Fundamental Discussions on Race and Ethnicity for the Cardiology Workforce for the United States of America.
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ABSTRACT:
SUBMITTER: Karim S
PROVIDER: S-EPMC8477880 | biostudies-literature | 2021 Jun
REPOSITORIES: biostudies-literature
Publications
Fundamental Discussions on Race and Ethnicity for the Cardiology Workforce for the United States of America.
Karim Saima S Tamirisa Kamala K Chaudhry Hina H
Journal of the American Heart Association 20210602 12
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Project description:Since 1969, racial and ethnic preferences have existed throughout the American medical academy. The primary purpose has been to increase the number of blacks and Hispanics within the physician workforce as they were deemed to be "underrepresented in medicine." To this day, the goal continues to be population parity or proportional representation. These affirmative action programs were traditionally voluntary, created and implemented at the state or institutional level, limited to the premedical and medical school stages, and intended to be temporary. Despite these efforts, numerical targets for underrepresented minorities set by the Association of American Medical Colleges have consistently fallen short. Failures have largely been attributable to the limited qualified applicant pool and legal challenges to the use of race and ethnicity in admissions to institutions of higher education. In response, programs under the appellation of diversity, inclusion, and equity have recently been created to increase the number of blacks and Hispanics as medical school students, internal medicine trainees, cardiovascular disease trainees, and cardiovascular disease faculty. These new diversity programs are mandatory, created and implemented at the national level, imposed throughout all stages of academic medicine and cardiology, and intended to be permanent. The purpose of this white paper is to provide an overview of policies that have been created to impact the racial and ethnic composition of the cardiology workforce, to consider the evolution of racial and ethnic preferences in legal and medical spheres, to critically assess current paradigms, and to consider potential solutions to anticipated challenges.
| S-EPMC7428635 | biostudies-literature
Project description:The relevance of race and ethnicity to genetics and medicine has long been a matter of debate. An emerging consensus holds that race and ethnicity are social constructs and thus poor proxies for genetic diversity. The goal of this study was to evaluate the relationship between race, ethnicity, and clinically relevant pharmacogenomic variation in cosmopolitan populations. We studied racially and ethnically diverse cohorts of 65,120 participants from the United States All of Us Research Program (All of Us) and 31,396 participants from the United Kingdom Biobank (UKB). Genome-wide patterns of pharmacogenomic variation-6311 drug response-associated variants for All of Us and 5966 variants for UKB-were analyzed with machine learning classifiers to predict participants' self-identified race and ethnicity. Pharmacogenomic variation predicts race/ethnicity with averages of 92.1% accuracy for All of Us and 94.3% accuracy for UKB. Group-specific prediction accuracies range from 99.0% for the White group in UKB to 92.9% for the Hispanic group in All of Us. Prediction accuracies are substantially lower for individuals who identified with more than one group in All of Us (16.7%) or as Mixed in UKB (70.7%). There are numerous individual pharmacogenomic variants with large allele frequency differences between race/ethnicity groups in both cohorts. Frequency differences for toxicity-associated variants predict hundreds of adverse drug reactions per 1000 treated participants for minority groups in All of Us. Our results indicate that race and ethnicity can be used to stratify pharmacogenomic risk in the US and UK populations and should not be discounted when making treatment decisions. We resolve the contradiction between the results reported here and the orthodoxy of race and ethnicity as non-genetic, social constructs by emphasizing the distinction between global and local patterns of human genetic diversity, and we stress the current and future limitations of race and ethnicity as proxies for pharmacogenomic variation.
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Project description:Current evidence and professional guidance recommend sleeping between 7 and 9 h in a 24-h period for optimal health. The present study examines the association between sleep duration and mortality and assesses whether this association varies by racial/ethnic identity for a large and diverse sample of United States adults. We use data on 274,836 adults, aged 25 and older, from the 2004-2014 waves of the National Health Interview Survey (NHIS) linked to prospective mortality through 2015 (23,382 deaths). Cox proportional hazards models were used in multi-variable regressions to estimate hazard ratios for mortality by sleep duration and racial/ethnic identity, controlling for sociodemographic, socioeconomic, and psychological distress variables. We find elevated risks of mortality from any cause for adults who sleep less than 5 h or more than 9 h in a 24-h period after all adjustments. Further, we find evidence that these elevated risks for mortality are more pronounced for some racial/ethnic groups and less pronounced for others. Improved understanding of differences in sleep duration and sleep health can facilitate more effective and culturally-tailored interventions around sleep health, improving overall well-being and enhancing longevity.
| S-EPMC9920264 | biostudies-literature
Project description:BackgroundIn a 2018 descriptive study, cancer incidence in children (age 0-19) in diagnosis years 2003 to 2014 was reported as being highest in New Hampshire and in the Northeast region.MethodsUsing the Cancer in North America (CiNA) analytic file, we tested the hypotheses that incidence rates in the Northeast were higher than those in other regions of the United States either overall or by race/ethnicity group, and that rates in New Hampshire were higher than the Northeast region as a whole.ResultsIn 2003 to 2014, pediatric cancer incidence was significantly higher in the Northeast than other regions of the United States overall and among non-Hispanic Whites and Blacks, but not among Hispanics and other racial minorities. However, there was no significant variability in incidence in the states within the Northeast overall or by race/ethnicity subgroup. Overall, statistically significantly higher incidence was seen in the Northeast for lymphomas [RR, 1.15; 99% confidence interval (CI), 1.10-1.19], central nervous system neoplasms (RR, 1.12; 99% CI, 1.07-1.16), and neuroblastoma (RR, 1.13; 99% CI, 1.05-1.21).ConclusionsPediatric cancer incidence is statistically significantly higher in the Northeast than in the rest of the United States, but within the Northeast, states have comparable incidence. Differences in cancer subtypes by ethnicity merit further investigation.ImpactOur analyses clarify and extend previous reports by statistically confirming the hypothesis that the Northeast has the highest pediatric cancer rates in the country, by providing similar comparisons stratified by race/ethnicity, and by assessing variability within the Northeast.
| S-EPMC9578755 | biostudies-literature
Project description:Adverse health outcomes caused by extreme heat represent the most direct human health threat associated with the warming of the Earth's climate. Socioeconomic, demographic, health, land cover, and temperature determinants contribute to heat vulnerability; however, nationwide patterns of residential and race/ethnicity disparities in heat vulnerability in the United States are poorly understood. This study aimed to develop a Heat Vulnerability Index (HVI) for the United States; to assess differences in heat vulnerability across geographies that have experienced historical and/or contemporary forms of marginalization; and to quantify HVI by race/ethnicity. Principal component analysis was used to calculate census tract level HVI scores based on the 2019 population characteristics of the United States. Differences in HVI scores were analyzed across the Home Owners' Loan Corporation (HOLC) "redlining" grades, the Climate and Economic Justice Screening Tool (CEJST) disadvantaged versus non-disadvantaged communities, and race/ethnicity groups. HVI scores were calculated for 55,267 U.S. census tracts. Mean HVI scores were 17.56, 18.61, 19.45, and 19.93 for HOLC grades "A"-"D," respectively. CEJST-defined disadvantaged census tracts had a significantly higher mean HVI score (19.13) than non-disadvantaged tracts (16.68). The non-Hispanic African American or Black race/ethnicity group had the highest HVI score (18.51), followed by Hispanic or Latino (18.19). Historically redlined and contemporary CEJST disadvantaged census tracts and communities of color were found to be associated with increased vulnerability to heat. These findings can help promote equitable climate change adaptation policies by informing policymakers about the national distribution of place- and race/ethnicity-based disparities in heat vulnerability.
| S-EPMC9744626 | biostudies-literature
Project description:Food insecurity, poised to increase with burgeoning concerns related to climate change, may influence sleep, yet few studies examined the food security-sleep association among racially/ethnically diverse populations with multiple sleep dimensions. We determined overall and racial/ethnic-specific associations between food security and sleep health. Using National Health Interview Survey data, we categorised food security as very low, low, marginal and high. Sleep duration was categorised as very short, short, recommended and long. Sleep disturbances included trouble falling/staying asleep, insomnia symptoms, waking up feeling unrested and using sleep medication (all ≥3 d/times in the previous week). Adjusting for socio-demographic characteristics and other confounders, we used Poisson regression with robust variance to estimate prevalence ratios (PRs) and 95 % confidence intervals (95 % CIs) for sleep dimensions by food security. Among 177 435 participants, the mean age of 47⋅2 ± 0⋅1 years, 52⋅0 % were women, and 68⋅4 % were non-Hispanic (NH)-White. A higher percent of NH-Black (7⋅9 %) and Hispanic/Latinx (5⋅1 %) lived in very low food security households than NH-White (3⋅1 %) participants. Very low v. high food security was associated with a higher prevalence of very short (PR = 2⋅61 [95 % CI 2⋅44-2⋅80]) sleep duration as well as trouble falling asleep (PR = 2⋅21 [95 % CI 2⋅12-2⋅30]). Very low v. high food security was associated with a higher prevalence of very short sleep duration among Asian (PR = 3⋅64 [95 % CI 2⋅67-4⋅97]) and NH-White (PR = 2⋅73 [95 % CI 2⋅50-2⋅99]) participants compared with NH-Black (PR = 2⋅03 [95 % CI 1⋅80-2⋅31]) and Hispanic/Latinx (PR = 2⋅65 [95 % CI 2⋅30-3⋅07]) participants. Food insecurity was associated with poorer sleep in a racially/ethnically diverse US sample.
| S-EPMC10214135 | biostudies-literature
Project description:BackgroundIn racially diverse communities, treatment of chronic diseases can vary across racial and ethnic groups.ObjectivesTo examine healthcare disparities in hemophilia care in the United States by evaluating receipt of immune tolerance induction (ITI) among different racial and ethnic groups.MethodsIn this cross-sectional study, people with severe hemophilia A with an inhibitor who entered the Center for Disease Control and Prevention Community Counts registry between 2013 and 2017, were aged ≥5 years at study entry, and had a history of an inhibitor (n = 614) were included. The proportion of participants receiving ITI was examined according to race and ethnicity in bivariable analysis and multivariable analysis adjusting for demographic and clinical covariates. Unadjusted and adjusted prevalence ratios and corresponding 95% CIs were computed.ResultsAmong 614 participants included in the study, 56.4% were non-Hispanic (NH) White, 19.7% were NH Black, 18.4% were Hispanic, and 4.9% were Asian. ITI was received by 85.2% of participants. On bivariable analysis, ITI treatment did not vary by race or ethnicity. On multivariable analysis, NH Black and Hispanic participants were significantly less likely to receive ITI compared to NH White participants (adjusted prevalence ratio, 0.91 [95% CI, 0.84-0.99] and 0.84 [95% CI, 0.75-0.93], respectively).ConclusionAlthough the role of ITI may evolve with growing use of emicizumab and the introduction of new hemophilia treatment products, understanding characteristics that influence care, particularly race and ethnicity, where physician bias and patient mistrust can occur, will remain relevant and applicable to other complex therapies, including gene therapy.
| S-EPMC10772873 | biostudies-literature
Project description:BackgroundAfter age 85, the U.S. non-Hispanic Black population mortality rate becomes less than that of the White population (called the Black-White mortality crossover). It is not known how this survival advantage compares to Asian and Hispanic groups, and whether differences persist to age 100+ years.MethodsThe U.S. period life table data were extracted to obtain life expectancy at birth and at ages 70, 85, and 100 years according to year, sex, and race and ethnicity. Age-specific death rates and adult modal age at death were calculated. We computed period probabilities of survival to age 100, from ages 70, 80, and 90. Pseudo-birth cohort calculations were undertaken to enable comparison with period-based results.ResultsIn 2019, the Black-White mortality crossover occurred at 86-88 years and persisted at ages 100 and 100+. Life expectancies at age 100 for non-Hispanic Black, Hispanic, and Asian populations were similar and were significantly greater than the non-Hispanic White population. From 2006 to 2019, the probability of survival from 70 and 80 years to age 100 was highest for the Hispanic population, followed by non-Hispanic Black and then non-Hispanic White populations. Probability of survival from age 90 to 100 years was similar for all but the non-Hispanic White population, which had a comparatively lower probability of survival. When Asian population data became available in 2019, this population had the highest probability of survival to age 100, starting from ages 70, 80, and 90 years. Pseudo-cohort results displayed patterns consistent with those observed over calendar years.ConclusionsRace- and ethnicity-based variation in mortality between ages 85 and 100+ years suggests differences in environmental and possibly genetic influences upon risk for exceptional longevity.
| S-EPMC11636438 | biostudies-literature
Project description: Not available
| S-EPMC9996638 | biostudies-literature
Project description:ImportanceThe prevalence of diabetes among Hispanic and Asian American subpopulations in the United States is unknown.ObjectiveTo estimate racial/ethnic differences in the prevalence of diabetes among US adults 20 years or older by major race/ethnicity groups and selected Hispanic and non-Hispanic Asian subpopulations.Design, setting, and participantsNational Health and Nutrition Examination Surveys, 2011-2016, cross-sectional samples representing the noninstitutionalized, civilian, US population. The sample included adults 20 years or older who had self-reported diagnosed diabetes during the interview or measurements of hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), and 2-hour plasma glucose (2hPG).ExposuresRace/ethnicity groups: non-Hispanic white, non-Hispanic black, Hispanic and Hispanic subgroups (Mexican, Puerto Rican, Cuban/Dominican, Central American, and South American), non-Hispanic Asian and non-Hispanic Asian subgroups (East, South, and Southeast Asian), and non-Hispanic other.Main outcomes and measuresDiagnosed diabetes was based on self-reported prior diagnosis. Undiagnosed diabetes was defined as HbA1c 6.5% or greater, FPG 126 mg/dL or greater, or 2hPG 200 mg/dL or greater in participants without diagnosed diabetes. Total diabetes was defined as diagnosed or undiagnosed diabetes.ResultsThe study sample included 7575 US adults (mean age, 47.5 years; 52% women; 2866 [65%] non-Hispanic white, 1636 [11%] non-Hispanic black, 1952 [15%] Hispanic, 909 [6%] non-Hispanic Asian, and 212 [3%] non-Hispanic other). A total of 2266 individuals had diagnosed diabetes; 377 had undiagnosed diabetes. Weighted age- and sex-adjusted prevalence of total diabetes was 12.1% (95% CI, 11.0%-13.4%) for non-Hispanic white, 20.4% (95% CI, 18.8%-22.1%) for non-Hispanic black, 22.1% (95% CI, 19.6%-24.7%) for Hispanic, and 19.1% (95% CI, 16.0%-22.1%) for non-Hispanic Asian adults (overall P < .001). Among Hispanic adults, the prevalence of total diabetes was 24.6% (95% CI, 21.6%-27.6%) for Mexican, 21.7% (95% CI, 14.6%-28.8%) for Puerto Rican, 20.5% (95% CI, 13.7%-27.3%) for Cuban/Dominican, 19.3% (95% CI, 12.4%-26.1%) for Central American, and 12.3% (95% CI, 8.5%-16.2%) for South American subgroups (overall P < .001). Among non-Hispanic Asian adults, the prevalence of total diabetes was 14.0% (95% CI, 9.5%-18.4%) for East Asian, 23.3% (95% CI, 15.6%-30.9%) for South Asian, and 22.4% (95% CI, 15.9%-28.9%) for Southeast Asian subgroups (overall P = .02). The prevalence of undiagnosed diabetes was 3.9% (95% CI, 3.0%-4.8%) for non-Hispanic white, 5.2% (95% CI, 3.9%-6.4%) for non-Hispanic black, 7.5% (95% CI, 5.9%-9.1%) for Hispanic, and 7.5% (95% CI, 4.9%-10.0%) for non-Hispanic Asian adults (overall P < .001).Conclusions and relevanceIn this nationally representative survey of US adults from 2011 to 2016, the prevalence of diabetes and undiagnosed diabetes varied by race/ethnicity and among subgroups identified within the Hispanic and non-Hispanic Asian populations.
| S-EPMC6990660 | biostudies-literature