Special Issue:
Challenges and Opportunities in Health Disparities
Laurens Holmes, Jr.
Global Epigenomic Research Analytics, Wilmington, DE 19802
Keerti Deepika
Global Epigenomic Research Analytics, Wilmington, DE 19802 ; Fellow of Translational Health Disparities Science (FTHDS), Wilmington, DE 19803, USA
Janille Williams
Global Epigenomic Research Analytics, Wilmington, DE 19802; Fellow of Translational Health Disparities Science (FTHDS), Wilmington, DE 19803, USA
Benjamin Ogundele
Global Epigenomic Research Analytics, Wilmington, DE 19802; Fellow of Translational Health Disparities Science (FTHDS), Wilmington, DE 19803, USA
Glen Philipcien
Emergency Department, Victoria Hospital, Castries, St. Lucia
Michael Enwere
Global Epigenomic Research Analytics, Wilmington, DE 19802; Fellow of Translational Health Disparities Science (FTHDS), Wilmington, DE 19803, USA; Public Health Department, Walden University, Minneapolis, MN 55401, USA
Shikha Jain
MVJ Medical College, Hoskote, Karnataka, India
Naresh Dasari
Medicine and Long-term care Associates, Cranston, RI 02920
Ram Sanjiv Alur
Marion Veterans affairs medical center, IL
Ramesh Adhikari
Franciscan Health, Lafayette, IN 47909
Gbadebo O Ogungbade
Global Health Services Initiatives Incorporated, Arlington, TX 76014 USA
Abstract
Purpose: Historically until date, viral pathogens remain very challenging with respect to transmission, severity, mortality and survival with respect to sub-population variances. While racial disparities in cumulative incidence (CmI) and mortality from the influenza pandemics of 1918 and 2009 implicated Blacks with survival disadvantage relative to Whites in the United States, COVID-19 currently indicates comparable disparities. We aimed to: assess COVID-19 CmI by race, determine the Black–White case fatality (CF) and risk differentials, and apply explanatory model for mortality risk differentials.
Methods: COVID-19 data on confirmed cases and deaths by selective states health departments were assessed using a cross-sectional ecologic design. Chi-square was used for CF independence, while binomial regression model for the Black–White risk differentials.
Results: The COVID-19 mortality CmI was disproportionate among Blacks/AA with 34% of the total mortality in the United States, albeit their 13% population size. The COVID-19 CF was higher among Blacks/AA relative to Whites; Maryland, (2.7% vs. 2.5%), Wisconsin (7.4% vs. 4.8%), Illinois (4.8% vs. 4.2%), Chicago (5.9% vs. 3.2%), Detroit (Michigan), 7.2% and St. John the Baptist Parish (Louisiana), 7.9%. Blacks/AA compared to Whites in Michigan were 15% more likely to die, CmI risk ratio (CmIRR) = 1.15, 95% CI, 1.01–1.32. Blacks/AA relative to Whites in Illinois were 13% more likely to die, CmIRR = 1.13, 95% CI, 0.93–1.39, while Blacks/AA compared to Whites in Wisconsin were 51% more likely to die, CmIRR = 1.51, 95% CI, 1.10–2.10. In Chicago, Blacks/AA were more than twice as likely to die, CmIRR = 2.24, 95% CI, 1.36–3.88.
Conclusion: Substantial racial/ethnic disparities are observed in COVID-19 CF and mortality with Blacks/AA disproportionately affected across the United States.
Leslie Zuniga-Rivas, MPH
Quality Improvement and Equity Project Manager, Center For Sustainable Health Care Quality and Equity, National Minority Quality Forum
Henry Nuss, PhD
Associate Professor, Louisiana State University Health New Orleans
Adewale Lawrence, MD, MS
CEO and Founder, Bioluminux Clinical Research Network, U.S.
Laura Hernandez
Data Quality Analyst, Baywell Health
Nushrat Sultana, MPH
Freelance Public Health Consultant, Center for Sustainable Health Care Quality and Equity, National Minority Quality Forum
Kristen Stevens Hobbs, MPH, CPH
CEO and Founder, The Equity Studio, LLC
DeLorean Ruffin, DrPH, MPH
CEO and Founder, Ruffin Consulting, LLC
Bishop Erik O. Nation
Senior Pastor, Hope Center Church of Oakland, California
Aneesa Choudhry, MPH
Quality Improvement and Equity Intern, Center For Sustainable Health Care Quality and Equity, National Minority Quality Forum
Laura Lee Hal, PhD
President Emeritus, Center for Sustainable Health Care Quality and Equity, National Minority Quality Forum
Abstract
Background: Type 2 Diabetes Mellitus (T2DM) is influenced by various factors, with racial and ethnic minorities experiencing higher prevalence. Existing diabetes management programs focus on primary prevention, often neglecting optimal hemoglobin A1C (HbA1c) management for individuals with prediabetes. Consistent HbA1c monitoring is crucial for comprehensive care. This study highlighted the need for secondary prevention and community collaboration to enhance health equity for individuals with T2DM.
The DRIVE program, conducted by the National Minority Quality Forum’s (NMQF) Center for Sustainable Health Care Quality and Equity (SHC), aimed to improve health outcomes for individuals with Type 2 Diabetes Mellitus (T2DM) in Oakland, CA. Building on prior successes in New Orleans, Los Angeles, and Queens, NY, DRIVE employs a flexible and sustainable approach that integrates quality improvement strategies at clinic sites, focusing on patient and community engagement. The study addressed barriers to medication adherence, provided Diabetes Self-Management Education and Support (DSMES), fostered community partnerships, and utilized culturally appropriate resources. The program’s impact was evaluated through changes in HbA1c levels and community participation.
Methods: A pre-and post-test design was used, targeting patients of Baywell Health, Oakland, CA, aged 18 and older with initial HbA1c levels greater than 9%. The intervention, developed using SHC’s DRIVE program, included components such as food distribution events, workflow enhancements, identification and mitigation of medication adherence barriers, rapid cycle improvement processes, community educational sessions, and the creation of patient resources. This two-year study implemented four Plan-Do-Study-Act (PDSA) cycles, each lasting 2-4 months, following a three-month planning phase. HbA1c levels were measured at baseline, six months after implementation, and again at 18-month follow-up.
Statistical Analysis
Univariate analyses described demographic data, while paired sample t-tests assessed changes in HbA1c levels. Independent sample t-tests and ANOVA with pairwise comparisons were used to determine group differences.
Results: Among the 255 participants, 58% identified as female and 42% as male. The majority were Black/African American (64%) and 73% were Non-Hispanic/Latino/a, with a mean age of 55.4 years. HbA1c levels were significantly reduced from an average of 10.3±1.4 to 9.4±2.1 at follow-up. Participants who enrolled the longest showed greater reductions. Community initiatives reached over 600 individuals, demonstrating the program’s effectiveness in building partnerships and sustainability.
Conclusion: SHC’s DRIVE program improved T2DM outcomes through community involvement, quality improvement, and culturally tailored education. This initiative highlighted the importance of addressing health inequities and barriers in diabetes care through culturally sensitive techniques and sustained interventions. DRIVE effectively reduced disparities and promoted sustainable health outcomes among minority groups. Collaborative efforts enhanced trust and demonstrated the advancement of health equity through tailored interventions, with DRIVE providing a flexible and sustainable framework for tailoring interventions to community needs. These findings underscored the need for individualized, culturally competent diabetes care, continuous education, community engagement, and equitable resource access to support communities of color and ethnic minorities in managing T2DM effectively.
Abha Agrawal, MD, FACP, FACHE
Chief Medical Officer, Humboldt Park Health, Chicago IL USA
Abstract
Equitable care has been recognized as one of the six core components of quality for over two decades, yet scant attention has been paid to understand and address healthcare disparities in the US. There is long-standing evidence of substantial health disparities and poor health outcomes along race, ethnicity and income levels in the US. The COVID-19 pandemic both exacerbated and exposed these inequities and catalyzed a national imperative to achieve equitable healthcare. The objective of this article is to provide a case study of a resource-challenged safety net hospital’s journey to advance health equity in Chicago. Humboldt Park Health (HPH) is a 200-bed independent community teaching hospital located on the West side of Chicago serving a multiracial, multilingual and socioeconomically disadvantaged population. Our journey started with the formation of a multidisciplinary health equity committee in 2021, reporting to the Board of Trustees, that was charged with formulating a strategy, developing an evidence-based framework and priorities for action, and implementing the action plan. We addressed four groups of stakeholders: our patients, our people, our organization, and our community. Our actions to advance equity have included (a) collection of patients’ demographic data such as race, ethnicity, language, sexual orientation, and gender identity; (b) assessment of social determinants of health (SDOH) along with connecting patients with social services; (c) the development of health disparities dashboards for various ambulatory preventive measures for stratification of quality data along race, ethnicity and language; (d) focus on LGBTQ+ community’s access to well-informed and sensitivity-trained behavioral health service providers, and (e) organization-wide training to embed the concepts of diversity, equity and inclusivity in the fabric of the organization. Other initiatives include the building of a community wellness center and a 100-unit affordable housing complex in the community. Digital health equity is an important domain that is being addressed by the launch of a patient portal to empower patients by providing them access to their information, and remote patient monitoring solutions. The next phase of our work involves evaluation studies to understand the impact of our interventions on health disparities and outcomes in our community.
Tarsha Jones, PhD, MSN, RN, PHNA-BC
Florida Atlantic University
Karen Wisdom-Chambers, DNP, APRN, FNP-BC, PMHNP-BC
Christine E. Lynn College of Nursing, Florida Atlantic University
Katherine Freeman, Dr.PH.
College of Medicine, Florida Atlantic University
Karethy Edwards, DrPH, APRN, FNP-BC, FAAN
Professor John F. Wymer, Jr. Endowed Distinguished Professor CEO FAU/NCHA Community Health Center. Member, National Advisory Committee, American Nurses Association/Substance Abuse and Mental Health Services Administration Minority Fellowship Program, Florida Atlantic University
Abstract
Background: In the United States (US), Black/African American women suffer disproportionately from breast cancer health disparities with a 40% higher death rate compared to White women. Mammography screening is considered a critical tool in mitigating disparities, yet Black women experience barriers to screening and are more likely to be diagnosed with advanced-stage breast cancer. The purpose of this study was to assess the relative frequency of mammography screening and to examine perceived and actual barriers to screening among women who receive care in our nurse-led community health center.
Methods: We conducted a survey examining frequency of mammography screening and beliefs about breast cancer including perceived susceptibility, perceived benefits, and perceived barriers to mammography screening, guided by the Champion Health Belief Model.
Results: A total of 30 Black/African American women completed the survey. The mean age of the participants was 54.3 years ± 9.17 (SD); 43.3% had a high school education or less; 50% had incomes below $60,000 per year; 26.7% were uninsured; 10% were on Medicaid; and only 50% were working full-time. We found that only half of the participants reported having annual mammograms 16 (53.3%), 1 (3.3%) every 6 months, 8 (26.6%) every 2-3 years, and 5 (16.7%) never had a mammogram in their lifetime. Frequently cited barriers included: ‘getting a mammogram would be inconvenient for me’; ‘getting a mammogram could cause breast cancer’; ‘the treatment I would get for breast cancer would be worse than the cancer itself’; ‘being treated for breast cancer would cause me a lot of problems’; ‘other health problems would keep me from having a mammogram’; concern about pain with having a mammogram would keep me from having one; and not being able to afford a mammogram would keep me from having one’. Having no health insurance was also a barrier.
Conclusion: This study found suboptimal utilization of annual screening mammograms among low-income Black women at a community health center in Florida and women reported several barriers. Given the high mortality rate of breast cancer among Black/African American women, we have integrated a Patient Navigator in our health system to reduce barriers to breast cancer screening, follow-up care, and to facilitate timely access to treatment, thus ultimately reducing breast cancer health disparities and promoting health equity.
Xinyuan YANG
Melbourne Dental School, University of Melbourne
Michelle CHOW
Melbourne Dental School, University of Melbourne
Yuti GANDHI
Melbourne Dental School, University of Melbourne
Jennifer NGUYEN
Melbourne Dental School, University of Melbourne
Brian TO
Melbourne Dental School, University of Melbourne
Mathew Albert Wei Ting LIM
Abstract
Background: People with disabilities and complex health needs have poorer oral health when compared to the rest of the population, with being able to find oral health professionals willing to provide treatment often identified as the main barrier. Despite this, our understanding of the barriers that oral health professionals face when treating these patients remains limited. This is crucial to overcoming the challenge of reducing oral health disparities faced by these vulnerable populations.
Aim: To provide an overview of barriers reported by oral health professionals in regards to treating patients with disabilities and complex health needs in the published literature.
Methods: Primary studies were searched for through PudMed, Ovid and Scopus databases using a search strategy developed by the research team. Articles were screened according to PRISMA guidelines and against inclusion and exclusion criteria.
Results: Eighteen studies fulfilled the criteria for evaluation, including studies using both qualitative and quantitative approaches. General dentists were most frequently included in the studies, but patient populations were highly variable, with the majority relating to people with disability. The reported barriers could be classified into three main areas: clinician, patient, and environment-related.
Conclusion: There are only a small number of studies reporting on barriers perceived by oral health professionals to impact on their ability to treat people with disabilities and complex health needs. While lack of training or experience was a factor underlying many of the reported concerns, studies raised concerns about clinicians being inadequately resourced or supported to provide this care. These are areas the dental profession will need to consider in order to address current oral health disparities experienced by people with disability and special health care needs.
Ehiremhen Ozah
Urology Unit, Department of Surgery, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
Esteem Tagar
General Surgery Unit, Department of Surgery, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
William Akerele
Paediatric Surgery Unit, Department of Surgery, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
Abstract
Background: Coronavirus disease had a devastating effect on the World, with significant disruption in healthcare, the burgeoning impact is still unfolding. The inequities and fragilities amongst nations particularly low and medium economic countries whose patients are dependent on out of pocket expenditure to access healthcare, has occasioned varied consequence of the pandemic on patients in the health care setting and it has reshaped how health care is practiced.
Aims: The aim of this review article was to assess the impact of Coronavirus disease on health care utilization by non -COVID patient during the pandemic.
Methods: The review article was carried out with a search engine focused on articles related to impact of Coronavirus disease published between December 2019 till date, which were identified and reviewed.
Conclusion: The review article gave an insight to the significant disruptions in health care services amongst patients witnessed across countries of the world, the disparities in the disruptions were due to heterogeneity amongst nations, national policies and health policies during the pandemic and the socioeconomic realities that ensued. Outpatient services witnessed varying reduction across the globe ranging between 30-50%. Sub-Saharan Africa witnessed disruption as much as 50% depending on load of COVID-19 infection amongst populace. The reason for the interruptions across the world was the fear of contracting the disease, access to health care setting due to lock down and shortage of health care personnel, in addition in sub-Saharan Africa, the economic down turn occasioned by the pandemic reduced household income which in turn reduced expenditure on health since most countries were dependent on out of pocket expenditure to fund health care services.
In-patient care was also not spared of the disruptions witnessed even though emergency care was prioritized. Overall, there was a reported reduction in admissions for respiratory diseases due to non- pharmacological measures aimed at stemming COVID-19 infection which was equally effective for other respiratory diseases. In some countries like United States the reduction in hospital admissions was paralleled by increasing mortality particularly amongst Hispanic blacks as more acute and severe cases were deemed to have presented for admissions. Surgical priority was maintaining emergency services and prioritization of cancer care, there was a measurable reduction in surgical procedures as elective surgeries were postponed or cancelled. Most laparoscopic and endoscopic procedures were cancelled because of the perceived notion that they are aerosol generating and could increase transmission of COVID-19 infection from asymptomatic carriers, however US jettisoned cancellation of its surgical procedures after 35 days considering that it could not cope. The psychosocial impact of the pandemic and health care access spiraled into increasing anxiety and depression for both health care workers and patients, while the fear of stigmatization was rife from contracting the disease.
Amanda S. Tripp, PhD, MPH
Avalere Health, 1201 New York Avenue NW, Suite 1000, Washington, DC 20005
Grecia Marrufo, PhD
Avalere Health, 1201 New York Avenue NW, Suite 1000, Washington, DC 20005
Thomas Kornfield, MPP
Avalere Health, 1201 New York Avenue NW, Suite 1000, Washington, DC 20005
Melissa Morley, PhD
Avalere Health, 1201 New York Avenue NW, Suite 1000, Washington, DC 20005
Abra Yeh, MPP
Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080
Donald Nichols, PhD
Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080
Abstract
Background: Under the 340B Drug Pricing Program, drug manufacturers are required to provide discounts to participating safety-net providers including hospitals serving a disproportionate share (DSH) of low-income patients. The program has experienced substantial growth in participating DSH providers due in part to growth in 340B DSH child sites, which are outpatient sites included on the DSH hospitals’ cost report. However, child sites are not required to be easily accessible to vulnerable patients.
Objectives: The objective of this study was to determine whether the 340B program’s expansion of child sites was associated with fewer health disparities for asthma-related care.
Research Design: We conducted a retrospective analysis of Medicare beneficiaries treated for moderate to severe asthma at 340B DSH hospitals with and without child sites. Measures: We evaluated five drug treatment measures and five adverse outcome measures related to asthma occurring within the first 12 months of the diagnosis date.
Results: For Medicare beneficiaries treated for asthma at 340B hospitals with and without child sites, we identified risk-adjusted disparities in drug treatments and adverse health outcomes based on race/ethnicity, dual eligibility status, and socioeconomic status. Statistically significant disparities across the ten outcomes were more likely to occur within 340B hospitals with child sites than 340Bhospitals without child sites. Differences in the magnitudes of the disparities varied by vulnerable subgroup.
Conclusions: Our findings suggest that the growth in 340B child sites have not universally expanded access to higher quality care for vulnerable patients, and as such policy changes may be needed.
Laurens Holmes, Jr
Global Epigenomic Research Analytics, Wilmington, DE 19802
Kerti Deepika
Global Epigenomic Research Analytics, Wilmington, DE 19802; 2 Fellow of Translational Health Disparities Science (FTHDS), Wilmington, DE 19803, USA
Janille Williams
Global Epigenomic Research Analytics, Wilmington, DE 19802 ; Fellow of Translational Health Disparities Science (FTHDS), Wilmington, DE 19803, USA
Benjamin Ogundele
Global Health Services Initiatives Inc, Arlington, TX, 76014; 2 Fellow of Translational Health Disparities Science (FTHDS), Wilmington, DE 19803, USA
Glen Philipcien
Emergency Department, Victoria Hospital, Castries, St. Lucia
Michael Enwere
Global Epigenomic Research Analytics, Wilmington, DE 19802; Fellow of Translational Health Disparities Science (FTHDS), Wilmington, DE 19803, USA; Public Health Department, Walden University, Minneapolis, MN 55401, USA
Shikha Jain
MVJ Medical College, Hoskote, Karnataka, India
Naresh Dasari
Medicine and Long-term care Associates, Cranston, RI 02920
Ram Sanjiv Alur
Marion Veterans affairs medical center, IL
Ramesh Adhikari
Franciscan Health, Lafayette, IN 47909
Gbadebo Ogungbade
Global Health Services Initiatives Incorporated, Arlington, TX 76014 USA
Abstract
Purpose: Viral infections had been historically observed in chronic disease development and complications including although not limited to hepatitis C, influenza A, cytomegalovirus (CMV), Epstein bar virus (EBV), HIV and herpes simplex. Epidemiologic data had implicated CMV, herpes simplex and hepatitis C in type II diabetes (T2D). With the observed increased incidence T2D in COVID-19 among children and adults, this review aimed to examine scientific literature on immune and endocrine systems dysregulation in T2D and pancreatic neoplasm.
Materials & Method: A qualitative systematic review (QSR) was utilized in assessing the immune system deregulation and endocrine system involvement in chronic disease development such as T2D. The PubMed was the main search engine in studies identification with several search terms such as “SARS-CoV-2 and T2D”, “COVID-19 and T2D”, SARS-CoV-2 and insulin resistant”, etc.
Results: Viral pathogens such as CMV, influenza A, and herpes simplex and hepatitis C infections have been implicated in decreased insulin sensitivity (IS) and increased insulin resistant (IR). Similarly, these pathogenic microbes increased the T2D incidence and complications. SARS-CoV-2 a COVID-19 causative pathogen had been observed in increased risk and incidence of T2D among children and adults. While data are not currently available on the precise mechanistic process, SARS-CoV-2 viral infection in T2D incidence may be explained by excess pro-inflammatory cytokines elaboration (cytokine storm) resulting in increased IR and decreased IS, leading to glucose intolerance and T2D. Further COVID-19 may increase pancreatic neoplasm in populations with increased incidence of COVID-19, due to pancreatic beta cells and insulin receptors dysregulation and cellular dysfunctionality as abnormal cellular proliferation.
Conclusions/Recommendation: SARS-CoV-2 a causative pathogen in COVID-19 morbidity is associated with increased incidence of T2D, which is explained in part by immune and endocrine system integration dysregulation, resulting in cytokine storm, decreased IS and increased IR, implying glucose intolerance and T2D. Additionally this pathogenic microbe may result in increasing incidence of pancreatic neoplasm, a malignant neoplasm with the worst prognosis and excess mortality due to late stage at diagnosis and marginalized biomarkers of susceptibility and morbidity.
Maryam Alkhatry
Ibrahim Bin Hamad Obaidullah Hospital (IBHO), Emirates Health Services, Ras Al Khaimah, United Arab Emirates
Hayder M. Hamadi
Al Qassemi Hospital, Emirates Health Services, Sharjah, United Arab Emirates
Abdulwahid Alwahedi
Al Qassemi Hospital, Emirates Health Services, Sharjah, United Arab Emirates
Zaki Al Muzaki
Al Qassemi Hospital, Emirates Health Services, Sharjah, United Arab Emirates
Bashar Almasri
Ibrahim Bin Hamad Obaidullah Hospital (IBHO), Emirates Health Services, Ras Al Khaimah, United Arab Emirates
Fedaa Housen
Ibrahim Bin Hamad Obaidullah Hospital (IBHO), Emirates Health Services, Ras Al Khaimah, United Arab Emirates
Mohammed Bataweel
Ibrahim Bin Hamad Obaidullah Hospital (IBHO), Emirates Health Services, Ras Al Khaimah, United Arab Emirates
Eman Alabar
Burjeel Specialty Hospital, Sharjah, United Arab Emirates
Hisham eltayeb
Saudi German Hospital, Ajman, United Arab Emirates
Abstract
Obesity poses a multifaceted challenge in the United Arab Emirates (UAE), demanding a comprehensive review of its epidemiology, causes, prevention strategies, and challenges. This article explores the intricate web of factors contributing to obesity, emphasizing a multidisciplinary approach that engages nutritionists, exercise physiologists, behavioral therapists, and surgeons. The epidemiology reveals a concerning rise in obesity rates, necessitating targeted interventions. Demographic influences, cultural dynamics, dietary patterns, sedentary lifestyles, and genetic factors are dissected to provide a nuanced understanding. Health implications extend beyond body weight, impacting public health systems and imposing an economic burden.
Prevention strategies encompass childhood obesity initiatives, community-based interventions, workplace wellness programs, and government policies. Challenges in implementing these strategies include cultural perceptions of body image, access to healthcare services, socioeconomic disparities, and resistance to change. Cultural sensitivity emerges as a key theme, guiding interventions tailored to align with diverse cultural norms. Multidisciplinary care, leveraging technology, community engagement, and educational programs are explored as integral components of a holistic approach.
This review emphasizes the need for societal commitment, empowering communities and individuals, policy advocacy, and the pivotal role of healthcare professionals in the fight against obesity. Future perspectives call for sustained commitment, research investment, and the integration of technology to pave the way for a healthier UAE. This review also provides a roadmap for forging a healthier future, acknowledging the complexity of obesity, and offering insights into tailored, culturally sensitive interventions.
Raj Lele
University of Michigan, Ann Arbor, Michigan, USA
Sheryl Haller
Enara Health Inc., San Mateo, California, USA
Kate David
Santa Clara University, Santa Clara, California, USA
Gaby Gutierrez
Santa Clara University, Santa Clara, California, USA
Shurouk Kattan Rahmani
University of Aleppo, Faculty of Medicine, Aleppo, Syria
Abstract
This paper examines disparities in obesity treatment and their implications for health equity. A comprehensive literature review was performed using Pubmed, Medline, and Google Scholar to identify studies examining obesity treatment options that reported data on African Americans, Asians, Hispanics, and Caucasians. These studies, published from 2000 to 2022, revealed disparities in behavioral/lifestyle, surgical, and pharmacological interventions for obesity. While a majority of behavioral/lifestyle and surgical treatment studies found disparities in weight loss and clinical outcomes, pharmacological studies found minimal to no evidence of disparities or favorable outcomes for racial and ethnic minorities for weight and cardiometabolic outcomes. All treatment pathways showed disparities in referral rates, access, and engagement/retention. These findings underscore the urgent need to incorporate obesity treatment as a central component in strategies addressing health inequities. By understanding and addressing these disparities, healthcare equity can be improved, ensuring a more inclusive approach to obesity management.
Karen Allison
Department of Ophthalmology, University of Rochester, Rochester, NY.
Leah Greene
Department of Clinical Research, New York Ophthalmology Associates PLCC, NYC, NY.
Chanbin Lee
Department of Ophthalmology, University of Rochester, Rochester, NY.
Deepkumar Patel
Department of Clinical Research, New York Ophthalmology Associates PLCC, NYC, NY.
Abstract
Background: Blindness describes a condition in which patients have low vision, are legally blind, or totally blind. Disparities in vision health is a public health concern because it decreases quality of life and subsequently leads to a series of other health-related issues. These disparities exist across demographics, socioeconomic status, disease history, genetics, and geographic location, particularly in the urban vs. rural setting. Public health professionals need to shed light on these disparities to properly address them to ensure that individuals affected by blindness can receive proper care.
Objective: To investigate if there are discrepancies or inequalities in vision care in a rural setting vs. urban setting.
Methods: A multivariate binary logistic regression analysis using cross-sectional data from the Vision and Eye Health Surveillance System (VEHSS) was done using SAS Studio. Blindness, the outcome of interest, was defined as best-corrected visual acuity at less than 20/200 in the better-seeing eye. Each demographic subgroup was assessed in the counties included for upstate New York and downstate New York. Prevalence rates are expressed as a percent.
Results: The multivariate binary logistic regression analysis showed that non-Hispanic black individuals from upstate New York and downstate New York were most likely to be blind compared to white, non-Hispanic, any Hispanic, and other individuals. Factors that were significantly associated with blindness include the female gender, individuals aged 65 years and older, non-Hispanic black individuals, and those without Medicare. Residents from upstate New York had a slightly increased likelihood to develop blindness, 1.04 (1.01, 1.07), compared to residents in downstate New York.
Conclusions and Relevance: Blindness prevalence was highest in upstate New York, among non-Hispanic black individuals, the female gender, and individuals 65 years and older. Despite the blindness prevalence highest upstate, the difference was not clinically significant compared to downstate New York, despite a considerably larger number of resources present downstate compared to upstate. Given the severity of blindness as a public health concern, the discrepancies in eye care in urban vs. rural settings need to be investigated further.
Sajda Qureshi, PhD
D.B. and Paula Varner Professor of Information Systems, Director ITD mHealth Cloud Computing Lab, Department of Information Systems & Quantitative Analysis, College of Information Science & Technology. University of Nebraska at Omaha, 6001 Dodge Street, Omaha, NE 68182-0116
Blessing Oladokun
Data Analytics Graduate Assistant, ITD mHealth Cloud Computing Lab, Department of Information Systems & Quantitative Analysis, College of Information Science & Technology. University of Nebraska at Omaha, 6001 Dodge Street, Omaha, NE 68182-0116
Abstract
While there are many causes of health disparities, the application of Artificial Intelligence tools in healthcare may have mixed results. The purpose of this paper is to investigate the role of human freedoms and accountability to achieving digital inclusion. It discovers the role of algorithmic bias in mediating the relationship between human freedom and mobile health. The following research questions are investigated: 1) How do human freedoms effect digital inclusion and mobile health? 2) Do human freedoms effect mobile health? And 3) Does AI accountability mediate the relationship between human freedoms and mobile health? The findings suggest that human freedoms are central to digital inclusion and mobile health. Accountability does affect the extent to which digital inclusion can be achieved through human freedoms. AI accountability significantly mediates the relationship between human freedoms and the mobile index. This offers an important contribution in uncovering the role of algorithmic bias in human freedom and mobile health, and of accountability between human freedom and digital inclusion.
Stephanie F. Dailey
College of Education and Human Development, George Mason University, Fairfax, Virginia. 4400 University Drive MSN 1H1 Fairfax, VA 22030.
Abstract
This article explores the nuanced relationship between COVID-related stressors and mental health outcomes, with a particular focus on sociodemographic patterns and implications for practice. It illuminates the psychological impacts of the pandemic, explores sociodemographic disparities outcomes among historically marginalized communities, and offers recommendations for practitioners and policymakers to address mental health challenges. It reviews current research highlighting the direct correlation between pandemic-related stressors and heightened levels of depression, anxiety, and economic instability across diverse demographic groups, while also exploring the most widely reported barriers these communities face in accessing mental health services. Through a comprehensive review of the literature, key strategies for addressing mental health disparities emphasize the importance of promoting social connectedness and dispositional mindfulness as protective factors. By integrating culturally responsive interventions, promoting mental health literacy, building resilience and coping skills, strengthening support systems, and advocating for policy changes, this article contributes to efforts aimed at reducing mental health inequities and promoting equitable access to care for all individuals affected by the pandemic.
Abstract
It is becoming well understood that insufficient sun exposure is a risk factor for many adverse health effects. Increased adverse health effects such as cancers and cardiovascular disease have been quantified with respect to measured levels of vitamin D, a marker for sun exposure. Most acquired vitamin D [measured as 25(OH)D level] is a result of ultraviolet radiation from sun exposure. Because of higher levels of melanin in the skin, individuals with darker skin obtain less vitamin D and other beneficial sun-produced biomolecules such as nitric oxide from a given amount of sun exposure. It is the purpose of this paper to report the published observed 25(OH)D levels in Black Americans and the correlated levels of adverse health effects. Our conclusion is that insufficient sun exposure is a major component of the observed health disparities between Black and White Americans, and that Black Americans can significantly attenuate these disparities by having enough additional sun exposure to raise their 25(OH)D levels to 30 ng/mL.
Natalia Neparidze, MD
Yale University School of Medicine New Haven, CT
Krystal W. Lau, PhD
Flatiron Health, New York, NY
Xiaoliang Wang, PhD
Flatiron Health, New York, NY
Scott Huntington, MD, MPH
Yale University School of Medicine New Haven, CT
Omer Jamy, MD
University of Alabama at Birmingham, Birmingham, AL
Gregory S. Calip, PharmD, MPH, PhD
Flatiron Health, New York, NY
Harsh Shah, DO
University of Utah, Huntsman Cancer Center, Salt Lake City, UT
Deborah M. Stephens, DO
University of Utah, Huntsman Cancer Center, Salt Lake City, UT
Rebecca Miksad, MD, MPH
Flatiron Health, New York, NY
Ravi B. Parikh, MD, MPP
University of Pennsylvania, Philadelphia, PA
Samuel Takvorian, MD, MSHP
University of Pennsylvania, Philadelphia, PA
Gaurav Goyal, MD
University of Alabama at Birmingham, Birmingham, AL
Erlene Seymour, MD
Flatiron Health, New York, NY
Abstract
Background: The COVID-19 pandemic impacted healthcare visit trends, transitioning care to utilize telemedicine. We aimed to investigate if the uptake in telemedicine during pandemic was equitable across racial groups for patients with hematologic malignancies.
Methods: Using the nationwide Flatiron Health electronic health record (EHR)-derived de-identified database we analyzed patients with diagnosis of acute myelogenous leukemia (AML), diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL), mantle cell lymphoma (MCL), chronic lymphocytic leukemia (CLL) or multiple myeloma (MM). Patients were categorized into treatment types within lines of therapy: outpatient (oral therapy and outpatient infusions combined with oral therapy) vs. inpatient treatments (chemotherapy, cellular therapy). Monthly visit rates were calculated as the number of visits (telemedicine or in-person [in-clinic treatment administration, vitals, and/or labs]) per active patient per 30-day standardized month. We used time-series forecasting methods on pre-pandemic monthly visit rate data (March 2016 – February 2020) to estimate projected counterfactual monthly visit rates between March 2020 – February 2021.Telemedicine uptake was descriptively analyzed over time (t).
Results: We included 18,924 active patients (2,394 Black and 16,530 White) and 884,504 visits (117,673 Black and 766,831 White). 4,053 AML, 3,468 diffuse large B cell lymphoma, 1,943 follicular lymphoma, 2,151 mantle cell lymphoma, 5,926 chronic lymphocytic leukemia and 7,752 myeloma patients. Black patients had no significant reductions in in-person visit rates throughout the pandemic period compared to the projected rates. Conversely, White patients experienced an 18% (95% PI 9.9% – 25%) lower rate of in-person visits for outpatient therapy during the early pandemic (March – May 2020) (actual monthly visit rate 1.61; projected visit rate 2.0 [95% CI 1.8-2.2]). Telemedicine uptake was significantly higher for White patients compared with Black patients for all diseases and treatment categories between March 2020-February 2021 (t = 9.5, p < 0.01), AML inpatient (t = 2.4, p = 0.04), MM outpatient (Figure 3C) (t = 6.0, p < 0.01) and MM inpatient treatment categories (Figure 3D) (t = 2.3, p = 0.04).
Conclusions: White patients had significantly higher telemedicine uptake compared with Black patients for all treatment categories. These findings challenge healthcare systems to direct efforts toward reducing the gap in healthcare access.
Malika Nipher, PhD, MPH
RAND Corporation, 1776 Main St., Santa Monica, CA 90401, USA
Roberts Lisa, DrPH, RN
Loma Linda University School of Nursing, 11262 Campus Street, West Hall, Loma Linda, CA 92350 USA
Alemi Qais, PhD, MPH, MBA
Loma Linda University, School of Behavioral Health, 11065 Campus St., Loma Linda, CA 92350
Casiano Carlos A, PhD
Center for Health Disparities and Molecular Medicine, Loma Linda University School of Medicine, 11085 Campus Street, Mortensen Hall, Loma Linda, CA 92350 USA
Montgomery Susanne, MS, MPH, PhD
Loma Linda University, School of Behavioral Health, 11065 Campus St., Loma Linda, CA 92350 USA ; Center for Health Disparities and Molecular Medicine, Loma Linda University School of Medicine, 11085 Campus Street, Mortensen Hall, Loma Linda, CA 92350 USA
Abstract
Objectives: The contribution of medical mistrust to healthcare utilization delays has been gaining increasing attention. However, few studies have examined these associations among subgroups of Black men (African Americans, Caribbean, and African immigrants) in relation to prostate cancer (PCa). This study addresses this gap by assessing how medical mistrust affects PCa screening behavior and to further understand perceptions of medical mistrust among subgroups of Black men.
Methods: This research employs a mixed-methods approach comprising two distinct phases. In Phase 1, a cross-sectional examination was conducted to evaluate the influence of medical mistrust toward healthcare organizations on prostate cancer screening among 498 Black men. In Phase 2, a qualitative investigation was undertaken to delve into the nuances of medical mistrust through six focus groups (n=51) and ten key informant interviews (n=10). Logistic regression and grounded theory methods were employed for data analysis.
Results: Quantitative findings unveiled disparities in mistrust among subgroups, with Caribbean immigrants exhibiting higher levels of medical mistrust. Nevertheless, individuals with a family history of PCa showed elevated likelihoods of undergoing screening, despite mistrust. Qualitative results revealed 1) differences in reasons for medical mistrust among Black subgroups, 2) cultural perceptions which influence medical mistrust and medical care seeking, 3) lack of education in relation to PCa that contributes to medical mistrust, 4) negative past experiences and poor provider communication contribute, and 5) when PCa directly affected one’s life, either personally or within the family, there was a recognized importance placed on monitoring one’s risk despite mistrust.
Conclusion: While medical mistrust may not significantly deter healthcare utilization among individuals with a family history or diagnosis of PCa, it underscores the variability of medical mistrust and its underlying reasons among different Black subgroups.
I. King Jordan
School of Biological Sciences, Georgia Institute of Technology, Atlanta, Georgia, USA; IHRC-Georgia Tech Applied Bioinformatics Laboratory, Atlanta, Georgia, USA; PanAmerican Bioinformatics Institute, Valle del Cauca, Cali, Colombia
Shivam Sharma
School of Biological Sciences, Georgia Institute of Technology, Atlanta, Georgia, USA
Shashwat Deepali Nagar
School of Biological Sciences, Georgia Institute of Technology, Atlanta, Georgia, USA
Leonardo Mariño-Ramírez
PanAmerican Bioinformatics Institute, Valle del Cauca, Cali, Colombia; National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA
Abstract
Fifty years ago, Richard Lewontin found that the vast majority of human genetic variation falls within (~85%) rather than between (~15%) racial groups. This result has been replicated numerous times since and is widely taken to support the notion that genetic differences between racial groups are trivial and thus irrelevant for clinical decision-making. The aim of this study was to consider how the apportionment of pharmacogenomic variation within and between racial and ethnic groups relates to risk disparities for adverse drug reactions. We confirmed that the majority of pharmacogenomic variation falls within (97.3%) rather than between (2.78%) the three largest racial and ethnic groups in the United States: Black, Hispanic, and White. Nevertheless, pharmacogenomic variants showing far greater within than between-group variation can have high predictive value for adverse drug reactions, particularly for minority racial and ethnic groups. We predicted excess adverse drug reactions for minority Black and Hispanic groups, compared to the majority White group, and considered these results in light of the apportionment of genetic variation within and between groups. For 85% within and 15% between group variation, there are 700 excess adverse drug reactions per 1,000 patients predicted for a recessive effect model and 300 for a dominant model. We found high numbers of predicted Black and Hispanic excess adverse drug reactions for widely prescribed platinum chemotherapy compounds, such as cisplatin and oxaliplatin, as well as controlled narcotics, including fentanyl and tramadol. Our results indicate that race and ethnicity, while imprecise proxies for genetic diversity, correlate with patterns of pharmacogenomic variation in a way that is clearly relevant to medical treatment decisions. The effects of this variation is particularly pronounced for Black and Hispanic minority groups, owing to genetic differences from the majority White group. Treatment decisions that are made based on (assumed) White pharmacogenomic variant frequencies can be harmful for minority groups. Ignoring clinically relevant genetic differences among racial and ethnic groups, however well-intentioned, will exacerbate rather than ameliorate health disparities.
Morgan Gianola
University of Miami, Department of Psychology
Maria M. Llabre
University of Miami, Department of Psychology
Linda C. Gallo
San Diego State University, Department of Psychology
Martha L. Daviglus
University of Illinois, College of Medicine
Daniela Sotres-Alvarez
University of North Carolina, Department of Biostatistics
Neil Schneiderman
University of Miami, Department of Psychology
Abstract
Stress and stressful events are widely accepted risk factors for cardiometabolic diseases, including coronary heart disease and diabetes. As language plays a seminal role in development and regulation of emotions and appraisals of stressful situations, it may contribute to documented differences in the stress-cardiometabolic disease association across ethnic groups. We investigated associations between language preferences (Spanish vs English) and downstream health consequences of stress. Using data from the Sociocultural Ancillary Study of the Hispanic Community Health Study/Study of Latinos, we assessed the relationship between reported stress and risk factors (alcohol use, smoking, body mass index, depressive symptoms) and prevalence of self-reported (coronary heart disease, stroke, chronic obstructive pulmonary disease [COPD]) and clinically assessed chronic conditions (diabetes, hypertension) among 5154 Hispanic/Latino adults living in the US. Factor analysis was used to calculate a composite stress variable from participants’ self-reported chronic stress, perceived stress, and adverse childhood experiences. Sampling weights and survey methodology were integrated in all analyses to account for this study’s complex survey design. After controlling for sociodemographic factors (Hispanic/Latino background, study site, years in the US, social acculturation, education, income, age, sex), higher composite stress scores were associated with elevated risk factors and greater prevalence of coronary heart disease, diabetes, and COPD. Furthermore, the relationship between stress and COPD was significantly stronger among Hispanic/Latino adults who preferred to be interviewed in Spanish (compared to English). Stronger connections between stress and likelihood of drinking alcohol among English-preferring persons also emerged. These results are interpreted in light of the Hispanic health paradox and the role of cultural processes in the development of health risk factors and chronic conditions. Our findings can be integrated into relevant approaches to address health disparities within and across Hispanic/Latino populations in the US.
Holmes L Jr.
Global Epigenomic Research Analytics, Wilmington, DE 19802; Biological Sciences Department, University of Delaware, Newark, DE 19716
Deepika K
Global Epigenomic Research Analytics, Wilmington, DE 19802
Williams J
Global Epigenomic Research Analytics, Wilmington, DE 19802; SUNY Downstate Health Sciences University, Brooklyn, NY 11203
Chinaka C
Global Epigenomic Research Analytics, Wilmington, DE 19802
John V
Global Epigenomic Research Analytics, Wilmington, DE 19802
Ogundele B
Global Epigenomic Research Analytics, Wilmington, DE 19802
Okundaye O
Global Epigenomic Research Analytics, Wilmington, DE 19802
Philipcien G
Victoria Hospital, Castries, St. Lucia W.I
Poleon M
Global Epigenomic Research Analytics, Wilmington, DE 19802
Thompson J
Compliance Resources Network, Houston, TX 77449
Enwere M
Global Epigenomic Research Analytics, Wilmington, DE 19802
Ward D
Medical College of Wisconsin, CTSI, Milwaukee, WI
Picolli T
Global Epigenomic Research Analytics, Wilmington, DE 19802
Comeaux C R
Global Epigenomic Research Analytics, Wilmington, DE 19802; Florida A&M University, Tallahassee, FL 32307
Shikha Jain
MVJ Medical College, Hoskote, Karnataka, India
Naresh Dasari
Medicine and Longterm care Associates, Cranston, RI 02920
Ram Sanjiv Alur
Marion Veterans affairs medical center, IL
Ramesh Adhikari
Franciscan Health, Lafayette, IN 47909
Gbadebo O Ogungbade
Global Health Services Initiatives Inc, 1600 Nandina Dr, Arlington, TX 76014
Abstract
Background: Historically, populations with deprived optimal care, preventive health services, value-based care, and low socio-economic status with marginalized social hierarchy had been observed with poor health outcomes and excess mortality during pandemics. The current COVID-19 global pandemic mirrors the flu pandemic of 1918, where the social gradient predicted the disproportionate burden of mortality among blacks in the United States (US). The current study aimed to assess the racial differentials in SARS-Cov-2 case positivity, case fatality and mortality in Washington DC, US as well as the potential explanatory model therein.
Materials and Methods: A cross-sectional ecologic design was used to examine the COVID-19 data from the Washington DC Department of Health (https://coronavirus.dc.gov/data ) by race/ethnicity, sex, ward (geographic locale), and age. This predictive model examined the pre- (November, 2020) and post-thanksgiving (December, 2020) data for trends. While the variables examined were in aggregate data format, chi square statistic and binomial regression models were used for variable characterization by race and mortality risk race prediction respectively.
Results: During late November, the SARS-Cov-2 case positivity in Washington DC was higher among Blacks/AA (n=9,441(46.7%)) relative to Whites, 4603 (22.8%). With respect to Hispanics, the SARS-Cov-2 case positivity was 4,853 (24.1%) and 13,477 (66.9%) among non-Hispanics. With respect to COVID-19 mortality, this was lowest among non-Hispanic Whites (NHW), 1.50%, intermediate among Hispanics (1.81%), and highest among non-Hispanic Blacks (NHB), 5.30%. There was sex differential in mortality cumulative incidence (CmI), with males (57.0%) compared to females (43.0%) illustrating higher mortality. The mortality CmI by age was lowest among cases, 20-29 years (6.4%), intermediate among cases, 50-69 years (36.3%) and highest among individuals, 70 years and older, 58.7%. With respect to the geographic locale (DC-Ward), the mortality CmI was higher in DC- Wards 4-6 (39.3%) and wards DC-7-8 (35.4%) but lower in DC-Wards 1-3 (22.1%). The mortality risk from COVID-19 illustrated racial/ethnic differentials. Relative to NHW in Washington DC, NHB were almost 4 times as likely to die from COVID-19 in November 2020 prior to Thanksgiving, prevalence odds ratio, (pOR)=3.62, 95%CI, 2.78-4.73, Attributable fraction of exposed (AFE),72%, while Hispanics were 25% more likely to die, Hispanics, pOR=1.25, 95%CI, 1.0-1.74, AFE(18%).
During the first week in December, post –thanksgiving period, the SARS-Cov-2 case positivity was lower among Whites (n, 5719, (23.0%)) compared to Blacks/AA, 11,218 (47%). The CmI mortality was highest among NHB, n=521 (74%), intermediate among Hispanics, n=93 (13.2%) and lowest among NHW, n=72, (10.2%). Similarly, there was racial differential in mortality risk,with increased risk observed among Blacks/AA, relative to their White counterparts in DC. Compared to Whites, Blacks/AA were 4 times as likely to die from COVID-19, pOR=4.00, 95%CI, 2.87-4.80, AFE (73%).
Conclusions: There were racial/ethnic disparities in SARS-Cov-2 case positivity, COVID-19 mortality and mortality risk, which was higher among Blacks/AA relative to their White counterparts in Washington DC. Additionally, mortality was higher in male compared to female as well as DC-ward variation by mortality.
Morgan Gianola
University of Miami, Department of Psychology
Maria M. Llabre
University of Miami, Department of Psychology
Linda C. Gallo
San Diego State University, Department of Psychology
Martha L. Daviglus
University of Illinois, College of Medicine
Daniela Sotres-Alvarez
University of North Carolina, Department of Biostatistics
Neil Schneiderman
University of Miami, Department of Psychology
Abstract
Stress and stressful events are widely accepted risk factors for cardiometabolic diseases, including coronary heart disease and diabetes. As language plays a seminal role in development and regulation of emotions and appraisals of stressful situations, it may contribute to documented differences in the stress-cardiometabolic disease association across ethnic groups. We investigated associations between language preferences (Spanish vs English) and downstream health consequences of stress. Using data from the Sociocultural Ancillary Study of the Hispanic Community Health Study/Study of Latinos, we assessed the relationship between reported stress and risk factors (alcohol use, smoking, body mass index, depressive symptoms) and prevalence of self-reported (coronary heart disease, stroke, chronic obstructive pulmonary disease [COPD]) and clinically assessed chronic conditions (diabetes, hypertension) among 5154 Hispanic/Latino adults living in the US. Factor analysis was used to calculate a composite stress variable from participants’ self-reported chronic stress, perceived stress, and adverse childhood experiences. Sampling weights and survey methodology were integrated in all analyses to account for this study’s complex survey design. After controlling for sociodemographic factors (Hispanic/Latino background, study site, years in the US, social acculturation, education, income, age, sex), higher composite stress scores were associated with elevated risk factors and greater prevalence of coronary heart disease, diabetes, and COPD. Furthermore, the relationship between stress and COPD was significantly stronger among Hispanic/Latino adults who preferred to be interviewed in Spanish (compared to English). Stronger connections between stress and likelihood of drinking alcohol among English-preferring persons also emerged. These results are interpreted in light of the Hispanic health paradox and the role of cultural processes in the development of health risk factors and chronic conditions. Our findings can be integrated into relevant approaches to address health disparities within and across Hispanic/Latino populations in the US.
