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Racial and Ethnic Disparities in Chronic Conditions among Adults and Older Adults

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Behavior, Chronic Disease and Health Promotion".

Deadline for manuscript submissions: closed (15 February 2021) | Viewed by 32697

Special Issue Editors


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Guest Editor
Department of Health and Behavioral Sciences, University of Colorado Denver, P.O. Box 173364, CB 188, Denver, CO 80217, USA
Interests: aging; chronic conditions; health disparities; neighborhood environment; and social determinants of health
Special Issues, Collections and Topics in MDPI journals

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Guest Editor
Capstone College of Nursing, The University of Alabama, Tuscaloosa, AL 35487, USA
Interests: cardiovascular disease; health disparities; rural; underserved populations; aging
Special Issues, Collections and Topics in MDPI journals

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Guest Editor
Institute of Public Health, Florida A&M University, 1515 MLK Boulevard, Tallahassee, FL 32307, USA
Interests: health disparities; minority health; access to care; aging
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

We are organizing a Special Issue on “Racial and Ethnic Disparities in Chronic Conditions among Adults and Older Adults” in the International Journal of Environmental Research and Public Health. The venue is a peer-reviewed scientific journal that publishes articles and communications in the interdisciplinary area of environmental health sciences and public health. For detailed information on the journal, we refer you to https://www.mdpi.com/journal/ijerph. 

Chronic health conditions are defined as those conditions that last a year or more and require ongoing medical attention and/or limit activities of daily living. The number of adults with multiple chronic conditions (e.g., asthma, arthritis, cancer, chronic obstructive pulmonary disease, depression, type II diabetes, heart disease, obesity, kidney disease, stroke, and cognitive and physical functioning difficulties) is growing in the United States of America (USA). The biggest contributor to the increased prevalence of chronic conditions in the USA is population aging, where people with chronic conditions use more healthcare and have higher risks of taking multiple medications, disability, and mortality. Chronic conditions are also the leading contributors to healthcare spending.

There is a disproportionate burden of chronic conditions among racial and ethnic minorities and adults and older adults with lower socioeconomic status. Pervasive racial and ethnic disparities in chronic conditions exist in the USA and other countries. Racial and ethnic minorities are likely to develop chronic conditions earlier in life, live with a higher number of chronic conditions, and are at greater risk of dying from their chronic conditions than White adults. However, we know less about the pathways or mechanisms connecting race and ethnicity to multiple chronic conditions, and there is a lack of longitudinal research on managing these conditions, or population-level interventions to address racial and ethnic disparities in chronic conditions. We encourage empirical research on race or ethnicity and chronic conditions, in the USA or internationally, using quantitative, qualitative, or mixed methods which speak to the following topics (but not limited to these):

  • Incorporating the social determinants of health with biomedical frameworks.
  • Examining pathways linking individual, interpersonal, and/or structural determinants to chronic conditions.
  • Intersectionality of race or ethnicity with age, gender, socioeconomic status, place, sexuality, etc. as part of existing pathways influencing chronic conditions.
  • The prevalence of multiple chronic conditions or comorbidity and people’s experiences managing them (i.e., self-care and medical care).
  • Family health history influencing health behaviors related to chronic conditions.
  • Health information seeking and use behaviors related to chronic conditions.
  • Current or future health care workforce needs to provide the best care for patients with chronic conditions.
  • Creating prevention, intervention, and/or policy solutions to reduce racial and ethnic disparities in chronic conditions.

This Special Issue will be edited by a team of researchers working at the intersections of race, ethnicity, and chronic conditions from the social sciences, public health, nursing, and gerontology: Associate Professor Ronica N. Rooks (University of Colorado Denver; [email protected]), Associate Professor Cassandra D. Ford (The University of Alabama; [email protected]), and Associate Professor Arlesia Mathis (Florida A&M University; [email protected]). Please email Drs. Rooks, Ford, or Mathis to indicate your interest in submitting a manuscript or for more information.

Authors are invited to submit abstracts related to the topic areas described above. The Guest Editors will review all abstracts to assess topic appropriateness and scientific rigor. Authors of high-scoring abstracts will be invited to submit a complete manuscript for anonymous peer review by the Guest Editors and additional peer reviewers. Please submit a 400 word structured abstract for initial review.

Assoc. Prof. Ronica N. Rooks
Assoc. Prof. Cassandra D. Ford
Assoc. Prof. Arlesia L. Mathis
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Race or ethnicity
  • Chronic conditions
  • Comorbidity
  • Adults, middle-aged, or older adults
  • Social determinants of health
  • Inequalities or inequities
  • Prevention or intervention
  • Policy
  • Intersectionality
  • Health care access

Related Special Issue

Published Papers (9 papers)

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Research

13 pages, 871 KiB  
Article
Timing of Home Health Care Initiation and 30-Day Rehospitalizations among Medicare Beneficiaries with Diabetes by Race and Ethnicity
by Jamie M. Smith, Haiqun Lin, Charlotte Thomas-Hawkins, Jennifer Tsui and Olga F. Jarrín
Int. J. Environ. Res. Public Health 2021, 18(11), 5623; https://doi.org/10.3390/ijerph18115623 - 25 May 2021
Cited by 12 | Viewed by 4636
Abstract
Older adults with diabetes are at elevated risk of complications following hospitalization. Home health care services mitigate the risk of adverse events and facilitate a safe transition home. In the United States, when home health care services are prescribed, federal guidelines require they [...] Read more.
Older adults with diabetes are at elevated risk of complications following hospitalization. Home health care services mitigate the risk of adverse events and facilitate a safe transition home. In the United States, when home health care services are prescribed, federal guidelines require they begin within two days of hospital discharge. This study examined the association between timing of home health care initiation and 30-day rehospitalization outcomes in a cohort of 786,734 Medicare beneficiaries following a diabetes-related index hospitalization admission during 2015. Of these patients, 26.6% were discharged to home health care. To evaluate the association between timing of home health care initiation and 30-day rehospitalizations, multivariate logistic regression models including patient demographics, clinical and geographic variables, and neighborhood socioeconomic variables were used. Inverse probability-weighted propensity scores were incorporated into the analysis to account for potential confounding between the timing of home health care initiation and the outcome in the cohort. Compared to the patients who received home health care within the recommended first two days, the patients who received delayed services (3–7 days after discharge) had higher odds of rehospitalization (OR, 1.28; 95% CI, 1.25–1.32). Among the patients who received late services (8–14 days after discharge), the odds of rehospitalization were four times greater than among the patients receiving services within two days (OR, 4.12; 95% CI, 3.97–4.28). Timely initiation of home health care following diabetes-related hospitalizations is one strategy to improve outcomes. Full article
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12 pages, 350 KiB  
Article
Determinants of Disability in Minority Populations in Spain: A Nationwide Study
by Javier Casillas-Clot, Pamela Pereyra-Zamora and Andreu Nolasco
Int. J. Environ. Res. Public Health 2021, 18(7), 3537; https://doi.org/10.3390/ijerph18073537 - 29 Mar 2021
Cited by 3 | Viewed by 3098
Abstract
Some population groups could be especially vulnerable to the effects of population ageing. The Global Activity Limitation Indicator (GALI) has been proposed as a measure of disability, but it has not been used in minority groups. The aim of this study is to [...] Read more.
Some population groups could be especially vulnerable to the effects of population ageing. The Global Activity Limitation Indicator (GALI) has been proposed as a measure of disability, but it has not been used in minority groups. The aim of this study is to estimate the prevalence of disability using the GALI and to analyse its determinants in immigrant and Roma populations. Data from the Spanish National Health Survey 2017 and the National Health Survey of the Roma Population 2014 were used, including adults aged 50 and above. Prevalence of disability was estimated, and odds ratios were calculated using logistic regression models to assess the association between disability and demographic, socioeconomic, and health variables. The prevalence of disability was estimated at 39.4%, 30.6%, and 58.7% in the native, immigrant, and Roma populations, respectively. Gender was a common determinant for the native and Roma populations. On the other hand, among immigrants, the risk of disability increased over the time residing in Spain. There were significant interactions with age and gender in the native population. Disability has different determinants in the three population groups. Public health measures to protect the Roma population and immigrants’ health should be considered. Full article
14 pages, 994 KiB  
Article
Racial Disparities in Post-Acute Home Health Care Referral and Utilization among Older Adults with Diabetes
by Jamie M. Smith, Olga F. Jarrín, Haiqun Lin, Jennifer Tsui, Tina Dharamdasani and Charlotte Thomas-Hawkins
Int. J. Environ. Res. Public Health 2021, 18(6), 3196; https://doi.org/10.3390/ijerph18063196 - 19 Mar 2021
Cited by 18 | Viewed by 4747
Abstract
Racial and ethnic disparities exist in diabetes prevalence, health services utilization, and outcomes including disabling and life-threatening complications among patients with diabetes. Home health care may especially benefit older adults with diabetes through individualized education, advocacy, care coordination, and psychosocial support for patients [...] Read more.
Racial and ethnic disparities exist in diabetes prevalence, health services utilization, and outcomes including disabling and life-threatening complications among patients with diabetes. Home health care may especially benefit older adults with diabetes through individualized education, advocacy, care coordination, and psychosocial support for patients and their caregivers. The purpose of this study was to examine the association between race/ethnicity and hospital discharge to home health care and subsequent utilization of home health care among a cohort of adults (age 50 and older) who experienced a diabetes-related hospitalization. The study was limited to patients who were continuously enrolled in Medicare for at least 12 months and in the United States. The cohort (n = 786,758) was followed for 14 days after their diabetes-related index hospitalization, using linked Medicare administrative, claims, and assessment data (2014–2016). Multivariate logistic regression models included patient demographics, comorbidities, hospital length of stay, geographic region, neighborhood deprivation, and rural/urban setting. In fully adjusted models, hospital discharge to home health care was significantly less likely among Hispanic (OR 0.8, 95% CI 0.8–0.8) and American Indian (OR 0.8, CI 0.8–0.8) patients compared to White patients. Among those discharged to home health care, all non-white racial/ethnic minority patients were less likely to receive services within 14-days. Future efforts to reduce racial/ethnic disparities in post-acute care outcomes among patients with a diabetes-related hospitalization should include policies and practice guidelines that address structural racism and systemic barriers to accessing home health care services. Full article
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14 pages, 821 KiB  
Article
Perceived Neighborhood Characteristics and Cognitive Functioning among Diverse Older Adults: An Intersectional Approach
by Amy D. Thierry, Kyler Sherman-Wilkins, Marina Armendariz, Allison Sullivan and Heather R. Farmer
Int. J. Environ. Res. Public Health 2021, 18(5), 2661; https://doi.org/10.3390/ijerph18052661 - 6 Mar 2021
Cited by 8 | Viewed by 3217
Abstract
Unfavorable neighborhood conditions are linked to health disparities. Yet, a dearth of literature examines how neighborhood characteristics contribute to cognitive health in diverse samples of older adults. The present study uses an intersectional approach to examine how race/ethnicity, gender, and education moderate the [...] Read more.
Unfavorable neighborhood conditions are linked to health disparities. Yet, a dearth of literature examines how neighborhood characteristics contribute to cognitive health in diverse samples of older adults. The present study uses an intersectional approach to examine how race/ethnicity, gender, and education moderate the association between neighborhood perceptions and cognitive functioning in later life. We used data from adults ≥65 years old (n = 8023) in the 2010–2016 waves of the nationally representative Health and Retirement Study (HRS). We conducted race/ethnicity-stratified linear regression models where cognitive functioning, measured using the 35-point Telephone Interview Cognitive Screen (TICS), was regressed on three neighborhood characteristics—cleanliness, safety, and social cohesion. We examine whether there is heterogeneity within race/ethnicity by testing if and how the relationship between neighborhood characteristics and cognitive functioning differs by gender and education. Among White adults, worse neighborhood characteristics were associated with lower cognitive functioning among those with less education. However, for Black adults, poor perceived quality of one’s neighborhood was associated with worse cognitive functioning among those with more years of education compared to those with fewer years of education. Among Mexicans, perceived neighborhood uncleanliness was associated with lower cognitive functioning among those with less education, but higher cognitive functioning for those with higher levels of education. Thus, this study contributes to the literature on racial/ethnic disparities in cognitive aging disparities by examining neighborhood contextual factors as determinants of cognitive functioning. In particular, we find that higher education in the context of less favorable neighborhood environments does not confer the same benefits to cognitive functioning among all older adults. Full article
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15 pages, 1872 KiB  
Article
Private Insurance and Mental Health among Older Adults with Multiple Chronic Conditions: A Longitudinal Analysis by Race and Ethnicity
by Hankyung Jun and Emma Aguila
Int. J. Environ. Res. Public Health 2021, 18(5), 2615; https://doi.org/10.3390/ijerph18052615 - 5 Mar 2021
Cited by 9 | Viewed by 2853
Abstract
Older adults with multiple chronic conditions have a higher risk than those without multiple conditions of developing a mental health condition. Individuals with both physical and mental conditions face many substantial burdens. Many such individuals also belong to racial and ethnic minority groups. [...] Read more.
Older adults with multiple chronic conditions have a higher risk than those without multiple conditions of developing a mental health condition. Individuals with both physical and mental conditions face many substantial burdens. Many such individuals also belong to racial and ethnic minority groups. Private insurance coverage can reduce the risks of developing mental illnesses by increasing healthcare utilization and reducing psychological stress related to financial hardship. This study examines the association between private insurance and mental health (i.e., depressive symptoms and cognitive impairment) among older adults in the United States with multiple chronic conditions by race and ethnicity. We apply a multivariate logistic model with individual fixed-effects to 12 waves of the Health and Retirement Study. Among adults with multiple chronic conditions in late middle age nearing entry to Medicare and of all racial and ethnic groups, those without private insurance have a stronger probability of having depressive symptoms. Private insurance and Medicare can mediate the risk of cognitive impairment among non-Hispanic Whites with multiple chronic conditions and among Blacks regardless of the number of chronic conditions. Our study has implications for policies aiming to reduce disparities among individuals coping with multiple chronic conditions. Full article
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8 pages, 2645 KiB  
Article
Description of Variation in Age of Onset of Functional Limitations of Native Hawaiian and Pacific Islanders Compared to Other Racial and Ethnic Groups
by Christopher S. Walter, Marie-Rachelle Narcisse, Jennifer L. Vincenzo, Pearl A. McElfish and Holly C. Felix
Int. J. Environ. Res. Public Health 2021, 18(5), 2445; https://doi.org/10.3390/ijerph18052445 - 2 Mar 2021
Cited by 3 | Viewed by 1958
Abstract
(1) Background: The purpose of this exploratory study was to describe variation in age of onset of functional limitations of Native Hawaiian and Pacific Islanders (NHPI) compared to other racial and ethnic groups. (2) Methods: Adults age 45 years and older who responded [...] Read more.
(1) Background: The purpose of this exploratory study was to describe variation in age of onset of functional limitations of Native Hawaiian and Pacific Islanders (NHPI) compared to other racial and ethnic groups. (2) Methods: Adults age 45 years and older who responded to the Functioning and Disability module within the 2014 National Health Interview Survey (NHIS) were included (n = 628 NHPI; 7122 non-Hispanic Whites; 1418 Blacks; 470 Asians; and 1216 Hispanic adults). The NHIS Functioning and Disability module included 13 items, which we organized into three domains of functional limitations using factor analysis: Mobility, Gross Motor Skills, and Fine Motor Skills. Responses were summed within each domain. (3) Results: After adjusting for age and sex, we found that racial/ethnic minority groups, with the exception of Asians, experience more functional limitations than Whites. Results further indicate that NHPI adults experienced an earlier surge in all three domains of functional limitations compared to other racial/ethnic groups. (4) Conclusions: These findings are novel and provide additional evidence to the existence of disparities in functional health outcomes across racial/ethnic groups. Future studies are needed to develop targeted and culturally tailored interventions for those most in need. Full article
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19 pages, 523 KiB  
Article
Intersections of Adverse Childhood Experiences, Race and Ethnicity and Asthma Outcomes: Findings from the Behavioral Risk Factor Surveillance System
by Tristen Hall, Ronica Rooks and Carol Kaufman
Int. J. Environ. Res. Public Health 2020, 17(21), 8236; https://doi.org/10.3390/ijerph17218236 - 7 Nov 2020
Cited by 8 | Viewed by 4187
Abstract
Racial and ethnic minority subpopulations experience a disproportionate burden of asthma and adverse childhood experiences (ACEs). These disparities result from systematic differences in risk exposure, opportunity access, and return on resources, but we know little about how accumulated differentials in ACEs may be [...] Read more.
Racial and ethnic minority subpopulations experience a disproportionate burden of asthma and adverse childhood experiences (ACEs). These disparities result from systematic differences in risk exposure, opportunity access, and return on resources, but we know little about how accumulated differentials in ACEs may be associated with adult asthma by racial/ethnic groups. We used Behavioral Risk Factor Surveillance System data (N = 114,015) from 2009 through 2012 and logistic regression to examine the relationship between ACEs and adult asthma using an intersectional lens, investigating potential differences for women and men aged 18 and older across seven racial/ethnic groups. ACEs were significantly related to asthma, adjusting for race/ethnicity and other covariates. Compared to the reference group (Asians), asthma risk was significantly greater for Black/African American, American Indian and Alaska Native (AIAN), White, and multiracial respondents. In sex-stratified interactional models, ACEs were significantly related to asthma among women. The relationship between ACEs and asthma was significantly weaker for Black/African American and AIAN women compared to the reference group (Asian women). The findings merit attention for the prevention and early detection of ACEs to mitigate long-term health disparities, supporting standardized screening and referrals in clinical settings, evidence-based prevention in communities, and the exploration of strategies to buffer the influence of adversities in health. Full article
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10 pages, 288 KiB  
Article
Neighborhood Disadvantage Is Associated with Depressive Symptoms but Not Depression Diagnosis in Older Adults
by Courtney J. Bolstad, Reagan Moak, Cynthia J. Brown, Richard E. Kennedy and David R. Buys
Int. J. Environ. Res. Public Health 2020, 17(16), 5745; https://doi.org/10.3390/ijerph17165745 - 8 Aug 2020
Cited by 6 | Viewed by 2718
Abstract
Disadvantaged neighborhood environments may have low access to healthcare, perpetuating health disparities. Previous research has reported on associations between neighborhood disadvantage (ND) and depressive symptomology but not depression diagnoses, which may indicate access to healthcare. This study tested how ND relates to depressive [...] Read more.
Disadvantaged neighborhood environments may have low access to healthcare, perpetuating health disparities. Previous research has reported on associations between neighborhood disadvantage (ND) and depressive symptomology but not depression diagnoses, which may indicate access to healthcare. This study tested how ND relates to depressive symptomology and diagnosis to assess for neighborhood disparities in mental health care cross-sectionally. Data from 998 community-dwelling, Black and White individuals aged 65+ included in the University of Alabama at Birmingham Study of Aging were analyzed. We obtained participants’ depressive symptomology from the Geriatric Depression Scale (n = 100) and a verified depression diagnosis from self-report and review of medication, physician-report, and/or hospital discharge summaries (n = 84). We assessed ND from US Census data, divided the sample into tertiles of ND and fit models with Generalized Estimating Equations covarying for various other variables (e.g., sex, race, physical performance, socioeconomic status, etc.). We found living in the high and mid-ND tertiles to be associated with depressive symptomology, yet ND had no significant relation to depression diagnosis. Therefore, older adults living in high and mid-disadvantaged neighborhoods may be more likely to experience depressive symptomology but not receive a diagnosis, indicating a possible disparity in mental health care. Full article
16 pages, 791 KiB  
Article
Prevalence of Multimorbidity among Asian Indian, Chinese, and Non-Hispanic White Adults in the United States
by Yifan Zhang, Ranjita Misra and Usha Sambamoorthi
Int. J. Environ. Res. Public Health 2020, 17(9), 3336; https://doi.org/10.3390/ijerph17093336 - 11 May 2020
Cited by 16 | Viewed by 3771
Abstract
Asian Americans are the fastest-growing minority group in the United States, yet little is known about their multimorbidity. This study examined the association of Asian Indians, Chinese and non-Hispanic whites (NHWs) to multimorbidity, defined as the concurrent presence of two or more chronic [...] Read more.
Asian Americans are the fastest-growing minority group in the United States, yet little is known about their multimorbidity. This study examined the association of Asian Indians, Chinese and non-Hispanic whites (NHWs) to multimorbidity, defined as the concurrent presence of two or more chronic conditions in the same individual. We used a cross-sectional design with data from the National Health Interview Survey (2012–2017) of Asian Indians, Chinese, and NHWs (N = 132,666). Logistic regressions were used to examine the adjusted association of race/ethnicity to multimorbidity. There were 1.9% Asian Indians, 1.8% Chinese, and 96.3% NHWs. In unadjusted analyses (p < 0.001), 17.1% Asian Indians, 17.9% Chinese, and 39.0% NHWs had multimorbidity. Among the dyads, high cholesterol and hypertension were the most common combination of chronic conditions among Asian Indians (32.4%), Chinese (41.0%), and NHWs (20.6%). Asian Indians (AOR = 0.73, 95% CI = (0.61, 0.89)) and Chinese (AOR = 0.63, 95% CI = (0.53, 0.75)) were less likely to have multimorbidity compared to NHWs, after controlling for age, sex, and other risk factors. However, Asian Indians and Chinese were more likely to have high cholesterol and hypertension, risk factors for diabetes and heart disease. Full article
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