Racial/Ethnic Disparities in Health Care Receipt Among Male Cancer Survivors

Objectives. We examined racial/ethnic disparities in health care receipt among a nationally representative sample of male cancer survivors.Methods. We identified men aged 18 years and older from the 2006–2010 National Health Interview Survey who reported a history of cancer. We assessed health care receipt in 4 self-reported measures: primary care visit, specialist visit, flu vaccination, and pneumococcal vaccination. We used hierarchical logistic regression modeling, stratified by age (< 65 years vs ≥ 65 years).Results. In adjusted models, older African American and Hispanic survivors were approximately twice as likely as were non-Hispanic Whites to not see a specialist (odds ratio [OR] = 1.78; 95% confidence interval [CI] = 1.19, 2.68 and OR = 2.09; 95% CI = 1.18, 3.70, respectively), not receive the flu vaccine (OR = 2.21; 95% CI = 1.45, 3.37 and OR = 2.20; 95% CI = 1.21, 4.01, respectively), and not receive the pneumococcal vaccine (OR = 2.24; 95% CI = 1.54, 3.24 and OR = 3.10; 95% CI = 1.75, 5.51, respectively).Conclusions. Racial/ethnic disparities in health care receipt are evident among older, but not younger, cancer survivors, despite access to Medicare. These survivors may be less likely to see specialists, including oncologists, and receive basic preventive care.Gender and racial/ethnic disparities in health care utilization are prevalent. Men are less likely than are women to use health care services, including physician office visits and preventive care visits.1,2 Minorities are also less likely to use health care services than are non-Hispanic Whites.3–6 Contributors to these disparities include low socioeconomic status7–10 and lack of health insurance.7,8,11,12 Even after controlling for socioeconomic status and health insurance coverage, racial/ethnic disparities in health care utilization persist.4 These disparities are associated with poorer health and higher mortality rates among minorities and have important implications for survival and well-being for men with serious and chronic health conditions such as cancer.5Although numerous studies have documented racial/ethnic disparities in cancer screening, diagnosis, treatment, and mortality,10,13–18 little is known about how racial/ethnic disparities in health care among posttreatment cancer survivors influence follow-up care. Such care includes monitoring and managing late and long-term effects and follow-up tests to monitor for recurrence and detect second cancers. Management of noncancer comorbidities (e.g., diabetes) and preventive health care19 (e.g., vaccinations) are also recommended for cancer survivors.20–22 Follow-up care may include visits to both primary care and specialist providers.13,23–25 It is strongly recommended that cancer survivors receive lifelong follow-up care because of increased risk of recurrence, morbidity, and mortality.19Prior studies have used administrative data to explore this issue,13,24,26,27 but few of these studies have focused on male cancer survivors and none included younger survivors who are not covered by Medicare. Additionally, it is not known how patterns of health care receipt might differ among men with and without a history of cancer.We assessed racial/ethnic disparities in health care receipt among adult male cancer survivors and men without cancer using the National Health Interview Survey (NHIS).28 We first wanted to compare cancer survivors to a noncancer group to shed light on whether the disparities are specific to cancer or reflect underlying disparities. We explored (1) racial/ethnic disparities in health care receipt among cancer survivors compared with men with no cancer history, (2) racial/ethnic disparities in cancer survivors, and (3) the extent to which predisposing, enabling, and need factors explain racial/ethnic disparities in health care receipt among male cancer survivors.     

Racial/Ethnic Disparities in Hypertension Prevalence: Reconsidering the Role of Chronic Stress

Objectives. We investigated the association between anticipatory stress, also known as racism-related vigilance, and hypertension prevalence in Black, Hispanic, and White adults.Methods. We used data from the Chicago Community Adult Health Study, a population-representative sample of adults (n = 3105) surveyed in 2001 to 2003, to regress hypertension prevalence on the interaction between race/ethnicity and vigilance in logit models.Results. Blacks reported the highest vigilance levels. For Blacks, each unit increase in vigilance (range = 0–12) was associated with a 4% increase in the odds of hypertension (odds ratio [OR] = 1.04; 95% confidence interval [CI] = 1.00, 1.09). Hispanics showed a similar but nonsignificant association (OR = 1.05; 95% CI = 0.99, 1.12), and Whites showed no association (OR = 0.95; 95% CI = 0.87, 1.03).Conclusions. Vigilance may represent an important and unique source of chronic stress that contributes to the well-documented higher prevalence of hypertension among Blacks than Whites; it is a possible contributor to hypertension among Hispanics but not Whites.Racial and ethnic disparities in hypertension are some of the most widely studied and consequential sources of social disparities in health in the United States.1–3 For example, recent prevalence estimates show that roughly 40% of Black adults but only 30% of White adults have hypertension.4 In addition, the incidence of hypertension occurs at younger ages for Blacks than Whites.1 These disparities are reflected in the larger burden of hypertension-related health and economic costs carried by non-White than White Americans. For example, mortality rates attributable to hypertension are roughly 15 deaths per 100 000 people for White men and women; the mortality rate for Black women is 40 per 100 000 and more than 50 per 100 000 for Black men.5 Among all health conditions, hypertension accounts for the greatest portion of disparities in years of lost life.6 Economically speaking, if Black Americans had the hypertension prevalence of White Americans, about $400 million would be saved in out-of-pocket health care expenses, about $2 billion would be saved in private insurance costs, and $375 million would be saved from Medicare and Medicaid—per year.7Despite the tremendous amount of research devoted to clarifying the factors that generate these disparities, most studies find that they persist after adjustment for a wide range of socioeconomic, behavioral, and biomedical risk factors.8 In fact, although disparities exist for several of these risk factors (e.g., socioeconomic status), numerous studies have shown no disparities in many others (e.g., smoking, obesity for men, lipid profile).2 Despite substantial investment in interventions to eliminate hypertension disparities, evidence suggests that these disparities have actually grown over the past few decades,9 suggesting that numerous unknown factors drive disparities in hypertension.3     

Depressive Symptomology and Hostile Affect among Latinos Using Housing Rental Assistance: the AHOME Study

Studies show that those residing in households subsidized with federal housing vouchers exhibit fewer mental health problems than residents of public housing. The role of housing conditions and neighborhood quality in this relationship is unclear. This study investigated the relationship between rental assistance, housing and neighborhood conditions, and the risk of depressive symptomology and hostile affect among low-income Latino adults living in the Bronx, NY. Latino adults participating in the Affordable Housing as an Obesity Mediating Environment (AHOME) study were used for analysis. All AHOME participants were eligible for federal low-income housing rental assistance (n = 385) and living in the Bronx, New York (2010–2012). Housing (crowding and structural deficiencies) and neighborhood (physical disorder and social cohesion) were measured by questionnaire during in-home interview. Depressive symptomology was measured using the Center for Epidemiologic Studies Depression Scale Short Form, CES-D 10 (score ≥10). Hostile affect was measured using items from the Cook-Medley Hostility Scale (score ≥ 4). Results suggest residents of Section 8 housing have similar levels of depressive symptomology and hostility compared to residents in public housing or those receiving no federal housing assistance. However, depressive symptomology was significantly associated with maintenance deficiencies [OR = 1.17; CI 1.02, 1.35] and social cohesion [OR = 0.71; CI 0.55, 0.93]. Hostility was significantly associated with perceived crowding [OR = 1.18; CI 1.16, 2.85], neighborhood physical disorder [OR = 1.94; CI 1.12, 3.40], and social cohesion [OR = 0.70; CI 0.50, 0.98]. Low-income housing assistance did not have an independent effect on mental health outcomes. However, characteristics of the housing and neighborhood environments were associated with depressive symptomology and hostility.     

Malnutrition: Prevalence and its associated factors in People living with HIV/AIDS,in Dilla University Referral Hospital

Background

Literatures on prevalence and factors associated with malnutrition among peoples living with HIV/AIDS are limited in Ethiopia and not well documented either. The proper implementation of nutritional support and its integration with the routine highly active antiretroviral therapy package demands a clear picture of the magnitude and associated factors of malnutrition. The objective of this study is, therefore, to assess the prevalence and factors associated with malnutrition among peoples living with HIV/AIDS.

Methods

Institution based cross sectional study was conducted in Dilla University referral Hospital including adult HIV patients who were in highly active anti retroviral therapy. Interview administered questionnaires were used to collect data on socio demographic factors. Besides, HIV related clinical information was extracted from anti retro viral therapy data base and clinical charts. The nutritional status of the patients was determined by Body Mass Index (BMI) where BMI < 18kg/m² was defined as malnutrition according to World Health Organization (WHO). Binary logistic regression was used to assess association between different risk factors and malnutrition. Confidence interval of 95% was considered to see the precision of the study and the level of significance was taken at α <0.05.

Results

A total of 520 patients were included in the analysis. The overall prevalence of malnutrition was 12.3% (95% CI 9.5–15.0). After full control of all variables; unemployment (OR = 3.61, 95% CI: 3.6 − 7.76), WHO clinical stage four (OR = 12.9, 95% CI: 2.49− 15.25), gastrointestinal symptoms (OR = 5.3, 95% CI: 2.56 − 10.78) and previous (one) opportunistic infection (OR = 3.1, 95% CI 2.06 − 5.46), and two & above previous opportunistic infections (OR = 4.5, 95% CI: 3.38 − 10.57) were significantly associated with malnutrition. However, moderately poor economic condition was found to be protective factor for malnutrition (OR = 0.4, 95% CI: 0.14 − 0.95).

Conclusion

Unemployment, WHO clinical AIDS stage four, one & more number of previous opportunistic infections and gastrointestinal symptoms were found to be important risk factors for malnutrition among People Living with HIV/AIDS. From this study it has been learnt that nutritional programs should be an integral part of HIV/AIDS continuum of care. Furthermore, it needs to improve household income of PLHIV with employment opportunity and to engage them in income generating activities as well.     

Sexual Orientation Disparities in Cancer-Related Risk Behaviors of Tobacco,Alcohol, Sexual Behaviors,and Diet and Physical Activity: Pooled Youth Risk Behavior Surveys

Objectives. We examined sexual orientation disparities in cancer-related risk behaviors among adolescents.Methods. We pooled data from the 2005 and 2007 Youth Risk Behavior Surveys. We classified youths with any same-sex orientation as sexual minority and the remainder as heterosexual. We compared the groups on risk behaviors and stratified by gender, age (< 15 years and > 14 years), and race/ethnicity.Results. Sexual minorities (7.6% of the sample) reported more risk behaviors than heterosexuals for all 12 behaviors (mean = 5.3 vs 3.8; P < .001) and for each risk behavior: odds ratios (ORs) ranged from 1.3 (95% confidence interval [CI] = 1.2, 1.4) to 4.0 (95% CI = 3.6, 4.7), except for a diet low in fruit and vegetables (OR = 0.7; 95% CI = 0.5, 0.8). We found sexual orientation disparities in analyses by gender, followed by age, and then race/ethnicity; they persisted in analyses by gender, age, and race/ethnicity, although findings were nuanced.Conclusions. Data on cancer risk, morbidity, and mortality by sexual orientation are needed to track the potential but unknown burden of cancer among sexual minorities.A 2011 Institute of Medicine report detailed the lack of national data to estimate cancer incidence and prevalence among lesbian, gay, bisexual, and transgender individuals,1 representing little progress since a 1999 report from the Institute on the health of lesbians that highlighted the absence of cancer data for that group.2 The persistent lack of national surveillance data on cancer among sexual minorities is a significant public health omission. Cancer remains the second most common cause of mortality in the United States, accounting for nearly 1 of every 4 deaths.3 Behaviors that increase the risk for cancer are elevated among sexual minorities, are likely to be apparent at young ages, and may become habitual over the life span by means of behavioral reinforcement and neurobiological reward circuits.     

The Effect of Religious Service Attendance on Race Differences in Depression: Findings from the EHDIC-SWB Study

In the EHDIC-SWB study, African-Americans are less likely to have depression than non-Hispanic whites. Religious service attendance is one possible explanation because studies have shown an inverse relationship between religious service attendance and depression. We examined the relationship between race, religious service attendance, and depression in 835 African-American and 573 non-Hispanic white adults aged 18 and older in the Exploring Health Disparities in Integrated Communities-Southwest Baltimore (EHDIC-SWB) study. Religious service attendance was measured according to participants’ response to “how often do you attend religious services?” Depression was measured using the Patient Health Questionnaire. African-Americans attended religious services more frequently than non-Hispanic whites, and had a lower percentage of depression (10.1% vs. 15.4%; p-value <0.05). After adjusting for the demographic variables and health-related characteristics, African-Americans displayed lower odds of having depression (OR = 0.68, 95% CI: 0.47–0.97) compared to non-Hispanic whites. However, when including religious service attendance in the model, we found race differences in depression (OR = 0.76, 95% CI: 0.52–1.11) were no longer significant. We concluded that among individuals living in a low-income, integrated urban environment, race disparities in depression were eliminated after accounting for race differences in religious service attendance. This suggests religious service attendance may serve as a protective factor against depression for African-Americans.     

Housing Instability and Incident Hypertension in the CARDIA Cohort

Housing instability, a growing public health problem, may be an independent environmental risk factor for hypertension, but limited prospective data exist. We sought to determine the independent association of housing instability in early adulthood (year 5, 1990–1991) and incident hypertension over the subsequent 15 years of follow-up (years 7, 10, 15, and 20) in the Coronary Artery Risk Development in Young Adults (CARDIA) study (N = 5,115). Because causes of inadequate housing and its effects on health are thought to vary by race and sex, we hypothesized that housing instability would exert a differential effect on incident hypertension by race and sex. At year 5, all CARDIA participants were asked about housing and those free of hypertension were analyzed (N = 4,342). We defined housing instability as living in overcrowded housing, moving frequently, or living doubled up. Of the 4,342 participants, 8.5 % were living in unstable housing. Across all participants, housing instability was not associated with incident hypertension (incidence rate ratio (IRR), 1.1; 95 % CI, 0.9–1.5) after adjusting for demographics, socioeconomic status, substance use, social factors, body mass index, and study site. However, the association varied by race and sex (p value for interaction, <0.001). Unstably housed white women had a hypertension incidence rate 4.7 times (IRR, 4.7; 95 % CI, 2.4–9.2) that of stably housed white women in adjusted analysis. There was no association among white men, black women, or black men. These findings suggest that housing instability may be a more important risk factor among white women, and may act independently or as a marker for other psychosocial stressors (e.g., stress from intimate partner violence) leading to development of hypertension. Studies that examine the role of these psychosocial stressors in development of hypertension risk among unstably housed white women are needed.     

Disparities in chronic medical conditions in the Mid-South

Objective. This study examined differences in socio-demographic characteristics and health behaviors relevant to chronic medical conditions (CMCs) in the Mid-South region (Alabama, Mississippi, Louisiana, Kentucky, Tennessee, and Arkansas), and identified subpopulations with increased burden of chronic disease.

Methods. Data were obtained from the 2013 Behavioral Risk Factor Surveillance System. The top five most prevalent CMCs in the Mid-South were analyzed: asthma, high blood pressure (HBP), obesity, arthritis, and depression. Adjusted odds ratios (AOR) and confidence intervals (CI) of race–gender combinations were estimated using logistic regression. Differences in associations between socio-demographic characteristics and CMCs according to income were also examined.

Results. The weighted prevalence estimates of the top five CMCs ranged from 66% (asthma) to 20% (depression). Higher income and employment were associated with better outcomes in all five CMCs. Higher educational attainment and physical activity were associated with better HBP, obesity, and arthritis status. Black and white females had higher odds of asthma compared to white males (black AOR?=?1.7, CI: 1.1–2.6, white AOR?=?1.7, CI: 1.3–2.2). Black males had lower odds of arthritis (AOR?=?0.8, CI: 0.6–0.9), while white females had higher odds (AOR?=?1.3, CI: 1.2–1.4). Similarly, the odds of depression were lower among black males (AOR?=?0.5, CI: 0.4–0.6) and higher among white females (AOR?=?2.2, CI: 2.0–2.5). Income-related differences by race were observed for HBP and obesity.

Conclusion. Disparities in CMCs are associated with income and disproportionately affect the black population. In the Mid-South, race and gender disparities in the top five chronic conditions are more prominent among higher-income rather than lower-income individuals.     

Race, occupation, and lung cancer: detecting disparities with death certificate data

OBJECTIVES: To determine whether the analysis of death certificate data would reveal the same relationship among race, occupational exposure, and lung cancer mortality observed by a large cohort study. METHODS: An occupation-specific mortality odds ratio (MOR) for lung cancer (ICD-162) versus all other causes was calculated for 218,341 black men and white men who had been employed in the metal industries. RESULTS: Black men were at increased risk for lung cancer mortality when compared with white men among the 4668 oven workers (MOR = 1.38, 95% CI = 1.10 to 1.73), but not among the 33,605 white-collar workers (MOR = 0.95, 95% CI = 0.74 to 1.23). CONCLUSIONS: Our findings corroborate a previously demonstrated association among exposure to carcinogenic coke oven emissions, race, and lung cancer mortality, and support the use of death certificate data to help identify occupations with racial disparities in lung cancer mortality.     

Do statutory holidays impact the number of opioid-related hospitalizations among Canadian adults? Findings from a national case-crossover study

ObjectiveIn Canada, emergency department visits, hospitalizations, and deaths due to opioid use have risen substantially in recent years. While these events have exhibited seasonal and day of week patterns, there have been no attempts to investigate the extent to which statutory holidays influence these patterns, particularly opioid-related hospitalizations.MethodsWe applied a time-stratified case-crossover study design to investigate whether statutory holidays were predictive of opioid-related hospitalizations using the Canadian Discharge Abstract Database (excluding Quebec) for fiscal years 2011/2012 to 2016/2017. This design controls for day of week effects. We restricted analyses to opioid hospitalizations (ICD-10 codes: F11.x, T40.0–T40.4, and T40.6) among individuals 15 years and older. Conditional logistic regression models were fit to estimate the odds of opioid-related hospitalization on holidays relative to non-holidays. We examined these patterns across different holiday types, namely social gathering holidays (e.g., Canada Day) and family holidays (e.g., Christmas). Stratified analyses were done to identify whether these associations varied by age group and sex.ResultsWe identified a total of 59,965 opioid-related hospitalizations. Overall, we found a 12% reduced odds in opioid hospitalizations on holidays (odds ratio [OR] = 0.88, 95% CI 0.83, 0.93) relative to non-holidays. Similar reductions were observed for both family (OR = 0.86, 95% CI 0.79, 0.93) and social gathering holidays (OR = 0.90, 95% CI 0.84, 0.96). No substantive differences were noted by age group or sex.ConclusionsOur findings support the hypothesis that opioid-related hospitalizations occur less frequently on statutory holidays. This knowledge may help inform healthcare resources and health promotion activities to reduce the impacts of opioid use.     

Oral Health among Residents of Publicly Supported Housing in Boston

Tooth loss in adults diminishes quality of daily life, affecting eating, speaking, appearance, and social interactions. Tooth loss is linked to severe periodontitis and caries; and to risk of stroke, cardiovascular disease, rheumatoid arthritis, and dementia. At the national (USA) level, poverty and African-American race have been linked to lower utilization of dental services, suggesting that the 7.5 million residents of publicly supported housing may be at risk of tooth loss and poor overall oral health. We assessed whether residence in publicly supported housing in Boston was associated with four oral health-related indicators. Compared to residents of nonpublicly supported housing, after adjusting for covariates residents of both public housing developments (PHDs) and rental assistance units (RAUs) had significantly lower odds of having had a dental cleaning in the past year (PHD, OR = 0.64 (95 % CI, 0.44–0.93); RAU, OR = 0.67 (95 % CI, 0.45–0.99))—despite parity in having had a past year dental visit. Further, residents of RAUs had double the odds of having had six or more teeth removed (OR = 2.20 (95 % CI, 1.39–3.50)). Associations of race/ethnicity and housing type with dental insurance were interrelated. Unadjusted results document a deficit in oral health-related indicators among public housing residents, taken as a group, giving a clear picture of an oral health care gap and identifying a defined real-world population that could benefit from services. Existing public housing infrastructure could provide both a venue and a foundation for interventions to reduce oral health disparities on a broad scale.     

Consumption of ultra-processed foods is associated with obesity,diabetes and hypertension in Canadian adults

ObjectiveTo assess the association between consumption of ultra-processed foods and obesity, diabetes, hypertension and heart disease in a nationally representative sample of Canadian adults.MethodsThis study used cross-sectional data from 13,608 adults (aged 19+ years) from the 2015 Canadian Community Health Survey–Nutrition. The survey provided data on food consumption (from 24-h recall) and prevalent obesity (BMI ≥ 30 kg/m²) and self-reported diabetes, hypertension and heart disease. All foods and drinks consumed were classified according to the extent and purpose of industrial processing using the NOVA classification. Ultra-processed food consumption was estimated as proportion of total daily energy intake. Multivariable logistic regression models assessed the association between ultra-processed food consumption and obesity, diabetes, hypertension and heart disease, adjusting for a range of socio-demographic and lifestyle factors.ResultsIn 2015, ultra-processed food contributed, on average, to 24% of total daily energy intake in the lowest tertile of ultra-processed food consumption and 73% in the highest tertile. Compared with those in the lowest tertile, adults in the highest tertile of ultra-processed food consumption had 31% higher odds of obesity (OR = 1.31, 95% CI: 1.06–1.60), 37% higher odds of diabetes (OR = 1.37, 95% CI: 1.01–1.85) and 60% higher odds of hypertension (OR = 1.60, 95% CI: 1.26–2.03), adjusting for a range of covariates.ConclusionHigher consumption of ultra-processed foods is associated with higher prevalence of obesity, diabetes and hypertension among Canadian adults. A comprehensive set of strategies and policies is needed to discourage consumption of ultra-processed foods in Canada and to make unprocessed or minimally processed foods more affordable, available and appealing.Electronic supplementary materialThe online version of this article (10.17269/s41997-020-00429-9) contains supplementary material, which is available to authorized users.     

Disparities by Sexual Orientation in Frequent Engagement in Cancer-Related Risk Behaviors: A 12-Year Follow-Up

Objectives. We examined sexual-orientation disparities in frequent engagement in cancer-related risk indicators of tobacco, alcohol, diet and physical activity, ultraviolet radiation, and sexually transmitted infections (STIs).Methods. We used longitudinal data from the national Growing Up Today Study (1999–2010). Of the analytic sample (n = 9958), 1.8% were lesbian or gay (LG), 1.6% bisexual (BI), 12.1% mostly heterosexual (MH), and 84.5% completely heterosexual (CH).Results. More sexual minorities (LGs, BIs, and MHs) than CHs frequently engaged in multiple cancer-related risk behaviors (33%, 29%, 28%, and 19%, respectively). Sexual-minority young women, especially BI and MH, more frequently engaged over time in substance use and diet and physical activity risk than CH women. More young gay than CH men frequently engaged over time in vomiting for weight control (odds ratio [OR] = 3.2; 95% confidence interval [CI] = 1.1, 9.4), being physically inactive (OR = 1.7; 95% CI = 1.2, 2.4), and using tanning booths (OR = 4.7; 95% CI = 3.0, 7.4), and had a higher prevalence of ever having an STI (OR = 3.5; 95% CI = 2.0, 6.4). Individual analyses were generally comparable to the group-level analyses.Conclusions. Young sexual minorities are at risk for cancer through frequent exposure to cancer-related risk behaviors over time. Long-term, longitudinal studies and surveillance data are essential and warranted to track frequent engagement in the risk behaviors and cancer-related morbidity and mortality.A 2011 report by the Institute of Medicine highlighted the absence of national data on cancer incidence and prevalence for sexual minorities (lesbians, gays, and bisexuals) and transgender individuals.1 The lack of data is surprising because cancer remains the second-leading cause of mortality in the United States, responsible for approximately 1 in 4 deaths.2 Furthermore, behaviors that increase the risk of cancer are more prevalent among sexual minorities. Despite the fact that cancer-related risk behaviors may become habitual over time through behaviorally reinforcing contingencies and neurobiological reward circuits, little is known about the extent to which sexual minorities engage in the behaviors over time. Frequent engagement in the behaviors over time would increase risk for cancer, as would the potential additive or synergistic effects resulting from clustering of the behaviors.Although the prevalence of engaging (yes or no) in risk behaviors among sexual minorities has been studied in literatures that are relatively independent of each other, rarely has the risk of many such behaviors for cancer been noticed. Such awareness and documentation are necessary to argue for the surveillance of cancer morbidity and mortality that the Institute of Medicine1 found lacking. We used a large national cohort of young people to document sexual-orientation disparities in frequent engagement over time in cancer-related risk behaviors at the group and individual levels of analysis.     

Race and region are associated with nutrient intakes among black and white men in the United States

Stroke mortality rates and prevalence of several chronic diseases are higher in Southern populations and blacks in the US. This study examined the relationships of race (black, white) and region (Stroke Belt, Stroke Buckle, other) with selected nutrient intakes among black and white American men (n = 9229). The Block 98 FFQ assessed dietary intakes and multivariable linear regression analysis was used to examine whether race and region were associated with intakes of fiber, saturated fat, trans fat, sodium, potassium, magnesium, calcium, and cholesterol. Race and region were significant predictors of most nutrient intakes. Black men consumed 1.00% lower energy from saturated fat compared with white men [multivariable-adjusted β: 1.00% (95% CI = -0.88, -1.13)]. A significant interaction between race and region was detected for trans fat (P < 0.0001), where intake was significantly lower among black men compared with white men only in the Stroke Belt [multivariable-adjusted β: -0.21 (95% CI = -0.11, -0.31)]. Among black men, intakes of sodium, potassium, magnesium, and calcium were lower, whereas cholesterol was higher, compared with white men (P < 0.05 for all). Comparing regions, men in the Stroke Buckle had the lowest intakes of fiber, potassium, magnesium, and calcium compared with those in the Stroke Belt and other regions; men in both the Stroke Buckle and Stroke Belt had higher intakes of cholesterol compared with those in other regions (P < 0.005 for all). Given these observed differences in dietary intakes, more research is needed to understand if and how they play a role in the health disparities and chronic disease risks observed among racial groups and regions in the US.     

Payer Status,Race/Ethnicity,and Acceptance of Free Routine Opt-Out Rapid HIV Screening Among Emergency Department Patients

Objectives. We estimated associations between payer status, race/ethnicity, and acceptance of nontargeted opt-out rapid HIV screening in the emergency department (ED).Methods. We analyzed data from a prospective clinical trial between 2007 and 2009 at Denver Health. Patients in the ED were offered free HIV testing. Patient demographics and payer status were collected, and we used multivariable logistic regression to estimate associations with HIV testing acceptance.Results. A total of 31 525 patients made 44 765 unique visits: 40% were White, 37% Hispanic, 14% Black, 1% Asian, and 7% unknown race/ethnicity. Of all visits, 10 237 (23%) agreed to HIV testing; 27% were self-pay, 23% state-sponsored, 18% Medicaid, 13% commercial insurance, 12% Medicare, and 8% another payer source. Compared with commercial insurance patients, self-pay patients (odds ratio [OR] = 1.63; 95% confidence interval [CI] = 1.51, 1.75), state-sponsored patients (OR = 1.64; 95% CI = 1.52, 1.77), and Medicaid patients (OR = 1.24; 95% CI = 1.14, 1.34) had increased odds of accepting testing. Compared with White patients, Black (OR = 1.29; 95% CI = 1.21, 1.38) and Hispanic (OR = 1.17; 95% CI = 1.11, 1.23) patients had increased odds of accepting testing.Conclusions. Many ED patients are uninsured or subsidized through government programs and are more likely to consent to free rapid HIV testing.Despite substantial public health efforts, infection with HIV remains an important cause of preventable death in the United States.1 It is estimated that 230 000 people remain unaware of their infections in the United States and 56 300 new infections occur each year, most of which are attributable to contact with those who remain unaware of their HIV status.2–5In an effort to have a further impact on the epidemiology of HIV infection in the United States, the Centers for Disease Control and Prevention (CDC) published revised recommendations for HIV testing in health care settings in 2006.6 These recommendations attempted to reduce exceptionalism associated with HIV testing by, in part, advocating the performance of routine (nontargeted) screening with an opt-out consent approach. Unfortunately, at that time, little was known about the effectiveness of this approach in most clinical settings, including emergency departments (EDs).Although our understanding of the impact of performing nontargeted HIV screening in EDs has been improved over the past several years, we still have little understanding of specific individual-level characteristics that may influence the performance of this important preventive intervention. In fact, several studies have reported varying proportions of testing when the testing is performed in an ED environment and have highlighted differences in the proportions of patients who accept HIV testing and those who actually complete testing.7–10 Perceived risk by the patient and the patient''s medical acuity likely contribute to the relatively small proportion of patients who accept HIV testing, and several operational considerations likely prevent many of those who accept testing to actually complete testing. Other considerations that may importantly contribute to patient acceptance of nontargeted HIV screening include the ability to pay, specific demographic characteristics, and socioeconomic status.11The primary goal of this study was to estimate associations between payer status, race/ethnicity, and acceptance of nontargeted opt-out rapid HIV screening when performed in the ED. The secondary goal was to estimate associations between payer status, race/ethnicity, and completion of nontargeted opt-out rapid HIV screening in the ED.     

Disparities in Mental Health Referral and Diagnosis in the New York City Jail Mental Health Service

Objectives. To better understand jail mental health services entry, we analyzed diagnosis timing relative to solitary confinement, nature of diagnosis, age, and race/ethnicity.Methods. We analyzed 2011 to 2013 medical records on 45 189 New York City jail first-time admissions.Results. Of this cohort, 21.2% were aged 21 years or younger, 46.0% were Hispanic, 40.6% were non-Hispanic Black, 8.8% were non-Hispanic White, and 3.9% experienced solitary confinement. Overall, 14.8% received a mental health diagnosis, which was associated with longer average jail stays (120 vs 48 days), higher rates of solitary confinement (13.1% vs 3.9%), and injury (25.4% vs 7.1%). Individuals aged 21 years or younger were less likely than older individuals to receive a mental health diagnosis (odds ratio [OR] = 0.86; 95% confidence interval [CI] = 0.80, 0.93; P < .05) and more likely to experience solitary confinement (OR = 4.99; 95% CI = 4.43, 5.61; P < .05). Blacks and Hispanics were less likely than Whites to enter the mental health service (OR = 0.57; 95% CI = 0.52, 0.63; and OR = 0.49; 95% CI = 0.44, 0.53; respectively; P < .05), but more likely to experience solitary confinement (OR = 2.52; 95% CI = 1.88, 3.83; and OR = 1.65; 95% CI = 1.23, 2.22; respectively; P < .05).Conclusions. More consideration is needed of race/ethnicity and age in understanding and addressing the punishment and treatment balance in jails.The care of persons with mental illness in the United States is inextricably linked to the criminal justice system. Approximately 12 million people pass through a jail or prison annually, with the majority cycling through local jails.1 Approximately one third of these persons have an identified mental illness diagnosed before or during incarceration. Treatment and discharge planning for this population represent considerable challenges. In some small jails, a single mental health professional may only be available for several hours a week, whereas in larger jails more comprehensive services may be available.Research shows that significant health disparities exist for incarcerated persons of color, including the occurrence of infection, violence, and mortality.2–5 The distribution of psychiatric morbidity and mortality by race in correctional settings is complex, with studies showing higher rates of major affective and depressive disorder diagnoses and suicide among White patients and higher rates of schizophrenia and nonschizophrenic psychotic disorder diagnoses among African American patients.6–10 Similar disparities exist in the community settings where these patients originate and for most, to which they will return.11In the New York City jail system, the Bureau of Correctional Health Services of the New York City Department of Health and Mental Hygiene is responsible for all aspects of medical and mental health care and the New York City Department of Correction is responsible for security and custody management. The New York City jail system is the nation’s second largest, with 70 000 annual admissions and 11 000 persons incarcerated at any given time, with a median length of incarceration of 9 days. Unlike most jail settings, which use relatively cursory intake health screenings, every person who enters the New York City jail system undergoes a comprehensive 4- to 6-hour intake history taking, physical examination, and preventive medicine encounter. Approximately 25% of those admitted to the jails will be admitted into the mental health service, and approximately 4% of those admitted will ultimately be designated as seriously mentally ill (SMI). Although the proportion of SMI patients has remained stable in recent years, the percentage of admitted persons who become part of the mental health service has increased from approximately 12% in 2004 to 25% today. (Note: Entrance into the mental health service is based on ever receiving a mental health diagnosis during incarceration in the New York City jail system.) In addition, because persons with mental illness have longer lengths of stay than others, they now represent approximately 38% of persons in jail at any given time. Entry into the jail mental health service is typically described as resulting from a mental health referral that occurs during the intake history or physical examination during jail admission. Nonetheless, we also have patients enter into the mental health service later in their stay and our clinical experience is that these later admissions may be associated with environmental stressors of the jail itself.Recent Correctional Health Services quality improvement studies on the issue of self-harm have revealed that SMI patients, in addition to adolescents and those in solitary confinement, are significantly more likely to self-harm while in jail.12 Solitary confinement refers to the isolation of persons from others for 22 to 24 hours per day in a locked cell, which is employed in the New York City jail system for punishment reasons. To better understand how persons with a mental health diagnosis initially come to the attention of the mental health service, we conducted an epidemiological analysis focused on timing of diagnosis during jail stay and, where relevant, relative to solitary confinement, nature of diagnosis, age, and race/ethnicity of patients. The overarching goal of this analysis is to improve the quality of care for patients by detecting characteristics of our health system and those of our patients that merit special attention.     

Utilization of Maternal Health Care Among Immigrant Mothers in New York City, 2016–2018

Immigrant women represent half of New York City (NYC) births, and some immigrant groups have elevated risk for poor maternal health outcomes. Disparities in health care utilization across the maternity care spectrum may contribute to differential maternal health outcomes. Data on immigrant maternal health utilization are under-explored in the literature. We conducted a cross-sectional analysis of the population-based NYC Pregnancy Risk Assessment Monitoring System survey, using 2016–2018 data linked to birth certificate variables, to explore self-reported utilization of preconception, prenatal, and postpartum health care and potential explanatory pathways. We stratified results by maternal nativity and, for immigrants, by years living in the US; geographic region of origin; and country of origin income grouping. Among immigrant women, 43% did not visit a health care provider in the year before pregnancy, compared to 27% of US-born women (risk difference [RD] = 0.16, 95% CI [0.13, 0.20]), 64% had no dental cleaning during pregnancy compared to 49% of US-born women (RD = 0.15, 95% CI [0.11, 0.18]), and 11% lost health insurance postpartum compared to 1% of US-born women (RD = 0.10, 95% CI [0.08, 0.11]). The largest disparities were among recent arrivals to the US and immigrants from countries in Central America, South America, South Asia, and sub-Saharan Africa. Utilization differences were partially explained by insurance type, paternal nativity, maternal education, and race and ethnicity. Disparities may be reduced by collaborating with community-based organizations in immigrant communities on strategies to improve utilization and by expanding health care access and eligibility for public health insurance coverage before and after pregnancy.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11524-021-00584-5.