Differences in overall survival for patients with cholangiocarcinoma: Racial/ethnic disparity or socioeconomic factors?

380 Background: Inequities in cancer survival are well documented. Whether disparities in overall survival (OS) result from inherent racial differences in underlying disease biology or socioeconomic factors (SEF) is not known. Our aim was to define the association of race/ethnicity and SEF with OS in pts with cholangiocarcinoma (CCA). Methods: Pts with CCA of all sites and stages in the National Cancer Data Base (2004-14) were included. Racial/ethnic groups were defined as non-Hispanic White (NH-W), non-Hispanic Black (NH-B), Asian, and Hispanic. Income and education were based on census data for pts’ zip code. Income was defined as high (³$63,000) vs low ( < $63,000). Primary outcome was OS. Results: 27,151 pts were included with a mean age of 68 yrs; 51% were male. 78% were NH-W, 8% NH-B, 6% Asian, and 6% Hispanic. 56% had Medicare, 33% private insurance, 7% Medicaid, and 4% were uninsured. 67% had high income. 21% lived in an area where > 20% of adults did not finish high school. NH-B and Hispanic pts had more unfavorable SEF including uninsured status, low income, and less formal education than NH-W and Asian pts (all p < 0.001). They were also younger, more likely to be female and to have metastatic disease (all p < 0.001). Despite this, NH-B race and Hispanic ethnicity were not associated with decreased OS. Male sex, older age, non-private insurance, low income, lower education, non-academic facility, location outside the Northeast, higher Charlson-Deyo score, worse grade, larger tumor size, and higher stage were all associated with decreased OS (all p < 0.001). On MV analysis, along with adverse pathologic factors, type of insurance (p = 0.003), low income (p < 0.001), and facility type and location of treatment (p < 0.001) remained associated with decreased OS; non-white race/ethnicity was not. Conclusions: Disparities in survival exist in CCA, however they are not driven by race/ethnicity. Non-privately insured and low-income pts had decreased OS, as did pts treated at non-academic centers and outside the Northeast. This suggests that decreased ability to access and afford care results in worse outcomes, rather than biological differences amongst racial/ethnic groups.

Download Full-text

Racial Disparities in Virologic Failure and Tolerability During Firstline HIV Antiretroviral Therapy

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz022 ◽

2019 ◽

Vol 6 (2) ◽

Cited By ~ 1

Author(s):

Priya Bhagwat ◽

Shashi N Kapadia ◽

Heather J Ribaudo ◽

Roy M Gulick ◽

Judith S Currier

Keyword(s):

Antiretroviral Therapy ◽

Adverse Events ◽

Socioeconomic Factors ◽

Ethnic Groups ◽

Virologic Failure ◽

Virologic Suppression ◽

Factors Associated ◽

Race Ethnicity ◽

The Impact ◽

Racial Ethnic

Abstract Background Racial/ethnic disparities in HIV outcomes have persisted despite effective antiretroviral therapy. In a study of initial regimens, we found viral suppression varied by race/ethnicity. In this exploratory analysis, we use clinical and socioeconomic data to assess factors associated with virologic failure and adverse events within racial/ethnic groups. Methods Data were from AIDS Clinical Trial Group A5257, a randomized trial of initial regimens with either atazanavir/ritonavir, darunavir/ritonavir, or raltegravir (each combined with tenofovir DF and emtricitabine). We grouped participants by race/ethnicity and then used Cox-proportional hazards regression to examine the impact of demographic, clinical, and socioeconomic factors on the time to virologic suppression and time to adverse event reporting within each racial/ethnic group. Results We analyzed data from 1762 participants: 757 self-reported as non-Hispanic black (NHB), 615 as non-Hispanic white (NHW), and 390 as Hispanic. The proportion with virologic failure was higher for NHB (22%) and Hispanic (17%) participants compared with NHWs (9%). Factors associated with virologic failure were poor adherence and higher baseline HIV RNA level. Prior clinical AIDS diagnosis was associated with virologic failure for NHBs only, and unstable housing and illicit drug use for NHWs only. Factors associated with adverse events were female sex in all groups and concurrent use of medications for comorbidities in NHB and Hispanic participants only. Conclusions Clinical and socioeconomic factors that are associated with virologic failure and tolerability of antiretroviral therapy vary between and within racial and ethnic groups. Further research may shed light into mechanisms leading to disparities and targeted strategies to eliminate those disparities.

Download Full-text

Racial/Ethnic and Socioeconomic Disparities in the Use of Autologous Hematopoietic Stem Cell Transplant (ASCT) Among Californians with Multiple Myeloma (MM)

Blood ◽

10.1182/blood.v128.22.846.846 ◽

2016 ◽

Vol 128 (22) ◽

pp. 846-846 ◽

Cited By ~ 1

Author(s):

Aaron S Rosenberg ◽

Ann M Brunson ◽

Joseph Tuscano ◽

Brian A Jonas ◽

Ted Wun ◽

...

Keyword(s):

Overall Survival ◽

Logistic Regression ◽

Health Insurance ◽

Ethnic Groups ◽

Research Funding ◽

Population Based ◽

Cell Transplant ◽

Lower Odds ◽

Race Ethnicity ◽

Racial Ethnic

Abstract Background: Recent clinical trials of ASCT have demonstrated improved progression-free and overall survival in MM patients. In a population-level analysis, we reported use of ASCT within 12 months of diagnosis was associated with improved overall survival compared to ASCT performed >12 months after diagnosis. Prior studies suggest that non-Hispanic Whites (NHW) were more likely to utilize ASCT than other racial/ethnic groups. However, no population-based studies have considered the effect of race/ethnicity, neighborhood socioeconomic status (nSES) and type of insurance on ASCT utilization. Methods: Patients diagnosed with MM between 2000 and 2012 were identified in the California Cancer Registry linked to the California Patient Discharge Database. Multivariable logistic regression estimated the effect of race/ethnicity, nSES and health insurance on the odds of undergoing ASCT at any time, accounting for age, sex, year of diagnosis, Elixhauser comorbidity index, marital status and urban (vs rural) residence. A multinomial logistic regression was used to determine the effects of covariates on the odds of receiving early (< 1 year from diagnosis) or late (> 1 year) ASCT (vs. no ASCT). Results are presented as adjusted odds ratios (OR) and 95% confidence intervals (CIs). Results: Of the 14,264 MM cases, 8,084 (57%) were NHW, 2,815 (20%) were Hispanic, 1837 (13%) were African-American (AA), 1326 (9%) were Asian/Pacific Islander (API), and 202 (1%) were of other/unknown race/ethnicity. AA and Hispanics were younger (mean age = 64 for both) than NHW and APIs (mean ages = 68 and 67, respectively). Patients undergoing ASCT were younger than those who did not (mean age 56 vs 69, P<0. 001). The racial/ethnic groups differed by nSES (P<0.001), with higher proportions of NHWs (57%) and APIs (50%) residing in the top 40% of nSES than AAs (30%) and Hispanics (24%). Type of health insurance also varied by race/ethnicity, with Medicaid insurance more common among AAs (13%), Hispanics (16%) and APIs (12%), than NHWs (4.3%), and private insurance more common among NHWs and AAs (49% for both) than Hispanics and APIs (42% for both). Medicare was utilized more frequently by NHW (43%) and APIs (41%) than AAs (34%) and Hispanics (36%) (P<0.001). The proportion of uninsured patients was low overall (1.5%), but somewhat higher in AAs (1.6%), Hispanics (2.9%) and APIs (1.9%) than NHWs (0.9%) (P<0.001). After accounting for baseline patient characteristics, older age, AA race/ethnicity (vs NHW), increased number of comorbidities prior to diagnosis, being unmarried, diagnosis earlier in the study time-period and lacking health insurance (vs. private) were associated with lower odds of ASCT at any time (Table). The effects of other factors differed for early and late ASCT. Patients residing in rural areas were more likely to receive early, but not late ASCT. Patients who resided in the lowest 2 nSES levels (vs highest nSES level) had lower odds of early, but not late ASCT. While both Medicaid and Medicare were associated with lower odds early ASCT, only Medicaid was associated with an increased use of late ASCT. Conclusions: This large, population-based analysis indicates that race/ethnicity, neighborhood nSES and insurance status are associated with ASCT use. Lower nSES and Medicaid insurance delayed, but did not prevent, ASCT use, implying that some economic barriers can be overcome. AAs are consistently less likely to undergo ASCT than NHWs, even after adjustment for other predictors, including age, comorbidities, nSES, and health insurance. As AAs are generally diagnosed at younger ages and younger age is associated with increased utilization of ASCT, the nearly 30% decrease in the odds of undergoing ASCT among AAs is striking. Given the demonstrated survival benefits associated with ASCT, further research is necessary to determine and overcome specific barriers to accessing ASCT in patients with MM. Disclosures Wun: Janssen Scientific Affairs, LLC: Consultancy, Research Funding; Pfizer: Consultancy, Research Funding; Daiichi: Research Funding.

Download Full-text

259. Racial Differences in Clinical Phenotype and Hospitalization of Blastomycosis Patients

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.334 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S144-S144

Author(s):

Jennifer L Anderson ◽

Holly M Frost ◽

Jennifer P King ◽

Jennifer K Meece

Keyword(s):

Ethnic Groups ◽

Racial Differences ◽

Clinical Presentation ◽

Fungal Infections ◽

Therapeutic Monitoring ◽

Alaskan Native ◽

Asian Patients ◽

Caucasian Patients ◽

Race Ethnicity ◽

Racial Ethnic

Abstract Background Dimorphic fungal infections, such as blastomycosis, cause significant morbidity and mortality. Most studies describing blastomycosis have focused on non-Hispanic Caucasians and our understanding of the clinical presentation and outcomes for patients of other race/ethnicities is limited. We evaluated whether clinical presentation and disease severity varied across racial/ethnic groups. Methods Blastomycosis patients were identified from Marshfield Clinic Health System and patient data were abstracted from electronic medical records. Blastomyces genotyping was performed for cases with available isolates. Univariate analyses using χ 2 tests and multivariate logistic regression modeling were used to determine the association of race/ethnicity with clinical presentation. Significance was defined as P ≤ 0.05. Results In total 477 patients were included.Age differences were observed across race/ethnicity categories (P < 0.0001). Non-Hispanic, Caucasians were oldest (47 years, SD 20) and Asians were the youngest (30 years, SD 18). Underlying medical conditions were more common in non-Hispanic Caucasians (55%) and African Americans (AA) (52%) than Hispanic Caucasians (27%) and Asians (29%, P = 0.0002). Risk for hospitalization was highest for Hispanic Caucasian (aOR 2.9, 95% CI 1.2–1.7), American Indian Alaskan Native (AIAN) (aOR = 2.4; 95% CI 1.0–5.5), and Asian (aOR = 1.9; 95% CI 1.0–3.6) patients when compared with non-Hispanic Caucasian patients. Ninety percent of B. dermatitidis infections occurred in non-Hispanic Caucasians whereas blastomycosis in Hispanic Caucasian, AIAN, and Asian patients was frequently caused by B. gilchristii (P < 0.0001). Conclusion Hispanic Caucasian, AIAN, and Asian blastomycosis patients were younger and healthier, but more frequently hospitalized. Patients in these racial/ethnic groups may need more aggressive treatment and closer therapeutic monitoring. Underlying host factors along with organism virulence likely play a role in these differences. Disclosures All authors: No reported disclosures.

Download Full-text

Applying the Health Belief Model to Characterize Racial/Ethnic Differences in Digital Conversations Related to Depression Pre– and Mid–COVID-19 (Preprint)

10.2196/preprints.33637 ◽

2021 ◽

Author(s):

Ruby Castilla-Puentes ◽

Jacqueline Pesa ◽

Caroline Brethenoux ◽

Patrick Furey ◽

Liliana Gil Valletta ◽

...

Keyword(s):

Health Belief Model ◽

Ethnic Groups ◽

Ethnic Differences ◽

Health Belief ◽

Depression Symptoms ◽

Seeking Help ◽

Key Drivers ◽

Race Ethnicity ◽

Belief Model ◽

Racial Ethnic

BACKGROUND The prevalence of depression symptoms in the United States is >3 times higher mid–COVID-19 versus pre-pandemic. Racial/ethnic differences in mindsets around depression and the potential impact of the COVID-19 pandemic are not well characterized. OBJECTIVE To describe attitudes, mindsets, key drivers, and barriers related to depression pre– and mid–COVID-19 by race/ethnicity using digital conversations about depression mapped to health belief model (HBM) concepts. METHODS Advanced search, data extraction, and AI-powered tools were used to harvest, mine, and structure open-source digital conversations of US adults who engaged in conversations about depression pre– (February 1, 2019-February 29, 2020) and mid–COVID-19 pandemic (March 1, 2020-November 1, 2020) across the internet. Natural language processing, text analytics, and social data mining were used to categorize conversations that included a self-identifier into racial/ethnic groups. Conversations were mapped to HBM concepts (ie, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy). Results are descriptive in nature. RESULTS Of 2.9 and 1.3 million relevant digital conversations pre– and mid–COVID-19, race/ethnicity was determined among 1.8 million (62%) and 979,000 (75%) conversations pre– and mid–COVID-19, respectively. Pre–COVID-19, 1.3 million conversations about depression occurred among non-Hispanic Whites (NHW), 227,200 among Black Americans (BA), 189,200 among Hispanics, and 86,800 among Asian Americans (AS). Mid–COVID-19, 736,100 conversations about depression occurred among NHW, 131,800 among BA, 78,300 among Hispanics, and 32,800 among AS. Conversations among all racial/ethnic groups had a negative tone, which increased pre– to mid–COVID-19; finding support from others was seen as a benefit among most groups. Hispanics had the highest rate of any racial/ethnic group of conversations showing an avoidant mindset toward their depression. Conversations related to external barriers to seeking treatment (eg, stigma, lack of support, and lack of resources) were generally more prevalent among Hispanics, BA, and AS than among NHW. Being able to benefit others and building a support system were key drivers to seeking help or treatment for all racial/ethnic groups. CONCLUSIONS Applying concepts of the HBM to data on digital conversation about depression allowed organization of the most frequent themes by race/ethnicity. Individuals of all groups came online to discuss their depression. There were considerable racial/ethnic differences in drivers and barriers to seeking help and treatment for depression pre– and mid–COVID-19. Generally, COVID-19 has made conversations about depression more negative, and with frequent discussions of barriers to seeking care. These data highlight opportunities for culturally competent and targeted approaches to address areas amenable to change that might impact the ability of people to ask for or receive mental health help, such as the constructs that comprise the HBM.

Download Full-text

Imagining Her Future: Diversity in Mothers’ Socialization Goals for Their Adolescent Daughters

Journal of Cross-Cultural Psychology ◽

10.1177/0022022117696802 ◽

2017 ◽

Vol 48 (4) ◽

pp. 593-610 ◽

Cited By ~ 2

Author(s):

Jennifer Ramirez ◽

Linda Oshin ◽

Stephanie Milan

Keyword(s):

United States ◽

African American ◽

Ethnic Groups ◽

Low Income ◽

The United States ◽

Social Traits ◽

Socialization Goals ◽

Racial Ethnic ◽

Q Sort

According to developmental niche theory, members of different cultural and ethnic groups often have distinct ideas about what children need to become well-adapted adults. These beliefs are reflected in parents’ long-term socialization goals for their children. In this study, we test whether specific themes that have been deemed important in literature on diverse families in the United States (e.g., Strong Black Woman [SBW], marianismo, familismo) are evident in mothers’ long-term socialization goals. Participants included 192 mothers of teenage daughters from a low-income city in the United States (58% Latina, 22% African American, and 20% European American [EA]/White). Socialization goals were assessed through a q-sort task on important traits for a woman to possess and content analysis of open-ended responses about what values mothers hoped they would transmit to their daughters as they become adults. Results from ANCOVAs and logistic regression indicate significant racial/ethnic differences on both tasks consistent with hypotheses. On the q-sort task, African American mothers put more importance on women possessing traits such as independence than mothers from other racial/ethnic groups. Similarly, they were more likely to emphasize self-confidence and strength in what they hoped to transmit to their daughters. Contrary to expectation, Latina mothers did not emphasize social traits on the q-sort; however, in open-ended responses, they were more likely to focus on the importance of motherhood, one aspect of marianismo and familismo. Overall, results suggest that these mothers’ long-term socialization goals incorporate culturally relevant values considered important for African American and Latino families.

Download Full-text

Racial/Ethnic Disparities in Cancer-Associated Thrombosis: A Population-Based Study

Blood ◽

10.1182/blood-2020-137268 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 53-55

Author(s):

Tatini Datta ◽

Ann M Brunson ◽

Anjlee Mahajan ◽

Theresa Keegan ◽

Ted Wun

Keyword(s):

Racial Differences ◽

Ethnic Differences ◽

Brain Cancer ◽

Lower Risk ◽

Prediction Models ◽

Population Based ◽

Risk Prediction Models ◽

Cancer Types ◽

Race Ethnicity ◽

Racial Ethnic

Introduction Risk factors for cancer-associated venous thromboembolism (CAT) include tumor type, stage at diagnosis, age, and patient comorbidities. In the general population, race/ethnicity has been identified as a risk factor for venous thromboembolism (VTE), with an increased risk of VTE in African Americans (AA) and a lower risk in Asians/Pacific Islanders (API) and Hispanics compared to non-Hispanic Whites (NHW) after adjustment for confounders such as demographic characteristics and patient comorbidities. However, the impact of race/ethnicity on the incidence of CAT has not been as well-studied. Methods We performed an observational cohort study using data from the California Cancer Registry linked to the California Patient Discharge Dataset and Emergency Department Utilization database. We identified a cohort of patients of all ages with first primary diagnosis of the 13 most common cancers in California between 2005-2014, including breast, prostate, lung, colorectal, bladder, uterine, kidney, pancreatic, stomach, ovarian, and brain cancer, Non-Hodgkin lymphoma, and multiple myeloma, and followed them for a diagnosis of VTE using specific ICD-9-CM codes. The 12-month cumulative incidences of VTE [pulmonary embolism (PE) alone, PE + lower extremity deep venous thrombosis (LE DVT), proximal LE DVT alone, and isolated distal DVT (iDDVT)] were determined by race/ethnicity, adjusted for the competing risk of death. Multivariable Cox proportional hazards regression models were performed to determine the effect of race/ethnicity on the risk of CAT adjusted for age, sex, cancer stage, type of initial therapy (surgery, chemotherapy, radiation therapy), neighborhood socioeconomic status, insurance type, and comorbidities. Patients with VTE prior to cancer diagnosis were excluded. Results A total of 736,292 cancer patients were included in the analysis cohort, of which 38,431 (5.2%) developed CAT within 12 months of diagnosis. When comparing the overall cancer cohort to those that developed VTE, AA (7.2 vs 10.5%) and NHW (61.9 vs 64.3%) appear to be over-represented, and API (11.6 vs 7.6%) under-represented in VTE cohort (Figure 1). The greatest disparities in incidence by race/ethnicity were seen in PE. AA had the highest and API had the lowest 12-month cumulative incidences for all cancer types except for brain cancer (Figure 2). These racial/ethnic differences were also seen among cumulative incidences of proximal LE DVT. For iDDVT, AA again had the highest cumulative incidence compared to the other racial groups among all cancer types except for myeloma. Racial differences were not as prominent when examining cumulative incidence of all VTE (PE+DVT). In adjusted multivariable models of overall CAT, compared to NHW, AA had the highest risk of CAT across all cancer types except for brain cancer and myeloma. API had significantly lower risk of CAT than NHW for all cancer types. When examining PE only in multivariable models, AA had significantly higher risk of PE compared to NHW in all cancer types except for kidney, stomach, brain cancer, and myeloma (Hazard Ratio (HR) ranging from 1.36 to 2.09). API had significantly lower risk of PE in all cancer types except uterine, kidney, and ovarian cancer (HR ranging from 0.45 to 0.87). Hispanics had lower risk of PE than NHW in breast, prostate, colorectal, bladder, pancreatic cancer, and myeloma (HR ranging from 0.64 to 0.87). [Figure 3] Conclusion In this large, diverse, population-based cohort of cancer patients, race/ethnicity was associated with risk of CAT even after adjusting for cancer stage, type of treatment, sociodemographic factors, and comorbidities. Overall, AA had a significantly higher incidence and API had a significantly lower incidence of CAT than NHW. These racial/ethnic differences were especially prominent when examining PE only, and PE appears to be the main driver for the racial differences observed in overall rates of CAT. Current risk prediction models for CAT do not include race/ethnicity as a parameter. Future studies might examine if incorporation of race/ethnicity into risk prediction models for CAT may improve their predictive value, as this may have important implications for thromboprophylaxis in this high-risk population. Disclosures Wun: Glycomimetics, Inc.: Consultancy.

Download Full-text

Potential Mechanisms for Racial and Ethnic Differences in Antimüllerian Hormone and Ovarian Reserve

International Journal of Endocrinology ◽

10.1155/2013/818912 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7 ◽

Cited By ~ 29

Author(s):

Reshef Tal ◽

David B. Seifer

Keyword(s):

Ethnic Groups ◽

Racial Differences ◽

Ethnic Differences ◽

Ovarian Reserve ◽

Pubertal Timing ◽

Reproductive Potential ◽

Racial And Ethnic Differences ◽

Antimullerian Hormone ◽

Antimüllerian Hormone ◽

Racial Ethnic

Accumulating evidence suggests that reproductive potential and function may be different across racial and ethnic groups. Racial differences have been demonstrated in pubertal timing, infertility, outcomes after assisted reproductive technology (ART) treatment, and reproductive aging. Recently, racial differences have also been described in serum antimüllerian hormone (AMH), a sensitive biomarker of ovarian reserve, supporting the notion that ovarian reserve differs between racial/ethnic groups. The existence of such racial/ethnic differences in ovarian reserve, as reflected by AMH, may have important clinical implications for reproductive endocrinologists. However, the mechanisms which may underlie such racial differences in ovarian reserve are unclear. Various genetic factors and environmental factors such as obesity, smoking, and vitamin D deficiency which have been shown to correlate with serum AMH levels and also display significant racial/ethnic variations are discussed in this review. Improving our understanding of racial differences in ovarian reserve and their underlying causes may be essential for infertility treatment in minority women and lead to better reproductive planning, improved treatment outcomes, and timely interventions which may prolong reproductive lifespan in these women.

Download Full-text

Racial/Ethnic Disparities in Mammogram Frequency Among Women With Intellectual Disability

Intellectual and Developmental Disabilities ◽

10.1352/1934-9556-57.3.177 ◽

2019 ◽

Vol 57 (3) ◽

pp. 177-187 ◽

Cited By ~ 1

Author(s):

Evelyn Arana ◽

Amy Carroll-Scott ◽

Philip M. Massey ◽

Nora L. Lee ◽

Ann C. Klassen ◽

...

Keyword(s):

Intellectual Disability ◽

Black Women ◽

Medical Record ◽

Ethnic Groups ◽

White Women ◽

Ethnic Disparities ◽

Medical Record Data ◽

Record Data ◽

Race Ethnicity ◽

Racial Ethnic

Abstract Little information exists on the associations between intellectual disability (ID) and race/ethnicity on mammogram frequency. This study collected survey and medical record data to examine this relationship. Results indicated that Hispanic and Black women with ID were more likely than White women with ID to have mammograms every 2 years. Participants who live in a state-funded residence, were aged 50+, and had a mild or moderate level of ID impairment were more likely to undergo mammography compared to participants living with family or alone, were <50, and had severe ID impairment. Further research is needed to understand the mechanisms explaining disparities in mammograms between these racial/ethnic groups.

Download Full-text

Racial/ethnic disparities in the risk of intracerebral hemorrhage recurrence

Neurology ◽

10.1212/wnl.0000000000008737 ◽

2019 ◽

Vol 94 (3) ◽

pp. e314-e322 ◽

Cited By ~ 1

Author(s):

Audrey C. Leasure ◽

Zachary A. King ◽

Victor Torres-Lopez ◽

Santosh B. Murthy ◽

Hooman Kamel ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Ethnic Groups ◽

Proportional Hazards ◽

Private Insurance ◽

Multivariable Analysis ◽

Ethnic Disparities ◽

Cox Proportional Hazards ◽

Risk Of Recurrence ◽

Asian Patients ◽

Racial Ethnic

ObjectiveTo estimate the risk of intracerebral hemorrhage (ICH) recurrence in a large, diverse, US-based population and to identify racial/ethnic and socioeconomic subgroups at higher risk.MethodsWe performed a longitudinal analysis of prospectively collected claims data from all hospitalizations in nonfederal California hospitals between 2005 and 2011. We used validated diagnosis codes to identify nontraumatic ICH and our primary outcome of recurrent ICH. California residents who survived to discharge were included. We used log-rank tests for unadjusted analyses of survival across racial/ethnic groups and multivariable Cox proportional hazards regression to determine factors associated with risk of recurrence after adjusting for potential confounders.ResultsWe identified 31,355 California residents with first-recorded ICH who survived to discharge, of whom 15,548 (50%) were white, 6,174 (20%) were Hispanic, 4,205 (14%) were Asian, and 2,772 (9%) were black. There were 1,330 recurrences (4.1%) over a median follow-up of 2.9 years (interquartile range 3.8). The 1-year recurrence rate was 3.0% (95% confidence interval [CI] 2.8%–3.2%). In multivariable analysis, black participants (hazard ratio [HR] 1.22; 95% CI 1.01–1.48; p = 0.04) and Asian participants (HR 1.29; 95% CI 1.10–1.50; p = 0.001) had a higher risk of recurrence than white participants. Private insurance was associated with a significant reduction in risk compared to patients with Medicare (HR 0.60; 95% CI 0.50–0.73; p < 0.001), with consistent estimates across racial/ethnic groups.ConclusionsBlack and Asian patients had a higher risk of ICH recurrence than white patients, whereas private insurance was associated with reduced risk compared to those with Medicare. Further research is needed to determine the drivers of these disparities.

Download Full-text

Worshiping across the Color Line: The Influence of Congregational Composition on Whites’ Friendship Networks and Racial Attitudes

Sociology of Race and Ethnicity ◽

10.1177/2332649218757804 ◽

2018 ◽

Vol 5 (1) ◽

pp. 100-114 ◽

Cited By ~ 3

Author(s):

Edward C. Polson ◽

Kevin D. Dougherty

Keyword(s):

Ethnic Groups ◽

Ethnic Diversity ◽

Ethnic Composition ◽

Friendship Networks ◽

Color Line ◽

Recent Scholarship ◽

Multiracial Congregations ◽

Race Ethnicity ◽

American Society ◽

Racial Ethnic

Religious participation has reinforced the color line in American society for generations. Despite rising racial and ethnic diversity across U.S. communities, most Americans continue to belong to congregations composed primarily of others from their own racial/ethnic groups. Yet recent scholarship suggests that the presence of multiple racial or ethnic groups in the same congregation is increasing. The authors examine how the racial/ethnic composition of U.S. congregations is related to white attenders’ friendship networks and comfort with other racial/ethnic groups (i.e., blacks, Hispanics, and Asians). Using national survey data, the authors find that whites in multiracial congregations report more diverse friendship networks and higher levels of comfort with nonwhites than do whites in nonmultiracial congregations. However, the influence of worshipping with another race/ethnicity seems to be most pronounced for whites in congregations with Hispanics. Moreover, neighbors and friends of other races have more impact on whites’ friendship networks and attitudes than do congregations. The authors discuss implications of these findings for understanding U.S. intergroup relations and the potential of congregations to address the color line.

Download Full-text