Provider factors and patient-reported healthcare discrimination in the Diabetes Study of California (DISTANCE)

Objective

We examined provider-level factors and reported discrimination in the healthcare setting.

Methods

With data from the Diabetes Study of Northern California (DISTANCE) - a race-stratified survey of diabetes patients in Kaiser Permanente Northern California - we analyzed patient-reported racial/ethnic discrimination from providers. Primary exposures were characteristics of the primary care provider (PCP, who coordinates care in this system), including specialty/type, and patient-provider relationship variables, including racial concordance.

Results

Subjects (n = 12,151) included 20% black, 20% Latino, 23% Asian, 30% white, and 6% other patients, with 2-8% reporting discrimination by racial/ethnic group. Patients seeing nurse practitioners as their PCP (OR = 0.09; 95% CI: 0.01-0.67) and those rating their provider higher on communication (OR = 0.70; 95% CI: 0.66-0.74) were less likely to report discrimination, while those with more visits (OR = 1.10; 95% CI: 1.03-1.18) were more likely to report discrimination. Racial concordance was not significant once adjusting for patient race/ethnicity.

Conclusions

Among diverse diabetes patients in managed care, provider type and communication were significantly related to patient-reported discrimination.

Practice implications

Given potential negative impacts on patient satisfaction and treatment decisions, future studies should investigate which interpersonal aspects of the provider-patient relationship reduce patient perceptions of unfair treatment.     

Ethnic differences in blood pressure monitoring and control in south east London

Background

High blood pressure is the single most important risk factor worldwide for the development of cardiovascular disease, and has been shown to affect some ethnic minority groups disproportionately.

Aim

To explore ethnic inequalities in blood pressure monitoring and control.

Method

Data from Lambeth DataNet was used, based on case records from GP practices in one inner-city London borough. Blood pressure monitoring and control was compared using Quality and Outcomes Framework (QOF) targets for patients with: diabetes, coronary heart disease, stroke, hypertension, and chronic kidney disease. The study controlled for age, sex, social deprivation, and clustering within GP practices.

Results

A total of 16 613 patients met the study criteria, with 5962 categorised as black/black British. Blood pressure monitoring was similar across ethnic groups and as good, if not better, for black patients compared to white. However, marked ethnic inequalities in blood pressure control were found, with black patients significantly less likely to achieve QOF targets than their white counterparts (odds ratio [OR] 0.73; 95% confidence interval [CI] = 0.64 to 0.82). Further inequalities were revealed in blood pressure control within disease groups and ethnic subgroups. In particular, blood pressure control was poor in African patients with diabetes (OR 0.63; 95% CI = 0.50 to 0.79) and Caribbean patients with coronary heart disease (OR 0.53; 95% CI = 0.37 to 0.77) when compared with white patients.

Discussion

While black patients with chronic conditions are equally likely to have their blood pressure monitored, their blood pressure control is consistently poorer than that of their white counterparts. This may have important implications for cardiovascular risk management in black patients.     

PTEN loss in intraductal carcinoma of the prostate has low incidence in Japanese patients

Clinical and genomic features of prostate cancer (PCa) vary considerably between Asian and Western populations. PTEN loss is the most frequent abnormality in intraductal carcinoma of the prostate (IDC-P) in Western populations. However, its prevalence and significance in Asian populations have not yet been well studied. In the present study, we evaluated PTEN expression in IDC-P in a Japanese population and its association with ERG expression. This study included 45 and 59 patients with PCa with and without IDC-P, respectively, who underwent radical prostatectomy. PTEN loss was observed in 10 patients with PCa with IDC-P (22%) and nine patients with PCa without IDC-P (17%). ERG expression was relatively frequent in patients with PCa with PTEN loss, although a significant difference was not observed. The co-occurrence of PTEN loss and ERG expression was observed in four patients with PCa with IDC-P and one without IDC-P. PTEN loss and ERG expression did not affect progression-free survival, regardless of the presence of IDC-P. The frequency of PTEN loss in IDC-P is lower in Asian patients than in Western patients. Our results indicate that mechanisms underlying IDC-P in Asian populations are different from those of Western populations.     

Race/Ethnicity Concordance Between Patients and Physicians

The growth of our population, especially the older than 65 segment, require more health providers. Moreover, compared to whites, persons of racial/ethnic minorities have less favorable clinical outcomes and this may be related to access to health care. Racial/ethnic concordance between physicians and patients improve outcomes and satisfaction with medical care. New medical schools have been opened, some schools have increased the size of the entering class, and there is the general desire to increase the enrollment and graduation of minority groups' physicians. This report summarizes current progress made in this area.     

河南地区回族围绝经期女性骨密度与体成分的关系

目的:从人体组成学的角度探讨围绝经期女性的骨密度、血生化指标和体成分的关系。方法:筛选围绝经期骨质疏松症患者(观察组)和健康女性(对照组),采用双能X线检测骨密度,采用生物电阻抗分析法检测体成分,并进一步检测相关的血生化指标。结果:骨量及腕部骨密度随着年龄的增长逐渐降低,并且观察组低于对照组。与对照组相比,50岁前体质量升高,50岁以后无变化;脂肪率在45岁以前降低而在45岁以后升高;观察组各年龄段的卵泡刺激素、甲状旁腺素、骨钙素均升高,而血清雌二醇降低;观察组的脂肪率在绝经前期降低,在绝经期和绝经后期升高,而骨量和腕部骨密度在3个时期均降低。在围绝经期,观察组的卵泡刺激素、甲状旁腺素和骨钙素升高,而雌二醇的浓度降低。此外,骨密度与骨钙素、骨量、血清雌二醇关系最为密切,其次为非脂肪率、脂肪率、甲状旁腺素、卵泡刺激素。结论:河南地区围绝经期女性骨密度既受雌激素、卵泡刺激素、甲状旁腺素等激素水平的影响,又与脂肪量、非脂肪率、骨量等体成分有着密切的关系,为利用体成分指标预测围绝经期女性骨质疏松症的发生提供可能的理论基础。     

Clinical Presentation of Hepatocellular Carcinoma in African Americans vs. Caucasians: A Retrospective Analysis

Hepatocellular carcinoma (HCC) remains an important form of cancer-related morbidity and mortality in the U.S. and worldwide. Previous U.S.-based studies on survival suggest ethnic disparities in HCC patients, but the complex interplay of multiple factors that contribute are still incompletely understood. Here we considered the influences of risk factors contributing towards HCC survival, including ethnic background, over ten years at a premier academic medical center with a majority (57.20%) African American (AA) population. Retrospective HCC data were collected from 2008–2018 at LSUHSC-Shreveport, an urban tertiary medical center. Data included demographics, comorbidities, liver disease characteristics, and tumor parameters. Statistical analysis was performed using Chi Square and one-way ANOVA. Results: 229 HCC patients were identified (male 78.6%). The mean HCC age at diagnosis was 61 years (SD = 7.3). Compared to non-Hispanic Caucasians (42.7%), AA patients (57.2% of total) were older at presentation, had more frequent diabetes/dyslipidemia/NAFLD (45 (34.3%) compared with 19 (19.3%) in non-Hispanic Caucasians, p = 0.02), and had a larger HCC burden at diagnosis. We conclude that compared to white patients, despite having similar BMI and MELD scores and rates of portal vein thrombosis, AA patients with HCC in our cohort were older at presentation, had a significantly increased incidence of modifiable metabolic risk factors including diabetes, higher AFP values, increased incidence of gallstones, and larger sized HCCs, and were more likely to be outside Milan criteria. These findings have important prognostic and diagnostic implications for developing a more targeted HCC surveillance program.     

Effects of ethnicity on sub-clinical PTSD and depressive symptoms,following exposure to missile attacks in Israel—A pilot study

Abstract

Objective. The aim of this pilot study was to compare the occurrence of post-traumatic stress disorder (PTSD) symptoms, major depression disorder (MDD)-related symptoms, and negative mood regulation capacities among Israeli Jewish and Arab children and their parents, all of whom had been exposed to recurrent missiles attacks during the Second Lebanon War. Methods. Participants consisted of 28 Jewish and 14 Arab children (aged 4–18 years) and their parents. They were assessed by self-report instruments and a semi-structured interview (K-SADS-PL). Results. Among children, PTSD and depressive symptoms were found to be interrelated. Parents’ depression and mood regulation were found to be related to their children's PTSD and depressive responses. Both children's and parents’ negative mood regulation capacities were inversely related to children's depressive and PTSD symptoms. Both Jewish and Arab children's scores on the Children Depression Inventory (CDI) and on the PTSD Scale Symptoms Interview (PSS-I) showed significant levels of emotional distress following the missile attacks. However, Arab children reported significantly higher levels of PTSD and depressive symptoms in comparison to Jewish children. Conclusion. Ethnicity seems to be an important factor in children's responses to war-related events.     

Daily spiritual experiences in a biracial,community-based population of older adults

Objectives: The objectives of this study were to describe the levels of daily spiritual experiences (DSEs) in community-dwelling older adults, to compare the levels of spiritual experiences with the levels of prayer and religious service attendance, and to examine the demographic and psychosocial correlates of spiritual experiences. The data came from 6534 participants in the Chicago Health and Aging Project, an ongoing population-based, biracial (65% African American) study of the risk factors for incident Alzheimer's disease among older adults. A 5-item version of the Daily Spiritual Experiences Scale (DSES) was used in the study. Multivariable linear regression models were used to examine the relationship between sociodemographic and psychosocial factors and DSES scores.

Results: The majority of the participants reported having spiritual experiences at least daily. In the bivariate analyses, African Americans and women had higher DSES scores than Whites and men, respectively (p's < 0.001). Prayer and worship were moderately associated with DSES scores. In the multivariable analyses, African American race, older age, female gender, better self-rated health, and greater social networks were associated with higher DSES scores, while higher levels of education and depressive symptoms were associated with lower DSES scores.

Conclusion: We observed high levels of spiritual experiences and found that the DSES is related to, but distinct from the traditional measures of religiosity. We found associations between DSES, demographic, and psychosocial factors that are consistent with the findings for other religiosity and spirituality (R/S) measures. Future research should test whether DSES contributes to our understanding of the relationship between R/S and health in older adults.