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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 25 of 639 Research Studies Displayed
Wurcel AG, Essien UR, Ortiz C
Variation by race in antibiotics prescribed for hospitalized patients with skin and soft tissue infections.
This cohort study examined antibiotics prescribed and variations by race among hospitalized patients with skin and soft tissue infections (SSTIs). A subanalysis of multisite, cross-sectional data collected through a national survey of acute care hospital groups within Vizient, Inc. considering adult inpatients treated for SSTIs was used. Of the 1242 adult inpatients included from 91 US hospitals, 45% were female, 18% were Black, and 69% were White with a mean age of 58 years. Penicillin allergy with hives was found in 23%, 19% with rash, and 18% with unknown effects, with allergy found more frequent in Black patients (23%) versus White (18%). Adjusting for multiple factors, White inpatients were at an increased risk of cefazolin use and decreased risk of clindamycin use compared with Black inpatients. Cefazolin use with less likely to be prescribed to Black inpatients than White inpatients and they were likely to be prescribed clindamycin. Cefazolin is considered a first-line SSTI treatment with clindamycin not recommended given frequent dosing and high potential for adverse effects including Clostridioides difficile infection (CDI). Although penicillin allergy is described as more prevalent among White patients, the authors observed an increased prevalence among Black inpatients compared with White inpatients treated for SSTI.
Citation: Wurcel AG, Essien UR, Ortiz C . Variation by race in antibiotics prescribed for hospitalized patients with skin and soft tissue infections. JAMA Netw Open 2021 Dec;4(12):e2140798. doi: 10.1001/jamanetworkopen.2021.40798..
Keywords: Antibiotics, Skin Conditions, Racial / Ethnic Minorities, Practice Patterns, Medication
Temkin-Greener H, Mao Y, McGarry B
Health care use and outcomes in assisted living communities: race, ethnicity, and dual eligibility.
The purpose of this study was to examine the type and quality of care received in residential long-term care setting by racial/ ethnic minorities or residents eligible for dual Medicare and Medicaid. With 2018 Medicare data, the researchers identified 255,564 fee-for-service Medicare beneficiaries over the age of 55 who were living in 24,108 assisted living facilities across the United States and evaluated the relationship between race/ethnicity and dual status with emergency room use, inpatient hospital admission, 30-day readmission, and placement in a nursing home. The study found variations within and across assisted living facilities for racial/ethnic minority and dual residents, suggesting that outcome disparities are the most significant by dual eligibility status instead of only race/ ethnicity. The researchers concluded that these results can be used to inform and guide future research, as well as healthcare providers and policy makers.
Citation: Temkin-Greener H, Mao Y, McGarry B . Health care use and outcomes in assisted living communities: race, ethnicity, and dual eligibility. Med Care Res Rev 2022 Aug;79(4):500-10. doi: 10.1177/10775587211050189..
Keywords: Elderly, Racial / Ethnic Minorities, Long-Term Care, Medicare
Blanco 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.
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 / 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.
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 / 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.
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 / 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.
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 / 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 / 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.
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 / 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.
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 / Ethnic Minorities
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.
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 / 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.
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 / Ethnic Minorities, Medicare, Prevention, Access to Care, Disparities, Health Insurance
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.
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 / 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.
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 / 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.
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 / 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 / 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.
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 / 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.
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 / 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.
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, Hypertension, Racial / Ethnic Minorities, Transplantation, Patient Self-Management
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.
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 / Ethnic Minorities
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.
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 / 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.
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 / 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.
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 / Ethnic Minorities
Bastani R, Glenn BA, Singhal R
Increasing HPV vaccination among low-income, ethnic minority adolescents: effects of a multicomponent system intervention through a county health department hotline.
The human papillomavirus (HPV) vaccine has cancer prevention benefits, yet low uptake. The purpose of the study was to evaluate an intervention intended to improve vaccine uptake in low-income, ethnic minority adolescents using a telephone hotline to seek county health department services. The researchers recruited participants through randomization of health department hotline callers who were caregivers of never-vaccinated adolescents aged 11-17. The intervention included multi-lingual print and telephone education and personalized referral to a low cost or free provider of vaccines. Participants completed baseline, 3-month, and 9-month telephone surveys. The study found that by the end of the 9-month follow up period, the HPV vaccination rates had increased, however there were no differences between the intervention (45%) and control (42%) groups. The researchers also observed significant improvements in perceived HPV knowledge, perceived HPV risk, and barriers to vaccination. The study concluded that the county hotline intervention did not produce a greater increase in HPV vaccine rates in the intervention group than the group without the intervention. The study authors recommend that future studies should evaluate interventions which are more intensive and address accessing and using services in complex, safety net settings. The authors also noted that because 44% of unvaccinated adolescents in both the intervention and control groups received at least one dose of the vaccine during the study period, investigators of future studies should be aware of the potential priming effects of participation in the study, which may impact the results of interventions.
Citation: Bastani R, Glenn BA, Singhal R . Increasing HPV vaccination among low-income, ethnic minority adolescents: effects of a multicomponent system intervention through a county health department hotline. Cancer Epidemiol Biomarkers Prev 2022 Jan;31(1):175-82. doi: 10.1158/1055-9965.Epi-20-1578..
Keywords: Children/Adolescents, Vaccination, Low-Income, Racial / Ethnic Minorities, Sexual Health, Prevention
Akingbade O, Peek ME, Tung EL. O, Peek ME, Tung EL
Network size or proximity? Association of network characteristics with violence-related stress and PTSD among racial/ethnic minorities in Chicago.
This research brief examined the association of network size compared to network size and proximity and the psychosocial health and PTSD rates among high-risk racial/ethnic minorities in two Chicago neighborhoods. A sample of 504 adults were surveyed from one South and one West side Chicago clinic in 2018. Only participants who self-reported lifetime exposure in the Brief Trauma Questionnaire to community violence were included, decreasing the sample size to 297. The majority of participants were female (69%) and non-Hispanic Black (75%). Two-thirds were direct victims of robbery or assault, and one-third tested positive for PTSD. Median number of network confidants was found to be 2. A larger network size (> 3 confidants) within 30 minutes from home was significantly associated with 67% lower adjusted odds of PTSD compared to those with no confidants within 30 minutes from home.
Citation: Akingbade O, Peek ME, Tung EL. O, Peek ME, Tung EL . Network size or proximity? Association of network characteristics with violence-related stress and PTSD among racial/ethnic minorities in Chicago. J Gen Intern Med 2022 Jan;37(1):255-57. doi: 10.1007/s11606-021-06607-w..
Keywords: Behavioral Health, Racial / Ethnic Minorities, Stress, Domestic Violence
Su WK, Coleman CM, Bossick AS
Racial differences in planned hysterectomy procedure route.
The objective of this study was to assess any racial differences in the likelihood of having a planned minimally invasive surgical (MIS) hysterectomy. Using data from the Henry Ford Health System, findings showed that Black women were not less likely than White women to have planned an MIS hysterectomy.
Citation: Su WK, Coleman CM, Bossick AS . Racial differences in planned hysterectomy procedure route. J Womens Health 2022 Jan;31(1):31-37. doi: 10.1089/jwh.2021.0132..
Keywords: Women, Racial / Ethnic Minorities, Surgery