Research on mental health disparities by race-ethnicity in the United States (US) during COVID-19 is limited and has generated mixed results. Few studies have included Asian Americans as a whole or ...by subgroups in the analysis.
Data came from the 2020 Health, Ethnicity, and Pandemic Study, based on a nationally representative sample of 2,709 community-dwelling adults in the US with minorities oversampled. The outcome was psychological distress. The exposure variable was race-ethnicity, including four major racial-ethnic groups and several Asian ethnic subgroups in the US. The mediators included experienced discrimination and perceived racial bias toward one's racial-ethnic group. Weighted linear regressions and mediation analyses were performed.
Among the four major racial-ethnic groups, Hispanics (22%) had the highest prevalence of severe distress, followed by Asians (18%) and Blacks (16%), with Whites (14%) having the lowest prevalence. Hispanics' poorer mental health was largely due to their socioeconomic disadvantages. Within Asians, Southeast Asians (29%), Koreans (27%), and South Asians (22%) exhibited the highest prevalence of severe distress. Their worse mental health was mainly mediated by experienced discrimination and perceived racial bias.
Purposefully tackling racial prejudice and discrimination is necessary to alleviate the disproportionate psychological distress burden in racial-ethnic minority groups.
It remains unclear how demographic and clinical characteristics are related to the risk of incident mild cognitive impairment (MCI) by its subtypes. Moreover, the contribution of the subtypes of ...incident MCI to the progression to dementia remains puzzling.
We used data collected by the National Alzheimer Coordinating Center. Our analysis sample included cognitively normal subjects at baseline. The associations were examined using competing-risks survival regression models and Cox proportional hazards models.
About 16.3% of subjects developed incident MCI of whom 15.8% progressed to Alz-heimer disease (overall mean follow-up of 4.3 years). The risk of incident amnestic MCI (aMCI) was greater in subjects with 1 copy (subhazard ratio SHR: 1.23; 95% CI: 1.00-1.50) or 2 copies (SHR: 2.14; 95% CI: 1.49-3.05) of the APOE ε4 allele than in those who had no ε4 allele. Multiple-domain aMCI patients were more likely to progress to dementia than single-domain aMCI patients (hazard ratio: 2.14; 95% CI: 1.28-3.58).
Cognitively normal subjects with an APOE ε4 allele had a higher likelihood of developing aMCI and the MCI subtype was associated with the dementia subtype. Our findings provide important information about practical indicators for the prediction of cognitive decline.
A growing number of studies and reviews have documented the impact of telemedicine on diabetes management. However, no meta-analysis has assessed whether including nutritional counseling as part of a ...telemedicine program has a significant impact on diabetes outcomes or what kind of nutritional counseling is most effective.
Original research articles examining the effect of telemedicine interventions on HbA1c levels in patients with Type 1 or Type 2 diabetes were included in this study. A literature search was performed and 92 studies were retained for analysis. We examined stratified results by differentiating interventions using no nutritional counseling from those that used nutritional counseling. We further compared between nutritional counseling administered via short message systems (SMS) such as email and text messages, and nutritional counseling administered via telephone or videoconference.
Telemedicine programs that include a nutritional component show similar effect in diabetes management as those programs that do not. Furthermore, subgroup analysis reveals that nutritional intervention via SMS such as email and text messages is at least as equally effective in reducing HbA1c when compared to personal nutritional counseling with a practitioner over videoconference or telephone.
The inclusion of nutritional counseling as part of a telemedicine program does not make a significant difference to diabetes outcomes. Incorporating nutritional counseling into telemedicine programs via SMS is at least as effective as counseling via telephone or videoconference.
Melanoma is the deadliest type of skin cancer. It is the eighth most common cancer in males and the tenth in females in Cyprus, an island in the Mediterranean with a high ultraviolet (UV) index. ...Cyprus is expected to be strongly affected by climate change and consequently, melanoma will likely become an increasing public health problem. Melanoma prevention is possible; however, it is unknown if people living in Cyprus are aware of melanoma and prevention methods. To this end, we used a validated survey to evaluate the level of melanoma knowledge and factors associated with it in the Cypriot population.
We conducted a 47-item survey with sections on demographics, knowledge of melanoma and risk factors, attitudes toward relevant health practices, and protective behaviors among six hundred Cypriot residents from October 2015 to April 2016.
Our results revealed that only 59% of participants check their skin for moles, 87% protect their skin from the sun during summer holidays, and 57% do not take measures to protect their skin from the sun during non-holiday periods. Protective behavior was positively associated with educational level (P=0.016) and district of residence (P<0.0001). Melanoma knowledge was positively associated with education level (P=0.002) and district of residence (P=0.004). Level of Concern was positively associated with age (P=0.026) and education level (P=0.041).
There are gaps in melanoma knowledge and prevention practices in the study population. Further education on melanoma and its prevention should be specifically targeted to individuals of lower education levels as well as teenagers, such that protective behaviors for melanoma are adopted early in life.
Background Racial and ethnic disparities in awareness of genetic testing for cancer risk are substantial. Purpose This study assesses the relative importance of contributing factors to gaps in ...awareness of genetic testing for cancer risk across racial and ethnic groups. Methods Data from the 2005 National Health Interview Survey (N=25,364) were analyzed in 2009 to evaluate the contribution of demographic factors, SES, health status, nativity/length of residency in the U.S., personal/family history of cancer, and perceived cancer risk to racial and ethnic disparities in genetic testing awareness for cancer risk. The contribution of each factor was assessed using the Fairlie decomposition technique. Results About 48% of non-Hispanic whites reported that they had heard about genetic testing, followed by 31% of blacks, 28% of Asians, and 19% of Hispanics. Education and nativity/length of residency in the U.S. explained 26% and 30% of the gap between whites and Hispanics, respectively. Education accounted for 22% of the white–black gap, with residential region explaining another 11%. Nativity/length of residency in the U.S. explained 51% of the white–Asian gap. Conclusions The relative importance of factors contributing to racial and ethnic disparities in genetic testing awareness is specific to the particular groups under comparison. Diverse, culturally competent approaches are needed to improve awareness for different racial and ethnic groups.
The COVID-19 pandemic has precipitated broad and extensive changes in the way people live and work. While the general subject of working from home has recently drawn increased attention, few studies ...have assessed gender differences in vulnerability to the potential mental health effects of working from home. Using data from 1,585 workers who participated in the Health, Ethnicity, and Pandemic (HEAP) study, a national survey conducted in the U.S. during the COVID-19 pandemic in October 2020, associations of working from home with psychological distress were examined with weighted logistic regression among 1,585 workers and stratified by gender. It was found that workers who worked from home had higher odds of psychological distress (aOR and 95% CI = 2.62 1.46, 4.70) compared to workers who did not work from home, adjusting for demographic factors, socioeconomic status, and health behaviors. In gender-stratified analyses, this positive association between working from home and psychological distress was significant in women (aOR and 95% CI = 3.68 1.68, 8.09) but not in men. These results have implications for female workers’ mental health in the transition towards working from home in the COVID-19 pandemic era.
•Countries with more unequal income distribution carried a higher disease burden of COVID-19.•COVID-19 testing intensity was positively associated with COVID-19 infection rate.•The stringency of ...implemented measures against the pandemic was positively associated with COVID-19 mortality rate.•Addressing income inequalities should be integrated into national strategies against COVID-19.
The COVID-19 pandemic presents a rare opportunity to assess national performance in responding to a historic crisis. It is not well understood how income inequality might be related to differential disease burden of COVID-19 across countries. Using recent data merged from Our World in Data 2020, the World Bank, and the Global Burden of Disease, we examined the association between income inequality (the Gini index) and COVID-19 infection and death rates among 74 countries with available data. After adjusting for differences in population size, age structure, longevity, population density, GDP per capita, health care expenditures, educational attainment, direct democracy index, stringency of implemented measures, and testing intensity for COVID-19, results from Cox Proportional Hazards regressions revealed that countries with more unequal income distribution carried a higher burden of COVID-19 infections and deaths in 2020. On average, each percentage point increase in the Gini index was associated with an 9% increase in the hazard of having a higher COVID-19 infection rate in the sample (AOR = 1.09, 95% CI 1.01, 1.18). The corresponding associated increase in the hazard of having a higher COVID-19 death rate was 14% (AOR = 1.14, 95% CI 1.06, 1.23). Countries with severe and persistent income inequality should develop national strategies to address this challenge to be better prepared for future pandemics.
Socioeconomic and geographic determinants of medical school application and matriculation may help explain the unequal distribution of physicians in the United States. This study describes trends in ...MD-granting medical school application and matriculation rates and explores the relationship between county median family income, proximity to a medical school, and medical school application and matriculation rates.
Data were obtained from the Association of American Medical Colleges, including the age, gender, and Federal Information Processing Standards code for county of legal residence for each applicant and matriculant to U.S. MD-granting medical schools from 2001 through 2015. The application and matriculation rates in each county were calculated using the number of applicants and matriculants per 100,000 residents. Counties were classified into 4 groups according to the county median family income (high-income, middle-income, middle-low-income, low-income). The authors performed chi-square tests to assess trends across the study period and the association of county median family income with application and matriculation rates.
There were 581,833 applicants and 262,730 (45.2%) matriculants to MD-granting medical schools between 2001 and 2015. The application rates per 100,000 residents during 2001-2005, 2006-2010, and 2011-2015 were 57.2, 62.7, and 69.0, respectively, and the corresponding matriculation rates were 27.5, 28.1, and 29.8. The ratios of the application rate in high-income counties to that in low-income counties during the 3 time periods were 1.9, 2.4, and 2.8, respectively.
The application and matriculation rates to MD-granting medical schools increased steadily from 2001 to 2015. Yet, applicants and matriculants disproportionately came from high-income counties. The differences in the application and matriculation rates between low-income and high-income counties grew during this period. Exploring these differences can lead to better understanding of the factors that drive geographic differences in physician access and the associated health disparities across the United States.
Objective. To assess the prevalence of health care utilization in Mexico by Texas border residents and to identify the main contributing factors to their cross‐border utilization of health care ...services.
Data and Methods. This study used primary data from a population‐based telephone survey that was conducted in the whole Texas border area in 2008. The survey included responses from 1,405 adults. Multivariate logistic regression models were estimated to determine predictors of utilizing a wide range of health care services in Mexico.
Principal Findings. Forty‐nine percent of the sample reported having ever purchased medications in Mexico, followed by 41 percent for dentist visits, 37.3 percent for doctor visits, and 6.7 percent for inpatient care. The most significant predictors of health care utilization in Mexico were lack of U.S. health insurance coverage, dissatisfaction with the quality of U.S. health care, and poor self‐rated health status.
Conclusions. The high prevalence of use of health care services in Mexico by Texas border residents is suggestive of unmet needs in health care on the U.S. side of the border. Addressing these unmet needs calls for a binational approach to improve the affordability, accessibility, and quality of health care in the U.S.–Mexico border region.
Previous studies suggest higher rates of caesarean section among women who identify as racial/ethnic minorities. The objective of this study was to understand factors contributing to differences in ...caesarean rates across racial and ethnic groups.
Data was collected from 2005 to 2014 Nebraska birth records on nulliparous, singleton births occurring on or after 37 weeks gestation (n = 87,908). Risk ratios (RR) and 95% confidence intervals (CI) for caesarean were calculated for different racial and ethnic categories, adjusting for maternal age, marital status, county of residence, education, insurance status, pre-pregnancy BMI, and smoking status. Fairlie decomposition technique was utilized to quantify the contribution of individual variables to the observed differences in caesarean.
In the adjusted analysis, relative to non-Hispanic (NH) White race, both Asian-NH (RR 1.21, 95% CI 1.14, 1.28) and Black-NH races (RR 1.13, 95% CI 1.08, 1.19) were associated with a significantly higher risk for caesarean. The decomposition analysis showed that among the variables assessed, maternal age, education, and pre-pregnancy BMI contributed the most to the observed differences in caesarean rates across racial/ethnic groups.
This analysis quantified the effect of social and demographic factors on racial differences in caesarean delivery, which may guide public health interventions aimed towards reducing racial disparities in caesarean rates. Interventions targeted towards modifying maternal characteristics, such as reducing pre-pregnancy BMI or increasing maternal education, may narrow the gap in caesarean rates across racial and ethnic groups. Future studies should determine the contribution of physician characteristics, hospital characteristics, and structural determinants of health towards racial disparities in caesarean rates.
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