Racial inequalities in journals highlighted in giant study.

The aim of this population-based cross-sectional study was to investigate access by 20 to 60 year-old women--both black and white--to early detection (pap-smear) exams for breast and cervical cancer in two towns--São Leopoldo and Pelotas--in Rio Grande do Sul State, southern Brazil. Estimates of the association between race/color and access to Pap-smear and breast exams were adjusted for income, education, economic class and age. Of the 2,030 women interviewed, 16.1% were black and 83.9%, white. Black women were significantly less likely to have had a Pap-smear and/or breast exam than white women. Racial inequalities in access to cancer early detection exams persisted after controlling for age and other socioeconomic factors. Racial differentials in access to early detection (Pap-smear) exams for breast and cervical cancers might result from racial and socioeconomic inequalities experienced by black women in access to reproductive health care services and programs.

Objectives There is limited evidence regarding the impact of race/racism and its intersection with socioeconomic status (SES) on breast and cervical cancer, the two most common female cancers globally. We investigated racial inequalities in breast and cervical cancer mortality and whether SES (education and household conditions) interacted with race/ethnicity. Design The 100 Million Brazilian Cohort data were linked to the Brazilian Mortality Database, 2004–2015 (n = 20,665,005 adult women). We analysed the association between self-reported race/ethnicity (White/‘Parda’(Brown)/Black/Asian/Indigenous) and cancer mortality using Poisson regression, adjusting for age, calendar year, education, household conditions and area of residence. Additive and multiplicative interactions were assessed. Results Cervical cancer mortality rates were higher among Indigenous (adjusted Mortality rate ratio = 1.80, 95%CI 1.39–2.33), Asian (1.63, 1.20–2.22), ‘Parda’(Brown) (1.27, 1.21–1.33) and Black (1.18, 1.09–1.28) women vs White women. Breast cancer mortality rates were higher among Black (1.10, 1.04–1.17) vs White women. Racial inequalities in cervical cancer mortality were larger among women of poor household conditions, and low education (P for multiplicative interaction <0.001, and 0.02, respectively). Compared to White women living in completely adequate (3–4) household conditions, the risk of cervical cancer mortality in Black women with 3–4, 1–2, and none adequate conditions was 1.10 (1.01–1.21), 1.48 (1.28–1.71), and 2.03 (1.56–2.63), respectively (Relative excess risk due to interaction-RERI = 0.78, 0.18–1.38). Among ‘Parda’(Brown) women the risk was 1.18 (1.11–1.25), 1.68 (1.56–1.81), and 1.84 (1.63–2.08), respectively (RERI = 0.52, 0.16–0.87). Compared to high-educated White women, the risk in high-, middle- and low-educated Black women was 1.14 (0.83–1.55), 1.93 (1.57–2.38) and 2.75 (2.33–3.25), respectively (RERI = 0.36, −0.05–0.77). Among ‘Parda’(Brown) women the risk was 1.09 (0.91–1.31), 1.99 (1.70–2.33) and 3.03 (2.61–3.52), respectively (RERI = 0.68, 0.48–0.88). No interactions were found for breast cancer. Conclusion Low SES magnified racial inequalities in cervical cancer mortality. The intersection between race/ethnicity, SES and gender needs to be addressed to reduce racial health inequalities.

We replicate previous research investigating changes in racial occupational inequality disaggregated by age and level of educational attainment (Hare, 1965; Siegel, 1965; Johnson and Sell, 1976) and then extend this research in four ways. First, wre update previous analyses by examining change in inequality between 1970 and 1980. Second, wre perform separate analyses by region as tell as analyses for the nation as a whole. Third, we investigate race differences in occupational attainment using the Index of Net Difference, a measure of ordinal inequality, as well as the more familiar Index of Dissimilarity (used in previous research), a measure of nominal differentiation. Fourth, wae investigate changes in inequality over the period 1940 to 1980 using constant age, education, and occupation categories. Our analyses reveal a number of significant findings including: (a) the Index of Net Difference reveals patterns of change in racial inequality over time that cannot be detected using the Index of Dissimilarity; (b) change in inequality favored whites for the nation as a whole and the non-South during the 1940s, andfavored blacks during the 1950s, 1960s, and 1970s, and (c) change in inequality favored whites for the South during the 1940s and 1950s andfavored blacks during the 1960s and 1970s.

Racial inequalities in cognitive health are well-established. Black older adults have worse cognitive health than White older adults. However, evidence has been primarily found using data on the U.S. population, limiting scientific insight into how historically and socially constructed racial structures impact racial inequalities in cognitive health. Using nationally, representative studies from the United States (HRS) and Brazil (ELSI-Brazil), I examine racial inequalities in cognitive functioning (global and domain-specific) and their life-course socioeconomic determinants. I use a series of linear regression models to examine racial differences in cognitive functioning and to determine how accounting for life course socioeconomic conditions (retrospective childhood socioeconomic status, educational attainment, and adulthood income adjusted for household size) attenuate observed differences. Results show different patterns in racial inequalities in cognitive functioning across countries, with Black Americans having the lowest cognitive functioning in the United States and Asian Brazilians having the lowest cognitive functioning in Brazil. In Brazil and the United States, White older adults had the highest levels of cognitive functioning. However, the magnitude of racial inequalities differed by country, with preliminary findings showing greater differences in the United States than in Brazil. Lastly, regardless of country, childhood socioeconomic conditions and educational attainment greatly attenuated racial differences in cognitive functioning, reducing some racial inequalities to non-significance, indicating that the early life opportunities in establishing cognitive functioning may be substantially contributing to racial inequalities in both contexts. This research points to the need to consider context in understanding how and why racial inequalities in cognitive health arise.

Background: It is unclear how the expected risk of Mild Cognitive Impairment (MCI) and conversion to dementia in the United States differs by Race/ethnicity and gender in older adults. It is unclear whether expectations about racial disparities have changed in light of changing trends in obesity and diabetes. Method: We analyzed six waves of the National Health and Aging Trends Study (NHATS), a nationally representative prospective cohort study of U.S. residents aged 65 and older. Participants were classified into four clinically meaningful mutually-exclusive groups: unimpaired, MCI, probable dementia and death. We used multistate survival models to examine individuals’ cognitive transitions and reported predictors using hazards ratios. Results: Participants (n=6,078) were 77 years old, on average, and the majority were white, females and high school graduates. Increased age was associated with risk of MCI and death. Adjusted for obesity status and diabetes, Hispanics were had a net reduced risk of death from dementia (HR=0.60; 95% CI [0.38-0.96]) but lived longer with MCI and dementia before death. Cognitively normal Blacks faced significantly increased risk of developing MCI (HR=2.54 95% CI [1.81-3.53]) and dementia (HR=1.77 95% CI [1.34-2.35]). Obese and overweight elderly had reduced risk across transitions to MCI then to dementia, but similar risks of death compared to lower body mass indices (BMI). BMI and diabetes reveal a suppression effect and racial inequalities became more apparent. Discussion: Results showed persistent racial inequalities in MCI, probable dementia, and death, supporting the theory that racial/ethnic factors are important to expectations of aging Americans.

Background:Cross-national comparisons allow the examination of the malleability of associations between race and health. Racial inequities in chronic conditions, indicators of health status and behavioural risk factors between two similar...

Scholarship on family member incarceration, and the gendered nature of this critical life event, has expanded rapidly in the last 20 years. Yet, in England and Wales, the experiences of racially minoritized women are unclear, despite stark racial disparities in the prison estate. Based on in-depth, qualitative interviews with British Pakistani women, this article makes a vital contribution to this lacuna in research. Using intersectionality as an analytical framework, it determines that these women’s experiences are underpinned by wider racial and ethnic inequalities in broader social contexts, discrimination within the criminal justice and prison systems, and their social positioning in socio-political, biographic and historic contexts, which converge to severely compound the social harm experienced by this population.

COVID-19 exposed longstanding racial and ethnic inequities among underserved populations. This retrospective cohort study examined inequities across stages of the hospitalization continuum-from COVID-19 diagnosis at admission to in-hospital mortality, including mortality patterns among COVID-19 hospitalizations-among Medicaid beneficiaries in Kentucky during 2020-2021. Statewide hospitalizations were analyzed using multivariable regression models, with propensity score matching (PSM) used as a confirmatory approach. Non-Hispanic Black patients were more likely than non-Hispanic White patients to be hospitalized with COVID-19 (adjusted odds ratio [aOR] = 1.41; 95% confidence interval [CI] = 1.26-1.59). Across the full cohort, COVID-19 hospitalizations were associated with substantially higher in-hospital mortality compared with non-COVID-19 hospitalizations (adjusted hazard ratio [aHR] = 2.38; 95% CI = 2.09-2.70). Additionally, hospitalizations among non-Hispanic Black patients had a modestly lower hazard of in-hospital mortality compared with non-Hispanic White patients (aHR = 0.81; 95% CI = 0.70-0.94). However, in analyses restricted to COVID-19 hospitalizations, adjusted estimates showed no Black-White differences in in-hospital mortality, with consistent findings from PSM analyses. These results indicate that racial inequities were more pronounced at hospital admission than during inpatient care, underscoring the importance of prevention, early diagnosis, and timely outpatient care as COVID-19 enters an endemic phase.

This paper explores recent racial and ethnic inequalities in poverty, estimating the share of racial poverty differentials that can be explained by variation in family structure and workforce participation. The authors use logistic regression to estimate the association between poverty and race, family structure, and workforce participation. They then decompose between-race differences in poverty risk to quantify how racial disparities in marriage and work explain observed inequalities in the log odds of poverty. They estimate that 47.7-48.9% of black-white differences in poverty risk can be explained by between-group variance in these two factors, while only 4.3-4.5% of the Hispanic-white differential in poverty risk can be explained by these variables. These findings underscore the continued association between racial disparities in poverty and those in labor and marriage markets. However, clear racial differences in the origin of poverty suggest that family- and worked-related policy interventions will not have uniformly effective or evenly distributed impacts on poverty reduction.

Uses of theory in racial health disparities research: a scoping review and application of public health critical race praxis

We present a simple equilibrium model of group conflict that formalizes several key insights of stratification economics. To begin with, discrimination is a purposeful activity pursued by dominant groups in order to maintain their status in society. However, not every member of the dominant group needs to fully engage in discriminatory efforts. In other words, dominant-group members can free ride on discriminatory actions taken by members of the same group. At the same time, though, someone must have discriminated, otherwise discrimination would not exist in equilibrium. We also show that discrimination is wasteful from a societal standpoint; yet, it persists because of the dominant group’s interest in maintaining their status, the fact that marginalized groups’ agency in lessening the effects of discrimination has costs, and the costly and imperfect nature of antidiscrimination enforcement. In particular, when the burden of proving discriminatory behavior falls on individuals in the marginalized group, discrimination will never be completely removed. Finally, we highlight how racial income inequality reverberates into wealth inequality (i.e., stratification), and we discuss the role of reparations in mitigating such outcomes.

Purpose: Black women in the United States face poor outcomes across reproductive health measures—from pregnancy outcomes to gynecologic cancers. Racial health inequities are attributable to systemic racism, but few population studies of reproductive health outcomes integrate upstream measures of systemic racism, and those who do are limited to maternal and infant health outcomes. Advances in understanding and intervening on the pathway from racism to reproductive health outcomes are limited by a paucity of methodological guidance toward this end. We aim to fill this gap by identifying quantitative measures of systemic racism that are salient across reproductive health outcomes.Methods: We conducted a review of literature from 2000 to 2019 to identify studies that use quantitative measures of exposure to systemic racism in population reproductive health studies. We analyzed the catalog of literature to identify cohesive domains and measures that integrate data across domains. For each domain, we contextualize its use within population health research, describe metrics currently in use, and present opportunities for their application to reproductive health research.Results: We identified four domains of systemic racism that may affect reproductive health outcomes: (1) civil rights laws and legal racial discrimination, (2) residential segregation and housing discrimination, (3) police violence, and (4) mass incarceration. Multiple quantitative measures are available for each domain. In addition, a multidimensional measure exists and additional domains of systemic racism are salient for future development into distinct measures.Conclusion: There are quantitative measures of systemic racism available for incorporation into population studies of reproductive health that investigate hypotheses, including and beyond those related to maternal and infant health. There are also promising areas for future measure development, such as the child welfare system and intersectionality. Incorporating such measures is critical for appropriate assessment of and intervention in racial inequities in reproductive health outcomes.

MP57-07 PATTERNS AND IMPACT OF BURNOUT AMONG WOMEN IN THE UROLOGY WORKFORCE

Reviewing public health, nutrition, and social science literature, this article examines how bottled water consumption and spending in the United States differ along lines of race, ethnicity, and income, how these consumption patterns have changed in recent years, and how those shifts map onto perceptions of the safety and trustworthiness of tap water supplies, both before and since the Flint water disaster. It also addresses the differential impact of bottled water spending on household income. The findings challenge the truism that bottled water consumption is positively correlated with income, instead showing a bimodal racial and class consumption pattern that reflects widely divergent perceptions—and the uneven distribution—of threats to tap water safety. Bottled water consumption and spending, as well as distrust of tap water, are highest among low‐income, Black, and Latino/a households, exacerbating social inequality. The article also addresses how the bottled water industry is responding to these dynamics, and considers potential routes to restoring both public water infrastructure and trust in tap water supplies. This contribution links several current and salient topics: the relationship between bottled water's growth and tap water consumption; the dynamics of growing racial and income inequality; historical legacies of systemic racism and economic marginalization; and the uneven effects of disinvestment in US water infrastructure on tap water safety, access, and affordability.This article is categorized under: Human Water &gt; Human Water Human Water &gt; Water Governance Human Water &gt; Rights to Water Engineering Water &gt; Water, Health, and Sanitation

Racial inequities in substance use disorder treatment, and specifically buprenorphine treatment, contribute to overdose inequities. Bridge Clinics are a low-threshold, transitional treatment model that may improve treatment access. This report assesses the change in visit volume for Black and Hispanic patients and those with limited English proficiency (LEP) after the implementation of the Bridge Clinic expansion across 4 distinct sites. Between October 2021 and 2023, 3 hospital-based Bridge Clinics were expanded, and a community-based Bridge Clinic was established, all in regions with high racial and language inequities in overdose mortality. Implementation included creating Bridge Clinic performance measures, which were reviewed with clinic leadership monthly, developing a toolkit, and launching mobile services. We present Bridge Clinic visit volume aggregated by calendar year for Black-non Hispanic, Hispanic (any race), and LEP patients. We calculated the percent of total visits for each patient group and assessed the change over time. Comparing 2021 to 2023, total visits increased from 5323 to 10,350, and unique patients increased from 1893 to 3316. Annual visits increased from 437 to 1151 visits for Black patients; 566 to 1609 for Hispanic patients; and 96 to 265 for LEP patients. The percent of visits grew significantly for Black (8.21% vs. 10.24%, P<0.001), Hispanic (10.63% vs. 15.55%, P<0.001) and LEP patients (1.80% vs. 2.56%, P=0.003) from 2021 to 2023. Expanding low-barrier Bridge Clinics may increase substance use disorder (SUD) treatment visits for Black and Hispanic patients and those with LEP.