predisposing, enabling, and need variables to the social mechanisms explaining lifetime HIV testing across racial/ethnic groups. Data for the study were derived from the National Health Interview Survey (collected 2013–2014), our final sample numbering 18,574 adults. Four subsamples reflected race/ethnicity: 13,347 Whites, 2267 Blacks, 2074 Hispanics, and 886 Asians. Logistic regression established respondent odds of ever having received HIV testing. Further statistical testing evaluated race/ethnicity’s potential moderating role in HIV testing. The findings generally support a role for Aday’s predisposing, enabling, and need factors in explaining HIV testing. Across the four subsamples, female gender, older age, and sexual minority status consistently increased lifetime HIV testing. However, we found racial/ethnic differences in HIV testing’s associations with these factors and others. Our study made a beginning in the effort to specify mechanisms leading to HIV testing—and reliable diagnosis—among four racial/ethnic groups. Understanding these mechanisms might multiply opportunities to raise testing rates for all, in turn reducing racial/ethnic disparities in HIV treatment.

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Nonelective hospital admissions, discharge disposition, and health services utilization in epilepsy patients: A population‐based study

Epilepsia ◽

10.1111/epi.16642 ◽

2020 ◽

Vol 61 (9) ◽

pp. 1969-1978

Author(s):

Churl‐Su Kwon ◽

Bonnie Wong ◽

Parul Agarwal ◽

Jung‐Yi Lin ◽

Madhu Mazumdar ◽

...

Keyword(s):

Health Services ◽

Hospital Admissions ◽

Health Services Utilization ◽

Population Based ◽

Population Based Study ◽

Services Utilization ◽

Discharge Disposition

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Geographic Regional Variation in Patterns of Racial and Ethnic Disparities in Late-Life Depression

Innovation in Aging ◽

10.1093/geroni/igaa057.545 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 168-168

Author(s):

Chirag Vyas ◽

Charles Reynolds ◽

David Mischoulon ◽

Grace Chang ◽

Olivia Okereke

Keyword(s):

Native American ◽

Ethnic Differences ◽

Ethnic Disparities ◽

Late Life ◽

Geographic Region ◽

Omega 3 ◽

Late Life Depression ◽

Item Level ◽

Racial Ethnic ◽

Hispanic White

Abstract There is evidence of racial/ethnic disparities in late-life depression (LLD) burden and treatment in the US. Geographic region may be a novel social determinant; yet, limited data exist regarding the interplay of geographic region with racial/ethnic differences in LLD severity, item-level symptom burden and treatment. We conducted a cross-sectional study among 25,503 men aged 50+ years and women aged 55+ years in VITAL-DEP (VITamin D and OmegA-3 TriaL-Depression Endpoint Prevention), an ancillary study to the VITAL trial. Racial/ethnic groups included Non-Hispanic White, Black, Hispanic, Asian, and other groups (Native American/Alaskan Native and other/multiple/unspecified-race/ethnicity). We assessed depression status using: the Patient Health Questionnaire-8 (PHQ-8); self-reported clinician/physician diagnosis of depression; medication and/or counseling treatment for depression. In the full sample, Midwest region was significantly associated with 12% lower severity of LLD, compared to Northeast region (rate ratio (RR) (95% confidence interval (CI)): 0.88 (0.83-0.93)). However, racial/ethnic differences in LLD varied by region. For example, in the Midwest, Blacks and Hispanics had significantly higher depression severity compared to non-Hispanic Whites (RR (95% CI): for Black, 1.16 (1.02-1.31); for Hispanic, 2.03 (1.38-3.00)). Furthermore, in multivariable-adjusted logistic regression models, minority vs. non-Hispanic White adults had 2- to 3-fold significantly higher odds of several item-level symptoms across all regions, especially in the Midwest and Southwest. Finally, among those endorsing PHQ-8≥10, Blacks had 60-80% significantly lower odds of depression treatment, compared to non-Hispanic Whites, in all regions. In summary, we observed significant geographic variation in patterns of racial/ethnic disparities in LLD outcomes. This requires further longitudinal investigation.

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Does the implementation of a national oral health policy reduce inequalities in oral health services utilization? The Brazilian experience

BMC Public Health ◽

10.1186/s12889-021-10586-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Maria Helena Rodrigues Galvão ◽

Angelo Giuseppe Roncalli

Keyword(s):

Health Policy ◽

Oral Health ◽

Health Services ◽

Health Services Utilization ◽

Age Groups ◽

Public Access ◽

Services Utilization ◽

Index Of Inequality ◽

Oral Health Services ◽

Oral Health Policy

Abstract Background This study aimed to assess the trend in income-related inequalities in oral health services utilization by the Brazilian population from 1998 to 2013. This period represents a timeline that includes different stages of implementation of the National Oral Health Policy. Methods The design was based on repeated cross-sectional surveys using secondary data from household-based studies carried out in Brazil in 1998, 2003, 2008, and 2013. The dependent variable was “having access to a dentist appointment at least once in a lifetime (yes/no).” Monthly household per capita income, based on Brazil’s minimum wage, was included as the main independent variable. To measure the inequalities in oral health access related to economic position, the following complex indexes based on regression were used: (a) the slope index of inequality (SII) and (b) the relative index of inequality (RII). Results There was a reduction in the percentage of individuals who never had a dentist appointment for all age groups and income classifications. In general, there was a reduction trend in absolute inequality for all age groups (p < 0.001). The relative inequality and reduction trend were different between the age groups studied. Conclusions The National Oral Health Policy was very important for expanding free of charge, public access to dental appointment. However, despite policy implementation, there continues to be high levels of inequality in access to dental consultation. Assessing which strategies are necessary to overcome this challenge is discussed.

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Ethnic Disparities in the Development of Sight-Threatening Diabetic Retinopathy in a UK Multi-Ethnic Population with Diabetes: An Observational Cohort Study

Journal of Personalized Medicine ◽

10.3390/jpm11080740 ◽

2021 ◽

Vol 11 (8) ◽

pp. 740

Author(s):

Manjula D. Nugawela ◽

Sarega Gurudas ◽

Andrew Toby Prevost ◽

Rohini Mathur ◽

John Robson ◽

...

Keyword(s):

Ethnic Groups ◽

Ethnic Differences ◽

Minority Groups ◽

Treatment Options ◽

Ethnic Disparities ◽

Ethnic Minority Groups ◽

The United Kingdom ◽

Increased Risk ◽

Observational Cohort ◽

General Practices

There is little data on ethnic differences in incidence of DR and sight threatening DR (STDR) in the United Kingdom. We aimed to determine ethnic differences in the development of DR and STDR and to identify risk factors of DR and STDR in people with incident or prevalent type II diabetes (T2DM). We used electronic primary care medical records of people registered with 134 general practices in East London during the period from January 2007–January 2017. There were 58,216 people with T2DM eligible to be included in the study. Among people with newly diagnosed T2DM, Indian, Pakistani and African ethnic groups showed an increased risk of DR with Africans having highest risk of STDR compared to White ethnic groups (HR: 1.36 95% CI 1.02–1.83). Among those with prevalent T2DM, Indian, Pakistani, Bangladeshi and Caribbean ethnic groups showed increased risk of DR and STDR with Indian having the highest risk of any DR (HR: 1.24 95% CI 1.16–1.32) and STDR (HR: 1.38 95% CI 1.17–1.63) compared with Whites after adjusting for all covariates considered. It is important to optimise prevention, screening and treatment options in these ethnic minority groups to avoid health inequalities in diabetes eye care.

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