Browsing by Subject "Racial Disparities"

Now showing 1 - 4 of 4
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    Association of State Medicaid Expansion With Racial/Ethnic Disparities in Liver Transplant Wait-listing in the United States
    (JAMA, 2020-10-08) Nephew, Lauren D.; Mosesso, Kelly; Desai, Archita; Ghabril, Marwan; Orman, Eric S.; Patidar, Kavish R.; Kubal, Chandrashekhar; Noureddin, Mazen; Chalasani, Naga; Medicine, School of Medicine
    Importance Millions of Americans gained insurance through the state expansion of Medicaid, but several states with large populations of racial/ethnic minorities did not expand their programs. Objective To investigate the implications of Medicaid expansion for liver transplant (LT) wait-listing trends for racial/ethnic minorities. Design, Setting, and Participants A cohort study was performed of adults wait-listed for LT using the United Network of Organ Sharing database between January 1, 2010, and December 31, 2017. Poisson regression and a controlled, interrupted time series analysis were used to model trends in wait-listing rates by race/ethnicity. The setting was LT centers in the United States. Main Outcomes and Measures (1) Wait-listing rates by race/ethnicity in states that expanded Medicaid (expansion states) compared with those that did not (nonexpansion states) and (2) actual vs predicted rates of LT wait-listing by race/ethnicity after Medicaid expansion. Results There were 75 748 patients (median age, 57.0 [interquartile range, 50.0-62.0] years; 48 566 [64.1%] male) wait-listed for LT during the study period. The cohort was 8.9% Black and 16.4% Hispanic. Black patients and Hispanic patients were statistically significantly more likely to be wait-listed in expansion states than in nonexpansion states (incidence rate ratio [IRR], 1.54 [95% CI, 1.44-1.64] for Black patients and 1.21 [95% CI, 1.15-1.28] for Hispanic patients). After Medicaid expansion, there was a decrease in the wait-listing rate of Black patients in expansion states (annual percentage change [APC], −4.4%; 95% CI, −8.2% to −0.6%) but not in nonexpansion states (APC, 0.5%; 95% CI, −4.0% to 5.2%). This decrease was not seen when Black patients with hepatitis C virus (HCV) were excluded from the analysis (APC, 3.1%; 95% CI, −2.4% to 8.9%), suggesting that they may be responsible for this expansion state trend. Hispanic Medicaid patients without HCV were statistically significantly more likely to be wait-listed in the post–Medicaid expansion era than would have been predicted without Medicaid expansion (APC, 13.2%; 95% CI, 4.0%-23.2%). Conclusions and Relevance This cohort study found that LT wait-listing rates have decreased for Black patients with HCV in states that expanded Medicaid. Conversely, wait-listing rates have increased for Hispanic patients without HCV. Black patients and Hispanic patients may have benefited differently from Medicaid expansion.
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    COVID-19s Impact on the Hispanic Community: How Understanding Culture Can Improve Outcomes
    (Indiana Medical Student Program for Research and Scholarship (IMPRS), 2020-12-15) Guerra Rodriguez, Yamilet; Hudson, Brenda L.; IU School of Medicine
    Background: A disproportionate burden of SARS-Cov-2 infection, or coronavirus disease 2019 (Covid-19), and death are highest among racial and ethnic minority groups. Based on data available on June 12, 2020, Hispanic people are more likely to acquire COVID-19 and have higher incidence of hospitalization and death compared to their white, non-Hispanic counterparts. While this issue is complex, many have hypothesized that the difference is due to societal factors and communication methods. The aim of this project was to evaluate information related to how the Hispanic population is affected by COVID-19 and how communications about the disease should be designed based on past research, physician input, and cultural sensitivities. Methods: We conducted a thorough literature search on COVID-19 articles, both peer reviewed and grey literature, evaluating race and ethnic differences in disease prevalence and severity. Additionally, we conducted interviews with a small number of Indiana doctors who treat Hispanic patients to obtain a doctor’s perspective on the Hispanic community’s needs during the pandemic and ways to help reduce prevalence. Results: Physicians in Indiana believe the main approach to help the Hispanic community is by utilizing trusted community resources to communicate information and build relationships with patients over time. It is recommended to develop new methods to deliver essential information about COVID-19 through multiple mediums, in a clear way, and in Spanish with focus on the collective good of the family. In addition, it is important not to just translate resources from English to Spanish but to design materials addressing barriers specific to the Hispanic community. Conclusion: More culturally tailored information should be released to educate the Hispanic community about COVID-19. This information will assist in the design of materials and initiatives for the Hispanic community that we hope will improve methods of communication and care delivery related to COVID-19.
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    Developing a Culturally Proficient Intervention for Young African American Men in Drug Court: Examining Feasibility and Estimating an Effect Size for Habilitation Empowerment Accountability Therapy (HEAT)
    (2018) Marlowe, Douglas B.; Shannon, Lisa M.; Ray, Bradley; Turpin, Darryl P.; Wheeler, Guy A.; Newell, Jennifer; Lawson, Spencer G.
    African American males between 18 and 29 years of age are substantially less likely than many other participants to graduate successfully from drug court. Unsuccessful termination from drug court can have serious repercussions for these young men, including possible incarceration and negative collateral consequences associated with having a criminal record. This article reports preliminary results from two pilot studies that examined the feasibility of implementing a culturally proficient intervention for young African American men in drug court, and estimated an effect size for the intervention in improving treatment retention and reducing termination rates. Results confirmed that participants with serious criminal and substance use histories were willing and able to complete the lengthy 9-month curriculum, were satisfied with the intervention, and graduated from drug court at substantially higher rates than are commonly observed in this at-risk population. A sufficient basis has been established to justify the effort and expense of examining this intervention — Habilitation Empowerment Accountability Therapy (HEAT) — in fully powered randomized controlled trials.
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    Race-Related disparities in COVID-19 thrombotic outcomes: Beyond social and economic explanations
    (Elsevier, 2020-11-20) Chaudhary, Rahul; Bliden, Kevin P.; Kreutz, Rolf P.; Jeong, Young-Hoon; Tantry, Udaya S.; Levy, Jerrold H.; Gurbel, Paul A.; Medicine, School of Medicine
    African Americans (AAs) have worse COVID-19-related outcomes than Caucasians and Asians, a disparity currently attributed to potential social and economic factors. In this commentary, we endeavor to examine important race-related differences in intrinsic thrombogenicity as another significant contributing factor and propose objective hemostasis assessments to address racial disparities in COVID-19 outcomes.