scholarly journals Race/Ethnicity Matters: Differences in Poststroke Inpatient Rehabilitation Outcomes

2019 ◽  
Vol 29 (4) ◽  
pp. 599-608 ◽  
Author(s):  
James J. García ◽  
Karlita L. Warren

Objective: To examine racial/ethnic differ­ences in poststroke inpatient rehabilitation outcomes.Design: Cross-sectional and retrospective study of administrative data across 2002- 2018.Setting: An inpatient rehabilitation facility in Southern California.Participants: 3,876 racial/ethnic people aged ≥ 18 years.Main Outcome Measures: Functional In­dependence Measure (FIM®) and discharge disposition.Results: Participants were non-Hispanic Whites (NHWs, 68.5%), Hispanics (17.1%), non-Hispanic Asians (NHAs, 7.4%), and non-Hispanic Blacks (NHBs, 6.4%) aged 18-102 years (Mage = 68.47±14.66 years; MLOS = 19.47±10.05 days). Above and beyond covariates, multivariate hierarchical regression analyses showed race/ethnicity significantly predicted admission, motor efficiency, and discharge FIM® scores. Compared with NHWs, the Hispanic and NHA groups were associated with lower cognitive, motor, and total FIM® scores at admission; the NHB group was associated with lower motor efficiency, lower discharge motor and total FIM® scores, whereas the Hispanic group was associated with higher discharge total FIM® scores. Lastly, Hispanics had higher odds of a discharge home compared with NHWs.Conclusions: Findings suggest racial/ethnic differences exist in poststroke rehabilitation outcomes. Ethn Dis. 2019;29(4):599-608; doi:10.18865/ed.29.4.599

2021 ◽  
Author(s):  
Yingjie Weng ◽  
Di Lu ◽  
Jenna Bollyky ◽  
Vivek Jain ◽  
Manisha Desai ◽  
...  

AbstractImportanceSurveys in the US have found that Black and Latinx individuals have more reservations than their white counterparts about COVID-19 vaccination. However, little is known about the degree to which racial-ethnic differences in COVID-19 vaccination intentions are explained by differences in beliefs or perceptions about COVID-19 vaccines.ObjectiveTo compare intention to receive COVID-19 vaccination by race-ethnicity, to identify perceptional factors that may mediate the association between race-ethnicity and intention to receive the vaccine, and to identify the demographic and perceptional factors most strongly predictive of intention to receive a vaccine.DesignCross-sectional survey conducted from November, 2020 to January, 2021, nested within two longitudinal cohort studies of prevalence and incidence of SARS CoV-2 among the general population and healthcare workers.SettingSix San Francisco Bay Area counties.Study Cohort3,161 participants in the Track COVID cohort (a population-based sample of adults) and 1,803 participants in the CHART Study cohort (a cohort of employees at three large medical centers).ResultsRates of high vaccine willingness were significantly lower among Black (45.3%), Latinx (62.5%), Asian (65%), multi-racial (67.2%), and other race (61.0%) respondents than among white respondents (77.6%). Black, Latinx, and Asian respondents were significantly more likely than white respondents to endorse reasons to not get vaccinated, especially lack of trust. Participants’ motivations and concerns about COVID-19 vaccination only partially explained racial-ethnic differences in vaccination willingness. Being a health worker in the CHART cohort and concern about a rushed government vaccine approval process were the two most important factors predicting vaccination intention.Conclusions and RelevanceSpecial efforts are required to reach historically marginalized racial-ethnic communities to support informed decision-making about COVID-19 vaccination. These campaigns must acknowledge the history of racism in biomedical research and health care delivery that has degraded the trustworthiness of health and medical science institutions among non-white population and may continue to undermine confidence in COVID-19 vaccines.HighlightsBlack, Latinx, Asian, Multi-racial, and Other race respondents were significantly less likely than white respondents to have high willingness to receive COVID-19 vaccination when surveyed around the time that the first COVID-19 vaccines received Emergency Use Authorization in the US.Racial-ethnic differences in vaccination intention were present for both health workers and the general population.Motivations and concerns about COVID-19 vaccination only partially explained racial-ethnic differences in COVID-19 vaccine willingness.The most important factors explaining COVID-19 vaccination intention were being a health worker, concern about government rushing the vaccine process, concern about having a bad reaction to the vaccine, motivation to protecting one’s self and family from COVID-19, and concern about getting COVID from the vaccine


2020 ◽  
Author(s):  
Jamila K Stockman ◽  
Brittany A Wood ◽  
Katherine M Anderson

BACKGROUND In the United States, racial and ethnic minorities are disproportionately affected by COVID-19, with persistent social and structural factors contributing to these disparities. At the intersection of race/ethnicity and gender, women of color may be disadvantaged in terms of COVID-19 outcomes due to their role as essential workers, their higher prevalence of pre-existing conditions, their increased stress and anxiety from the loss of wages and caregiving, and domestic violence. OBJECTIVE The purpose of this study is to examine racial and ethnic differences in the prevalence of COVID-19 outcomes, stressors, fear, and prevention behaviors among adult women residing in the United States. METHODS Between May and June 2020, women were recruited into the Capturing Women’s Experiences in Outbreak and Pandemic Environments (COPE) Study, a web-based cross-sectional study, using advertisements on Facebook; 491 eligible women completed a self-administered internet-based cross-sectional survey. Descriptive statistics were used to examine racial and ethnic differences (White; Asian; Native Hawaiian or other Pacific Islander; Black; Hispanic, Latina, or Spanish Origin; American Indian or Alaskan Native; multiracial or some other race, ethnicity, or origin) on COVID-19 outcomes, stressors, fear, and prevention behaviors. RESULTS Among our sample of women, 16% (73/470) reported COVID-19 symptoms, 22% (18/82) were concerned about possible exposure from the people they knew who tested positive for COVID-19, and 51.4% (227/442) knew where to get tested; yet, only 5.8% (27/469) had been tested. Racial/ethnic differences were observed, with racial/ethnic minority women being less likely to know where to get tested. Significant differences in race/ethnicity were observed for select stressors (food insecurity, not enough money, homeschooling children, unable to have a doctor or telemedicine appointment) and prevention behaviors (handwashing with soap, self-isolation if sick, public glove use, not leaving home for any activities). Although no racial/ethnic differences emerged from the Fear of COVID-19 Scale, significant racial/ethnic differences were observed for some of the individual scale items (eg, being afraid of getting COVID-19, sleep loss, and heart racing due to worrying about COVID-19). CONCLUSIONS The low prevalence of COVID-19 testing and knowledge of where to get tested indicate a critical need to expand testing for women in the United States, particularly among racial/ethnic minority women. Although the overall prevalence of engagement in prevention behaviors was high, targeted education and promotion of prevention activities are warranted in communities of color, particularly with consideration for stressors and adverse mental health.


2021 ◽  
Author(s):  
Ruby Castilla-Puentes ◽  
Jacqueline Pesa ◽  
Caroline Brethenoux ◽  
Patrick Furey ◽  
Liliana Gil Valletta ◽  
...  

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.


Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Jia Pu ◽  
Sukyung Chung ◽  
Beinan Zhao ◽  
Vani Nimbal ◽  
Elsie J Wang ◽  
...  

Background: This study assesses racial/ethnic differences in CVD outcomes among patients with hypertension (HTN) or type 2 diabetes (T2DM) across Asian American subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese), Mexican, non-Hispanic black (NHB), and non-Hispanic White (NHW) in a large, mixed payer ambulatory care setting in northern California. Study Design: We estimated the rate of CVD incidence among adult patients with HTN (N=171,864) or T2DM (N=10,570), or both (N=36,589) using electronic health records between 2000-2013. Average follow-up was 4.5 years. CVD, including CHD (410-414), PVD (415, 440.2, 440.3, 443.9, 451, 453), and stroke (430-434), was defined by ICD-9 codes; HTN and T2DM were defined by ICD-9 codes, medication history, or two or more elevated blood pressure measures/abnormal glucose lab test results. Cox proportional hazard models were used to estimate hazard ratios for CHD, PVD, and stroke across race/ethnicity. Results: Among these patients, 10.5% developed CVD by the end of year 2013 (5.4% CHD, 3.4%PVD, 3.6% stroke). There was a gender difference in the risk of incident CHD. Among males, the age-adjusted hazard ratios for CHD were significantly higher for Asian Indians (HR: 1.3, 95% CI: 1.2-1.5) and significantly lower for Chinese (HR: 0.6, CI: 0.5-0.7) and Japanese (HR: 0.8, CI: 0.6-0.9) compared to NHWs. Among females, the age-adjusted hazard ratios for CHD were significantly higher for Mexican (HR: 1.3, CI: 1.1-1.5) and NHBs (HR: 1.7, CI: 1.4-2.0) and significantly lower for Chinese (HR: 0.6, CI: 0.5-0.7) and Japanese (HR: 0.5, CI: 0.4-0.7). NHB men and women also had significantly higher age-adjusted hazard ratios for PVD (men: HR: 1.5, CI: 1.2-1.9; women: HR: 1.6, CI: 1.3-1.9) and stroke (men: HR: 1.3, CI: 1.1-1.7; women: HR: 1.3, CI: 1.1-1.6) compared to NHWs. The age-adjusted hazard ratios for PVD and stroke were lower or equivalent to NHWs for all Asian subgroups and Mexican men and women. Patients with both HTN and T2DM were at elevated risk to develop CVD compared to patients with only one of the two conditions, regardless of their race/ethnicity. Conclusions: Compared to previous studies, we found less racial/ethnic variation in CVD outcomes, in particular stroke, among patients with HTN or T2DM. Our finding suggests the higher stroke incidence rates in several races/ethnicities are likely to be explained by the higher prevalence of HTN and T2DM among these groups. However, Asian Indian men and NHB and Mexican women with HTN or T2DM were at elevated risk for CHD compared to NHWs. Since the majority of patients in the study cohort had health insurance, further studies are needed to better understand the reasons for the observed racial/ethnic differences beyond disparities in access to health care. Special attention needs to be paid to patients with multiple conditions.


Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 53-55
Author(s):  
Tatini Datta ◽  
Ann M Brunson ◽  
Anjlee Mahajan ◽  
Theresa Keegan ◽  
Ted Wun

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.


Author(s):  
Fatima Rodriguez ◽  
Nicole Solomon ◽  
James A. de Lemos ◽  
Sandeep R. Das ◽  
David A. Morrow ◽  
...  

Background: The COVID-19 pandemic has exposed longstanding racial/ethnic inequities in health risks and outcomes in the U.S.. We sought to identify racial/ethnic differences in presentation and outcomes for patients hospitalized with COVID-19. Methods: The American Heart Association COVID-19 Cardiovascular Disease Registry is a retrospective observational registry capturing consecutive patients hospitalized with COVID-19. We present data on the first 7,868 patients by race/ethnicity treated at 88 hospitals across the US between 01/17/2020 and 7/22/2020. The primary outcome was in-hospital mortality; secondary outcomes included major adverse cardiovascular events (MACE: death, myocardial infarction, stroke, heart failure) and COVID-19 cardiorespiratory ordinal severity score (worst to best: death, cardiac arrest, mechanical ventilation with mechanical circulatory support, mechanical ventilation with vasopressors/inotrope support, mechanical ventilation without hemodynamic support, and hospitalization without any of the above). Multivariable logistic regression analyses were performed to assess the relationship between race/ethnicity and each outcome adjusting for differences in sociodemographic, clinical, and presentation features, and accounting for clustering by hospital. Results: Among 7,868 patients hospitalized with COVID-19, 33.0% were Hispanic, 25.5% were non-Hispanic Black, 6.3% were Asian, and 35.2% were non-Hispanic White. Hispanic and Black patients were younger than non-Hispanic White and Asian patients and were more likely to be uninsured. Black patients had the highest prevalence of obesity, hypertension, and diabetes. Black patients also had the highest rates of mechanical ventilation (23.2%) and renal replacement therapy (6.6%) but the lowest rates of remdesivir use (6.1%). Overall mortality was 18.4% with 53% of all deaths occurring in Black and Hispanic patients. The adjusted odds ratios (ORs) for mortality were 0.93 (95% confidence interval [CI] 0.76-1.14) for Black patients, 0.90 (95% CI 0.73-1.11) for Hispanic patients, and 1.31 (95% CI 0.96-1.80) for Asian patients compared with non-Hispanic White patients. The median OR across hospitals was 1.99 (95% CI 1.74-2.48). Results were similar for MACE. Asian patients had the highest COVID-19 cardiorespiratory severity at presentation (adjusted OR 1.48, 95% CI 1.16-1.90). Conclusions: Although in-hospital mortality and MACE did not differ by race/ethnicity after adjustment, Black and Hispanic patients bore a greater burden of mortality and morbidity due to their disproportionate representation among COVID-19 hospitalizations.


2018 ◽  
Vol 5 ◽  
pp. 2333794X1875613 ◽  
Author(s):  
Janelle Aby ◽  
Juliann Lipps Kim

Objective. The purpose of this study is to describe the range and frequency of cutaneous lumbosacral and coccygeal findings encountered during the newborn examination in a population of apparently healthy babies, to determine if the prevalence of these findings is associated with race/ethnicity, and to report the frequency of co-occurrence of low-risk cutaneous findings. Methods. Lumbosacral physical findings of 1121 infants were documented on well newborns at least 35 weeks or greater gestational age under the authors’ care. The overall frequency of each physical finding was tabulated in addition to determining whether frequencies varied by race/ethnicity. Co-occurrence of the most common physical findings was also examined. Results. Of 1096 infants included in the study, 24.8% had deviated or duplicated gluteal creases, 15.6% had dimples, and 24.7% had lumbosacral and/or coccygeal hairiness. All racial/ethnic groups had double to quadruple the risk of lumbosacral hair when compared with Caucasians. A total of 44.1% of study infants had lumbosacral/coccygeal slate-grey patches, which were least common in Caucasians. Seven infants had coccygeal skin tags, and 14 infants had lumbosacral vascular macules. Thirty-one percent had more than 1 cutaneous lumbosacral finding present, 24.8% had 2 findings, and 6.2% had 3 or more findings. Conclusion. Coccygeal dimples, increased lumbosacral and/or coccygeal hair, deviations and/or duplications of the gluteal crease, and lumbosacral slate-grey patches are common in healthy newborns and vary by race/ethnicity. Eleven percent of study infants had 2 or more low-risk cutaneous findings excluding slate-grey patches. Distinction between low-risk and common versus high-risk findings is important when deciding which patients need further evaluation.


2021 ◽  
Author(s):  
Moin Syed

Psychological researchers have long sought to make universal claims about behavior and mental processes. The various crises in psychology—reproducibility, replication, measurement, theory, generalizability—have all demonstrated that such claims are premature, and perhaps impossible using mainstream theoretical and methodological approaches. Both the lack of diversity of samples and simplistic conceptualizations of diversity (e.g., WEIRD, individualism/collectivism) have contributed to an “inference crisis,” in which researchers are ill equipped to make sense of group variation in psychological phenomena, particularly with respect to race/ethnicity. This talk will highlight how the lack of sophisticated frameworks for understanding racial/ethnic differences is a major barrier to developing a reproducible, cumulative psychology.


2019 ◽  
Vol 22 (4) ◽  
pp. 583-587 ◽  
Author(s):  
Andrea H Weinberger ◽  
Cristine D Delnevo ◽  
Jiaqi Zhu ◽  
Misato Gbedemah ◽  
Joun Lee ◽  
...  

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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