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

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.

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Racial/Ethnic Disparities in Maternal Vaccine Knowledge, Attitudes, and Intentions

Public Health Reports ◽

10.1177/0033354920974660 ◽

2021 ◽

pp. 003335492097466

Author(s):

Matthew Z. Dudley ◽

Rupali J. Limaye ◽

Daniel A. Salmon ◽

Saad B. Omer ◽

Sean T. O’Leary ◽

...

Keyword(s):

Black Women ◽

Health Care Providers ◽

White Women ◽

Ethnic Disparities ◽

Vaccine Safety ◽

Care Providers ◽

Vaccine Acceptance ◽

Race Ethnicity ◽

Perceive Risk ◽

Racial Ethnic

Objectives Although disparities in maternal vaccine acceptance among racial/ethnic groups are well documented, the reasons for these disparities are unclear. The objective of this study was to describe differences in pregnant women’s knowledge, attitudes, beliefs, intentions, and trust regarding maternal and infant vaccines by race/ethnicity. Methods We collected survey data from 1862 pregnant women from diverse prenatal care practices in Georgia and Colorado from June 2017 through July 2018. We performed multiple logistic regressions to determine differences in intentions, knowledge, attitudes, beliefs, and trust by race/ethnicity and calculated odds ratios (ORs) and 95% CIs. Results Compared with White women, Black and Hispanic women were less confident in vaccine safety and efficacy and less likely to perceive risk of acquiring vaccine-preventable diseases, report provaccine social norms, indicate having enough vaccine knowledge, and trust vaccine information from health care providers and public health authorities. Black women were the least confident in the safety of the maternal influenza vaccine (OR = 0.37; 95% CI, 0.27-0.49); maternal tetanus, diphtheria, and acellular pertussis vaccine (OR = 0.37; 95% CI, 0.27-0.52); and infant vaccines overall (OR = 0.40; 95% CI, 0.28-0.58), and were least likely to intend to receive both maternal vaccines (OR = 0.35; 95% CI, 0.27-0.47) or all infant vaccines on time (OR = 0.45; 95% CI, 0.34-0.61) as compared with White women. Conclusions Understanding differences in behavioral constructs integral to vaccine decision making among women of different races/ethnicities can lead to tailored interventions to improve vaccine acceptance.

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

American Journal of Perinatology ◽

10.1055/s-0039-1697587 ◽

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.

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Neighborhood Privilege, Preterm Delivery, and Related Racial/Ethnic Disparities: An Intergenerational Application of the Index of Concentration at the Extremes

American Journal of Epidemiology ◽

10.1093/aje/kwz279 ◽

2020 ◽

Vol 189 (5) ◽

pp. 412-421 ◽

Cited By ~ 1

Author(s):

Bina Patel Shrimali ◽

Michelle Pearl ◽

Deborah Karasek ◽

Carolina Reid ◽

Barbara Abrams ◽

...

Keyword(s):

Early Childhood ◽

Black Women ◽

Preterm Delivery ◽

White Women ◽

Hispanic Women ◽

Ethnic Disparities ◽

Estimating Equation ◽

Individual Level ◽

Race Ethnicity ◽

Racial Ethnic

Abstract We assessed whether early childhood and adulthood experiences of neighborhood privilege, measured by the Index of Concentration at the Extremes (ICE), were associated with preterm delivery and related racial/ethnic disparities using intergenerationally linked birth records of 379,794 California-born primiparous mothers (born 1982–1997) and their infants (born 1997–2011). ICE measures during early childhood and adulthood approximated racial/ethnic and economic dimensions of neighborhood privilege and disadvantage separately (ICE-income, ICE-race/ethnicity) and in combination (ICE–income + race/ethnicity). Results of our generalized estimating equation models with robust standard errors showed associations for ICE-income and ICE–income + race/ethnicity. For example, ICE–income + race/ethnicity was associated with preterm delivery in both early childhood (relative risk (RR) = 1.12, 95% confidence interval (CI): 1.08, 1.17) and adulthood (RR = 1.07, 95% CI: 1.03, 1.11). Non-Hispanic black and Hispanic women had higher risk of preterm delivery than white women (RR = 1.32, 95% CI: 1.28, 1.37; and RR = 1.11, 95% CI: 1.08, 1.14, respectively, adjusting for individual-level confounders). Adjustment for ICE–income + race/ethnicity at both time periods yielded the greatest declines in disparities (for non-Hispanic black women, RR = 1.23, 95% CI: 1.18, 1.28; for Hispanic women, RR = 1.05, 95% CI: 1.02, 1.09). Findings support independent effects of early childhood and adulthood neighborhood privilege on preterm delivery and related disparities.

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Racial and Ethnic Disparities in Maternal Outcomes and the Disadvantage of Peripartum Black Women: A Multistate Analysis, 2007–2014

American Journal of Perinatology ◽

10.1055/s-0038-1675207 ◽

2018 ◽

Vol 36 (08) ◽

pp. 835-848 ◽

Cited By ~ 11

Author(s):

Virginia Tangel ◽

Robert S. White ◽

Anna S. Nachamie ◽

Jeremy S. Pick

Keyword(s):

Black Women ◽

Length Of Stay ◽

Cesarean Delivery ◽

White Women ◽

Average Length ◽

Ethnic Disparities ◽

Maternal Outcomes ◽

Racial And Ethnic Disparities ◽

Mortality And Morbidity ◽

Race Ethnicity

Objective Racial and ethnic disparities in obstetric care and delivery outcomes have shown that black women experience high rates of pregnancy-related mortality and morbidity, along with high rates of cesarean delivery, compared with other racial and ethnic groups. We aimed to quantify these disparities and test the effects of race/ethnicity in stratified statistical models by insurance payer and socioeconomic status, adjusting for comorbidities specific to an obstetric population. Study Design We analyzed maternal outcomes in a sample of 6,872,588 delivery records from California, Florida, Kentucky, Maryland, and New York from 2007 to 2014 from the State Inpatient Databases, Healthcare Cost and Utilization Project. We compared present-on-admission characteristics of parturients by race/ethnicity, and estimated logistic regression and generalized linear models to assess outcomes of in-hospital mortality, cesarean delivery, and length of stay. Results Compared with white women, black women were more likely to die in-hospital (odds ratio [OR]: 1.90, 95% confidence interval [CI]: 1.47–2.45) and have a longer average length of stay (incidence rate ratio: 1.10, 95% CI: 1.09–1.10). Black women also were more likely to have a cesarean delivery (OR: 1.12, 95% CI 1.12–1.13) than white women. These results largely held in stratified analyses. Conclusion In most insurance payers and socioeconomic strata, race/ethnicity alone is a factor that predicts parturient outcomes.

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Maternal Age Patterns of Preterm Birth: Exploring the Moderating Roles of Chronic Stress and Race/Ethnicity

Annals of Behavioral Medicine ◽

10.1093/abm/kaaa008 ◽

2020 ◽

Vol 54 (9) ◽

pp. 653-664 ◽

Cited By ~ 1

Author(s):

Sangmi Kim ◽

Eun-Ok Im ◽

Jianghong Liu ◽

Connie Ulrich

Keyword(s):

Preterm Birth ◽

Black Women ◽

Chronic Stress ◽

Maternal Age ◽

Ethnic Disparities ◽

Birth Certificates ◽

Future Research ◽

Age Related ◽

Race Ethnicity ◽

Racial Ethnic

Abstract Background Despite the suggested contribution of cumulative chronic stress to the racial/ethnic disparities in preterm birth (PTB), it is unclear how chronic stress, maternal age, and race/ethnicity are linked underlying PTB. Purpose We investigated the moderating effect of chronic stress on the maternal age–PTB association among non-Hispanic (N-H) White, N-H Black, Hispanic, and Asian women. Methods We analyzed the Washington State’s Pregnancy Risk Assessment Monitoring System data linked with birth certificates. The sample included women aged 18 years or older who birthed the first, singleton baby without birth defects. Chronic stress was measured by race/ethnicity-specific chronic stress indices. A maternal age–chronic stress interaction was modeled to predict PTB by logistic regression stratified by race/ethnicity. In subanalysis, the moderating role of racism was investigated in the maternal age–chronic stress interaction among three minority groups combined. Results Women’s maternal age trajectory of PTB varied by their race/ethnicity and chronic stress level. N-H White and N-H Black women showed a steeper maternal age-related increase in PTB (weathering) under higher chronic stress, indicating a chronic stress’ cumulative effect with maternal age. Besides, the extent of weathering was amplified by racism on top of chronic stress, particularly among N-H Black women. Conclusions These results show that both chronic stress and racism may develop accelerated PTB risk among minority women. Future research should use more objective and accurate chronic stress measures to ascertain the complex relationships among chronic stress, racial discrimination, and maternal age underlying the racial/ethnic differentials in PTB.

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Trends in Cigar Use in the United States, 2002–2016: Diverging Trends by Race/Ethnicity

Nicotine & Tobacco Research ◽

10.1093/ntr/ntz060 ◽

2019 ◽

Vol 22 (4) ◽

pp. 583-587 ◽

Cited By ~ 1

Author(s):

Andrea H Weinberger ◽

Cristine D Delnevo ◽

Jiaqi Zhu ◽

Misato Gbedemah ◽

Joun Lee ◽

...

Keyword(s):

United States ◽

Black Women ◽

Ethnic Group ◽

Ethnic Groups ◽

Ethnic Differences ◽

Mixed Race ◽

The United States ◽

Race Ethnicity ◽

Racial Ethnic ◽

Over Time

Abstract Introduction Although there are racial/ethnic differences in cigarette use, little is known about how non-cigarette tobacco use differs among racial/ethnic groups. This study investigated trends in cigar use from 2002 to 2016, by racial/ethnic group, in nationally representative US data. Methods Data were drawn from the 2002–2016 National Survey on Drug Use and Health public use data files (total analytic sample n = 630 547 including 54 060 past-month cigar users). Linear time trends of past-month cigar use were examined by racial/ethnic group (Non-Hispanic [NH] White, NH Black, Hispanic, NH Other/Mixed Race/Ethnicity) using logistic regression models. Results In 2016, the prevalence of past-month cigar use was significantly higher among NH Black respondents than among other racial/ethnic groups (ps < .001). Cigar use was also higher among NH White respondents than among Hispanic and NH Other/Mixed Race/Ethnicity respondents. The year by racial/ethnic group interaction was significant (p < .001). Past-month cigar use decreased significantly from 2002 to 2016 among NH White and Hispanic respondents (ps = .001), whereas no change in prevalence was observed among NH Black (p = .779) and NH Other/Mixed Race/Ethnicity respondents (p = .152). Cigar use decreased for NH White men (p < .001) and did not change for NH White women (p = .884). Conversely, cigar use increased for NH Black women (p < .001) and did not change for NH Black men (p = .546). Conclusions Cigar use remains significantly more common among NH Black individuals in the United States and is not declining among NH Black and NH Other/Mixed Race/Ethnicity individuals over time, in contrast to declines among NH White and Hispanic individuals. Implications This study identified racial/ethnic differences in trends in past-month cigar use over 15 years among annual cross-sectional samples of US individuals. The highest prevalence of cigar use in 2016 was found among NH Black individuals. In addition, cigar use prevalence did not decline from 2002 to 2016 among NH Black and NH Other/Mixed Race/Ethnicity groups over time, in contrast to NH White and Hispanic groups. Further, cigar use increased over time for NH Black women. Targeted public health and clinical efforts may be needed to decrease the prevalence of cigar use, especially for NH Black individuals.

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Abstract 50: Persistent Racial/Ethnic Disparities Despite Declining Rates of Ischemic Stroke Hospitalizations Among Medicare Beneficiaries, 2001-2013

Stroke ◽

10.1161/str.48.suppl_1.50 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Judith H Lichtman ◽

Erica C Leifheit-Limson ◽

Yun Wang ◽

Tatjana Rundek ◽

Larry B Goldstein ◽

...

Keyword(s):

Ischemic Stroke ◽

Ethnic Groups ◽

Mixed Model ◽

Systems Of Care ◽

Ethnic Disparities ◽

Fee For Service ◽

Hospitalization Rates ◽

The Us ◽

Race Ethnicity ◽

Racial Ethnic

Background: Stroke hospitalizations in the US have declined over the last decade, but little is known about whether decreases are similar across racial/ethnic groups. We compared ischemic stroke hospitalization rates and geographic patterns across the US from 2001-2013 for elderly Hispanics, Blacks, Whites, and those of other race/ethnicity. Methods: Ischemic stroke hospitalizations (ICD-9 primary discharge codes 433, 434, 436) were identified among Medicare fee-for-service beneficiaries aged ≥65y in 2001-2003 and 2011-2013. National annualized rates for each period were calculated per 100,000 person-years (PY). A spatial mixed model with a Poisson link function and adjustment for age and sex was fit to calculate and map county-specific risk-standardized stroke hospitalization rates for each racial/ethnic group. Results: National annualized stroke hospitalization rates decreased by 15% between 2001-2003 and 2011-2013 (1298/100,000 PY to 1103/100,000 PY). County-level risk-standardized hospitalization rates varied across the US and among the four racial/ethnic groups (figure). Regardless of time period, Blacks had the highest rates, followed by Whites, Hispanics, and other races. The absolute and relative declines in risk-standardized hospitalization rates were smallest for Hispanics (173/100,000 PY; 15%) and Blacks (196/100,000 PY; 12%) compared to Whites (243/100,000 PY; 19%) and other races (273/100,000 PY; 33%). Conclusions: Although national hospitalization rates for ischemic stroke among those aged ≥65y decreased between 2001 and 2013, the decline varied by race/ethnicity, with persistent disparities between groups. Despite the declines in US stroke hospitalizations, these racial/ethnic differences call for greater prioritization of prevention intervention programs to reduce stroke disparities. AHA/ASA efforts to expand stroke systems of care also need to address these disparities.

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Racial and Ethnic Disparities in Cesarean Delivery and Indications Among Nulliparous, Term, Singleton, Vertex Women

Journal of Racial and Ethnic Health Disparities ◽

10.1007/s40615-021-01057-w ◽

2021 ◽

Author(s):

Ijeoma C. Okwandu ◽

Meredith Anderson ◽

Debbie Postlethwaite ◽

Aida Shirazi ◽

Sandra Torrente

Keyword(s):

Logistic Regression ◽

Black Women ◽

Cesarean Delivery ◽

Regression Models ◽

White Women ◽

Ethnic Disparities ◽

Logistic Regression Models ◽

Nulliparous Women ◽

Race Ethnicity ◽

Failure To Progress

Abstract Objective To compare cesarean delivery rates and indications by race/ethnicity among nulliparous women with term, singleton, vertex presentation deliveries. Methods This is a retrospective cohort study of nulliparous women delivering term, singleton, vertex neonates at Kaiser Permanente Northern California from 1/1/2016 to 6/30/2017. Women with cesarean for elective, malpresentation, or previa were excluded. Multivariable logistic regression models adjusting for maternal, neonatal, and facility factors were used to assess the likelihood of cesarean by race/ethnicity. Further modeling was performed to examine odds of cesarean for the indications of failure to progress and fetal intolerance by race/ethnicity. Results The cohort of 16,587 racially/ethnically diverse women meeting inclusion and exclusion criteria consisted of 41.62% White, 27.73% Asian, 22.11% Hispanic, 5.32% Black, and 3.21% multiple race/other women. In adjusted logistic regression models, all race and ethnic categories had higher odds of cesarean deliveries in comparison to White women. Black women had the highest odds of cesarean delivery (adjusted OR [aOR] = 1.73, 95% CI: 1.45–2.06), followed by Asian (aOR = 1.59, 95% CI: 1.45–2.06), multiple race/other (aOR = 1.45, 95% CI: 1.17–1.80), and Hispanic (aOR = 1.43, 95% CI: 1.28–1.59) women. Compared with White women, Asian (aOR = 1.46, 95% CI: 1.22–1.74) and Hispanic (aOR = 1.25, 95% CI: 1.03–1.52) women had higher odds of failure to progress as the indication. Among women with failure to progress, Black (aOR = 0.50, 95% CI: 0.30–0.81), Hispanic (aOR = 0.68, 95% CI: 0.53–0.87), and Asian (aOR = 0.77, 95% CI: 0.61–0.96) women were less likely than White women to reach 10 cm dilation. Compared with White women, Black women were more likely to have cesarean delivery for fetal intolerance (aOR = 1.51, 95% CI: 1.10–2.07). Among women with fetal intolerance of labor, there were no significant differences by race/ethnicity for Apgar score or neonatal intensive care unit admission. Conclusions Race/ethnicity was significantly associated with the odds of cesarean and indication. All other race/ethnicity groups had higher odds of cesarean compared with White women. Compared with White women, Black women had greater odds of fetal intolerance as an indication, while Hispanic and Asian women had greater odds of failure to progress. Maternal, neonate, and facility factors for cesarean delivery did not explain the observed disparities in cesarean delivery rates.

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Abstract 044: Trends in Race/Ethnic Disparities in Ideal Cardiovascular Health: NHANES 1999-2006

Circulation ◽

10.1161/circ.125.suppl_10.a044 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Norrina B Allen ◽

Hongyan Ning ◽

Donald Lloyd-Jones

Keyword(s):

Physical Activity ◽

Blood Pressure ◽

Ethnic Groups ◽

Cardiovascular Health ◽

Ethnic Disparities ◽

Percentage Change ◽

Theil Index ◽

Health Factors ◽

Race Ethnicity ◽

Racial Ethnic

Background: Significant racial/ethnic disparities exist in the cardiovascular health of the nation. Prior studies have identified differences between groups, but have not summarized trends in these disparities across multiple race/ethnic subgroups, which could allow us to assess the extent to which we are achieving disparity-related goals. Methods: We used NHANES Surveys from cycles 1999–2000, 2001–2002, 2003–2004, and 2005–2006 to examine the age-adjusted prevalence of ideal levels of CV health factors by race/ethnicity. Ideal levels of BMI, cholesterol, glucose, blood pressure, diet, physical activity and smoking were defined according to the AHA 2020 strategic goals. Racial/ethnic groups were categorized as Hispanic, Non-Hispanic White, Non-Hispanic Black and other. Both absolute (Between Group Variance- BGV) and relative measures (Theil Index -T) of disparities were calculated, calculations were weighted by population share. The percentage change in disparities relative to 1999–2000 was examined. Results: Age-adjusted rates of ideal CV health components and the percentage change from 1999–2006 varied by race/ethnicity (see Table). Disparities in the prevalence rates of ideal levels of blood pressure, cholesterol and physical activity have increased dramatically between race/ethnic groups in both men and women (see Table). Disparities in smoking and diet have increased in men but decreased in women. Disparities in BMI have changed little in men (BGV= 0.5%, T=−37.8%), but increased dramatically in women (BGV= 894%, T=280%). Findings were generally similar for both absolute and relative measures of disparities. Conclusions: Representative national data on these summary measures of disparities suggest that disparities between race/ethnic groups have increased for many cardiovascular health factors over the past decade. Understanding the issues underlying these increasing disparities and addressing them will be critical to improving the cardiovascular health of all Americans by 2020 and beyond.

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Gender Linked Fate, Race/Ethnicity, and the Marriage Gap in American Politics

Political Research Quarterly ◽

10.1177/1065912917702499 ◽

2017 ◽

Vol 70 (3) ◽

pp. 509-522 ◽

Cited By ~ 20

Author(s):

Christopher T. Stout ◽

Kelsy Kretschmer ◽

Leah Ruppanner

Keyword(s):

Black Women ◽

Political Ideology ◽

White Women ◽

Linked Fate ◽

National Election Study ◽

Self Interest ◽

Women’S Perceptions ◽

Race Ethnicity ◽

Political Differences ◽

Racial Ethnic

In this study, we explore the predictors of gender linked fate with a focus on marital status for different racial/ethnic groups. We argue that marriage alters women’s perceptions of self-interest by institutionalizing their partnerships with men and consequently leading women to feel less connected to other women. We assess our hypothesis using the 2012 American National Election Study. While we find that married white women and Latinas have significantly lower levels of linked fate than unmarried women of the same race/ethnicity, we find no such relationship for black women. We then explore the implications of these findings by examining the role of gender linked fate in explaining political differences among married and unmarried women using mediation analysis. Ultimately, we find that differences in perceptions of linked fate explain a significant amount of the variation in political ideology and partisanship for white and Latina women.

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