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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
101 to 125 of 749 Research Studies DisplayedBlanco C, Kato EU, Aklin WM
AHRQ Author: Kato EU, Tong ST, Bierman A, Meyers D
Research to move policy - using evidence to advance health equity for substance use disorders.
This paper discusses ways that evidence-based research can advance health equity for substance use disorder (SUD) treatment. Racial and ethnic disparities in treatment access and outcomes have widened, despite substantial efforts to address the epidemic of overdose-related deaths in the US. Overdose rates are rising faster in Black, Latinx, and American Indian and Alaska Native populations than in White populations. Possible opportunities to address these disparities include addressing social determinants of health, implementing prevention measures, and supporting data science. The steps to ensure that research reduces disparities are to: 1) include members of underrepresented groups in the development of preventive interventions and treatments, 2) adequately recruit members of historically represented groups and ensure that studies are large enough to measure differences in outcomes according to race and ethnic group, 3) establish equitable partnerships with people who currently have or have had SUDS and their families and engage these groups in evidence production, 4) diversify the scientific workforce, and 4) have investigators measure the effects of policies and interventions on equity.
AHRQ-authored.
Citation: Blanco C, Kato EU, Aklin WM .
Research to move policy - using evidence to advance health equity for substance use disorders.
N Engl J Med 2022 Jun 16;386(24):2253-55. doi: 10.1056/NEJMp2202740..
Keywords: Substance Abuse, Behavioral Health, Policy, Racial and Ethnic Minorities, Disparities, Social Determinants of Health
Givan A, Downer B, Chou LN
Cognitive impairment and low physical function among older Mexican Americans: findings from a 20-year follow-up(☆).
This longitudinal study’s aim was to examine the association between cognitive impairment and low physical function over a 20-year follow-up period among Mexican Americans aged 65 and older. The final sample included 1545 community-dwelling Mexican Americans from the Hispanic Established Population for the Epidemiological Study of the Elderly, who scored moderate-high on Short Physical Performance Battery (SPPB) and were non-disabled at baseline (1993/94). The Mini Mental State Examination scale defines cognitive impairment as less than 21 points. General Estimating Equation was used to estimate the odds of having low physical function (defined with the SPPB at <7 points) over time as a function of cognitive impairment, adjusting for socio-demographics, self-reported medical conditions, body mass index, and depressive symptoms. Participants with cognitive impairment had increased odds of lower physical function over time compared to those without cognitive impairment.
AHRQ-funded; HS026133.
Citation: Givan A, Downer B, Chou LN .
Cognitive impairment and low physical function among older Mexican Americans: findings from a 20-year follow-up(☆).
Ann Epidemiol 2022 Jun;70:9-15. doi: 10.1016/j.annepidem.2022.03.006..
Keywords: Elderly, Racial and Ethnic Minorities, Neurological Disorders
Wall SP, Castillo P, Shuchat Shaw F
Including medical footage and emotional content in organ donation educational videos for Latinx viewers.
The purpose of this 2 x 3 randomized controlled trial was to evaluate whether different types of videos shown in Latinx-owned barbershops and beauty salons affected deceased organ donor registration. Videos included medical footage of organ preservation and transplantation, as well as sad, uplifting, or unresolved stories. Impact was measured as it related to the impact of medical footage and storylines on three variables: registry enrollment, donation willingness and stage of change, and emotions. The study found that 14.8% of participants registered for deceased organ donation. Medical footage, sad, and unresolved stories did not differentially affect registration or willingness to donate organs. Compared to the uplifting story, the sad and unresolved stories increased sadness and decreased positive affect. The educational videos which included or excluded medical footage of organ preservation and transplantation and varying emotional levels of stories did not differentially affect registration. The researchers concluded that future work is necessary to analyze qualitative data that was collected with a subset of participants in order to report the qualitative reasons for participants' registration decisions.
AHRQ-funded; HS016482.
Citation: Wall SP, Castillo P, Shuchat Shaw F .
Including medical footage and emotional content in organ donation educational videos for Latinx viewers.
Health Educ Behav 2022 Jun;49(3):424-36. doi: 10.1177/10901981211022240..
Keywords: Transplantation, Education: Patient and Caregiver, Racial and Ethnic Minorities
Roberson ML, Nichols HB, Olshan AF
Trends in surgical treatment of early-stage breast cancer reveal decreasing mastectomy use between 2003 and 2016 by age, race, and rurality.
The authors sought to examine trends in the surgical treatment of breast cancer by age, rurality, and among Black women in a populous, racially diverse, state in the Southeastern United States of America. Using data from the North Carolina Central Cancer Registry, they found declining mastectomy rates in the early 2000s in a Southern US state with a racially and geographically diverse population. These decreasing trends were consistent among key subgroups affected by cancer inequities, including Black and White rural women.
AHRQ-funded; HS027299.
Citation: Roberson ML, Nichols HB, Olshan AF .
Trends in surgical treatment of early-stage breast cancer reveal decreasing mastectomy use between 2003 and 2016 by age, race, and rurality.
Breast Cancer Res Treat 2022 Jun;193(2):445-54. doi: 10.1007/s10549-022-06564-w..
Keywords: Cancer: Breast Cancer, Cancer, Women, Surgery, Racial and Ethnic Minorities, Rural Health
Temkin-Greener H, Guo W, Hua Y
End-of-life care in assisted living communities: race and ethnicity, dual enrollment status, and state regulations.
The purpose of this study was to evaluate the relationships between death at home and home hospice care with race, ethnicity, community characteristics, strictness of state-level regulations for assisted living facilities, dual Medicare-Medicaid enrollment, and other individual characteristics. The researchers found that almost 60% of the 100,783 fee-for-service Medicare beneficiaries residing in 16,560 assisted living communities who died in 2018-2019, died at home. Of those individuals, 84% were with home hospice care. Dual Medicare-Medicaid enrollment was a more important predictor of death at home than race or ethnicity; yet race was a stronger predictor than dual enrollment for hospice care at death. In states with lower regulatory strictness for assisted living communities, residents were less likely to die at home. The study concludes that these results imply an important role for state regulation of assisted living facilities and can help guide efforts to ensure equitable access to the individual’s preference for end-of-life-care.
Citation: Temkin-Greener H, Guo W, Hua Y .
End-of-life care in assisted living communities: race and ethnicity, dual enrollment status, and state regulations.
Health Aff 2022 May;41(5):654-62. doi: 10.1377/hlthaff.2021.01677..
Keywords: Elderly, Palliative Care, Long-Term Care, Racial and Ethnic Minorities
Ferucci ED, Arnold RI, Holck P
Factors associated with telemedicine use for chronic disease specialty care in the Alaska Tribal Health System, 2015-2019.
The purpose of this study was to explore and describe factors associated with telemedicine use in the setting of usual care in the Alaskan Tribal Health System (ATHS) prior to the COVID-19 pandemic. The researchers collected electronic health records (EHR) data from 2015 through 2019 for 3,075 patients with chronic diseases requiring specialty care from 4 regions in the ATHS to identify ever users (799) and never users (2,276) of telemedicine. The study found that the factors of male gender, age, geographic region, rate of outpatient visits per year, and having had at least one cardiology clinic visit were all associated with telemedicine use.
AHRQ-funded; HS026208.
Citation: Ferucci ED, Arnold RI, Holck P .
Factors associated with telemedicine use for chronic disease specialty care in the Alaska Tribal Health System, 2015-2019.
Telemed J E Health 2022 May;28(5):682-89. doi: 10.1089/tmj.2021.0131..
Keywords: Telehealth, Chronic Conditions, Racial and Ethnic Minorities, Health Information Technology (HIT)
Kurasz AM, Smith GE, Curiel RE
Patient values in healthcare decision making among diverse older adults.
This study investigated the types of values that culturally diverse older adults incorporate in medical decision making. Focus groups were held with 49 individuals, 49% with mild cognitive impairment, and 51% Hispanic. Participants described barriers and facilitators that interfere with or promote value solicitation and incorporation. A wide range of values relating to individual factors, familial/cultural beliefs and expectations, balancing risks and benefits, receiving decisional support, and considering values other than their own were expressed. Participants also emphasized that values are individual-specific, influenced by aging, and change throughout life.
AHRQ-funded; HS024159.
Citation: Kurasz AM, Smith GE, Curiel RE .
Patient values in healthcare decision making among diverse older adults.
Patient Educ Couns 2022 May;105(5):1115-22. doi: 10.1016/j.pec.2021.08.031..
Keywords: Elderly, Decision Making, Racial and Ethnic Minorities
Hunte R, Klawetter S, Paul S
"Black nurses in the home is working": advocacy, naming, and processing racism to improve Black maternal and infant health.
The purpose of this qualitative study was to examine how Black women’s health, pregnancy and parenting are impacted by racism, and how the relationship between Black women’s health, pregnancy and parenting and racism-related stress are affected by a culturally-specific perinatal care program. The researchers conducted focus groups and utilized a Black Feminist approach to center the perspectives and lived experiences of Black women. Four themes surfaced in the analysis, including: 1) The widespread reach of structural racism, 2) Trust and healing facilitated through shared identities, 3) Racism directly impacts mental health, and 4) Advocacy at all levels is a vital service. The researchers concluded that structural racism has chronic and toxic effects on Black women’s physical and mental health, and Black perinatal care should include: culturally-specific approaches, advocacy, mental health support with specific attention to racism-related stress, and examination of implicit biases.
AHRQ-funded; HS026370.
Citation: Hunte R, Klawetter S, Paul S .
"Black nurses in the home is working": advocacy, naming, and processing racism to improve Black maternal and infant health.
Matern Child Health J 2022 Apr;26(4):933-40. doi: 10.1007/s10995-021-03283-4..
Keywords: Racial and Ethnic Minorities, Women, Maternal Care, Pregnancy, Newborns/Infants, Cultural Competence
Brennan MB, Powell WR, Kaiksow F
Association of race, ethnicity, and rurality with major leg amputation or death among Medicare beneficiaries hospitalized with diabetic foot ulcers.
The authors report that diabetic foot ulcer patients self-identifying as Black and also those living in disadvantaged and rural neighborhoods are at an increased risk of above-ankle amputations. The purpose of the study was to evaluate Medicare beneficiaries hospitalized with diabetic foot ulcers to assess whether intersecting identities of Black race, ethnicity, and living in a disadvantaged neighborhood or rural residence were associated with a higher risk of major leg amputation or death. The retrospective study looked at 2013-2014 data from the US National Medicare Claims Data Database of patients hospitalized with a diabetic foot ulcer. The study focused on major leg amputation or death during hospitalization or within 30 days of discharge from the hospital. The study cohort included 124,487 patients with a mean age of 71.5 years. Of those, 71,286 were men (57.3%), 21,649 (17.4%) identified as Black, and 13,100 (10.5%) were rural. Major leg amputations or death were experienced by 17.6% of the cohort, 18.3% of rural patients, and 21.9% patients who identified as Black. The proportion of those experiencing major leg amputations or death among the 1239 rural patients identifying as Black was 28%, which exceeded by more than 2-fold the expected excess for rural patients plus those identifying as Black, reflecting a significant interaction between race and rural residence. The study concluded that rural patients identifying as Black had a more than 10% increased risk of major leg amputation or death when compared with the full cohort, and that when investigating disparities in major leg amputations and death in patients with diabetic foot ulcers, a perspective of intersectionality should be considered.
AHRQ-funded; HS026279.
Citation: Brennan MB, Powell WR, Kaiksow F .
Association of race, ethnicity, and rurality with major leg amputation or death among Medicare beneficiaries hospitalized with diabetic foot ulcers.
JAMA Netw Open 2022 Apr;5(4):e228399. doi: 10.1001/jamanetworkopen.2022.8399..
Keywords: Diabetes, Chronic Conditions, Racial and Ethnic Minorities
Jacobs PD, Abdus S
AHRQ Author: Jacobs PD, Abdus S
Changes in preventive service use by race and ethnicity after Medicare eligibility in the United States.
Researchers examined whether widespread eligibility for Medicare at age 65 narrows disparate preventive service use by race and ethnicity. Using MEPS data and examining six preventive services, they found that, for non-Hispanic Black adults, preventive service use increased after age 65. Further, for all four preventive health measures that were lower for Hispanic adults compared with non-Hispanic White adults prior to age 65, service use was indistinguishable between these groups after reaching the Medicare eligibility age. They concluded that Medicare eligibility appeared to reduce most racial and ethnic disparities in preventive service use.
AHRQ-authored.
Citation: Jacobs PD, Abdus S .
Changes in preventive service use by race and ethnicity after Medicare eligibility in the United States.
Prev Med 2022 Apr;157:106996. doi: 10.1016/j.ypmed.2022.106996..
Keywords: Medical Expenditure Panel Survey (MEPS), Racial and Ethnic Minorities, Medicare, Prevention, Access to Care, Disparities, Health Insurance
Valbuena VSM, Barbaro RP, Claar D
Racial bias in pulse oximetry measurement among patients about to undergo extracorporeal membrane oxygenation in 2019-2020: a retrospective cohort study.
This study examined whether pulse oximeters detect arterial hypoxemia less effectively in Black, Hispanic, and/or Asian patients than in White patients in respiratory failure who are about to undergo extracorporeal membrane oxygenation (ECMO). Data on adult patients with respiratory failure readings 6 hours before ECMO from 324 centers from January 2019 to July 2020 who were in the Extracorporeal Life Support Organization registry was used. The author’s primary analysis was of rates of occult hypoxemia-low arterial oxygen saturation (Sao(2) ≤ 88%) on arterial blood gas measurement despite a pulse oximetry reading in the range of 92% to 96%. The rate of pre-ECMO occult hypoxemia was 10.2% for 186 White patients with peripheral oxygen saturation; 21.5% for 51 Black patients; 8.6% for 70 Hispanic patients; and 9.2% for 75 Asian patients. The risk of occult hypoxemia was comparable for Hispanic and Asian patients to White patients, but the prevalence of occult hypoxemia was higher in Black patients than for White patients about to undergo ECMO for respiratory failure.
AHRQ-funded; HS028038.
Citation: Valbuena VSM, Barbaro RP, Claar D .
Racial bias in pulse oximetry measurement among patients about to undergo extracorporeal membrane oxygenation in 2019-2020: a retrospective cohort study.
Chest 2022 Apr;161(4):971-78. doi: 10.1016/j.chest.2021.09.025..
Keywords: Racial and Ethnic Minorities, Medical Devices, Respiratory Conditions
Crockett KB, Borgatti A, Tan F
Weight discrimination experienced prior to enrolling in a behavioral obesity intervention is associated with treatment response among Black and White adults in the Southeastern U.S.
This study examined the role that weight discrimination and race is associated with pre-treatment depressive symptoms. A cohort of Black and White adults were enrolled in a 16-week obesity intervention treatment (N = 271; mean BMI = 35.7 kg/m2); 59% Black; 92% women). They reported prior experiences of weight discrimination and completed the Center for Epidemiological Studies Depression (CES-D) Scale at baseline. Their weekly attendance at group sessions was recorded, and weight was measured at baseline and post-treatment. Participants with a history of weight discrimination scored 2.4 points higher on the CES-D and lost 2% less weight relative to those without weight discrimination. Race modified the association between weight discrimination and treatment session attendance, such that Black participants attended fewer sessions if they had prior experience of weight discrimination. However, this association was not true among White individuals.
AHRQ-funded; HS013852.
Citation: Crockett KB, Borgatti A, Tan F .
Weight discrimination experienced prior to enrolling in a behavioral obesity intervention is associated with treatment response among Black and White adults in the Southeastern U.S.
Int J Behav Med 2022 Apr;29(2):152-59. doi: 10.1007/s12529-021-10009-x..
Keywords: Obesity, Obesity: Weight Management, Behavioral Health, Racial and Ethnic Minorities, Depression
Kostick-Quenet KM, Cohen IG, Gerke S
Mitigating racial bias in machine learning.
This article discusses the challenges in applying existing guidelines for mitigating algorithmic bias in a machine learning (ML) and/or artificial intelligence (AI) tool for real-world clinical decisions making by physicians and patients. The authors then discuss the existing legal regulation of ML/AI racial bias and future directions. Their team developed a decision support framework for patients with severe heart failure that includes a prognostic ML algorithm to calculate personalized estimates for patients about their likely outcomes after receiving a left ventricular-assist device (LVAD). Their goal is to identify the potential for racial bias in the tool’s algorithm identified practical challenges regarding algorithmic bias that other developers may face. The algorithms’ training data base was examined to review data quality. The authors also examined other comorbidities and their role in predicting LVAD outcomes. Existing and proposed initiatives to address algorithmic bias through regulation is also discussed in detail. The authors, who are mostly bioethics experts recommend that developers seeking to mitigate bias in ML use their algorithms as leverage to call upon stakeholders who are responsible for generating relevant datasets to make a concerted effort to document race and associated variables to enable systematic inquiries into sources of potential racial bias.
AHRQ-funded; HS027784.
Citation: Kostick-Quenet KM, Cohen IG, Gerke S .
Mitigating racial bias in machine learning.
J Law Med Ethics 2022;50(1):92-100. doi: 10.1017/jme.2022.13..
Keywords: Racial and Ethnic Minorities, Health Information Technology (HIT)
Jindal M, Mistry KB, McRae A
AHRQ Author: Mistry KB,
"It makes me a better person and doctor": a qualitative study of residents' perceptions of a curriculum addressing racism.
The purpose of this study was to explore how pediatric residents perceive the impact of a curriculum addressing racism on their knowledge, motivation, skills and behaviors and investigate the contextual factors that promote or impede the curriculum's effectiveness. Semi structured interviews were conducted at two academic medical centers among pediatric residents. Findings showed that medical education addressing racism can facilitate the perceived acquisition of foundational knowledge regarding race and racism, motivation and skill-building to combat racism, and action planning aimed at improving patient care.
AHRQ-authored.
Citation: Jindal M, Mistry KB, McRae A .
"It makes me a better person and doctor": a qualitative study of residents' perceptions of a curriculum addressing racism.
Acad Pediatr 2022 Mar;22(2):332-41. doi: 10.1016/j.acap.2021.12.012..
Keywords: Education: Curriculum, Education: Continuing Medical Education, Racial and Ethnic Minorities, Provider: Physician
Riviello ED, Dechen T, O'Donoghue AL
Assessment of a crisis standards of care scoring system for resource prioritization and estimated excess mortality by race, ethnicity, and socially vulnerable area during a regional surge in COVID-19.
Researchers analyzed the association of a crisis standards of care (CSOC) scoring system with resource prioritization and estimated excess mortality by race, ethnicity, and residence in a socially vulnerable area during the COVID-19 pandemic. Using data from 6 hospitals in greater Boston, Massachusetts, they found that a CSOC priority score resulted in lower prioritization of Black patients to receive scarce resources. Also, a model using a random lottery resulted in more estimated excess deaths overall without improving equity by race.
AHRQ-funded; HS024288.
Citation: Riviello ED, Dechen T, O'Donoghue AL .
Assessment of a crisis standards of care scoring system for resource prioritization and estimated excess mortality by race, ethnicity, and socially vulnerable area during a regional surge in COVID-19.
JAMA Netw Open 2022 Mar;5(3):e221744. doi: 10.1001/jamanetworkopen.2022.1744..
Keywords: COVID-19, Racial and Ethnic Minorities, Mortality, Public Health, Vulnerable Populations
Kleinman LC, Howell EA
Equity and the hazard of veiled injustice: a methodological reflection on risk adjustment.
The researchers report that in the context of quality improvement research, risk adjustment (RA) methods can obscure disparities in health care. In this study the researchers address the impact of considering equity when conducting risk adjustments in pediatric health, and describe the danger of veiled justice, a type of overadjustment that takes place when risk adjustments obscure real disparities because more than one covariate, such as race and socioeconomic status, are on related causal paths. Underadjustment can occur when these same structural characteristics are not addressed when calculating models of payment. The purpose of this study was to describe the literature and present a conceptual framework that identifies these two problems for validity related to the interactions between risk adjustment and health equity in pediatric health care. The researchers conclude that the science of quality improvement must address issues of health equity as an essential construct, with the development of a specific conceptual model. Statistical analysis should be interpreted using the conceptual model, and the dynamics of child development and life course should also be addressed, as well as additional contextual and process factors such as the role of caregivers and public insurance, the epidemiology of the disease, family financial status, and others. The goal of RA is to make valid conclusions such that observed differences can be attributed to the relevant causes. When higher risk is attributed to social determinants and not disease differences, RA can obscure disparities (veiled injustice) and differences at the population level and experienced by individuals are falsely hidden. Not addressing these same structural characteristics when calculating models of payment can lead to patterns of underadjustment. The authors advise that these 2 sides of a similar coin reveal the critical importance of both the underlying model and the capacity to reliably evaluate disparities and quality.
AHRQ-funded; HS020518; 233201550088A.
Citation: Kleinman LC, Howell EA .
Equity and the hazard of veiled injustice: a methodological reflection on risk adjustment.
Pediatrics 2022 Mar;149(Suppl 3). doi: 10.1542/peds.2020-045948G.
Keywords: Children/Adolescents, Disparities, Racial and Ethnic Minorities, Risk
Fernandez JR, Richmond J, Nápoles AM
Everyday discrimination and cancer metaphor preferences: the mediating effects of needs for personal significance and cognitive closure.
This study examined the relationship between discrimination and preferences for cancer battle metaphors versus journey metaphors. Four-hundred twenty-seven cancer patients completed an online survey. Question items included on every day discrimination, need for personal significance, need for cognitive closure, and preference for cancer scenarios using battle or journey metaphors. Discrimination was associated with battle metaphor preferences through serial mediation when discrimination was not associated to race. When discrimination was associated with race, it was directly associated with journey metaphor preferences and the serial medication was nonsignificant. The single mediation model was strongest for non-Hispanic White participants and varied across racial/ethnic groups.
AHRQ-funded; HS026122.
Citation: Fernandez JR, Richmond J, Nápoles AM .
Everyday discrimination and cancer metaphor preferences: the mediating effects of needs for personal significance and cognitive closure.
SSM Popul Health 2022 Mar;17:100991. doi: 10.1016/j.ssmph.2021.100991..
Keywords: Cancer, Racial and Ethnic Minorities
Van Gerwen OT, Talluri R, Camino AF
Human immunodeficiency virus/sexually transmitted infection testing preferences for young Black men who have sex with men in the Southeastern United States: implications for a post-COVID-19 era.
Study researchers used a discrete choice experiment to assess the preferences of Young Black Men Who Have Sex with Men (YBMSM) in the Southeastern U.S. regarding their preferences for human immunodeficiency virus (HIV)/ sexually transmitted infection (STI) testing locations, staffing, cost, and hours of operation. Between June 2018 and December 2019, 213 YBMSM between the ages of 16-35 years, located in Birmingham, Alabama and Jackson, Mississippi completed online surveys evaluating their preferences. Traditional, stationary testing locations were preferred by both groups over mobile testing vans. The most significant difference in preference was for local health departments in Alabama, and STI testing-only clinics in Mississippi. Both groups preferred clinician-performed testing over technician-performed testing or self-testing, with additional preferences for free testing and phone results notification (versus text). The most preferred combination among all participants was the $5 clinician-performed testing at the health department. The study concluded that YBMSM in the Southeastern United States prefer traditional testing locations staffed by experienced personnel. The study researchers advise that more research is needed to inform the best ways to approach HIV/STI testing services for YBMSM, especially in the post-COVID-19 era when delivery models are shifting toward health-focused strategies which are home-based and remote.
AHRQ-funded; HS013852.
Citation: Van Gerwen OT, Talluri R, Camino AF .
Human immunodeficiency virus/sexually transmitted infection testing preferences for young Black men who have sex with men in the Southeastern United States: implications for a post-COVID-19 era.
Sex Transm Dis 2022 Mar;49(3):208-15. doi: 10.1097/olq.0000000000001559..
Keywords: COVID-19, Human Immunodeficiency Virus (HIV), Infectious Diseases, Racial and Ethnic Minorities, Men's Health
Gianaris K, Vargas GB, Johnson M
Perceived susceptibility to chronic kidney disease and hypertension self-management among Black and White live kidney donors.
This study examines the theory whether Black kidney donors are more likely than White donors to develop hypertension (HTN) and chronic kidney disease after donation. The authors ascertained electronic medical records and phone survey data from live donors enrolled in the multi-center Wellness and Health Outcomes of LivE Donors (WHOLE-Donor) Hypertension Care Study between May 2013 and April 2020. The study cohort included 318 US-based live kidney donors who developed post-donation HTN with 57.6% female, 78.9% White, 18.6% Black, and a mean age of 46.7 years. Donors with diabetes or who were older than 50 years reported being moderately or strongly concerned about kidney disease. A large majority (87%) reported taking at least one action to help control blood pressure, with no significant differences by sociodemographic factors. They found no substantial differences in perceived susceptibility to kidney disease among Black and White donors, despite published evidence that Black donors may experience greater risk of developing kidney disease than White donors.
AHRQ-funded; HS024600.
Citation: Gianaris K, Vargas GB, Johnson M .
Perceived susceptibility to chronic kidney disease and hypertension self-management among Black and White live kidney donors.
Ethn Dis 2022 Spring;32(2):101-08. doi: 10.18865/ed.32.2.101..
Keywords: Kidney Disease and Health, Chronic Conditions, Racial and Ethnic Minorities, Transplantation, Patient Self-Management, Blood Pressure
Fraiman YS, Stewart JE, Litt JS
Race, language, and neighborhood predict high-risk preterm infant follow up program participation.
This study investigated whether infants born to Black mothers, non-English speaking mothers, and mothers who live in “Very Low” Child Opportunity Index (COI) neighborhoods would have decreased odds of using the Infant Follow Up Program (IFUP) for their preterm infants after discharge from a NICU. A total of 477 infants eligible for IFUP between 2015 and June 2017 from a single large academic Level III NICU were included. Primary outcome considered was at least one visit to IFUP. Two hundred infants (41.9%) participated in IFUP, with the odds of participation lower for Black compared to white race, “Very Low” COI compared to “Very High”, and primary non-English speaking.
AHRQ-funded; HS000063.
Citation: Fraiman YS, Stewart JE, Litt JS .
Race, language, and neighborhood predict high-risk preterm infant follow up program participation.
J Perinatol 2022 Feb;42(2):217-22. doi: 10.1038/s41372-021-01188-2..
Keywords: Newborns/Infants, Hospital Discharge, Transitions of Care, Racial and Ethnic Minorities
Johnson TJ, Goyal MK, Lorch SA
Racial/ethnic differences in pediatric emergency department wait times.
The authors sought to determine whether racial/ethnic differences exist in wait times for children presenting to pediatric emergency departments (PEDs) and to examine between-site and within-site differences. They found that median wait time was 35 minutes. Further, in unadjusted analyses, non-White children experienced longer PED wait times than non-Hispanic White (NHW) children. After adjusting for illness severity, patient demographics, and overcrowding measures, wait times for non-Hispanic Black and other race children were largely determined by site of care. Hispanic children experienced longer within-site and between-site wait times compared with NHW children.
AHRQ-funded; HS020270.
Citation: Johnson TJ, Goyal MK, Lorch SA .
Racial/ethnic differences in pediatric emergency department wait times.
Pediatr Emerg Care 2022 Feb;38(2):e929-e35. doi: 10.1097/pec.0000000000002483..
Keywords: Children/Adolescents, Emergency Department, Racial and Ethnic Minorities
Dos Santos Marques IC, Herbey II, Theiss LM
Understanding the surgical experience for Black and White patients with inflammatory bowel disease (IBD): the importance of health literacy.
The purpose of this qualitative study was to describe the surgical experience for Black and White inflammatory bowel disease patients. Same race, semi-structured qualitative interviews with patients with IBD who had undergone surgery were conducted to explore barriers and facilitators to a positive or negative surgical experience. The study reported that 6 focus groups were conducted with 10 Black and 17 White IBD participants with a mean age of 44.8 years, 52% of whom were male and 65% of whom had Crohn’s disease. Four themes were identified that most characterized the surgical experience: the impact of the IBD diagnosis, the quality of the information that was provided, disease management, and the surgery. Within these theme groupings, identified barriers to a positive surgical experience included inadequate personal knowledge of IBD, ineffective written and verbal communication, lack of a support system and complications after surgery. Both groups indicated that information was provided inconsistently which led to unclear expectations of surgical outcomes. The study concluded that surgical experiences vary between Black and White patients, but both groups emphasized the need for understandable, accurate, and trustworthy health information.
AHRQ-funded; HS023009; HS013852.
Citation: Dos Santos Marques IC, Herbey II, Theiss LM .
Understanding the surgical experience for Black and White patients with inflammatory bowel disease (IBD): the importance of health literacy.
Am J Surg 2022 Feb;223(2):303-11. doi: 10.1016/j.amjsurg.2021.06.003..
Keywords: Health Literacy, Surgery, Racial and Ethnic Minorities, Racial and Ethnic Minorities, Digestive Disease and Health, Patient Experience
Mallela DP, Canner JK, Zarkowsky DS
Association between race and perioperative outcomes after carotid endarterectomy for asymptomatic carotid artery stenosis in NSQIP.
This study investigated the association of race on carotid endarterectomy (CEA) outcomes. Perioperative outcomes (at 30 days) were compared for Black vs. White patients adjusting for age/sex, comorbidities and disease characteristics. Out of 16,764 patients from the ACS-NSQIP targeted vascular database (2011-2019), 95.2% were White and 4.8% were Black. Black patients were slightly younger and more frequently (79.5% vs 74.0%) had high-grade carotid artery stenosis compared to White patients. Comorbidities including hypertension, diabetes, kidney disease, congestive heart failure, and coronary artery disease were all more prevalent among Black patients. Crude perioperative stroke and stroke/death were higher for Black patients, but myocardial infarction leading to death were similar. After adjusting for baseline differences between groups, the risk of perioperative stroke and stroke/death remained significantly higher for Black patients than White patients.
AHRQ-funded; HS024547.
Citation: Mallela DP, Canner JK, Zarkowsky DS .
Association between race and perioperative outcomes after carotid endarterectomy for asymptomatic carotid artery stenosis in NSQIP.
J Am Coll Surg 2022 Jan;234(1):65-73. doi: 10.1097/xcs.0000000000000016..
Keywords: Racial and Ethnic Minorities, Surgery, Cardiovascular Conditions, Stroke, Risk, Adverse Events
Steinberg RS, Nayak A, Burke MA
Association of race and gender with primary caregiver relationships and eligibility for advanced heart failure therapies.
Caregiver support is considered necessary after heart transplant (HT) and left ventricular assist device (LVAD) for patients with end-stage heart failure (HF). Few studies have demonstrated how caregivers differ by gender and race, and whether that impacts therapy eligibility. In this study, the investigators examined caregiver relationships among 674 patients (32% women, 55% Black) evaluated at Emory University from 2011 to 2017.
AHRQ-funded; HS026081.
Citation: Steinberg RS, Nayak A, Burke MA .
Association of race and gender with primary caregiver relationships and eligibility for advanced heart failure therapies.
Clin Transplant 2022 Jan;36(1):e14502. doi: 10.1111/ctr.14502..
Keywords: Caregiving, Racial and Ethnic Minorities, Heart Disease and Health, Cardiovascular Conditions
Carroll AR, Hall M, Brown CM
Association of race/ethnicity and social determinants with rehospitalization for mental health conditions at acute care children's hospitals.
This retrospective cohort study evaluated the associations of race/ethnicity and social determinants with 90-day rehospitalization of children with mental health conditions to acute non-psychiatric children’s hospitals. Children included were aged 5 to 18 years at 32 freestanding U.S. children’s hospitals from 2016-2018 using the Children’s Hospital Association’s Pediatric Health Information System (PHIS) database to assess the association of race/ethnicity and social determinants (insurance payer, neighborhood median household income, and rurality of patient home location) with 90-day rehospitalization. Among 23,556 index hospitalizations, 5.9% (n = 1382) were rehospitalized for mental health within 90 days. Non-Hispanic Black children were 26% more likely to be rehospitalized than non-Hispanic White children. Those with government insurance were 18% more likely to rehospitalized than those with private insurance. Those living in a suburban location were 22% less likely to be rehospitalized than those living in an urban location.
AHRQ-funded; HS026122.
Citation: Carroll AR, Hall M, Brown CM .
Association of race/ethnicity and social determinants with rehospitalization for mental health conditions at acute care children's hospitals.
J Pediatr 2022 Jan;240:228-34.e1. doi: 10.1016/j.jpeds.2021.08.078..
Keywords: Children/Adolescents, Hospital Readmissions, Behavioral Health, Social Determinants of Health, Racial and Ethnic Minorities