Search Results (63)

Purpose: Because of shared mechanisms such as decreased access to health care, rurality and poverty may act synergistically to decrease colorectal cancer (CRC) survival. Methods: We conducted a retrospective cohort analysis of SEER data (22 registries) with census tract-level measures of poverty/rurality for the period 2006–2015. Multivariable Cox proportional hazard regressions were applied to examine the independent and intersectional associations of persistent poverty and rurality on 5-year cause-specific CRC survival across five racial/ethnic groups. Results: Among 532,868 CRC patients, non-Hispanic Blacks (NHB) demonstrated lower 5-year survival probability (64.2% vs. 68.3% in non-Hispanic Whites [NHW], 66.5% in American Indian/Alaska Natives [AI/AN], 72.1% in Asian/Pacific Islanders, and 68.7% in Hispanic groups) (p-value < 0.001). In adjusted analysis, CRC patients living in rural areas with poverty were at a 1.2–1.6-fold increased risk of CRC death than those who did not live in these areas in five racial/ethnic groups. In particular, AI/AN patients living in rural areas with poverty were 66% more likely to die from CRC (95% CI, 1.32, 2.08). Conclusions: CRC patients who live in rural or poverty areas in SEER areas in the U.S. have a poorer survival compared with those who do not live in such areas regardless of race/ethnicity. Significantly greater risk of CRC death was observed in AI/ANs. Impact: Patient navigators, community education or screening, and other health care system interventions may be helpful to address these disparities by socioeconomic status, race, and geographic residence. Multi-level interventions aimed at institutional racism and medical mistrust may also be helpful. Full article

Objectives: To describe the association of race with type 2 diabetes complications and determine if differences in rates of complications exist between racial/ethnic groups of adult type 2 diabetes patients in the United States. Additionally, we model the odds of in-hospital patient mortality across racial/ethnic groups. Methods: A retrospective cohort study was conducted using data from the 2018 National Inpatient Sample of Healthcare Cost and Utilization Project, including 97,314 unweighted and 486,500 weighted adults with type 2 diabetes. Chi-square analysis was used to determine the association of race with diabetes complications, along with z-tests to determine the differences in complication rates of 11 different complications between racial/ethnic groups and binary logistic regression to model in-hospital mortality. Results: Our analysis revealed significant racial/ethnic disparities in both complication rates and odds of in-hospital mortality. Whites had the lowest rate of complications overall, except for arthropathy/oral complications (18.8%) and foot/skin ulcers (18.2%), while Black/African Americans had the highest rates of hyperosmolarity (7.3%), ketoacidosis (21.2%), neurological complications (8.9%), and hyperglycemia (13.4%). Asian/Pacific Islanders had the highest rates of hypoglycemia (17.6%) as well as kidney (7.2%) and ophthalmic (0.3%) complications, and Hispanics the highest rates of circulatory complications (19.0%). Hispanic ethnicity was associated with 10.6% reduced odds of in-hospital mortality, and Asian/Pacific Islanders and Other races had increased odds of mortality by 25.2% and 27.0%, respectively. Notably, neurological (OR = 0.278, 95% CI: 0.111, 0.702) complications and hyperglycemia (OR = 0.304, 95% CI: 0.124, 0.749) were associated with a reduction in mortality odds by 62.2% and 69.6%, possibly reflecting the study’s focus on in-hospital rather than all-cause or 30-day mortality. Conclusions: We demonstrated disparities in both rates of type 2 diabetes complications and odds of mortality between different racial/ethnic groups. These results lay groundwork for future research into the root causes of these disparities and highlight the importance of targeting interventions and equitable case for those most at risk. Full article

Background/Objectives: Health care workers are at greater risk for death by suicide compared to the general population and are less likely to seek assistance. More information about correlates of suicidality and treatment-seeking behavior are needed to reduce risk. Methods: The American Foundation for Suicide Prevention developed an Interactive Screening Program to identify and engage at-risk staff and trainees in health care settings. The study reports on the prevalence and demographic and clinical predictors of current suicidal thoughts, behaviors and mental health treatment at a single site (n = 5898) from 2009 to 2024. Results: The study found that 18.2% of respondents reported current suicidal thoughts and behaviors. These were more common among respondents who were younger, male, and who identified as a race/ethnicity other than non-Hispanic White. Suicidal thoughts and behaviors were more likely among those with higher PHQ-8 scores (OR = 1.23, p < 0.01) and those who endorsed maladaptive coping behaviors, hopelessness, loneliness, stress and nervousness (ORs 1.36–3.04, ps < 0.01). Current mental health treatment was more likely among women, non-Hispanic White respondents compared with Asian or Pacific Islander respondents, and nurses relative to physicians. Mental health treatment was also associated with higher PHQ-8 scores, lifetime suicide attempts, difficulty controlling eating and alcohol consumption, and recent feelings of anxiety, stress and nervousness. Conclusions: Findings suggest a continued need to identify and engage health care trainees and staff who are at risk for suicide and to establish new approaches to linking these individuals to resources or interventions aimed at reducing risk. The study identified male and/or Asian/Pacific Islander-identifying health care workers who reported intense loneliness and/or hopelessness, use of non-prescription drugs and recent suicidal thoughts and/or behaviors as high-risk individuals who may require enhanced methods of outreach, identification, acceptance and accessibility of treatment. Full article

Background: The volume of cardiac valve and coronary artery revascularization procedures is rising in the United States. This cross-sectional study explores ethnic disparities in mortality in cardiac surgery attributed to mechanical failures of implantable heart valves and coronary artery grafts. Methods: We used the CDC Wide-Ranging Online Data for Epidemiologic Research Multiple Causes of Death database to identify patients whose single cause of death was categorized by complications of cardiovascular prosthetic devices, implants, and grafts (ICD-10 code T82) between 1999 and 2020. The Joinpoint software (version 5.2.0, National Cancer Institute) was used to construct log-linear regression models to estimate the average annual percent changes in age-adjusted mortality (per 100,000). These patterns were compared and stratified by sex, age (0–44, 44–64, and 65 years or older), and US census regions between White, Black, Hispanic, non-Hispanic, American Indian, Alaskan Native, Asian American, and Pacific Islanders. Results: Age-adjusted mortality due to mechanical failures of cardiac implants and grafts declined across ethnicities from 2.21 (95% CI 2.16–2.27) in 1999 to 0.88 (95% CI 0.85–0.91) in 2020. Black populations (1.31 [95% CI 1.20–1.42]), both men (1.56 [95% CI 1.37–1.74]) and women (1.02 [95% CI 0.90–1.15]) experienced higher mortality in 2020 compared to all other ethnicities. This disparity was pronounced in younger groups (age 0–64), wherein age-adjusted mortality among Black populations (0.18 [95% CI 0.13–0.25]) more than doubled that of White populations (0.08 [95% CI 0.06–0.10]). Conclusions: Over the last two decades, age-adjusted mortality due to mechanical complications of cardiovascular implants has declined significantly. However, Black men and women, particularly younger patients, continue to experience higher death rates compared to other ethnicities. Full article

Internalized racism is the internalization of beliefs about racism and colonization that contribute to the acceptance of negative messaging or stereotypical misrepresentations that inform perceptions about worth and ability. Internalized racism is associated with psychological distress in racially diverse people. Collective racial self-esteem is a potential protective factor that can serve as a moderator in reducing distress and facilitating psychological well-being. The sample for the present study consisted of 526 participants who self-identified as African American, Asian American/Pacific Islander, Latinx American, or American of Arab or Middle Eastern descent. The researchers used regression with the Process macro to investigate the potential moderating properties of collective racial self-esteem on the relationship between internalized racism and psychological distress in the sample. The findings indicated that specific domains of collective racial self-esteem moderated the internalized racism–psychological distress relationship. Full article

Low-grade glioma (LGG) is a malignancy of the central nervous system that is often treatable with surgical resection and chemoradiation. However, despite an initial positive response to standard therapy, most LGG eventually progress to high-grade gliomas which are nearly uniformly fatal. There is a pressing need for more clinical trials and greater clinical trial accessibility to improve the standard of care of LGG to delay or prevent its progression. In this study, we systematically examined the scope and inclusion of clinical trials for LGG based in the United States. This cross-sectional study analyzes trends in trial design and reported demographic data from completed LGG trials registered on ClinicalTrials.gov between 2010 to 2023. Inclusion criteria, investigational therapies, primary outcomes, and preliminary results were compared and summarized. A total of 14 trials with 1067 participants were included in the study. Most of the trials were not exclusive to LGGs and 14% had mutation-specific inclusion criteria. To date, two of the trials have led to new FDA-approved treatments. All trials reported age and sex, while only 57% reported race and 43% reported ethnicity. Individuals identifying as Black or African American and Asian or Pacific Islander were statistically underrepresented. Lastly, we investigated the geographic distributions of trial sites across the United States, which demonstrated several coverage gaps in the Rocky Mountain and Southeast regions. These findings suggest specific areas for improvement in LGG clinical trial reporting and accessibility. Full article

Introduction: Colorectal cancer (CRC) is the third most common cancer globally and a leading cause of cancer-related deaths. While liver metastasis is common, brain metastasis (BM) is rare, occurring in 0.1% to 14% of cases. Risk factors for BM include lung metastasis at diagnosis, rectal cancer, and mutations in RAS and KRAS genes. Due to its rarity, guidelines for BM screening and treatment are limited. The aim of this study is to identify the clinical characteristics and predictors of BM at the time of the initial diagnosis of CRC. Methods: We evaluated patients ≥18 years old with metastatic colorectal cancer and brain metastases at diagnosis from the SEER database (2010–2021). A retrospective cohort study was conducted to analyze overall survival and predictive factors for brain metastasis, utilizing multivariate logistic regression, Kaplan–Meier survival analysis, and the Cox proportional hazards models, with p-values < 0.05 considered significant. Results: Out of 24,703 patients with metastatic colorectal cancer (mCRC), 228 (0.92%) had brain metastasis (BM) at diagnosis. BM was more prevalent in average-onset mCRC (≥50 years) compared to early-onset (<50 years) (1% vs. 0.55%, p = 0.004). Certain factors, such as older age and adenocarcinoma subtype, were associated with BM. Additionally, Asians/Pacific-Islanders (HR 1.83 CI: 1.01-3-33, p = 0.045) and American Indians/Alaska Natives (HR 4.79 CI 1.15–19.97, p = 0.032) had higher mortality rates, while surgical treatment and chemotherapy were linked to decreased mortality. Patients with BM had significantly worse overall survival (6 months vs. 21 months, p < 0.001). Conclusion: BM in mCRC is uncommon, but it is associated with significantly worse outcomes, including markedly reduced overall survival. Our study highlights several critical factors associated with the presence of BM, such as older age and specific racial/ethnic groups, which may inform risk stratification and early-detection strategies. Our findings emphasize the need for heightened awareness and screening for BM in high-risk mCRC patients, as well as the inclusion of these patients in clinical trials to explore tailored therapeutic approaches aimed at improving survival and quality of life. Full article

(1) Background: Adolescent girls have increasingly faced mental health challenges. We examined prevalence trends and associated risk factors for depression among adolescent girls. (2) Methods: Data for girls aged 12 to 17 years (N = 4346) from the 2021 cross-sectional National Survey on Drug Use and Health were analyzed. Factors associated with depression were examined using multiple regression analysis. (3) Results: Rates of severe depression were significantly higher (p < 0.001) in older girls (adjusted odds ratio [AOR]: 1.63, 1.61), those who did not have authoritative parents (AOR: 3.40), and those with negative school experiences (AOR: 4.03). Black and Asian/Native Hawaiian or other Pacific Islanders were less likely to report severe depression than white girls. As previously reported, non-white girls were significantly less likely to receive treatment for depression (p < 0.05). Parents’ characteristics and school experiences had no effect on the likelihood of receiving mental health treatment. (4) Conclusions: Depression has become increasingly common among American adolescent girls, who are now three times as likely as adolescent boys to have had recent experiences with depression. Our results show that family structure, parenting style, and negative school experiences significantly contribute to the rate of depression and that treatment disparities exist with regard to race and ethnicity. The results of our research could be valuable for policymakers, healthcare professionals, and educators in developing specific preventative initiatives and support networks that effectively address these unique challenges. Full article

Although perception of stigma (PS) has been dubbed as a key barrier to the optimal uptake of PrEP, research on PS is sparse. More specifically, no scholarly work has explored factors associated with the expression of PS toward PrEP use. This study addresses the literature gap by investigating factors associated with PS toward PrEP use. Data were drawn from the baseline survey (2017–2019) of the “Keeping It LITE Study”, involving a large cohort (n = 3330) of young sexual minority men, transgender men and women, and non-binary individuals in the US. Participants’ ages ranged from 13 to 34 years, with the majority (87%) assigned male at birth. The racial composition of the sample was diverse, with 53.9% identifying as white, 19.8% as Latinx, 10.7% as Black or African American, and smaller proportions as Asian, American Indian or Alaska Native, Native Hawaiian or other Pacific Islander, and another race/ethnicity. Logistic regression models were utilized to examine two common measures of PS in PrEP use: (1) the perception that PrEP users are seen as promiscuous and (2) the perception that PrEP users are assumed to be HIV-positive. Two sets of models were developed to account for the correlation between gender identity and sex assigned at birth. The results suggest strong PS among current PrEP users, which can explain the weak PrEP adherence reported among this group. The findings underscore the need for targeted interventions to mitigate PS and enhance PrEP uptake and adherence in vulnerable populations. Social and practical implications of the results and directions for future research are discussed. Full article

Urban green space (UGS) is a fundamental infrastructure in modern urban settings, crucial for regulating the urban climate and improving public health. Accessibility to UGS represents a significant environmental justice issue, influencing the sustainable development of local communities. In this work, we comprehensively evaluated the temporal dynamics of UGS accessibility and the disparity in exposure for all 31 metropolitan divisions in the United States from 2013 to 2022. Our findings indicate that there have been no significant changes in both population-weighted UGS exposure and within-city inequality of UGS exposure for all racial/ethnic groups across the study period. Furthermore, a consistent racial/ethnic disparity in UGS exposure was noted throughout the study period, with the White group tending to have higher-than-average UGS accessibility, and all other racial/ethnic groups, including Asian, Black, Hispanic, Native American, and Pacific Islander, experiencing lower-than-average UGS accessibility. These findings underscore the urgency for urban planning and policy-making strategies to address these inequities, promoting healthy and sustainable urban development. Full article

Background: Reports of escalated discrimination experiences among Asian American and Native Hawaiian Pacific Islanders (AANHPI) continue. Methods: Using the original and follow-up surveys of the COVID-19 Effects on the Mental and Physical Health of AAPI (Asian American and Pacific Islanders) Survey Study (COMPASS I and COMPASS II) (n = 3177), we examined changes over approximately a 1-year period in discrimination experiences attributable to being AAPI and factors associated with worse mental health outcomes. Results: Experiences of discrimination remained high in COMPASS II with 60.6% (of participants (compared to 60.2% among the same people in COMPASS I) reporting one or more discrimination experiences, and 28.6% reporting worse mental health outcomes. Experiences of discrimination were associated with modest but significant increase in the odds of worse mental health: adjusted OR 1.02 (95% CI 1.01–1.04). Being younger, being of Native Hawaiian/Pacific Islander or Hmong descent (relative to Asian Indian), and having spent 50% or less of their lifetime in the US (vs. US born), were significantly associated with worse mental health. Conclusions: The fall-out from the pandemic continues to adversely impact AANHPI communities. These findings may help influence policy initiatives to mitigate its effects and support interventions designed to improve mental health outcomes. Full article

Background: Helicobacter pylori (H. Pylori) eradication has been the mainstream for preventing and treating gastric mucosa-associated lymphoid tissue (MALT) lymphoma. Prior data showed disparities in eradication rates of H. Pylori between different populations. This can potentially impact the occurrence of gastric MALT lymphoma. There are limited data on the incidence and mortality rates and trends of gastric MALT lymphoma in the US. Therefore, the aim of the current study was to conduct a time-trend analysis of gastric MALT lymphoma incidence and mortality rates in different populations. Methods: The incidence rates of gastric MALT lymphoma were calculated from the United States Cancer Statistics (USCS) database (which covers nearly 98% of the US population) between 2001–2020 and were age-adjusted to the standard 2000 US population using SEER*Stat software (version 8.4.3, national cancer institute “NCI”). Incidence-based mortality (IBM) rates, also age-adjusted to the standard 2000 US population, were calculated from the Surveillance Epidemiology and End Results (SEER) database. Tumor location was specified using ICD-O-3 codes C 160–C 169 with malignant behavior. Histopathology was specified using the ICD-O-3 code 9699. The rates were categorized by sex, age, race/ethnicity, and tumor stage at diagnosis. Age groups were older adults (aged 55 years or older) and younger adults (aged younger than 55 years). Race/ethnic groups included Non-Hispanic White (White), Non-Hispanic Black (Black), Hispanic, Non-Hispanic Asian/Pacific Islander (API), and Non-Hispanic American Indian/Alaska Native (AI/AN), as reported in the database. Stage at diagnosis included early stage (in situ and localized tumors) and late stage (regional and distant site tumors). Joinpoint Regression Software (version 5.0.2, NCI) using the weighted Bayesian Information Criteria method was used to generate time trends. Trends were reported as annual percentage change (APC) and average APC (AAPC). Parametric estimations were used with a two-sided t-test to evaluate the trends with a p-value cutoff at 0.05. Results: There were 21,625 patients diagnosed with gastric MALT lymphoma in the US between 2001 and 2020. Overall, incidence rates were significantly decreasing over the study period (AAPC = −1.93). This decrease was seen in males (AAPC = −1.67) and in females (AAPC = −1.66) (Figure). When categorized by age groups, older adults also experienced a significant decrease in gastric MALT lymphoma incidence rates (AAPC = −1.66). While this was also seen in younger adults, the rates were decreasing at a slower pace (AAPC = −1.38). When categorizing the trends by race/ethnicity, incidence rates were significantly decreasing in White (AAPC = −2.09), Hispanic (AAPC = −1.61), and API (AAPC = −3.92) populations. However, the rates were stable among Blacks. While early-stage tumors experienced a significant decrease (AAPC = −1.10), the rates were stable for late-stage tumors. When evaluating mortality, there were 11,036 patients whose death was attributed to gastric MALT lymphoma between 2000 and 2020. IBM rates were decreasing in males (AAPC = −1.47), older adults (AAPC = −1.55), Whites (AAPC = −1.23), Hispanics (AAPC = −1.73), APIs (AAPC = −2.30), and early-stage tumors (AAPC = −1.08). On the other hand, IBM rates were stable in females, younger adults, Blacks, and late-stage tumors. Discussion: An extensive nationwide data analysis encompassing nearly 98% of patients diagnosed with gastric MALT lymphoma in the US unveils a declining trend in the incidence of cancer overall over the past two decades. This decline is observed in both sexes and various age groups. When stratifying by race and ethnicity, this incidence has been decreasing in all populations except among Black individuals. While early-stage tumors have also demonstrated a significant decrease in incidence rates, late-stage tumors have shown no parallel decline. Mortality evaluation also revealed an improvement in most of the US population except among females, younger adults, Black individuals, and late-stage tumors. While the cause of our findings is unclear, it could be driven by disproportionate exposure to risk factors, including H. Pylori, and disparities in screening, management, and outcomes. Future studies are warranted to investigate factors contributing to worse outcomes of gastric MALT lymphoma, especially in the Black population. Full article

Background and Objectives: Non-Hodgkin lymphoma (NHL) has the sixth-highest malignancy-related mortality in the United States (US). However, inequalities exist in access to advanced care in specific patient populations. We aim to study the racial disparities in major adverse cardiovascular and cerebrovascular events (MACCEs) in NHL patients. Materials and Methods: Using ICD-10 codes, patients with NHL were identified from the US National Inpatient Sample 2016–2019 database. Baseline characteristics, comorbidities, and MACCE outcomes were studied, and results were stratified based on the patient’s race. Results: Of the 777,740 patients with a diagnosis of NHL, 74.22% (577,215) were White, 9.15% (71,180) were Black, 9.39% (73,000) were Hispanic, 3.33% (25,935) were Asian/Pacific Islander, 0.36% (2855) were Native American, and 3.54% (27,555) belonged to other races. When compared to White patients, all-cause mortality (ACM) was significantly higher in Black patients (aOR 1.27, 95% CI 1.17–1.38, p < 0.001) and in Asian/Pacific Islander patients (aOR 1.27, 95% CI 1.12–1.45, p < 0.001). Sudden cardiac death was found to have a higher aOR in all racial sub-groups as compared to White patients; however, it was statistically significant in Black patients only (aOR 1.81, 95% CI 1.52–2.16, p < 0.001). Atrial fibrillation (AF) risk was significantly lower in patients who were Black, Hispanic, and of other races compared to White patients. Acute myocardial infarction (AMI) was noted to have a statistically significantly lower aOR in Black patients (0.70, 95% CI 0.60–0.81, p < 0.001), Hispanic patients (0.69, 95% CI 0.59–0.80, p < 0.001), and patients of other races (0.57, 95% CI 0.43–0.75, p < 0.001) as compared to White patients. Conclusions: Racial disparities are found in MACCEs among NHL patients, which is likely multifactorial, highlighting the need for healthcare strategies stratified by race to mitigate the increased risk of MACCEs. Further research involving possible epigenomic influences and social determinants of health contributing to poorer outcomes in Black and Asian/Pacific Islander patients with NHL is imperative. Full article

Stigmatization, hostility, and violence towards the Asian American and Pacific Islander (AAPI) community have increased sharply during the COVID-19 pandemic. It is important to conduct research to promote understanding of the effects of such stigmatization on the AAPI community. Accordingly, the present study used a combined minority stress and integrated threat framework to examine whether factors related to AAPI identity would moderate the relationship between stigmatization/threat associated with AAPI identity and increased psychological distress and behavioral vigilance. AAPI individuals were recruited online from both Turk Prime and Reddit and completed measures of perceived stigmatization; integrated threat; depression, anxiety, and stress; and behavioral vigilance. Perceptions of stigmatization and threat predicted relevant outcomes both as individual predictors and in multivariate analyses. However, factors relating to the strength of AAPI identification did not moderate the effects of stigmatization and threat on psychological distress and behavioral vigilance, which is a result that failed to support this aspect of the broader conceptual model on which this project was based. Instead, these proposed moderators were themselves predicted by stigmatization and threat variables. The implications of these findings for effective interventions to alleviate the negative consequences of anti-Asian stigmatization are discussed. Full article

The study used the American Time Use Survey data from 2010 to 2019 to compare the daily moderate-to-vigorous activity of Native Hawaiians and Pacific Islanders (NHPI) and seven Asian ethnic subgroups. Adults aged 24 years and older were included. The study analyzed activities from sports and recreation, household activities, and all activities carried out during the day. Outcomes were determined by the completion of 30 min or more of moderate-to-vigorous activity and the type of activity carried out in the day. Significant ethnic differences were observed for sports and recreation but not for household activities and not for all activities carried out during the day. Of the ethnic populations, NHPI were the least active, and Asian Indians and Chinese were the most active. A majority achieved 30 min or more of moderate-to-vigorous activity during the day from all their activities. Physical activity from household activities exceeded physical activity from sports and recreation. The most physically active group was adults over the age of 65 years, perhaps reflecting more time to exercise or greater concerns about their health. For sports and recreation, exercising with someone doubled the minutes of moderate-to-vigorous activity. The results emphasize the importance of activities performed around the household in addition to sports and recreation and the benefit of exercising with someone. Ethnic populations may be receptive to interventions that emphasize activities they are performing in their daily lives. Full article