IU Indianapolis ScholarWorks :: Browsing by Subject "Racial disparities"

Browsing by Subject "Racial disparities"

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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 Medicine
Background: 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.
A Fork In The Road to Health Equity: Lesson from Odetta
(American Medical Association, 2022-07-01) Breathett, Khadijah; Medicine, School of Medicine
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.
Association between clinician team segregation, receipt of cardiovascular care and outcomes in valvular heart diseases
(Wiley, 2025) Bolakale-Rufai, Ikeoluwapo Kendra; Knapp, Shannon M.; Bisono, Janina Quintero; Johnson, Adedoyin; Moore, Wanda; Yankah, Ekow; Yee, Ryan; Trabue, Dalancee; Nallamothu, Brahmajee; Hollingsworth, John M.; Watty, Stephen; Williamson, Francesca; Pool, Natalie; Hebdon, Megan; Ezema, Nneamaka; Capers, Quinn; Blount, Courtland; Kimbrough, Nia; Johnson, Denee; Evans, Jalynn; Foree, Brandi; Holman, Anastacia; Lightbourne, Karen; Brown, David; Tucker Edmonds, Brownsyne; Breathett, Khadijah; Medicine, School of Medicine
Aims: Racial disparities exist in clinical outcomes for valvular heart disease (VHD). It is unknown whether clinician segregation contributes to these disparities. Among an adequately insured population, we evaluated the relationship between clinician segregation in a hospital and receipt of care by a cardiologist according to patient race. We also evaluated the association between clinician segregation, race and care by a cardiologist on 30-day readmission and 1-year survival. Methods and results: Using Optum's Clinformatics® Data Mart Database (CDM, US commercial and Medicare beneficiaries) from 2010 to 2018, we identified patients with a primary diagnosis of VHD. Hospitals were categorized into low, medium and high segregation groups (SG), according to clinician segregation index (SI). SI can range from 0-1 (0: the ratio of Black to White patients is the same for all clinicians; 1: each clinician treats only Black or only White patients). Outcomes were analysed using generalized linear mixed effect models. Among 8649 patients [median age 75 (67-82), 45.4% female, 16.1% Black, 83.9% White], odds of care from a cardiologist did not vary across race for all SGs [Low SG adjusted odds ratio (aOR): 0.79 (95% CI: 0.58-1.08), P = 0.14; Medium SG aOR: 0.86 (95% CI: 0.60-1.25), P = 0.43; High SG aOR: 1.07 (95% CI: 0.68-1.69), P = 0.76]. Among those that received care from a cardiologist, there was no difference in the 30-day readmission between Black and White patients across SGs [Low SG aOR: 1.05 (95% CI: 0.83-1.31), P = 0.70; Medium SG aOR: 1.22 (95% CI: 0.92-1.61), P = 0.17; High SG aOR: 0.81 (95% CI: 0.57-1.17), P = 0.27]. Among patients that did not receive care from a cardiologist, Black patients in low SG had higher odds of 30-day readmission compared to White patients [aOR: 2.74 (95%CI:1.38-5.43), P < 0.01]. Odds of 1-year survival were similar across race for all SG irrespective of receipt of care from a cardiologist [seen by a cardiologist: Low SG aOR: 1.13 (95% CI: 0.86-1.48), P = 0.38; Medium SG aOR: 0.83 (95% CI: 0.59-1.17), P = 0.29; High SG aOR: 1.01 (95% CI: 0.66-1.52), P = 0.98; not seen by a cardiologist: Low SG aOR: 0.56 (95% CI: 0.23-1.34), P = 0.19; Medium SG aOR: 0.81 (95% CI: 0.28-2.37), P = 0.70; High SG aOR: 0.63 (95% CI: 0.23-1.74), P = 0.37]. Conclusions: Among an insured population, race was not associated with care by a cardiologist for VHD or survival. Black patients not seen by cardiologists had higher odds of 30-day readmission in low clinician SG.
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 Health
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 Health
Background: 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.
Feasibility and Delivery of Patient-Reported Outcomes in Clinical Practice Among Racially Diverse Bladder and Prostate Cancer Patients
(Elsevier, 2021) Smith, Angela B.; Samuel, Cleo A.; McCabe, Sean D.; Deal, Allison; Jonsson, Mattias; Mueller, Dana E.; Mahbooba, Zahra M.; Bennett, Antonia V.; Chung, Arlene E.; Nielsen, Matthew E.; Tan, Hung-Jui; Wallen, Eric; Pruthi, Raj; Wang, Andrew; Basch, Ethan; Reeve, Bryce B.; Chen, Ronald C.; Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health
Objective: To assess the feasibility of enrollment and collecting patient-reported outcome (PRO) data as part of routine clinical urologic care for bladder and prostate cancer patients and examine overall patterns and racial variations in PRO use and symptom reports over time. Subjects/patients and methods: We recruited 76 patients (n = 29 Black and n = 47 White) with prostate or bladder cancer at a single, comprehensive cancer center. The majority of prostate cancer patients had intermediate risk (57%) disease and underwent either radiation or prostatectomy. Over half (58%) of bladder cancer patients had muscle invasive disease and underwent cystectomy. Patients were asked to complete PRO symptom surveys using their preferred mode [web- or phone-based interactive voice response (IVR)]. Symptom summary reports were shared with providers during visits. Surveys were completed at 3 time points and assessed urinary, sexual, gastrointestinal, anxiety/depression, and sleep symptoms. Feasibility of enrollment and survey completion were calculated, and linear mixed effects models estimated differences in outcomes by race and time. Results: Sixty three percent of study participants completed all PRO measures at all 3 time points. Black patients were more likely to select IVR as their survey mode (40% vs. 13%, P < 0.05), and less likely to complete all surveys (55% vs. 74%, P = 0.13). Patients using IVR were also less likely to complete all surveys (41% vs. 69%, P = 0.046). Conclusions: Reported preferences for survey mode and completion rates differ by race, which may influence survey completion rates and highlight potential obstacles for equitable implementation of PROs into clinical care.
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 Medicine
Background: 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.
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 Medicine
Minoritized 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.
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 Medicine
Background: 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.

Browsing by Subject "Racial disparities"

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