Factors Associated With Patient's Refusal of Recommended Cancer Surgery: Based on Surveillance, Epidemiology, and End Results

ObjectivesMost non-metastatic cancer patients can harvest a preferable survival after surgical treatment, however, patients sometimes refuse the recommended cancer-directed surgery. It is necessary to uncover the factors associated with patent's decision in taking cancer surgery and explore racial/ethnic disparities in surgery refusal.MethodsBased on the Surveillance, Epidemiology and End Results (SEER)-18 program, we extracted data of non-metastatic cancer patients who didn't undergo surgery. Ten common solid cancers were selected. Four racial/ethnic categories were included: White, black, Hispanic, and Asian/Pacific Islander (API). Primary outcome was patient's refusal of surgery. Multivariable logistic regression models were used, with reported odds ratio (OR) and 95% confidence interval (CI).ResultsAmong 318,318 patients, the incidence of surgery refusal was 3.5%. Advanced age, female patients, earlier cancer stage, uninsured/Medicaid and unmarried patients were significantly associated with higher odds of surgery refusal. Black and API patients were more likely to refuse recommended surgery than white patients in overall cancer (black-white: adjusted OR, 1.18; 95% CI, 1.11–1.26; API-white: adjusted OR, 1.56; 95% CI, 1.41–1.72); those racial/ethnic disparities narrowed down after additionally adjusting for insurance type and marital status. In subgroup analysis, API-white disparities in surgery refusal widely existed in prostate, lung/bronchus, liver, and stomach cancers.ConclusionsPatient's socioeconomic conditions reflected by insurance type and marital status may play a key role in racial/ethnic disparities in surgery refusal. Oncological surgeons should fully consider the barriers behind patient's refusal of recommended surgery, thus promoting patient-doctor shared decision-making and guiding patients to the most appropriate therapy.

Gender and Ethnic Disparities of Acute Kidney Injury in COVID-19 Infected Patients: A Literature Review

Coronavirus disease 2019(COVID-19) has become a public health emergency of concern worldwide. COVID-19 is a new infectious disease arising from Coronavirus 2 (SARS-CoV-2). It has a strong transmission capacity and can cause severe and even fatal respiratory diseases. It can also affect other organs such as the heart, kidneys and digestive tract. Clinical evidence indicates that kidney injury is a common complication of COVID-19, and acute kidney injury (AKI) may even occur in severely ill patients. Data from China and the United States showed that male sex, Black race, the elderly, chronic kidney disease, diabetes, hypertension, cardiovascular disease, and higher body mass index are associated with COVID-19‐induced AKI. In this review, we found gender and ethnic differences in the occurrence and development of AKI in patients with COVID-19 through literature search and analysis. By summarizing the mechanism of gender and ethnic differences in AKI among patients with COVID-19, we found that male and Black race have more progress to COVID-19-induced AKI than their counterparts.

Racial/ethnic disparities in exposure to COVID-19, susceptibility to COVID-19 and access to health care - findings from a U.S. national cohort

We examined the influence of racial/ethnic differences in socioeconomic position on COVID-19 seroconversion and hospitalization within a community-based prospective cohort enrolled in March 2020 and followed through October 2021 (N=6740). The ability to social distance as a measure of exposure to COVID-19, susceptibility to COVID-19 complications, and access to healthcare varied by race/ethnicity with non-white participants having more exposure risk and more difficulty with healthcare access than white participants. Participants with more (versus less) exposure had greater odds of seroconversion (aOR:1.64, 95% Confidence Interval [CI] 1.18-2.29). Participants with more susceptibility and more barriers to healthcare had greater odds of hospitalization (respective aOR:2.36; 1.90-2.96 and 2.31; 1.69-2.68). Race/ethnicity positively modified the association between susceptibility and hospitalization (aORnon-White:2.79, 2.06-3.78). Findings may explain the disproportionate burden of COVID-19 infections and complications among Hispanic and non-Hispanic Black persons. Primary and secondary prevention efforts should address disparities in exposure, COVID-19 vaccination, and treatment.

Cumulative Racial and Ethnic Disparities Along the School-to-Prison Pipeline

Using the cumulative disadvantage theoretical framework, the current study explores whether school suspension and expulsion provide an indirect path through which race and ethnicity affect the likelihood of experiencing arrest, any incarceration, and long-term incarceration in adulthood. To address these issues, we use data from Waves I, II, and IV of the Add Health survey (N = 14,484), and we employ generalized multilevel structural equation models and parametric regression methods using counterfactual definitions to estimate direct and indirect pathways. We observe that Black (but not Latinx) individuals are consistently more likely than White persons to experience exclusionary school discipline and criminal justice involvement. However, we find a path through which race and Latinx ethnicity indirectly affect the odds of adulthood arrest and incarceration through school discipline. Disparate exposure to school suspension and expulsion experienced by minority youth contributes to racial and ethnic inequalities in justice system involvement. By examining indirect paths to multiple criminal justice consequences along a continuum of punitiveness, this study shows how discipline amplifies cumulative disadvantage during adulthood for Black and, to a lesser extent, Latinx individuals who are disproportionately funneled through the “school-to-prison pipeline.”

Explanatory role of sociodemographic, clinical, behavioral, and social factors on cognitive decline in older adults with diabetes

Background The aim of the study was to examine the explanatory role of sociodemographic, clinical, behavioral, and social factors on racial/ethnic differences in cognitive decline among adults with diabetes. Methods Adults aged 50+ years with diabetes from the Health and Retirement Survey were assessed for cognitive function (normal, mild cognitive impairment [MCI], and dementia). Generalized estimating equation (GEE) logistic regression models were used to account for repeating measures over time. Models were adjusted for sociodemographic (gender, age, education, household income and assets), behavioral (smoking), clinical (ie. comorbidities, body mass index), and social (social support, loneliness, social participation, perceived constraints and perceived mastery on personal control) factors. Results Unadjusted models showed non-Hispanic Blacks (NHB) and Hispanics were significantly more likely to progress from normal cognition to dementia (NHB OR: 2.99, 95%CI 2.35–3.81; Hispanic OR: 3.55, 95%CI 2.77–4.56), and normal cognition to MCI (NHB OR = 2.45, 95%CI 2.14–2.82; Hispanic OR = 2.49, 95%CI 2.13–2.90) compared to non-Hispanic Whites (NHW). Unadjusted models for the transition from mild cognitive decline to dementia showed Hispanics were more likely than NHW to progress (OR = 1.43, 95%CI 1.11–1.84). After adjusting for sociodemographic, clinical/behavioral, and social measures, NHB were 3.75 times more likely (95%CI 2.52–5.56) than NHW to reach dementia from normal cognition. NHB were 2.87 times more likely (95%CI 2.37–3.48) than NHW to reach MCI from normal. Hispanics were 1.72 times more likely (95%CI 1.17–2.52) than NHW to reach dementia from MCI. Conclusion Clinical/behavioral and social factors did not explain racial/ethnic disparities. Racial/ethnic disparities are less evident from MCI to dementia, emphasizing preventative measures/interventions before cognitive impairment onset are important.

Racial/Ethnic Disparities of Depressive Symptoms in the United States A Systematic Review and Meta-Analysis of Individual Participant Data

Although a growing body of research has documented racial/ethnic disparities in depressive symptoms in the United States, the precise magnitude of these differences is not known. We conducted a systematic review and meta-analysis of individual participant data to (1) estimate the average difference of depressive symptoms between Whites and racial/ethnic minorities, as well as differences between (i.e., Asian American, African American, Latinxs, Multiracial, Native American, other race) and within (i.e., Latinx: Central American, Cuban American, Mexican American, Puerto Rican, other Latinx) minority groups, and (2) determine if moderators account for these differences. We screened 2,425 nationally-representative studies from the Inter-university Consortium for Political and Social Research (ICPSR), and identified 127 datasets of studies conducted from 1971 to 2018. We included 73 datasets from 26 nationally-representative studies (N = 2,116,853). The average absolute difference was d = 0.09, 95% CI [0.07, 0.12] between White and minority participants; was d = 0.07, 95% CI [0.06, 0.09] between minority participants; and d = 0.10, 95% CI [0.06, 0.15] within minority Latinx participants. Increases in socioeconomic status exacerbated these disparities. Psychometric analyses showed that measure reliability was related to larger differences. We discuss the implications of these findings.