Social factors and injury characteristics associated with the development of perceived injury stigma among burn survivors

Improvement in burn survival has shifted the focus of burn care from beyond merely preserving life to improving the quality of life for burn survivors. Healthy psychosocial function is critical to the development of sustained elevations in quality of life after injury, with social and community integration serving a crucial role. Accordingly, the experience of social stigma could pose a significant hindrance to the process of recovery. In this retrospective analysis of patient-reported outcomes following burn injury as captured in the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) Burn Model Systems database, we examined the patient and injury characteristics associated with the subsequent experience of social stigma by burn survivors. Using multivariable regression analysis, we found that facial burns and amputations are independent risk factors for experiencing social stigma, while male sex and increased community integration were protective. Taken together, these findings suggest a role for targeted counseling for patients who sustain facial burns and/or amputations, as well as the continued investment in burn-survivor outreach programs aimed at improving social support for survivors.     

Racial and Ethnic Disparities in Short-Stay Total Knee Arthroplasty

BackgroundThe purpose of this study was to understand racial and ethnic disparities in hospital-based, Medicare-defined outpatient total knee arthroplasty (TKA). We aimed to determine the following: 1) whether there are differences in preoperative characteristics or postoperative outcomes in outpatient TKA between racial/ethnic groups and 2) trends in outpatient TKA volume, based on race/ethnicity.MethodsThis was a retrospective cohort study of a large national database. Outpatient TKAs performed between 2012 and 2018 were identified. Patient demographics, comorbidities, and 30-day postoperative outcomes were compared between White, Black, Asian, and Hispanic patients.ResultsOf 54,183 outpatient patients, 85.6% were White, 7.4% Black, 2.6% Asian, and 4.1% Hispanic. Black patients had the highest body mass index, and there were higher rates of diabetes among all minority groups (P < .001). All minority groups were more likely to be discharged to a rehabilitation or a skilled care facility compared to White patients (P < .001). Annual percentage increases in outpatient TKA were most pronounced for Asians and Hispanics and least pronounced among Blacks, when compared to White patients.ConclusionThe outcomes of outpatient TKA are impacted by risk factors that reflect underlying disparities in healthcare. As joint arthroplasties have come off the inpatient-only list and procedures move to ambulatory settings, these disparities will likely magnify and impact outcomes, costs, and access points. Extensive preoperative optimization and interventions that target medical and social factors may help to reduce these disparities in TKA and increase access among minority patients.Level of EvidenceIII, retrospective cohort study.     

Self‐reported Racial Discrimination and Endothelial Reactivity to Acute Stress in Women

This study investigated the effect of self‐reported racial discrimination on endothelial responses to acute laboratory mental stress among post‐menopausal women. One‐hundred thirteen women (n = 94 self‐identified as White and n = 19 self‐identified as racial/ethnic minority), 43% with type 2 diabetes, reported lifetime experiences of racial/ethnic discrimination. Repeated assessments of flow‐mediated dilation were performed at baseline, immediately after 5 min of mental arithmetic and at 20‐min recovery. Both White and racial/ethnic minority women reported lifetime discrimination, with rates significantly higher among minorities. Self‐reported lifetime discrimination was associated with attenuated flow‐mediated dilation at recovery. Confounding variables, including clinical characteristics, mood, personality traits, other life stressors and general distress, did not better account for the effect of racial discrimination. Neither race/ethnicity nor diabetes status moderated the effect. The perceived stressfulness of the mental arithmetic was not associated with the endothelial response. In conclusion, self‐reported lifetime discrimination is associated with attenuated endothelial recovery from acute mental stress. Elucidating the effects of discrimination and the biological mechanisms through which it affects the vasculature may suggest interventions to improve health. Copyright © 2012 John Wiley & Sons, Ltd.     

Prevalence of painful bladder symptoms and effect on quality of life in black, Hispanic and white men and women

PURPOSE: The prevalence of painful bladder symptoms is poorly defined, especially in racial and ethnic minority groups. We estimated the prevalence of painful bladder symptoms in a community based sample, assessed symptom variation by age, gender, race/ethnicity and socioeconomic status, and estimated their impact on quality of life. MATERIALS AND METHODS: A population based cross-sectional survey of individuals was done in the Boston area using a multistage stratified cluster sample. A 2-hour in person interview performed by a bilingual interviewer was done, generally in the home of the subject. The research design was for equal numbers of subjects in each of 24 design cells, as defined by age (30 to 39, 40 to 49, 50 to 59 and 60 to 79 years), gender and race/ethnicity (black, Hispanic and white). The sample of 5,506 subjects was recruited from April 2002 through June 2005. Multiple definitions of painful bladder symptoms were used based on consensus statements, research definitions and published articles. The effect of gender, age, race/ethnicity and socioeconomic status on symptom prevalence was assessed. RESULTS: The prevalence of painful bladder syndrome symptoms was 0.83% to 2.71% in women and 0.25% to 1.22% in men depending on the definition used. Multivariate analyses revealed that symptoms were significantly more common in women, middle-aged individuals (40 to 59 years old) and lower socioeconomic status groups. For most definitions there were no variations by race or ethnicity. The presence of symptoms was associated with a significant adverse impact on quality of life. CONCLUSIONS: Painful bladder symptoms are more common than suggested by coded physician diagnoses. Although most bladder pain research cohorts have included predominantly white women, these population based findings indicate no racial/ethnic disparity and limited gender disparity in the prevalence of painful bladder symptoms. This suggests that the burden of painful bladder syndrome may be greater in nonwhite individuals and men than previously suspected.     

Hemodialysis Disparities in African Americans: The Deeply Integrated Concept of Race in the Social Fabric of Our Society

End‐stage renal disease (ESRD) is one of the starkest examples of racial/ethnic disparities in health. Racial/ethnic minorities are 1.5 to nearly 4 times more likely than their non‐Hispanic White counterparts to require renal replacement therapy (RRT), with African Americans suffering from the highest rates of ESRD. Despite improvements over the last 25 years, substantial racial differences are persistent in dialysis quality measures such as RRT modality options, dialysis adequacy, anemia, mineral and bone disease, vascular access, and pre‐ESRD care. This report will outline the current status of racial disparities in key ESRD quality measures and explore the impact of race. While the term race represents a social construct, its association with health is more complex. Multiple individual and community level social determinants of health are defined by the social positioning of race in the U.S., while biologic differences may reflect distinct epigenetic changes and linkages to ancestral geographic origins. Together, these factors conspire to influence dialysis outcomes among African Americans with ESRD.     

Toward improved rehabilitation services for ethnically diverse survivors of traumatic brain injury

Traumatic brain injury is an important public health problem in the United States, especially for individuals from racial and ethnic minorities. The first part of this article provides a synthesis of findings and discussions of cultural issues in the rehabilitation, medical, and psychological scientific literature highlighting the needs and challenges of our diverse population of minority traumatic brain injury survivors in the United States. The second part offers practical recommendations for rehabilitation professionals who desire to improve the healthcare and health outcomes of these individuals. Through an examination of research, guidelines, and resources, we justify the importance of cultural sensitivity in everyday provider interactions with minority clients and their families.     

Examining Minority Attrition Among Women in Longitudinal Trauma Research

Research suggests that racial and ethnic minorities are more likely to attrit from longitudinal trauma studies than non‐Hispanic Whites. Yet, little is known about how the loss of minority participants influences longitudinal findings as well as internal and external validity of study findings. Thus, the present study examined the effects of race/ethnicity on attrition in a longitudinal trauma study of women (minority = 223, non‐Hispanic White or majority = 459) exposed to a campus shooting. Survival analyses were used to compare the attrition rates of minority participants to majority participants and assess the extent to which race/ethnicity, among other variables, predicted attrition. Minority participants were more likely to attrit than majority participants, hazard ratio (HR) = 0.69, 95% CI [0.48, 0.99], even after adjusting for study variables. A main effect was also found for age, HR = 1.06, 95% CI [1.01, 1.12]. Race/ethnicity did not interact with other study variables to influence attrition. The findings underscored the importance of assessing the effects of attrition on longitudinal findings and external validity.     

Head and neck burns are associated with long-term patient-reported dissatisfaction with appearance: A Burn Model System National Database study

Introduction

Burns affecting the head and neck (H&N) can lead to significant changes in appearance. It is postulated that such injuries have a negative impact on patients’ social functioning, quality of life, physical health, and satisfaction with appearance, but there has been little investigation of these effects using patient reported outcome measures. This study evaluates the effect of H&N burns on long-term patient reported outcomes compared to patients who sustained burns to other areas.

Revisiting survival differences by race and ethnicity among hemodialysis patients: the Dialysis Outcomes and Practice Patterns Study

Hemodialysis (HD) patients who are identified as belonging to racial or ethnic minority groups have longer survival than non-Hispanic white HD patients. This study sought to determine to what extent this survival difference is explained by comprehensive adjustment for measurable case-mix and treatment characteristics. A cohort analysis was conducted among 6677 patients between 1996 and 2001 in the American arm of the first phase of the Dialysis Outcomes and Practice Patterns Study, a prospective observational study. Using multivariable proportional hazards analysis, all-cause mortality by racial/ethnic category was compared before and after adjustment for other patient-level variables that are associated with mortality. Factors that influence the statistical associations of race/ethnicity with mortality were explored. The statistically significant (P < 0.001) associations of racial/ethnic minority categories with lower mortality in unadjusted analyses were attenuated or lost in the multivariable model. Compared with non-Hispanic white patients, the adjusted hazard ratio (HR) (95% confidence interval [CI]) for mortality was 0.86 (0.72 to 1.03) for Hispanic patients; among non-Hispanic patients, the HR (95% CI) were 0.97 (0.85 to 1.11) for black patients, 0.82 (0.56 to 1.20) for Asian patients, 0.95 (0.52 to 1.73) for Native American patients, and 0.95 (0.60 to 1.50) for patients of other races (overall P = 0.66). The survival advantages for racial/ethnic minority categories were explained most notably by the combined influence of unbalanced distributions of numerous demographic, morbidity, nutritional, and laboratory variables. The associations of race/ethnicity with survival varied little by duration of ESRD and were not influenced substantially by different rates of kidney transplantation among patients who were on HD. The survival advantages for racial and ethnic minority groups on HD are explained largely by measurable case-mix and treatment characteristics. Individual racial minority group or Hispanic patients should not be expected to survive longer on HD than non-Hispanic white patients with similar clinical attributes.     

Physical,functional, and psychosocial recovery from burn injury are related and their relationship changes over time: A Burn Model System study

Objective

While burn injuries can have dramatic effect on patients’ physical health, they can also lead to intense psychological distress, loss of important social and role functioning, and alterations in outward appearance. We aimed to identify potential leading indicators of recovery in the post-discharge period following acute burn injury and hospitalization.

Disparities in preventative diabetic foot examination

The objective of this study was to assess the overall differences in the standard of preventive foot care for patients at risk of diabetic foot ulceration and to identify specific demographic factors affecting these health care practices, including race and ethnicity. The National Health and Nutrition Examination Survey data for 2011 to 2018 were analyzed. Participants (20 years and older) with diabetes were categorized as White, Black, Hispanic, Asian, and others (including multiracial participants) based on self-reported race and ethnicity. The primary outcome was foot examination over the past year administered by a medical professional. Logistic regression was performed to examine the effects of race and ethnicity on the annual diabetic foot examination, controlling for age (65 years and older), gender, and health insurance status. Among the 2,836 participants included in the study (weighted percentage: 61.1% were White, 13.9% were Black, 15.1% were Hispanic, 5.4% were Asian, and 4.5% were other), 2,018 (weighted percentage: 71.6%) received annual diabetic foot examination over the past year. Hispanic participants (adjusted odds ratio [aOR] = 0.685; 95% CI, 0.52–0.90) were significantly less likely than White participants to receive an annual foot examination (Black participants: aOR = 1.11; 95% CI, 0.83–1.49; Asian participants: aOR = 0.80; 95% CI, 0.60–1.07; other participants: aOR = 0.66; 95% CI, 0.40–1.10). Factors associated with receipt of foot examination were age 65 years or older (aOR = 1.42; 95% CI, 1.05–1.92) and having health insurance (aOR = 3.02; 95% CI, 2.27–4.03). Our findings suggest that Hispanic adults with diabetes are receiving disproportionately lower rates of preventive foot care compared with their White counterparts. This significant variation in the standard of care for individuals with diabetes reflects the need to further identify factors driving the disparities in preventive foot care services among racial and ethnic minority groups.     

Racial and ethnic differences in pediatric surgery utilization in the United States: A nationally representative cross-sectional analysis

ObjectivesChildren of minority background have reduced access to surgery. This study assessed for racial/ethnic differences in surgical utilization by location.Materials and methodsWe conducted a cross-sectional analysis of U.S. children (0–17 years of age) participating in the nationally representative Medical Expenditure Panel Survey (MEPS, 2015–2018). Race/ethnicity was the variable of interest. The primary outcome variables were prevalence rates of surgery defined by location of surgical procedure (inpatient, emergency department, hospital outpatient, and office). Covariates included contextual factors that may influence access to and need for healthcare services, including age, sex, insurance status, residential geographic status, usual source of care, and parental reports of child's physical and mental health. We employed multivariate logistic regression models to assess the relationship between outcomes and race/ethnicity.ResultsThe study population included 31,024 children with an overall surgical rate of 4.8%. Adjusted odds of surgery in an ambulatory location were lower for all racial/ethnic minority groups compared to non-Hispanic White counterparts (non-Hispanic Black aOR = 0.3, 95% CI: 0.2–0.5; Hispanic aOR = 0.4, 95% CI: 0.3–0.6; non-Hispanic Asian aOR = 0.2, 95% CI 0.0–0.5 for hospital outpatient surgery; for office-based setting, non-Hispanic Black aOR = 0.4, 95% CI 0.3–0.6; Hispanic aOR = 0.5, 95% CI: 0.4–0.7; non-Hispanic Asian aOR = 0.4; 95% CI 0.3–0.7). No racial/ethnic differences were observed for surgical procedures in inpatient or emergency department locations.ConclusionsStaggering differences exist in pediatric surgery utilization patterns by racial/ethnic background, even after adjusting for important contextual factors (income, insurance, health status). Our findings in a nationally representative dataset may suggest systemic barriers related to racial/ethnic background for the pediatric surgical population.     

Determinants of Racial and Ethnic Disparities in Surgical Care

Racial and ethnic disparities are a pervasive and persistent problem in health care. This article has three main objectives: 1) To highlight key studies related to racial disparities in cardiovascular care and outcomes; 2) To explore determinants of disparities specifically related to access to renal transplantation as a model for understanding racial disparities in greater depth; and 3) To present promising approaches to eliminate racial disparities in care. Performance reports of the quality of medical and surgical care by race and ethnicity will be a crucial and expanding tool as more organizations ascertain complete data on their patients’ race, ethnicity, language, and socioeconomic characteristics. Efforts to improve the quality of care and health outcomes of underserved racial and ethnic groups will also require effective coordination of care, patient-centered communication, and constructive engagement with communities to eliminate disparities in health care and health.     

Racial and Neighborhood-Level Disparities in COVID-19 Incidence among Patients on Hemodialysis in New York City

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected socially disadvantaged populations. Whether disparities in COVID-19 incidence related to race/ethnicity and socioeconomic factors exist in the hemodialysis population is unknown.MethodsOur study involved patients receiving in-center hemodialysis in New York City. We used a validated index of neighborhood social vulnerability, the Social Vulnerability Index (SVI), which comprises 15 census tract–level indicators organized into four themes: socioeconomic status, household composition and disability, minority status and language, and housing type and transportation. We examined the association of race/ethnicity and the SVI with symptomatic COVID-19 between March 1, 2020 and August 3, 2020. COVID-19 cases were ascertained using PCR testing. We performed multivariable logistic regression to adjust for demographics, individual-level social factors, dialysis-related medical history, and dialysis facility factors.ResultsOf the 1378 patients on hemodialysis in the study, 247 (17.9%) developed symptomatic COVID-19. In adjusted analyses, non-Hispanic Black and Hispanic patients had significantly increased odds of COVID-19 compared with non-Hispanic White patients. Census tract–level overall SVI, modeled continuously or in quintiles, was not associated with COVID-19 in unadjusted or adjusted analyses. Among non-Hispanic White patients, the socioeconomic status SVI theme, the minority status and language SVI theme, and housing crowding were significantly associated with COVID-19 in unadjusted analyses.ConclusionsAmong patients on hemodialysis in New York City, there were substantial racial/ethnic disparities in COVID-19 incidence not explained by neighborhood-level social vulnerability. Neighborhood-level socioeconomic status, minority status and language, and housing crowding were positively associated with acquiring COVID-19 among non-Hispanic Whites. Our findings suggest that socially vulnerable patients on dialysis face disparate COVID-19–related exposures, requiring targeted risk-mitigation strategies.     

Environmental scan of mental health supports across Canadian burn centers: A healthcare providers’ perspective

BackgroundEarly mental health care and psychosocial support after burn injury provided by a variety of specialists and non-mental health professionals is instrumental in prevention of long-term mental health sequalae such as post-traumatic stress, depressive or substance use disorders. Diversity of mental health supports available to burn survivors vary across geography, resulting in variation of long-term mental health outcomes following burn injury.MethodsA mixed-methods study utilizing a semi-structured questionnaire to explore resources available for burn survivors in Canada as an inpatient, outpatient, and more broadly in the aftercare community. Interviews were completed with 17 Canadian burn centers, with a variety of burn care professionals.ResultsIn the continuum of burn care, a lack of available mental health professionals in certain regions and in the outpatient and community phases was observed. Emerging themes demonstrated the need for regular screening for mental health concerns among burn survivors and providing up to date discharge resources. In addition, increasing educational opportunities available to burn care staff with respect to burn survivor mental health was emphasized. Lastly, the importance of proactive and prolonged psychological support for burn survivors as they progress through an outpatient, rehabilitation and community setting was underlined.ConclusionsIdentification of burn care practices and resources across Canada provides the opportunity to compare, unify and improve gaps in care that exist across the Canadian burn network.     

Persistent racial discrimination among vascular surgery trainees threatens wellness

ObjectiveRacial/ethnic discrimination is one form of mistreatment and a known risk factor for physician burnout. In the present study, we aimed to characterize the forms and identify the sources of racial/ethnic discrimination among vascular surgery trainees.MethodsWe performed a cross-sectional study of U.S. vascular surgery trainees who had voluntarily participated in an anonymous survey administered after the 2021 Vascular Surgery In-Training Examination. The primary outcome measures were self-reported mistreatment and sources of mistreatment between race and ethnicity groups. We used χ² tests and logistic regression for bivariate and multivariable analyses, respectively.ResultsRepresenting all 123 vascular surgery training programs, 510 trainees (66.9% men) participated in the survey (83.6% response rate). Most of the trainees had self-identified as White (53.1%), followed by Asian (24.4%), Hispanic/Latinx (7.6%), Black (4.2%), and other/prefer not to say (10.8%). No significant differences were found in the self-reported duty hour violations among the groups. Black (56.3%) and Asian (36.3%) trainees reported higher rates of racial/ethnic discrimination compared with the White, Hispanic/Latinx, and other/prefer not to say groups (P < .001). Patients and their families were reported as the most common source (74.7%). Other reported sources of discrimination included nurses or staff (60%), attendings (37.4%), co-residents (31.3%), and administration (16.9%). Regarding specific forms of racial discrimination, Black and Asian trainees reported the highest rates of different standards of evaluation (20% and 5.9%, respectively), being mistaken for a nonphysician (50.0% and 5.9%, respectively), slurs and/or hurtful comments (13.3% and 5.9%, respectively), social isolation (13.0% and 1.0%, respectively), and being mistaken for another trainee of the same race/ethnicity (60.0% and 33.7%, respectively). Only 62.5% of Black trainees reported their program/institution would take their mistreatment report seriously compared with the White (88.9%), Hispanic/Latinx (88.2%), Asian (83.2%), and other/prefer not to say (71.4%) trainees (P = .01). On multivariable analysis, female gender (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.44-4.33), Asian race (OR, 6.9; 95% CI, 3.53-13.3), Black race (OR, 13.6; 95% CI, 4.25-43.4), and training in the Southeastern United States (OR, 3.8; 95% CI, 1.17-12.80) were risk factors for racial/ethnic discrimination.ConclusionsThe results from the survey revealed that racial/ethnic discrimination persists in surgical training programs, with Asian and Black trainees reporting higher rates than other racial and ethnic groups. Overall, patients and family members were the most common source of racial/ethnic discrimination. However, faculty, staff, and co-trainees also contributed to racial/ethnic discrimination. Further interventions that optimize diversity, equity, and inclusion strategies and policies to address all forms of racial/ethnic discrimination with faculty, staff, and patients within the hospital are critically needed.     

Body image, mood and quality of life in young burn survivors

This study looks at the body image, mood and quality of life of a group of 36 young people aged between 11 and 19 years who had burns as children, compared with an age-matched control group of 41 young people who had not had these injuries. Participants completed the Body Esteem Scale (BES), the Satisfaction With Appearance Scale (SWAP), the Beck Depression Inventory-II (BDI-II) and the Youth Quality of Life Questionnaire (YQOL). It was hypothesised that young burn survivors would report more dissatisfaction with their appearance, a lower mood and a lower quality of life compared with non-injured controls. However, young burn survivors reported significantly more positive evaluations of how others view their appearance (p=0.018), more positive weight satisfaction (p=0.001) and a higher quality of life (p=0.005) than the control group. They also reported more positive general feelings about their appearance, although this was just below the level for statistical significance (p=0.067) and a similar mood to the school sample (p=0.824). The data suggest that young burn survivors appear to be coping well in comparison to their peers, and in some areas may be coping better, in spite of living with the physical, psychological and social consequences of burns.     

Racial and ethnic disparities in clinical trials and peripheral artery disease

As peripheral artery disease (PAD) continues to affect many people in our population, the search continues for medical advances to improve the treatment algorithms for this debilitating disease. Prior research studies have more than adequately documented the disparity that exists in the outcomes of patients with PAD based on race and ethnicity. One of the paths to clinical improvement and removal of the disparate outcomes is through application of the studied variables in a well-constructed clinical trial. Unfortunately, the groups that are known for worse outcomes are also those with limited enrollment into clinical trials, which exacerbates the problem. This article evaluates the issue of underrepresentation of racial and ethnic minority populations in clinical trials, addresses factors contributing to the problem, and provides possible pathways to a viable solution.     

Outcomes in racial minorities after robotic Roux-en-Y gastric bypass and sleeve gastrectomy: a retrospective review of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database

BackgroundThe rate of robotic-assisted metabolic and bariatric surgery (MBS) is increasing. While discord remains about racial disparity in primary MBS, there are no data on robotic MBS outcomes in racial cohorts.ObjectivesTo determine whether outcomes following robotic-assisted Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are mediated by race or ethnicity.SettingUniversity Hospital, United States.MethodsRobotic RYGB and SG cases were identified from the 2015–2017 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) databases using Current Procedure Terminology codes 43644, 43645, and 43775. Selected cases were stratified by race and ethnicity. Case-control matched and logistic regression analyses were performed.ResultsMatched analyses compared outcomes in 2666 RYGB cases of Black versus White patients and 1794 RYGB cases of Hispanic versus White patients. Black RYGB patients had longer operative lengths (OLs; P = .0008) and postoperative lengths of stay (P = .001), and a higher rate of pulmonary embolism (P = .05). Hispanic (versus White) RYGB patients had longer lengths of stay (P = .007). All other outcomes were similar between RYGB racial and ethnic cohorts. Matched analyses also compared outcomes of 8328 SG cases in Black versus White patients and 4852 SG cases in Hispanic versus White patients. Black patients had longer OLs (P = .004), had longer lengths of stay (P < .0001), had higher overall morbidity (P = .02), had higher bariatric-related morbidity (P = .02), had higher rates of readmission (P = .009), and were more likely to have an operative drain present at 30 days (P = .001). All other outcome measures were similar between racial/ethnic SG cohorts.ConclusionRobotic-assisted SG is associated with higher overall and bariatric-related morbidity, but not mortality. However, robotic-assisted RYGB and SG remain safe, with lower rates of mortality and morbidity.