• 【在美国,降低大肠癌发病率和阶段的黑白差异。】 复制标题 收藏 收藏
    DOI:10.1158/1055-9965.EPI-16-0834 复制DOI
    作者列表:May FP,Glenn BA,Crespi CM,Ponce N,Spiegel BMR,Bastani R
    BACKGROUND & AIMS: :Background: There are long-standing black-white disparities in colorectal cancer incidence and outcomes in the United States. Incidence and stage at diagnosis reflect the impact of national efforts directed at colorectal cancer prevention and control. We aimed to evaluate trends in black-white disparities in both indicators over four decades to inform the future direction of prevention and control efforts.Methods: We used Surveillance, Epidemiology, & End Results (SEER) data to identify whites and blacks with histologically confirmed colorectal cancer from January 1, 1975 through December 31, 2012. We calculated the age-adjusted incidence and the proportion of cases presenting in late stage by race and year. We then calculated the annual percentage change (APC) and average APC for each indicator by race, examined changes in indicators over time, and calculated the incidence disparity for each year.Results: There were 440,144 colorectal cancer cases from 1975 to 2012. The overall incidence decreased by 1.35% and 0.46% per year for whites and blacks, respectively. Although the disparity in incidence declined from 2004 to 2012 (APC = -3.88%; P = 0.01), incidence remained higher in blacks in 2012. Late-stage disease declined by 0.27% and 0.45% per year in whites and blacks, respectively. The proportion of late-stage cases became statistically similar in whites and blacks in 2010 (56.60% vs. 56.96%; P = 0.17).Conclusions: Black-white disparities in colorectal cancer incidence and stage at presentation have decreased over time.Impact: Our findings reflect the positive impact of efforts to improve colorectal cancer disparities and emphasize the need for interventions to further reduce the incidence gap. Cancer Epidemiol Biomarkers Prev; 26(5); 762-8. ©2016 AACR.
    背景与目标: 背景:在美国,结直肠癌的发病率和结局存在长期的黑白差异。诊断的发生率和阶段反映了针对大肠癌预防和控制的国家努力的影响。我们旨在评估四个指标中黑白差异的趋势,以期为未来的预防和控制工作指明方向。方法:我们使用监测,流行病学和最终结果(SEER)数据来识别经组织学确认的白人和黑人1975年1月1日至2012年12月31日的大肠癌。我们按种族和年份计算了年龄调整后的发病率和晚期病例的比例。然后,我们按种族计算了每个指标的年度百分比变化(APC)和平均APC,检查了指标随时间的变化,并计算了每年的发病率差异。结果:从1975年到2012年,有440,144例大肠癌病例。总体白人和黑人的发病率每年分别下降1.35%和0.46%。尽管从2004年到2012年发病率差异有所下降(APC = -3.88%; P = 0.01),但2012年黑人发病率仍较高。白人和黑人的晚期疾病每年分别下降0.27%和0.45%。 2010年白人和黑人的晚期病例比例在统计学上相似(56.60%vs.56.96%; P = 0.17)。结论:随着时间的推移,大肠癌发病率和分期中的黑白差异有所减少。我们的发现反映了改善大肠癌差异的努力的积极影响,并强调了采取干预措施以进一步减少发病率差距的必要性。癌症流行病生物标志物26(5); 762-8。 ©2016 AACR。
  • 【美国2型糖尿病患者在初级保健质量方面与保险有关的差异。】 复制标题 收藏 收藏
    DOI:10.1186/s12939-016-0413-x 复制DOI
    作者列表:Lee DC,Liang H,Shi L
    BACKGROUND & AIMS: BACKGROUND:This study explored insurance-related disparities in primary care quality among Americans with type 2 diabetes. METHODS:Data came from the household component of the 2012 Medical Expenditure Panel Survey (MEPS). Analysis focused on adult subjects with type 2 diabetes. Logistic regressions were performed to investigate the associations between insurance status and primary care attributes related to first contact, longitudinality, comprehensiveness, and coordination, while controlling for confounding factors. RESULTS:Preliminary findings revealed differences among three insurance groups in the first contact domain of primary care quality. After controlling for confounding factors, these differences were no longer apparent, with all insurance groups reporting similar primary care quality according to the four domains of interest in the study. There were significant differences in socioeconomic status among different insurance groups. CONCLUSION:This study reveals equitable primary care quality for diabetes patients despite their health insurance status. In addition to insurance-related differences, the other socioeconomic stratification factors are assumed to be the root cause of disparities in care. This research emphasizes the crucial role that primary care plays in the accessibility and quality of care for chronically ill patients. Policy makers should continue their commitment to reduce gaps in insurance coverage and improve access as well as quality of diabetic care.
    背景与目标: 背景:本研究探讨了美国2型糖尿病患者在保险方面的基本医疗质量差异。
    方法:数据来自2012年医疗支出小组调查(MEPS)的家庭部分。分析集中于患有2型糖尿病的成人受试者。进行逻辑回归分析,以调查保险状况与与首次接触,纵向,全面性和协调性相关的初级保健属性之间的关联,同时控制混杂因素。
    结果:初步发现显示,在初级保健质量的首次接触领域中,三个保险集团之间存在差异。在控制了混杂因素之后,这些差异不再明显,根据研究的四个领域,所有保险集团都报告了相似的初级保健质量。不同保险集团之间的社会经济地位存在显着差异。
    结论:本研究揭示了尽管糖尿病患者具有健康保险状态,但他们仍享有公平的初级保健质量。除了与保险有关的差异外,其他社会经济分层因素也被认为是医疗服务差异的根本原因。这项研究强调了初级保健在慢性病患者的可及性和医疗质量中的关键作用。决策者应继续致力于减少保险覆盖率的差距,并改善糖尿病护理的可及性和质量。
  • 【博茨瓦纳新出现的卫生差距:在艾滋病流行期间检查孤儿的状况。】 复制标题 收藏 收藏
    DOI:10.1016/j.socscimed.2007.03.002 复制DOI
    作者列表:Miller CM,Gruskin S,Subramanian SV,Heymann J
    BACKGROUND & AIMS: :Botswana has the second highest HIV prevalence rate and highest rate of orphanhood in the world. Although child mortality rates have doubled in 15 years, the extent to which health disparities are connected to orphan status remains unclear. We conducted an analysis of the 2000 Botswana Multiple Indicator Cluster Survey to examine whether orphan-based health disparities exist. We measured health inequalities using anthropometric data among 2723 under-five year olds, nested in 1854 households, and 208 communities. We calculated multilevel logistic regression models to estimate the child, household, and regional determinants of growth failure. We found that orphaned children aged 0-4 are 49% more likely to be underweight than nonorphans (p<0.05) controlling for household poverty and other factors; and orphans disproportionately live in the poorest households. Throughout sub-Saharan Africa (SSA), Botswana is a leader in responding to the AIDS epidemic, in particular as one of the first countries to offer universal antiretroviral treatment. However, orphan-based health disparities confirm that the orphan response is still insufficient. Better data are needed to fully understand the mechanisms that lead to these disparities, and the public sector needs an increased capacity to fully implement the policies and programs designed to meet the needs of orphans. Findings from this study have important implications for countries throughout SSA, and Southern Africa in particular, where the number of orphans has doubled to tripled over the past 15 years.
    背景与目标: :博茨瓦纳的艾滋病毒感染率是全球第二高,孤儿率最高。尽管儿童死亡率在15年内翻了一番,但健康差异与孤儿状况有关的程度仍不清楚。我们对2000年博茨瓦纳多指标类集调查进行了分析,以检查是否存在基于孤儿的健康差异。我们使用人体测量学数据测量了2854名1854个家庭和208个社区的5岁以下儿童的健康不平等状况。我们计算了多级逻辑回归模型来估计儿童,家庭和区域性成长失败的决定因素。我们发现,在控制家庭贫困和其他因素的情况下,0-4岁的孤儿比非孤儿的体重过轻的可能性高49%(p <0.05);孤儿不成比例地生活在最贫穷的家庭中。在整个撒哈拉以南非洲地区(SSA),博茨瓦纳是应对艾滋病流行的领导者,特别是作为首批提供普遍抗逆转录病毒治疗的国家之一。但是,基于孤儿的健康差异证实了孤儿的反应仍然不足。需要更好的数据来充分理解导致这种差距的机制,公共部门需要增强能力,以充分执行旨在满足孤儿需求的政策和方案。这项研究的发现对整个撒哈拉以南非洲地区尤其是南部非洲的国家都具有重要意义,在过去的15年中,这些国家的孤儿人数翻了一番,达到了两倍。
  • 【疗养院居民中流感和肺炎球菌疫苗接种中的种族/种族差异:系统评价。】 复制标题 收藏 收藏
    DOI:10.1093/geront/gnw193 复制DOI
    作者列表:Travers JL,Schroeder KL,Blaylock TE,Stone PW
    BACKGROUND & AIMS: :This systematic review analyzes research examining racial/ethnic disparities in influenza and pneumococcal vaccination coverage between White and racial/ethnic minority (Black and Hispanic) nursing home residents. A review of the literature for years 1966-2014 using Medline, Web of Science, and PubMed was conducted. The Epidemiological Appraisal Instrument was used to appraise the quality of the 13 included studies. Overall, articles were strong in reporting and data analysis, but weak in sample selection and measurement quality. Disparities between vaccination coverage among racial/ethnic minorities versus Whites ranged from 2% to 20% for influenza and 6% to 15% for pneumococcal vaccination. Researchers reported racial/ethnic minorities were more likely to refuse vaccinations and less likely to have vaccinations offered and their vaccination status tracked compared to Whites. Policies/strategies that focus on ensuring racial/ethnic minorities are offered influenza and pneumococcal vaccinations and their vaccination status are tracked in nursing homes are warranted. Updated evaluation on vaccination disparities is also needed.
    背景与目标: :这篇系统的综述分析了研究白人和种族/少数民族(黑人和西班牙裔)疗养院居民之间在流感和肺炎球菌疫苗接种覆盖率方面的种族/种族差异。使用Medline,Web of Science和PubMed对1966-2014年的文献进行了回顾。流行病学评估工具用于评估13项纳入研究的质量。总体而言,文章在报告和数据分析方面表现出色,但在样品选择和测量质量方面表现不佳。种族/族裔少数民族与白人之间的疫苗接种覆盖率之间的差异在流感的2%至20%和肺炎球菌疫苗的6%至15%之间。研究人员报告说,与白人相比,种族/族裔少数群体拒绝接种疫苗的可能性更高,提供疫苗接种的可能性也更低,并且追踪其接种状况的可能性也较小。着重确保向种族/族裔少数群体提供流感和肺炎球菌疫苗的政策/策略应得到保证,并在疗养院中跟踪其疫苗接种状况。还需要对疫苗接种差异进行最新评估。
  • 【美国胸科学会和欧洲呼吸学会的正式政策声明:呼吸健康方面的差异。】 复制标题 收藏 收藏
    DOI:10.1183/09031936.00062113 复制DOI
    作者列表:Schraufnagel DE,Blasi F,Kraft M,Gaga M,Finn P,Rabe KF
    BACKGROUND & AIMS: :Health disparities, defined as a significant difference in health between populations, are more common for diseases of the respiratory system than for those of other organ systems, because of the environmental influence on breathing and the variation of the environment among different segments of the population. The lowest social groups are up to 14 times more likely to have respiratory diseases than are the highest. Tobacco smoke, air pollution, environmental exposures, and occupational hazards affect the lungs more than other organs and occur disproportionately in ethnic minorities and those with lower socioeconomic status. Lack of access to quality healthcare contributes to disparities. The executive committees of the American Thoracic Society (ATS) and European Respiratory Society (ERS) established a writing committee to develop a policy on health disparities. The document was reviewed, edited, and approved by their full executive committees and boards of directors of the societies. This document expresses a policy to address health disparities by promoting scientific inquiry and training, disseminating medical information and best practices, and monitoring and advocating for public respiratory health. The ERS and the ATS have strong international commitments and work with leaders from governments, academia, and other organisational bodies to address and reduce avoidable health inequalities. Their training initiatives improve the function of healthcare systems and health equality. Both the ATS and the ERS support all aspects of this document, confer regularly, and act together when possible, but the activities to bring about change may vary because of the differences in the continents where the two organisations carry out most of their activities. The ATS and ERS pledge to frame their actions to reduce respiratory health disparities. The vision of the ATS and ERS is that all persons attain better and sustained respiratory health. They call on all their members and other societies to join in this commitment.
    背景与目标: :由于人口对环境的影响以及不同人群之间环境的变化,健康差异被定义为人群之间健康的显着差异,因此呼吸系统疾病比其他器官系统更常见。最低的社会群体患呼吸道疾病的可能性是最高的群体的14倍。烟草烟雾,空气污染,环境暴露和职业危害对肺部的影响比其他器官更多,并且在少数民族和社会经济地位较低的人群中不成比例地发生。缺乏优质医疗保健的机会加剧了差距。美国胸科学会(ATS)和欧洲呼吸学会(ERS)的执行委员会成立了一个写作委员会,以制定有关健康差异的政策。该文件由其整个执行委员会和协会董事会进行了审核,编辑和批准。该文件表达了一项政策,旨在通过促进科学探究和培训,传播医学信息和最佳实践以及监测和倡导公共呼吸健康来解决健康差异。 ERS和ATS拥有强大的国际承诺,并与政府,学术界和其他组织机构的领导人合作,以解决和减少可避免的健康不平等现象。他们的培训计划改善了医疗保健系统的功能和健康平等。 ATS和ERS都支持本文档的各个方面,定期举行会议,并在可能的情况下共同行动,但是,由于两个组织执行其大部分活动的大陆不同,因此带来变革的活动可能会有所不同。 ATS和ERS承诺采取行动减少呼吸系统健康差异。 ATS和ERS的愿景是所有人都能获得更好和持续的呼吸健康。他们呼吁所有成员和其他社会加入这一承诺。
  • 【传染病的产前筛查:加州差异和政策遵守情况的分析。】 复制标题 收藏 收藏
    DOI:10.1007/s10995-008-0341-5 复制DOI
    作者列表:Sheikh LA,Sarnquist C,Grieb EM,Sullivan B,Maldonado YA
    BACKGROUND & AIMS: OBJECTIVES:Prenatal infectious diseases are a major cause of mortality and morbidity among newborns, but many are preventable with proper maternal screening and treatment. METHODS; Adherence to prenatal infectious disease screening guidelines and demographic factors that influence adherence were determined utilizing existing data on 1837 live births from 1999-2003. RESULTS:We found higher rates of testing for syphilis (94.54%), rubella (92.69%) and hepatitis B (94.23%) than for HIV (73.82%) and GBS (69.05%). Adherence to testing guidelines varied by both disease and maternal factors. Lack of insurance, geographic location, inadequate prenatal care and incarceration were the main maternal factors associated with lack of testing. CONCLUSIONS:Disease screening rates may be improved by reducing socioeconomic barriers to prenatal testing, supporting access to insurance, eliminating provider biases and providing adequate prenatal care.
    背景与目标: 目的:产前传染病是新生儿死亡和发病的主要原因,但通过适当的母亲筛查和治疗可以预防许多疾病。方法;利用1999-2003年间1837例活产的现有数据,确定是否遵守产前传染病筛查指南和影响依从性的人口统计学因素。
    结果:我们发现梅毒(94.54%),风疹(92.69%)和乙型肝炎(94.23%)的检测率高于HIV(73.82%)和GBS(69.05%)的检测率。遵循测试指南的情况因疾病和孕产妇因素而异。缺乏保险,地理位置,产前护理不足和监禁是缺乏检测的主要产妇因素。
    结论:可以通过减少产前检查的社会经济障碍,支持获得保险,消除医疗服务提供者的偏见以及提供适当的产前保健来提高疾病筛查率。
  • 【减少口腔健康差异:关注社会和文化决定因素。】 复制标题 收藏 收藏
    DOI:10.1186/1472-6831-6-S1-S4 复制DOI
    作者列表:Patrick DL,Lee RS,Nucci M,Grembowski D,Jolles CZ,Milgrom P
    BACKGROUND & AIMS: :Oral health is essential to the general health and well-being of individuals and the population. Yet significant oral health disparities persist in the U.S. population because of a web of influences that include complex cultural and social processes that affect both oral health and access to effective dental health care. This paper introduces an organizing framework for addressing oral health disparities. We present and discuss how the multiple influences on oral health and oral health disparities operate using this framework. Interventions targeted at different causal pathways bring new directions and implications for research and policy in reducing oral health disparities.
    背景与目标: :口腔健康对于个人和人群的整体健康和福祉至关重要。然而,由于一系列影响因素(包括影响口腔健康和获得有效牙齿保健服务的复杂的文化和社会过程),美国人口中仍然存在严重的口腔健康差异。本文介绍了解决口腔健康差异的组织框架。我们介绍并讨论如何使用此框架对口腔健康和口腔健康差异产生多重影响。针对不同因果途径的干预措施对减少口腔健康差异的研究和政策提出了新的方向和启示。
  • 【脊髓损伤后结局方面的种族差异。】 复制标题 收藏 收藏
    DOI:10.1089/neu.2012.2540 复制DOI
    作者列表:Lad SP,Umeano OA,Karikari IO,Somasundaram A,Bagley CA,Gottfried ON,Isaacs RE,Ugiliweneza B,Patil CG,Huang K,Boakye M
    BACKGROUND & AIMS: :Spinal Cord Injury (SCI) is an acute trauma to the neural elements resulting in temporary or permanent sensory and motor deficit. Studies have indicated that although 66% of SCI occur in Caucasians, there are a growing number of other racial groups affected by SCI. Furthermore, there has been a lack of research concerning racial disparities in outcomes following SCI. As such, a retrospective analysis using the National Trauma Data Bank (NTDB) from 2000 to 2009 was performed. African Americans, Caucasians, Hispanics, Asians, and Native Americans were included in the study. We calculated adjusted odds ratios (OR) to examine the relationship between racial backgrounds and mortality, length of intensive care unit (ICU) stay, length of hospital stay, in-hospital complications, and patient disposition. Our results showed that significant differences were found in length of hospital stay, with African American and Hispanic populations having longer hospital stays than Caucasian and Asians. For all type complications, African Americans (OR 1.228, confidence interval [CI] 1.11-1.356) and Native Americans (OR 1.618, CI 1.083-2.419) were more likely than Caucasian and Hispanic patients to have in-hospital complications. For disposition status, African Americans (OR 0.844, CI 0.730-0.976) and Asians (OR 0.475, CI 0.297-0.760) were much less likely than Caucasians or Hispanic populations to be discharged to an acute rehabilitation program. The results from this large-scale study (n=18,671) demonstrate a number of racial disparities following SCI at the national level, including rate of complications, length of stay, and disposition to acute rehabilitation centers. This should raise awareness to cultural differences but also serve as an opportunity to reduce gaps in care across ethnicities for this universally life-altering condition.
    背景与目标: :脊髓损伤(SCI)是神经元的急性损伤,导致暂时或永久的感觉和运动障碍。研究表明,尽管66%的SCI发生在高加索人中,但仍有越来越多的其他种族受到SCI的影响。此外,缺乏关于SCI后结局中种族差异的研究。因此,使用国家创伤数据库(NTDB)对2000年至2009年进行了回顾性分析。这项研究包括非裔美国人,高加索人,西班牙裔,亚裔和美洲原住民。我们计算了校正后的优势比(OR),以检查种族背景与死亡率,重症监护病房(ICU)住院时间,住院时间,医院内并发症以及患者处置之间的关系。我们的结果表明,住院时间的长短存在显着差异,非洲裔美国人和西班牙裔人的住院时间比白种人和亚洲人长。对于所有类型的并发症,非洲裔美国人(OR 1.228,置信区间[CI] 1.11-1.356)和美洲印第安人(OR 1.618,CI 1.083-2.419)比白种人和西班牙裔患者更有可能发生院内并发症。就处置状态而言,非裔美国人(OR 0.844,CI 0.730-0.976)和亚洲人(OR 0.475,CI 0.297-0.760)被排除在白人或拉美裔人群的急性康复计划之外的可能性要小得多。这项大规模研究的结果(n = 18,671)表明,在国家一级实施SCI后,存在许多种族差异,包括并发症发生率,住院时间和对急性康复中心的处置。这应该提高人们对文化差异的认识,同时也为减少这种普遍改变生活状况的族裔之间在照料方面的差距提供机会。
  • 【解决美国和全球大肠癌筛查率和差异的策略和资源。】 复制标题 收藏 收藏
    DOI:10.1146/annurev-publhealth-031912-114436 复制DOI
    作者列表:Potter MB
    BACKGROUND & AIMS: :Colorectal cancer is a significant cause of mortality in the United States and globally. In the United States, increased access to screening and effective treatment has contributed to a reduction in colorectal cancer incidence and mortality for the general population, though significant disparities persist. Worldwide, the disparities are even more pronounced, with vastly different colorectal cancer mortality rates and trends among nations. Newly organized colorectal cancer screening programs in economically developed countries with a high burden of colorectal cancer may provide pathways to reduce these disparities over time. This article provides an overview of colorectal cancer incidence, mortality, screening, and disparities in the United States and other world populations. Promising strategies and resources are identified to address colorectal cancer screening rates and disparities in the United States and worldwide.
    背景与目标: 在美国和全球,结直肠癌是导致死亡的重要原因。在美国,尽管仍然存在重大差距,但增加筛查和有效治疗的机会有助于降低普通人群的结直肠癌发病率和死亡率。在世界范围内,这种差异更加明显,各国之间大肠癌的死亡率和趋势存在很大差异。在经济发达的国家中,结直肠癌负担很重的新组织的结直肠癌筛查计划可能会为减少这些差异提供途径。本文概述了美国和其他世界人群中大肠癌的发病率,死亡率,筛查和差异。确定有前途的策略和资源来解决美国和全球范围内的大肠癌筛查率和差异。
  • 【中老年人和以色列成年人在残疾方面的种族差异:社会经济劣势和创伤性生活事件的作用。】 复制标题 收藏 收藏
    DOI:10.1177/0898264313478653 复制DOI
    作者列表:Osman A,Walsemann KM
    BACKGROUND & AIMS: OBJECTIVE:We examined the contribution of socioeconomic disadvantage and traumatic life events to ethnic disparities in disability among Israeli adults. METHOD:We used data from the Survey of Health, Aging and Retirement in Europe (SHARE-Israel), a sample of Israeli adults aged 50 or older (N = 1,546). Disability measures included functional limitations, limitations in activities of daily living (ADL), and limitations in instrumental activities of daily living (IADL). RESULTS:Arabs and immigrants from the Former Soviet Union (FSU) experienced higher rates of functional limitations and limitations in IADLs compared to veteran Jews. The rate of having limitations in ADLs was similar for Arabs and veteran Jews, but was higher for FSU immigrants compared to veteran Jews. Inclusion of education, income, and traumatic life events attenuated, but did not eliminate ethnic disparities in disability. DISCUSSION:Identifying factors driving ethnic health disparities in Israel is imperative if we hope to achieve health equity.
    背景与目标: 目的:我们研究了社会经济劣势和创伤性生活事件对以色列成年人中残疾人种族差异的影响。
    方法:我们使用了来自欧洲健康,老龄化和退休调查(SHARE-以色列)的数据,该数据是年龄在50岁或以上(N = 1,546)的以色列成年人的样本。残疾措施包括功能限制,日常生活活动的限制(ADL)和日常生活活动的限制(IADL)。
    结果:与经验丰富的犹太人相比,来自前苏联(FSU)的阿拉伯人和移民经历了更高的功能限制和IADL限制。阿拉伯人和经验丰富的犹太人对ADL的限制率相似,但与经验丰富的犹太人相比,FSU移民的ADL受到限制的比率更高。对教育,收入和创伤性生活事件的包容性减弱了,但并没有消除残疾方面的种族差异。
    讨论:如果我们希望实现健康平等,必须确定导致以色列种族健康差异的因素。
  • 【健康方面的歧视和种族差异:证据和需要的研究。】 复制标题 收藏 收藏
    DOI:10.1007/s10865-008-9185-0 复制DOI
    作者列表:Williams DR,Mohammed SA
    BACKGROUND & AIMS: :This paper provides a review and critique of empirical research on perceived discrimination and health. The patterns of racial disparities in health suggest that there are multiple ways by which racism can affect health. Perceived discrimination is one such pathway and the paper reviews the published research on discrimination and health that appeared in PubMed between 2005 and 2007. This recent research continues to document an inverse association between discrimination and health. This pattern is now evident in a wider range of contexts and for a broader array of outcomes. Advancing our understanding of the relationship between perceived discrimination and health will require more attention to situating discrimination within the context of other health-relevant aspects of racism, measuring it comprehensively and accurately, assessing its stressful dimensions, and identifying the mechanisms that link discrimination to health.
    背景与目标: :本文提供了关于歧视和健康感知的实证研究的回顾和批判。健康方面种族差异的模式表明,种族主义可以通过多种方式影响健康。感知的歧视就是这样一种途径,本文回顾了发表于2005年至2007年间PubMed上有关歧视与健康的研究。这项最新研究继续证明歧视与健康之间存在反比关系。现在,这种模式在更广泛的背景下和更广泛的结果中显而易见。增进我们对感知到的歧视与健康之间关系的理解,将需要更多地注意在种族主义其他与健康有关的其他方面确定歧视,进行全面和准确的衡量,评估其压力范围以及确定将歧视与健康联系起来的机制。
  • 【全国医疗补助接受者样本中抑郁症的治疗和治疗类型的种族和种族差异。】 复制标题 收藏 收藏
    DOI:10.1176/appi.ps.201900407 复制DOI
    作者列表:McGregor B,Li C,Baltrus P,Douglas M,Hopkins J,Wrenn G,Holden K,Respress E,Gaglioti A
    BACKGROUND & AIMS: OBJECTIVE:The purpose of this secondary data analysis was to describe racial-ethnic disparities in receipt of depression treatment and treatment modality among adult Medicaid beneficiaries with depression from a nationally representative sample-28 states and the District of Columbia-of Medicaid beneficiaries (N=599,421). METHODS:Medicaid claims data were extracted from the full 2008-2009 Medicaid Analytic Extract file. The primary outcome was type of depression treatment: medication only, therapy only, medication and therapy, and no treatment. The secondary outcome was treatment for depression (yes-no). Crude and adjusted odds ratios (AORs) were generated for univariate and multivariate models, respectively, and 95% confidence intervals of odds ratios and p values were calculated. RESULTS:There were 599,421 individuals in the sample. Rates of depression treatment were lower for African Americans and Hispanics, compared with Caucasians. Percentages receiving no treatment were 19.9% of African Americans, 15.2% of Hispanics, and 11.9% of Caucasians. After full adjustment, African Americans were about half as likely as Caucasians to receive treatment (AOR=0.52), Hispanics were about a third as likely (AOR=0.71), and those from other racial-ethnic groups were about a fifth as likely (AOR=0.84). Caucasians were more likely than any other group to receive medication only. CONCLUSIONS:This study contributes to evidence about the intersection of social factors and health outcomes and discusses health care engagement, stigma, and policy drivers of racial-ethnic disparities. The study is the first to identify disparities in rates and types of depression treatment among racial-ethnic subgroups of Medicaid beneficiaries in a nationally representative sample.
    背景与目标: 目的:本次数据分析的目的是描述来自具有全国代表性的28个州和哥伦比亚特区的医疗补助受益人中,患有抑郁症的成年医疗补助受益人在接受抑郁治疗和治疗方式方面的种族差异。 599,421)。
    方法:从完整的2008-2009 Medicaid Analytic Extract提取文件中提取Medicaid索赔数据。主要结果是抑郁症治疗的类型:仅药物治疗,仅药物治疗,药物治疗和药物治疗,不接受治疗。次要结果是治疗抑郁症(是-否)。分别为单变量和多变量模型生成了原始和调整后的优势比(AOR),并计算了优势比和p值的95%置信区间。
    结果:样本中有599,421个人。与高加索人相比,非洲裔美国人和西班牙裔人的抑郁症治疗率更低。未接受治疗的百分比是19.9%的非洲裔美国人,15.2%的西班牙裔美国人和11.9%的白种人。经过全面调整后,非洲裔美国人接受治疗的可能性是白种人的一半左右(AOR = 0.52),西班牙裔美国人接受治疗的可能性约为白种人的三分之一(AOR = 0.71),其他种族群体的接受治疗的可能性约为白种人(三分之一) AOR = 0.84)。高加索人比其他任何人仅接受药物治疗的可能性更高。
    结论:本研究为社会因素与健康结果之间的交集提供了证据,并讨论了医疗保健的参与,污名化以及种族差异的政策驱动因素。该研究是首次在全国代表性的样本中确定医疗补助受益人的种族亚组之间的抑郁症治疗率和类型方面的差异。
  • 【西班牙裔患者接受血管内和开放性腹主动脉瘤修复的预后差异。】 复制标题 收藏 收藏
    DOI:10.1016/j.avsg.2012.06.006 复制DOI
    作者列表:Williams TK,Schneider EB,Black JH 3rd,Lum YW,Freischlag JA,Perler BA,Abularrage CJ
    BACKGROUND & AIMS: BACKGROUND:Previous studies have demonstrated racial and ethnic disparities associated with the outcomes of abdominal aortic aneurysm (AAA) repair, although little is known about the influence of race and ethnicity on the costs associated with these disparities. The current study was undertaken to examine the influence of race and ethnicity on the outcomes of endovascular (EVAR) and open repair (open AAA) of unruptured AAA and its effect on costs in contemporary practice. METHODS:The Nationwide Inpatient Sample (2005 to 2008) was queried using ICD-9-CM codes for unruptured AAA (441.4). The primary outcomes were mortality and total hospital charges. Multivariate analyses were performed adjusting for age, gender, race, comorbidities (Charlson index), year, insurance type, and hospital characteristics. RESULTS:A total of 62,728 patients underwent EVAR and 24,253 patients underwent open AAA. White patients (72%) were more likely to undergo EVAR than Hispanic (69%) or black patients (69%; P = 0.02). On univariate analysis, in-hospital mortality after EVAR was increased in Hispanic patients compared with white patients (1% vs 2%; P = 0.02). There were no differences in mortality after EVAR between white and black patients, and there were no racial or ethnic differences in mortality after open AAA. Hispanic ethnicity remained an independent risk factor for increased mortality after AAA repair on multivariate analysis (RR 1.64; 95% CI [1.05 to 2.57]; P = 0.03). Hispanic ethnicity was associated with increased hospital charges compared with white ethnicity after both EVAR ($108,886 vs $77,748; P < 0.001) and open AAA ($134,356 vs $85,536; P < 0.001) and for black patients after open AAA ($101,168 vs $85,536; P = 0.04). CONCLUSIONS:Hispanic ethnicity is an independent risk factor for mortality after AAA repair independent of insurance type or hospital characteristics. There were dramatic disparities in hospital costs for Hispanic patients undergoing either EVAR or open AAA and for black patients after open AAA compared with white patients. This observation seems unrelated to length of stay, postoperative complications, and admission status. Further studies are needed to determine whether these disparities extend beyond the primary hospitalization.
    背景与目标: 背景:以前的研究表明,种族和种族差异与腹主动脉瘤(AAA)修复的结果有关,尽管对种族和种族对与这些差异相关的成本的影响知之甚少。当前的研究旨在检验种族和种族对未破裂AAA的血管内(EVAR)和开放式修复(open AAA)的结果及其对现代实践中成本的影响。
    方法:使用ICD-9-CM代码对未破裂的AAA(441.4)进行全国住院患者样本(2005年至2008年)的查询。主要结果是死亡率和总住院费用。进行了多元分析,调整了年龄,性别,种族,合并症(查尔森指数),年限,保险类型和医院特征。
    结果:共有62728例患者接受了EVAR,24253例患者接受了开放AAA。白人患者(72%)比西班牙裔患者(69%)或黑人患者(69%; P = 0.02)更有可能接受EVAR。单因素分析显示,西班牙裔患者与白人患者相比,EVAR后住院死亡率增加(1%比2%; P = 0.02)。白人和黑人患者的EVAR术后死亡率无差异,开放AAA后死亡率无种族或种族差异。西班牙裔种族仍然是多因素分析AAA修复后死亡率增加的独立危险因素(RR 1.64; 95%CI [1.05至2.57]; P = 0.03)。在EVAR($ 108,886 vs $ 77,748; P <0.001)和AAA开放性手术后(134,356 vs $ 85,536; P <0.001)和AAA开放后黑人患者($ 101,168 vs $ 85,536; P = 0.04)。
    结论:西班牙裔是AAA修复后死亡率的独立危险因素,与保险类型或医院特征无关。与白人患者相比,接受EVAR或开放性AAA的西班牙裔患者和开放性AAA后的黑人患者的住院费用存在巨大差异。该观察结果似乎与住院时间,术后并发症和入院状态无关。需要进一步研究以确定这些差异是否超出了主要住院治疗的范围。
  • 【烧伤外科领导之间的种族和种族差异。】 复制标题 收藏 收藏
    DOI:10.1093/jbcr/iraa026 复制DOI
    作者列表:Kettering CE,Egro FM,Konanur A,Smith BT,Corcos AC,Stofman GM,Ziembicki JA
    BACKGROUND & AIMS: :The underrepresentation of racial and ethnic minority groups has been well-documented in general and plastic surgery but not in burn surgery. The aim of this study is to evaluate current minority group disparities among burn surgery leadership. A cross-sectional analysis was performed. Burn surgeons included directors of American Burn Association-verified burn centers in the United States, past and current presidents of the American Burn Association, and editorial board members of five major burn journals (Journal of Burn Care & Research, Burns, Burns & Trauma, Annals of Burns & Fire Disasters, and the International Journal of Burns and Trauma). Surgeons were compared based on factors including age, gender, training, academic rank, and Hirsch index (h-index). Among 71 burn center directors, 50 societal presidents, and 197 journal editors, minority groups represented 18.3, 2.0, and 34.5%, respectively. Among burn center directors, the group classified collectively as nonwhite was significantly younger (49 vs 56; P < .01), graduated more recently (2003 vs 1996; P < .01), and had a lower h-index (9.5 vs 17.4; P < .05). There were no significant differences in gender, type of residency training, advanced degrees obtained, fellowships, academic rank, and academic leadership positions between white and nonwhite groups. When compared with the 2018 U.S. National Census, burn unit directors had a 5.1% decrease in nonwhite representation. Disparities in representation of ethnic and racial minorities exist in burn surgery despite having similar qualifying factors.
    背景与目标: :种族和少数民族群体的代表性不足在普通外科和整形外科中得到了充分证明,但在烧伤外科中却没有。这项研究的目的是评估烧伤手术领导者之间当前的少数群体差异。进行横截面分析。烧伤外科医师包括经美国烧伤协会认证的美国烧伤中心主任,美国烧伤协会前任和现任主席以及五种主要烧伤期刊的编辑委员会成员(《烧伤护理与研究》,《烧伤,烧伤和创伤》, 《烧伤和火灾灾难纪事》,以及《国际烧伤和创伤杂志》。根据年龄,性别,培训,学历和Hirsch指数(h-index)等因素对外科医生进行比较。在71名烧伤中心主任,50名社会主席和197名期刊编辑中,少数群体分别占18.3%,2.0%和34.5%。在烧伤中心主任中,被归类为非白人的小组明显年轻(49比56; P <.01),毕业较近(2003年与1996; P <0.01),并且h指数较低(9.5比17.4) ; P <.05)。白人和非白人群体在性别,居住培训类型,获得的高级学位,研究金,学术等级和学术领导职位方面无显着差异。与2018年美国国家人口普查相比,烧伤部门主任的非白人代表减少了5.1%。尽管有类似的资格因素,但烧伤手术中存在少数民族和种族代表的差异。
  • 【美国减肥手术患者的死亡率种族差异。】 复制标题 收藏 收藏
    DOI:10.1007/s11695-013-0957-4 复制DOI
    作者列表:Nguyen GC,Patel AM
    BACKGROUND & AIMS: BACKGROUND:Non-Hispanic blacks bear a disproportionate burden of the growing obesity epidemic. Bariatric surgery is an effective treatment for morbid obesity. We sought to assess for racial disparities in short-term outcomes following bariatric surgery. METHODS:Patients undergoing bariatric surgery were extracted from the Nationwide Inpatient Sample between 1999 and 2007. In-hospital mortality and length of stay were compared between different racial groups undergoing bariatric surgery after stratification by gender, and multivariate analysis was conducted to adjust for demographic, surgery year, and clinical and hospital characteristics. RESULTS:There were 115,507 bariatric surgeries. Overall mortality rate was 2.5 deaths per 1,000 and was higher among non-Hispanic blacks compared to non-Hispanic whites (3.7 vs. 2.3 per 1,000; P = 0.007). Racial mortality disparities were most pronounced among males and at hospitals with lowest surgical volumes. In multivariate analysis, predictors of mortality were non-Hispanic black race (odds ratio [OR], 1.73; 95% confidence interval [CI], 1.22-2.45), increasing age, increasing Charlson index (OR, 1.26; 95% CI, 1.16-1.37), Medicare (OR, 2.13; 95% CI, 1.57-2.91), and Medicaid (OR, 3.35; 95% CI, 2.29-4.91) insurance. Incremental calendar year had reduced odds of mortality (OR, 0.80; 95% CI, 0.76-0.83). Above national median neighborhood income (OR, 0.59; 95% CI, 0.42-0.83) was protective in males, while teaching hospital status conveyed greater mortality (OR, 2.12; 95% CI, 1.40-3.22). CONCLUSIONS:Non-Hispanic blacks undergoing bariatric surgery demonstrate higher in-hospital mortality than their racial counterparts. It is unclear if this disparity is due to susceptibility to obesity-related mortality or suboptimal delivery of healthcare in the perioperative setting.
    背景与目标: 背景:非西班牙裔黑人承担着日益严重的肥胖流行病的不成比例的负担。减肥手术是一种有效的治疗病态肥胖的方法。我们试图评估减肥手术后短期结果中的种族差异。
    方法:从1999年至2007年的全国住院患者样本中提取接受减肥手术的患者。按性别分层比较接受减肥手术的不同种族人群的住院死亡率和住院时间,并进行多因素分析以调整人口统计学特征,手术年份,以及临床和医院特点。
    结果:减重手术115507例。总体死亡率为每1000例中有2.5例死亡,非西班牙裔黑人中的死亡率高于非西班牙裔白人中的死亡率(3.7相对于每千人中2.3例; P = 0.007)。种族死亡率差异在男性中和外科手术量最低的医院中最为明显。在多因素分析中,死亡率的预测因素是非西班牙裔黑人(赔率[OR]为1.73; 95%置信区间[CI]为1.22-2.45),年龄增长,查尔森指数增加(OR为1.26; 95%CI为1.16-1.37),Medicare(OR,2.13; 95%CI,1.57-2.91)和Medicaid(OR,3.35; 95%CI,2.29-4.91)保险。递增日历年降低了死亡率(OR,0.80; 95%CI,0.76-0.83)。高于全国居民收入中位数(OR,0.59; 95%CI,0.42-0.83)对男性具有保护作用,而教导医院的状况则表明死亡率更高(OR,2.12; 95%CI,1.40-3.22)。
    结论:进行减肥手术的非西班牙裔黑人的住院死亡率高于种族种族。目前尚不清楚这种差异是否是由于对肥胖相关死亡率的敏感性或围手术期医疗服务的最佳选择所致。

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