Trends and socioeconomic disparities in all-cause mortality among adults with diagnosed diabetes by race/ethnicity: a population-based cohort study - USA, 1997-2015.
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ABSTRACT: Objectives
By race/ethnicity and socioeconomic position (SEP), to estimate and examine changes over time in (1) mortality rate, (2) mortality disparities and (3) excess mortality risk attributed to diagnosed diabetes (DM).Design
Population-based cohort study using National Health Interview Survey data linked to mortality status from the National Death Index from survey year up to 31 December 2015 with 5 years person-time.Participants
US adults aged ≥25 years with (31 586) and without (332 451) DM.Primary outcome
Age-adjusted all-cause mortality rate for US adults with DM in each subgroup of SEP (education attainment and income-to-poverty ratio (IPR)) and time (1997-2001, 2002-2006 and 2007-2011).Results
Among adults with DM, mortality rates fell from 23.5/1000 person-years (p-y) in 1997-2001 to 18.1/1000 p-y in 2007-2011 with changes of -5.2/1000 p-y for non-Hispanic whites; -5.2/1000 p-y for non-Hispanic blacks; and -5.4/1000 p-y for Hispanics. Rates significantly declined within SEP groups, measured as education attainment (Conclusions
There were substantial improvements in all-cause mortality among US adults. However, we observed SEP disparities in mortality across race/ethnic groups or for adults with and without DM despite targeted efforts to improve access and quality of care among disproportionately affected populations.
SUBMITTER: Mercado C
PROVIDER: S-EPMC8098944 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:IntroductionInfant mortality rates are higher in nonmetropolitan areas versus large metropolitan areas. Variation by race/ethnicity and cause of death has not been assessed. Urban-rural infant mortality rate differences were quantified by race/ethnicity and cause of death.MethodsNational Vital Statistics System linked birth/infant death data (2014-2016) were analyzed in 2019 by 3 urban-rural county classifications: large metropolitan, medium/small metropolitan, and nonmetropolitan. Excess infant mortality rates (rate differences) by urban-rural classification were calculated relative to large metropolitan areas overall and for each racial/ethnic group. The number of excess deaths, population attributable fraction, and proportion of excess deaths attributable to underlying causes of death was calculated.ResultsNonmetropolitan areas had the highest excess infant mortality rate overall. Excess infant mortality rates were substantially lower for Hispanic infants than other races/ethnicities. Overall, 7.4% of infant deaths would be prevented if all areas had the infant mortality rate of large metropolitan areas. With more than half of births occurring outside of large metropolitan areas, the population attributable fraction was highest for American Indian/Alaska Natives (20.3%) and whites, non-Hispanic (14.3%). Excess infant mortality rates in both nonmetropolitan and medium/small metropolitan areas were primarily attributable to sudden unexpected infant deaths (42.3% and 31.9%) and congenital anomalies (30.1% and 26.8%). This pattern was consistent for all racial/ethnic groups except black, non-Hispanic infants, for whom preterm-related and sudden unexpected infant deaths accounted for the largest share of excess infant mortality rates.ConclusionsInfant mortality increases with rurality, and excess infant mortality rates are predominantly attributable to sudden unexpected infant deaths and congenital anomalies, with differences by race/ethnicity regarding magnitude and cause of death.
| S-EPMC6980981 | biostudies-literature
Project description:Importance:Large racial/ethnic disparities in breastfeeding are associated with adverse health outcomes. Objectives:To examine breastfeeding trends by race/ethnicity from 2009 to 2015 and changes in breastfeeding gaps comparing racial/ethnic subgroups with white infants from 2009-2010 to 2014-2015. Design, Setting, and Participants:This study used data from 167?842 infants from the National Immunization Survey-Child (NIS-Child), a random-digit-dialed telephone survey among a complex, stratified, multistage probability sample of US households with children aged 19 to 35 months at the time of the survey. This study analyzed data collected from January 1, 2011, through December 31, 2017, for children born between 2009 and 2015. Exposures:Child's race/ethnicity categorized as Hispanic or non-Hispanic white, black, Asian, or American Indian or Alaskan Native. Main Outcomes and Measures:Breastfeeding rates, including ever breastfeeding, exclusive breastfeeding through 6 months, and continuation of breastfeeding at 12 months. Results:This study included 167?842 infants (mean [SD] age, 2.33 [0.45] years; 86?321 [51.4%] male and 81?521 [48.6%] female). Overall unadjusted breastfeeding rates increased from 2009 to 2015 by 7.1 percentage points for initiation, 9.2 percentage points for exclusivity, and 11.3 percentage points for duration, with considerable variation by race/ethnicity. Most racial/ethnic groups had significant increases in breastfeeding rates. From 2009-2010 to 2014-2015, disparities in adjusted breastfeeding rates became larger between black and white infants. For example, the difference for exclusive breastfeeding through 6 months between black and white infants widened from 0.5 to 4.5 percentage points with a 4.0% difference in difference (P?<?.001) from 2009-2010 to 2014-2015. In contrast, the breastfeeding differences between Hispanic, Asian, and American Indian or Alaskan Native infants and white infants became smaller or stayed the same except for continued breastfeeding at 12 months among Asians. For example, the difference in continued breastfeeding at 12 months between Hispanic and white infants decreased from 7.8 to 3.8 percentage points between 2 periods, yielding a -4.0% difference in difference (P?<?.001). Because of positive trends among all race/ethnicities, these reduced differences were likely associated with greater increases among white infants throughout the study years. Conclusions and Relevance:Despite breastfeeding improvements among each race/ethnicity group, breastfeeding disparities between black and white infants became larger when breastfeeding improvements decreased even further among black infants in 2014-2015. The reduced breastfeeding gaps among all other nonwhite groups may be associated with greater increases among white infants. More efforts appear to be needed to improve breastfeeding rates among black infants.
| S-EPMC6802058 | biostudies-literature
Project description:BACKGROUND AND OBJECTIVES:Race/ethnicity and socioeconomic factors are associated with worse cancer outcomes. Our aim was to determine the association of these factors with receipt of surgery and multimodality therapy for cholangiocarcinoma. METHODS:Patients with cholangiocarcincoma in the National Cancer Database were identified. Racial/ethnic groups were defined as non-Hispanic White, non-Hispanic Black, Asian, and Hispanic. Socioeconomic factors were insurance status, income, and education. RESULTS:Of 12?095 patients with non-metastatic cholangiocarcinoma, 42% received surgery. Black race was associated with decreased odds of receiving surgery (odds ratio [OR]: 0.66l; P?<?.001) compared to White patients. Socioeconomic factors accounted for 21% of this disparity. Accounting for socioeconomic and clinicopathologic variables, Black race (OR: 0.73; P?<?.001), uninsured status (OR: 0.43; P?<?.001), and Medicaid insurance (OR: 0.63; P?<?.001) were all associated with decreased receipt of surgery. Of 4808 patients who received surgery, 47% received multimodality therapy. There were no racial/ethnic or socioeconomic differences in receipt of multimodality therapy once patients accessed surgical care. Similar results were seen in patients with advanced disease who received chemotherapy as primary treatment. CONCLUSION:Racial/ethnic and socioeconomic disparities exist in treatment for cholangiocarcinoma, however only for primary treatment. In patients who received surgery or chemotherapy, there were no disparities in receipt of multimodality therapy. This emphasizes the need to improve initial access to health care for minority and socioeconomical disadvantaged patients.
| S-EPMC6752195 | biostudies-literature
Project description:ObjectivesThis study sought to describe the health status of outpatients with heart failure and reduced ejection fraction (HFrEF) by sex, race/ethnicity, and socioeconomic status (SES).BackgroundAlthough a primary goal in treating patients with HFrEF is to optimize health status, whether disparities by sex, race/ethnicity, and SES exist is unknown.MethodsIn the CHAMP-HF (Change the Management of Patients with Heart Failure) registry, the associations among sex, race, and SES and health status, as measured by the Kansas City Cardiomyopathy Questionnaire-overall summary (KCCQ-os) score (range 0 to 100; higher scores indicate better health status) was compared among 3,494 patients from 140 U.S. clinics. SES was categorized by total household income. Hierarchical multivariate linear regression estimated differences in KCCQ-os score after adjusting for 31 patient characteristics and 10 medications.ResultsOverall mean KCCQ-os scores were 64.2 ± 24.0 but lower for women (29% of sample; 60.3 ± 24.0 vs. 65.9 ± 24.0, respectively; p < 0.001), for blacks (60.5 ± 25.0 vs. 64.9 ± 23.0, respectively; p < 0.001), for Hispanics (59.1 ± 21.0 vs. 64.9 ± 23.0, respectively; p < 0.001), and for those with the lowest income (<$25,000; mean: 57.1 vs. 63.1 to 74.7 for other income categories; p < 0.001). Fully adjusted KCCQ-os scores were 2.2 points lower for women (95% confidence interval [CI]: -3.8 to -0.6; p = 0.007), no different for blacks (p = 0.74), 4.0 points lower for Hispanics (95% CI: -6.6 to -1.3; p = 0.003), and lowest in the poorest patients (4.7 points lower than those with the highest income (95% CI: 0.1 to 9.2; p = 0.045; p for trend = 0.003).ConclusionsAmong outpatients with HFrEF, women, blacks, Hispanics, and poorer patients had worse health status, which remained significant for women, Hispanics, and poorer patients in fully adjusted analyses. This suggests an opportunity to further optimize treatment to reduce these observed disparities.
| S-EPMC6003698 | biostudies-literature
Project description:Millennials (ages 18-35) are now the largest living generation in the US, making it important to understand and characterize the rising trend of colorectal cancer incidence in this population, as well as other younger generations of Americans. Data from the New Jersey State Cancer Registry (n = 181 909) and Surveillance, Epidemiology, and End Results program (n = 448 714) were used to analyze invasive CRC incidence trends from 1979 to 2014. Age, sex, race, ethnicity, subsite, and stage differences between younger adults (20-49) and screening age adults (?50) in New Jersey (NJ) were examined using chi-square; and, we compared secular trends in NJ to the United States (US). Whites, men, and the youngest adults (ages 20-39) are experiencing greater APCs in rectal cancer incidence. Rates among younger black adults, overall, were consistently higher in both NJ and the US over time. When compared to older adults, younger adults with CRC in NJ were more likely to be: diagnosed at the late stage, diagnosed with rectal cancer, male, non-white, and Hispanic. Invasive CRC incidence trends among younger adults were found to vary by age, sex, race, ethnicity, and subsite. Large, case-level, studies are needed to understand the role of genetics, human papillomavirus (HPV), and cultural and behavioral factors in the rise of CRC among younger adults. Provider and public education about CRC risk factors will also be important for preventing and reversing the increasing CRC trend in younger adults.
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Project description:BackgroundDementia is often underdiagnosed and this problem is more common among some ethnoracial groups.ObjectiveThe objective of this study was to examine racial and ethnic disparities in the timeliness of receiving a clinical diagnosis of dementia.Research designThis was a prospective cohort study.SubjectsA total of 3966 participants age 70 years and above with probable dementia in the Health and Retirement Study, linked with their Medicare and Medicaid claims.MeasuresWe performed logistic regression to compare the likelihood of having a missed or delayed dementia diagnosis in claims by race/ethnicity. We analyzed dementia severity, measured by cognition and daily function, at the time of a dementia diagnosis documented in claims, and estimated average dementia diagnosis delay, by race/ethnicity.ResultsA higher proportion of non-Hispanic Blacks and Hispanics had a missed/delayed clinical dementia diagnosis compared with non-Hispanic Whites (46% and 54% vs. 41%, P<0.001). Fully adjusted logistic regression results suggested more frequent missed/delayed dementia diagnoses among non-Hispanic Blacks (odds ratio=1.12; 95% confidence interval: 0.91-1.38) and Hispanics (odds ratio=1.58; 95% confidence interval: 1.20-2.07). Non-Hispanic Blacks and Hispanics had a poorer cognitive function and more functional limitations than non-Hispanic Whites around the time of receiving a claims-based dementia diagnosis. The estimated mean diagnosis delay was 34.6 months for non-Hispanic Blacks and 43.8 months for Hispanics, compared with 31.2 months for non-Hispanic Whites.ConclusionsNon-Hispanic Blacks and Hispanics may experience a missed or delayed diagnosis of dementia more often and have longer diagnosis delays. When diagnosed, non-Hispanic Blacks and Hispanics may have more advanced dementia. Public health efforts should prioritize racial and ethnic underrepresented communities when promoting early diagnosis of dementia.
| S-EPMC8263486 | biostudies-literature
Project description:Study objectivesGrowing evidence indicates sleep is a major public health issue. Race/ethnicity and socioeconomics may contribute to sleep problems. This study assessed whether sleep symptoms were more prevalent among minorities and/or the socioeconomically disadvantaged.DesignCross-sectional.SettingEpidemiologic survey.Patients or participants2007-2008 National Health and Nutrition Examination Survey (N = 4,081).InterventionsNone.Measurements and resultsSociodemographics included age, sex, race/ethnicity, marital status, and immigration. Socioeconomics included poverty, education, private insurance, and food insecurity. Sleep symptoms assessed were sleep latency > 30 min, difficulty falling asleep, sleep maintenance difficulties, early morning awakenings, non-restorative sleep, daytime sleepiness, snorting/gasping, and snoring. Decreased reported problems for most symptoms were found among minorities, immigrants, and lower education levels. In general, in fully adjusted models, long sleep latency was associated with female gender, being black/African American, lower education attainment, no private insurance, and food insecurity. Difficulty falling asleep, sleep maintenance difficulties, early morning awakenings, and non-restorative sleep were also associated with female gender and food insecurity. Daytime sleepiness was seen in female and divorced respondents. Snorting/gasping was more prevalent among male, other-Hispanic/Latino, and 9(th)- to 11(th)-grade-level respondents. Snoring was prevalent among male, other-Hispanic/Latino, less-educated, and food-insecure respondents.ConclusionsSleep symptoms were associated with multiple sociodemographic and economic factors, though these relationships differed by predictor and sleep outcome. Also, reports depended on question wording.
| S-EPMC3746717 | biostudies-literature
Project description:To efficiently estimate race/ethnicity using administrative records to facilitate health care organizations' efforts to address disparities when self-reported race/ethnicity data are unavailable.Surname, geocoded residential address, and self-reported race/ethnicity from 1,973,362 enrollees of a national health plan.We compare the accuracy of a Bayesian approach to combining surname and geocoded information to estimate race/ethnicity to two other indirect methods: a non-Bayesian method that combines surname and geocoded information and geocoded information alone. We assess accuracy with respect to estimating (1) individual race/ethnicity and (2) overall racial/ethnic prevalence in a population.The Bayesian approach was 74 percent more efficient than geocoding alone in estimating individual race/ethnicity and 56 percent more efficient in estimating the prevalence of racial/ethnic groups, outperforming the non-Bayesian hybrid on both measures. The non-Bayesian hybrid was more efficient than geocoding alone in estimating individual race/ethnicity but less efficient with respect to prevalence (p<.05 for all differences).The Bayesian Surname and Geocoding (BSG) method presented here efficiently integrates administrative data, substantially improving upon what is possible with a single source or from other hybrid methods; it offers a powerful tool that can help health care organizations address disparities until self-reported race/ethnicity data are available.
| S-EPMC2653886 | biostudies-other
Project description:ImportanceCOVID-19 has disproportionately affected racial and ethnic minority groups, and race and ethnicity have been associated with disease severity. However, the association of socioeconomic determinants with racial disparities in COVID-19 outcomes remains unclear.ObjectiveTo evaluate the association of race and ethnicity with COVID-19 outcomes and to examine the association between race, ethnicity, COVID-19 outcomes, and socioeconomic determinants.Data sourcesA systematic search of PubMed, medRxiv, bioRxiv, Embase, and the World Health Organization COVID-19 databases was performed for studies published from January 1, 2020, to January 6, 2021.Study selectionStudies that reported data on associations between race and ethnicity and COVID-19 positivity, disease severity, and socioeconomic status were included and screened by 2 independent reviewers. Studies that did not have a satisfactory quality score were excluded. Overall, less than 1% (0.47%) of initially identified studies met selection criteria.Data extraction and synthesisPreferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Associations were assessed using adjusted and unadjusted risk ratios (RRs) and odds ratios (ORs), combined prevalence, and metaregression. Data were pooled using a random-effects model.Main outcomes and measuresThe main measures were RRs, ORs, and combined prevalence values.ResultsA total of 4 318 929 patients from 68 studies were included in this meta-analysis. Overall, 370 933 patients (8.6%) were African American, 9082 (0.2%) were American Indian or Alaska Native, 101 793 (2.4%) were Asian American, 851 392 identified as Hispanic/Latino (19.7%), 7417 (0.2%) were Pacific Islander, 1 037 996 (24.0%) were White, and 269 040 (6.2%) identified as multiracial and another race or ethnicity. In age- and sex-adjusted analyses, African American individuals (RR, 3.54; 95% CI, 1.38-9.07; P = .008) and Hispanic individuals (RR, 4.68; 95% CI, 1.28-17.20; P = .02) were the most likely to test positive for COVID-19. Asian American individuals had the highest risk of intensive care unit admission (RR, 1.93; 95% CI, 1.60-2.34, P < .001). The area deprivation index was positively correlated with mortality rates in Asian American and Hispanic individuals (P < .001). Decreased access to clinical care was positively correlated with COVID-19 positivity in Hispanic individuals (P < .001) and African American individuals (P < .001).Conclusions and relevanceIn this study, members of racial and ethnic minority groups had higher risks of COVID-19 positivity and disease severity. Furthermore, socioeconomic determinants were strongly associated with COVID-19 outcomes in racial and ethnic minority populations.
| S-EPMC8586903 | biostudies-literature
Project description:BackgroundThere are large and persistent disparities in life expectancy among racial-ethnic groups in the USA, but the extent to which these patterns vary geographically on a local scale is not well understood. This analysis estimated life expectancy for five racial-ethnic groups, in 3110 US counties over 20 years, to describe spatial-temporal variations in life expectancy and disparities between racial-ethnic groups.MethodsWe applied novel small-area estimation models to death registration data from the US National Vital Statistics System and population data from the US National Center for Health Statistics to estimate annual sex-specific and age-specific mortality rates stratified by county and racial-ethnic group (non-Latino and non-Hispanic White [White], non-Latino and non-Hispanic Black [Black], non-Latino and non-Hispanic American Indian or Alaska Native [AIAN], non-Latino and non-Hispanic Asian or Pacific Islander [API], and Latino or Hispanic [Latino]) from 2000 to 2019. We adjusted these mortality rates to correct for misreporting of race and ethnicity on death certificates and then constructed abridged life tables to estimate life expectancy at birth.FindingsBetween 2000 and 2019, trends in life expectancy differed among racial-ethnic groups and among counties. Nationally, there was an increase in life expectancy for people who were Black (change 3·9 years [95% uncertainty interval 3·8 to 4·0]; life expectancy in 2019 75·3 years [75·2 to 75·4]), API (2·9 years [2·7 to 3·0]; 85·7 years [85·3 to 86·0]), Latino (2·7 years [2·6 to 2·8]; 82·2 years [82·0 to 82·5]), and White (1·7 years [1·6 to 1·7]; 78·9 years [78·9 to 79·0]), but remained the same for the AIAN population (0·0 years [-0·3 to 0·4]; 73·1 years [71·5 to 74·8]). At the national level, the negative difference in life expectancy for the Black population compared with the White population decreased during this period, whereas the negative difference for the AIAN population compared with the White population increased; in both cases, these patterns were widespread among counties. The positive difference in life expectancy for the API and Latino populations compared with the White population increased at the national level from 2000 to 2019; however, this difference declined in a sizeable minority of counties (615 [42·0%] of 1465 counties) for the Latino population and in most counties (401 [60·2%] of 666 counties) for the API population. For all racial-ethnic groups, improvements in life expectancy were more widespread across counties and larger from 2000 to 2010 than from 2010 to 2019.InterpretationDisparities in life expectancy among racial-ethnic groups are widespread and enduring. Local-level data are crucial to address the root causes of poor health and early death among disadvantaged groups in the USA, eliminate health disparities, and increase longevity for all.FundingNational Institute on Minority Health and Health Disparities; National Heart, Lung, and Blood Institute; National Cancer Institute; National Institute on Aging; National Institute of Arthritis and Musculoskeletal and Skin Diseases; Office of Disease Prevention; and Office of Behavioral and Social Science Research, US National Institutes of Health.
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