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Financial toxicity refers to the financial strain caused by the costs of medical care, indirect cost, and lost wages. In stroke survivors, financial toxicity is particularly severe due to the high costs of acute care, rehabilitation, and long-term disability resulting from stroke, often leading to delayed care and worse health outcomes. Evaluating variations in the financial toxicity of stroke among racial and ethnic groups is crucial because disparities in healthcare access, socioeconomic status, and insurance coverage can exacerbate the financial burden for certain populations. Understanding these differences can inform policies to reduce inequities for underserved groups. Individual-level income and wealth values were calculated from self-reported financial data in the Medical Expenditure Panel Survey collected between 2018 and 2021. The analysis employed fixed effects regression to control for unobserved individual heterogeneity, thereby isolating the impact of stroke on income and wealth from other time-invariant personal characteristics with greater accuracy than other analytic methods. Interaction terms were included to assess the differential impacts of stroke on racial and ethnic groups. Due to changing financial dynamics, individuals over age 65 were assessed differentials financial dynamics Heckman regression models tested the robustness of findings to skewness in the distribution of income and wealth. About 2.73% (N = 414) of respondents under age 65 and 10.8% (N = 667) of respondents aged 65 and above reported having had a stroke. After controlling for demographic, health, and household characteristics, stroke was associated with 13% to 15% reduction in income among those less than age 65 and a 16% to 18% reduction is wealth among those age 65 and above. Stroke had a disparate impact on the income of young Black (-10.04%) and Hispanic (-19.19%) respondents and the wealth of older Black (-6.05%) and Hispanic (-3.01%) respondents. These findings were consistent across different model specifications, highlighting the robustness of the results. This study offers robust estimates of the financial impact of stroke indicating significantly difference financial burdens among Black and Hispanic respondents. These findings indicate the need to address the income and wealth impacts of stroke to mitigate financial toxicity in vulnerable populations.
Ethnic enclaves, as an area-level social determinant of health, have significant implications for understanding ethnic health disparities. While a growing body of literature examines the impacts of residing in ethnic enclaves on the health of co-ethnics, studies often map enclaves solely from population concentrations within individual census tract. This approach overlooks the spatial clustering of populations in adjacent census tracts and the presence of cultural resources like ethnic-specific businesses and organizations. We develop and assess a hybrid clustering enclave model (HCEM) that maps spatial clustering patterns of both ethnic populations and cultural resources. We apply this approach to identify Chinese, Japanese, and Korean enclaves in Los Angeles County and compare the resulting ethnic enclaves to those mapped only from thresholds of ethnic population concentrations in individual census tracts. Depending on the types of health disparities assessed and the specific ethnicity of the enclave being mapped, different approaches to mapping Asian ethnic enclaves yield areas with larger or smaller health disparities than tracts mapped from population thresholds. Our results highlight the importance of aligning ethnic enclave measures with its conceptualization and potential health mechanisms when examining enclaves' health impacts. We offer an approach to make and assess maps which may help researchers to capture the multidimensional features of enclaves and to distinguish diverse types of enclaves for answering a range of specific questions about the role of place in ethnic health disparities.
Previous research has shown narrowing racial disparities in self-reported health. However, these disparities may have worsened in recent years, particularly during and after the COVID-19 pandemic. Less is known regarding the current state of disparities in self-reported health. Participants are from the 2023 and 2024 U.S. National Health Interview Survey. Using survey-weighted, age- and sex-adjusted modified Poisson regression models, we examined associations of race, ethnicity, and socioeconomic status with fair or poor self-reported health, both overall and stratified by levels of education, income, and health insurance status. Among 251,930,438 adults aged ≥ 18 years (unweighted N = 60,449), 14.9% (95% CI: 14.5, 15.3) reported fair or poor health. Compared to those with a bachelor's degree or higher, those who had not completed high school had a higher prevalence of fair or poor health (prevalence ratio [PR] = 3.79, 95% CI: 3.52, 4.08). Additionally, compared to people with household income ≥ 4 times the federal poverty line, those with household incomes below the federal poverty line had a higher prevalence of fair or poor health (PR = 3.94, 95% CI: 3.70, 4.19). Non-Hispanic Black (PR = 1.56, 95% CI: 1.46, 1.67) and Hispanic (PR = 1.49, 95% CI: 1.39, 1.59) adults were more likely than non-Hispanic White adults to report fair or poor health. In this U.S. nationally representative study, fair or poor self-reported health was more prevalent among adults with lower socioeconomic status and among non-Hispanic Black and Hispanic adults. These findings underscore the need for policy interventions that simultaneously address socioeconomic inequality and structural racism to improve population health outcomes.
Racial and ethnic disparities disproportionately impact children with medical complexity (CMC), including children with tracheostomies. Children hospitalized for bacterial tracheostomy-associated infections (bTRAINs) experience care variations that may exacerbate disparities. Our study aimed to quantify disparities in length of stay (LOS) for children hospitalized with bTRAINs. We conducted a multicenter observational study of children aged 0 to 21 years who were hospitalized and treated for a bTRAIN at 6 children's hospitals between August 2020 and August 2024, excluding children with outlier LOS (>30 days). Our primary predictor was race and ethnicity, as documented in the electronic medical record. Our primary outcome was LOS (days). We used mixed-effects regression modeling to account for repeated encounters, nesting of patients within hospitals, and adjusting for confounders (socioeconomic factors, comorbidities and illness severity). We included 662 children (39% white, 35% Hispanic, 22% Black, and 4% Asian) representing 1349 unique encounters. The median age at hospitalization was 6 years (IQR 2-13) and 72% of children had public insurance. Median LOS was 8 days (IQR 5-12). When adjusting for confounders, all other racial groups had longer LOS compared with white children with ratio of means of 1.14 (95% CI: 1.03-1.28) for Black; 1.12 (95% CI: 1.01-1.25) for Hispanic; and 1.29 (95% CI: 1.07-1.54) for Asian children. Black, Hispanic, and Asian children hospitalized for a bTRAIN experience longer LOS than white children. Understanding is needed on how implicit bias, systemic racism, and care-team preferences lead to disparities and if standardized care can improve outcomes.
Little is known about the prevalence of structural racism in Canada or the extent to which it contributes to racial/ethnic inequality in population health and wellbeing. This scoping review examines which racial/ethnic groups are represented in Canadian population research, how structural racism is quantitatively measured and operationalized in the Canadian context, and which health indicators are associated with exposure to structural racism. Key gaps and opportunities to advance the study of racial/ethnic health inequality in Canada are identified. We searched Web of Science, SocIndex, Medline, and Canada Business & Canadian Affairs databases to identify original, peer-reviewed research that analyzed Canadian samples, included at least one quantitative structural racism measure, and estimated at least one health-, wellbeing- or healthcare-related outcome. After removing duplicates, remaining articles were screened and assessed using predefined eligibility criteria. Twenty-eight studies met the inclusion criteria. The majority of studies focused on the health impacts of structural racism among Indigenous populations, with comparatively few examining visible minority racial/ethnic groups. The majority of studies relied on self-reported measures of perceived discrimination across social institutions, including healthcare and housing, or self-reported cultural and historical loss. Across studies, exposure to structural racism was consistently associated with adverse physical and mental health outcomes. Advancing this field will require: (1) improved collection and dissemination of racial/ethnic demographic data; (2) increased data disaggregation for visible minority populations, (3) the development of theoretically grounded, Canada-specific measures of structural racism and (4) greater attention to the behavioral- and healthcare-related mechanisms linking structural racism to health.
In the United States, Black women are three to four times more likely to die from pregnancy-related complications than White women and experience disproportionately higher rates of maternal mental health issues across pregnancy, childbirth, and the postpartum period. Structural racism, healthcare bias, and inequitable access to culturally responsive care position Black women among the most underserved and undertreated populations in the nation and contribute to intergenerational impacts on Black families and communities. This study aimed to understand how Black communities conceptualize perinatal mental health and wellbeing and identify barriers and facilitators to care, with the goal of informing culturally responsive, community-centered, and family-focused interventions that promote safety, confidence, and agency. Semi-structured virtual interviews were conducted with Black pregnant and postpartum mothers, fathers, and community members (N = 17) using a qualitative, descriptive approach while noting recurring themes. Participants were English-speaking, residents of the United States, aged 18 years or older, and recruited through purposive sampling via community networks and social media. We analyzed data using reflexive thematic analysis to examine multilevel influences on perinatal mental health. The Social-Ecological Model (SEM) was used as a guiding framework to understand how individual, interpersonal, community, and structural factors shape perinatal mental health and wellbeing as well as access to care. Among the four levels of the Socioecological model, including individual, interpersonal, organizational, and community/policy, ten subthemes emerged, including perinatal health literacy, supportive networks, collective resilience, healthcare harm and advocacy, medical institutional environments, parenting while Black, and perinatal health climate. Findings highlight the need for multilevel, culturally responsive, and community-centered strategies to advance Black perinatal mental health and wellbeing.
The sustained impact of Adverse Childhood Experiences (ACE) on mental health outcomes in adulthood is well documented in the literature. ACE survivors may be especially vulnerable to poor mental health outcomes if they have limited or no social support. This study examined the moderating role of social support on the association of ACEs and mental health across different racial groups. Data were obtained from the 2022 Behavioral Risk Factor Surveillance System (n = 14,327). The nine ACE questions about traumatic events in childhood were used to create ACE scores. Chi-square tests were used for bivariate comparisons. Both stratified and unstratified adjusted multivariable logistic regression models were fitted to assess the association between ACEs and poor mental health using social support as a moderator. Across racial and ethnic groups, higher ACE scores were associated with greater odds of poor mental health after adjustment for covariates, and this association varied by social support. Among White and Hispanic adults without social support, reporting four or more ACEs was associated with significantly higher odds of poor mental health compared with reporting no ACEs (White: AOR = 3.45, 95% CI: 2.22 to 5.35; Hispanic: AOR = 2.64, 95% CI: 1.05 to 6.64). When social support was present, four or more ACEs remained significantly associated with poor mental health across all racial and ethnic groups, including White (AOR = 2.57, 95% CI: 2.20 to 3.00), Black (AOR = 2.81, 95% CI: 1.42 to 5.54), Hispanic (AOR = 3.70, 95% CI: 2.36 to 5.80), and other racial groups (AOR = 2.90, 95% CI: 1.54 to 5.42). This study calls for developing culturally responsive, ACE-informed mental health promotion strategies that strengthen social capital and reduce disparities in psychological well-being.
The fecal immunochemical test (FIT) is widely used as a first-line, noninvasive colorectal cancer (CRC) screening tool due to its convenience, affordability, and high patient adherence. However, its effectiveness depends on timely follow-up colonoscopy, and failure to complete diagnostic colonoscopy after a positive FIT can result in missed or delayed detection of precancerous lesions or CRC. It remains unclear whether FIT-based screening and subsequent follow-up are equally effective across age groups and racial and ethnic populations. This study evaluates real-world differences in colonoscopy adherence and diagnostic yield following a positive FIT and examines their implications for disparities in CRC outcomes and all-cause mortality. A retrospective cohort study was conducted using de-identified patient data from the TriNetX research network. Adult patients aged ≥ 45 years who underwent colorectal cancer screening were identified using ICD-10 codes, and positive FIT results were identified using LOINC code 29,771-3. Patients were stratified into two cohorts based on whether they had a diagnostic colonoscopy performed within 1 year of the positive FIT. The study population was further stratified into three age-based cohorts (45-50, 51-64, and 65-85 years), two ethnicity-based cohorts (Hispanic and non-Hispanic), and five race-based cohorts (White, Black, Asian, Native Hawaiian or Other Pacific Islander, and American Indian or Alaska Native). To reduce selection bias and account for potential confounders, 1:1 propensity score matching was performed using demographic characteristics and relevant comorbidities. Matched cohorts were compared using odds ratios (ORs) for colonoscopy adherence, polyp detection, and colorectal cancer detection at both the 1-year and 10-year follow-up intervals. All-cause mortality was compared between matched cohorts using hazard ratios (HRs) at the same 1-year and 10-year follow-up intervals. The study included 45,598 adults with a positive FIT, of whom 17,727 completed colonoscopy within 1 year and 27,871 did not. After propensity score matching, 17,101 patients remained in each group. Patients who completed colonoscopy had higher CRC detection at 1 year (OR 2.401, 95% CI 1.771-3.257) and 10 years (OR 1.501, 95% CI 1.189-1.895), as well as higher polyp detection at 1 year (OR 17.610, 95% CI 16.534-18.756) and 10 years (OR 14.331, 95% CI 13.577-15.126). Colonoscopy completion was associated with lower all-cause mortality at 1 year (HR 0.604, 95% CI 0.516-0.707) and 10 years (HR 0.799, 95% CI 0.744-0.859). Adults aged 45-50 had higher colonoscopy adherence than those aged 51-64 (OR 1.214, 95% CI 1.111-1.326), while adults aged 51-64 had higher adherence than those aged 65-85 (OR 1.248, 95% CI 1.195-1.304). Hispanic patients demonstrated higher adherence than non-Hispanic patients (OR 1.686, 95% CI 1.537-1.848). Polyp detection was higher among Hispanic versus non-Hispanic patients (OR 1.165, 95% CI 1.059-1.282) and White versus Black patients (OR 1.111, 95% CI 1.026-1.202). No significant differences in CRC detection were observed across age, race, or ethnicity subgroups. In this large real-world cohort study, patients who underwent diagnostic colonoscopy after a positive FIT had lower all-cause mortality at both 1 and 10 years compared with those who did not. Colonoscopy adherence after a positive FIT varied by demographic group, with higher completion rates among Hispanic and Asian patients and younger adults. Polyp detection was also higher in Hispanic versus non-Hispanic patients, with no differences among age groups, while CRC detection did not vary across any subgroup. These findings highlight missed opportunities for early detection and prevention of colorectal cancer and underscore the need for targeted interventions to improve colonoscopy follow-up in lower-adherence populations.
American Indian/Alaska Native (AI/AN) communities experience persistent oral health disparities shaped by a range of social determinants of health (e.g., social, economic, and healthcare access factors). However, associations between demographic and socioeconomic characteristics and oral health outcomes among AI/AN populations remains understudied. The objective of this study was to conduct an exploratory analysis of demographic and socioeconomic factors and oral health outcomes among the Tribal Behavioral Risk Factor Surveillance System (TBRFSS) population. Demographic and general health variables were assessed through the TBRFSS. Exposure variables included age, sex, income, employment status, and dentist office type. The nine independent, ordinal outcome variables included: difficulty with chewing, difficulty with speech, dry mouth, felt anxious, felt embarrassment, avoided smiling, reduced social activities, problems sleeping, and experienced pain. Multivariable ordinal logistic regressions were conducted to produce proportional ORs and 95% CIs. A total of 379 responses from participants who identified as AI/AN were included for analysis. Amongst those 379 participants, most identified as female (62% n = 224), had healthcare coverage (92%, n = 343), were Oklahoma residents (78%, n = 295), and were employed full-time (60%, n = 220). Multivariable ordinal logistic regression analyses revealed a statistically significant association between household income and oral health for seven out of the nine outcomes. The age group categories, income, and sex varied in association with the outcomes. Understanding factors associated as it relates with oral health among AI/AN communities is an integral component of addressing health inequities.
The trends and contributors of racial and ethnic disparities in causes of death among patients with clear cell renal cell carcinoma remain unclear. We analyse SEER data (2000-2019) and find that Black patients have the highest 5-year cumulative incidence of death (22.4% vs. 21.7% in whites). Despite a decreasing trend in mortality, the disparities persist between Black and white people (HR 1.15, 95% CI 1.09-1.22) and between AIAN and white people (1.25, 1.10-1.43). Disparities in death from cardiovascular disease between Black and white people increase over time. Stage at diagnosis, receipt of surgery, income, and geographic factors partially explain the observed disparities in mortality patterns. This study identifies specific, measurable contributors to mortality disparities, suggesting that interventions targeting earlier detection, equitable treatment, and socioeconomic barriers are needed.
A growing body of literature on the association of federal housing interventions from the 1930s and 1940s reveals the enduring legacy of legally sanctioned discrimination against marginalized and underserved communities in the United States. This study examined the associations between two historical racialized federal housing interventions-HOLC security maps and urban renewal-and neighborhood racial composition, median household income, and food environment across six recruitment sites of the Multi-Ethnic Study of Atherosclerosis. We estimated mean census tract characteristics for each decennial census year from 1940 to 2010, overall and by exposure to HOLC Grade D, urban renewal, both, and neither. Additionally, we estimated associations between the same exposures and levels of healthier and less healthy food sources as a composite measure in 2010. Census tracts affected by both interventions or HOLC Grade D only had a higher proportion of Black residents and consistently lower median household incomes. Census tracts that experienced urban renewal only had a lower proportion of Black residents and a higher median income but also had a higher food swamp score compared to those exposed to HOLC Grade D or both. Tracts exposed to HOLC Grade D -either alone or in combination with urban renewal are consistent with previous literature showing persistent trends associated with these federal housing interventions. Our findings for urban renewal in places that were not also exposed to HOLC Grade D indicate different trajectories of outcomes, more similar to places that experienced neither, which deserve further study.
Latino/a adolescents report worse mental health than other ethnic-racial groups in the United States, including elevated depressive symptoms and anxiety, yet they remain less likely to access mental health services. Negative perception about mental health within Latino/a communities, shaped by negative beliefs about mental illness and limited knowledge of treatment, poses significant obstacles to care. Low mental health literacy, including poor understanding of depression, anxiety, and the role of therapy and medication, further contributes to negative attitudes about mental health. Prior work shows that Latino/a adolescents often avoid disclosing mental health concerns to parents to prevent burdening them, and this lack of communication impacts their help-seeking behaviors. To examine these challenges, we conducted six focus groups (n = 56) with Latino/a parents and adolescents aged 14-17 from Michigan and Texas. Analysis identified negative perceptions about mental health as a central obstacle for both parents and adolescents, limiting open dialogue about mental health. Adolescents reported fears of judgment or symptom minimization, contributing to delayed help-seeking behaviors. Parents expressed a need for greater mental health knowledge, including symptom recognition, treatments, and strategies for discussing mental health with their adolescent children. Adolescents emphasized the importance of trust, confidentiality, and family acceptance in facilitating disclosure and support. Findings underscore the need for interventions that reduce negative perception about mental health, improve mental health literacy, and strengthen parent-adolescent communication to enhance Latino/a adolescents' access to mental health care. Practitioners can support families by providing tools that support dialogue and reduce negative-perceptions about mental health.
Māori experience a disproportionate burden of Type 2 diabetes mellitus (T2DM), with ongoing inequities in access, continuity, and outcomes of care. While culturally responsive approaches are recognised as important, limited qualitative research centers kaumātua (Māori elders aged 50 years and over) voices in evaluating current diabetes care and informing service redesign. To explore kaumātua and Māori health providers' perspectives on the cultural responsiveness, strengths, and limitations of current T2DM management in New Zealand, and to examine perceived opportunities for community-embedded and mobile models of care. A qualitative study informed by Kaupapa Māori principles was conducted using a wānanga-based (collective forum for discussion and knowledge-sharing) approach. Kaumātua living with T2DM were purposively recruited through a Māori community organisation. Collective kōrero (conversation/discussion) were audio-recorded and analysed using reflexive thematic analysis, interpreted through a Kaupapa Māori analytic lens. Reporting followed the Consolidated Criteria for Strengthening Reporting of Health Research Involving Indigenous Peoples (CONSIDER). Seven kaumātua and Māori health providers participated. Current diabetes care was described as fragmented and insufficiently responsive to cultural and contextual needs. Effective care was grounded in whanaungatanga (relationships and connectedness), manaakitanga (care, respect, and dignity), whānau engagement, culturally safe spaces, and accessibility. Structural barriers, including transport challenges, financial pressures, and fragmented information systems, constrained continuity of care. Participants strongly endorsed a mobile, community-embedded diabetes service as a culturally appropriate approach to improving access, continuity, and equity. Kaumātua perspectives highlight the need for relational, culturally grounded, and accessible diabetes care. Mobile, community-embedded models offer a promising pathway to address structural barriers while upholding mana, dignity, and whānau-centred care.
Black men in the United States face disproportionately high rates of prostate cancer incidence and mortality. Despite this, few prostate-specific antigen (PSA) testing guidelines include race-conscious guidelines, and few studies exists on specific, equity-related barriers to accessing PSA testing for Black men. This qualitative study, conducted in collaboration with the Black and African Descent Collaborative for Prostate Cancer Action (BACPAC), explores the perspectives, beliefs, and equity-related barriers affecting PSA testing access among Black men in Washington State. Using a community-engaged approach, semi-structured interviews were conducted with 29 Black men, both with and without a history of prostate cancer. Interviews were analyzed using a framework that considered structural, social, and health-related determinants of equity. Five key themes emerged: (1) trust and patient-provider relationships are essential but often challenged by historical and personal experiences of systemic racism; (2) PSA testing is viewed as an important component of routine healthcare, but is inconsistently offered; (3) participants reported a lack of accessible, accurate, and culturally relevant information about prostate cancer risks for Black men; (4) family and community support plays a critical role in promoting awareness and screening; and (5) masculinity, sexual health concerns, and stigma act as barriers to seeking care. Our findings highlight the need for culturally tailored educational materials, improvements in provider communication, and community-driven efforts to normalize conversations about PSA testing and health. Addressing these factors through culturally responsive and patient-centered strategies can improve access to PSA testing and early detection and reduce prostate cancer inequities among Black men.
Racial self-identification can change across the life course, yet relatively little is known about how patterns of racial identity stability and fluidity are associated with mental health beyond adolescence. Using data from the National Longitudinal Study of Adolescent to Adult Health (Add Health; ages 12-43, spanning adolescence through early midlife), we examined trajectories of depressive symptoms, assessed with the Center for Epidemiologic Studies Depression Scale (CES-D), and suicidal ideation for monoracial-stable, multiracial-stable, and racially fluid identity patterns, adjusting for sociodemographic factors. Stable Black and stable White respondents reported lower depressive symptoms than racially fluid peers in adolescence (b = -0.17, p < 0.05; b = -0.44, p < 0.001, respectively), and these differences persisted into adulthood. Stable Asian respondents did not differ from fluid peers in depressive symptoms at baseline, but experienced a steeper age-related decline (Asian×Age b = -0.02, p < 0.001). For suicidal ideation, stable Black identity was associated with lower odds (OR = 0.47, p < 0.001), while stable American Indian identity was associated with higher odds (OR ≈ 4.0, p < 0.05); no race-by-age interactions emerged. Across both outcomes, the aggregated racially fluid category generally occupied an intermediate position, although supplementary analyses suggested heterogeneity within this category, particularly between transitions into versus out of multiracial identification. These findings suggest that mental health differences associated with longitudinal racial identity patterns vary across the life course rather than reflecting fixed disparities.
Experiencing racism and anti-immigrant discrimination has a negative impact on health, including healthcare utilization. A growing body of research has connected vicarious experiences of racism and anti-immigrant discrimination to health decline; however, there is a dearth of literature examining the impact of these vicarious experiences on healthcare utilization. Using data from the 2023 and 2024 California Health Interview Survey (n = 46,481), we examined the association between vicarious experiences of hate incidents in the last 12 months motivated by race or skin color and immigration status and indicators of healthcare utilization in the past 12 months. Logistic regression models were used to calculate adjusted odds ratios (AORs) of all study outcomes. Analyses were stratified by white and Black, Indigenous, and People of Color (BIPOC) for hate incidents motivated by race or skin color, and by United States (US) born citizens, naturalized citizens, and noncitizens for hate incidents motivated by immigrant status. After accounting for confounders, among all participants, witnessing a hate incident motivated by the race or skin color of the target was associated with higher odds of foregoing or delaying healthcare services, receiving care from telemedicine, and visiting the emergency room. Among the entire sample, witnessing a hate incident motivated by immigration status of the target was associated with higher odds of foregoing or delaying healthcare services and receiving care from telemedicine. Witnessing hate incidents motivated by race, skin color, or immigrant status has a negative impact on healthcare utilization for everyone, regardless of racial background or citizenship status.
The prevalence and impact of mental health challenges among racially and ethnically diverse populations have received growing attention in recent years. This study investigates the factors associated with mental health service utilization and unmet mental health care needs among minoritized adults in the United States. Drawing on data from the 2021-2022 National Health Interview Survey (NHIS), an annual survey of the U.S. civilian, noninstitutionalized population that understands public health conditions, this study included a sample of Asian, Black/African American, and Hispanic participants (N = 16,245). A secondary data analysis was conducted using a multinomial logistic regression framework to examine how predisposing, enabling, and need-based factors influence patterns of mental health service use, guided by Andersen's Behavioral Model of Health Services Use. Findings highlight persistent disparities, showing that Black and Hispanic individuals who reported living with disabilities were more likely to forgo mental health services due to cost. Additionally, Asian older adults were less likely to report receiving mental health services. Meanwhile, Asian young adults who had never been married and who experienced anxiety had the highest odds of delaying mental health care. Together, these findings underscore the importance of culturally responsive strategies to improve access and equity in mental health services for minoritized individuals with intersecting social identities, as well as the need to strengthen training for culturally competent providers with attention to cultural diversity, acculturation processes, language proficiency, and advocacy.
American Indian infants have heightened rates of low birth weight (LBW) and preterm birth (PTB) in the United States. This study aims to evaluate variation by maternal age in racial disparities in these outcomes, indicative of birth risk weathering. Potential mechanisms of these disparities are also considered. We conducted a cross-sectional study of births occurring between 2014 and 2022 to Montana residents who self-identified as non-Hispanic White (NHW) or American Indian/Alaskan Native (AI/AN), using Montana birth certificate data. Logistic regression models were used to examine mediators of the association between AI/AN identity and experiencing a PTB (< 37 weeks gestation) and LBW outcome (< 2500 g at birth). Age-interactions tested the weathering hypothesis of maternal age variation in health disparities among AI/AN people. Four mediator variables were considered: pregnancy health risk, adequacy of prenatal care, distance to deliver, and prenatal smoking. Findings indicate that AI/AN individuals had heightened rates of PTB and LBW relative to NHWs (41% and 15% higher odds, respectively). Disparities are larger at older ages. The indirect effects of pregnancy health risk, adequacy of prenatal care, distance to deliver, and prenatal smoking partially explains the association between AI identity and outcomes; but age-graded disparities persist, particularly for PTB. Findings illustrate the importance of addressing maternal social determinants of health that may increase stress during the perinatal period, including by addressing barriers to accessing culturally responsive and safe prenatal care.
Breast cancer screening and timely diagnosis are essential for reducing mortality and improving outcomes. However, access to preventive services and early detection remains uneven across social groups, particularly in low- and middle-income countries such as Brazil. This study aimed to describe educational, racial, and geographic inequalities in breast cancer screening and diagnosis among Brazilian women using data from the 2019 Brazilian National Health Survey. The sample included women aged 50 to 69 years. The outcomes were breast cancer diagnosis and screening, including mammography and clinical breast examination (CBE). Skin color, area of residence, and educational level were used as equity stratifiers. Simple and complex measures of inequality were applied, including the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII). White women, urban residents, and those with higher education levels had greater access to mammography referrals, screening, and CBE. Among women with the same education level, the prevalence of breast cancer diagnosis was higher among White women (2.6%) and Brown women (3.4%) than among Black women (2.3%). Likewise, urban residents had a higher prevalence of breast cancer diagnosis (3.1%) than rural residents (1.9%).These findings indicate that breast cancer screening and diagnosis disproportionately benefit White, highly educated, and urban-dwelling women. Educational, racial, and geographic inequalities persist in breast cancer screening and diagnosis in Brazil, even among women with similar levels of education. These results highlight the need for equitable screening programs, awareness strategies, and public health policies targeting structurally disadvantaged groups to reduce disparities in breast cancer outcomes.
This study investigated trajectories of ethnic and racial sleep disparities during the first two years of college, focusing on several dimensions of sleep. Ethnically and racially diverse first-year college students (n = 451; Asian = 19%, Black = 15%, Latinx = 19%, multiracial = 23%, White = 24%; female = 76%, male = 22%, non-binary = 2%) wore wrist actigraphs for two weeks every semester for four semesters. Findings suggest that across different sleep dimensions (duration, bedtime, risetime, and efficiency), ethnic and racial disparities emerge over time. White students had the most improvements in sleep over time, with increases in sleep duration and no change to their sleep efficiency. During this period, Black and Latinx students woke up later, white and multiracial students went to bed earlier, and Asian students had no change in bedtime or risetime. All racial and ethnic minority students declined in sleep efficiency. These findings document persisting ethnic and racial sleep disparities among diverse college students across a range of sleep dimensions and have implications for targeted interventions to improve sleep outcomes for diverse youth.