scholarly journals Association of Socioeconomic Status and Comorbidities with Racial Disparities during Kidney Transplant Evaluation

2020 ◽  
Vol 15 (6) ◽  
pp. 843-851 ◽  
Author(s):  
Karly A. Murphy ◽  
John W. Jackson ◽  
Tanjala S. Purnell ◽  
Ashton A. Shaffer ◽  
Christine E. Haugen ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Relative Risk ◽  
Racial Disparities ◽  
Racial Disparity ◽  
Indirect Effects ◽  
Odds Ratio ◽  
Cox Proportional Hazards ◽  
Interquartile Range ◽  
Direct And Indirect Effects ◽  
White Patients

Background and objectivesBlack patients referred for kidney transplantation have surpassed many obstacles but likely face continued racial disparities before transplant. The mechanisms that underlie these disparities are unclear. We determined the contributions of socioeconomic status (SES) and comorbidities as mediators to disparities in listing and transplant.Design, setting, participants, & measurementsWe studied a cohort (n=1452 black; n=1561 white) of patients with kidney failure who were referred for and started the transplant process (2009–2018). We estimated the direct and indirect effects of SES (self-reported income, education, and employment) and medical comorbidities (self-reported and chart-abstracted) as mediators of racial disparities in listing using Cox proportional hazards analysis with inverse odds ratio weighting. Among the 983 black and 1085 white candidates actively listed, we estimated the direct and indirect effects of SES and comorbidities as mediators of racial disparities on receipt of transplant using Poisson regression with inverse odds ratio weighting.ResultsWithin the first year, 876 (60%) black and 1028 (66%) white patients were waitlisted. The relative risk of listing for black compared with white patients was 0.76 (95% confidence interval [95% CI], 0.69 to 0.83); after adjustment for SES and comorbidity, the relative risk was 0.90 (95% CI, 0.83 to 0.97). The proportion of the racial disparity in listing was explained by SES by 36% (95% CI, 26% to 57%), comorbidity by 44% (95% CI, 35% to 61%), and SES with comorbidity by 58% (95% CI, 44% to 85%). There were 409 (42%) black and 496 (45%) white listed candidates transplanted, with a median duration of follow-up of 3.9 (interquartile range, 1.2–7.1) and 2.8 (interquartile range, 0.8–6.3) years, respectively. The incidence rate ratio for black versus white candidates was 0.87 (95% CI, 0.79 to 0.96); SES and comorbidity did not explain the racial disparity.ConclusionsSES and comorbidity partially mediated racial disparities in listing but not for transplant.

Racial Disparities in Invasive Management for Patients With Acute Myocardial Infarction With Chronic Kidney Disease

2021 ◽  
Author(s):  
Jennifer A. Rymer ◽  
Shuang Li ◽  
Patrick H. Pun ◽  
Laine Thomas ◽  
Tracy Y. Wang
Keyword(s):  
Myocardial Infarction ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Racial Disparities ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Logistic Regression Models ◽  
Black Patients ◽  
Invasive Management ◽  
White Patients

Background: Due to increased risks of contrast nephropathy, chronic kidney disease (CKD) can deter consideration of invasive management for patients with myocardial infarction (MI). Black patients have a higher prevalence of CKD. Whether racial disparities exist in the use of invasive MI management for patients with CKD presenting with MI is unknown. Methods: We examined 717 012 White and 99 882 Black patients with MI treated from 2008 to 2017 at 914 hospitals in the National Cardiovascular Data Registry Chest Pain—MI Registry. CKD status was defined as estimated glomerular filtration rate (eGFR) ≥90 mL/(min·1.73 m 2 ; no CKD), eGFR <90 but ≥60 (mild), eGFR <60 but ≥30 (moderate), and eGFR <30 or dialysis (severe). We used multivariable logistic regression models to examine the interaction of race and CKD severity in invasive MI management. Results: Among those with MI, Black patients were more likely than White patients to have CKD (eGFR <90; 61.4% versus 58.5%; P <0.001). Among those with MI and CKD, Black patients were more likely than White patients to have severe CKD (21.2% versus 12.4%; P <0.001). Patients with CKD were more likely than those without CKD to have diabetes or heart failure; Black patients with CKD were more likely to have these comorbidities when compared with White patients with CKD (all P <0.0001). Black race and CKD were associated with a lower likelihood of invasive management (adjusted odds ratio, 0.78 [95% CI, 0.75–0.81]; adjusted odds ratio, 0.72 [95% CI, 0.70–0.74]; P <0.001 for both). At eGFR levels ≥10, Black patients were significantly less likely than White patients to undergo invasive management. Conclusions: Black patients with MI and mild or moderate CKD were less likely to undergo invasive management compared with White patients with similar CKD severity. National efforts are needed to address racial disparities that may remain in the invasive management of MI.

Direct and Indirect Effects of Socioeconomic Status on Public Affairs Knowledge

1994 ◽  
Vol 71 (2) ◽  
pp. 433-442 ◽  
Author(s):  
Douglas M. McLeod ◽  
Elizabeth M. Perse
Keyword(s):  
Socioeconomic Status ◽  
News Media ◽  
Indirect Effects ◽  
Media Use ◽  
Public Affairs ◽  
Direct And Indirect Effects ◽  
Perceived Utility ◽  
The Impact ◽  
Lisrel Model

This study investigates the impact of socioeconomic status (SES), perceived utility indicators, and news media use on public affairs knowledge. A LISREL model was used to evaluate various theoretical arguments that have been used to account for public affairs knowledge. Results reveal that SES was significantly linked to knowledge through each of the aforementioned factors. In addition, we located a strong direct SES effect on public affairs knowledge.

Racial disparities in emergency care for seizures in the United States

2021 ◽  
Vol 13 (9) ◽  
pp. 373-377
Author(s):  
Sriman Gaddam
Keyword(s):  
Relative Risk ◽  
Racial Disparities ◽  
Life Support ◽  
Statistical Significance ◽  
Advanced Life Support ◽  
The United States ◽  
Chi Square ◽  
Time Critical ◽  
To Receive ◽  
White Patients

Background: Racial disparities exist regarding emergency medical services, and advanced life support (ALS) is superior to basic life support (BLS) for patients experiencing a seizure. Aims: This study aims to identify if there are racial disparities regarding access to ALS care for patients having a seizure. Methods: This study analysed 624 011 seizure cases regarding the provision of BLS rather than ALS care per racial group. Chi-square testing was used to check statistical significance and effect size was measured using relative risk. Findings: On average, non-white patients experiencing a seizure had a 21% higher relative risk of receiving BLS care than white patients. The highest disparity concerned American Indian patients, who had a 66% higher relative risk of receiving BLS care than white patients. Conclusions: Overall, non-white patients are less likely to receive ALS when experiencing a seizure than white patients, potentially leading to worse prehospital outcomes from less access to time-critical medications.

Racial Differences in Surgical Evaluation, Treatment, and Outcome of Locoregional Esophageal Cancer: A Population-Based Analysis of Elderly Patients

2005 ◽  
Vol 23 (3) ◽  
pp. 510-517 ◽  
Author(s):  
Ewout W. Steyerberg ◽  
Craig C. Earle ◽  
Bridget A. Neville ◽  
Jane C. Weeks
Keyword(s):  
Esophageal Cancer ◽  
Elderly Patients ◽  
Racial Disparities ◽  
Racial Differences ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Curative Surgery ◽  
Black Patients ◽  
Surgical Evaluation ◽  
White Patients

Purpose We investigated racial disparities in access to surgical evaluation, receipt of surgery, and survival among elderly patients with locoregional esophageal cancer. Methods We selected 2,946 white patients and 367 black patients who were older than 65 years and had clinically locoregional esophageal cancer in the Surveillance, Epidemiology, and End Results (SEER) registry (1991 to 1999). Treatment and outcome data were obtained from the linked SEER-Medicare databases. We used logistic regression analysis to estimate odds ratios (ORs) for being seen by a surgeon and for undergoing surgery. Cox proportional hazards analyses were performed to estimate hazard ratios (HRs) for survival adjusted for medical, nonmedical, and treatment characteristics. Results The rate of surgery for black patients was half that of white patients (25% v 46%; OR, 0.38; P < .001), which was caused by both a lower rate of seeing a surgeon (70% v 78%; OR, 0.66; P < .001) and a lower rate of surgery once seen (35% v 59%; OR, 0.38; P < .001). These racial disparities were only partly explained by differences in patient and cancer characteristics, and not by nonmedical factors, such as socioeconomic status. The 2-year survival rate was lower for black patients (18% v 25%; HR, 1.18; P = .004), but this racial difference disappeared when corrected for treatment received (adjusted HR, 1.02; P = .80). Conclusion Underuse of potentially curative surgery is an important potential explanation for the poorer survival of black patients with locoregional esophageal cancer. Barriers to surgical evaluation and treatment need to be reduced, whether related to patient or healthcare system factors.

Racial disparities in emergency care for seizures in the United States

2021 ◽  
Vol 11 (3) ◽  
pp. 62-66
Author(s):  
Sriman Gaddam
Keyword(s):  
Relative Risk ◽  
Racial Disparities ◽  
Life Support ◽  
Statistical Significance ◽  
Advanced Life Support ◽  
The United States ◽  
Chi Square ◽  
Time Critical ◽  
To Receive ◽  
White Patients

Background Racial disparities exist regarding emergency medical services, and advanced life support (ALS) is superior to basic life support (BLS) for patients experiencing a seizure. Aims This study aims to identify if there are racial disparities regarding access to ALS care for patients having a seizure. Methods This study analysed 624 011 seizure cases regarding the provision of BLS rather than ALS care per racial group. Chi-square testing was used to check statistical significance and effect size was measured using relative risk. Findings On average, non-white patients experiencing a seizure had a 21% higher relative risk of receiving BLS care than white patients. The highest disparity concerned American Indian patients, who had a 66% higher relative risk of receiving BLS care than white patients. Conclusions Overall, non-white patients are less likely to receive ALS when experiencing a seizure than white patients, potentially leading to worse prehospital outcomes from less access to time-critical medications.

scholarly journals Dispositional Awe and Online Altruism: Testing a Moderated Mediating Model

2021 ◽  
Vol 12 ◽  
Author(s):  
RongMao Lin ◽  
YanPing Chen ◽  
YiLin Shen ◽  
XiaXin Xiong ◽  
Nan Lin ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Prosocial Behavior ◽  
Indirect Effect ◽  
Indirect Effects ◽  
Meaning In Life ◽  
Direct And Indirect Effects ◽  
Large Sample ◽  
Subjective Socioeconomic Status ◽  
Positive Effect ◽  
Chinese Undergraduates

Dispositional awe has a positive effect on prosociality. However, it has not been tested whether this disposition appears in online altruism. Using a large sample of 3,080 Chinese undergraduates, this study tested a moderated mediating model that takes self-transcendent meaning in life (STML) as a mediator and subjective socioeconomic status (SSES) as a moderator. As predicted, dispositional awe was positively correlated with online altruism, partly via the indirect effect of STML. SSES moderated both the direct and indirect effects. Specifically, the predictive effects of dispositional awe on both online prosocial behavior and STML were greater for lower rather than higher SSES. This study extends the prosociality of dispositional awe to cyberspace. Other implications are also discussed herein.

scholarly journals 6. Effects of Exposure on Prevalence and Cumulative Relative Risk: Direct and Indirect Effects in a Recursive Hazard Model

2009 ◽  
Vol 39 (1) ◽  
pp. 185-232 ◽  
Author(s):  
Lawrence L. Wu ◽  
Steven P. Martin
Keyword(s):  
Relative Risk ◽  
Indirect Effects ◽  
Hazard Model ◽  
Decomposition Methods ◽  
Proportional Hazard ◽  
Direct And Indirect Effects ◽  
Exposure Effect ◽  
First Sexual Intercourse ◽  
Relative Prevalence ◽  
Hispanic White

This paper outlines decomposition methods for assessing how exposure affects prevalence and cumulative relative risk. Let x denote a vector of exogenous covariates and suppose that a single dimension of time t governs two event processes T1 and T2. If the occurrence of the event T1 determines entry into the risk of the event T2, then subgroup variation in T1 will affect the prevalence T2, even if subgroups in the population are otherwise identical. Although researchers often acknowledge this phenomenon, the literature has not provided procedures to assess the magnitude of an exposure effect of T1 on the prevalence of T2. We derive decompositions that assess how variation in exposure generated by direct and indirect effects of the covariates x affect measures of absolute and relative prevalence of T2. We employ a parametric but highly flexible specification for baseline hazard for the T1 and T2 processes and use the resulting parametric proportional hazard model to illustrate the direct and indirect effects of family structure when T1 is age at first sexual intercourse and T2 is age at a premarital first birth for data on a cohort of non-hispanic white U.S. women.

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