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Assessing equitable care for Indigenous and Afrodescendant women in Latin America.

OBJECTIVE: To identify and understand the barriers to equitable care within health care settings that women of ethnic minorities encounter in Latin America and to examine possible strategies for mitigating the issues. METHODS: This was a comprehensive review of the literature from 2000-2015 available from the online databases PubMed, Google Scholar, EBSCOhost, and SciELO in Spanish, English, and Portuguese, using a keyword search that included the Region and country names. RESULTS: Health provider discrimination against Indigenous and Afrodescendant women is a primary barrier to quality heal

The AFFIRM Framework for gender-affirming care: qualitative findings from the Transgender and Gender Diverse Health Equity Study.

BACKGROUND: Transgender, nonbinary, and gender diverse (TGD) people experience stigma in healthcare settings impacting healthcare utilizatio … or gender-affirming care and create care models that resist intersecting oppressive systems such as racism and cisgenderism. (4) Interacts with community: Patients desired intentional interaction with TGD community to holistically address health and unmet gender affirmation needs. (5) Retains patients in care: Patients shared the need to collaboratively …

Insights from preventability assessments across 42 state and city maternal mortality reviews in the United States.

BACKGROUND: The rising trend in maternal mortality over the past 3 decades sets the United States apart from all other high-income countries … the states. Based on data from 20 Maternal Mortality Review Committees with available information, racism or discrimination were noted in relation to 37.7% of pregnancy-related deaths. CONCLUSION: A large proportion of pregnancy-associated deaths and pregnancy-related deaths in the U.S. are preventable. However, likely due to differences in Maternal Mo …

Experiences of Indigenous Patients Receiving Dialysis: Systematic Review of Qualitative Studies.

RATIONALE & OBJECTIVE: Indigenous People suffer a high burden of kidney disease. Those receiving maintenance dialysis have worse outcomes co … lysis. They described lacking awareness of kidney disease, poor access to health services, systemic racism, inadequate cultural safety, and being dislocated from family, community, and culture. These findings indicate that respectful collaboration with Indigenous Peoples to craft and implement policy changes holds promise to improve prevention, integrate …

Cumulative Lifespan Stress, Inflammation, and Racial Disparities in Mortality Between Black and White Adults.

IMPORTANCE: In the US, Black individuals experience higher mortality risk than White individuals. Greater stress exposure and its biological … ack and White US individuals. The findings underscore the need for policies that address structural racism, alongside treatments that reduce inflammation and limit stress exposure to reduce mortality disparities.

Racial and Ethnic Disparities in Cesarean Birth Trends in the United States.

IMPORTANCE: Inequity by race and ethnicity persists in obstetric practice. A comprehensive comparison of the rates of cesarean birth by race … ement efforts to reduce unnecessary cesarean births should address this inequity and the structural racism that drives it.

Prediabetes Prevalence by Adverse Social Determinants of Health in Adolescents.

IMPORTANCE: Several clinical practice guidelines advise race- and ethnicity-based screening for youth-onset type 2 diabetes (T2D) due to a higher prevalence among American Indian and Alaska Native, Asian, Black, and Hispanic youths compared with White youths. However, rather than a biological risk, this disparity likely reflects the inequitable distribution of adverse social determinants of health (SDOH), a product of interpersonal and structural racism. OBJECTIVE: To evaluate prediabetes prevalence by presence or absence of adverse SDOH in adolescents eligible for T2D screening based on weig…

Racial and Sex Inequities in the Use of and Outcomes After Left Ventricular Assist Device Implantation Among Medicare Beneficiaries.

IMPORTANCE: While left ventricular assist devices (LVADs) increase survival for patients with advanced heart failure (HF), racial and sex ac … in LVAD access may have resulted from differences in clinician decision-making because of systemic racism and discrimination, implicit bias, or patient preference.

Mediators of Racial Disparity in the Use of Prostate Magnetic Resonance Imaging Among Patients With Prostate Cancer.

IMPORTANCE: Racial disparity in the use of prostate magnetic resonance imaging (MRI) presents obstacles to closing gaps in prostate cancer d … adults, mediation analysis revealed that sociodemographic factors and manifestations of structural racism, including poverty and residential segregation, explained most of the racial disparity in the use of prostate MRI among older Black and White men with prostate cancer. These findings can be applied to develop targeted strategies to improve cancer ca …

Racial and Socioeconomic Differences in Eye Care Utilization among Medicare Beneficiaries with Glaucoma.

PURPOSE: Evaluate differences in eye care utilization among patients with glaucoma by race and socioeconomic status (SES). DESIGN: Retrospe … oma. These differences persisted among Blacks after stratification by SES, suggesting that systemic racism may be an independent driver in this population.

Differences between physician social networks for cardiac surgery serving communities with high versus low proportions of black residents.

BACKGROUND: Compared with white patients, black patients are more likely to undergo cardiac surgery at low-quality hospitals, even when they live closer to high-quality ones. Opportunities for organizational interventions to alleviate this problem remain elusive. OBJECTIVES: To explore physician isolation in communities with high proportions of black residents as a factor contributing to racial disparities in access to high-quality hospitals for cardiac surgery. RESEARCH DESIGN: Using national Medicare data (2008-2011), we mapped physician social networks at hospitals where coronary artery b

Patterns of social determinants of health associated with drug use among women living with HIV in Canada: a latent class analysis.

BACKGROUND AND AIMS: Identifying typologies of social determinants of health (SDoH) vulnerability influencing drug use practices among women living with HIV (WLWH) can help to address associated harms. This research aimed to explore the association of SDoH clusters with drug use among WLWH. DESIGN: Latent class analysis (LCA) was used to identify the distinct clusters of SDoH. Inverse probability weighting (IPW) was employed to account for confounding and potential selection bias. Associations were analyzed using generalized linear model with log link and Poisson distribution, and then weight

Implementation of a Socio-structural Demonstration Project to Improve HIV Outcomes Among Young Black Men in the Deep South.

BACKGROUND: We describe the background, rationale, intervention components, and formative results of a demonstration project aimed to ameliorate five socio-structural barriers to HIV services for young Black men aged 18-29 living with and at risk for HIV in Louisiana. METHODS: The interventions and activities consisted of (1) five person-centered approaches to enhance linkage to HIV services and improve socio-economic outcomes; (2) the implementation of systematic mystery shopping tests to document instances of housing discrimination; (3) the development and implementation of a multi-prong co

Расовая неравноправие, множественный склероз и внедрение нового лечения алгоритма на уровне системы здравоохранения.

СПРАВОЧНАЯ ИНФОРМАЦИЯ И ЗАДАЧИ: Достижения в области множественного склероза (МС) не привели к справедливому улучшению лечения НР или результатов среди миниатюризированных людей. Наша цель заключалась в том, чтобы определить, осуществляются ли меры системы здравоохранения, направленные на расширение использования высокоэффективных методов лечения, на справедливой основе и привели ли они к аналогичным улучшениям в показателях НР среди расовых и этнических групп.МЕТОДЫ: Мы разработали и внедрили алгоритм лечения MS, который увязывает риск инвалидности человека с надлежащим образом эффективными м

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… are predictors of poor prognosis independent of health care quality; 9 such algorithms can increase risk of unconscious bias; and there is growing evidence for the harm of racialized medicine. 17 Instead, the algorithm incorporates attention to barriers to care that might be driven by structural racism … (1) algorithmic approaches to treatment have been shown to reduce racial and ethnic disparities in other conditions 19 , 20 ; (2) focusing on an individual's disease characteristics should lead to reduced unconscious bias; and (3) incorporating attention to care barriers that arise from structural racism …

Racial disparity in mortality from tuberculosis in the US between states with and without a history of Jim-Crow laws: an analysis of the Global Burden of Disease (GBD) and risk factors study, 1990 to 2019.

BACKGROUND: While TB-related mortality in the US declined four-fold from 1990 to 2019, country-level estimates of TB burden obscure within-s … past generations may still be felt in subsequent generations. Understanding the role of structural racism at the intersection of science and medicine shows the complex ways historical laws, such as Jim-Crow laws, continue to negatively impact health outcomes and warn of future dangers, such as COVID-19, to avoid.

A review of dairy food intake for improving health among black adults in the US.

The adult life stage encompasses a range of new experiences, opportunities, and responsibilities that impact health and well-being. During this life stage, health disparities continue to increase for Black Americans, with Black adults having a disproportionate burden of obesity, chronic diseases, comorbidities, and worse treatment outcomes compared to their White peers. While many of the underlying factors for these disparities can be linked to longstanding sociopolitical factors such as systemic racism, food insecurity, and poor access to healthcare, there are also several modifiable risk fac…

Defining global strategies to improve outcomes in sickle cell disease: a Lancet Haematology Commission.

All over the world, people with sickle cell disease (an inherited condition) have premature deaths and preventable severe chronic complications, which considerably affect their quality of life, career progression, and financial status. In addition, these people are often affected by stigmatisation or structural racism, which can contribute to stress and poor mental health. Inequalities affecting people with sickle cell disease are also reflected in the distribution of the disease—mainly in sub-Saharan Africa, India, and the Caribbean—whereas interventions, clinical trials, and funding are most…

Racial Disparities in Cleft Palate Repair.

BACKGROUND: Various factors can influence outcomes in cleft palate care. This study sought to determine the impact of race on admissions, hospital costs, and short-term complications in cleft palate repair. METHODS: Cleft palate operations were identified in the Kids' Inpatient Database data, from 2000 to 2009. Data were combed for demographics, perioperatives, complications, and hospital characteristics. Bivariate and multivariate analyses were performed between races in total, primary, and revision cohorts. RESULTS: There were 3464 white, 1428 Hispanic, 413 black, 398 Asian/Pacific-Islande