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Background: Black/African American women with breast cancer have a disproportionately higher risk of mortality compared to other race groups, although their overall incidence of disease is lower. Despite this, advance care planning (ACP) and consequent code status documentation remain low in this vulnerable patient population. Code status orders (i.e., Full code, Do Not Attempt Resuscitation [DNAR], Do Not Intubate [DNI]) allow consideration of patient preferences regarding the use of aggressive treatments, such as cardiopulmonary resuscitation and intubation. The aim of this study is to characterize presence of code status orders and determine whether race affects code status documentation after the first encounter for breast cancer., Methods: Data were derived from 7524 women with breast cancer from the University of Chicago Medical Center (UCMC) between 2016 and 2021. Cox regression was used to estimate the effects of race and adjusted for age, ethnicity, inpatient stays, metastatic breast cancer, marital status, and body mass index., Results: The sample included 60.5% White, 3.6% Asian/Mideast Indian, 28.9% Black/African American, and 7.0% other or unknown race. Results indicate that code status orders after the first breast cancer encounter were uncommon (7.2%). Black/African American race (HR = 2.74; 95% CI: 1.75, 4.28) emerged as a significant factor associated with any code status orders compared to other race groups even when adjusting for covariates., Conclusions: Code status documentation in this sample of women with breast cancer was low overall, yet rates were higher among Black/African American patients compared to other race groups. In fact, race remains a significant predictor of code status documentation even when accounting for indirect measures of cancer severity. This could be denoting the racial disparities (e.g., higher cancer malignancy such as triple negative breast cancer) in breast cancer mortality risk. Future research is needed to identify factors unique to Black/African American women that would increase code status documentation so that goal concordant care can be prioritized among patients with breast cancer., Competing Interests: Declarations Ethics approval and consent to participate The University of Chicago Institutional Review Board approved the extraction and use of these data from electronic health records. The requirement to obtain informed consent was waived. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: In several European Union countries, undocumented migrants face significant barriers to accessing universal healthcare. In Spain, Royal Decree-Law 16/2012 introduced restrictions that limited undocumented migrants' access to healthcare services, offering only emergency, maternal, and paediatric care. The implementation of this law created significant disparities in access to healthcare across regions. Although the law was later amended and some regions introduced alternative programs to restore access, disparities in healthcare access remain. This study aims to analyse the contribution of Community-based Health Insurance (CBHI), developed by migrant organisations, to improving healthcare access for Senegalese migrants in Spain., Methods: We conducted 28 in-depth interviews and one discussion group across various Spanish localities between 2019 and 2022 to examine how CBHI influences healthcare access among Senegalese migrants. Using purposive sampling, we ensured diversity in participants' administrative status, sociodemographic profiles, and employment situations. Grounded theory was employed to analyse the data, focusing on the social innovation and organizational dynamics of the tontines, as well as the role migrant organizations play in facilitating healthcare access through these solidarity-based financial mechanisms., Results: The findings show that CBHI has emerged as a socially innovative, collective response to unmet medical needs. Through the mobilization of community funds, Senegalese migrant organizations have filled gaps left by the public and private healthcare systems, offering a crucial alternative for those excluded from formal services. Our findings also highlight the rise of transnational healthcare trends, as community insurance funds are allocated not only for healthcare in Spain but also for return and care in Senegal. This dual focus demonstrates the importance of these grassroots microfinance initiatives in enhancing healthcare access for migrants., Conclusions: CBHI through tontines represents an essential community-led solution that enhances healthcare access for undocumented Senegalese migrants in Spain. Migrant organizations serve as key intermediaries, using solidarity-based microfinance models to bridge healthcare gaps left by restrictive policies. These initiatives demonstrate the capacity for grassroots innovation to address structural barriers to healthcare access in both destination and origin countries, providing a model for other migrant communities facing similar challenges., Competing Interests: Declarations Ethics approval and consent to participate The research has obtained ethics approval by the Ethics Committee of the University of Granada (1038/CEIH/2020). All participants signed informed consent to partake in the study prior to the interview. The research was conducted in accordance with the relevant guidelines and regulations (Declaration of Helsinki). Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: A growing body of evidence suggests inequitable access to disease-modifying therapies (DMTs) for multiple sclerosis (MS) in publicly funded healthcare systems. This retrospective study examined the impact of ethnicity and deprivation on the access to DMTs., Methods: All adults diagnosed with relapsing-remitting MS between 2010 and 2020 were included. The impact of ethnicity and deprivation on being offered and starting any DMTs and high-efficacy DMTs were measured using binary, multinomial logistic and Cox regression models. These analyses were adjusted for sex, age at diagnosis and year of diagnosis., Results: 164/1648 people with MS (PwMS) were from non-white ethnicities. 461/1648 who were living in the most deprived areas, were less likely to be offered DMTs, with an OR of 0.66 (95% CI 0.47 to 0.93), less likely to start high-efficacy DMTs with an OR of 0.67 (95% CI 0.48 to 0.93) and more likely to experience a delay in starting high-efficacy DMTs with an HR of 0.76 (95% CI 0.63 to 0.92), when also adjusted for ethnicity. Although the offer of DMTs did not depend on ethnicity, PwMS from non-white ethnicities were more likely to decline DMTs, less likely to start any DMTs and high-efficacy DMTs with ORs of 0.60 (95% CI 0.39 to 0.93) and 0.61 (95% CI 0.38 to 0.98), respectively, and more likely to experience a delay in starting DMTs with an HR of 0.79 (95% CI 0.66 to 0.95), when also adjusted for deprivation., Conclusions: In a publicly funded healthcare system, the access to DMTs varied depending on ethnicities and levels of deprivation., Competing Interests: Competing interests: DR reports a relationship with Actelion, Biogen, Celgene, Hikma, Janssen, MedDay, Merck, Mitsubishi, Novartis, Roche, Sanofi, Teva, TG Therapeutics that includes consulting or advisory, funding grants and speaking and lecture fees., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Data regarding unequal diagnostic and therapeutic access in patients with acute stroke based on ethnicity and race are inconclusive in Europeans. The objectives of our study were to evaluate the effect of race/ethnicity on access to acute stroke care and treatments and outcomes., Methods: In this retrospective cohort study, we enrolled adult patients admitted to the emergency department of a comprehensive stroke center for suspected stroke. Based on race/ethnicity, patients were divided into two main groups: Western European Whites (WEW) and non-Western European Whites (nWEW). We also divided the nWEW group into four subgroups based on the Office of Management and Budget classification of human races and ethnicities (White-Others, Hispanic, Asian, Black). Univariate comparisons and logistic regression analyses were also performed., Results: 9167 patients were enrolled in the study: 582 in the nWEW and 8585 in the WEW group. Patients with ischemic stroke in the nWEW group were significantly younger than those in the other group (p < 0.001). Once adjusted for possible confounders, belonging to the nWEW group was found to be an independent predictor of a lower likelihood of receiving revascularization treatments (p = 0.006), regardless similar onset-to-door times. There were no differences in stroke outcomes and prevalence of stroke mimic diagnosis between the groups., Conclusions: Racial/ethnic disparities in healthcare represent a challenging issue, even in universal healthcare systems, that should be addressed promptly through education campaigns of healthcare personnel and implementation measures, such as integrating readily available interpreter staff for medical emergencies., Competing Interests: Declaration of competing interest The authors have no relevant financial or non-financial interests to disclose., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Study Design: Retrospective review., Objective: The purpose of this study was to evaluate disparities in patient-reported outcome measures (PROM) completion rates and baseline function scores among newly presenting spine patients., Summary of Background Data: Prior studies have demonstrated that minority patients and those of low socioeconomic status may present with worse physical and mental health on PROMs. As PROMs are increasingly used in clinical care, research, and health policy, accurate assessment of health status among populations relies on the successful completion of PROM instruments., Methods: A retrospective review of 10,803 consecutive new patients presenting to a single multidisciplinary spine clinic from June 2020 to September 2022 was performed. Univariate statistics were performed to compare demographics between patients who did and did not complete PROMs. Multivariable analysis was used to compare PROM instrument completion rates by race, ethnicity, and Social Vulnerability Index (SVI) and baseline scores among responders., Results: A total of 68.4% of patients completed PROMs at the first clinic visit. After adjusting for age, sex, body mass index, and diagnosis type, patients of non-White race (OR=0.661, 95% CI=0.599-0.729, P <0.001), Hispanic ethnicity (OR=0.569, 95% CI=0.448-0.721, P <0.001), and increased social vulnerability (OR=0.608, 95% CI=0.511-0.723, P <0.001) were less likely to complete PROMs. In the multivariable models, patients of non-White race reported lower levels of physical function (β=-6.5, 95% CI=-12.4 to -0.6, P =0.032) and higher levels of pain intensity (β=0.6, 95% CI=0.2-1.0, P =0.005). Hispanic ethnicity (β=1.5, 95% CI=0.5-2.5, P =0.004) and increased social vulnerability (β=1.1, 95% CI=0.4-1.8, P =0.002) were each associated with increased pain intensity., Conclusions: Among newly presenting spine patients, those of non-White race, Hispanic ethnicity, and with increased social vulnerability were less likely to complete PROMs. As these subpopulations also reported worse physical function or pain intensity, additional strategies are needed to better capture patient-reported health status to avoid bias in clinical care, outcomes research, and health policy., Level of Evidence: 4., Competing Interests: Chad Patton is a board or committee member with the North America Spine Society. The remaining authors report no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: Structural racism (SR) is a potential driver of health disparities, but research quantifying its impacts on cancer outcomes has been limited. We aimed to develop a multidimensional county-level SR measure and to examine the association of SR with breast cancer (BC) treatment delays among Black and White patients., Methods: The cohort included 32,095 individuals from the North Carolina Central Cancer Registry with stage I to III BC diagnosed between 2004 and 2017 and linked to multipayer insurance claims from the Cancer Information and Population Health Resource. County-level data were drawn from multiple public sources aggregated in the Robert Wood Johnson County Health Rankings database. Racial gaps in eight social determinants across five domains were quantified at the county level and ranked on a 0-100 minimum-maximum scale. Domain scores were averaged to create a SR Composite Index (SRCI) score. We used multilevel logistic regression with random intercepts and multiple cross-level interaction terms to evaluate the association between county-level SRCI and patient-level treatment delays, adjusting for patient-level characteristics and stratified by race., Results: The SRCI score ranged from 21 to 75 with a median (IQR) of 39.0 (31.8, 45.7). For Black patients, a 10-unit increase in SRCI score was associated with increased odds of delay (Adjusted odds ratios [aOR], 1.25; 95% confidence limits [CL], 1.08 to 1.45). No such association was found for White patients (OR, 1.05; 95% CL, 0.97 to 1.15)., Conclusion: Area-level SR measured by a composite index is associated with higher odds of BC treatment delays among Black, but not White patients. Increasing county-level SR is associated with increasing Black-White disparities in treatment delay. Further research is needed to refine the measurement of SR and to examine its association with other cancer care disparities.

Background: In 2023, President Biden issued an executive order requiring cost-benefit analyses for new regulations to account for distributional effects. To inform new tobacco regulations, we estimate for the first time racial and ethnic disparities in spending and outcomes associated with smoking., Methods: With the 2008-2019 Medical Expenditure Panel Survey linked to the National Health Interview Survey, n=118 084 adults-years, logit models estimate the per cent of the top 10 health conditions attributable to smoking. Two-part regression models estimate the share of and total annual healthcare spending attributable to smoking., Results: White adults had higher ever-smoked rates, but minority smoking adults had twice as much of their annual medical spending associated with smoking than white smoking adults, 25% vs 12% (p<0.01). minority adults who smoked had 41% (p<0.05) higher risks of multiple chronic conditions associated with smoking than white adults. While the share of white smoking adults trying to quit declined to 53% in 2019, this desire increased to 63% for minorities. From 2008-2016, smoking comprised 7.5% of the nation's spending for white adults and 10.7% for minorities (p<0.05). In 2017-2019, this declined to 2.5% of the nation's spending for white adults and 8.9% for minorities (p<0.05). For any new antitobacco regulation, the cost savings would be $134 million per year for every 100 000 minorities averted from initiating smoking, 135% more than the $57 million saved annually for 100 000 white adults averted., Implications: Minority adults may benefit substantially more from antitobacco regulations and past federal cost-benefit analyses would have overlooked this., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Māori are less likely to survive their lung cancer once diagnosed, but it remains unclear whether this is partially driven by poorer access to best-practice diagnostic services., Methods: We examined all lung cancer registrations in Aotearoa New Zealand between 2007-2019 (n=27,869) linked to national administrative health datasets and further stratified by ethnicity, tumour type and stage of disease. Using descriptive and regression analyses, we compared ethnic groups in terms of the basis of diagnosis (e.g., histology, cytology), receipt of bronchoscopy and travel distance and time to access bronchoscopy., Results: We found no differences in access to a pathological diagnosis between ethnic groups regardless of cancer type or stage. We found that Māori within the cohort were marginally more likely to access bronchoscopy than the majority European group; however, we also found that Māori had lower odds of living close to the location of their bronchoscopy, and correspondingly higher odds of living 100-200km (adjusted odds ratio [adj. OR] 1.46, 95% confidence interval [CI] 1.26-1.69) or more than 200km away (1.36, 95% CI 1.15-1.61) than Europeans., Conclusion: Interventions that aim to further support Māori to overcome the systematic and cumulative disadvantages in access to cancer care should be broadly supported and resourced., Competing Interests: The authors have no relevant financial or non-financial interests to disclose., (© PMA.)

Peripheral artery disease (PAD) is a progressive atherosclerotic disease that causes lower extremity arterial stenosis or occlusion. Patients with PAD are at increased risk of myocardial infarction, stroke, limitations in ambulation, and amputation. Despite the advances in medicine and technology, the outcomes from PAD, including critical limb-threatening ischemia, acute limb ischemia amputation, and mortality, remain increased among specific racial and ethnic groups that have been historically marginalized in America, including Black, Hispanic, and American Indian individuals in the United States when compared with White persons. The purpose of this review is to summarize PAD literature that incorporates racial and ethnic disparities in PAD. There are a rising number of studies focused on the interface of racial and ethnic disparities and PAD. The majority of these studies are specifically focused on Black race, whereas there are limited studies focused on other minoritized racial and ethnic groups in the United States. The application of race and ethnicity has also been shown to play a synergistic role with socioeconomic status on PAD outcomes. Effective strategies focused on implementing policies that support quality measures and focus on social determinants of health have been shown to promote health equity and reduce disparities. Current evidence suggests that biological differences are less likely to be the leading cause of disparities in PAD between racial and ethnic groups compared with White Americans and supports a renewed focus on social determinants of health to achieve health equity.

Background: Immigrants are disproportionately affected by cardiovascular disease burden. Heart health screenings, including blood pressure, fasting blood glucose (FBG), and blood cholesterol screenings, can help identify cardiovascular disease risk. Evidence on heart health screenings among diverse immigrant groups is still limited. This study examined the disparities in heart health screenings among the immigrant population compared with US-born White adults., Methods and Results: A cross-sectional design was used to analyze data from the 2011 to 2018 National Health Interview Survey. Generalized linear models with Poisson distribution were applied to compare the prevalence of annual blood pressure, fasting blood glucose, and blood cholesterol screenings among Latino, Black, and Asian immigrants and US-born White adults. The analysis included 145 149 adults (83.60% US-born White adults, 9.55% Latino immigrants, 1.89% Black immigrants, and 4.96% Asian immigrants), with a mean age of 50 years and 53.62% women. Latino (adjusted odds ratio [aOR], 0.92 [95% CI, 0.91-0.93]) and Asian (aOR, 0.93 [95% CI, 0.92-0.94]) immigrants were less likely to have blood pressure screening than US-born White adults. Latino (aOR, 1.22 [95% CI, 1.19-1.25]), Black (aOR, 1.15 [95% CI, 1.09-1.21]), and Asian (aOR, 1.12 [95% CI, 1.08-1.15]) immigrants were more likely to have fasting blood glucose screening, and Latino (aOR, 1.11 [95% CI, 1.09-1.13]), Black or (aOR, 1.12 [95% CI, 1.09-1.16]), and Asian (aOR, 1.05 [95% CI, 1.04-1.07]) immigrants were more likely to have blood cholesterol screening than US-born White adults., Conclusions: Latino and Asian immigrants have lower odds of annual blood pressure screenings than US-born White adults. More studies exploring facilitators and barriers to the accessibility and use of heart health screenings are needed.

The COVID-19 pandemic had a disproportionate impact on minoritised ethnic groups in the UK, including newly arrived Roma communities. Employing ethnographic and participatory methods, this study illustrates how systemic barriers, including precarious employment and overcrowded housing, coupled with strategies of identity concealment to avoid stigma, severely restrict access to healthcare among Bulgarian Roma communities in the UK. Drawing from fieldwork in Leicester and London, the research reveals how the pandemic amplified the vulnerabilities of Roma populations, directly linking the effects of the pandemic with broader sociopolitical dynamics, including the uncertainties and discrimination associated with Brexit. The findings point to the critical role of community, mutual and familial support networks as essential survival strategies. However, these social networks are also increasingly depleted, revealing the fragility and limits of informal communal resources. The study calls for the development of inclusive health strategies sensitive to the socio-economic and political complexities affecting marginalised communities in the UK and beyond., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Objective: To describe sociodemographic and racial disparities in receipt of poly ADP-ribose polymerase inhibitors (PARPi) and bevacizumab among insured patients with ovarian cancer., Methods: This retrospective study used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to identify patients with advanced stage, high grade serous ovarian cancer diagnosed between 2010 and 2019. The primary outcome of interest was receipt of PARPi or bevacizumab at any time after diagnosis. χ 2 tests were used to compare categorical variables. Factors independently associated with the receipt of PARPi and/or bevacizumab were identified using a multivariable logistic regression., Results: The cohort included 6242 patients; 276 (4.4%) received PARPi, 2142 (34.3%) received bevacizumab, and 389 (6.2%) received both. Receipt of either targeted treatment increased over the study period. On univariate analysis, patients who received either targeted therapy were younger (63% vs 48% aged <75 years; p<0.001), had a lower comorbidity index (86% vs 80% Charlson Comorbidity Index 0-1; p<0.001), and higher socioeconomic status (74% vs 71% high socioeconomic status; p=0.047) compared with those who did not receive targeted therapy. In the multivariable model, non-Hispanic black patients were less likely than non-Hispanic white patients to receive either targeted therapy (odds ratio 0.77; 95% confidence interval 0.61 to 0.98; p=0.032). Older patients (aged >74 years) were also less likely to receive PARPi or bevacizumab compared with those aged 65-69 years (all p<0.001)., Conclusion: Sociodemographic and racial disparities exist in receipt of PARPi and bevacizumab among patients with advanced ovarian cancer insured by Medicare. As targeted therapies become more commonly used, a widening disparity gap is likely., Competing Interests: Competing interests: None declared., (© IGCS and ESGO 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: People from minoritised ethnic groups are diagnosed with dementia later in the disease. We explored pathways that may determine the timing of diagnoses in a UK ethnically diverse, urban area., Methods: We conducted 61 semi-structured interviews: 10 community-dwelling older people from minoritised ethnic backgrounds with diagnosed and undiagnosed dementia (mean age = 72 years; males = 5/10), 30 family members (51; 10/30), 16 health or social care professionals (42; 3/15), 3 paid carers and 2 interpreters for people with dementia. We used reflexive thematic analysis and the Model of Pathways to Treatment to consider diagnostic delay., Findings: We identified three themes: (1) Cultural identity and practices shape responses: gendered expectations that families relieve elders of household roles reduce awareness or concern when functioning declines; expectations that religious practices are maintained mean problems doing so triggers help-seeking. Second-generation family members often held insider and outsider identities, balancing traditional and Western perspectives. (2) Becoming like a tourist: daily experiences became unfamiliar for people developing dementia in an adopted country, sometimes engendering a need to reconnect with a home country. For professionals and interpreters, translating meanings faithfully, and balancing relatives' and clients' voices, were challenging. (3) Naming and conceptualising dementia: the term dementia was stigmatised, with cultural nuances in how it was understood; initial presentations often included physical symptoms with cognitive concerns., Conclusion: Greater understanding of dilemmas faced by minoritised ethnic communities, closer collaboration with interpreters and workforce diversity could reduce time from symptom appraisal to diagnosis, and support culturally competent diagnostic assessments., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Geriatrics Society.)

Purpose To evaluate racial disparities in preoperative breast MRI use and surgical margin outcomes among patients with recently diagnosed breast cancer. Materials and Methods This retrospective study included patients with breast cancer who presented to a single cancer center between 2008 and 2020, underwent breast surgery, and self-identified as White or Black. Patients were divided into MRI or no-MRI cohorts based on preoperative MRI use. MRI use and positive surgical margin rates were determined for all patients and racial subgroups. Data were collected from the electronic medical record and analyzed using the χ 2 test for significance. Results The study included 28 384 female patients (mean age, 56 years ± 13 [SD]) with recently diagnosed breast cancer who self-identified as White (90.36%, n = 25 647) or Black (9.64%, n = 2737). Of the entire cohort, 32.78% (9305 of 28 384) underwent preoperative MRI. Black patients had a lower rate of preoperative MRI use than White patients (29.85% [817 of 2737] vs 33.10% [8488 of 25 647], respectively; P < .001). The MRI cohort had a lower positive margin rate compared with the no-MRI cohort (2.90% [133 of 4592] vs 4.78% [539 of 11 271], respectively; P = .03). In the no-MRI cohort, Black patients had a higher positive margin rate than White patients (6.17% [68 of 1103] vs 4.63% [471 of 10 168], respectively; P = .03). In the MRI cohort, there was no evidence of a difference in positive margin rates between Black and White patients (3.17% [12 of 379] vs 2.87% [121 of 4213], respectively; P = .90). Conclusion Compared with White patients, Black patients with breast cancer were less likely to undergo preoperative MRI and had a higher positive surgical margin rate. Keywords: MR Imaging, Breast Cancer, Breast MRI © RSNA, 2024 See also the commentary by Tran and Miles in this issue.

Background: Racial and ethnic disparities in diagnosis and overall outcomes for HCC are well known. We present updated real-world data on racial or ethnic differences in LT and post-LT survival among patients with HCC in a large population-based database., Methods: We used the TriNetX database to retrospectively identify patients who had HCC (ICD-10 C22.0, C22.8) and underwent LT (CPT codes 47,135, 47,140, 47,140, 47,141, 47,142) from 2012 to 2022 and compared outcomes across racial and ethnic subgroups., Results: Majority of the patients were Caucasians (2403/2901, 84.8%), followed by African Americans (267/2901, 9.2%) Hispanic/Asian (231/2901, 7.9%). At follow up of 5 years, we noted no significant difference in mortality between AA and Caucasian patients [HR = 1.087 (95% CI 0.76, 1.56, p = 0.59)] as well as Hispanic/Asian and Caucasian patients [HR = 1.14 (95% CI 0.73, 1.78, p = 0.10)]., Conclusions: These results indicate that stringent implementation of policies aimed at ensuring equitable access to LT may contribute to bridging disparities in overall outcomes in HCC., (© 2024 The Author(s). Cancer Medicine published by John Wiley & Sons Ltd.)

Significance: Non-Hispanic Black patients diagnosed with prostate cancer between 2014 and 2019 and treated at a comprehensive cancer center were less likely to use tumor-specific genomic testing compared with non-Hispanic White patients. Disparities in the use of precision oncology technologies should be monitored and addressed to ensure equitable cancer care., (©2024 The Authors; Published by the American Association for Cancer Research.)

Over the past few decades, Vietnam has experienced a substantial improvement in health outcomes, providing an example of a low-income country that has achieved a major success in public health despite the lack of resources. However, inequalities in access to healthcare services persist among the poor, ethnic minorities, and other vulnerable groups. To address this issue, the Vietnamese government implemented a healthcare support program in ethnic minority areas in 2013. We examine the effects of this program on healthcare utilization among older individuals aged 55-74. Employing a difference-in-differences approach and data from the Vietnam Household Living Standards Survey from 2008 to 2018, we find that the program has a positive effect on inpatient visits at public health facilities. However, the program has no impact on outpatient visits. Additional analysis reveals that the program increases outpatient visits at commune health stations and inpatient visits at district hospitals. There is also suggestive evidence of a switch from private to public facilities. Our results suggest that providing healthcare resources to disadvantaged areas can increase healthcare utilization of older people, which can, in turn, improve their health outcomes., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Black and Hispanic older adults in the United States have higher prevalence of hypertension, less adequate treatment, less consistent blood pressure control, and worse cardiovascular outcomes than their white counterparts. Genetic differences are insufficient to explain these disparities-various social, economic, and environmental factors notably contribute. Racial and ethnic differences in living circumstances, household income, access to appropriate care, food security, educational attainment, and tobacco use all negatively impact long-term hypertension outcomes in minoritized older adults. To remedy these inequities, the search for solutions must include a complete assessment of the social, racial, and cultural components of the problem., Competing Interests: Disclosures S. D. Nesbitt, MD, MS, serves as a site principal investigator for a clinical trial sponsored by Ablative Solutions. S. V. Carter has nothing to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Peripheral nerve block (PNB) usage in plastic surgery is associated with reduction in post-operative opioid consumption and pain demonstrating benefits in breast reconstruction (BR). This retrospective study explored whether racial-ethnic disparities exist with PNB use for postoperative analgesia in patients undergoing BR. Using the American College of Surgeons National Surgical Quality Improvement Program database, women who underwent BR from 2012-2021 and received "regional" in addition to general anesthesia were included in the study. Patients without race and ethnicity data and who received other additional anesthesia were excluded. Unweighted rates of PNB use were compared between racial-ethnic groups and BR modality. Multivariate logistic regression assessed whether race and ethnicity were independently associated with receiving PNBs. A total of 25,188 patients underwent BR and 9429 patients (37.4%) received PNB for postoperative analgesia. Patient demographics reached statistical, but not clinical, significance in age and BMI. Comorbidities were not significantly different between groups. Black patients were less likely to receive PNBs (p < 0.001), while Asian and Other patients were more likely to receive PNBs compared to White patients (p < 0.001). Black patients were less likely to receive PNB in immediate implant-based and autologous BR, as well as delayed autologous (p < 0.05). Asian patients were more likely to receive PNB for all implant-based BR compared to White patients (p < 0.001). Ethnicity had no significant impact on receipt of PNB. As a conclusion, racial disparity exists in use of PNBs for postoperative analgesia in BR. Equitable access to PNBs should be championed to not augment baseline racial disparity in BR., Competing Interests: Conflict of interest All authors have no conflict of interest to disclose., (Copyright © 2024. Published by Elsevier Ltd.)

Background: Pediatric patients from minoritized racial and ethnic groups receive red blood cell (RBC) transfusions more frequently while undergoing major surgical procedures. Our objective was to identify the contribution of preoperative anemia to racial and ethnic differences in RBC transfusion rates in adolescent spine surgery., Study Design and Methods: This is a multicenter, retrospective cohort study of the National Surgical Quality Improvement Program Pediatric database, 2016 to 2021 for patients in the United States and Canada., Results: Adolescents identifying as non-Hispanic Black, Hispanic, and other race/ethnicity presented with higher rates of preoperative anemia than non-Hispanic White adolescents (16.3%, 10.6%, and 9.9%, vs. 7.8%, respectively; p < .0001) and were transfused at higher rates (14.4%, 11.9%, 16.5%, vs. 10.0%, respectively; p < .0001). Minoritized groups demonstrated higher adjusted odds of RBC transfusion compared with non-Hispanic Whites (non-Hispanic Black: aOR 1.45 95% CI 1.26-1.65, Hispanic: aOR 1.17 95% CI 0.96-1.41, other race/ethnicity: aOR 1.63 95% CI 1.26-2.09). Of the total effect of minoritized race and/or ethnicity on RBC transfusion, 13.9% was attributed to the indirect effect through preoperative anemia., Discussion: In this cohort study, patients from minoritized racial and ethnic groups received RBC transfusions at a higher rate than non-Hispanic White patients, and the difference was partially mediated by preoperative anemia. Future efforts to minimize transfusions and improve health equity should target this modifiable risk factor alongside other sources of disparity and discrimination., (© 2024 AABB.)

Introduction: This narrative review aims to frame the historical context of American Indian/Alaska Native (AI/AN) pediatric intensive care and offers suggestions for mitigating the impact of unique social drivers., Methods: Recent literature was surveyed to determine pertinent studies describing intensive care outcomes in AI/AN children and was summarized in a narrative review., Results: American Indian/Alaska Native people experience disproportionate health inequites due to unique social drivers of health, including settler colonialism, historical trauma, and systemic racism. These factors contribute to inequities in the pediatric intensive care experience, including rates of admission for injury and infectious diseases and mortality due to injuries and following cardiac surgery., Discussion: These inequities are understudied and require dedicated evaluation. Institutions and providers are responsible for educating, modeling, and providing culturally competent care and aiming to achieve workforce equity to improve outcomes for AI/AN children receiving intensive care., Competing Interests: CONFLICTS OF INTEREST The authors have no conflicts of interest relevant to this article to disclose., (Copyright © 2024 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.)

Rationale and Objectives: Disparities in healthcare access in the United States have been associated with race and ethnicity, as well as socioeconomic factors. Because delays in imaging may result in delayed diagnosis or clinical management, we are evaluating practices within our radiology department in hopes of decreasing disparities in access to imaging. The objective of this study is to determine the disparities in time to outpatient MRI scheduling and completion by race, ethnicity, primary language, socioeconomic status, insurance and other factors at a tertiary children's hospital., Methods: After Institutional Review Board approval, we retrospectively extracted data from all outpatient MRI exams completed at our center between 10/5/2020 and 8/31/2022. Collected data included sex, age, race/ethnicity, primary language, medical complexity, insurance type, address, need for anesthesia, ordering specialty, and order acuity. We determined times to MRI scheduling or completion using mixed effects Cox regression models and determined associations between unadjusted and fully adjusted models., Results: We analyzed 14,002 completed outpatient MRI orders from 9714 unique patients. 56.2% were White, 19.2% Hispanic, 8.4% Asian, 4.5% Black/African-American, 1.4% American Indian/Alaska Native, 0.7% Native Hawaiian/Pacific Islander, 5.7% two or more races/ethnicities, and 3.8% "Other." In fully adjusted models, there was no significant association between race/ethnicity and time to MRI scheduling and completion. In fully adjusted models, time to completion of MRI was slower among those with Medicaid (adjusted hazard ratio [95% confidence interval] of 0.92 [0.87, 0.98]), a primary language other than English (0.90 [0.82, 0.99]), non-complex chronic illness (0.72 [0.67, 0.79]), complex chronic illness (0.72 [0.67, 0.78]) and need for anesthesia (0.75 [0.71, 0.79])., Conclusion: At our tertiary children's hospital, time to completion of outpatient MRI was not associated with race, but was greater among those with Medicaid insurance, whose primary language was not English, and needing anesthesia. Advocating for faster prior authorization by Medicaid, utilizing our hospital's live interpreter phone number for scheduling, and incorporating greater child life support to decrease anesthesia use are considerations for decreasing these disparities, although surveying patients and families most impacted by these discrepancies will be important to identify the most promising interventions., Data Availability Statement: Data are not publicly available to preserve individuals' privacy due to IRB restrictions. Data may be available upon reasonable request by contacting the corresponding author., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

Purpose: Elective induction of labor (IOL) has been increasingly performed since growing data suggesting its safety and potential improved maternal and neonatal outcomes. Recommendations of elective IOL for patients from racial or ethnic minority backgrounds given the data showing increased risk of stillbirth for some populations has been met with criticism. This scoping review aims to determine if there are racial disparities in access to elective IOL and maternal and neonatal outcomes., Methods: A review of the literature on IOL that appeared in English journals was performed using MEDLINE and EMBASE. The search strategy included the combination of key terms "induction of labour" and "race" or "ethnicity" in titles, abstracts, or keywords., Results: A total of 8 studies were identified and included. The articles were heterogenous in the race or ethnicity distinctions they used for analysis. Three out of 4 studies that analyzed the rate of elective IOL by race found that White patients were more likely to receive the intervention. Three out of 4 studies that analyzed outcomes of IOL found no difference, while one study found Black patients benefit most from IOL at 38 weeks compared to other races that had the lowest risk of complications with IOL at 39 weeks., Conclusion: Racial and ethnic disparities exist with White patients being most likely to access this intervention. The majority of data points to similar outcomes, suggesting no increased harm to elective IOL for a particular group. However, the optimal timing of elective IOL given disproportionate stillbirth risk remains to be elucidated., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: Research highlights racial disparities among those experiencing intimate partner violence (IPV), yet little is known about disparities in addressing IPV in the emergency department (ED). This study was designed to examine variability in offering IPV universal education to adult caregivers across patient race within an urban pediatric ED and to explore provider attitudes regarding the role of race in this process., Methods: We conducted a mixed-methods study using quantitative data on rates of offering adult caregivers IPV universal education and rates of missing documentation for when IPV universal education was not offered to adult caregivers from January 2016 to December 2020. Analyses compared both rates by patient race listed in the electronic health record. We also conducted semistructured interviews with ED providers, which were qualitatively analyzed for common themes., Results: Caregivers of Black patients were both more likely to have received IPV universal education compared with caregivers of White patients (31.1% vs 27.3%, P < 0.05) and more likely to lack a documented reason for not offering than caregivers of White patients (70.4% vs 53.9%, P < 0.05). Our semistructured interviews with nurses, nurse practitioners, and physicians in the pediatric ED were able to ascertain specific racial biases that may influence these disparities., Conclusions: Our study showed that racial disparities exist in both offering IPV universal education and documentation deferral in our pediatric ED. Combined analysis of our quantitative and qualitative data shows the importance of identifying biases that cause health disparities and increasing diversity among healthcare providers. The results of this study can be used to inform new methodologies for healthcare providers to address their personal biases and ensure that all caregivers visiting the ED are offered IPV support resources., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

The purpose of this article is to summarize disparities in blood pressure (BP) by race in the United States, discuss evidence-based strategies to increase equity in BP, review recent American Heart Association BP equity initiatives, and highlight missed opportunities for achieving equity in hypertension. Over 122 million American adults have hypertension, with the highest prevalence among Black Americans. Racial disparities in hypertension and BP control in the United States are estimated to be the single largest contributor to the excess risk for cardiovascular disease among Black versus White adults. Worsening disparities in cardiovascular disease and life expectancy during the COVID-19 pandemic warrant an evaluation of the strategies and opportunities to increase equity in BP in the United States. Racial disparities in hypertension are largely driven by systemic inequities that limit access to quality education, economic opportunities, neighborhoods, and health care. To address these root causes, recent studies have evaluated evidence-based strategies, including community health workers, digital health interventions, team-based care, and mobile health care to enhance access to health education, screenings, and BP care in Black communities. In 2021, the American Heart Association made a $100 million pledge and 10 commitments to support health equity. This commitment included implementing multifaceted interventions with a focus on hypertension as a seminal risk factor contributing to disparities in cardiovascular disease mortality and morbidity. The American Heart Association is one organizational example of advocacy for equity in BP. Achieving equity nationwide will require sustained collaboration among individual stakeholders and public, private, and community organizations to address barriers across multiple socioecological levels., Competing Interests: V. Fontil is a recipient of a Small Business Innovation Research grant to commercialize a clinical decision-support tool for hypertension (Engage Rx) that he developed in his research work. G.H. Dillon is an employee of the American Heart Association. The other authors report no conflicts.

Background: We investigated clinical characteristics and prostate cancer survival patterns among Latino patients considering nativity compared with non-Latino Black (NLB) and non-Latino White (NLW) patients., Methods: We used data from the California Cancer Registry (1995-2021), which included 347,540 NLW, 50,032 NLB, and 75,238 Latino patients with prostate cancer. Frequencies of sociodemographic and clinical variables were assessed using χ2 tests. Multivariable regression models were fitted to evaluate determinants of treatment reception, Gleason upgrade, and survival differences. Exploratory analyses were conducted grouping Latino cases into US born and non-US born by country of origin., Results: Compared with NLW, NLB cases had the greatest proportion of younger patients, whereas non-US-born Latino patients had the greatest proportion of low socioeconomic status and uninsured patients. Non-US-born Latinos showed a greater proportion of diagnoses completed with <6 core biopsies, Gleason >8, stage IV tumors, and metastasis. Multivariable analyses showed that compared with NLW, Latino patients were as likely to receive treatment, whereas NLB cases were less likely (OR = 0.81; 95% confidence interval, 0.67-0.98; P = 0.029). Compared with NLW, non-US-born Latino cases were less likely to die of prostate cancer (HR = 0.78; 95% confidence interval, 0.64-0.94; P = 0.011), with no difference reported for NLB cases., Conclusions: Considering sociodemographic and clinical characteristics, non-US-born Latino patients with prostate cancer had better survival than NLW. This highlights the need to identify key determinants of these survival differences and the importance of sociodemographic and clinical determinants in survival disparities., Impact: Our study emphasizes the importance of considering nativity among Latino patients to understand prostate cancer disparities and outcomes in this population., (©2024 American Association for Cancer Research.)

Background: Unmet need for home and community-based services (HCBS) may disparately impact older adults from racial and ethnic minoritized groups. We examined racial and ethnic differences in unmet need for HCBS among consumers ≥65 years using publicly funded HCBS., Methods: We analyzed the National Core Indicators-Aging and Disability survey data (2015-2019) from 21,739 community-dwelling HCBS consumers aged ≥65 years in 23 participating states. Outcome measures included self-reported unmet need in six service types (i.e., personal care, homemaker/chore, delivered meals, adult day services, transportation, and caregiver support). Racial and ethnic groups included non-Hispanic Black, Asian, non-Hispanic White, Hispanic, and multiracial groups. Logistic regression models examined associations between race and ethnicity and unmet need, adjusting for sociodemographic, health, and HCBS program (i.e., Medicaid, Older Americans Act [OAA], Program for All-Inclusive Care for the Elderly [PACE]) characteristics, and use of specific service types., Results: Among 21,739 respondents, 23.3% were Black, 3.4% were Asian, 10.8% were Hispanic, 58.8% were non-Hispanic White, and 3.7% were multiracial or identified with other races/ethnicities. Asian and Black consumers had higher odds of reporting unmet need in personal care than White consumers (adjusted odds ratio [aOR], 1.45, p value < 0.01; and aOR, 1.25, p < 0.001, respectively). Asian and Black consumers had significantly higher odds of unmet need in adult day services versus White consumers (aOR, 1.94, p < 0.001 and aOR, 1.39, p < 0.001, respectively). Black consumers had higher odds of unmet need versus non-Hispanic White consumers in meal delivery and caregiver support services (aOR, 1.29; p < 0.01; and aOR 1.26, p < 0.05, respectively). Race and ethnicity were not significantly associated with experiencing unmet need for homemaker/chore or transportation services., Conclusions: Future research should identify driving forces in disparities in unmet need to develop culturally appropriate solutions., (© 2024 The American Geriatrics Society.)

Background: Implicit bias may prevent patients with abdominal pain from receiving optimal workup and treatment. We hypothesized that patients from socially disadvantaged backgrounds would be more likely to experience delays in receiving operative treatment for cholecystitis. To study this question, we examined factors related to having a prior emergency department presentation for abdominal pain (prior emergency department visit) within 3 months of urgent cholecystectomy., Methods: We performed a retrospective analysis of consecutive patients who received an urgent cholecystectomy at an urban safety net public hospital between July 2019 and December 2022. The main outcome of interest was prior emergency department visit within 3 months of index cholecystectomy. We examined patient age, sex, race, ethnicity, preferred language, insurance, and employment status. Bivariate comparisons and logistic regression were used to determine the relationship between patient factors and prior emergency department visit., Results: Of 508 cholecystectomy patients, 138 (27.2%) had a prior emergency department visit in the 3 months preceding their surgery. In bivariate analysis, younger age, Black race, Hispanic ethnicity, non-English preferred language, and type of insurance (P < .05) were associated with prior emergency department visit. In regression, younger age, Black race, Hispanic ethnicity, and having Medicare or being uninsured were associated with higher odds of having a prior emergency department visit., Conclusion: More than 1 in 4 patients had an evaluation for abdominal pain within 3 months of having an urgent cholecystectomy, and these patients were more likely to be from socially disadvantaged backgrounds. Standardized evaluation pathways for abdominal pain are needed to reduce disparities from institutional or implicit bias., Competing Interests: Conflict of Interest/Disclosure V.P.H. was supported by the CTSC of Cleveland (KL2TR002547). V.P.H.’s spouse is a consultant to Zimmer Biomet, Sig Medical, Atricure, and Astra Zeneca and has received research support from Zimmer Biomet and the Intuitive Foundation., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: Despite considerable national attention, racial disparities in surgical outcomes persist. We sought to consider whether race-based inequities in outcomes following major elective surgery have improved in the contemporary era. Methods: All adult hospitalization records for elective coronary artery bypass grafting, abdominal aortic aneurysm repair, colectomy, and hip replacement were tabulated from the 2016-2020 National Inpatient Sample. Patients were stratified by Black or White race. To consider the evolution in outcomes, we included an interaction term between race and year. We designated centers in the top quartile of annual procedural volume as high-volume hospitals (HVH). Results: Of ∼2,838,485 patients, 245,405 (8.6%) were of Black race. Following risk-adjustment, Black race was linked with similar odds of in-hospital mortality, but increased likelihood of major complications (Adjusted Odds Ratio [AOR] 1.41, 95%Confidence Interval [CI] 1.36-1.47). From 2016-2020, overall risk-adjusted rates of major complications declined (patients of White race: 9.2% to 8.4%; patients of Black race 11.8% to 10.8%, both P < .001). Yet, the delta in risk of adverse outcomes between patients of White and Black race did not significantly change. Of the cohort, 158,060 (8.4%) were treated at HVH. Following adjustment, Black race remained associated with greater odds of morbidity (AOR 1.37, CI 1.23-1.52; Ref:White). The race-based difference in risk of complications at HVH did not significantly change from 2016 to 2020. Conclusion: While overall rates of complications following major elective procedures declined from 2016 to 2020, patients of Black race faced persistently greater risk of adverse outcomes. Novel interventions are needed to address persistent racial disparities and ensure acceptable outcomes for all patients., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Importance: Racial inequity elevates risk for certain diagnoses and health disparities. Current data show disparities for Black women when comparing open versus minimally invasive hysterectomy. It is unknown if a similar disparity exists in surgical management of pelvic organ prolapse., Objective: The objective of this study was to determine whether racial or ethnic disparities exist for open abdominal versus minimally invasive sacrocolpopexy., Study Design: Cross-sectional data of the Healthcare Cost and Utilization Project National Inpatient Sample and the Nationwide Ambulatory Surgery Sample for the year 2019 was used. Bivariate analysis identified demographic and perioperative differences between abdominal versus minimally invasive sacrocolpopexy, which were compared in a multivariable logistic regression., Results: Forty-one thousand eight hundred thirty-seven patients underwent sacrocolpopexy: 35,820 (85.6%), minimally invasive sacrocolpopexy, and 6,016, (14.4%) abdominal sacrocolpopexy. In an unadjusted analysis, Black patients were more likely to undergo an abdominal sacrocolpopexy compared to non-Hispanic White patients (OR 2.14, 95% CI 1.16-3.92, P <0.01). Hispanic patients were more likely to undergo abdominal sacrocolpopexy compared to non-Hispanic White patients (OR 1.69, 95% CI 1.26-2.26, P <0.001). Other factors associated with abdominal sacrocolpopexy are zip code quartile, payer status, composite comorbidity score, hospital control, and hospital bed size. In the regression model, Black patients remained more likely to undergo abdominal sacrocolpopexy compared to those who identified as White (aOR 2, 95% CI 1.26-3.16, P < 0.003). Hispanic patients were more likely to undergo abdominal sacrocolpopexy compared to those who identified as White (aOR 1.73, 95% CI 1.31-2.28, P < 0.001)., Conclusion: Abdominal sacrocolpopexy was more likely to occur in patients who identified as Black or Hispanic., (Copyright © 2024 American Urogynecologic Society. All rights reserved.)

Background: Disparities in hypertension control across race, ethnicity, and language have been a long-standing problem in the United States., Objective: To assess whether a multi-pronged intervention can improve hypertension control for a target population and reduce disparities., Design: This stepped wedge cluster randomized trial was conducted at 15 adult primary care clinics affiliated with Massachusetts General Hospital. PCPs were randomized to receive the intervention in twelve groups., Participants: The target population was patients who met one of the following criteria based on self-identification: (1) Asian, Black, Indigenous, multi-racial, or other race; (2) Hispanic ethnicity; or (3) preferred language other than English. Reference population was White, English-speaking patients., Interventions: PCPs were given access to an online equity dashboard that displays disparities in chronic disease management and completed an equity huddle with population health coordinators (PHCs), which involved reviewing target patients whose hypertension was not well controlled. In addition, community health workers (CHWs) were available in some practices to offer additional support., Main Measures: The primary outcome was change in the proportion of target patients meeting the hypertension control goal when comparing intervention and control periods., Key Results: Of the 365 PCPs who were randomized, 311 PCPs and their 10,865 target patients were included in the analysis. The intervention led to an increase in hypertension control in the target population (RD 0.9%; 95% CI [0.3,1.5]) and there was a higher intervention effect in the target population compared to the reference population (DiD 2.1%; 95% CI [1.1, 3.1])., Conclusions: Utilizing data on disparities in quality outcome measures in routine clinical practice augmented by clinical support provided by PHCs and CHWs led to modest, but statistically significant, improvement in hypertension control among BIPOC, Hispanic, and LEP patients., Trial Registration: ClinicalTrials.gov Identifier: NCT05278806., Competing Interests: Declarations Conflict of Interest: Dr. Horn reports personal fees from Devoted Health, outside the submitted work. All other authors have nothing to disclose., (© 2024. The Author(s), under exclusive licence to Society of General Internal Medicine.)

Introduction: Racial and ethnic disparities in potentially inappropriate medication (PIM) use among older adults with dementia are unclear., Methods: Data were drawn from the baseline visits of participants who were ≥60 years old and diagnosed with dementia in the National Alzheimer's Coordinating Center Uniform Data Set (NACCUDS) recruited from National Institute on Aging (NIA)-funded Alzheimer's Disease Research Centers (ADCs) throughout the United States. PIM utilization was evaluated using the 2019 American Geriatrics Society Beers Criteria for PIM Use in Older Adults. We estimated the association between race and ethnicity and the following outcomes and estimation models: (1) any PIM use, any PIM in each drug class, and any PIM best avoided in dementia patients using logistic regression models, (2) total number of medications, total number of PIMs, and anticholinergic burden scale (ACBS) using Poisson or negative binomial regression models, and (3) proportion of total medications that were PIMs using generalized linear models (GLM)., Results: Compared to White participants, Black, Hispanic, and Asian participants reported taking fewer total medications (incidence rate ratio [IRR] ± standard error[SE] = 0.903 ± 0.017, 0.875 ± 0.021, and 0.912 ± 0.041, respectively, all p < 0.01). Asian participants were less likely to be exposed to any PIM (odds ratio [OR] ± SE = 0.619 ± 0.118, p < 0.05). Compared to White participants, Black participants were less likely to be exposed to benzodiazepine (OR ± SE = 0.609 ± 0.094, p < 0.01) and antidepressant (OR ± SE = 0.416 ± 0.103, p < 0.001) PIMs, but greater antipsychotic (OR ± SE = 1.496 ± 0.204, p < 0.01), cardiovascular (OR ± SE = 2.193 ± 0.255, p < 0.001), and skeletal muscle relaxant (OR ± SE = 2.977 ± 0.860, p < 0.001) PIMs. Hispanic participants were exposed to greater skeletal muscle relaxant PIMs and had lower anticholinergic burden. Asian participants were exposed to fewer benzodiazepine PIMs., Discussion: Significant racial and ethnic disparities in exposure to PIMs and PIMs by medication category in dementia research participants who have access to dementia experts found in the study suggest that disparities may be wider in the larger community., (© 2024 The American Geriatrics Society.)

This systematic review and meta-analysis delved into the impact of race and ethnicity on outcomes following foot and ankle surgery, an area garnering increasing attention within the medical community. Despite significant literature on postsurgical clinical and functional outcomes, limited research has explored the influence of racial and ethnic factors on postoperative outcomes. In this study, data from 33 relevant studies, involving a total of 557,734 patients, were analyzed to assess outcomes across different racial and ethnic groups. Notably, only 6 studies met the criteria for inclusion in the final meta-analysis due to variations in outcome reporting. Findings revealed disparities in functional scores, pain levels, and resource utilization among different racial and ethnic cohorts. Specifically, non-White and minority patients exhibited higher rates of foot and ankle fractures and lower extremity surgeries, worse functional outcomes, increased pain, longer hospital stays, and a greater incidence of complications compared to their White counterparts. However, some studies presented contradictory results, emphasizing the necessity for further investigation to elucidate these discrepancies fully. This research underscores the importance of considering racial and ethnic factors in foot and ankle surgery outcomes and highlights the need for targeted interventions to address existing disparities., (Copyright © 2024 the American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

Introduction: Delay in surgical management for orthopaedic emergencies and severe fracture types can result in notable morbidity and even mortality for patients. Disparities in various facets of orthopaedic care have been identified based on race/ethnicity, socioeconomic status, and payer status, but disparities in time to surgery have been poorly explored. The purpose of this study was, therefore, to investigate whether disparities exist in time to emergent orthopaedic surgery., Methods: Patients who underwent surgery for hip fracture, femur fracture, pelvic fracture, septic knee, septic hip, or cauda equina syndrome over 2012 to 2020 were identified using national data. Multivariable linear regression models were constructed, controlling for age, sex, race/ethnicity, payer status, socioeconomic status, hospital setting, and comorbidities to examine the effect of payer status and race/ethnicity, on time to surgery., Results: Over 2012 to 2020, 247,370 patients underwent surgery for hip fracture, 64,827 for femur fracture, 14,130 for pelvic fracture, 14,979 for septic knee, 3,205 for septic hip, and 4,730 for cauda equina syndrome. On multivariable analysis, patients with Medicaid experienced significantly longer time to surgery for hip fracture, femur fracture, pelvic fracture, septic knee, and cauda equina syndrome ( P < 0.05 all). Black patients experienced longer time to surgery for hip fracture, femur fracture, septic knee, septic hip, and cauda equina syndrome, and Hispanic patients experienced longer time to surgery for hip fracture, femur fracture, pelvic fracture, and cauda equina syndrome ( P < 0.05 all)., Discussion: The results of this study demonstrate that Medicaid-insured patients, and often minority patients, experience longer delays to surgery than privately insured and White patients. Future work should endeavor to identify causes of these disparities to promote creation of policies aimed at improving timely access to care for Medicaid-insured and minority patients., Level of Evidence: III., (Copyright © 2024 by the American Academy of Orthopaedic Surgeons.)

Purpose: To describe the association between geographic location of residence and use of aneuploidy screening or prenatal genetic counseling and how it is modified by maternal race and ethnicity., Methods: Retrospective cohort of individuals at a tertiary care center between 2017-2019. County of residence was classified as rural or metropolitan based in US Office of Management and Budget 2019 definitions. Maternal race and ethnicity were self-identified. Our composite outcome was defined as use of aneuploidy screening or genetic counseling visit. The composite outcome was compared by geographic location and ethnicity. Logistic regression was used to model the relationship between geographic location and the composite outcome., Results: A total of 8774 pregnancies were included. Of these, 4770 (54%) had genetic screening, and 3781 (43%) had at least 1 genetic counseling visit. Rural patients were significantly less likely to have the composite outcome compared with metropolitan peers (37.1% vs 47.2%, P < .001). In addition, we identified differences in the composite outcome between White rural patients and LatinX rural patients (37.7% vs 35.6%, P < .001) and between Asian rural patients and LatinX and Black rural patients (41.0% vs 35.6%, P < .001; 41.0% vs 36.8%, P < .001). Logistic regression demonstrated that rural patients were significantly less likely to have the composite outcome compared with metropolitan peers, after adjusting for LatinX ethnicity and gestational age at first prenatal visit (OR 0.72, [0.55, 0.95], P = .002)., Conclusion: Rural, minority patients were significantly less likely to receive reproductive genetic services compared with metropolitan peers extending our knowledge of disparities in maternity care., Competing Interests: Conflict of Interest Asha N. Talati receives research support from the National Institutes of Health, Billion to One, and The Greenwall Foundation. Divya P. Mallampati receives salary support from the Department of Health and Human Services. Neeta L. Vora receives research support from National Institutes of Health and received supplies in kind from Illumina unrelated to this research., (Copyright © 2024. Published by Elsevier Inc.)

Objective: To determine whether immigrant status is associated with likelihood of audiogram and hearing aid use among US adults with hearing loss., Study Design: Cross-sectional study., Setting: Nationally representative data from 2009 to 2010, 2011 to 2012, 2015 to 2016, and 2017 to 2020 National Health and Nutrition Examination Survey (NHANES) cycles., Methods: This cross-sectional study of 4 merged cycles of NHANES included 12,455 adults with subjective (self-reported) or objective (audiometric) hearing loss. Sequentially adjusted logistic regressions were used to assess the association of immigration status with likelihood of having undergone audiogram among those with objective and self-reported hearing loss, and with likelihood of hearing aid use among candidates with objective hearing loss., Results: Immigrants were less likely to have received an audiogram among subjects with subjective (odds ratio [OR]: 0.81, 95% confidence interval [CI]: 0.75-0.87), and objective (OR: 0.76, 95% CI: 0.72-0.81) hearing loss, compared to nonimmigrants. The association persisted for those with subjective (OR: 0.88, 95% CI: 0.81-0.96), and objective (OR: 0.87, 95% CI: 0.80-0.96) hearing loss after adjusting for sociodemographic factors, comorbidities, insurance, and hearing quality, but disappeared in both groups after adjusting for English proficiency. Immigrants were less likely to use hearing aids (OR: 0.90, 95% CI: 0.87-0.93). However, this association disappeared (OR: 0.98, 95% CI: 0.93-1.04) in the adjusted model., Conclusion: Immigrant status is a significant barrier to hearing health care and is associated with lower rates of audiometric testing and hearing aid use among individuals with hearing loss., (© 2024 American Academy of Otolaryngology–Head and Neck Surgery Foundation.)

Background. Several disparities exist for Black mothers during the postpartum period, including but not limited to increased maternal mortality and morbidity rates, decreased access to care, and limited access to resources. Given the racial discrepancies in attention to postpartum care, coupled with the critical importance of the postpartum period for preventing adverse maternal health outcomes, research is warranted to explore how mobile health (mHealth) applications may help to alleviate maternal health disparities by optimizing postpartum care and addressing barriers to care for postpartum Black women. Thus, this review examines the perceptions of mHealth applications and their utility in health outcomes among postpartum Black women. Methods. We undertook a comprehensive literature search using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We included peer-reviewed articles published between 2010 and 2022 that were written in English, utilized mHealth as a primary intervention, and focused on postpartum health and access to resources, primarily among Black women in the United States. Results. A total of eight articles were included in our synthesis, encompassing mobile phone-based interventions for Black women. Cultural tailoring was included in five studies. Interventions that incorporated tailored content and fostered interactions reported high rates of follow-up. Conclusions. Tailored mHealth interventions can effectively promote behavior change and improve health care outcomes for Black women. However, there is a critical need for more research to assess user engagement and retention and whether these improvements indicate long-term sustainability.

Objective: Motor neuron disease (MND) is a group of neurological diseases, the majority being amyotrophic lateral sclerosis (ALS), with varying clinical presentations across demographics. Clinical trial enrollment reflecting global disease burden improves understanding of diverse presentations and aids personalized therapy development. We assessed the sex, racial, and ethnic composition of MND/ALS clinical trial participants relative to global disease burdens., Methods: We searched 'motor neuron disease OR amyotrophic lateral sclerosis' on ClinicalTrials.gov from 02/2000-04/2024. We extracted trial (start year, study site, sponsor location, phase, masking, intervention) and demographic data (sex, race, ethnicity) from randomized interventional studies. We obtained sex-based MND/ALS disease burden estimates from the Global Burden of Disease database. For females, we calculated pooled participation-to-prevalence ratio (PPR) with 95% confidence intervals (CIs), with PPR of 0.8-1.2 indicating adequate enrollment. We used Kruskal-Wallis tests to compare demographic groups across trial characteristics., Results: Of 85 trials, females comprised 37.47% ( n  = 5011) of 13,372 participants; the pooled female PPR was 0.97 (95% CI: 0.77-1.16). Of 41 trials (9340 participants) reporting race, 121 (1.30%) participants were Black or African American, 16 (0.17%) American Indian or Alaskan Native, and 6 (0.06%) Native Hawaiian or Other Pacific Islander. 24 trials (595 participants) reported ethnicity, with a minority of Hispanic participants ( n  = 153; 2.57%)., Conclusions: MND/ALS clinical trials had adequate female enrollment relative to global disease burdens. Race and ethnicity data were underreported. However, there were enrollment disparities of racial and ethnic groups. Increased trial leadership diversity, equitable enrollment policies, and addressing barriers to participation could improve enrollment diversity.

Study Objective: To investigate the association between race and route of hysterectomy among patients undergoing hysterectomy for abnormal uterine bleeding (AUB) in the absence of uterine myoma disease and excluding malignancy., Design: A cross-sectional cohort study utilizing the Healthcare Cost and Utilization Project Nationwide Inpatient Sample and National Ambulatory Surgical databases to compare abdominal to minimally invasive routes of hysterectomy., Setting: Hospitals and hospital-affiliated ambulatory surgical centers participating in the Healthcare Cost and Utilization Project in 2019., Patients: A total of 75 838 patients who had undergone hysterectomy for AUB, excluding uterine myoma and malignancy., Interventions: n/a MEASUREMENTS AND MAIN RESULTS: Of the 75 838 hysterectomies performed for AUB in the absence of uterine myomas and malignancy, 10.1% were performed abdominally and 89.9% minimally invasively. After adjusting for confounders, Black patients were 38% more likely to undergo abdominal hysterectomy compared to White patients (OR 1.38, CI 1.12-1.70 p = .002). Black race, thus, is independently associated with open surgery., Conclusion: Despite excluding uterine myomas as a risk factor for an abdominal route of hysterectomy, Black race remained an independent predictor for abdominal versus minimally invasive hysterectomy, and Black patients were found to undergo a disproportionately higher rate of abdominal hysterectomy compared to White patients., (Copyright © 2024 AAGL. Published by Elsevier Inc. All rights reserved.)

Objective: While understanding racial/ethnic disparities in mental health services use is a growing priority in colleges and universities, little is known the attitudes that may contribute to these disparities. Methods: This study investigates the relationship between clinic diversity, ethnic-racial identity, discrimination, and treatment attitudes. College students n  = 250 (Asian 21%, Black 11%, Latinx 23%, and White 45%) participated in an online experimental task rating hypothetical clinic websites that varied by clinician diversity and completed a series of self-report questionnaires. Results: Clinician diversity did not influence treatment attitudes, but discrimination and ethnic-racial identity were significantly related to treatment attitudes. Additionally, the relationship between public regard and treatment attitudes was moderated by race/ethnicity. Conclusions: By focusing on treatment attitudes rather than behaviors, this study addresses potential areas of intervention to address racial/ethnic disparities in college mental health.

Purpose: Peer support networks have been suggested to have significant utility in the care of patients with cancer, especially among racial minorities. This article proposes an approach to integrate peer support networks into the care of racial minorities with cancer., Methods: Methods to integrate peer support groups across racial minorities with cancer include utilizing language and religion in strategic recruitment of peer supporters, recruiting minority peer supporters in online oncology peer support groups, and emphasizing relationship & trust building for participant retention., Results: Language concordance among peer support groups may enhance patient understandability, emotional expression, and create a sense of community and safety. Religious integration may also promote support group accessibility, particularly among Blacks, who tend to depend on their religious communities for cancer care guidance to a greater extent. In addition to providing knowledge, online opportunities may also decrease cancer-related stress, depression, and trauma. Trust between individuals and their sociocultural environment and healthcare system, as well as between the community and the healthcare system, is necessary, particularly for racial minorities who may harbor a historical mistrust of the healthcare system., Conclusions: To close the racial cancer care gap, a multi-pronged approach is crucial. This includes establishing tailored peer support networks within minority communities that account for language, religion, and cultural factors to build trust and meet psycho-social needs. However, peer support is just one tool. Other critical tools such as holding healthcare institutions accountable for providing equitable care to racial minorities is equally vital in reducing disparities and improving survival outcomes., Competing Interests: Declarations Conflict of interest Oyepeju Abioye, Lauren Kiel, and Rebekah Kaufman declare no financial or non-financial interests. Narjust Florez reports a consultant/advisor role to Merck, DSI, Pfizer, AstraZeneca, BMS, Regeneron Janssen, Novartis, and NeoGenomics. Narjust Florez reports a consultant/advisor role to Merck, DSI, Pfizer, AstraZeneca, BMS, Regeneron Janssen, Novartis, and NeoGenomics., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: Continuous glucose monitor (CGM) use improves type 1 diabetes (T1D) outcomes, yet children from diverse backgrounds and on public insurance have worse outcomes and lower CGM utilization. Using novel CGM data acquisition and analysis of two T1D cohorts, we test the hypothesis that T1D youth from different backgrounds experience disparities in meaningful CGM use following both T1D diagnosis and CGM uptake., Methods: Cohorts drawn from a pediatric T1D program were followed for one year beginning at diagnosis ( n = 815, 2016-2020) or CGM uptake ( n = 1392, 2015-2020). Using chart and CGM data, CGM start and meaningful use outcomes between racial/ethnic and insurance groups were compared using median days, one-year proportions, and survival analysis., Results: Publicly compared with privately insured were slower to start CGM (233, 151 days, P < .01), had fewer use-days in the year following uptake (232, 324, P < .001), and had faster first discontinuation rates (hazard ratio [HR] = 1.61, P < .001). Disparities were more pronounced among Hispanic and black compared with white subjects for CGM start time (312, 289, 149, P = .0013) and discontinuation rates (Hispanic HR = 2.17, P < .001; black HR = 1.45, P = .038), and remained even among privately insured (Hispanic/black HR = 1.44, P = .0286)., Conclusions: Given the impact of insurance and race/ethnicity on CGM initiation and use, it is imperative that we target interventions to support universal access and sustained CGM use to mitigate the potential impact of provider biases and systemic disadvantage and racism. By enabling more equitable and meaningful T1D technology use, such interventions will begin to alleviate outcome disparities between youth with T1D from different backgrounds., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: To assess whether the provision of fertility treatment for patients with polycystic ovary syndrome (PCOS) varies by patient and physician-level demographic characteristics., Design: Retrospective cohort study., Setting: University health system., Patient(s): Patients seeking care for PCOS and infertility from 2007-2021., Intervention(s): Patient age, body mass index, race, ethnicity, estimated household income, primary insurance payor, provider sex, and provider medical specialty., Main Outcome Measure(s): Prescriptions for fertility treatment, including clomiphene citrate (CC), letrozole, and injectable gonadotropins. Differences in patient and physician demographics between patients who did as well as did not receive a prescription were identified with univariable analysis. Multilevel mixed-effects logistic regression was performed to determine associations between patient and physician demographics and prescription receipt., Result(s): A total of 3,435 patients with PCOS and infertility were identified, with a mean age of 31.1 ± 5.7 years. Of the 68.8% of patients who received a prescription, 47.8% of prescriptions were CC, 38.6% were letrozole, and 13.7% were injectable gonadotropins. There were lower odds of prescription receipt for Black patients compared with White patients (adjusted odds ratio [aOR], 0.75; 95% confidence interval [CI], 0.61-0.93), those with estimated household income below the federal poverty level compared with those above the national median (aOR, 0.71; 95% CI, 0.46-0.97), and those with public compared with commercial insurance (aOR, 0.53; 95% CI, 0.40-0.71). These disparities persisted in a subanalysis of patients prescribed oral medications only with lower odds of prescription receipt for Black compared with White patients (aOR, 0.74; 95% CI, 0.57-0.95), those with estimated household income below the federal poverty level compared with above the national median (aOR, 0.93; 95% CI, 0.87-0.98), and those with public compared with commercial insurance (aOR, 0.57; 95% CI, 0.42-0.76). Black patients waited, on average, 153.3 days longer than White patients, from the initial visit to the prescription receipt. Patients had lower odds of receiving any prescription from family medicine physicians (aOR, 0.36; 95% CI, 0.24-0.52) and general internal medicine physicians (aOR, 0.55; 95% CI, 0.42-0.73) compared with reproductive endocrinologists., Conclusion(s): Racial and socioeconomic disparities exist in the provision of infertility treatments for patients with PCOS. Fewer primary care physicians engaged in first-line fertility treatment, indicating an opportunity for physician education to improve access to fertility care., (Copyright © 2024 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: The authors examined the effects of race and ethnicity on the likelihood of experiencing delays to surgery, postoperative surgical complications, and prolonged hospital length of stay (LOS) after primary cleft lip repair., Methods: Patients who underwent cleft lip repair were identified in the 2006 through 2012 Kids' Inpatient Database. Primary outcomes were defined as treatment after 6 months of age, any surgical complication, LOS greater than 1 day, and total hospital charges. Multivariable analyses were performed to adjust for sociodemographic and clinical characteristics that might account for differences in outcomes., Results: There were 5,927 eligible patients with cleft lip: 3,724 White, 1,316 Hispanic, 279 Black, 277 Asian or Pacific Islander, and 331 other (including American Indian or Alaska Native, multiple races, or races/ethnicities not specified within the dataset). Across all outcomes, there were significant unadjusted differences ( P < 0.001) by race and ethnicity, with White children having the lowest odds of delayed surgery, complications, and prolonged LOS, and the lowest charges. Multivariable analyses suggested that differences in baseline health status may account for much of this disparity in combination with factors such as income, insurance type, and location. Even after adjusting for covariates, significantly increased odds of delayed surgery and higher charges remained for Hispanic and Asian or Pacific Islander patients., Conclusion: There are significant differences in the odds of delays, complications, prolonged hospital stays, and total charges among patients with cleft lip of different races or ethnicities. Advocacy efforts to ameliorate disparity in early infant health may subsequently improve equity in cleft outcomes., Clinical Question/level of Evidence: Risk, II., (Copyright © 2024 by the American Society of Plastic Surgeons.)

Objective: To quantify the effect of neighborhood socioeconomic vulnerability as it relates to racial disparity in uterine cancer treatment and survival., Methods: Patients with a diagnosis of uterine cancer who underwent hysterectomy in New York State from 2004 to 2017 were included in this retrospective cohort study. Neighborhood socioeconomic vulnerability as quantified by the Area Deprivation Index was calculated. Primary outcome was guideline adherent treatment; secondary outcome was 5 year overall survival., Results: A total of 34,356 patients were included in the final cohort. Residence within a vulnerable neighborhood was associated with a lower likelihood of receiving appropriate adjuvant chemotherapy (59.7% vs 75.7% with aRR = 0.81; 95% CI, 0.77-0.86) and timely surgery (63.7% vs. 74.5% with aRR = 0.85; 95% CI, 0.82-0.87). All-cause mortality was 24% higher for those who resided in vulnerable neighborhoods compared to affluent neighborhoods (aHR = 1.24; 95% CI, 1.16-1.32). The greatest Black/White racial disparity in 5 year overall survival was seen in the most affluent neighborhoods at 18.6%, with survival being 79.8% for White patients and 61.2% for Black patients (aHR 1.31; 95% CI 1.14-1.51). For patients with advanced stage disease, this disparity was driven by improved survival for White patients with increasing neighborhood affluence but no change in survival for Black patients. On adjusted analysis controlling for age, comorbidities, insurance, tumor histology, stage, and grade, the disparity remained widest in the most affluent neighborhoods in NYC (aHR = 1.59; 95%CI 1.26-1.2.01)., Conclusions: Neighborhood socioeconomic vulnerability is associated with poor outcomes for patients with uterine cancer. The greatest Black/White survival disparities are in the wealthiest neighborhoods. Neighborhood affluence may not affect survival of Black patients with advanced stage endometrial cancer., Competing Interests: Declaration of competing interest JDW is a consultant for UpToDate and has research funding from Merck. No other author has any conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Americans have increasingly turned to online crowdfunding to pay for healthcare costs, but our understanding of the inequalities in medical crowdfunding remains limited. This study investigates racial disparities in medical crowdfunding outcomes and examines the role of communication in amplifying, altering, or even reducing the disparities. Using data from 1,127 medical crowdfunding campaigns on GoFundMe, the study found that beneficiaries of color received significantly fewer donations than their White counterparts. The differences in donations between racial groups were partly attributable to sharing disparities. Campaigns for beneficiaries of color were shared less via e-mail or social media than campaigns for White beneficiaries. Campaign narratives with more humanizing details about beneficiaries were associated with more donations. However, humanizing details did not predict more shares, nor were they linked to smaller disparities in campaign outcomes between racial groups. Post-hoc analyses showed that more humanizing details were linked to fewer campaign donations for male beneficiaries of color. The findings contribute to the scholarship addressing the intersections of communication and health inequality on digital platforms.

Background: Minority racial and ethnic populations have the highest prevalence of type 2 diabetes mellitus but lower use of sodium-glucose co-transporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1ra), novel medications that reduce morbidity and mortality. Observed disparities may be due to differences in insurance coverage, which have variable cost-sharing, prior authorization, and formulary restrictions that influence medication access., Objective: To assess whether racial/ethnic differences in SGLT2i and GLP1ra use differ by payer., Design: Cross-sectional analysis of 2018 and 2019 Medical Expenditure Panel Survey data., Participants: Adults ≥ 18 years old with diabetes., Main Measures: We defined insurance as private, Medicare, or Medicaid using ≥ 7 months of coverage in the calendar year. We defined race/ethnicity as White (non-Hispanic) vs non-White (including Hispanic). The primary outcome was use of ≥ 1 SGLT2i or GLP1ra medication. We used multivariable logistic regression to assess the interaction between payer and race/ethnicity adjusted for cardiovascular, socioeconomic, and healthcare access factors., Key Results: We included 4997 adults, representing 24.8 million US adults annually with diabetes (mean age 63.6 years, 48.8% female, 38.8% non-White; 33.5% private insurance, 56.8% Medicare, 9.8% Medicaid). In our fully adjusted model, White individuals with private insurance had significantly more medication use versus non-White individuals (16.1% vs 8.3%, p < 0.001), which was similar for Medicare beneficiaries but more attenuated (14.7% vs 11.0%, p = 0.04). Medication rates were similar among Medicaid beneficiaries (10.0% vs 9.0%, p = 0.74)., Conclusions: Racial/ethnic disparities in novel diabetes medications were the largest among those with private insurance. There was no disparity among Medicaid enrollees, but overall prescription rates were the lowest. Given that disparities vary considerably by payer, differences in insurance coverage may account for the observed disparities in SGLT2i and GLP1ra use. Future studies are needed to assess racial/ethnic differences in novel diabetes use by insurance formulary restrictions and out-of-pocket cost-sharing., Competing Interests: Declarations: Conflict of Interest: The authors declare that they do not have a conflict of interest., (© 2024. The Author(s).)

Clinical trial enrollment provides various benefits to study participants including early access to novel therapies that may potentially alter the trajectory of disease states. Trial sponsors benefit from enrolling demographically diverse trial participants enabling the trial outcomes to be generalizable to a larger proportion of the community at large. Despite these and other well-documented benefits, clinical trial enrollment for Black and Hispanic Americans as well as women continues to be low. Specific disease states such as peripheral artery disease (PAD) have a higher prevalence and clinical outcomes are relatively worse in Black Americans compared with non-Hispanic white Americans. The recruitment process for PAD clinical trials can be costly and challenging and usually comes at the expense of representation. Participant willingness and trust, engagement, and socioeconomic status play essential roles in the representation of under-represented minority (URM) groups. Despite the contrary belief, URM groups such as Blacks and Hispanics are just as willing to participate in a clinical trial as non-Hispanic Whites. However, financial burdens, cultural barriers, and inadequate health literacy and education may impede URMs' access to clinical trials and medical care. Clinical trials' enrollment sites often pose transportation barriers and challenges that negatively impact creating a diverse study population. Lack of diversity among a trial population can stem from the stakeholder level, where corporate sponsors of academic readers do not consider diversity in clinical trials a priority due to false cost-benefit assumptions. The funding source may also impact the racial reporting or the results of a given trial. Industry-based trials have always been criticized for over-representing non-Hispanic White populations, driven by the desire to reach high completion rates with minimum financial burdens. Real efforts are warranted to ensure adequate minorities' representation in the PAD clinical trials and to the process toward the ultimate goal of developing more durable and effective PAD treatments that fit the needs of real-world populations., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Importance: Sacral neuromodulation (SNM) is an effective treatment for fecal incontinence (FI). Previous studies found that Black women undergo SNM for urinary incontinence less than White women, but there is less known about racial disparities for FI., Objective: This study assessed differences in Black and White patients' FI treatment; SNM counseling was the primary outcome., Study Design: This was a retrospective cohort study of adult non-Hispanic Black and White patients who received FI treatment at an academic institution from 2011 to 2021. Medical records were queried for treatments, testing, and treating specialties for a 2:1 age-matched cohort of White:Black patients., Results: Four hundred forty-seven women were included: 149 Black women and 298 age-matched White women. A total of 24.4% (109) of patients had documented SNM counseling, significantly fewer in Black patients (14.8% vs 29.2%, P < 0.001). A total of 5.1% (23) of patients received SNM, less frequent in Black patients (2.7% vs 6.4%, P = 0.003). Among patients with SNM counseling, there was no difference between cohorts. Black patients were less likely to be referred for physical therapy (59.7% vs 77.2%, P < 0.001), sphincter imaging (0.7% vs 5.7%, P = 0.011), and defecography (8.1% vs 17.1%, P = 0.009). Different specialties managed the 2 cohorts. Black patients were less likely to see urogynecology and colorectal surgery (21.5% vs 34.6%, P = 0.004; 9.4% vs 15.4%, P = 0.077). Patients seen by these surgeons were more likely to discuss SNM (48.6% vs 8.5%, P < 0.001)., Conclusions: There were differences between Black and White patients' FI treatment, including counseling about SNM. Multidisciplinary work is needed to provide equitable education for this life-altering condition., Competing Interests: The authors have declared they have no conflicts of interest., (Copyright © 2024 American Urogynecologic Society. All rights reserved.)

Objective: Racial and ethnic disparities in total joint replacements have been documented. Our objective was to determine the rates of total joint replacements for Alaska Native/American Indian (AN/AI) individuals compared with non-AN/AI individuals in Alaska and investigate the differences in characteristics and outcomes by race., Methods: We used hospital discharge data from the Alaska Health Facilities Data Reporting Program from 2015 to 2018. We identified people with an inpatient primary or revision total knee arthroplasty (TKA) or total hip arthroplasty (THA). We determined the population proportion of each procedure, age-adjusted rates by race, age-specific rates, and multivariable adjusted rate ratios for TKA or THA. We compared the characteristics of people undergoing primary TKA and THA by race., Results: In 2,195,806 person-years, there were 8,131 arthroplasty procedures (4,594 primary TKAs, 2,791 primary THAs, 378 revision TKAs, and 368 revision THAs). Primary TKAs and THAs were less likely in people of AN/AI or "Other" race compared with people of White race, with some heterogeneity in the "Other" race category. In multivariable models, the adjusted rate ratio for AN/AI compared with White race for TKA was 0.70 (95% confidence interval [CI] 0.60-0.82) and for THA was 0.69 (95% CI 0.55-0.85). AN/AI individuals undergoing TKA and THA were more likely to reside in rural locations, be younger than 65 years, have longer hospital stay, and discharge to home., Conclusion: This study confirmed the existence of racial disparities in TKA and THA in Alaska. There may be many underlying causes, and future research should focus on improving access to care., (© 2024 American College of Rheumatology.)