Exploring Factors Associated With Hepatitis B Screening Among a Multilingual and Diverse Population

Abstract Background: Racial/ethnic minorities bear a disproportionate burden of hepatitis B virus (HBV) infection and disease. Disparities in HBV screening contribute to worse outcomes for communities of color. We examined the impact of race/ethnicity, language preference, and having a usual place of care on HBV screening in a multilingual, urban cohort. Methods: We used questions from the Health Information National Trends Survey and added validated questions about healthcare access and health literacy. We administered this survey in English, Spanish, and Chinese to a selected convenience sample of San Francisco city/county residents in 2017, with pre-specified targets for populations with known cancer disparities: 25% Spanish-speaking, 25% Chinese- speaking, and 25% African Americans. Using weighted multivariable logistic regression analyses, we assessed how race/ethnicity, language preference, and having a usual place of care impacts self-report of HBV screening. Results: Overall, 1,027 participants completed the survey (50% of surveys administered in English, 25% in Spanish, and 25% in Chinese). Only 50% of participants reported HBV screening. In multivariable analysis, Black (OR=0.20, 95% CI 0.08-0.49), Latinx (OR=0.33, 95% CI 0.13-0.85), Asian (OR=0.31, 95% CI 0.10, 0.94), and ‘Other’ race/ethnicity (OR=0.17, 95% CI 0.05-0.53) respondents had lower odds of HBV screening compared to non-Hispanic White respondents. Participants who had insurance had increased odds of HBV screening (OR=2.70, 95% CI 1.48-4.93).Conclusions: HBV screening disparities persist for African Americans, Asian Americans, Latinx, and the uninsured. Future studies should explore reasons why current strategies have not been implemented or are not successful, particularly in addressing racial/ethnic and insurance disparities.

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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.

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Voting Rights, Election Administration, and Turnout for Racial Minorities

Accessible Elections ◽

10.1093/oso/9780197537251.003.0006 ◽

2020 ◽

pp. 91-110

Author(s):

Michael Ritter

Keyword(s):

African Americans ◽

Ethnic Minorities ◽

Asian Americans ◽

Race And Ethnicity ◽

Hispanic Americans ◽

Election Administration ◽

Midterm Elections ◽

The Impact ◽

Racial Ethnic ◽

Over Time

Race and ethnicity group identity also shape participation in politics, with non-Hispanics whites being the most likely to vote in U.S. elections over time. Can accessible elections shrink turnout inequality between non-Hispanic whites and racial/ethnic minorities (African Americans, Hispanic Americans, and Asian Americans)? Chapter 6 empirically evaluates the impact of convenience voting laws and election administration on the change in the probably of voting in midterm and presidential elections comparing across racial subgroups. The results show that same day registration boosts turnout among non-Hispanics whites, as well as Asian Americans, Hispanics, and African Americans, in presidential and midterm elections. Early in-person voting especially advantages blacks and Hispanics in midterm elections, while absentee/mail voting is found to have similar effects for Asian Americans. Both non-Hispanic whites and racial and ethnic minorities benefit from quality state election administration.

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Military Cohorts, Substance Use, and Male-Perpetrated Intimate Partner Violence

Violence Against Women ◽

10.1177/1077801219893475 ◽

2020 ◽

pp. 107780121989347

Author(s):

Roberto Cancio

Keyword(s):

Intimate Partner Violence ◽

Substance Use ◽

Partner Violence ◽

Military Families ◽

Intimate Partner ◽

Adult Health ◽

National Longitudinal Study ◽

Race Ethnicity ◽

The Impact ◽

Racial Ethnic

This study considers variations of intimate partner violence (IPV) from the point of the perpetrator to test the impact of demographic factors on the type of IPV most prevalent among pre-9/11 and post-9/11 military families from the National Longitudinal Study of Adolescent to Adult Health (1994–2008): Waves I and IV in-home interviews ( N = 499). Study findings indicate that the perpetration of physical and sexual IPV depends on the context of veteran cohort and race/ethnicity. Models for substance use and IPV patterns were not similar across military cohorts and/or racial/ethnic groups.

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Impact of Ethnicity On Incidence and Survival Among Adults with Acute Lymphoblastic Leukemia in the United States; Insights From 2005 SEER Data.

Blood ◽

10.1182/blood.v114.22.3069.3069 ◽

2009 ◽

Vol 114 (22) ◽

pp. 3069-3069

Author(s):

Casey L O'Connell ◽

Pedram Razavi ◽

Roberta McKean-Cowdin ◽

Malcolm C. Pike

Keyword(s):

T Cell ◽

B Cell ◽

Ethnic Groups ◽

Lymphoblastic Leukemia ◽

The United States ◽

Incidence Rates ◽

The Us ◽

Race Ethnicity ◽

The Impact ◽

Racial Ethnic

Abstract Abstract 3069 Poster Board III-6 Background Acute lymphoblastic leukemia (ALL) is an aggressive malignancy whose incidence declines through adolescence and then increases steadily with age. Prognosis appears to be inversely related to age among adults. We sought to explore the impact of race/ethnicity on incidence and survival among adults with ALL in the United States (US). Methods We examined trends in incidence and survival among adults with ALL in the US using the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) program which includes data from 17 SEER registries. We calculated the incidence rates for the most recent time period (2001-2005) because the classification for ALL subtypes was more complete during this time. For the survival analysis we used the data collected between 1975 and 2005. We categorized race/ethnicity into 5 mutually exclusive categories: non-Hispanic whites (NHW), Hispanic whites (HW), African Americans (AA), Asian/Pacific Islanders (API) and American Indians/Native Alaskans (AI/NA). Hispanic ethnicity was defined using SEER's Hispanic-origin variable which is based on the NAACCR Hispanic Identification Algorithm (NHIA); 11 patients dually coded as black and Hispanic were included in the AA group for our analyses. Few ALL cases were identified among AI/NA, so that group is not represented in the final analyses. We included ALL cases coded in the SEER registry using the International Classification of Disease for Oncology (ICD-0-3) as 9827-9829 and 9835-9837. We excluded cases of Burkitt's leukemia (n=228), cases that were not confirmed by microscopic or cytologic tests (n=132), cases that were reported only based on autopsy data (n=3) and cases whose race/ethnicity were unknown (n=20). The average annual incidence rates per 100,000 for 2001-2005, age-adjusted to the 2000 US standard population were calculated using SEER*Stat Version 6.4.4 statistical software. We used multivariate Cox hazard models stratified by SEER registry and age category to estimate the hazard ratios (HR) and 95% confidence intervals (95% CI) for relative survival of adult ALL cases across race/ethnicity, sex and cell of origin (B- or T-cell). All models were adjusted for the diagnosis era, and use of non-CNS radiation. The model also included an interaction term for age and diagnosis era. We performed a separate stratified analysis of the impact of race/ethnicity on survival within age subgroups (20-29, 30-39, 40-59, 60-69, 70+). Results The highest incidence rate (IR) of ALL was observed for HW (IR: 1.60; 95% CI: 1.43-1.79). HW had a significantly higher IR across all age categories as compared to the other racial/ethnic groups, while AA had the lowest IR. In particular, the observed rate of B-cell ALL among HW (IR 0.77; 95% CI 0.69-0.87) was more than twice that of NHW (IR: 0.29; 95% CI: 0.27-0.32) and more than three times the rate observed among AA (IR: 0.20; 95% CI: 0.15-0.26). In contrast, we did not observe statistically significant variability in the rates of T-cell ALL across race/ethnic groups (overall IR: 0.12; 95% CI: 0.11-0.14). Survival was significantly poorer among AA (HR: 1.26; 95% CI: 1.09-1.46), HW (HR: 1.21; 95% CI: 1.09-1.46), and API (HR: 1.18; 95% CI: 1.06-1.32) compared to NHW with all subtypes of ALL. Among adults younger than 40 with B-cell ALL, survival was significantly poorer among AA (HR: 1.60; 95% CI:1.021-2.429) and HW (HR: 1.53; 95% CI:1.204-1.943) with a non-signficant trend among API (HR: 1.22; 95% 0.834-1.755) compared to NHW. Survival differences between the different racial/ethnic groups were no longer statistically significant among adults with B-cell ALL over the age of 40. For T-cell ALL, survival was significantly poorer among AA (HR: 1.61; 95% CI: 1.22-2.10), HW (HR: 1.49; 95% CI: 1.14-1.93) and API (HR: 1.57; 95% CI: 1.13-2.13), as compared to NHW. A similar survival pattern by age (adults above and below age 40 years) was observed for T-cell as described for B-cell, with AA under 40 having a particularly dismal prognosis (HR: 2.89; 95% CI 1.96-4.17) compared to NHW. Conclusions The incidence rate of B-cell ALL among adults in the US is higher among HW than other ethnic groups. Survival is significantly poorer among AA and HW than among NHW under the age of 40 with B-cell ALL. Survival is also significantly poorer among AA, HW and API than among NHW with T-cell ALL in adults under 40. Survival trends appear to converge after the age of 40 among all racial/ethnic groups. Disclosures No relevant conflicts of interest to declare.

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Evaluation of the effect of care at NCI comprehensive cancer centers (NCICCCs) on disparities in outcome within adolescents and young adults (AYAs) with cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.9512 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 9512-9512

Author(s):

Julie Anna Wolfson ◽

Can-Lan Sun ◽

Heeyoung Kim ◽

Tongjun Kang ◽

Smita Bhatia

Keyword(s):

African Americans ◽

Older Age ◽

Age At Diagnosis ◽

Cancer Center ◽

Insurance Status ◽

Cox Regression Analysis ◽

Risk Of Death ◽

Increased Risk ◽

Race Ethnicity ◽

The Impact

9512 Background: AYAs (15-39y at diagnosis) with cancer have not seen the survival improvement evidenced by younger and older age groups with similar diagnoses, leaving an AYA Gap. While treatment on pediatric protocols is associated with superior survival in 15-21 year-olds, the impact of site of care on survival for vulnerable AYA subpopulations (age at diagnosis or race/ ethnicity) between 22-and 39y at diagnosis remains unstudied. Methods: We constructed a cohort of 10,727 patients newly diagnosed between the ages of 22- and 39y with lymphoma, leukemia, brain tumors, melanoma, thyroid and GU cancers, and reported to the LA County cancer registry between 1998 and 2008. Multivariable Cox regression analysis was conducted, and included race/ethnicity, age at diagnosis, SES, insurance status, primary cancer diagnosis and diagnosis year in the model; the analysis was stratified by site of care (NCICCC vs. non-NCICCC). Results: A total of 928 (9%) patients received treatment at the 3 NCICCCs (City of Hope, Jonsson Cancer Center and Norris Cancer Center) in LA County, and 9,799 received care elsewhere. Five-year overall survival (5y OS) was significantly worse for patients treated at non-NCICCC (87%) when compared with those treated at NCICCC (84%, p=0.02). In addition, 5y OS was worse for African Americans (71%) vs. non-Hispanic whites (89%, p<0.0001) and for older patients (31-39yo: 84%, vs. 22-30yo: 86%, p=0.0004). Multivariable analysis adjusting for SES, insurance status, diagnosis and diagnosis year revealed that African Americans (HR=1.4, p=0.0002) and older AYAs (31-39y: HR=1.24, p<0.0001) were at an increased risk of death. Among patients treated at NCICCC, the difference in risk of death due to race (African Americans: HR=0.8, p=0.7) and age (31-39yo: HR=1.1, p=0.6) was abrogated. On the other hand, among patients treated at non-NCICCC, these differences in outcome persisted (African Americans: HR=1.45, p =0.0002; 31-39yo: HR=1.25, p<.0001). Conclusions: Population-based data reveal that receipt of care at an NCICCC abrogates the effects of race and older age on mortality in AYAs with cancer. Barriers to accessing care at NCICCCs are being explored.

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Responsiveness to cigarette prices by different racial/ethnic groups of US adults

Tobacco Control ◽

10.1136/tobaccocontrol-2016-053434 ◽

2017 ◽

Vol 27 (3) ◽

pp. 301-309 ◽

Cited By ~ 6

Author(s):

Tingting Yao ◽

Michael K Ong ◽

Wendy Max ◽

Courtney Keeler ◽

Yingning Wang ◽

...

Keyword(s):

African Americans ◽

Ethnic Groups ◽

Price Elasticity ◽

Local Level ◽

Smoking Intensity ◽

Cigarette Demand ◽

Tobacco Tax ◽

The Impact ◽

Racial Ethnic ◽

Cigarette Prices

ObjectiveTo evaluate the impact of cigarette prices on adult smoking for four US racial/ethnic groups: whites, African–Americans, Asians and Hispanics.MethodsWe analysed pooled cross-sectional data from the 2006/2007 and 2010/2011 Tobacco Use Supplement to the Current Population Survey (n=339 921 adults aged 18+) and cigarette price data from the Tax Burden on Tobacco. Using a two-part econometric model of cigarette demand that controlled for sociodemographic characteristics, state-level antismoking sentiment, local-level smoke-free air laws and monthly indicator, we estimated for each racial/ethnic group the price elasticities of smoking participation, smoking intensity and total demand for cigarettes.ResultsSmoking prevalence for whites, African–Americans, Asians and Hispanics during the study period was 18.3%, 16.1%, 8.2% and 11.3%, respectively. The price elasticity of smoking participation was statistically significant for whites, African–Americans, Asians and Hispanics at −0.26, –0.10, −0.42 and −0.11, respectively. The price elasticity of smoking intensity was statistically significant among whites (−0.22) and African–Americans (−0.17). Overall, the total price elasticity of cigarette demand was statistically significant for all racial/ethnic groups: 0.48 for whites, −0.27 for African–Americans, −0.22 for Asians and −0.15 for Hispanics.ConclusionsOur results suggest that raising cigarette prices, such as via tobacco tax increases, would result in reduced cigarette consumption for all racial/ethnic groups. The magnitude of the effect and the impact on cessation and reduced smoking intensity differ across these groups.

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Race/ethnicity and other risk of factors associated with cryptosporidiosis as an initial AIDS-defining condition in California, 1980–99

Epidemiology and Infection ◽

10.1017/s0950268801006239 ◽

2001 ◽

Vol 127 (3) ◽

pp. 535-543 ◽

Cited By ~ 7

Author(s):

A. KHALAKDINA ◽

F. TABNAK ◽

R. K. P. SUN ◽

J. M. COLFORD

Keyword(s):

African Americans ◽

Case Control Study ◽

Large Population ◽

Population Based ◽

Race Ethnicity ◽

The Difference ◽

Bisexual Males ◽

Racial Ethnic ◽

Biologic Factors ◽

Control Study

To study whether African-Americans are less likely than whites to present with cryptosporidiosis as an AIDS-defining condition (ADC), a case-control study was conducted using a large, population-based surveillance registry of AIDS patients in California. Data from January 1980 through June 1999 were analysed using risk factor stratification and multivariate logistic regression to evaluate confounding by other risk factors such as gender, injection drug use (IDU), CD4 counts, age and sexual orientation. Cases included 1373 subjects with cryptosporidiosis as an ADC and controls included 97419 subjects with other ADC. The results indicate a significantly lower risk for presentation with cryptosporidiosis as an ADC among African-Americans compared with whites (OR vs. whites = 0·5, 95% CI 0·4, 0·7). Additionally, there is evidence that heterosexuals are less likely than homosexual/bisexual males to present with cryptosporidiosis (OR = 0·5, 95% CI 0·4, 0·7). Our analyses also suggest a decreasing risk with increasing age. The possibility that there may be biologic factors or differential lifetime exposures that account for the difference between the racial/ethnic groups merits further investigation.

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Trends in medical and surgical admission length of stay by race/ethnicity and socioeconomic status: a time series analysis

10.1101/2021.05.27.21257925 ◽

2021 ◽

Author(s):

Arnab K Ghosh ◽

Orysya Soroka ◽

Mark A Unruh ◽

Martin Shapiro

Keyword(s):

Socioeconomic Status ◽

Length Of Stay ◽

Median Income ◽

Adverse Health Outcomes ◽

Race Ethnicity ◽

The Impact ◽

Racial Ethnic ◽

Fourth Quartile ◽

Zip Code ◽

Surgical Admission

Length of stay, a metric of hospital efficiency, differs by race/ethnicity and socioeconomic status (SES). Longer LOS is associated with adverse health outcomes. We assessed differences in average adjusted length of stay (aALOS) over time by race/ethnicity, and SES stratified by discharge destination (home or non-home). Using the 2009-2014 State Inpatient Datasets from three states, we examined trends in aALOS differences by race/ethnicity, and SES (defined first vs fourth quartile of median income by zip code) controlling for patient, disease and hospital characteristics. For those discharged home, racial/ethnic and SES aALOS differences remained stable. Notably, for those discharged to non-home destinations, Black vs White, and low vs high SES aALOS differences increased significantly from 2009 to 2013, more sharply after Q3 2011, the introduction of the Affordable Care Act (ACA). Further research to understand the impact of the ACA on hospital efficiencies, and relationship to racial/ethnic and SES differences in LOS is warranted.

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Ethnic Differences in Perceptions of Mental Illness: Examining Intergroup Relations

10.31234/osf.io/wcfg9 ◽

2020 ◽

Author(s):

Alexandra Sara Aringer ◽

Jimmy Calanchini

Keyword(s):

Mental Illness ◽

African Americans ◽

Ethnic Groups ◽

Asian Americans ◽

Mentally Ill ◽

Factor Analyses ◽

People With Mental Illness ◽

Exploratory Factor Analyses ◽

Race Ethnicity ◽

Racial Ethnic

People with mental illness are often stereotyped as dangerous, unstable, or unreliable, and these stereotypes perpetuate prejudice against those who are already vulnerable. However, many of these stereotypes are Eurocentric due to a lack of diversity within psychology. The present, preregistered research investigates whether depictions of mental illness are idiosyncratic to various racial/ethnic groups, or if these perceptions generalize across groups. Participants reported their endorsement of a series of mental illness descriptions (e.g., “This person spontaneously explodes in outbursts of anger”) as they apply to African Americans, Asian Americans, Hispanic/Latinxs, Caucasians, as well as to individuals with unspecified race/ethnicity. Exploratory factor analyses of these descriptions revealed three factors that describe mentally ill people -- ashamed, self-destructive, irresponsible -- and participants’ perceptions of mental illness on these three factors varied by racial/ethnic groups. Participants rated Asian Americans as more ashamed, but less self-destructive and irresponsible than other racial/ethnic groups. Conversely, participants rated Caucasians as less ashamed, but more self-destructive and irresponsible than other racial/ethnic groups. Perceptions of mental illness did not differ between Hispanic/Latinxs and African Americans. Additional analyses indicate that, compared to Caucasian participants, non-Caucasian participants rated mentally ill members of their ingroup as more ashamed but less self-destructive and irresponsible. This research indicates that participants from different racial/ethnic groups vary in the extent to which they ascribe different facets of mental illness to their ingroup versus outgroups. Implications for Eurocentric versus more diverse perceptions of mental illness are discussed.

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Racial/ethnic and prior willingness disparities in potential living kidney donors’ self-assessed responses to advancing American kidney health regulation

BMC Public Health ◽

10.1186/s12889-021-12023-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Selena E. Ortiz ◽

Ashton M. Verdery ◽

Jonathan Daw

Keyword(s):

Living Donor ◽

Ethnic Disparities ◽

Indirect Costs ◽

Self Report ◽

Kidney Donors ◽

Living Kidney Donors ◽

Knowledge And Attitudes ◽

Race Ethnicity ◽

Racial Ethnic ◽

Kidney Health

Abstract Background Racial/ethnic disparities in living donor kidney transplantation (LDKT) are large, and rates of LDKT may be limited by indirect costs of living donation. A 2019 Executive Order– Advancing American Kidney Health (AAKH)– sought to remove indirect costs through an expanded reimbursement program. We examine how potential living kidney donors in the U.S. believe regulation stemming from the AAKH initiative will impact their living donor evaluation likelihood, how these beliefs vary by minority race/ethnicity and prior willingness to be evaluated, and how differences are explained by ability to benefit or knowledge and attitudes. Methods Data from a 2019 online survey (Families of Renal Patients Survey) were used. Respondents are U.S. adult (> 18 years) members of the Qualtrics Survey Panel who reported having relatives with weak or failing kidneys (N = 590). Respondents’ likelihood to be evaluated for living kidney donation are measured by self-report. Prior willingness is measured by past donation-related actions and current attitudes. Ability to benefit is measured by self-reported labor force participation and financial strain. Transplant knowledge is measured by self-report and a knowledge test, and transplant-related attitudes are measured by self-report. Average marginal effects of minority race/ethnicity and prior willingness for response to each provision in fully-adjusted models were estimated. Formal tests of mediation were conducted using the Karlson, Holm, and Breen (KHB) mediation model. Stata/MP 14.2 was used to conduct all analyses. Results Majorities of all groups report favorable responses to the provisions stipulated in AAKH regulation. Responses to provisions are significantly associated with race/ethnicity and prior willingness, with racial/ethnic minorities and those not previously willing to be evaluated less likely to report favorable responses to these provisions. Prior willingness differences are partially explained by group differences in ability to benefit and transplant-related knowledge and attitudes, but racial/ethnic differences largely are not. Conclusions Regulation stemming from the AAKH initiative is likely to effectively promote LDKT, but may also exacerbate racial/ethnic disparities. Therefore, the regulation may need to be supplemented by efforts to address non-financial obstacles to LDKT in racial/ethnic minority communities in order to ensure equitable increases in LDKT rates and living donor support.

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