• Call to Action on the Categorization of Sex, Gender, Race and Ethnicity in Surgical Research

      Nahmias, Jeffry; Zakrison, Tanya L; Haut, Elliott R; Gurney, Onaona; Joseph, Bellal; Hendershot, Kimberly; Ghneim, Mira; Stey, Anne; Hoofnagle, Mark H; Bailey, Zinzi; et al. (Elsevier Inc., 2021-05-05)
    • Disparities in diffuse cortical white matter integrity between socioeconomic groups

      Shaked, D.; Leibel, D.K.; Katzel, L.I.; Davatzikos, C.; Gullapalli, R.P.; Seliger, S.L.; Evans, M.K.; Zonderman, A.B.; Waldstein, S.R. (Frontiers Media S.A., 2019-06-12)
      There is a growing literature demonstrating a link between lower socioeconomic status (SES) and poorer neuroanatomical health, such as smaller total and regional gray and white matter volumes, as well as greater white matter lesion volumes. Little is known, however, about the relation between SES and white matter integrity. Here we examined the relation between SES and white matter integrity of the brain's primary cortical regions, and evaluated potential moderating influences of age and self-identified race. Participants were 192 neurologically intact, community-dwelling African American and White adults (mean age = 52 years; 44% male, 60% White, low SES = 52%) from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) SCAN study. Participants underwent 3.0-T cranial magnetic resonance imaging. Diffusion tensor imaging was used to estimate regional fractional anisotropy (FA) to quantify the brain's white matter integrity and trace to capture diffusivity. Multiple regression analyses examined independent and interactive associations of SES, age, and race with FA of the frontal, temporal, parietal, and occipital lobes bilaterally. Sensitivity analyses assessed the influence of several biopsychosocial risk factors on these associations. Exploratory analyses examined these relations with trace and using additional SES indicators. Results indicated there were no significant interactions of SES, age, and race for any region. Individuals with low SES had lower FA in all regions, and higher trace in the right and left frontal, right and left temporal, and left occipital lobes. Findings remained largely unchanged after inclusion of sensitivity variables. Older age was associated with lower FA and greater trace for all regions, except for the right temporal lobe with FA. No main effects were found for race in FA, and Whites had higher trace values in the parietal lobes. Novel findings of this study indicate that relative to the high SES group, low SES was associated with poorer white matter integrity and greater diffusivity. These results may, in part, reflect exposures to various biopsychosocial risk factors experienced by those of lower SES across the lifespan, and may help explain the preponderance of cognitive and functional disparities between socioeconomic groups. Copyright 2019 Shaked, Leibel, Katzel, Davatzikos, Gullapalli, Seliger, Erus, Evans, Zonderman and Waldstein.
    • EAP and COVID-19: Actively working to be more antiracist in the employee assistance field

      Jacobson Frey, J. (Routledge, 2020)
      In addition to the ongoing response to the Novel Coronavirus Disease-2019 (COVID-19), workplaces are addressing and beginning in many cases to dismantle long-standing systems and structures that uphold racism. These changes are happening quickly and around the globe. Employee Assistance Programs (EAPs) have an opportunity to support and guide workplaces leaders as they seek out guidance and new solutions to the two pandemics of COVID-19 and racism. To start this work; however, EAPs need to work internally to examine, challenge and change their own practices and behaviors in an effort to be a more diverse, inclusive, and anti-racist work and professional environment. This article describes 10 steps EAPs can take to start or continue on their journey to be more anti-racist within their own workplaces and with the workplaces they support.
    • Evaluating for Differences by Race/Ethnicity in the Association Between Income and Gambling Disorder

      Day, B.; Rosenthal, G.; Adetunji, F.; Monaghan, A.; Scheele, C.; Tracy, J.K. (Springer, 2020)
      Multiple studies show an increased prevalence of gambling disorder among African Americans compared to whites. However, few studies take an analytic approach to understanding differences in risk factors by race/ethnicity. Income is inversely associated with gambling disorder; we hypothesized that this association would vary by race/ethnicity. The main objective was to evaluate whether the association between income and gambling disorder varies by race/ethnicity. With data from the baseline visit of a prospective cohort study, Prevention and Etiology of Gambling Addiction Study in the United States, we used multivariable logistic regression analysis to determine whether the association between income and gambling disorder varies by race/ethnicity. 1164 participants were included in the final analyses. Measures included: demographics (age, sex, race/ethnicity, education, employment, annual household income), veteran status, marital status, homelessness, smoking, substance abuse, alcohol abuse, marijuana use, and lifetime gambling disorder diagnosis as derived from Alcohol Use Disorder and Associated Disabilities Interview Schedule. There was no evidence of effect modification by race/ethnicity in the association between income and gambling disorder (global p value = 0.17). Income was associated with increased odds of gambling disorder, but only for those with low income (< $15,000; OR 2.27, 95% CI 1.46, 3.53). There was no evidence that the effect of income on gambling disorder varies by race/ethnicity. For all race/ethnicities combined, low income was associated with significantly increased odds of gambling disorder (OR 2.27, 95% CI 1.46, 3.53). Further research is needed to better understand racial/ethnic differences in gambling disorder. Copyright 2020, The Author(s).
    • Optimal Donor for African Americans with Hematologic Malignancy: HLA-Haploidentical Relative or Umbilical Cord Blood Transplant.

      Solomon, Scott R; St Martin, Andrew; Zhang, Mei-Jie; Ballen, Karen; Bashey, Asad; Battiwalla, Minoo; Baxter-Lowe, Lee Ann; Brunstein, Claudio; Chhabra, Saurabh; Perez, Miguel Angel Diaz; et al. (Elsevier Inc., 2020-07-07)
      Although hematopoietic cell transplantation from an HLA-matched unrelated donor is potentially curative for hematologic malignancies, survival is lower for African Americans compared with Caucasians. Because only approximately 20% of African Americans will have an HLA-matched unrelated donor, many of these patients undergo HLA-haploidentical relative or umbilical cord blood transplantation. In this study, we analyzed outcomes after HLA-haploidentical related donor (n = 249) and umbilical cord blood (n = 118) transplantations in African American patients with hematologic malignancy between 2008 and 2016. The predominant disease was acute myelogenous leukemia for recipients of both types of donor grafts. The incidences of grade II-IV and III-IV acute graft-versus-host disease were higher after umbilical cord blood transplantation compared with HLA-haploidentical relative transplantation (56% and 29%, respectively, versus 33% and 11%, respectively; P < .0001). The 2-year incidence of transplantation-related mortality adjusted for age and conditioning regimen intensity was higher after umbilical cord blood transplantation compared with HLA-haploidentical related donor transplantation (31% versus 18%; P = .008); however, there were no between-group differences in the 2-year adjusted incidence of relapse (30% versus 34%; P =. 51), overall survival (54% versus 57%; P =. 66), or disease-free survival (43% versus 47%; P =. 46). Our findings show that the use of HLA-haploidentical and umbilical cord blood transplants expands the access to transplantation with comparable leukemia-free and overall survival for African Americans with hematologic malignancies.
    • Race and other sociodemographic categories are differentially linked to multiple dimensions of interpersonal-level discrimination: Implications for intersectional, health research

      Beatty Moody, Danielle L; Waldstein, Shari R; Leibel, Daniel K; Hoggard, Lori S; Gee, Gilbert C; Ashe, Jason J; Brondolo, Elizabeth; Al-Najjar, Elias; Evans, Michele K; Zonderman, Alan B (Public Library of Science, 2021-05-19)
      Objectives To examine whether intersections of race with other key sociodemographic categories contribute to variations in multiple dimensions of race- and non-race-related, interpersonal-level discrimination and burden in urban-dwelling African Americans and Whites. Methods Data from 2,958 participants aged 30–64 in the population-based Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study were used to estimate up to four-way interactions of race, age, gender, and poverty status with reports of racial and everyday discrimination, discrimination across multiple social statuses, and related lifetime discrimination burden in multiple regression models. Results We observed that: 1) African Americans experienced all forms of discrimination more frequently than Whites, but this finding was qualified by interactions of race with age, gender, and/or poverty status; 2) older African Americans, particularly African American men, and African American men living in poverty reported the greatest lifetime discrimination burden; 3) older African Americans reported greater racial discrimination and greater frequency of multiple social status-based discrimination than younger African Americans; 4) African American men reported greater racial and everyday discrimination and a greater frequency of social status discrimination than African American women; and, 5) White women reported greater frequency of discrimination than White men. All p’s < .05. Conclusions Within African Americans, older, male individuals with lower SES experienced greater racial, lifetime, and multiple social status-based discrimination, but this pattern was not observed in Whites. Among Whites, women reported greater frequency of discrimination across multiple social statuses and other factors (i.e., gender, income, appearance, and health status) than men. Efforts to reduce discrimination-related health disparities should concurrently assess dimensions of interpersonal-level discrimination across multiple sociodemographic categories, while simultaneously considering the broader socioecological context shaping these factors.
    • Racial/ethnic disparities in prevalence, treatment, and control of hypertension among US adults following application of the 2017 American College of Cardiology/American Heart Association guideline

      Al Kibria, Gulam Muhammed (Elsevier Inc., 2019-03-14)
      The 2017 American College of Cardiology/American Heart Association (ACC/AHA) Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults recommends reduced systolic/diastolic blood pressure (SBP/DBP)cutoffs to define hypertension (i.e., by changing these from ≥140/90 to ≥130/80 mmHg), including new recommendations about indications and goals of antihypertensive treatment. This study reported the differences in age-adjusted prevalence and treatment status of hypertension according to race among US adults per the 2017 ACC/AHA guideline. The National Health and Nutrition Examination Survey 2011–16 data was analyzed. The main outcomes were age-adjusted prevalence and treatment status of hypertension among adults aged ≥20 years. After prevalence estimation, other proportions were obtained. The analysis included 16,103 adults (mean age: 47.6 years, 51.8% women). The age-adjusted proportions of adults with hypertension (59.0%, 95% confidence interval [CI]: 57.4%–60.6%), treatment-eligible for hypertension (49.3%, 95% CI: 47.7%–50.8%), and unmet treatment goals (63.8%, 95% CI: 60.0%–67.5%)among the treated were highest among non-Hispanic blacks. A large proportion of Mexican-Americans (46.5%, 95% CI: 42.0%–51.0%)and people of other races/ethnicities (49.3%, 95% CI: 45.5%–53.0%)were not receiving treatment despite having indication. Non-Hispanic blacks also had the highest prevalence of stage 2 hypertension. Among all races, prevalence, treatment-eligibility, and unmet treatment goals were higher among people with older age, male gender, diabetes, higher body weight, and higher cardiovascular disease risk while the majority of younger, lower/normal body weight, or non-diabetic people were untreated despite being eligible for treatment. The prevalence, treatment-eligibility, and unmet goals were substantially higher among non-Hispanic blacks. Moreover, disparities exist in treatment where Mexican-Americans and people of ‘other races/ethnicities’ were largely untreated despite having indication. © 2019 The Author