Correlates of Single Versus Multiple Functional Disabilities Among Aging Americans: Race/Ethnicity and Region of Birth

Background: Significant racial/ethnic disparities exist in the prevalence of functional disability among older Americans. Objective: The study analyzed the odds of older people in the United States experiencing single and multiple disabilities, by race and region of birth. Method: Data came from the American Community Survey (2011–2015). Multinomial logistic regression analysis was used. Results: Region of birth, race/ethnicity, age, citizenship status, duration of stay, sex, marital status, veteran status, educational attainment, poverty status, and class of workers were all significantly associated with reports of either single or multiple disabilities. However, the introduction of the interaction terms for citizenship status by race modified some of the significant results. For instance, being born in Latin America no longer reduced the odds in reports of both single and multiple disabilities. However, compared with Whites and native-born of all races, both Hispanics who were either naturalized or were noncitizens had lower odds of reporting multiple disabilities (27% and 28% lower, respectively), whereas naturalized Hispanics also had significantly reduced odds (22%) for a single disability. Conclusion: These findings add to the disability, race/ethnicity, and place of birth literature.

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Race/ethnic Differences in Post-Stroke Depression (PSD): Findings from the Stroke Warning Information and Faster Treatment (SWIFT) Study

Ethnicity & Disease ◽

10.18865/ed.26.1.1 ◽

2016 ◽

Vol 26 (1) ◽

pp. 1 ◽

Cited By ~ 6

Author(s):

Emily Goldmann ◽

Eric T. Roberts ◽

Nina S. Parikh ◽

Aaron S. Lord ◽

Bernadette Boden-Albala

Keyword(s):

Ethnic Differences ◽

Multinomial Logistic Regression ◽

Prospective Trial ◽

Early Period ◽

Ethnic Disparities ◽

Stroke Patients ◽

Multinomial Logistic Regression Analysis ◽

Post Stroke ◽

Post Stroke Depression ◽

Race Ethnicity

Objectives: Post-stroke depression (PSD) is common and associated with poor stroke outcomes, but few studies have examined race/ethnic disparities in PSD. Given the paucity of work and inconsistent findings in this important area of research, this study aims to examine race/ethnic differences in depression in a multi-ethnic cohort of stroke patients.Design: Longitudinal.Setting: Prospective trial of a post-stroke educational intervention.Patients or Participants: 1,193 mild/moderate ischemic stroke/TIA patients.Main Outcome Measures: We used the Center for Epidemiologic Studies Depression (CES-D) Scale to assess subthreshold (CES-D score 8-15) and full (CES-D score ≥ 16) depression at one month (“early”) and 12 months (“late”) following stroke. Multinomial logistic regression analysis examined the association between race/ethnicity and early and late PSD separately.Results: The prevalence of subthreshold and full PSD was 22.5% and 32.6% in the early period and 22.0% and 27.4% in the late period, respectively. Hispanics had 40% the odds of early full PSD compared with non-Hispanic Whites after adjusting for other covariates (OR=0.40, 95% CI: 0.22, 0.76). Race/ethnicity was not significantly associated with late PSD.Conclusions: Hispanic stroke patients had half the odds of PSD in early period compared with whites, but no difference was found in the later period. Further studies comparing trajectories of PSD between race/ethnic groups may further our understanding of race/ethnic disparities in PSD and help identify effective interventions. Ethn Dis. 2016;26(1):1-8; doi:10.18865/ed.26.1.1

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Racial and Ethnic Disparities in Years of Potential Life Lost Attributable to COVID-19 in the United States: An Analysis of 45 States and the District of Columbia

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18062921 ◽

2021 ◽

Vol 18 (6) ◽

pp. 2921

Author(s):

Jay J. Xu ◽

Jarvis T. Chen ◽

Thomas R. Belin ◽

Ronald S. Brookmeyer ◽

Marc A. Suchard ◽

...

Keyword(s):

United States ◽

District Of Columbia ◽

Ethnic Disparities ◽

The United States ◽

Attributable Mortality ◽

Race Ethnicity ◽

Using Data ◽

Rate Ratios ◽

Degree Of Association ◽

Racial Ethnic

The coronavirus disease 2019 (COVID-19) epidemic in the United States has disproportionately impacted communities of color across the country. Focusing on COVID-19-attributable mortality, we expand upon a national comparative analysis of years of potential life lost (YPLL) attributable to COVID-19 by race/ethnicity (Bassett et al., 2020), estimating percentages of total YPLL for non-Hispanic Whites, non-Hispanic Blacks, Hispanics, non-Hispanic Asians, and non-Hispanic American Indian or Alaska Natives, contrasting them with their respective percent population shares, as well as age-adjusted YPLL rate ratios—anchoring comparisons to non-Hispanic Whites—in each of 45 states and the District of Columbia using data from the National Center for Health Statistics as of 30 December 2020. Using a novel Monte Carlo simulation procedure to perform estimation, our results reveal substantial racial/ethnic disparities in COVID-19-attributable YPLL across states, with a prevailing pattern of non-Hispanic Blacks and Hispanics experiencing disproportionately high and non-Hispanic Whites experiencing disproportionately low COVID-19-attributable YPLL. Furthermore, estimated disparities are generally more pronounced when measuring mortality in terms of YPLL compared to death counts, reflecting the greater intensity of the disparities at younger ages. We also find substantial state-to-state variability in the magnitudes of the estimated racial/ethnic disparities, suggesting that they are driven in large part by social determinants of health whose degree of association with race/ethnicity varies by state.

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Racial/Ethnic Disparities in Hypertension Prevalence, Awareness, Treatment, and Control in the United States, 2013 to 2018

Hypertension ◽

10.1161/hypertensionaha.121.17570 ◽

2021 ◽

Author(s):

Rahul Aggarwal ◽

Nicholas Chiu ◽

Rishi K. Wadhera ◽

Andrew E. Moran ◽

Inbar Raber ◽

...

Keyword(s):

United States ◽

Ethnic Disparities ◽

The United States ◽

Self Report ◽

Similar Treatment ◽

Hypertension Prevalence ◽

Health And Nutrition ◽

Race Ethnicity ◽

And Control ◽

White Adults

We evaluated the prevalence, awareness, treatment, and control of hypertension (defined as a systolic blood pressure [BP]) ≥140 mm Hg, diastolic BP ≥90 mm Hg, or a self-reported use of an antihypertensive agent) among US adults, stratified by race/ethnicity. This analysis included 16 531 nonpregnant US adults (≥18 years) in the three National Health and Nutrition Examination Survey cycles between 2013 and 2018. Race/ethnicity was defined by self-report as White, Black, Hispanic, Asian, or other Americans. Among 76 910 050 (74 449 985–79 370 115) US adults with hypertension, 48.6% (47.3%–49.8%, unadjusted) have controlled BP. When compared with BP control rates for White adults (49.0% [46.8%–51.2%], age-adjusted), BP control rates are lower in Black (39.2%, adjusted odds ratio [aOR], 0.71 [95% CI, 0.59–0.85], P <0.001), Hispanic (40.0%, aOR, 0.71 [95% CI, 0.58–0.88], P =0.003), and Asian (37.8%, aOR, 0.68 [95% CI, 0.55–0.84], P =0.001) Americans. Black adults have higher hypertension prevalence (45.3% versus 31.4%, aOR, 2.24 [95% CI, 1.97–2.56], P <0.001) but similar awareness and treatment rates as White adults. Hispanic adults have similar hypertension prevalence, but lower awareness (71.1% versus 79.1%, aOR, 0.72 [95% CI, 0.58–0.89], P =0.005) and treatment rates (60.5% versus 67.3%, aOR, 0.78 [95% CI, 0.66–0.94], P =0.010) than White adults. Asian adults have similar hypertension prevalence, lower awareness (72.5% versus 79.1%, aOR, 0.75 [95% CI, 0.58–0.97], P =0.038) but similar treatment rates. Black, Hispanic, and Asian Americans have different vulnerabilities in the hypertension control cascade of prevalence, awareness, treatment, and control. These differences can inform targeted public health efforts to promote health equity and reduce the burden of hypertension in the United States.

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Anxiety and depression among racial/ethnic minorities and impoverished women testing positive for BRCA1/2 mutations in the United States

10.21203/rs.3.rs-887893/v1 ◽

2021 ◽

Author(s):

Kate E Dibble ◽

Avonne E Connor

Keyword(s):

United States ◽

Depressive Symptoms ◽

Hispanic Women ◽

Ethnic Disparities ◽

The United States ◽

Medically Underserved ◽

Increased Risk ◽

Poverty Status ◽

Race Ethnicity ◽

Severe Anxiety

Abstract PurposeTo outline the association between race/ethnicity and poverty status and perceived anxiety and depressive symptomologies among BRCA1/2-positive United States (US) women to identify high-risk groups of mutation carriers from medically underserved backgrounds.Methods211 BRCA1/2-positive women from medically underserved backgrounds were recruited through national Facebook support groups and completed an online survey. Adjusted odds ratios (aOR) and 95% confidence intervals (CIs) were estimated using multivariable logistic regression for associations between race/ethnicity, poverty status, and self-reported moderate-to-severe anxiety and depressive symptoms.ResultsWomen ranged in age (18–75, M = 39.5, SD = 10.6). Most women were non-Hispanic white (NHW) (67.2%) and were not impoverished (76.7%). Hispanic women with BRCA1/2 mutations were 6.11 times more likely to report moderate-to-severe anxiety (95% CI, 2.16–17.2, p = 0.001) and 4.28 times more likely to report moderate-to-severe depressive symptoms (95% CI, 1.98–9.60, p = < 0.001) than NHW women with BRCA1/2. Associations were not statistically significant among other minority women. Women living in poverty were significantly less likely to report moderate-to-severe depressive symptoms than women not in poverty (aOR, 0.42, 95% CI, 0.18–0.95, p = 0.04).ConclusionHispanic women with BRCA1/2 mutations from medically underserved backgrounds are an important population at increased risk for worse anxiety and depressive symptomology. Our findings among Hispanic women with BRCA1/2 mutations add to the growing body of literature focused on ethnic disparities experienced across the cancer control continuum.

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Racial/Ethnic Disparities in Mortality: Contributions and Variations by Rurality in the United States, 2012–2015

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16030436 ◽

2019 ◽

Vol 16 (3) ◽

pp. 436 ◽

Cited By ~ 5

Author(s):

Jeffrey Hall ◽

Ramal Moonesinghe ◽

Karen Bouye ◽

Ana Penman-Aguilar

Keyword(s):

Rural Areas ◽

Ethnic Disparities ◽

The United States ◽

Mortality Rates ◽

Malignant Neoplasms ◽

Ethnic Populations ◽

Asian Pacific Islanders ◽

Race Ethnicity ◽

Asian Pacific ◽

Racial Ethnic

The value of disaggregating non-metropolitan and metropolitan area deaths in illustrating place-based health effects is evident. However, how place interacts with characteristics such as race/ethnicity has been less firmly established. This study compared socioeconomic characteristics and age-adjusted mortality rates by race/ethnicity in six rurality designations and assessed the contributions of mortality rate disparities between non-Hispanic blacks (NHBs) and non-Hispanic whites (NHWs) in each designation to national disparities. Compared to NHWs, age-adjusted mortality rates for: (1) NHBs were higher for all causes (combined), heart disease, malignant neoplasms, and cerebrovascular disease; (2) American Indian and Alaska Natives were significantly higher for all causes in rural areas; (3) Asian Pacific islanders and Hispanics were either lower or not significantly different in all areas for all causes combined and all leading causes of death examined. The largest contribution to the U.S. disparity in mortality rates between NHBs and NHWs originated from large central metropolitan areas. Place-based variations in mortality rates and disparities may reflect resource, and access inequities that are often greater and have greater health consequences for some racial/ethnic populations than others. Tailored, systems level actions may help eliminate mortality disparities existing at intersections between race/ethnicity and place.

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Infant Mortality among Adolescent Mothers in the United States: A 5-Year Analysis of Racial and Ethnic Disparities

American Journal of Perinatology ◽

10.1055/s-0040-1714678 ◽

2020 ◽

Author(s):

Matthew D. Moore ◽

Anne E. Brisendine ◽

Martha S. Wingate

Keyword(s):

United States ◽

Preterm Birth ◽

Infant Mortality ◽

Ethnic Disparities ◽

The United States ◽

Racial And Ethnic Disparities ◽

Postneonatal Mortality ◽

Maternal Characteristics ◽

Race Ethnicity ◽

Racial Ethnic

Objective This study was aimed to examine differences in infant mortality outcomes across maternal age subgroups less than 20 years in the United States with a specific focus on racial and ethnic disparities. Study Design Using National Center for Health Statistics cohort-linked live birth–infant death files (2009-2013) in this cross-sectional study, we calculated descriptive statistics by age (<15, 15–17, and 18–19 years) and racial/ethnic subgroups (non-Hispanic white [NHW], non-Hispanic black [NHB], and Hispanic) for infant, neonatal, and postneonatal mortality. Adjusted odds ratios (aOR) were calculated by race/ethnicity and age. Preterm birth and other maternal characteristics were included as covariates. Results Disparities were greatest for mothers <15 and NHB mothers. The risk of infant mortality among mothers <15 years compared to 18 to 19 years was higher regardless of race/ethnicity (NHW: aOR = 1.40, 95% confidence interval [CI]: 1.06–1.85; NHB: aOR = 1.28, 95% CI: 1.04–1.56; Hispanic: aOR = 1.36, 95%CI: 1.07–1.74). Compared to NHW mothers, NHB mothers had a consistently higher risk of infant mortality (15–17 years: aOR = 1.12, 95% CI: 1.03–1.21; 18–19 years: aOR = 1.21, 95% CI: 1.15–1.27), while Hispanic mothers had a consistently lower risk (15–17 years: aOR = 0.72, 95% CI: 0.66–0.78; 18–19 years: aOR = 0.74, 95% CI: 0.70–0.78). Adjusting for preterm birth had a greater influence than maternal characteristics on observed group differences in mortality. For neonatal and postneonatal mortality, patterns of disparities based on age and race/ethnicity differed from those of overall infant mortality. Conclusion Although infants born to younger mothers were at increased risk of mortality, variations by race/ethnicity and timing of death existed. When adjusted for preterm birth, differences in risk across age subgroups declined and, for some racial/ethnic groups, disappeared. Key Points

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Racial/Ethnic Disparities in Lost Earnings From Cancer Deaths in the United States

JNCI Cancer Spectrum ◽

10.1093/jncics/pkaa038 ◽

2020 ◽

Vol 4 (5) ◽

Cited By ~ 1

Author(s):

Jingxuan Zhao ◽

Kimberly D Miller ◽

Farhad Islami ◽

Zhiyuan Zheng ◽

Xuesong Han ◽

...

Keyword(s):

United States ◽

Economic Burden ◽

Ethnic Disparities ◽

The United States ◽

Pacific Islanders ◽

Equal Access ◽

Years Of Life Lost ◽

Cancer Death ◽

Race Ethnicity ◽

Racial Ethnic

Abstract Background Little is known about disparities in economic burden due to premature cancer deaths by race or ethnicity in the United States. This study aimed to compare person-years of life lost (PYLLs) and lost earnings due to premature cancer deaths by race/ethnicity. Methods PYLLs were calculated using recent national cancer death and life expectancy data. PYLLs were combined with annual median earnings to generate lost earnings. We compared PYLLs and lost earnings among individuals who died at age 16-84 years due to cancer by racial/ethnic groups (non-Hispanic [NH] White, NH Black, NH Asian or Pacific Islander, and Hispanic). Results In 2015, PYLLs due to all premature cancer deaths were 6 512 810 for NH Whites, 1 196 709 for NH Blacks, 279 721 for NH Asian or Pacific Islanders, and 665 968 for Hispanics, translating to age-standardized lost earning rates (per 100 000 person-years) of $34.9 million, $43.5 million, $22.2 million, and $24.5 million, respectively. NH Blacks had higher age-standardized PYLL and lost earning rates than NH Whites for 13 of 19 selected cancer sites. If age-specific PYLL and lost earning rates for NH Blacks were the same as those of NH Whites, 241 334 PYLLs and $3.2 billion lost earnings (22.6% of the total lost earnings among NH Blacks) would have been avoided. Disparities were also observed for average PYLLs and lost earnings per cancer death for all cancers combined and 18 of 19 cancer sites. Conclusions Improving equal access to effective cancer prevention, screening, and treatment will be important in reducing the disproportional economic burden associated with racial/ethnic disparities.

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Sociodemographic and Clinical Risk Factors Associated With Tuberculosis Mortality in the United States, 2009-2013

Public Health Reports ◽

10.1177/0033354917698117 ◽

2017 ◽

Vol 132 (3) ◽

pp. 366-375 ◽

Cited By ~ 16

Author(s):

Haylea A. Hannah ◽

Roque Miramontes ◽

Neel R. Gandhi

Keyword(s):

United States ◽

Risk Factors ◽

Multinomial Logistic Regression ◽

The United States ◽

Multidrug Resistant ◽

Multinomial Logistic Regression Analysis ◽

Factors Associated ◽

Specific Mortality ◽

Stage Renal Disease ◽

End Stage

Objectives: The objectives of our study were (1) to determine risk factors associated with tuberculosis (TB)–specific and non–TB-specific mortality among patients with TB and (2) to examine whether risk factors for TB-specific mortality differed from those for non–TB-specific mortality. Methods: We obtained data from the National Tuberculosis Surveillance System and included all patients who had TB between 2009 and 2013 in the United States and its territories. We used multinomial logistic regression analysis to determine the adjusted odds ratio (aOR) of each risk factor for TB-specific and non–TB-specific mortality. Results: Of 52 175 eligible patients with TB, 1404 died from TB, and 2413 died from other causes. Some of the risk factors associated with the highest odds of TB-specific mortality were multidrug-resistant TB diagnosis (aOR = 3.42; 95% CI, 1.95-5.99), end-stage renal disease (aOR = 3.02; 95% CI, 2.23-4.08), human immunodeficiency virus infection (aOR = 2.63; 95% CI, 2.02-3.42), age 45-64 years (aOR = 2.57; 95% CI, 2.01-3.30) or age ≥65 years (aOR = 5.76; 95% CI, 4.37-7.61), and immunosuppression (aOR = 2.20; 95% CI, 1.71-2.83). All of these risk factors except multidrug-resistant TB were also associated with increased odds of non–TB-specific mortality. Conclusion: TB patients with certain risk factors have an elevated risk of TB-specific mortality and should be monitored before, during, and after treatment. Identifying the predictors of TB-specific mortality may help public health authorities determine which subpopulations to target and where to allocate resources.

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Measuring the missing: greater racial and ethnic disparities in COVID-19 burden after accounting for missing race/ethnicity data

10.1101/2020.09.30.20203315 ◽

2020 ◽

Author(s):

Katie Labgold ◽

Sarah Hamid ◽

Sarita Shah ◽

Neel R. Gandhi ◽

Allison Chamberlain ◽

...

Keyword(s):

Ethnic Disparities ◽

Case Fatality ◽

The United States ◽

Infection Rates ◽

Bias Adjustment ◽

Social Inequities ◽

Increased Risk ◽

Race Ethnicity ◽

The Difference ◽

Racial Ethnic

AbstractBlack, Hispanic, and Indigenous persons in the United States have an increased risk of SARS-CoV-2 infection and death from COVID-19, due to persistent social inequities. The magnitude of the disparity is unclear, however, because race/ethnicity information is often missing in surveillance data. In this study, we quantified the burden of SARS-CoV-2 infection, hospitalization, and case fatality rates in an urban county by racial/ethnic group using combined race/ethnicity imputation and quantitative bias-adjustment for misclassification. After bias-adjustment, the magnitude of the absolute racial/ethnic disparity, measured as the difference in infection rates between classified Black and Hispanic persons compared to classified White persons, increased 1.3-fold and 1.6-fold respectively. These results highlight that complete case analyses may underestimate absolute disparities in infection rates. Collecting race/ethnicity information at time of testing is optimal. However, when data are missing, combined imputation and bias-adjustment improves estimates of the racial/ethnic disparities in the COVID-19 burden.

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Racial and Ethnic Disparities in Years of Potential Life Lost Attributable to COVID-19 in the United States: An Analysis of 45 States and the District of Columbia

10.1101/2021.01.28.21249411 ◽

2021 ◽

Author(s):

Jay J. Xu ◽

Jarvis T. Chen ◽

Thomas R. Belin ◽

Ronald S. Brookmeyer ◽

Marc A. Suchard ◽

...

Keyword(s):

United States ◽

District Of Columbia ◽

Ethnic Disparities ◽

The United States ◽

Attributable Mortality ◽

Estimation Uncertainty ◽

Race Ethnicity ◽

Using Data ◽

Rate Ratios ◽

Racial Ethnic

AbstractThe coronavirus disease 2019 (COVID-19) epidemic in the United States has disproportionately impacted communities of color across the country. Focusing on COVID-19-attributable mortality, we expand upon a national comparative analysis of years of potential life lost (YPLL) attributable to COVID-19 by race/ethnicity (Bassett et al., 2020), estimating percentages of total YPLL for non-Hispanic Whites, non-Hispanic Blacks, Hispanics, non-Hispanic Asians, and non-Hispanic American Indian or Alaska Natives, contrasting them with their respective percent population shares, as well as age-adjusted YPLL rate ratios – anchoring comparisons to non-Hispanic Whites – in each of 45 states and the District of Columbia using data from the National Center for Health Statistics as of December 30, 2020. Using a novel Monte Carlo simulation procedure to quantify estimation uncertainty, our results reveal substantial racial/ethnic disparities in COVID-19-attributable YPLL across states, with a prevailing pattern of non-Hispanic Blacks and Hispanics experiencing disproportionately high and non-Hispanic Whites experiencing disproportionately low COVID-19-attributable YPLL. Furthermore, observed disparities are generally more pronounced when measuring mortality in terms of YPLL compared to death counts, reflecting the greater intensity of the disparities at younger ages. We also find substantial state-to-state variability in the magnitudes of the estimated racial/ethnic disparities, suggesting that they are driven in large part by social determinants of health whose degree of association with race/ethnicity varies by state.

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