Race/Ethnicity, Enrichment/Fortification, and Dietary Supplementation in the U.S. Population, NHANES 2009–2012

In the United States (U.S.), food fortification and/or enrichment and dietary supplement (DS) use impacts nutrient intakes. Our aim was to examine race/ethnicity and income (Poverty Income Ratio, PIR) differences in meeting the Dietary Reference Intakes based on estimated dietary intakes among the U.S. population age ≥2 years (n = 16,975). Two 24-hour recalls from the National Health and Nutrition Examination Survey (NHANES) cycles 2009–2012 were used to estimate the intake of 15 nutrients as naturally occurring, enriched/fortified, and plus DSs. Across racial/ethnic groups and within PIR categories, significant differences were observed in the %< Estimated Average Requirement (EAR) for vitamin A following enrichment/fortification (E/F) and for vitamin B12 and riboflavin following both E/F and DS use when comparing non-Hispanic blacks, Hispanics, and the other race/ethnicity group to non-Hispanic whites. The %<EAR for iron and calcium also differed depending on race/ethnicity within PIR category (p < 0.05). The %<EAR was significantly lower for vitamin D after E/F for Hispanics, and after E/F combined with DS use for vitamins C and B6 for Hispanics and the other race/ethnicity group than non-Hispanic whites. Non-Hispanic blacks were inadequate in all nutrients examined except vitamin C based on the %<EAR than individuals of other races/ethnicities. Differences in the tolerable upper intake level (UL) of nutrients, especially folate and zinc, also varied by race/ethnicity and PIR category.

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Effect of Race/ethnicity, Insurance Status, and Area Deprivation on Hip Fracture Outcomes Among Older Adults in the United States

Clinical Nursing Research ◽

10.1177/10547738211061216 ◽

2021 ◽

pp. 105477382110612

Author(s):

Chiyoung Lee ◽

Eleanor Schildwachter McConnell ◽

Sijia Wei ◽

Tingzhong (Michelle) Xue ◽

Hideyo Tsumura ◽

...

Keyword(s):

Hip Fracture ◽

The United States ◽

The Other ◽

Area Deprivation ◽

Insurance Status ◽

Post Discharge ◽

Black Patients ◽

Race Ethnicity ◽

Racial Ethnic ◽

Deprived Areas

This retrospective cohort study used electronic health records to explore the effect of race/ethnicity, insurance status, and area deprivation on post-discharge outcomes in older patients undergoing hip fracture surgery between 2015 and 2018 ( N = 1,150). Inverse probability of treatment weight-adjusted regression analysis was used to identify the effects of the predictors on outcomes. White patients had higher 90- and 365-day readmission risks than Black patients and higher all-period readmissions than the Other racial/ethnic (Hispanic, Asian, American Indian, and Multicultural) group ( p < .000). Black patients had a higher risk of 30- and 90-day readmission than the Other racial/ethnic group ( p < .000). Readmission risk across 1-year follow-up was generally higher among patients from less deprived areas than more deprived areas ( p < .05). The 90- and 365-day mortality risk was lower for patients from less deprived areas (vs. more deprived areas) and patients with Medicare Advantage (vs. Medicare), respectively ( p < .05). Our findings can guide efforts to identify patients for additional post-discharge support. Nevertheless, the findings regarding readmission risks contrast with previous knowledge and thus require more validation studies.

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Trends in neonatal intensive care unit admissions by race/ethnicity in the United States, 2008–2018

Scientific Reports ◽

10.1038/s41598-021-03183-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Youngran Kim ◽

Cecilia Ganduglia-Cazaban ◽

Wenyaw Chan ◽

MinJae Lee ◽

David C. Goodman

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Ethnic Differences ◽

Very Low Birth Weight ◽

The United States ◽

Admission Rates ◽

Race Ethnicity ◽

Nicu Admission ◽

Racial Ethnic ◽

The U.S

AbstractTo examine temporal trends of NICU admissions in the U.S. by race/ethnicity, we conducted a retrospective cohort analysis using natality files provided by the National Center for Health Statistics at the U.S. Centers for Disease Control and Prevention. A total of 38,011,843 births in 2008–2018 were included. Crude and risk-adjusted NICU admission rates, overall and stratified by birth weight group, were compared between white, black, and Hispanic infants. Crude NICU admission rates increased from 6.62% (95% CI 6.59–6.65) to 9.07% (95% CI 9.04–9.10) between 2008 and 2018. The largest percentage increase was observed among Hispanic infants (51.4%) compared to white (29.1%) and black (32.4%) infants. Overall risk-adjusted rates differed little by race/ethnicity, but birth weight-stratified analysis revealed that racial/ethnic differences diminished in the very low birth weight (< 1500 g) and moderately low birth weight (1500–2499 g) groups. Overall NICU admission rates increased by 37% from 2008 to 2018, and the increasing trends were observed among all racial and ethnic groups. Diminished racial/ethnic differences in NICU admission rates in very low birth weight infants may reflect improved access to timely appropriate NICU care among high-risk infants through increasing health care coverage coupled with growing NICU supply.

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A Differential Item Functional Analysis by Age of Perceived Interpersonal Discrimination in a Multi-racial/ethnic Sample of Adults

Ethnicity & Disease ◽

10.18865/ed.25.4.479 ◽

2015 ◽

Vol 25 (4) ◽

pp. 479

Author(s):

Sherry Owens ◽

Alfgeir Kristjansson ◽

Haslyn E.R. Hunte

Keyword(s):

African Americans ◽

The United States ◽

The Other ◽

Racial Groups ◽

Asian Studies ◽

Item Functioning ◽

Multiple Indicator ◽

Race Ethnicity ◽

Interpersonal Discrimination ◽

Racial Ethnic

We investigated whether individual items on the nine item William’s Perceived Everyday Discrimination Scale (EDS) functioned differently by age (<45 vs ≥45) within five racial groups in the United States: Asians (n=2,017); Hispanics (n=2,688); Black Caribbeans (n=1,377); African Americans (n=3,434); and Whites (n=854). We used data from the 2001-2003 National Survey of American Lives and the 2001- 2003 National Latino and Asian Studies. Multiple-indicator, multiple-cause models (MIMIC) were used to examine differential item functioning (DIF) on the EDS by age within each racial/ethnic group. Overall, Asian and Hispanic respondents reported less discrimination than Whites; on the other hand, African Americans and Black Caribbeans reported more discrimination than Whites. Regardless of race/ethnicity, the younger respondents (aged <45 years) reported less discrimination than the older respondents (aged ≥45 years). In terms of age by race/ethnicity, the results were mixed for 19 out of 45 tests of DIF (40%). No differences in item function were observed among Black Caribbeans. “Being called names or insulted” and others acting as “if they are afraid” of the respondents were the only two items that did not exhibit differential item functioning by age across all racial/ethnic groups. Overall, our findings suggest that the EDS scale should be used with caution in multi-age multi-racial/ethnic samples. Ethn Dis.2015;25(4):479-486; doi:10.18865/ed.25.4.479

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Population Age-Ineligible for COVID-19 Vaccine in the United States: Implications for State, County, and Race/Ethnicity Vaccination Targets

10.1101/2021.02.11.21251562 ◽

2021 ◽

Author(s):

Elizabeth B. Pathak ◽

Janelle Menard ◽

Rebecca Garcia

Keyword(s):

American Indians ◽

Minority Groups ◽

Vaccine Coverage ◽

The United States ◽

Census Bureau ◽

Vaccine Hesitancy ◽

Race Ethnicity ◽

Us Census ◽

Racial Ethnic ◽

The U.S

ABSTRACTBackgroundWe examined the geographic and racial/ethnic distribution of the SARS-CoV-2 vaccine age-ineligible population (0-15 years old) in the U.S., and calculated the proportion of the age-eligible population that will need to be vaccinated in a given geo-demographic group in order to achieve either 60% or 75% vaccine coverage for that population as a whole.MethodsUS Census Bureau population estimates for 2019 were used to calculate the percent vaccine ineligible and related measures for counties, states, and the nation as a whole. Vaccination targets for the 30 largest counties by population were calculated. Study measures were calculated for racial/ethnic populations at the national (n=7) and state (n=6) levels.ResultsPercent of population ineligible for vaccine varied widely both geographically and by race/ethnicity. State values ranged from 15.8% in Vermont to 25.7% in Utah, while percent ineligible of the major racial/ethnic groups was 16.4% of non-Hispanic whites, 21.6% of non-Hispanic Blacks, and 27.5% of Hispanics. Achievement of total population vaccine coverage of at least 75% will require vaccinating more than 90% of the population aged 16 years and older in 29 out of 30 of the largest counties in the U.S.ConclusionsThe vaccine-ineligibility of most children for the next 1-2 years, coupled with reported pervasive vaccine hesitancy among adults, especially women and most minorities, means that achievement of adequate levels of vaccine coverage will be very difficult for many vulnerable geographic areas and for several racial/ethnic minority groups, particularly Hispanics, Blacks, and American Indians.

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Health Care Access Measures and Palliative Care Use by Race/Ethnicity among Metastatic Gynecological Cancer Patients in the United States

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18116040 ◽

2021 ◽

Vol 18 (11) ◽

pp. 6040

Author(s):

Jessica Y. Islam ◽

Veeral Saraiya ◽

Rebecca A. Previs ◽

Tomi Akinyemiju

Keyword(s):

Palliative Care ◽

Cancer Patients ◽

Gynecological Cancer ◽

The United States ◽

Care Utilization ◽

Treatment Facility ◽

Facility Type ◽

Race Ethnicity ◽

Distance To Care ◽

The U.S

Palliative care improves quality-of-life and extends survival, however, is underutilized among gynecological cancer patients in the United States (U.S.). Our objective was to evaluate associations between healthcare access (HCA) measures and palliative care utilization among U.S. gynecological cancer patients overall and by race/ethnicity. We used 2004–2016 data from the U.S. National Cancer Database and included patients with metastatic (stage III–IV at-diagnosis) ovarian, cervical, and uterine cancer (n = 176,899). Palliative care was defined as non-curative treatment and could include surgery, radiation, chemotherapy, and pain management, or any combination. HCA measures included insurance type, area-level socioeconomic measures, distance-to-care, and cancer treatment facility type. We evaluated associations of HCA measures with palliative care use overall and by race/ethnicity using multivariable logistic regression. Our population was mostly non-Hispanic White (72%), had ovarian cancer (72%), and 24% survived <6 months. Five percent of metastatic gynecological cancer patients utilized palliative care. Compared to those with private insurance, uninsured patients with ovarian (aOR: 1.80,95% CI: 1.53–2.12), and cervical (aOR: 1.45,95% CI: 1.26–1.67) cancer were more likely to use palliative care. Patients with ovarian (aOR: 0.58,95% CI: 0.48–0.70) or cervical cancer (aOR: 0.74,95% CI: 0.60–0.88) who reside >45 miles from their provider were less likely to utilize palliative care than those within <2 miles. Ovarian cancer patients treated at academic/research programs were less likely to utilize palliative care compared to those treated at community cancer programs (aOR: 0.70, 95%CI: 0.58–0.84). Associations between HCA measures and palliative care utilization were largely consistent across U.S. racial-ethnic groups. Insurance type, cancer treatment facility type, and distance-to-care may influence palliative care use among metastatic gynecological cancer patients in the U.S.

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Racial and Ethnic Disparities in Years of Potential Life Lost Attributable to COVID-19 in the United States: An Analysis of 45 States and the District of Columbia

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18062921 ◽

2021 ◽

Vol 18 (6) ◽

pp. 2921

Author(s):

Jay J. Xu ◽

Jarvis T. Chen ◽

Thomas R. Belin ◽

Ronald S. Brookmeyer ◽

Marc A. Suchard ◽

...

Keyword(s):

United States ◽

District Of Columbia ◽

Ethnic Disparities ◽

The United States ◽

Attributable Mortality ◽

Race Ethnicity ◽

Using Data ◽

Rate Ratios ◽

Degree Of Association ◽

Racial Ethnic

The coronavirus disease 2019 (COVID-19) epidemic in the United States has disproportionately impacted communities of color across the country. Focusing on COVID-19-attributable mortality, we expand upon a national comparative analysis of years of potential life lost (YPLL) attributable to COVID-19 by race/ethnicity (Bassett et al., 2020), estimating percentages of total YPLL for non-Hispanic Whites, non-Hispanic Blacks, Hispanics, non-Hispanic Asians, and non-Hispanic American Indian or Alaska Natives, contrasting them with their respective percent population shares, as well as age-adjusted YPLL rate ratios—anchoring comparisons to non-Hispanic Whites—in each of 45 states and the District of Columbia using data from the National Center for Health Statistics as of 30 December 2020. Using a novel Monte Carlo simulation procedure to perform estimation, our results reveal substantial racial/ethnic disparities in COVID-19-attributable YPLL across states, with a prevailing pattern of non-Hispanic Blacks and Hispanics experiencing disproportionately high and non-Hispanic Whites experiencing disproportionately low COVID-19-attributable YPLL. Furthermore, estimated disparities are generally more pronounced when measuring mortality in terms of YPLL compared to death counts, reflecting the greater intensity of the disparities at younger ages. We also find substantial state-to-state variability in the magnitudes of the estimated racial/ethnic disparities, suggesting that they are driven in large part by social determinants of health whose degree of association with race/ethnicity varies by state.

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Racial/Ethnic Disparities in Hypertension Prevalence, Awareness, Treatment, and Control in the United States, 2013 to 2018

Hypertension ◽

10.1161/hypertensionaha.121.17570 ◽

2021 ◽

Author(s):

Rahul Aggarwal ◽

Nicholas Chiu ◽

Rishi K. Wadhera ◽

Andrew E. Moran ◽

Inbar Raber ◽

...

Keyword(s):

United States ◽

Ethnic Disparities ◽

The United States ◽

Self Report ◽

Similar Treatment ◽

Hypertension Prevalence ◽

Health And Nutrition ◽

Race Ethnicity ◽

And Control ◽

White Adults

We evaluated the prevalence, awareness, treatment, and control of hypertension (defined as a systolic blood pressure [BP]) ≥140 mm Hg, diastolic BP ≥90 mm Hg, or a self-reported use of an antihypertensive agent) among US adults, stratified by race/ethnicity. This analysis included 16 531 nonpregnant US adults (≥18 years) in the three National Health and Nutrition Examination Survey cycles between 2013 and 2018. Race/ethnicity was defined by self-report as White, Black, Hispanic, Asian, or other Americans. Among 76 910 050 (74 449 985–79 370 115) US adults with hypertension, 48.6% (47.3%–49.8%, unadjusted) have controlled BP. When compared with BP control rates for White adults (49.0% [46.8%–51.2%], age-adjusted), BP control rates are lower in Black (39.2%, adjusted odds ratio [aOR], 0.71 [95% CI, 0.59–0.85], P <0.001), Hispanic (40.0%, aOR, 0.71 [95% CI, 0.58–0.88], P =0.003), and Asian (37.8%, aOR, 0.68 [95% CI, 0.55–0.84], P =0.001) Americans. Black adults have higher hypertension prevalence (45.3% versus 31.4%, aOR, 2.24 [95% CI, 1.97–2.56], P <0.001) but similar awareness and treatment rates as White adults. Hispanic adults have similar hypertension prevalence, but lower awareness (71.1% versus 79.1%, aOR, 0.72 [95% CI, 0.58–0.89], P =0.005) and treatment rates (60.5% versus 67.3%, aOR, 0.78 [95% CI, 0.66–0.94], P =0.010) than White adults. Asian adults have similar hypertension prevalence, lower awareness (72.5% versus 79.1%, aOR, 0.75 [95% CI, 0.58–0.97], P =0.038) but similar treatment rates. Black, Hispanic, and Asian Americans have different vulnerabilities in the hypertension control cascade of prevalence, awareness, treatment, and control. These differences can inform targeted public health efforts to promote health equity and reduce the burden of hypertension in the United States.

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Factor Structure for Chronic Stress Before and During Pregnancy by Racial/Ethnic Group

Western Journal of Nursing Research ◽

10.1177/0193945918788852 ◽

2018 ◽

Vol 41 (5) ◽

pp. 704-727 ◽

Cited By ~ 1

Author(s):

Sangmi Kim ◽

Eun-Ok Im ◽

Jianghong Liu ◽

Connie Ulrich

Keyword(s):

New York ◽

Chronic Stress ◽

Physical Violence ◽

The United States ◽

Birth Certificates ◽

Specific Factor ◽

Pregnancy Risk ◽

Chronic Stressors ◽

Race Ethnicity ◽

Racial Ethnic

This study aimed to explore race/ethnicity-specific dimensionalities of chronic stress before and during pregnancy for non-Hispanic (N-H) White, N-H Black, Hispanic, and Asian women in the United States. This study analyzed the data among 6,850 women from the New York City and Washington State Pregnancy Risk Assessment Monitoring System (2004-2007) linked with birth certificates. Separate exploratory factor analysis was conducted by race/ethnicity using a maximum-likelihood extraction method with 26 chronic stress items before and during pregnancy. Correlations and internal consistency reliabilities among items and latent factors determined race/ethnicity-specific factor structures of chronic stress. Chronic stress was race/ethnicity-distinctive and multidimensional with low correlations among the factors ( r = .07-.28, p < .05). Despite financial hardship, perceived isolation, and physical violence underlying chronic stress among the racial/ethnic groups, intergroup variations existed under each group’s cultural or sociopolitical contexts. This study could help develop targeted strategies to intervene with women’s chronic stressors before childbirth.

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Current Nuclear Strategies and Arsenals of the United States of America and the Russian Federation

Vojenské rozhledy ◽

10.3849/2336-2995.30.2021.04.023-044 ◽

2021 ◽

Vol 30 (4) ◽

pp. 23-44

Author(s):

Adam Potočňák

Keyword(s):

Cold War ◽

United States Of America ◽

The United States ◽

The Other ◽

Nuclear Forces ◽

Nuclear Strategy ◽

The Usa ◽

The Russian Federation ◽

The Cold War ◽

The U.S

The article holistically analyses current strategies for the use and development of nuclear forces of the USA and Russia and analytically reflects their mutual doctrinal interactions. It deals with the conditions under which the U.S. and Russia may opt for using their nuclear weapons and reflects also related issues of modernization and development of their actual nuclear forces. The author argues that both superpowers did not manage to abandon the Cold War logic or avoid erroneous, distorted or exaggerated assumptions about the intentions of the other side. The text concludes with a summary of possible changes and adaptations of the American nuclear strategy under the Biden administration as part of the assumed strategy update expected for 2022.

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The Differential Incidence and Severity of Food Insecurity by Racial, Ethnic, and Immigrant Groups over the Great Recession in the United States

AEA Papers and Proceedings ◽

10.1257/pandp.20181106 ◽

2018 ◽

Vol 108 ◽

pp. 379-383 ◽

Cited By ~ 1

Author(s):

Alfonso Flores-Lagunes ◽

Hugo B. Jales ◽

Judith Liu ◽

Norbert L. Wilson

Keyword(s):

Food Insecurity ◽

Great Recession ◽

Decomposition Analysis ◽

The United States ◽

Structural Factors ◽

Immigrant Status ◽

The Great Recession ◽

Extensive And Intensive Margins ◽

Race Ethnicity ◽

Racial Ethnic

We document the differences in food insecurity incidence and severity by race/ethnicity and immigrant status over the Great Recession. We show that the disadvantaged groups with a higher incidence of food insecurity do not necessarily have a higher severity of food insecurity, which underscores the importance of examining both the extensive and intensive margins of food insecurity. Our decomposition analysis indicates that the contribution of compositional and structural factors to the observed differences in exposure to food insecurity is heterogeneous across these groups and over the Great Recession. Finally, SNAP does not seem to fundamentally change the patterns documented.

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