scholarly journals Clinician–Patient Racial/Ethnic Concordance Influences Racial/Ethnic Minority Pain: Evidence from Simulated Clinical Interactions

Pain Medicine ◽  
2020 ◽  
Vol 21 (11) ◽  
pp. 3109-3125 ◽  
Author(s):  
Steven R Anderson ◽  
Morgan Gianola ◽  
Jenna M Perry ◽  
Elizabeth A Reynolds Losin
Keyword(s):  
African American ◽  
Pain Treatment ◽  
The United States ◽  
Ethnic Discrimination ◽  
Medical Procedure ◽  
Black African ◽  
Clinical Interactions ◽  
Racial Ethnic ◽  
Hispanic White ◽  
White Patients

Abstract Objective Racial and ethnic minorities in the United States report higher levels of both clinical and experimental pain, yet frequently receive inadequate pain treatment. Although these disparities are well documented, their underlying causes remain largely unknown. Evidence from social psychological and health disparities research suggests that clinician–patient racial/ethnic concordance may improve minority patient health outcomes. Yet whether clinician–patient racial/ethnic concordance influences pain remains poorly understood. Methods Medical trainees and community members/undergraduates played the role of “clinicians” and “patients,” respectively, in simulated clinical interactions. All participants identified as non-Hispanic Black/African American, Hispanic white, or non-Hispanic white. Interactions were randomized to be either racially/ethnically concordant or discordant in a 3 (clinician race/ethnicity) × 2 (clinician–patient racial/ethnic concordance) factorial design. Clinicians took the medical history and vital signs of the patient and administered an analogue of a painful medical procedure. Results As predicted, clinician–patient racial/ethnic concordance reduced self-reported and physiological indicators of pain for non-Hispanic Black/African American patients and did not influence pain for non-Hispanic white patients. Contrary to our prediction, concordance was associated with increased pain report in Hispanic white patients. Finally, the influence of concordance on pain-induced physiological arousal was largest for patients who reported prior experience with or current worry about racial/ethnic discrimination. Conclusions Our findings inform our understanding of the sociocultural factors that influence pain within medical contexts and suggest that increasing minority, particularly non-Hispanic Black/African American, physician numbers may help reduce persistent racial/ethnic pain disparities.

Abstract WP178: Acute Stroke Ischemic Symptom Onset-to-Arrival Time in Michigan Hospitals

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Muhammad U Farooq ◽  
Kathie Thomas
Keyword(s):  
African American ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Patient Outcomes ◽  
Symptom Onset ◽  
Arrival Time ◽  
Heart Association ◽  
The United States ◽  
Stroke Patients ◽  
White Patients

Objectives: Stroke is the fifth-leading cause of death and the leading cause of disability in the United States. One of the primary goals of the American Heart Association/American Stroke Association is to increase the number of acute stroke patients arriving at emergency departments (EDs) within 1-hour of symptom onset. Earlier treatment with thrombolysis in patients with acute ischemic stroke translates into improved patient outcomes. The objective of this abstract is to examine the association between the use of emergency medical services (EMS) and symptom onset-to-arrival time in patients with ischemic stroke. Methods: A retrospective review of ischemic stroke patients (n = 8873) from 25 Michigan hospitals from January 2012-December 2014 using Get With the Guidelines databases was conducted. Symptom onset-to-ED arrival time and arrival mode were examined. Results: It was found that 17.4% of ischemic stroke patients arrived at the hospitals within 1-hour of symptom onset. EMS transported 69.1% of patients who arrived within 1-hour of symptom onset. During this 1-hour period African American patients (22%) were less likely to use EMS transportation as compared to White patients (72%). The majority of patients, 41.8%, arrived after 6-hours of symptom onset. EMS transported only 40% of patients who arrived after 6-hours of symptom onset. As before, during this 6-hour period African American patients (20%) were also less likely to use EMS transportation as compared to White patients (75%). Symptom onset-to-ED arrival time was shorter for those patients who used EMS. The median pre-hospital delay time was 2.6 hours for those who used EMS versus 6.2 hours for those who did not use EMS. Conclusions: The use of EMS is associated with a decreased pre-hospital delay, early treatment with thrombolysis and improved patient outcomes in ischemic stroke patients. Community interventions should focus on creating awareness especially in minority populations about stroke as a neurological emergency and encourage EMS use amongst stroke patients.

Disparities in access to surgery for glioblastoma multiforme at high-volume Commission on Cancer–accredited hospitals in the United States

2021 ◽  
pp. 1-10
Author(s):  
Anshit Goyal ◽  
Jad Zreik ◽  
Desmond A. Brown ◽  
Panagiotis Kerezoudis ◽  
Elizabeth B. Habermann ◽  
...  
Keyword(s):  
United States ◽  
Surgical Intervention ◽  
Residential Location ◽  
High Volume ◽  
The United States ◽  
National Cancer Database ◽  
Subgroup Analyses ◽  
Access To Surgery ◽  
Hispanic White ◽  
White Patients

OBJECTIVE Although it has been shown that surgery for glioblastoma (GBM) at high-volume facilities (HVFs) may be associated with better postoperative outcomes, the use of such hospitals may not be equally distributed. The authors aimed to evaluate racial and socioeconomic differences in access to surgery for GBM at high-volume Commission on Cancer (CoC)–accredited hospitals. METHODS The National Cancer Database was queried for patients with GBM that was newly diagnosed between 2004 and 2015. Patients who received no surgical intervention or those who received surgical intervention at a site other than the reporting facility were excluded. Annual surgical case volume was calculated for each hospital, with volume ≥ 90th percentile defined as an HVF. Multivariable logistic regression was performed to identify patient-level predictors for undergoing surgery at an HVF. Furthermore, multiple subgroup analyses were performed to determine the adjusted odds ratio of the likelihood of undergoing surgery at an HVF in 2016 as compared to 2004 for each patient subpopulation (by age, race, sex, educational group, etc.). RESULTS A total of 51,859 patients were included, with 10.7% (n = 5562) undergoing surgery at an HVF. On multivariable analysis, Hispanic White patients (OR 0.58, 95% CI 0.49–0.69, p < 0.001) were found to have significantly lower odds of undergoing surgery at an HVF (reference = non-Hispanic White). In addition, patients from a rural residential location (OR 0.55, 95% CI 0.41–0.72, p < 0.001; reference = metropolitan); patients with nonprivate insurance status (Medicare [OR 0.78, 95% CI 0.71–0.86, p < 0.001], Medicaid [OR 0.68, 95% CI 0.60–0.78, p < 0001], other government insurance [OR 0.68, 95% CI 0.52–0.86, p = 0.002], or who were uninsured [OR 0.61, 95% CI 0.51–0.72, p < 0.001]); and lower-income patients ($50,354–$63,332 [OR 0.68, 95% CI 0.63–0.74, p < 0.001], $40,227–$50,353 [OR 0.84, 95% CI 0.76–0.92, p < 0.001]; reference = ≥ $63,333) were also found to be significantly associated with a lower likelihood of surgery at an HVF. Subgroup analyses revealed that elderly patients (age ≥ 65 years), both male and female patients and non-Hispanic White patients, and those with private insurance, Medicare, metropolitan residential location, median zip code–level household income in the first and second quartiles, and educational attainment in the first and third quartiles had increased odds of undergoing surgery at an HVF in 2016 compared to 2004 (all p ≤ 0.05). On the other hand, patients with other governmental insurance, patients with a rural residence, and those from a non-White racial category did not show a significant difference in odds of surgery at an HVF over time (all p > 0.05). CONCLUSIONS The present analysis from the National Cancer Database revealed significant disparities in access to surgery at an HVF for GBM within the United States. Furthermore, there was evidence that these racial and socioeconomic disparities may have widened between 2004 and 2016. The findings should assist health policy makers in the development of strategies for improving access to HVFs for racially and socioeconomically disadvantaged populations.

scholarly journals Imagining Her Future: Diversity in Mothers’ Socialization Goals for Their Adolescent Daughters

2017 ◽  
Vol 48 (4) ◽  
pp. 593-610 ◽  
Author(s):  
Jennifer Ramirez ◽  
Linda Oshin ◽  
Stephanie Milan
Keyword(s):  
United States ◽  
African American ◽  
Ethnic Groups ◽  
Low Income ◽  
The United States ◽  
Social Traits ◽  
Socialization Goals ◽  
Racial Ethnic ◽  
Q Sort

According to developmental niche theory, members of different cultural and ethnic groups often have distinct ideas about what children need to become well-adapted adults. These beliefs are reflected in parents’ long-term socialization goals for their children. In this study, we test whether specific themes that have been deemed important in literature on diverse families in the United States (e.g., Strong Black Woman [SBW], marianismo, familismo) are evident in mothers’ long-term socialization goals. Participants included 192 mothers of teenage daughters from a low-income city in the United States (58% Latina, 22% African American, and 20% European American [EA]/White). Socialization goals were assessed through a q-sort task on important traits for a woman to possess and content analysis of open-ended responses about what values mothers hoped they would transmit to their daughters as they become adults. Results from ANCOVAs and logistic regression indicate significant racial/ethnic differences on both tasks consistent with hypotheses. On the q-sort task, African American mothers put more importance on women possessing traits such as independence than mothers from other racial/ethnic groups. Similarly, they were more likely to emphasize self-confidence and strength in what they hoped to transmit to their daughters. Contrary to expectation, Latina mothers did not emphasize social traits on the q-sort; however, in open-ended responses, they were more likely to focus on the importance of motherhood, one aspect of marianismo and familismo. Overall, results suggest that these mothers’ long-term socialization goals incorporate culturally relevant values considered important for African American and Latino families.

scholarly journals 1A Nationwide Analysis of U.S. Racial/Ethnic Disparities in Emergency Department Patients with Mental Health and Substance Use Disorders

2021 ◽  
Author(s):  
Joanne Weinreb ◽  
Penina Gavrilova ◽  
Jonathan Avery ◽  
Sean M. Murphy ◽  
Jyotishman Pathak
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Substance Use Disorders ◽  
Wait Time ◽  
Wait Times ◽  
Hispanic Patients ◽  
Racial Ethnic ◽  
Triage Level ◽  
Hispanic White ◽  
White Patients

Abstract BackgroundRacial and ethnic health disparities have been linked with inequalities in access to health care and outcomes. The present study considers whether inequalities persist between racial/ethnic groups among patients with mental health or substance use disorders who visit the emergency department (ED). MethodsWe analyzed data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2012-2018, assessing health disparities among patients diagnosed with mental health or substance use disorders by observing whether significant differences exist in ED wait time and length of visit (LOV) for patients of different races/ethnicities. Stratified models were performed to further understand the impact of regions across the U.S., year, and triage level on the association analysis. ResultsFrom 2012-2018, non-Hispanic Black and Hispanic patients experienced significantly longer ED wait times and LOV as compared to White patients. Patients with private insurance experienced significantly shorter wait times compared to patients with self-pay, and shorter LOV than those with Medicaid/ Children’s Health Insurance Program, or Medicare. Male patients had significantly longer LOV compared to female patients. We observed year by year differences in wait times of non-Hispanic Black patients with improvement appearing between the years 2013 to 2016, while LOV remained consistently longer. We observed both regional and triage level differences, with the U.S. Northeast presenting with the most disparities. Additionally, we noted a general upward trend of SUD diagnoses. Conclusion Our analysis suggests that while there has been an overall improvement in median ED wait time through the years, non-Hispanic Black and Hispanic patients experience significantly longer ED wait time compared to non-Hispanic White patients. Additionally, non-Hispanic Black and Hispanic patients have a significantly longer ED LOV compared to non-Hispanic White patients.

Predictors of Feminist Identity Utilizing an Intersectional Lens With a Focus on Non-Hispanic White, Hispanic, and African American MSW Students

Affilia ◽  
2020 ◽  
pp. 088610992096301
Author(s):  
Mollie Lazar Charter
Keyword(s):  
African American ◽  
Social Work ◽  
Social Work Students ◽  
Multiple Regression Model ◽  
Feminist Identity ◽  
Msw Students ◽  
Feminist Identification ◽  
Feminist Attitudes ◽  
Racial Ethnic ◽  
Hispanic White

A fundamental value of social work is social justice, which includes gender and racial/ethnic equality. Feminists address gender-based oppression and often work to address racial/ethnic inequalities as well as many other forms of oppression. However, most literature suggest that less than half of social work students identify as feminists. This study investigated factors that contribute to student feminist self-identification, focusing on how racial/ethnic identity may influence feminist identity. Four predicting constructs were identified: method of exposure to feminism, feminist knowledge, feminist attitudes and ideologies, and description of feminists. A multiple regression model was applied to the overall sample ( N = 660) and to each racial/ethnic group. Findings indicate that in the overall sample, all four constructs significantly contributed to predicting feminist identification, while in the non-Hispanic white sample ( n = 366), method of exposure, feminist attitudes and ideologies, and description of feminists made significant contributions; for the Hispanic sample ( n = 157), only feminist attitudes and ideologies made significant contributions to predicting feminist identification; and for the African American sample ( n = 137), method of exposure and description of feminists made significant contributions. These findings indicate differences among racial/ ethnic background in feminist identity and provide a comprehensive picture of feminist identity among Master’s of Social Work (MSW) students.

scholarly journals Expanded Prospective Payment System and Use of and Outcomes with Home Dialysis by Race and Ethnicity in the United States

2019 ◽  
Vol 14 (8) ◽  
pp. 1200-1212 ◽  
Author(s):  
Jenny I. Shen ◽  
Kevin F. Erickson ◽  
Lucia Chen ◽  
Sitaram Vangala ◽  
Lynn Leng ◽  
...  
Keyword(s):  
Ethnic Differences ◽  
Race And Ethnicity ◽  
Prospective Payment System ◽  
The United States ◽  
Similar Proportion ◽  
Home Dialysis ◽  
Dialysis Outcomes ◽  
Racial Ethnic ◽  
Over Time ◽  
White Patients

Background and objectivesWe investigated whether the recent growth in home dialysis use was proportional among all racial/ethnic groups and also whether there were changes in racial/ethnic differences in home dialysis outcomes.Design, setting, participants, & measurementsThis observational cohort study of US Renal Data System patients initiating dialysis from 2005 to 2013 used logistic regression to estimate racial/ethnic differences in home dialysis initiation over time, and used competing risk models to assess temporal changes in racial/ethnic differences in home dialysis outcomes, specifically: (1) transfer to in-center hemodialysis (HD), (2) mortality, and (3) transplantation.ResultsOf the 523,526 patients initiating dialysis from 2005 to 2013, 55% were white, 28% black, 13% Hispanic, and 4% Asian. In the earliest era (2005–2007), 8.0% of white patients initiated dialysis with home modalities, as did a similar proportion of Asians (9.2%; adjusted odds ratio [aOR], 0.95; 95% confidence interval [95% CI], 0.86 to 1.05), whereas lower proportions of black [5.2%; aOR, 0.71; 95% CI, 0.66 to 0.76] and Hispanic (5.7%; aOR, 0.83; 95% CI, 0.86 to 0.93) patients did so. Over time, home dialysis use increased in all groups and racial/ethnic differences decreased (2011–2013: 10.6% of whites, 8.3% of blacks [aOR, 0.81; 95% CI, 0.77 to 0.85], 9.6% of Hispanics [aOR, 0.94; 95% CI, 0.86 to 1.00], 14.2% of Asians [aOR, 1.04; 95% CI, 0.86 to 1.12]). Compared with white patients, the risk of transferring to in-center HD was higher in blacks, similar in Hispanics, and lower in Asians; these differences remained stable over time. The mortality rate was lower for minority patients than for white patients; this difference increased over time. Transplantation rates were lower for blacks and similar for Hispanics and Asians; over time, the difference in transplantation rates between blacks and Hispanics versus whites increased.ConclusionsFrom 2005 to 2013, as home dialysis use increased, racial/ethnic differences in initiating home dialysis narrowed, without worsening rates of death or transfer to in-center HD in minority patients, as compared with white patients.

scholarly journals Differential Association of HIV Funding With HIV Mortality by Race/Ethnicity, United States, 1999-2017

2020 ◽  
Vol 135 (1_suppl) ◽  
pp. 149S-157S
Author(s):  
Benedict I. Truman ◽  
Ramal Moonesinghe ◽  
Yolanda T. Brown ◽  
Man-Huei Chang ◽  
Jonathan H. Mermin ◽  
...  
Keyword(s):  
United States ◽  
The United States ◽  
Rate Of Change ◽  
Fiscal Year ◽  
Death Rates ◽  
Black Residents ◽  
Race Ethnicity ◽  
Hiv Funding ◽  
Racial Ethnic ◽  
Hispanic White

Objective Federal funds have been spent to reduce the disproportionate effects of HIV/AIDS on racial/ethnic minority groups in the United States. We investigated the association between federal domestic HIV funding and age-adjusted HIV death rates by race/ethnicity in the United States during 1999-2017. Methods We analyzed HIV funding data from the Kaiser Family Foundation by federal fiscal year (FFY) and US age-adjusted death rates (AADRs) by race/ethnicity (Hispanic, non-Hispanic white, non-Hispanic black, and Asian/Pacific Islander and American Indian/Alaska Native [API+AI/AN]) from Centers for Disease Control and Prevention WONDER detailed mortality files. We fit joinpoint regression models to estimate the annual percentage change (APC), average APC, and changes in AADRs per billion US dollars in HIV funding, with 95% confidence intervals (CIs). For 19 data points, the number of joinpoints ranged from 0 to 4 on the basis of rules set by the program or by the user. A Monte Carlo permutation test indicated significant ( P < .05) changes at joinpoints, and 2-sided t tests indicated significant APCs in AADRs. Results Domestic HIV funding increased from $10.7 billion in FFY 1999 to $26.3 billion in FFY 2017, but AADRs decreased at different rates for each racial/ethnic group. The average rate of change in AADR per US billion dollars was −9.4% (95% CI, −10.9% to −7.8%) for Hispanic residents, −7.8% (95% CI, −9.0% to −6.6%) for non-Hispanic black residents, −6.7% (95% CI, −9.3% to −4.0%) for non-Hispanic white residents, and −5.2% (95% CI, −7.8% to −2.5%) for non-Hispanic API+AI/AN residents. Conclusions Increased domestic HIV funding was associated with faster decreases in age-adjusted HIV death rates for Hispanic and non-Hispanic black residents than for residents in other racial/ethnic groups. Increasing US HIV funding could be associated with decreasing future racial/ethnic disparities in the rate of HIV-related deaths.

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