Browsing by Subject "Racial disparities"
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Item A Comparative Analysis of Bleeding Peptic Ulcers in Hospitalizations With and Without End-Stage Renal Disease(Elmer Press, 2023) Dahiya, Dushyant Singh; Mandoorah, Sohaib; Gangwani, Manesh Kumar; Ali, Hassam; Merza, Nooraldin; Aziz, Muhammad; Singh, Amandeep; Perisetti, Abhilash; Garg, Rajat; Cheng, Chin-I; Dutta, Priyata; Inamdar, Sumant; Sanaka, Madhusudhan R.; Al-Haddad, Mohammad; Medicine, School of MedicineBackground: End-stage renal disease (ESRD) patients are highly susceptible to peptic ulcer bleeding (PUB). We aimed to assess the influence of ESRD status on PUB hospitalizations in the United States (USA). Methods: We analyzed the National Inpatient Sample to identify all adult PUB hospitalizations in the USA from 2007 to 2014, which were divided into two subgroups based on the presence or absence of ESRD. Hospitalization characteristics and clinical outcomes were compared. Furthermore, predictors of inpatient mortality for PUB hospitalizations with ESRD were identified. Results: Between 2007 and 2014, there were 351,965 PUB hospitalizations with ESRD compared to 2,037,037 non-ESRD PUB hospitalizations. PUB ESRD hospitalizations had a higher mean age (71.6 vs. 63.6 years, P < 0.001), and proportion of ethnic minorities i.e., Blacks, Hispanics, and Asians compared to the non-ESRD cohort. We also noted higher all-cause inpatient mortality (5.4% vs. 2.6%, P < 0.001), rates of esophagogastroduodenoscopy (EGD) (20.7% vs. 19.1%, P < 0.001), and mean length of stay (LOS) (8.2 vs. 6 days, P < 0.001) for PUB ESRD hospitalizations compared to the non-ESRD cohort. After multivariate logistic regression analysis, Whites with ESRD had higher odds of mortality from PUB compared to Blacks. Furthermore, the odds of inpatient mortality from PUB decreased by 0.6% for every 1-year increase in age for hospitalizations with ESRD. Compared to the 2011 - 2014 study period, the 2007 - 2010 period had 43.7% higher odds (odds ratio (OR): 0.696, 95% confidence interval (CI): 0.645 - 0.751) of inpatient mortality for PUB hospitalizations with ESRD. Conclusions: PUB hospitalizations with ESRD had higher inpatient mortality, EGD utilization, and mean LOS compared to non-ESRD PUB hospitalizations.Item A Fork In The Road to Health Equity: Lesson from Odetta(American Medical Association, 2022-07-01) Breathett, Khadijah; Medicine, School of MedicineItem Are the racial disparities in school discipline the result of or a function of systemic racism mediated by educators' dispositions?(2015-08-28) Williams, Nathaniel Andrew; Scheurich, James Joseph; Hughes, Robin Lee; Skiba, Russell; Murtadha, Khaula H.With over 40 years of research on the well-documented issue of racial disparities in school discipline, scholars have begun to explore a plethora of plausible causalities for this phenomenon. Recent literature on the causal agents have centered on cultural differences and/or racial prejudices held by educators. Building from this emerging logic, this dissertation specifically focused on the disposition (e.g. enduring traits, character type, mentality, and temperament) of educators and its influence, if any, on discipline-related outcomes. Additionally, this exploratory study sought to build a conceptual map for future research to explore how educators' dispositions may act as conduits between systemic racism and the historic racial disparities in discipline-related outcomes. Through an intensive, multiyear embedded case study of four middle schools with both high and low rates of racial disproportionality in school discipline and with the creation and use of the Four Domains, this dissertation explored whether discipline-related outcomes are the result of systemic racism mediated by educators' dispositions. Findings from the analysis suggested the existence of shared characteristics among the dispositions of those categorized as high and low referring. Specific to those findings, trends within low referring teachers suggested that low referring teachers maintain high and consistent expectations of student behavior, but allowed for flexibility in how their discipline response was mediated out among their students. Despite a deferred approach within discipline response, low referring teachers were consistent and did not show favoritism. On the contrary, high referring teachers were inconsistent with their responses and demonstrated biases in actions and beliefs. Accordingly, it was found that high referring teachers held racially deficit beliefs about Black students and their families. Additionally, high referring teachers were more represented by the Four Domains in comparison to lower referring teachers. As a result, findings from the Four Domains support the existence of a causal link among systemic racism, higher referring teachers, and racial disparities in school discipline. In particular, it was found that classroom teachers engage in and hold racially deficit views of Blacks and these same teachers disproportionately refer Black students for out-of-school suspension.Item Declaring racism a public health crisis brings more attention to solving long-ignored racial gaps in health(The Conversation US, Inc., 2021-04-22) Halverson, Paul K.; Health Policy and Management, Richard M. Fairbanks School of Public HealthItem Disparities in Adjuvant Treatment of High-Grade Endometrial Cancer in the Medicare Population(Elsevier, 2022) Corey, Logan; Cote, Michele L.; Ruterbusch, Julie J.; Winer, Ira; Epidemiology, Richard M. Fairbanks School of Public HealthBackground: Black women experience worse survival effects with high-grade endometrial cancer. Differences in adjuvant treatment have been proposed to be major contributors to this disparity. However, little is known about the differences in type or timing of adjuvant treatment as it relates to race and ethnicity in the Medicare population. Objective: This study aimed to examine patterns of adjuvant therapy and survival for non-Hispanic Black women vs non-Hispanic White women and Hispanic women who have undergone surgery for high-grade endometrial cancer in the Medicare population. Study design: We used the Medicare-linked Surveillance, Epidemiology, and End Results database to identify women who underwent surgery as a primary treatment for uterine grade 3 endometrioid adenocarcinoma, carcinosarcoma, clear-cell carcinoma, or serous carcinoma between the years 2000 and 2015. Women who did not identify as White or Black race or Hispanic ethnicity were excluded. Multinomial logistic regression was used to estimate odds ratios and 95% confidence intervals for receiving a treatment delay or not receiving adjuvant treatment (compared with those who received adjuvant treatment within 12 weeks) adjusted for clinical and demographic characteristics. Overall survival was stratified by race and ethnicity, route of surgery, operative complications, and type and timing of adjuvant therapy, which were analyzed using the Kaplan-Meier method. Cox proportional-hazards regression was used to estimate the hazard ratio of death by race and ethnicity adjusted for known predictors and surgical outcomes and adjuvant therapy patterns. Results: A total of 12,201 women met the study inclusion criteria. Non-Hispanic Black patients had a significantly worse 5-year overall survival than Hispanic and non-Hispanic White patients (30.9 months vs 51.0 months vs 53.6 months, respectively). Approximately 632 of 7282 patients (8.6%) who received adjuvant treatment experienced a treatment delay. Delay in treatment of ≥12 weeks was significantly different by race and ethnicity (P=.034), with 12% of Hispanic, 9% of non-Hispanic Black, and 8% of non-Hispanic White women experiencing a delay. After adjustment for the number of complications, age, histology (endometrioid vs nonendometroid), International Federation of Gynecology and Obstetrics stage, marital status, comorbidity count, surgical approach, lymph node dissection, and urban-rural code, Hispanic women had a 71% increased risk of treatment delay (odds ratio, 1.71; 95% confidence interval, 1.23-2.38) for all stages of disease. In the same model, non-Hispanic Black race was independently predictive of decreased use of adjuvant treatment for the International Federation of Gynecology and Obstetrics stage II and higher (odds ratio, 1.32; 95% confidence interval, 1.04-1.68). Non-Hispanic Black race, number of perioperative complications, and nonendometrioid histology were predictive of worse survival in univariate models. Treatment delay was not independently predictive of worse 1- or 5-year survival at any stage. Conclusion: Non-Hispanic Black race was predictive of worse 5-year survival across all stages and was associated with omission of adjuvant treatment in International Federation of Gynecology and Obstetrics stage II or higher high-grade endometrial cancer. In unadjusted analyses, patients who experience treatment omission or delay experienced poorer overall survival, but these factors were not independently associated in multivariate analyses. This study suggests that race and ethnicity are independently associated with the type and timing of adjuvant treatment in patients with high-grade endometrial cancer. Further efforts to identify specific causes of barriers to care and timely treatment are imperative.Item Group Dynamics and Allocation of Advanced Heart Failure Therapies-Heart Transplants and Ventricular Assist Devices-By Gender, Racial, and Ethnic Group(American Heart Association, 2023) Breathett, Khadijah; Yee, Ryan; Pool, Natalie; Thomas Hebdon, Megan C.; Knapp, Shannon M.; Herrera-Theut, Kathryn; de Groot, Esther; Yee, Erika; Allen, Larry A.; Hasan, Ayesha; Lindenfeld, JoAnn; Calhoun, Elizabeth; Carnes, Molly; Sweitzer, Nancy K.; Medicine, School of MedicineBackground: US regulatory framework for advanced heart failure therapies (AHFT), ventricular assist devices, and heart transplants, delegate eligibility decisions to multidisciplinary groups at the center level. The subjective nature of decision‐making is at risk for racial, ethnic, and gender bias. We sought to determine how group dynamics impact allocation decision‐making by patient gender, racial, and ethnic group. Methods and Results: We performed a mixed‐methods study among 4 AHFT centers. For ≈ 1 month, AHFT meetings were audio recorded. Meeting transcripts were evaluated for group function scores using de Groot Critically Reflective Diagnoses protocol (metrics: challenging groupthink, critical opinion sharing, openness to mistakes, asking/giving feedback, and experimentation; scoring: 1 to 4 [high to low quality]). The relationship between summed group function scores and AHFT allocation was assessed via hierarchical logistic regression with patients nested within meetings nested within centers, and interaction effects of group function score with gender and race, adjusting for patient age and comorbidities. Among 87 patients (24% women, 66% White race) evaluated for AHFT, 57% of women, 38% of men, 44% of White race, and 40% of patients of color were allocated to AHFT. The interaction between group function score and allocation by patient gender was statistically significant (P=0.035); as group function scores improved, the probability of AHFT allocation increased for women and decreased for men, a pattern that was similar irrespective of racial and ethnic groups. Conclusions: Women evaluated for AHFT were more likely to receive AHFT when group decision‐making processes were of higher quality. Further investigation is needed to promote routine high‐quality group decision‐making and reduce known disparities in AHFT allocation.Item Heart Failure with Reduced Ejection Fraction and COVID-19, when the Sick Get Sicker: Unmasking Racial and Ethnic Inequities During a Pandemic(Elsevier, 2023) Contreras, Johanna; Tinuoye, Elizabeth O.; Folch, Alejandro; Aguilar, Jose; Free, Kendall; Ilonze, Onyedika; Mazimba, Sula; Rao, Roopa; Breathett, Khadijah; Medicine, School of MedicineMinoritized racial and ethnic groups have the highest incidence, prevalence, and hospitalization rate for heart failure. Despite improvement in medical therapies and overall survival, the morbidity and mortality of these groups remain elevated. The reasons for this disparity are multifactorial, including social determinant of health (SDOH) such as access to care, bias and structural racism. These same factors contributed to higher rates of COVID-19 infection among minoritized racial and ethnic groups. In this review, we aim to explore the lessons learned from the COVID 19 pandemic and its interconnection between heart failure and SDOH. The pandemic presents a window of opportunity for achieving greater equity in the health care of all vulnerable populations.Item Identification of Bias in Ordering Further Imaging in Ethnic Groups With Indeterminate Ultrasound for Appendicitis(Springer Nature, 2022-08-17) Desai, Puja; Haut, Lindsey; Wagers, Brian; Coffee, R. Lane, Jr.; Kelker, Heather; Wyderko, Michael; Sarmiento, Elisa J.; Kanis, Jessica; Emergency Medicine, School of MedicineBackground: Recent studies have shown a higher incidence of complications from acute appendicitis in Hispanic populations. Hispanic ethnicity alone has been shown to be a risk factor. In contrast, one study found little evidence of racial disparities in complication rates. The objective of this study was to identify physician bias regarding whether ethnicity drives further testing after initial radiologic imaging has been obtained in the evaluation of appendicitis in our pediatric emergency department (PED). The use of computed tomography (CT) scan in the diagnosis of appendicitis was compared between Hispanic versus non-Hispanic populations when ultrasound (US) was indeterminate. Methodology: This is a retrospective cohort study of Hispanic and non-Hispanic patients aged 2-18 who presented to the PED with right lower quadrant abdominal pain over a one-year period (January 1, 2017 to December 29, 2017). Both groups were subdivided into positive, negative, or indeterminate US findings for appendicitis. Each subgroup was analyzed based on those who had CT imaging done. Results: A total of 471 ultrasounds were performed, 162 Hispanic and 309 non-Hispanic patients. Indeterminate US scans were documented in 90/162 (56%) Hispanic versus 155/309 (50%) non-Hispanic patients. Of those with indeterminate US scans, 30% Hispanic versus 32% non-Hispanic patients received CT scans. Negative US scans were documented in 54/162 (33%) Hispanic versus 102/309 (33%) non-Hispanic patients. Of those with negative US scans, 7% Hispanic versus 5% non-Hispanic patients received CT scans. Chi-square analysis comparing both the proportion of CT scans received for indeterminate US scans (p=0.71) and negative US scans (p=0.52) showed no statistical significance. Conclusions: There was no significant difference in the number of CT scans ordered for indeterminate US scans between Hispanic and non-Hispanic patients. One can infer that there is no inherent bias toward ordering advanced imaging in Hispanic children based on ethnicity alone.Item Lack of Cultural and Language Concordant Nutrition Education for Hispanic/Latinx Individuals with CKD: A Call to Action(Wolters Kluwer, 2022) Perez, Luis M.; Biruete, Annabel; Nutrition and Dietetics, School of Health and Human SciencesItem Pilot test of a Multi-Component Implementation Strategy for Equity in Advanced Heart Failure Allocation(Elsevier, 2023) Breathett, Khadijah; Yee, Ryan H.; Pool, Natalie; Hebdon, Megan C.; Knapp, Shannon M.; Calhoun, Elizabeth; Sweitzer, Nancy K.; Carnes, Molly; Medicine, School of MedicineAdvanced heart failure (AHF) therapy allocation is vulnerable to bias related to subjective assessments and poor group dynamics. Our objective was to determine whether an implementation strategy for AHF team members could feasibly contribute to organizational and culture change supporting equity in AHF allocation. Using a pretest-posttest design, the strategy included an 8-week multicomponent training on bias reduction, standardized numerical social assessments, and enhanced group dynamics at an AHF center. Evaluations of organizational and cultural changes included pretest-posttest AHF team member surveys, transcripts of AHF meetings to assess group dynamics using a standardized scoring system, and posttest interviews guided by a framework for implementing a complex strategy. Results were analyzed with qualitative descriptive methods and Brunner-Munzel tests for relative effect (RE, RE >0.5 signals posttest improvement). The majority of survey metrics revealed potential benefit with RE >0.5. REs were >0.5 for 5 of 6 group dynamics metrics. Themes for implementation included (1) promoting equitable distribution of scarce resources, (2) requiring a change in team members' time investment to correct bias and change the meeting structure, (3) slowing and then accelerating the allocation process, and (4) adaptable beyond AHF and reinforceable with semi-annual trainings. An implementation strategy for AHF equity demonstrated the feasibility for organizational and culture changes.