Search Results (800)

Alzheimer’s disease (AD) and related dementias (ADRD) are neurodegenerative conditions that cause gradual deterioration of cognition, memory and language in the elderly. AD has been declared as a health priority by the World Health Organization (WHO) considering its severity and unavailability of a permanent cure. Although the global AD/ADRD population is made up of many ethno-racial groups, the majority of AD studies have focused on the Caucasian population. The few AD studies conducted on minority populations in the US have found that significant AD health disparities exist, demonstrating that African Americans and Hispanics have a significantly higher prevalence of AD and related dementias, with their risk often approaching twice that of White individuals. For the past few years, epigenomic research has played an important role in understanding health disparities among diverse racial and ethnic groups. Unlike genetic studies, which focus on the DNA sequence that one is born with, epigenomics investigates how changes in gene expression due to extrinsic environmental exposures may impact disease pathophysiology. Recent epigenomic studies appear to be promising in not only understanding disease pathology but also in developing diagnostic and therapeutic tools for AD with population specificity. However, there is only a handful of studies and review articles available addressing the epigenomic applications in irradicating racial disparities in AD/ADRD. Therefore, the aim of this review is to discuss the recent findings of epigenomic studies in AD and related dementias, their contribution in irradicating racioethnic disparities and insights into the future direction of their application in precision medicine. Full article

Background: Maternal mortality in Brazil remains a critical indicator of social and racial inequalities, reflecting structural failures in access to and quality of obstetric care. Black women, particularly those categorized as black or brown, are at a higher risk of dying during pregnancy, childbirth, or the postpartum period. This is the result of the intersection of institutional racism, poverty, and social vulnerabilities. This study aimed to analyze trends and associated factors of maternal mortality among black women in Brazil from 2000 to 2020. Methods: This is a retrospective cohort analytical study using data from the Brazilian Mortality Information System. The sample included women aged 10 to 49 years whose underlying cause of death was classified under ICD-10 codes O00–O99. Descriptive and bivariate analyses were conducted, as well as Poisson and multinomial logistic regressions to estimate adjusted risk ratios according to skin color, education, region, type, and place of death. Results: A total of 40,907 maternal deaths were identified, with 59.2% occurring among black women. The maternal mortality ratio was 39% higher among black women compared to white women and more than double among Indigenous women. Low education, residence in the North and Northeast regions, deaths outside hospital settings, and lack of formal investigation were independently associated with increased risk. Direct obstetric causes accounted for most deaths, with hypertensive disorders and puerperal complications being the leading conditions. Conclusions: Maternal mortality among black women in Brazil reveals deep structural inequalities. Urgent public policies that incorporate an intersectional perspective, addressing race, gender, and class, are necessary to reduce disparities and ensure equitable and dignified maternal healthcare. Full article

Background/Objectives: African American women are less likely to breastfeed in general and to breastfeed exclusively for the first six months of infancy. Racial and ethnic breastfeeding disparities are especially pronounced in the South, particularly in rural communities. These differences are attributed largely to structural lactation impediments that include less breastfeeding support in healthcare settings, workplaces, and communities. While a great deal of research has explored racial differences in breastfeeding, minimal attention has been paid to the social correlates and racial disparities associated with the 2022 U.S. infant formula shortage. Our study explores racial distinctions in the formula shortage’s effect on breastfeeding support among Gulf Coast Mississippians. Methods: We use data from the second wave of the Mississippi REACH (Racial and Ethnic Approaches to Community Health) Social Climate Survey to determine if racial differences are evident in the formula shortage’s influence on breastfeeding support. We predict that the infant formula shortage will have prompted African American respondents to become much more supportive of breastfeeding than their White counterparts, net of sociodemographic controls. This hypothesis is based on the lower prevalence of exclusive breastfeeding among African Americans, thereby indicating a greater reliance on formula. The study uses a general population (random digit dial) sample and purposive (exclusively African American) oversample to analyze validated data from a cross-sectional survey. Sampling took place between September and December 2023, with a sample population of adult male and female Mississippians. A series of binary logistic regression models were employed to measure the association of race with breastfeeding support changes resulting from the infant formula shortage. Results: The study results support the hypothesis, as seen by a positive association between African Americans and increased breastfeeding support directly related to the infant formula shortage. Further, the baseline statistical model reveals African American respondents to be five times more likely than White respondents (p < 0.001) to report that the formula shortage increased their support of breastfeeding. Conclusions: We conclude by discussing this study’s implications and promising directions for future research. Full article

Background and Objectives: Cervical adenocarcinoma (CAC) is a histologically distinct subtype of cervical cancer with a rising incidence in many regions. While the roles of key driver mutations are known, a comprehensive understanding of its genomic landscape, particularly variations across different populations and tumor stages, remains incomplete. This study aims to characterize the somatic genomic landscape of CAC by identifying recurrent mutations, copy number alterations (CNAs), and patterns of co-occurrence, with a focus on variations across racial groups and between primary and metastatic tumors. Materials and Methods: We conducted a comprehensive genomic analysis of 102 tumor samples from 99 patients diagnosed with cervical adenocarcinoma using data from the American Association for Cancer Research (AACR) Project Genomics Evidence Neoplasia Information Exchange (GENIE) database. Results: The most frequently mutated genes were PIK3CA (25.5%), TP53 (21.6%), ARID1A (20.6%), and KRAS (16.7%). Significant amplification of ERBB2 was also observed (n = 3; 4.83%). Our analysis revealed notable genomic disparities across racial groups, with TP53 mutations being significantly more frequent in White patients compared to Asian and Black patients (p = 0.0236). Furthermore, we identified significant co-occurrence between mutations in KRAS and MSH2 (p = 0.011) as well as ATM and STK11 (p = 0.037). In comparing tumor types, mutations in BCL6 were found to be significantly enriched in metastatic samples. Conclusions: This study validates the primary drivers of cervical adenocarcinoma and reveals novel findings, including notable racial disparities in TP53 mutation frequency and unique patterns of co-occurring mutations. These findings highlight the genomic heterogeneity of the disease and suggest that ancestry and tumor evolution may influence its molecular pathogenesis, offering potential avenues for the development of targeted therapies and personalized biomarkers. Full article

Background: While colorectal cancer (CRC) incidence and mortality have declined among patients aged ≥50 years (late-onset), rates are increasing in those aged <50 years (early-onset). Historically, non-Hispanic Whites (NHW) have had better 5-year survival compared with non-Hispanic Blacks (NHB), and rectal cancer has had better outcomes than colon cancer. Whether these disparities by race and tumor location are evident for both early-onset (EOCRC) and late-onset (LOCRC) CRC remains unclear. Methods: CRC cases diagnosed from 2011 to 2022 were identified from the Louisiana Tumor Registry. EOCRC was defined as diagnoses at ages 20–49 years, and LOCRC was defined as diagnoses at ages ≥50 years. Racial groups included NHW and NHB; tumor location was categorized as proximal colon, distal colon, or rectum. Cox regression was used to assess unadjusted and adjusted overall and cancer-specific survival. Results: Of 23,738 CRC patients, 10.7% were diagnosed at age <50 years. Compared to LOCRC, EOCRC patients included a higher proportion of NHB (37.5% vs. 32.6%) and rectal tumors (44.4% vs. 29.9%). NHB had worse overall survival than NHW in early-onset distal colon cancer (adjusted HR [aHR] = 1.358; 95%CI: 1.024–1.801). Conversely, NHB had better overall (aHR = 0.899; 95%CI: 0.831–0.973) and cancer-specific survival (aHR = 0.873; 95%CI: 0.793–0.960) in late-onset rectal cancer. Among EOCRC NHW, proximal tumors were associated with worse overall (aHR = 1.407; 95%CI: 1.102–1.796) and cancer-specific survival (aHR = 1.379; 95%CI: 1.057–1.799) compared with distal tumors. Conclusions: Survival differences by race and tumor subsite are observed between EOCRC and LOCRC, with NHB showing a lower hazard of death in some LOCRC subgroups. These findings highlight the need to consider the age of onset and tumor location when addressing racial disparities in CRC outcomes. Full article

Racial and ethnic disparities in acute myeloid leukemia (AML) survival persist despite advances in treatment, with non-Hispanic black (NHB) patients and Hispanic patients often experiencing worse outcomes than Non-Hispanic White (NHW) patients due to a combination of clinical, socioeconomic, and biological factors. This review focuses on these disparities and emphasizes potential contributions of biology, as illustrated by the effects of the nucleophosmin 1 (NPM1) mutation. Mutation landscapes and chromosomal abnormalities strongly influence AML patient outcomes. While AML cases with NPM1 mutations are associated with favorable prognoses for NHW patients, NHB patients with NPM1-mutated AML have adverse outcomes. Thus, treatment algorithms and prognostic systems based on outcomes from a single racial ancestry group are inadequate. Beyond the more traditional socioeconomic determinants of health, addressing disparities in AML to achieve equity in care requires exploring biological factors linked to ancestry that shape treatment response. Full article

Background/Objectives: Persistent inequities in healthcare experiences and outcomes among marginalized racial/ethnic groups and sexual and gender minority (SGM) populations have been well documented. However, disparities in perceptions of discrimination and bias between patients and health providers remain insufficiently understood. This review synthesizes the current evidence on how these groups differently perceive discrimination, how bias manifests in clinical encounters, and how intersecting identities shape healthcare experiences. Methods: A comprehensive review using SANRA guidelines examined racial/ethnic discrimination, SGM-related bias, provider implicit attitudes, minority stress processes, and structural determinants of inequity in healthcare settings. Articles were identified through systematic search strategies across major databases, and their conceptual, methodological, and theoretical contributions were analyzed. Results: Across studies, marginalized patients consistently reported discrimination, stigma, and mistrust in healthcare, whereas providers often underestimated the prevalence and impact of these experiences. Evidence indicates that implicit pro-White biases among providers influence communication quality, clinical decision-making, and patient comfort. Structural racism and intersecting minority statuses further compound disparities, contributing to delayed care, unmet health needs, and poorer outcomes. Limited alignment between patient and provider perceptions suggests a gap in recognition of inequitable treatment and its drivers. Conclusions: Healthcare inequities arise from interconnected, interpersonal, and structural mechanisms. Addressing these disparities requires multilevel interventions targeting provider training, institutional policy reform, and system-level barriers. Integrating both patient and provider perspectives is essential for developing equitable, affirming models of care and improving health outcomes for racial/ethnic and SGM populations. Full article

RNA In Situ Hybridization (RISH) is a powerful tool for spatial gene expression analysis, yet its quantitative use remains limited by the high cost and inaccessibility of commercial software, particularly in under-resourced settings. This study developed an Artificial Intelligence/Machine Learning (AI/ML)-assisted RISH quantification pipeline to evaluate expression patterns of High Mobility Group AT Hook-2 (HMGA2) in prostate cancer (PCa), focusing on racial disparities. We created a machine learning model capable of analyzing RISH images. Expressions of full-length (wild-type) and truncated HMGA2 isoforms were assessed in tissues from 85 men of African descent, European American, and Asian descent. A training dataset was generated for supervised learning analysis of the full cohort. RISH findings revealed that the wild-type HMGA2 isoform was significantly more abundant in tumors from men of African descent and positively correlated with increasing Gleason grade. The truncated isoform was less abundant and did not display a consistent expression pattern across racial groups. These results demonstrate the feasibility of AI/ML-based RISH quantification and suggest that elevated wild-type HMGA2 expression may represent a biomarker linked to prostate cancer aggressiveness and racial disparities. These findings highlight the importance of interdisciplinary collaboration and equitable computational tools in advancing biomarker discovery and addressing cancer health inequities. Full article

Background/Objectives: Obstructive sleep apnea (OSA) is diagnosed using pulse oximetry, which is less accurate in patients with darker skin. Two hypopnea definitions are in use: the American Academy of Sleep Medicine allows either (A) a 30% airflow decrease with a 3% oxygen desaturation or EEG arousal (“3% Rule”) or (B) a 30% airflow decrease with a 4% oxygen desaturation (“4% Rule”). The Centers for Medicare and Medicaid Services and many payers use only the 4% Rule. We hypothesized that patients from racial minority groups with darker skin tones would be less likely to qualify for OSA treatment using the 4% Rule compared to the 3% Rule. A secondary aim was to examine sex disparities. Methods: We reviewed records of adults undergoing overnight sleep studies at an urban academic hospital. Demographics, medical history, and comorbidities were collected. Analyses controlled for age, sex, BMI, anxiety, depression, hypertension, COPD, and smoking. Results: A total of 1354 records were analyzed. We found no racial or sex disparities in the proportion of participants who met the 3% but not the 4% Rule. After controlling for covariates, no racial group differed from White participants in meeting only the 3% Rule. However, female participants were significantly less likely than males to meet the 4% Rule. Conclusions: Despite known limitations of pulse oximetry associated with skin tone, no racial differences in the diagnosis of OSA were seen in this cohort. However, female patients had lower odds of meeting the 4% Rule, suggesting a potential barrier to treatment. Full article

Background: Infectious diseases accounted for approximately 18.4% of global mortality in 2019. According to the World Health Organization (WHO), vaccines are available for about 30 potentially lethal diseases. Vaccination prevents substantial mortality and hospitalization. However, its ability to improve overall public health depends on equitable access across all populations, regardless of race, ethnicity, education, or socioeconomic status. Objectives: This study aims to examine how disparities in social determinants of health (SDOH) affect COVID-19 vaccination uptake across Jefferson County, Kentucky. Using ZIP code–level spatial mapping, this study investigates the intersection of SDOH, racial composition, and geographic characteristics to identify inequities and inform equitable interventions. Methods: Data from the Kentucky Immunization Registry (KYIR) were analyzed to assess two-dose COVID-19 vaccination rates at the ZIP code and regional levels in Jefferson County, Kentucky. Vaccination rates were stratified by race and ethnicity and linked with SDOH, including education, employment, insurance status, and income, obtained from the 2021 American Community Survey. Results: By May 2021, vaccination rates ranged from 25.9% in the West region to 57.0% in the Inner East region; by May 2022, these rates increased to 46.2% and 73.9%, respectively. White residents consistently had the highest two-dose vaccination rates (66.4% by May 2022), while Black and Hispanic residents had lower rates (45.7% and 43.9%, respectively). Vaccination rates were strongly correlated with SDOH, especially educational attainment, average family income, and employment rate, underscoring the role of socioeconomic inequities in vaccination disparities. Conclusions: Geographical and racial disparities emphasize the influence of social and economic inequality on vaccine uptake. Full article

Louisiana is one of the most disaster-prone states, with hurricanes ranking among the most destructive hazards. Hurricanes impede sustainability by straining hospital infrastructure, overwhelming emergency departments, and disrupting continuity of care. Louisiana’s healthcare system, characterized by high uninsured rates, limited rural access, and notable racial and socioeconomic disparities, is particularly vulnerable during disasters. This research explores trends of mental and respiratory health in Louisiana surrounding Hurricanes Laura (2020), Delta (2020), and Ida (2021). Analysis reveals a substantial increase in admissions after landfall of all three storms, with mental health conditions showing a larger surge than respiratory ones in already-vulnerable communities. Gender disparities were evident, with female patients accounting for a higher percentage across all three hurricanes and across all age groups. The results suggest the importance of considering social determinants of health during disasters and ensuring adequate resources for older populations with complex medical needs, thereby promoting more sustainable health systems. These results underscore how critical preparedness and recovery planning are for hospitals in hurricane-prone areas. Incorporating resilience measures such as reliable power systems, clearer evacuation pathways, and better coordination of post-disaster care can help protect patients and providers in the future. Full article

Over recent decades, planners in the U.S. have increasingly adopted mixed-use projects to reduce automobile dependency and strengthen local community identity, although results remain inconsistent across cities. Urban health and fitness outcomes are shaped by complex interactions between the built environment, socioeconomic factors, and demographic characteristics. This study introduces a Health and Fitness Index (HFI) for 28,758 U.S. ZIP codes, derived from normalized measures of walkability, healthcare facility density, and carbon emissions, to assess spatial disparities in health-supportive environments. Using four modeling approaches—lasso regression, multiple linear regression, decision trees, and k-nearest neighbor classifiers—we evaluated the predictive importance of 15 urban and socioeconomic variables. Multiple linear regression produced the strongest generalization performance (R² = 0.60, RMSE = 0.04). Key positive predictors included occupied housing units, business density, land-use mix, household income, and racial diversity, while income inequality and population density were negatively associated with health outcomes. This study evaluates five statistical formulations (Metropolis Hybrid Models) that incorporate different combinations of walkability, land-use mix, environmental variables, and socioeconomic indicators to test whether relationships between urban form and socioeconomic conditions remain consistent under different variable combinations. In cross-sectional multivariate regression, although mixed-use development in high-density areas is strongly associated with healthcare facilities, these areas tend to serve younger and more racially diverse populations. Decision tree feature importance rankings and clustering profiles highlight structural inequalities across regions, suggesting that enhancing business diversity, land-use integration, and income equity could significantly improve health-supportive urban design. This research provides a data-driven framework for urban planners to identify underserved neighborhoods and develop targeted interventions that promote walkability, accessibility to health infrastructure, and sustainability. It contributes to the growing literature on urban health analytics, integrating machine learning, spatial clustering, and multidimensional urban indicators to advance equitable and resilient city planning. Full article

Background: Colorectal cancer (CRC) incidence and mortality have declined in the United States over the past two decades, yet disparities persist by age, sex, race/ethnicity, and geography. To characterize population-level survival signals, we examined trends in age-adjusted incidence rates (AAIR), mortality rates (AAMR), and the mortality-to-incidence ratio (AAMIR) from 1999 to 2021, stratified by key subgroups. Methods: This retrospective analysis utilized de-identified data from the CDC WONDER United States Cancer Statistics database, encompassing incident CRC cases (SEER codes 21041–21052) and deaths (ICD-10 codes C18–C20) in adults aged 20 years and older. Age-adjusted rates (per 100,000, 2000 U.S. standard population) and AAMIR were calculated using Stata 17.0. Joinpoint regression identified trends (annual or average annual percent change [APC/AAPC], p < 0.05). Results: Among 3,489,881 cases and 1,225,986 deaths, AAIR decreased from 78.24 (1999) to 50.79 (2021; AAPC: −2.20%, 95% CI: −2.52 to −1.89), AAMR decreased from 29.34 to 17.92 (AAPC: −2.33%, −2.46 to −2.20), and AAMIR from 0.375 to 0.353 (AAPC: −0.08%, −0.47 to 0.30; p = 0.669). Women showed a significant AAMIR decline (AAPC: −0.29%), unlike men (AAPC: 0.07%). Young adults (20–39 years) had rising AAIR (AAPC: 2.42%) and AAMR (0.87%) but improving AAMIR (AAPC: −1.71%). Non-Hispanic Black individuals had the highest AAMIR (0.400 in 2021; AAPC: −0.54%). The Northeast had the most favorable AAMIR trend (AAPC: −0.40%), while the Midwest, South, and West were stable. States like New Jersey and Massachusetts achieved low AAMIR (0.292 and 0.304 in 2021), contrasting with Nebraska and Arizona (0.402 in both). Conclusions: Although colorectal cancer incidence and mortality have declined substantially in the United States from 1999 to 2021, the mortality-to-incidence ratio improved only marginally and remained markedly uneven across subgroups. Targeted interventions—enhancing screening and treatment access for men, racial/ethnic minorities, younger adults, and high-burden regions and states—can promote equitable outcomes. Full article

Since the 2023 Supreme Court decision, which declared race-conscious affirmative action in college admissions unconstitutional, the national climate for diversity, equity, and inclusion (DEI) efforts, especially those addressing racial and ethnic disparities in higher education, has undergone a dramatic shift. Most recently, presidential executive orders and state legislation aimed at dismantling DEI in higher education have resulted in many colleges not only eliminating their DEI offices and staff but also any program, initiative, and funding explicitly related to race and ethnicity. Drawing on the current discourse, the author utilizes Afrofuturism and future scenario planning to construct three different fictional stories to illustrate possible impacts, challenges, and strategies for navigating a future without formal structures that support DEI in higher education. Following each story, the author provides practical strategies for how institutions, DEI professionals, and DEI advocates can navigate these potential futures to maintain support for DEI. Full article

Background: Inequities in pain management are well documented in chronic pain and outpatient settings, yet little is known about disparities in inpatient Acute Pain Service (APS) care. This study evaluated demographic, clinical, and social factors associated with APS utilization and outcomes in an urban safety-net hospital, with a subgroup analysis of trauma patients who presented with at least three rib fractures. Methods: We performed a retrospective cohort study of two patient populations from our institution: (1) all patients receiving APS consultation from 1 January 2020 to 1 November 2022 (n = 1445) and (2) all patients with traumatic rib fractures during this time, stratified by APS consult status (n = 650). Demographics, insurance, comorbidities, opioid prescribing, and discharge outcomes were analyzed using descriptive statistics, multivariable logistic regression, and log-linear models. As APS consultation criteria were not standardized during the study period, referral patterns reflected routine clinical practice rather than predefined eligibility criteria. Results: Across the full APS cohort, patients were disproportionately represented from vulnerable groups: 30.5% were Black, 81.0% had public insurance, and 32.9% had a substance use disorder (SUD). Methadone use was a strong predictor of non-home discharge, including discharges to a medical facility, hospice, or against medical advice (AMA). In the rib fracture cohort, patients receiving APS consults had significantly higher injury severity scores (Injury Severity Score 17.1 vs. 13.0, p < 0.001). Black patients were less likely to receive APS consult (17.3% vs. 28.8%, p = 0.024). However, this association appeared to be attributable to the younger age and male predominance within this subgroup, as both factors were identified as significant predictors of APS consultation. Conclusions: APS utilization at a high-volume safety-net hospital highlights the intersection of medical vulnerability and structural inequities, with greater involvement among patients who were members of racial and ethnic minorities, publicly insured, or diagnosed with SUD. In trauma populations, younger Black men were over-represented, reinforcing the heightened injury risks Black men may face and the downstream effects on patient care. Taken together, these results highlight how APS involvement acts not only as a marker of increased injury severity but also as an intervention to improve care for vulnerable patient populations. As APS teams regularly serve these populations, they are well-positioned to bridge broader gaps through the integration of addiction and social support services, individualized pain management, and seamless coordination of care across specialties. These findings underscore the need for standardized consultation criteria and integration of social and addiction medicine resources into APS care models. Full article