scholarly journals Ethnic Disparities in Cardio-Metabolic and Reproductive Profiles in Women With Polycystic Ovary Syndrome per the New International Guideline: A United-States Based Multi-Center Study

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A739-A740
Author(s):  
Maryam Kazemi ◽  
Kathleen M Hoeger ◽  
Steven D Spandorfer ◽  
Marla E Lujan
Keyword(s):  
White Women ◽  
New York State ◽  
Ethnic Disparities ◽  
Sex Hormone Binding Globulin ◽  
Clinical Population ◽  
Interval Length ◽  
Model Assessment ◽  
Abdominal Adiposity ◽  
Asian Group ◽  
Hispanic White

Abstract The magnitude and direction to which cardio-metabolic and reproductive aberrations may disproportionately impact diverse populations of women with PCOS are relevant yet unclear. The uncertainty stems, in part, from heterogeneity in PCOS diagnostic criteria used and technical challenges in the reliable assessment of this clinical population. We evaluated whether cardio-metabolic (abdominal adiposity, hypertension, impaired glucoregulatory status) and reproductive (hyperandrogenism, polycystic ovarian morphology [PCOM], menstrual irregularity) outcomes were different in PCOS (n = 120, 18-36 yrs.) across 4 groups: (1) Non-Hispanic White (n = 76); (2) Non-Hispanic Black (n = 14); (3) Non-Hispanic Asian (n = 15); and, (4) Hispanic White (n = 15). Women were prospectively recruited across 3 academic medical centers in New York State and were matched for age and body mass index. PCOS was defined by the Rotterdam criteria using the recommended thresholds of the 2018 International Evidence-based Guideline for the Assessment and Management of PCOS. Concerning abdominal adiposity, the Asian group (mean ± standard deviation; 0.78 ± 0.06) had a lower waist to hip ratio (WHR) compared to the White group (0.85 ± 0.09; P = 0.01). Also, the Asian group had a higher sex hormone binding globulin (SHBG, 65.9 ± 23.4 nmol/L) compared to all other groups (White [40.5 ± 22.3]; Black [43.8 ± 21.9]; Hispanic [36.8 ± 18.8] nmol/L; All: P < 0.04). In contrast, the White group were most hyperandrogenic, evidenced by their higher modified Ferriman-Gallwey (mFG) scores (10 ± 4) compared to other groups (Black [4 ± 0]; Asian [2 ± 0]; Hispanic [4 ± 1]; All: P ≤ 0.001). Consistently, the White group (1.0 ± 0.5 ng/dL) exhibited increased free testosterone (FT) compared to other groups (Black [0.5 ± 0]; Asian [0.4 ± 0]; Hispanic [0.6 ± 0.1] ng/dL; All: P ≤ 0.001), unlike total testosterone (P = 0.12). Regarding PCOM, the White group exhibited higher follicle numbers per ovary (FNPO 2-9 mm, 48 ± 22) compared to other groups (Black [30 ± 16]; Asian [26 ± 5]; Hispanic [22 ± 17]; All: P ≤ 0.05). Unlike Black (12.4 ± 1.3 mm; P = 0.05) and Hispanic (13.5 ± 1.1 mm; P = 0.89) groups, the White group (13.9 ± 2.1 mm) also exhibited larger ovarian volume (OV) compared to Asian group (12.4 ± 1.5 mm; P = 0.03). Women had comparable blood pressure (systolic, diastolic), fasting glucose, homeostatic model assessment of insulin resistance, or intermenstrual interval length (All: P ≥ 0.09). Overall, Asian women in the US likely exhibit the mildest PCOS metabolic (decreased WHR, increased SHBG) phenotype, whereas White women show the most severe reproductive (increased mFG, FT, FNPO, OV) phenotype. If confirmed by larger studies, our observations warrant additional population-specific diagnostic considerations to prevent and manage PCOS cardio-metabolic (e.g., metabolic syndrome risk) and reproductive (e.g., hirsutism, PCOM) complications across ethnicities.

Racial and Ethnic Disparities in Peripartum Hysterectomy Risk and Outcomes

2021 ◽  
Author(s):  
Margaret H. Bogardus ◽  
Timothy Wen ◽  
Cynthia Gyamfi-Bannerman ◽  
Jason D. Wright ◽  
Dena Goffman ◽  
...  
Keyword(s):  
Black Women ◽  
Race And Ethnicity ◽  
White Women ◽  
Hispanic Women ◽  
Intraoperative Complications ◽  
Ethnic Disparities ◽  
Peripartum Hysterectomy ◽  
Increased Risk ◽  
Surgical Site Complications ◽  
Hispanic White

Objective This study aimed to determine whether race and ethnicity contribute to risks associated with peripartum hysterectomy. Study Design This retrospective cross-sectional study utilized the 2000–2014 Nationwide Inpatient Sample to analyze risk of peripartum hysterectomy and associated severe maternal morbidity, mortality, surgical injury, reoperation, surgical-site complications, and mortality by maternal race and ethnicity. Race and ethnicity were categorized as non-Hispanic white, non-Hispanic black, Hispanic, other, and unknown. Multivariable log-linear regression models including patient, clinical, and hospital risk factors were performed with adjusted risk ratios (aRRs) and 95% confidence intervals (CIs). Results Of 59,854,731 delivery hospitalizations, there were 45,369 peripartum hysterectomies (7.6 per thousand). Of these, 37.8% occurred among non-Hispanic white, 13.9% among non-Hispanic black, and 22.8% among Hispanic women. In adjusted analyses, non-Hispanic black (aRR: 1.21, 95% CI: 1.17–1.29) and Hispanic women (aRR: 1.25, 95% CI: 1.22–1.29) were at increased risk of hysterectomy compared with non-Hispanic white women. Risk for severe morbidity was increased for non-Hispanic black (aRR: 1.25, 95% CI: 1.19–1.33), but not for Hispanic (aRR: 1.02, 95% CI: 0.97–1.07) women. Between these three groups, risk for intraoperative complications was highest among non-Hispanic white women, risk for reoperation was highest among Hispanic women, and risk for surgical-site complications was highest among non-Hispanic black women. Evaluating maternal mortality, non-Hispanic black women (RR: 3.83, 95% CI: 2.65–5.53) and Hispanic women (RR: 2.49, 95% CI: 1.74–3.59) were at higher risk than non-Hispanic white women. Conclusion Peripartum hysterectomy and related complications other than death differed modestly by race. In comparison, mortality differentials were large supporting that differential risk for death in the setting of this high-risk scenario may be an important cause of disparities. Key Points

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.

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 and Infant Outcomes Among Opioid-Exposed Mother–Infant Dyads in Massachusetts (2017–2019)

2020 ◽  
Vol 110 (12) ◽  
pp. 1828-1836
Author(s):  
Mary Peeler ◽  
Munish Gupta ◽  
Patrice Melvin ◽  
Allison S. Bryant ◽  
Hafsatou Diop ◽  
...  
Keyword(s):  
Black Women ◽  
White Women ◽  
Hispanic Women ◽  
Ethnic Disparities ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Infant Outcomes ◽  
Race Ethnicity ◽  
Hispanic White ◽  
Maternal Race

Objectives. To examine the extent to which differences in medication for opioid use disorder (MOUD) in pregnancy and infant neonatal opioid withdrawal syndrome (NOWS) outcomes are associated with maternal race/ethnicity. Methods. We performed a secondary analysis of a statewide quality improvement database of opioid-exposed deliveries from January 2017 to April 2019 from 24 hospitals in Massachusetts. We used multivariable mixed-effects logistic regression to model the association between maternal race/ethnicity (non-Hispanic White, non-Hispanic Black, or Hispanic) and prenatal receipt of MOUD, NOWS severity, early intervention referral, and biological parental custody at discharge. Results. Among 1710 deliveries to women with opioid use disorder, 89.3% (n = 1527) were non-Hispanic White. In adjusted models, non-Hispanic Black women (AOR = 0.34; 95% confidence interval [CI] = 0.18, 0.66) and Hispanic women (AOR = 0.43; 95% CI = 0.27, 0.68) were less likely to receive MOUD during pregnancy compared with non-Hispanic White women. We found no statistically significant associations between maternal race/ethnicity and infant outcomes. Conclusions. We identified significant racial/ethnic differences in MOUD prenatal receipt that persisted in adjusted models. Research should focus on the perspectives and treatment experiences of non-Hispanic Black and Hispanic women to ensure equitable care for all mother–infant dyads.

scholarly journals Ethnic Disparities in Breast Tumor Phenotypic Subtypes in Hispanic and Non-Hispanic White Women

2011 ◽  
Vol 20 (10) ◽  
pp. 1543-1550 ◽  
Author(s):  
Lisa M. Hines ◽  
Betsy Risendal ◽  
Tim Byers ◽  
Sarah Mengshol ◽  
Jan Lowery ◽  
...  
Keyword(s):  
Breast Tumor ◽  
White Women ◽  
Ethnic Disparities ◽  
Hispanic White

Association between utilization patterns and racial disparities in hospice enrollment among women dying of ovarian cancer.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 142-142
Author(s):  
Megan Mullins ◽  
Shitanshu Uppal ◽  
Michele L. Cote ◽  
Philippa Clarke ◽  
Julie J. Ruterbusch ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Black Women ◽  
White Women ◽  
Ethnic Disparities ◽  
Outpatient Setting ◽  
Inpatient Setting ◽  
Outpatient Management ◽  
Goals Of Care ◽  
Race Ethnicity ◽  
Hispanic White

142 Background: Goals of care conversations are associated with less aggressive end of life care and may be most effective in an outpatient setting. Yet, the relationship between initial utilization of care and subsequent hospice enrollment is unknown. We evaluated whether inpatient, outpatient and emergency department (ED) evaluation and management (E/M) visits differed by patient race/ethnicity, and whether less outpatient management was associated with failure to enroll in hospice in a sample of women dying of ovarian cancer. Methods: Women diagnosed with first and only ovarian cancer who died between 2000 and 2016 and had ≥ one inpatient and outpatient ovarian cancer E/M encounter between diagnosis and the last two months of life in SEER-Medicare were included (N = 8,806). Women whose proportion of outpatient E/M encounters fell below the median were classified as having low outpatient management (vs. high). Multivariable-adjusted logistic regression was used to estimate the association of: (1) race/ethnicity with outpatient management, and (2) outpatient management with hospice enrollment, stratified by race/ethnicity. Models were adjusted for stage at diagnosis, histology, survival time, age, Charlson score, geographic region, and year. Results: In this sample, 29.2% of ovarian cancer E/M took place in an inpatient setting, 66.4% outpatient, and 4.4% in the ED. Non-Hispanic Black women had 53.9% of their E/M occur in an outpatient setting, compared to 67.6% in non-Hispanic White women, 60.7% in Hispanic women, and 64.2% in women of other races (p <.001). Black women had 78% greater odds of low outpatient management when compared to non-Hispanic White women (adjusted OR 1.78, 95%CI: 1.46-2.18). Women with low (vs. high) outpatient management had 33% greater odds of not enrolling in hospice (adjusted OR 1.33, 95%CI: 1.20-1.48). The association of low outpatient management with not enrolling in hospice was most pronounced among Black women (Black adjusted OR: 1.54, 95%CI: 1.02-2.32 vs. Non-Hispanic White adjusted OR: 1.32, 95%CI: 1.18-1.48). Conclusions: Although most ovarian cancer care takes place in an outpatient setting, Black women have the lowest proportion of outpatient care, and low outpatient management was associated with not enrolling in hospice. When deploying interventions to improve goals of care conversations for women with ovarian cancer, racial/ethnic disparities in care settings must be considered.

Racial/Ethnic Disparities in Intensive Care Admissions in a Pregnant and Postpartum Population, Hawai‘i, 2012-2017

2021 ◽  
pp. 003335492110211
Author(s):  
Pamela Estrada ◽  
Hyeong Jun Ahn ◽  
Scott A. Harvey
Keyword(s):  
Maternal Morbidity ◽  
Clinical Characteristics ◽  
White Women ◽  
Ethnic Disparities ◽  
Severe Maternal Morbidity ◽  
Obstetric Outcomes ◽  
Icu Admission ◽  
Race Ethnicity ◽  
Racial Ethnic ◽  
Hispanic White

Objective Maternal morbidity and mortality is a global concern despite advances in medical care and technology and improved economic resources of nations worldwide. The primary objective of our study was to describe racial/ethnic disparities in severe maternal morbidity by using admission to an intensive care unit (ICU) as a marker. The secondary objective was to evaluate associations between patient characteristics, including obstetric outcomes, and severe maternal morbidity. Methods This retrospective cohort study used a large inpatient database to identify pregnancy and postpartum hospitalizations in Hawai‘i from January 2012 through September 2017. We evaluated associations between sociodemographic and clinical characteristics and race/ethnicity by using χ2 tests. We used multivariable logistic regression to assess associations between race/ethnicity and ICU admission. We used a post hoc analysis to assess associations between ICU admission and obstetric outcomes by race/ethnicity. Results After adjustment, we found a significantly higher ICU admission rate among Asian (adjusted odds ratio [aOR] = 1.30; 95% CI, 1.04-1.62; P = .02), Filipino (aOR = 1.45; 95% CI, 1.17-1.79; P < .001), and Native Hawaiian/Other Pacific Islander (aOR = 1.39; 95% CI, 1.15-1.68; P < .001) women compared with non-Hispanic White women. Multiple clinical characteristics and outcomes were associated with ICU admission, such as preexisting chronic conditions and pregnancy-induced hypertensive disorders. Conclusion We found that severe maternal morbidity represented by ICU admission is higher among Asian, Filipino, and Native Hawaiian/Other Pacific Islander women than among non-Hispanic White women in Hawai’i. Our findings reemphasize the need for health care providers to be vigilant in caring for members of racial/ethnic minority groups and managing their comorbidities.

The Association between Maternal Race and Ethnicity and Risk Factors for Primary Cesarean Delivery in Nulliparous Women

2019 ◽  
Author(s):  
Elisabeth L. Stark ◽  
William A. Grobman ◽  
Emily S. Miller
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Black Women ◽  
Cesarean Delivery ◽  
White Women ◽  
Ethnic Disparities ◽  
Nulliparous Women ◽  
Race Ethnicity ◽  
Racial Ethnic ◽  
Hispanic White

Abstract Objective To understand whether maternal, perinatal, and systems-level factors can be identified to explain racial/ethnic disparities in cesarean delivery rates. Study Design This retrospective cohort study included nulliparous women with singleton gestations who delivered at a tertiary care center from 2015 to 2017. Maternal, perinatal, and systems-level factors were compared by race/ethnicity. Multilevel multivariable logistic regression was used to identify whether race/ethnicity was independently associated with cesarean. Effect modification was evaluated using interaction terms. Bivariable analyses and multinomial logistic regression were used to determine differences in indication for cesarean. Results Of 9,865 eligible women, 2,126 (21.5%) delivered via cesarean. The frequency of cesarean was lowest in non-Hispanic white women (19.2%) and highest in non-Hispanic black women (28.2%; p < 0.001). Accounting for factors associated with cesarean delivery did not lessen the odds of cesarean associated with non-Hispanic black race (aOR: 1.58, 95% CI: 1.31–1.91). Compared with non-Hispanic white women, non-Hispanic black women were more likely to undergo cesarean for nonreassuring fetal status (aOR: 2.73, 95% CI: 2.06–3.61). Conclusion Examined maternal, perinatal, and systems-level risk factors for cesarean delivery did not explain the racial/ethnic disparities observed in cesarean delivery rates. Increased cesarean delivery for nonreassuring fetal status contributed substantially to this disparity.

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

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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