REVIEW | doi:10.20944/preprints201809.0418.v1
Subject: Biology And Life Sciences, Immunology And Microbiology Keywords: Glaucoma, Genetics, Ethnicity
Online: 20 September 2018 (16:11:29 CEST)
Glaucoma is undoubtedly a major worldwide disease and cause of blindness. The term glaucoma however encompasses a group of disorders with differing age of incidence, intraocular pressures and varying degrees of hereditability in which vision loss occurs through a characteristic mode of retinal ganglion cell death. There are also significant differences in frequencies of incidence and gene associations for this group of disorders amongst different groups of populations. The current literature often states definitive trends in incidence for ethnic groups that fail to take into account an overall genetic fine structure for these groups. The present review intends to present an overview of some of the background necessary to discuss the genetic basis of glaucoma before describing some of the literature concerning the illness in Gypsy, Japanese, Scandinavian, Latino (Mexican and Brazilian) and Sub-Saharan African populations. It is intended that this review will give the reader a clearer picture of the diversity of worldwide glaucoma presentation which perhaps prove to question the current Ethnic view.
ARTICLE | doi:10.20944/preprints202006.0029.v1
Subject: Medicine And Pharmacology, Anesthesiology And Pain Medicine Keywords: COVID-19; ethnicity; BAME; deprivation
Online: 4 June 2020 (08:03:48 CEST)
On the 9th March 2020, the first patient with COVID-19 was admitted to ICU in the Royal Gwent Hospital, Newport, Wales. We prospectively recorded the rate of ICU admissions of 52 patients with COVID-19 over 60 days, focusing on the epidemiology of ethnicity and deprivation. Patients were 65% (34 of 52) male and had a median (IQR) age of 55 (48-62) years. Prevalent comorbidities included obesity (52%); diabetes (33%), and asthma (23%). COVID-19 hospital and ICU inpatient numbers peaked on days 23 and 39, respectively – a lag of 16 days. The ICU mortality rate was 33% (17 of 52). Black, Asian and Minority Ethnics (BAME) population represented 35% of ICU COVID-19 admissions (18 of 52) and 35% of deaths (6 of 17). Within the BAME group, 72% (13 of 18) were found to reside in geographical areas representing the 20% most deprived in Wales, versus 27% of Caucasians (9 of 33). Less than 5% of the population within the hospital catchment area are of BAME descent, yet they represent a disproportionately high proportion of patients with ICU admission and mortality suffering from COVID-19. The interplay between ethnicity and deprivation, which is complex, may be a factor in our findings. This in turn could be related to an increased prevalence of co-morbidities; higher community exposure; or genetic polymorphisms.
REVIEW | doi:10.20944/preprints201812.0140.v1
Subject: Medicine And Pharmacology, Dermatology Keywords: acne; polymorphism; genetics; CYP17; ethnicity
Online: 12 December 2018 (05:30:43 CET)
Acne vulgaris is one of the most common skin diseases and genetic relationships have been documented. The aim was to evaluate the association of CYP17 (T-34C) polymorphism related to the risk of acne in a meta-analysis study. The databases (Scopus, Web of Science, PubMed, and Cochrane Library) were searched until September 2018 to check the relationship between acne risk and CYP17 (T-34C) polymorphism and impact of this polymorphism on severity of acne. We used Review Manager 5.3 software to analyze the data using OR and 95% CI to check this relationship. Four studies were included and analyzed in the meta-analysis. The OR in analysis of C versus T in acne patients compared to the healthy controls was 1.42 (P=0.02), in CC vs. TT was 1.54 (P=0.04), in TC vs. TT was 1.46 (P=0.12), in TC + CC vs. TT was 1.55 (P=0.04), and in CC vs. TT + TC was 1.39 (P=0.06). There was no acne risk related to CYP17 (T-34C) in none of genetic models in Caucasian ethnicity, whereas in Asian ethnicity, there was higher acne risk related to CYP17 (T-34C) without heterogeneity. The results of the present meta-analysis showed the presence of C allele and CC genotype of CYP17 polymorphism can be risk factors for acne, mainly in the Asian ethnicity.
ARTICLE | doi:10.20944/preprints201903.0016.v1
Subject: Medicine And Pharmacology, Obstetrics And Gynaecology Keywords: Costs, delivery, cesarean section, ethnicity, maternal morbidity
Online: 1 March 2019 (14:33:15 CET)
Recent policy and service provision recommends a woman-centered approach to maternity care and encourages the development of personalized models of clinical assistance. As ethnicity has been recognized as determinant in the risk calculation of some obstetric complication, our aim was to assess costs for birth assistance according to the maternal ethnicities. In a five-year period (2012-16) all women admitted for delivery at the Department of Obstetrics and Gynaecology, Fondazione Policlinico Universitario ‘A. Gemelli’ IRCCS, Rome, Italy were investigated. Economic evaluations were performed by using the ‘diagnosis-related group’ (DRG) approach. Cost analysis was completed by including maternal ethnicity, delivery mode and perinatal complications. A total of 18,093 patients were involved in the analysis. An overall care expense of €42.663.481 was calculated. Caucasian was the main ethnicity (90.7%), leaving the minority groups to 9.3%. Vaginal delivery (VD) was the most common mode of delivery in all ethnic clusters, with a global rate of 59.6%. Not including Asiatic women, increased CS rates were recorded in all minority ethnic groups (Maghreb (51.5%) and Afro-Caribbean (47.8%)). A double incidence of complicated VD was observed in the minority groups, primarily among Afro-Caribbean (69.9%), followed by Asiatic (64.1%), Maghreb (63.2%) and Latin-America (62.7%) patients. By logistic regression, Afro-Caribbean delivering women had a significant increased risk of complicated CS among all subgroups. Minority groups (Afro-Caribbean, in particular) increase the health care cost for birth assistance due to higher incidence of adverse perinatal outcomes.
REVIEW | doi:10.20944/preprints201609.0029.v1
Subject: Medicine And Pharmacology, Endocrinology And Metabolism Keywords: HLA; type 1 diabetes; ethnicity; screening; haplotype
Online: 7 September 2016 (12:49:02 CEST)
Aims/Hypothesis): Type 1 diabetes is an immune-mediated disease with destruction of the pancreatic β-cells, a process that is conditioned by multiple genes and other factors. HLA counts as the major susceptibility gene. Significant variations in HLA genetic susceptibility to type 1 diabetes between Caucasians, African and Asian and other ethnic groups may have led to the variation in incidence of type 1 diabetes globally. Type 1 diabetes is characterized upon HLA identification. In this chapter we discuss global variations in genetic susceptibility of HLA with regard to type 1 diabetes globally with a particular attention to Arab population. Methods): Haplotype configuration of HLA class I A, B, C and Class II –DR/DQ/DP were studied in Caucasians, African and Asian and in Arab population to see if that is responsible for the exponential rise in the rate of type 1 diabetes. Results): Although Arabs have one of the highest global incidence and prevalence rates of type 1 diabetes, unfortunately, there is a dearth amount of information regarding HLA genetic susceptibility to type 1 diabetes in the Arab world. HLA haplotype configurations contribute to its risk value. However, out of an insufficient present study there are examples of misjudgment of HLA risk according to HLA alleles rather than haplotypes. Conclusion): To date HLA outlooks for the characterization of type 1 diabetes. There is an ethnicity difference in HLA characteristics which is responsible for variation in type 1 diabetes. Although Arab population have contributed heavily in the rise of burden of type 1 diabetes, however, there is significantly a dearth amount of studies on HLA in Arab population. Obviously, any future prediction, prevention or cure of the disease will be based on the HLA genetics. There is a dire need for a systematic screening of HLA for Arab population with type 1 diabetes, identification of Arab HLA-risk values and identify those who are prone to get the disease.
ARTICLE | doi:10.20944/preprints201904.0057.v1
Subject: Medicine And Pharmacology, Obstetrics And Gynaecology Keywords: miscarriage; fetal loss; risk factor; ethnicity; maternal race
Online: 4 April 2019 (15:52:25 CEST)
In last decades, growing migration flows have modified the obstetric clinical care, requiring specific attention by health care systems. The aim was to describe the phenomenon focusing on miscarriage (pregnancy loss at <20 weeks). Patients admitted for care at miscarriage in a six-year period (2012-17) were revised. Miscarriage rates in all ethnic groups, dichotomized in early (within the first 12 weeks of gestation) and late (at <20 weeks) pregnancy loss. Associations between women's characteristics (age, parity, inter-pregnancy interval (IPI)) were explored to elucidate any differences. A total of 1,940 patients were included, segregated in early (n = 1769, 91.2%) and late (n = 171, 8.8%) pregnancy losses. Caucasian ethnicity was the most common (87.9%), leaving the minority groups to 12.1%. Maternal age was higher among Caucasians women than other subgroups, in contrast to Asiatic patients. Nulliparity was observed in 1045 (53.9%) patient, more widespread among Caucasian and Maghrebins. A positive obstetric history counting at least one miscarriage was frequent, ranging from 22.2% to 75%, in particular among Asiatic women, while the recurrence in Caucasians. In Afro-Carribeans the most relevant rate of late miscarriage was found. By multiple regression modelling, maternal age, nulliparity and Afro-Carribean were identified as determinants. Maternal ethnicity should be considered in the management of pregnancy losses in combination with already well-defined risk factors, including age at miscarriare and nulliparity.
ARTICLE | doi:10.20944/preprints201809.0502.v1
Subject: Social Sciences, Sociology Keywords: suburbs; locational attainment; spatial assimilation; race and ethnicity
Online: 26 September 2018 (08:26:39 CEST)
The present study examines inner and outer suburban ring attainment outcomes among racial and ethnic groups residing in the nation’s metropolitan areas. The main objective is to evaluate the extent to which the relationship between racial and ethnic group’s socioeconomic status characteristics and residence between inner and outer suburban rings conforms to the tenets of the spatial assimilation model. Using micro-level data from the 5-year 2012-2016 American Community Survey, the author calculates multinomial logistic regression models to determine the effects of SES and other relevant predictors on residence within the nation’s metropolitan area’s suburban inner and outer rings. The results both confirm and contradict the main tenets of the spatial assimilation model. To the extent that income, education, and homeownership are positively related to residence in both suburban rings, the findings also suggest that access to inner and outer rings is hierarchically stratified by race and ethnicity.
ARTICLE | doi:10.20944/preprints201704.0084.v1
Subject: Medicine And Pharmacology, Pediatrics, Perinatology And Child Health Keywords: extended newborn screening; ethnic screening differences; Roma ethnicity
Online: 14 April 2017 (08:31:47 CEST)
Authors present The First Results of the National Extended Newborn Screening (ENS) in Slovakia in the majority (M) and the Roma (R ) ethnic populations. The follow-up of the ethnicity has been introduced in Newborn Screening for Cystic Fibrosis (NSCF) and after to entire ENS program comprising of 23 Hereditary Metabolic Disorders (HMD). Results: In 2013-2015, a total of 165,648 newborns were investigated in ENS, 23,321 of them (15,3%) were the R ethnic group, a total of 313 positive cases were discovered (total ENS prevalence = 1:529, M=1:758, R=1:198). In the R ethnic group, there was slightly higher prevalence in cong. hypothyreosis (CH), only one case of CF, and no cases of CAH in the R ethnic group. The ENS prevalence of HMD detected by MS/MS was expressively higher in the R ethnic group than in M group (M=1:1670 vs. R=1:234, OR:7,13). Significant differences in the prevalence of individual types of HMD were found. Whereas the PKU and spectrum of aminoaciduria and organic acidurias dominate in the M group, the fatty acids oxidation disorders (MCAD, SCAD) and carnitine defects (CUD) were frequent in the R newborn group. Conclusion: Despite the presented results are preliminary, the ethnic approach to ENS is enabling the recording of the ethnic differences in the screening prevalence of individual disorders, which would be missing during unitary approach.
ARTICLE | doi:10.20944/preprints201709.0132.v1
Subject: Social Sciences, Sociology Keywords: minority threat; conceal carry laws; Missouri; race and ethnicity
Online: 27 September 2017 (02:03:15 CEST)
Conceal carry weapon (CCW) laws have generated a great deal of public discussion in the past decades, but little social science attention. Scholarly worked on the topic has been focused on finding potential effects of such laws on crime and victimization; little has attempted to explain the trends behind the adoption of the laws. This paper attempts to fill that gap by testing a series of hypotheses grounded in minority threat approaches. Our paper examines whether or not changes in the racial and ethnic composition of a county predict the voting outcome of Missouri’s 1999 conceal-carry referendum. Findings fail to reject the null hypothesis and show the best predictor of the vote within a county was how that county voted in the 2000 Presidential election.
ARTICLE | doi:10.20944/preprints202003.0352.v1
Subject: Medicine And Pharmacology, Pediatrics, Perinatology And Child Health Keywords: vaginal; cesarean section; African American women; infant mortality; race/ethnicity
Online: 23 March 2020 (11:21:46 CET)
Objective: Racial/ethnic disparities in infant mortality (IM) continue to persist in the United States, with Black/African Americans (AA) being disproportionally affected with threefold increase in mortality compared to Whites. Epidemiologic data have identified maternal characteristics as risk IM such as eclampsia, maternal education, smoking, maternal weight, maternal SES, and family structure. Understanding the cause of causes including the method of labor and delivery and the racial heterogeneity may facilitate intervention mapping in narrowing the Black White IM risk differences. We aimed to assess the temporal/racial trends and the methods of delivery, mainly vaginal versus cesarean section (C-section) as exposure function of IM. Methods: The United States linked Birth/Infant Death records (2007-2016) were used with a cross-sectional ecologic design. The analysis involved chi squared statistic, incidence rate estimation, and period percent change. Results: Of the 40,445,070 births between 2007 and 2016, cumulative mortality incidence was 249,135 (1.16 per 1000). The IM rate was highest among Black/AA (11.41 per 1000), intermediate among Whites (5.19 per 1000), and lowest among Asian /Pacific Islanders (4.24 per 1000). The cumulative incidence rate difference, comparing vaginal to cesarean procedure was 1.73 per 1000 infants, implying excess IM with C-section. Compared to C-section, there was a 31% decreased risk of IM among mothers with vaginal delivery, rate ratio (RR) = 0.69, 95% CI 0.64-0.74. Racial disparities was observed in the method of delivery associated with IM. Black/AA mothers with vaginal delivery had a 6% decreased risk of IM compared to C-section, RR = 0.94, 95%CI 0.92-0.95, while Whites with vaginal delivery had a 38% decrease risk of IM relative to C-section, RR= 0.68, 95%CI 0.67-0.69, p<0.001. Conclusion: Infant mortality varied by race, with Black/AA disproportionally affected which is explained in part by labor and delivery procedures, suggesting reliable and equitable intrapartum assessment of Black/AA mothers during labor.
ARTICLE | doi:10.20944/preprints202310.1719.v1
Subject: Public Health And Healthcare, Public Health And Health Services Keywords: SARS-CoV-2; asymptomatic; COVID-19; symptom profile; demographic; testing; ethnicity
Online: 26 October 2023 (11:34:13 CEST)
We investigated 328 SARS-CoV-2 cases in Barwon South West Victoria, Australia, in the 2020 pre-vaccination period, comparing infections with symptoms to those that remained asymptomatic. De-identified self-reported data from three sequential questionnaires on case characteristics and symptom progression were examined. Multivariable logistic regression were used to model associations between demographic profile and symptoms. Asymptomatic cases were more than three times as likely to be from ethnic minority groups [OR 3.2, 95% CI 1.5 – 6.7, p<0.01], and approximately seven times more likely to be seniors (≥ 65 years) [OR 7.3, 95% CI 1.0 – 50.1] after adjusting for sex and occupation. The overrepresentation of ethnic minority groups among asymptomatic infections is suggestive of genetic haplotype variability by ethnic group, conferring greater cross protection from other coronaviruses in the early stages of the COVID-19 pandemic. This research should be repeated post-vaccination to reassess symptom expression according to ethnicity, and better comprehend case ascertainment impacts of cultural biases in testing and infection reporting, and the reliance on symptoms to trigger testing. These findings may in part reflect differences in testing patterns by ethnicity and true differences in disease expression, both important for appropriate transmission prevention strategies, and tailoring testing messaging towards ethnic minority communities.
ARTICLE | doi:10.20944/preprints202305.0511.v1
Subject: Medicine And Pharmacology, Epidemiology And Infectious Diseases Keywords: diet; behaviour; exercise; health program; healthcare prevention; ethnicity; pediatric; high risk population
Online: 8 May 2023 (10:21:06 CEST)
Lifestyle physical activity (PA) and nutrition are known to be effective interventions in preventing and managing obesity related comorbidities is adult populations, but less so in children and adolescents. We examined the effectiveness of lifestyle interventions in children from minority ethnic populations in western high-income countries. Our systematic review included 53 studies involving 26045 children from minority ethnic populations within western countries, who followed lifestyle intervention programs lasting between 8 weeks and 5 years with an aim to prevent and/or manage childhood obesity and associated comorbidities, including adiposity and cardiometabolic risks. Studies were heterogenous in terms of lifestyle intervention components (nutrition, PA, behavioural counselling) and settings (community vs. schools and after schools). Our meta-analysis included 31 eligible studies and showed no significant effects of lifestyle interventions when they focused on body weight and body mass index (BMI) outcomes [pooled BMI mean change = -0.09 (95% CI -0.19, 0.01), p=0.09]. This was irrespective of the intervention program duration (< 6 months vs. ≥ 6 months), type (PA vs nutrition/combined intervention) and weight status (overweight or obese vs no normal weight), all showed no significant effects in the sensitivity analysis. Nonetheless, 19 of the 53 studies reported reduction in BMI, BMI z scores and body fat percentage. However, majority of lifestyle interventions adopting a quasi-design with a combined primary and secondary obesity measures (11 out of 15 studies), were effective in reducing obesity comorbidities of cardiometabolic risks including metabolic syndrome, insulin sensitivity, and blood pressure in children with overweight and obesity. Preventing childhood obesity and associated comorbidities in children from high-risk ethnic minority groups is best achieved using a combined PA and nutrition intervention approach, which jointly target preventing obesity and cardiometabolic disease primary and secondary outcomes, especially measures of diabetes, hypertension, and cardiovascular disease.
REVIEW | doi:10.20944/preprints202004.0234.v1
Subject: Biology And Life Sciences, Biochemistry And Molecular Biology Keywords: coronavirus; COVID-19; comorbidity; race and ethnicity; health disparities; income; inequality; influenza
Online: 15 April 2020 (09:25:47 CEST)
Recent clinical SARS-CoV-2 studies link diabetes, cardiovascular disease, and hypertension to increased disease severity. In the US, racial and ethnic minorities and low socioeconomic status (SES) individuals are more likely to have increased rates of these comorbidities, lower baseline health, limited access to care, increased perceived discrimination, and limited resources, all of which increase their vulnerability to severe disease and poor health outcomes from SARS-CoV-2. Previous studies demonstrated the disproportionate impact of pandemic and seasonal influenza on these populations, due to these risk factors. This paper reviews increased health risks and documented health disparities of racial and ethnic minorities and low SES individuals in the US. Pandemic response must prioritize these marginalized communities to minimize the negative, disproportionate impacts of SARS-CoV-2 on them and manage spread throughout the entire population. This paper concludes with recommendations applicable to healthcare facilities and public officials at various government levels.
ARTICLE | doi:10.20944/preprints202201.0227.v1
Subject: Social Sciences, Behavior Sciences Keywords: Bayesian inference; race and ethnicity imputation; All Payer Claims Database; vital statistics death records; validation
Online: 17 January 2022 (12:40:15 CET)
Background: All Payer Claims Databases (APCD) are a rich source of health information, however, race and ethnicity (R&E) data are largely missing. Bayesian Improved Surname Geocoding (BISG) is a common R&E imputation method, yet, validation of BISG in APCDs is lacking. We used the BISG to impute missing R&E in the Oregon APCD. Methods: BISG imputed R&E for Asian Pacific Islanders (API), Blacks, Hispanics and Whites were contrasted to the gold standard (vital statistics) and sensitivity and specificity improvements were assessed. Logistic regression examined whether missing R&E was random across patient characteristics. Results: Among 85,857 individuals in the study, 32.1% (n=27,594) had missing R&E. Missing R&E was not randomly distributed. There were higher odds of missingness among males, Whites, those age 65 and older, and commercially insured individuals. Differences in the percent missing were also found by co-morbid conditions and mortality causes. Imputing the missing R&E with BISG method improved the sensitivity to identify White, Black, API, and Hispanics. Conclusions: APCDs can benefit from enhancing missing R&E with BISG imputation to perform more robust population-health level analyses and identify inequities according to R&E without losing power or dropping non-random records with missing R&E data.
ARTICLE | doi:10.20944/preprints202107.0489.v1
Subject: Social Sciences, Education Keywords: academia; affective dimension; defense formats; ethnicity; field of study; gender; socio-demographic dimensions; viva; viva voce
Online: 21 July 2021 (11:26:00 CEST)
The doctoral defense, which is an essential requirement for the doctoral degree, is considered to have three dimensions: the scholarly dimension, the emotional (affective) dimension, and the cultural dimension. In this work, I explore the link between sociodemographic factors and students’ perception of the doctoral defense. In particular, I focus on gender, ethnicity, and age at time of defense, as well as current position, and field of study. To address the influence of these aspects on the affective dimension of the doctoral defense, I first reviewed the literature on these socio-demographic aspects as well as the affective dimension of the defense. I then carried out an international survey on doctoral defenses, defense formats, and students’ perceptions and analyzed the 204 completed surveys for this study using quantitative and qualitative methods. The analysis included cross-correlations between students’ perceptions and the studied sociodemographic aspects. The main results of these analyses are that gender affects various aspects of the students’ perception of the doctoral defense and long-term perception, and that female candidates experience more issues with their committee. Ethnicity is important as well, although the participations of non-white respondents in this survey was limited. The influence of age at the defense is limited, and only for the youngest and oldest age groups I observe some differences in perception. There is no relation between current position and perception of the candidates during the defense. Finally, field of study is correlated for various aspects of student perception, committee issues, and long-term perception. The conclusion of this work is that socio-demographic aspects, and in particular gender, ethnicity, and field of study, influence how doctoral candidates experience their defense.
ARTICLE | doi:10.20944/preprints202302.0017.v1
Subject: Social Sciences, Psychology Keywords: Digital Mental Health; deprivation; service activity; Mental health concerns; ethnicity; time-series analysis; Covid-19; Text-based online therapy
Online: 2 February 2023 (01:30:05 CET)
The adoption of digital health technologies accelerated during Covid-19, with concerns over the equity of access due to digital exclusion. Using data from a text-based online mental health service for children and young people we explore the impact of the pandemic on service access and presenting concerns and whether differences were observed by sociodemographic characteristics in terms of access (gender, ethnicity and deprivation). We used interrupted time-series models to assess whether there was a change in the level and rate of service use during the Covid-19 pandemic (April 2020-April 2021) compared to pre-pandemic trends (June 2019-March 2020). Routinely collected data from 61221 service users were extracted for observation, those represented half of the service population as only those with consent to share their data were used. The majority of users identified as female (74%) and White (80%), with an age range between 13 and 20 years of age,. There was evidence of a sudden increase (13%) in service access at the start of the pandemic (RR 1.13 95% CI 1.02, 1.25), followed by a reduced rate (from 25% to 21%) of engagement during the pandemic compared to pre-pandemic trends (RR 0.97 95% CI 0.95,0.98). There was a sudden increase in almost all presenting issues apart from physical complaints. There was evidence of a step increase in the number of contacts for Black/African/Caribbean/Black British (38% increase; 95% CI: 1%-90%) and White ethnic groups (14% increase; 95% CI: 2%-27%) ), the sudden increase in service use at the start of the pandemic for the most (58% increase; 95% CI: 1%-247%) and least (47% increase; 95% CI: 6%-204%) deprived areas. During the pandemic, contact rates decreased, and referral sources change at the start. Findings on access and service activity align with other studies observing reduced service utilisation. The lack of differences in deprivation levels and ethnicity at lockdown suggests exploring equity of access to the anonymous service. The study provides unique insights into changes in digital mental health use during Covid-19 in the UK.
ARTICLE | doi:10.20944/preprints202102.0039.v1
Subject: Public Health And Healthcare, Nursing Keywords: Chronic conditions; diabetes; older adults; race or ethnicity; health care access; home health care; social determinants of health; inequalities or inequities
Online: 1 February 2021 (14:03:38 CET)
Racial and ethnic disparities exist in diabetes prevalence, health services utilization, and out-comes including disabling and life-threatening complications. Home health care may especially benefit older adults with diabetes through individualized education, advocacy, care coordina-tion, and psychosocial support for patients and their caregivers. This study examined factors as-sociated with hospital discharge to home health care and subsequent utilization of home health care among a cohort of Medicare beneficiaries with diabetes, age 50 and older, living in the United States. The cohort (n=786,758) was followed for 14 days after a diabetes-related index hospitalization, using linked Medicare administrative, claims, and assessment data (2014-2016). Multivariate logistic regression models included patient demographics, comorbidities, hospital length of stay, geographic region, neighborhood area deprivation, and rural/urban setting. In ful-ly adjusted models, hospital discharge to home health care was significantly less likely among Hispanic (OR 0.8, 95% CI 0.8-0.8) and American Indian (OR 0.8, CI 0.8-0.8) compared to white patients. Among those discharged to home health care, all racial/ethnic minority patients were less likely to receive services within 14-days. Further work should focus on eliminating systemic racism in home health care referral and systemic barriers to receiving home health care services.
ARTICLE | doi:10.20944/preprints202307.0095.v1
Subject: Public Health And Healthcare, Public Health And Health Services Keywords: Ethnic and Racial Minorities; Ethnicity; Covid-19; Covid-19 Vaccines; Vaccination Hesitancy; Health Inequities; Primary Health Care; Public Health; Health Promotion; Systemic Racism
Online: 3 July 2023 (13:55:22 CEST)
People from Black and Asian backgrounds are more likely to die from Covid-19 but less likely to be vaccinated, threatening to exacerbate health inequalities already experienced by ethnic minority groups. Literature suggests that mistrust rooted in structural inequality may be a key barrier to Covid-19 vaccine uptake. We need to better understand how structural inequalities influence vaccine confidence. Understanding and addressing these processes is likely to lead to longer-term impacts than information alone. We draw on health and sociological theories of structure and agency to inform our understanding of structural factors. We conducted qualitative interviews and focus groups with 22 people from London and surrounding areas in December 2021 to March 2022. Fifteen participants were members of the public from ethnic minority backgrounds and 7 were professionals working with the public to address concerns and encourage vaccine uptake. Our findings suggest that people from ethnic minority backgrounds make decisions regarding Covid-19 vaccination based on a combination of how they experience external social structures (including political authority, social positioning and racial inequality) and internal processes (what they believe and understand about Covid-19 vaccines). We may be able to support knowledge accumulation through the provision of reliable and accessible information, particularly through primary and community care. But we recommend a number of changes to research, policy and practice which address structural inequalities. These include working with communities to improve ethnicity data collection, increasing funding allocation to health conditions where ethnic minority communities experience poorer outcomes, greater transparency and public engagement in the vaccine development process, and culturally adapted research recruitment processes.
Subject: Public Health And Healthcare, Public Health And Health Services Keywords: chronic conditions; diabetes; older adults; race or ethnicity; social determinants of health; in-equalities or inequities; policy; health care access; home health care
Online: 6 April 2021 (14:40:37 CEST)
Older adults with diabetes are at elevated risk of complications following hospitalization. Home health care services mitigate the risk of adverse events and facilitate a safe transition home. In the United States, when home health care services are prescribed, federal guidelines require they begin within two days of hospital discharge. This study examined the association between timing of home health care initiation and 30-day rehospitalization outcomes in a cohort of 786,734 Medicare beneficiaries following a diabetes-related index hospitalization. Of these patients, 26.6% were discharged to home health care. To evaluate the association between timing of home health care initiation and 30-day rehospitalizations, multivariate logistic regression models including patient demographics, clinical, geographic variables, and neighborhood socio-economic variables were used. Inverse probability-weighted propensity scores were incorporated into the analysis to account for potential confounding between the timing of home health care initiation and the outcome in the cohort. Compared to patients who received home health care within the recommended first two days, patients who received delayed services (3-7 days after discharge) had higher odds of rehospitalization (OR 1.28, 95% CI 1.25-1.32). Among patients who received late services (8-14 days after discharge), the odds of rehospitalization were four times greater than for patients receiving services within 2 days (OR 4.12, 95% CI 3.97-4.28). Timely initiation of home health care following diabetes-related hospitalizations is one strategy to improve outcomes.