The Relationship Between Discrimination and High-Risk Social Ties by Race/Ethnicity: Examining Social Pathways of HIV Risk

High-risk social ties portend differences in opportunity for HIV exposures and may contribute to racial/ethnic disparities in HIV transmission. Discrimination may affect the formation of high-risk social ties and has not been explored as a possible explanation for these persistent disparities. Using data from injection and non-injection drug users, we examined the association between the number of high-risk sex and drug ties with discrimination due to race, drug use, and incarceration stratified by race/ethnicity. Negative binomial regression models were used. While blacks had significantly fewer injecting ties than Latinos and whites, blacks who reported racial discrimination compared to blacks who did not, had more sex and injecting ties. Latinos who reported drug use discrimination compared to Latinos who did not also had more sex ties. Latinos and whites who reported drug use discrimination had more injecting ties than Latinos and whites who did not. Discrimination is associated with high-risk social ties among all racial/ethnic groups. But, these data highlight different forms of discrimination within racial/ethnic group are associated with risky social ties. More research is needed to confirm these findings and further explore the association between various forms of discrimination and social ties that may help explain racial/ethnic disparities in HIV.     

Race- and sex-associated differences in rate-adjusted QT,QTpeak, ST elevation and other regional measures of repolarization: The Atherosclerosis Risk in Communities (ARIC) Study

Background

Data are limited about race-and sex-associated differences in prognostically important ECG measures of regional repolarization.

Methods and results

The normal reference group from the Atherosclerosis Risk in Communities (ARIC) study included 8,676 white and African-American men and women aged 40–65 years. Exclusion criteria included cardiovascular disease, hypertension, diabetes and major ECG abnormalities. Notable sex differences (p < 0.001) were observed in the upper 98% limits for rate-adjusted QTend (QT_ea) which was 435 ms in white and African-American men and 445 ms in white and African-American women, and for left ventricular epicardial repolarization time (RT_epi) which was 345 ms in white and African-American men and 465 ms in white and African-American women. These sex differences reflect earlier onset and end of repolarization in men than in women. Upper normal limits for STJ amplitude in V2–V3 were 100 μV in white and African-American women, 150 μV in white men and 200 μV in African-American men (p < 0.001 for sex differences), and for other chest leads, aVL and aVF 50 μV in white women, 100 μV in African-American women, 100 μV in white men and 150 μV in African-American men (p < 0.001 for sex and race differences).

Conclusions

Shorter QT_ea and RT_epi in men than in women reflect earlier onset and end of repolarization in men. STJ amplitudes in African-American men were higher than in other subgroups by race and sex. These sex and race differences need to be considered in clinical and epidemiological applications of normal standards.     

The lived experiences of racial bias for Black,Asian and Minority Ethnic students in practice: A hermeneutic phenomenological study

AimThis study explored the lived experiences of racial bias for Black, Asian and Minority Ethnic students undertaking an undergraduate or post-graduate degree in nursing, midwifery and allied health courses in the United Kingdom.BackgroundPrevious research indicates that students from Black, Asian and Minority Ethnic groups have fewer opportunities to succeed at university and this has brought about a race awarding gap in their degree attainment. The reasons for this awarding gap are complex and multi-factorial and it is crucial that the lived experiences of racial bias are explored from the student perspective.DesignA hermeneutic phenomenological approach was adopted to elicit individual and collective experiences in the practice environment, a mandatory component of the student’s degree.MethodsA focus group and individual semi-structured interviews were conducted to collect data from sixteen participants and analysed using thematic analysisResultsThree encompassing themes were identified which included a sense of not belonging, trauma impact on mental health and understanding covert and overt racism. Participants reported incidences of racism and appeared to be traumatised by their experiences within practice and the university. They also reported poor mental health and well-being as shared experiences and a lack of confidence in the university and practice to mitigate racial issues.ConclusionsMeaningful action must be taken by universities and practice partners to advance racial inequality initiatives by having robust anti-racism action plans and processes. These should be co-created with students and staff to reduce the race awarding gap.     

Culture,Ethnicity, and Level of Education in Alzheimer’s Disease

Alzheimer’s disease (AD) is the most frequent cause of dementia, where the abnormal accumulation of beta-amyloid (Aβ) and tau lead to neurodegeneration as well as loss of cognitive, behavioral, and functional abilities. The present review analyzes AD from a cross-cultural neuropsychological perspective, looking at differences in culture-associated variables, neuropsychological test performance and biomarkers across ethnic and racial groups. Studies have found significant effects of culture, preferred language, country of origin, race, and ethnicity on cognitive test performance, although the definition of those grouping terms varies across studies. Together, with the substantial underrepresentation of minority groups in research, the inconsistent classification might conduce to an inaccuratte diagnosis that often results from biases in testing procedures that favor the group to which test developers belong. These biases persist even after adjusting for variables related to disadvantageous societal conditions, such as low level of education, unfavorable socioeconomic status, health care access, or psychological stressors. All too frequently, educational level is confounded with culture. Minorities often have lower educational attainment and lower quality of education, causing differences in test results that are then attributed to culture. Higher levels of education are also associated with increased cognitive reserve, a protective factor against cognitive decline in the presence of neurodegeneration. Biomarker research suggests there might be significant differences in specific biomarker profiles for each ethnicity/race in need of accurate cultural definitions to adequately predict risk and disease progression across ethnic/racial groups. Overall, this review highlights the need for diversity in all domains of AD research that lack inclusion and the collection of relevant information from these groups.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13311-022-01193-z.     

Racial aspects of comorbidity in systemic lupus erythematosus

Objective. To investigate racial differences in the expression of systemic lupus erythematosus (SLE) by comparing comorbidity at death among individuals with SLE. Methods. Proportional mortality rates were estimated for common contributing causes of death among white and black females in the United States, 1989–1991, whose death certificates listed SLE as an underlying or contributing cause. Logistic regression analysis was used to assess the effects of SLE and race on variation in proportional mortality using rates from non SLE deaths as a comparison baseline. Results. Common contributing causes of death listed with SLE included conditions that are known sequelae of the disease. Proportional mortality rates for these conditions varied with race and age. However, among black deaths that listed SLE, the rates of renal disease surpassed those of all other conditions regardless of age. When rates of renal disease among black SLE deaths or among white SLE deaths in any age group were compared to those among white non-SLE deaths, proportional mortality ratios were significantly greater than 1. This also held when rates of renal disease among black non-SLE deaths were compared to rates among white non-SLE deaths. However, across all ages, the proportional mortality ratios for renal disease in black SLE deaths significantly exceeded corresponding ratios for white SLE deaths and for black non-SLE deaths. Conclusion. Black females who die with SLE appear to experience a combination of the excess renal disease reported for persons with SLE and for all blacks. This combination may be a source of the elevated SLE mortality rates observed among US blacks.     

Intergenerational transmission of socio-economic status: The role of neighborhood effects

IntroductionLittle attention has been paid to the role of neighborhoods as a predictor of intergenerational transmission of socio-economic status. This study uses a nationally representative, longitudinal sample from the United States to examine how neighborhoods impact racial/ethnic disparities in the intergenerational transmission of socio-economic status.MethodsThe study sample is derived from Waves 1 and 4 of the National Longitudinal Study of Adolescent to Adult Health. The sample size comprises 13,738 participants (aged 15 at Wave 1; 51% female). Multilevel regression is used to predict racial/ethnic disparities in intergenerational transmission of socio-economic status. Six neighborhood-level indicators are regressed on the indicators of intergenerational transmission of education, income and occupational prestige, while controlling for a range of individual socio-demographic variables.ResultsResults reveal that: (1) African-American and Hispanic children are less likely to surpass their parents’ levels of education, income and occupational prestige than Asian-Pacific Islander and non-Hispanic white children; (2) these racial/ethnic differences in intergenerational transmission of socio-economic status are attenuated but not fully explained by neighborhood-level indicators; (3) all but one of the neighborhood-level factors examined were significant in predicting the pace of intergenerational transmission of socio-economic status.ConclusionsThe implication of these results is that policies aimed at reducing inequalities between residential neighborhoods are likely to beneficially affect all racial/ethnic groups but are not sufficient in reducing racial/ethnic disparities in intergenerational transmission of socio-economic status.     

Disparities in Stage at Diagnosis in an Equal-access Integrated Delivery System: A Retrospective Cohort Study of 7244 Patients With Bladder Cancer

BackgroundDisparities in bladder cancer survival by race/ethnicity and gender are likely related to differences in diagnosis. We assessed disparities in stage at diagnosis and potential contributing factors within a large, integrated delivery system.Patients and MethodsWe conducted a retrospective cohort study of 7244 patients with bladder cancer age ≥ 21 years diagnosed from January 2001 to June 2015 within Kaiser Permanente Southern California. Bivariate analyses compared stage at diagnosis – as well as comorbidities, health plan membership length, and health care utilization prior to diagnosis – by race/ethnicity, gender, and age. Multivariable generalized linear mixed models with urologist as a random effect were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for diagnosis of muscle-invasive bladder cancer (MIBC) versus non–muscle-invasive bladder cancer.ResultsIn multivariable analyses, stage at diagnosis varied significantly by race/ethnicity (P < .001). Non-Hispanic black patients had significantly higher odds of being diagnosed with MIBC than non-Hispanic white patients (OR, 1.33; 95% CI, 1.05-1.67), whereas Asian patients had significantly lower odds (OR, 0.67; 95% CI, 0.49-0.91). Women were significantly more likely to be diagnosed with MIBC than men (OR, 1.40; 95% CI, 1.22-1.61). Non-Hispanic black women had the highest proportion (39%) of MIBC diagnoses. Among Hispanic and Asian patients, a greater proportion of diagnoses occurred at younger ages.ConclusionsHealth care coverage within an equal-access system did not eliminate disparities in stage at diagnosis by race/ethnicity or gender. Studies are needed to identify etiologic factors and aspects of care delivery (eg, patient-physician interactions) that may affect the diagnostic process to inform efforts to improve health equity.