Introduction Progress toward the global elimination of cervical cancer as a public health concern remains slow and highly uneven across countries.High-income nations such as Australia and FinlandDboth of which have ac...Introduction Progress toward the global elimination of cervical cancer as a public health concern remains slow and highly uneven across countries.High-income nations such as Australia and FinlandDboth of which have achieved high human papillomavirus(HPV)vaccination coverage and implemented quality-assured cervical cancer screening programs-have successfully decreased the incidence rates to below 8 cases per 100,000 women~1.These countries are on track to reach the elimination threshold of fewer than 4 cases per 100,000 women within the next few years,as defined by the World Health Organization(WHO).展开更多
BACKGROUND Liver disease is a major cause of mortality in Mexico.Liver transplantation(LT)remains severely limited,and there are no reports on equity of access.AIM To analyze geographical disparities in LT access in M...BACKGROUND Liver disease is a major cause of mortality in Mexico.Liver transplantation(LT)remains severely limited,and there are no reports on equity of access.AIM To analyze geographical disparities in LT access in Mexico.METHODS LT waitlist registrations and LT rates in Mexico from 2014 to 2023 were assessed.LT listings per million persons(pmp)were calculated.Observed-to-expected listings were calculated by controlling listings pmp and mortality rate per 10000.LT and waitlist mortality was calculated as 90-day rate,overall rate and rate per 100 person-years.We compared access to waitlist,transplantation and mortality between patients living in Mexican States with higher LT activity and those living in other States.RESULTS There were 2600 new waitlist registrations;1572 registrations(60.4%)living in Mexico City and State,Jalisco and Nuevo Leon.There were 1755 LT;92.5%of them performed in States with higher LT activity,and 1101(62.7%vs 37.3%;P<0.001)done in patients living in those States.Listings pmp in the Mexican States with high LT activity were 3.8,1.5 vs 1.2,0.6(P<0.001);observed-to-expected listings were 1.3,0.4 vs 0.4,0.2(P<0.001);LT pmp were 2.7,0.9 vs 0.7,0.5(P<0.001).After controlling for other variables,patients living in high LT activity States had a HR 1.14(95%CI:1.03-1.26;P=0.009)to be a case of transplantation after listing.CONCLUSION Geographic disparities substantially affect LT access in Mexico.The population living near Transplant Centers has a 3.2-fold higher access to the waiting list and a 3.8-fold higher likelihood of LT.Current referral system,and resource allocation need urgent revision to remove the barriers associated with geographic disparity.展开更多
Childhood neuroblastoma,a leading cause of cancer-related mortality in young children,accounts for approximately 8%-10%of pediatric cancers1.Originating from neural crest cells of the sympathetic nervous system,these ...Childhood neuroblastoma,a leading cause of cancer-related mortality in young children,accounts for approximately 8%-10%of pediatric cancers1.Originating from neural crest cells of the sympathetic nervous system,these tumors affect primarily children younger than 5 years of age and are often diagnosed in advanced stages,because of their aggressive nature and vague early symptoms2-4.展开更多
BACKGROUND Metabolic dysfunction-associated steatohepatitis(MASH)is increasingly common,as is hepatocellular carcinoma(HCC)in the background of MASH.Liver transplantation(LT)provides superior long-term survival for pa...BACKGROUND Metabolic dysfunction-associated steatohepatitis(MASH)is increasingly common,as is hepatocellular carcinoma(HCC)in the background of MASH.Liver transplantation(LT)provides superior long-term survival for patients with unresectable MASH-HCC,but not all patients have equal access to transplant.MASH-HCC disproportionately affects Hispanic patients,but minorities are less likely to undergo LT for HCC.Additionally,females also undergo LT at lower rates than males.AIM To investigate whether race/ethnicity and sex affect LT waitlist outcomes.METHODS Records of adults with MASH-HCC in the United States Organ Procurement and Transplantation Network database listed for LT between 1/2015 and 12/2021 were analyzed.RESULTS Most of the 3810 patients waitlisted for LT for MASH-HCC were non-Hispanic(NH)white(71.2%)or Hispanic(23.4%),with only 49(1.1%)NH Black candidates.Hispanics underwent LT at lower rates than NH whites(71.6%vs 78.4%,P<0.001),but race/ethnicity did not affect waitlist mortality(P=0.06).Patients with Hispanic[hazard ratio(HR)=0.85,95%CI:0.77-0.95,P=0.002]or Asian(HR=0.79,95%CI:0.63-0.98,P=0.04)race/ethnicity were less likely to undergo LT.Women were also less likely to receive LT(male:HR=1.16,95%CI:1.04-1.29,P=0.01).Patients in regions 1 and 9 were less likely to be transplanted as well(P=0.07).CONCLUSION Hispanic patients are less likely to undergo LT for MASH-HCC,concerning given their susceptibility to MASH and HCC.There were very few NH Black candidates.Disparities were also unequal across regions,which is particularly concerning in states where at-risk populations have rising cancer incidence.Additional research is needed to identify strategies for mitigating these differences in access to LT for MASH-HCC.展开更多
BACKGROUND There is widespread debate about the impact of metabolically healthy obesity(MHO)on cardiovascular outcomes.However,studies have not exclusively examined the impact of MHO on cardiovascular outcomes in the ...BACKGROUND There is widespread debate about the impact of metabolically healthy obesity(MHO)on cardiovascular outcomes.However,studies have not exclusively examined the impact of MHO on cardiovascular outcomes in the postmeno-pausal population.AIM To explore the prevalence of MHO and its relationship with hospitalization outcomes,including major adverse cardiac or cerebrovascular events(MACCE),in postmenopausal women.METHODS We extracted data from the National Inpatient Sample 2020 database using International Classification of Disease,Tenth Revision,Clinical Modification codes for all admissions of postmenopausal women.We excluded patients with diabetes,hypertension,and hyperlipidemia to obtain metabolically healthy patients and then identified patients with obesity to create obese and non-obese cohorts.We used a 1:1 propensity score matching method to match patients with and without MHO based on age,and then we did a multivariable regression analysis for in-hospital MACCE.RESULTS In 2020,1304185 metabolically healthy postmenopausal women were admitted;148250(11.4%)had MHO.After propensity score matching for age,a statistically significant difference was observed in overall MACCE[odds ratio(OR):1.08,95%confidence interval(CI):1.01-1.16,P=0.028]among MHO and non-MHO cohorts,especially in patients of African-American ethnicity(OR:1.23,95%CI:1.01-1.49,P=0.035)and the lowermost income quartile(OR:1.24,95%CI:1.06-1.44,P=0.007).CONCLUSION Postmenopausal patients with MHO are at risk of MACCE,especially black patients and those with lower incomes.Larger prospective studies can demystify MHO’s impact on cardiovascular outcomes among postmenopausal women.展开更多
Based on daily precipitation data from 192 observation stations in South China during the pre-flood period(April-June)from 1965 to 2016,this study analyzed the spatiotemporal variations of the heavy precipitation conc...Based on daily precipitation data from 192 observation stations in South China during the pre-flood period(April-June)from 1965 to 2016,this study analyzed the spatiotemporal variations of the heavy precipitation concentration index(Q index).The results showed that the intensity of heavy precipitation exhibited an increasing trend across most regions of South China.The multi-year mean Q index for the stations ranged from 0.3 to 0.6,with an overall average of 0.375.Notably,significant upward trends in both the heavy precipitation and Q index were observed in the inland and western mountainous areas of South China,indicating a higher flood risk in these regions.Moreover,an analysis of precipitation duration showed that 2-day heavy rainfall events are increasing in the inland areas,western mountains,and eastern Guangdong,while 3-day and 4-day heavy rainfall events steadily increased primarily in coastal areas,with 3-day events also increasing in eastern Guangzhou.The observed rise of heavy precipitation during the pre-flood period across the western mountainous areas,eastern Guangdong,and southeastern coastal areas of South China is mainly attributed to an increase in long-duration heavy precipitation.展开更多
BACKGROUND Barrett's esophagus(BE)is a known premalignant precursor to esophageal adenocarcinoma(EAC).The prevalence rates continue to rise in the United States,but many patients who are at risk of EAC are not scr...BACKGROUND Barrett's esophagus(BE)is a known premalignant precursor to esophageal adenocarcinoma(EAC).The prevalence rates continue to rise in the United States,but many patients who are at risk of EAC are not screened.Current practice guidelines include male gender as a predisposing factor for BE and EAC.The population-based clinical evidence regarding female gender remains limited.AIM To study comparative trends of gender disparities in patients with BE in the United States.METHODS A nationwide retrospective study was conducted using the 2009-2019 National Inpatient Sample(NIS)database.Patients with a primary or secondary diagnosis code of BE were identified.The major outcome of interest was determining the gender disparities in patients with BE.Trend analysis for respective outcomes for females was also reported to ascertain any time-based shifts.RESULTS We identified 1204190 patients with BE for the study period.Among the included patients,717439(59.6%)were men and 486751(40.4%)were women.The mean age was higher in women than in men(67.1±0.4 vs 66.6±0.3 years,P<0.001).The rate of BE per 100000 total NIS hospitalizations for males increased from 144.6 in 2009 to 213.4 in 2019(P<0.001).The rate for females increased from 96.8 in 2009 to 148.7 in 2019(P<0.001).There was a higher frequency of obesity among women compared to men(17.4%vs 12.6%,P<0.001).Obesity prevalence among females increased from 12.3%in 2009 to 21.9%in 2019(P<0.001).A lower prevalence of smoking was noted in women than in men(20.8%vs 35.7%,P<0.001).However,trend analysis showed an increasing prevalence of smoking among women,from 12.9%in 2009 to 30.7%in 2019(P<0.001).Additionally,there was a lower prevalence of alcohol abuse,Helicobacter pylori(H.pylori),and diabetes mellitus among females than males(P<0.001).Trend analysis showed an increasing prevalence of alcohol use disorder and a decreasing prevalence of H.pylori and diabetes mellitus among women(P<0.001).CONCLUSION The prevalence of BE among women has steadily increased from 2009 to 2019.The existing knowledge concerning BE development has historically focused on men,but our findings show that the risk in women is not insignificant.展开更多
BACKGROUND Non-alcoholic fatty liver disease(NAFLD)increases cardiovascular disease(CVD)risk irrespective of other risk factors.However,large-scale cardiovascular sex and race differences are poorly understood.AIM To ...BACKGROUND Non-alcoholic fatty liver disease(NAFLD)increases cardiovascular disease(CVD)risk irrespective of other risk factors.However,large-scale cardiovascular sex and race differences are poorly understood.AIM To investigate the relationship between NAFLD and major cardiovascular and cerebrovascular events(MACCE)in subgroups using a nationally representative United States inpatient sample.METHODS We examined National Inpatient Sample(2019)to identify adult hospitalizations with NAFLD by age,sex,and race using ICD-10-CM codes.Clinical and demographic characteristics,comorbidities,and MACCE-related mortality,acute myocardial infarction(AMI),cardiac arrest,and stroke were compared in NAFLD cohorts by sex and race.Multivariable regression analyses were adjusted for sociodemographic characteristics,hospitalization features,and comorbidities.RESULTS We examined 409130 hospitalizations[median 55(IQR 43-66)years]with NFALD.NAFLD was more common in females(1.2%),Hispanics(2%),and Native Americans(1.9%)than whites.Females often reported non-elective admissions,Medicare enrolment,the median age of 55(IQR 42-67),and poor income.Females had higher obesity and uncomplicated diabetes but lower hypertension,hyperlipidemia,and complicated diabetes than males.Hispanics had a median age of 48(IQR 37-60),were Medicaid enrollees,and had non-elective admissions.Hispanics had greater diabetes and obesity rates than whites but lower hypertension and hyperlipidemia.MACCE,all-cause mortality,AMI,cardiac arrest,and stroke were all greater in elderly individuals(P<0.001).MACCE,AMI,and cardiac arrest were more common in men(P<0.001).Native Americans(aOR 1.64)and Asian Pacific Islanders(aOR 1.18)had higher all-cause death risks than whites.CONCLUSION Increasing age and male sex link NAFLD with adverse MACCE outcomes;Native Americans and Asian Pacific Islanders face higher mortality,highlighting a need for tailored interventions and care.展开更多
Hepatitis C virus(HCV)is a significant public health challenge globally,with substantial morbidity and mortality due to chronic liver disease.Despite the availability of highly effective and well-tolerated direct-acti...Hepatitis C virus(HCV)is a significant public health challenge globally,with substantial morbidity and mortality due to chronic liver disease.Despite the availability of highly effective and well-tolerated direct-acting antiviral therapies,widespread disparities remain in hepatitis C screening,access to treatment,linkage to care,and therapeutic outcomes.This review article synthesizes evi-dence from various studies to highlight the multifactorial nature of these dispari-ties,which affects ethnic minorities,people with lower socioeconomic status,in-dividuals with substance use disorders,and those within correctional facilities.The review also discusses policy implications and targeted strategies needed to overcome barriers and ensure equitable care for all individuals with HCV.Recom-mendations for future research to address gaps in knowledge and evaluation of the effectiveness of interventions designed to reduce disparities are provided.展开更多
BACKGROUND Most studies have defined economic well-being as socioeconomic status,with little attention given to whether other indicators influence self-esteem.Little is known about racial/ethnic disparities in the rel...BACKGROUND Most studies have defined economic well-being as socioeconomic status,with little attention given to whether other indicators influence self-esteem.Little is known about racial/ethnic disparities in the relationship between economic wellbeing and self-esteem during adulthood.AIM To explore the impact of economic well-being on self-esteem in adulthood and differences in the association across race/ethnicity.METHODS The current study used data from the National Longitudinal Survey of Youth 1979.The final sample consisted of 2267 African Americans,1425 Hispanics,and 3678 non-Hispanic Whites.Ordinary linear regression analyses and logistic regression analyses were conducted.RESULTS African Americans and Hispanics were more likely to be in poverty in comparison with non-Hispanic Whites.More African Americans were unemployed than Whites.Those who received fringe benefits,were more satisfied with jobs,and were employed were more likely to have higher levels of self-esteem.Poverty was negatively associated with self-esteem.Interaction effects were found between African Americans and job satisfaction predicting self-esteem.CONCLUSION The role of employers is important in cultivating employees’self-esteem.Satisfactory outcomes or feelings of happiness from the workplace may be more important to non-Hispanic Whites compared to African Americans and Hispanics.展开更多
Background: Cardiovascular diseases such as hypertension (HTN) are one of the main causes of death in Cameroon. This study aimed at assessing prevalence disparities and determinants of hypertension amongst Bamilé...Background: Cardiovascular diseases such as hypertension (HTN) are one of the main causes of death in Cameroon. This study aimed at assessing prevalence disparities and determinants of hypertension amongst Bamiléké adults residing in two different agroecological zones of Cameroon. Methods: A cross-sectional and descriptive survey was conducted among Bamiléké population living in the Highlands zone (Western region) and in the Monomodal Rainforest zone (Littoral region) of Cameroon from August 2016 to August 2017. Participants (962) were aged at least 20 years old. Data on sociodemographic, hemodynamic, anthropometric, and biochemical parameters and lifestyle of the participants were collected. Results: Results obtained revealed that 34.2% were hypertensive and those residing in the highland zone were more affected than those living in the monomodal rainforest zone (44.5% vs 22.9%). The different subtypes of HTN (Isolated systolic hypertension (14.1%), isolated diastolic hypertension (7.2%) and Systo-diastolic hypertension (23.3%)) were also more prevalent in the Highlands Zone. The most prevalent stage of HTN was pre-HTN (31.5%). However, people living in the monomodal rainforest zone were more affected by pre-HTN compared to Bamiléké living in the highland zone (33.6% vs. 29.6%). Results also showed that high consumption (≥ 3 times/week) of carbohydrate- and fat-rich foods, ageing, obesity, and marital status were associated with high blood pressure in both agroecological zones. Besides, secondary education (OR = 0.68;95% CI: 0.42 - 0.99) in the Highlands Zone and high (≥3 times/week) vegetable consumption (OR = 0.66;95% CI: 0.44 - 0.98) in the Monomodal Rainforest Zone had a protective effect on elevated blood pressure of population. Conclusion: There is a disparity in the prevalence of hypertension and some of its determinants among Bamiléké adults residing in different agroecological zones. This work highlights the need to advocate for local and ethno-cultural health policies to prevent, diagnose and manage hypertension.展开更多
This paper delves into the intricate interplay between artificial intelligence(AI)systems and the perpetuation of Anti-Black racism within the United States medical industry.Despite the promising potential of AI to en...This paper delves into the intricate interplay between artificial intelligence(AI)systems and the perpetuation of Anti-Black racism within the United States medical industry.Despite the promising potential of AI to enhance healthcare outcomes and reduce disparities,there is a growing concern that these technologies may inadvertently/advertently exacerbate existing racial inequalities.Focusing specifically on the experiences of Black patients,this research investigates how the following AI components:medical algorithms,machine learning,and natural learning processes are contributing to the unequal distribution of medical resources,diagnosis,and health care treatment of those classified as Black.Furthermore,this review employs a multidisciplinary approach,combining insights from computer science,medical ethics,and social justice theory to analyze the mechanisms through which AI systems may encode and reinforce racial biases.By dissecting the three primary components of AI,this paper aims to present a clear understanding of how these technologies work,how they intersect,and how they may inherently perpetuate harmful stereotypes resulting in negligent outcomes for Black patients.Furthermore,this paper explores the ethical implications of deploying AI in healthcare settings and calls for increased transparency,accountability,and diversity in the development and implementation of these technologies.Finally,it is important that I prefer the following paper with a clear and concise definition of what I refer to as Anti-Black racism throughout the text.Therefore,I assert the following:Anti-Black racism refers to prejudice,discrimination,or antagonism directed against individuals or communities of African descent based on their race.It involves the belief in the inherent superiority of one race over another and the systemic and institutional practices that perpetuate inequality and disadvantage for Black people.Furthermore,I proclaim that this form of racism can be manifested in various ways,such as unequal access to opportunities,resources,education,employment,and fair treatment within social,economic,and political systems.It is also pertinent to acknowledge that Anti-Black racism is deeply rooted in historical and societal structures throughout the U.S.borders and beyond,leading to systemic disadvantages and disparities that impact the well-being and life chances of Black individuals and communities.Addressing Anti-Black racism involves recognizing and challenging both individual attitudes and systemic structures that contribute to discrimination and inequality.Efforts to combat Anti-Black racism include promoting awareness,education,advocacy for policy changes,and fostering a culture of inclusivity and equality.展开更多
The coronavirus disease 2019 pandemic affects psychiatric patients disproportionately compared to the general population.In this narrative review,we examine the impact of the pandemic on significant global health disp...The coronavirus disease 2019 pandemic affects psychiatric patients disproportionately compared to the general population.In this narrative review,we examine the impact of the pandemic on significant global health disparities affecting vulnerable populations of psychiatric patients:People of diverse ethnic background and color,children with disabilities,sexual and gender minorities,pregnant women,mature adults,and those patients living in urban and rural communities.The identified disparities cause worsened mental health outcomes placing psychiatric patients at higher risk for depression,anxiety and posttraumatic stress disorder symptoms.Those psychiatric patients who are ethnic minorities display barriers to care,including collective trauma and structural racism.Sexual and gender minorities with mental illness face discrimination and limited access to treatment.Pregnant women with psychiatric diagnoses show higher exposure to domestic violence.Children with disabilities face a higher risk of worsening behavior.Mature adults with psychiatric problems show depression due to social isolation.Psychiatric patients who live in urban communities face pollutants and overcrowding compared to those living in rural communities,which face limited access to telehealth services.We suggest that social programs that decrease discrimination,enhance communal resilience,and help overcome systemic barriers of care should be developed to decrease global health disparities in vulnerable population.展开更多
AIM:To investigate sex-based differences in the occurrence of intra-operative and post-operative complications and associated visual outcomes following cataract surgery.METHODS:This was a retrospective study of patien...AIM:To investigate sex-based differences in the occurrence of intra-operative and post-operative complications and associated visual outcomes following cataract surgery.METHODS:This was a retrospective study of patients who had phacoemulsification cataract surgery at the University of Colorado School of Medicine.Data collected included the patient’s health history,ocular comorbidities,operative and post-operative complications,and the post-operative best corrected visual acuity(BCVA).The data were analyzed using univariate and multivariable logistic regression with generalized estimating equations to account for the correlation of some patients having two eyes included in the study.RESULTS:A total of 11977 eyes from 7253 patients were included in the study.Ocular comorbidities differed by sex,with males having significantly higher percentages of traumatic cataracts(males 0.7%vs females 0.1%),prior ocular surgery(6.7%vs 5.5%),and mature cataracts(2.8%vs 1.9%).Conversely,females had significantly higher rates of pseudoexfoliation(2.0%vs 3.2%).In unadjusted analysis,males had higher rates of posterior capsular rupture(0.8%vs 0.4%)and vitreous loss(1.0%vs 0.6%),but this difference was not significant after adjustment for confounders.Males had a significantly increased risk of post-operative retinal detachment,but in multivariable analysis this was no longer significant.Males were significantly less likely to undergo post-operative neodymium-doped yttrium aluminum garnet(Nd:YAG)laser capsulotomy for posterior capsule opacification(OR=0.8,95%CI=0.7-0.9,P=0.0005).The BCVA was slightly worse for males pre-operatively;but post-operatively,both sexes exhibited similar visual acuity of Snellen equivalent 20/25.CONCLUSION:The study finds that in a cohort of patients presenting for cataract surgery,sex differences exist in pre-operative comorbidities and surgical characteristics that contribute to higher rates of some complications for males.However,observed surgical complication rates exhibit almost no difference by sex after adjusting for pre-operative differences and post-operative BCVA is similar between sexes.展开更多
In this narrative review, we highlight the disparities in the incidence and mortality of gastric cancer across various racial and ethnic populations in the United States (US). Despite the low and decreasing trend in t...In this narrative review, we highlight the disparities in the incidence and mortality of gastric cancer across various racial and ethnic populations in the United States (US). Despite the low and decreasing trend in the incidence of gastric cancer in the US, the incidence remains significantly high among Asian and Hispanic Americans, showing a striking racial and ethnic disparity. The low survival rate of gastric cancer further accentuates the magnitude of this disparity. In addition, there is a marked funding disparity among different cancers in the US, reflecting the significantly lower level of support for cancers, such as gastric cancer, which are more prevalent in minority populations, compared to the cancers more prevalent among non-Hispanic Whites (NHW). Moreover, the economic burden from health disparities remains high. Although studies from the US and Asia suggest that screening for stomach cancer may be cost-effective, there is no currently available guideline for scree-ning high-risk populations in the US. A multidimensional framework involving the community, physicians, and policymakers is proposed to tackle these gastric cancer disparities and to develop population-based screening and surveillance programs to reduce the burden of gastric cancer.展开更多
In the context of China’s ongoing efforts to promote countryside revitalization and facilitate domestic economic circulation,it is of great significance to reduce the consumption disparity among rural households and ...In the context of China’s ongoing efforts to promote countryside revitalization and facilitate domestic economic circulation,it is of great significance to reduce the consumption disparity among rural households and unleash the consumption potential in the countryside.Based on data from China Family Panel Studies,this paper adopts a staggered difference-in-differences method to assess the impact of the e-commerce to enter rural areas on the consumption disparity among rural households.Findings:the comprehensive demonstration work of promoting e-commerce to enter rural areas has reduced the consumption disparity among rural households through the following mechanisms.Firstly,this policy initiative has mitigated the consumption-inhibiting effect on rural household consumption due to the local market size and external market accessibility by promoting the distribution of consumer goods to villages.Secondly,this policy initiative has also increased the agricultural income of rural households and reduced their consumption disparity by distributing farm produce to cities and enhancing the agricultural income of rural households.Moreover,the work is characterized by inclusive growth and is not susceptible to the“elite capture”phenomenon.展开更多
AIM To describe racial/ethnic differences in treatment and survival among liver cancer patients in a populationbased cancer registry.METHODS Invasive cases of primary hepatocellular carcinoma, n = 33270, diagnosed bet...AIM To describe racial/ethnic differences in treatment and survival among liver cancer patients in a populationbased cancer registry.METHODS Invasive cases of primary hepatocellular carcinoma, n = 33270, diagnosed between January 1, 1988-December 31, 2012 and reported to the California Cancer Registry were analyzed by race/ethnicity, age, gender, geographical region, socio-economic status, time period of diagnosis, stage, surgical treatment, and survival. Patients were classified into 15 racial/ethnic groups: non-Hispanic White(White, n = 12710), Hispanic(n = 8500), Chinese(n = 2723), non-Hispanic Black(Black, n = 2609), Vietnamese(n = 2063), Filipino(n = 1479), Korean(n = 1099), Japanese(n = 658), American Indian/Alaskan Native(AIAN, n = 281), Laotian/Hmong (n = 244), Cambodian(n = 233), South Asian(n = 190), Hawai`ian/Pacific Islander(n = 172), Thai(n = 95), and Other Asian(n = 214). The main outcome measures were receipt of surgical treatment, and cause-specific and all-cause mortality.RESULTS After adjustment for socio-demographic characteristics, time period, and stage of disease, compared to Whites, Laotian/Hmong [odds ratio(OR) = 0.30, 95%CI: 0.17-0.53], Cambodian(OR = 0.65, 95%CI: 0.45-0.96), AIAN(OR = 0.66, 95%CI: 0.46-0.93), Black(OR = 0.76, 95%CI: 0.67-0.86), and Hispanic(OR = 0.78, 95%CI: 0.72-0.84) patients were less likely, whereas Chinese(OR = 1.58, 95%CI: 1.42-1.77), Koreans(OR = 1.45, 95%CI: 1.24-1.70), Japanese(OR = 1.41, 95%CI: 1.15-1.72), and Vietnamese(OR = 1.26, 95%CI: 1.12-1.42) were more likely to receive surgical treatment. After adjustment for the same covariates and treatment, cause-specific mortality was higher for Laotian/Hmong [(hazard ratio(HR) = 1.50, 95%CI: 1.29-1.73)], Cambodians(HR = 1.35, 95%CI: 1.16-1.58), and Blacks(HR = 1.07, 95%CI: 1.01-1.13), and lower for Chinese(HR = 0.82, 95%CI: 0.77-0.86), Filipinos(HR = 0.84, 95%CI: 0.78-0.90), Vietnamese(HR = 0.85, 95%CI: 0.80-0.90), Koreans(HR = 0.90, 95%CI: 0.83-0.97), and Hispanics(HR = 0.91, 95%CI: 0.88-0.94); results were similar for all-cause mortality.CONCLUSION Disaggregated data revealed substantial racial/ethnic differences in liver cancer treatment and survival, demonstrating the need for development of targeted interventions to mitigate disparities.展开更多
Summary： Health disparities between the western, central and eastern regions of rural China, and the impact of national health improvement policies and programming were assessed. A total of 400 counties were randomly...Summary： Health disparities between the western, central and eastern regions of rural China, and the impact of national health improvement policies and programming were assessed. A total of 400 counties were randomly sampled. ANOVA and Logistic regression modeling were employed to estimate differ- ences in health outcomes and determinants. Significant differences were found between the western, central and eastern rural regions in community infrastructure and health outcomes. From 2000 to 2010, health indicators in rural China were improved significantly, and the infant mortality rate （IMR）, mater- nal mortality rate （MMR） and under 5 mortality rate （U5MR） had fallen by 62.79%, 71.74% and 61.92%, respectively. Central rural China had the greatest decrease in IMR （65.05%）; whereas, western rural China had the greatest reduction in MMR （72.99%） but smallest reduction in U5MR （57.36%）. Despite these improvements, Logistic regression analysis showed regional differences in key health outcome indicators （odds ratios）： IMR （central： 2.13; western： 5.31）, U5MR （central： 2.25; western： 5.69）, MMR （central： 1.94; western： 3.31）, and prevalence of infectious diseases （central： 1.62; western： 3.58）. The community infrastructure and health outcomes of the western and central rural regions of China have been improved markedly during the first decade of the 21st century. However, health dis- parities still exist across the three regions. National efforts to increase per capita income, community empowerment and mobilization, community infrastructure, capacity of rural health facilities, and health literacy would be effective policy options to attain health equity.展开更多
Colorectal cancer(CRC)is the second leading cause of cancer related deaths in the United States.There are significant differences in CRC incidence and mortality by race with the highest burden occurring among blacks.T...Colorectal cancer(CRC)is the second leading cause of cancer related deaths in the United States.There are significant differences in CRC incidence and mortality by race with the highest burden occurring among blacks.The underlying factors contributing to CRC disparities are multiple and complex.Studies have suggested that a higher prevalence of putative risk factors for CRC,limited access to healthcare services,lower utilization of healthcare resources and increased biological susceptibilities contribute to this disparity by race.This article reviews the factors associated with the disproportionally higher burden of CRC among blacks;addresses the controversies regarding the age to begin CRC screening and the screening modality to use for blacks;and proffers solutions to eliminate CRC disparity by race.展开更多
Racial and ethnic disparities in cancer care are major public health concerns and their identification is necessary to develop interventions to eliminate these disparities. We and others have previously observed marke...Racial and ethnic disparities in cancer care are major public health concerns and their identification is necessary to develop interventions to eliminate these disparities. We and others have previously observed marked disparities in gastric cancer outcomes between Eastern and Western patients. These disparities have long been attributed to surgical technique and extent of lymphadenectomy. However, more recent evidence suggests that other factors such as tumor biology, environmental factors such as Helicobacter pylori infection and stage migration may also significantly contribute to these observed disparities. We review the literature surrounding disparities in gastric cancer and provide data pertaining to potential contributing factors.展开更多
文摘Introduction Progress toward the global elimination of cervical cancer as a public health concern remains slow and highly uneven across countries.High-income nations such as Australia and FinlandDboth of which have achieved high human papillomavirus(HPV)vaccination coverage and implemented quality-assured cervical cancer screening programs-have successfully decreased the incidence rates to below 8 cases per 100,000 women~1.These countries are on track to reach the elimination threshold of fewer than 4 cases per 100,000 women within the next few years,as defined by the World Health Organization(WHO).
文摘BACKGROUND Liver disease is a major cause of mortality in Mexico.Liver transplantation(LT)remains severely limited,and there are no reports on equity of access.AIM To analyze geographical disparities in LT access in Mexico.METHODS LT waitlist registrations and LT rates in Mexico from 2014 to 2023 were assessed.LT listings per million persons(pmp)were calculated.Observed-to-expected listings were calculated by controlling listings pmp and mortality rate per 10000.LT and waitlist mortality was calculated as 90-day rate,overall rate and rate per 100 person-years.We compared access to waitlist,transplantation and mortality between patients living in Mexican States with higher LT activity and those living in other States.RESULTS There were 2600 new waitlist registrations;1572 registrations(60.4%)living in Mexico City and State,Jalisco and Nuevo Leon.There were 1755 LT;92.5%of them performed in States with higher LT activity,and 1101(62.7%vs 37.3%;P<0.001)done in patients living in those States.Listings pmp in the Mexican States with high LT activity were 3.8,1.5 vs 1.2,0.6(P<0.001);observed-to-expected listings were 1.3,0.4 vs 0.4,0.2(P<0.001);LT pmp were 2.7,0.9 vs 0.7,0.5(P<0.001).After controlling for other variables,patients living in high LT activity States had a HR 1.14(95%CI:1.03-1.26;P=0.009)to be a case of transplantation after listing.CONCLUSION Geographic disparities substantially affect LT access in Mexico.The population living near Transplant Centers has a 3.2-fold higher access to the waiting list and a 3.8-fold higher likelihood of LT.Current referral system,and resource allocation need urgent revision to remove the barriers associated with geographic disparity.
基金supported by grants from the National Natural Science Foundation of China(Grant No.82470544)the Fundamental Research Funds for the Central Universities(Grant No.226-2024-00153).
文摘Childhood neuroblastoma,a leading cause of cancer-related mortality in young children,accounts for approximately 8%-10%of pediatric cancers1.Originating from neural crest cells of the sympathetic nervous system,these tumors affect primarily children younger than 5 years of age and are often diagnosed in advanced stages,because of their aggressive nature and vague early symptoms2-4.
文摘BACKGROUND Metabolic dysfunction-associated steatohepatitis(MASH)is increasingly common,as is hepatocellular carcinoma(HCC)in the background of MASH.Liver transplantation(LT)provides superior long-term survival for patients with unresectable MASH-HCC,but not all patients have equal access to transplant.MASH-HCC disproportionately affects Hispanic patients,but minorities are less likely to undergo LT for HCC.Additionally,females also undergo LT at lower rates than males.AIM To investigate whether race/ethnicity and sex affect LT waitlist outcomes.METHODS Records of adults with MASH-HCC in the United States Organ Procurement and Transplantation Network database listed for LT between 1/2015 and 12/2021 were analyzed.RESULTS Most of the 3810 patients waitlisted for LT for MASH-HCC were non-Hispanic(NH)white(71.2%)or Hispanic(23.4%),with only 49(1.1%)NH Black candidates.Hispanics underwent LT at lower rates than NH whites(71.6%vs 78.4%,P<0.001),but race/ethnicity did not affect waitlist mortality(P=0.06).Patients with Hispanic[hazard ratio(HR)=0.85,95%CI:0.77-0.95,P=0.002]or Asian(HR=0.79,95%CI:0.63-0.98,P=0.04)race/ethnicity were less likely to undergo LT.Women were also less likely to receive LT(male:HR=1.16,95%CI:1.04-1.29,P=0.01).Patients in regions 1 and 9 were less likely to be transplanted as well(P=0.07).CONCLUSION Hispanic patients are less likely to undergo LT for MASH-HCC,concerning given their susceptibility to MASH and HCC.There were very few NH Black candidates.Disparities were also unequal across regions,which is particularly concerning in states where at-risk populations have rising cancer incidence.Additional research is needed to identify strategies for mitigating these differences in access to LT for MASH-HCC.
文摘BACKGROUND There is widespread debate about the impact of metabolically healthy obesity(MHO)on cardiovascular outcomes.However,studies have not exclusively examined the impact of MHO on cardiovascular outcomes in the postmeno-pausal population.AIM To explore the prevalence of MHO and its relationship with hospitalization outcomes,including major adverse cardiac or cerebrovascular events(MACCE),in postmenopausal women.METHODS We extracted data from the National Inpatient Sample 2020 database using International Classification of Disease,Tenth Revision,Clinical Modification codes for all admissions of postmenopausal women.We excluded patients with diabetes,hypertension,and hyperlipidemia to obtain metabolically healthy patients and then identified patients with obesity to create obese and non-obese cohorts.We used a 1:1 propensity score matching method to match patients with and without MHO based on age,and then we did a multivariable regression analysis for in-hospital MACCE.RESULTS In 2020,1304185 metabolically healthy postmenopausal women were admitted;148250(11.4%)had MHO.After propensity score matching for age,a statistically significant difference was observed in overall MACCE[odds ratio(OR):1.08,95%confidence interval(CI):1.01-1.16,P=0.028]among MHO and non-MHO cohorts,especially in patients of African-American ethnicity(OR:1.23,95%CI:1.01-1.49,P=0.035)and the lowermost income quartile(OR:1.24,95%CI:1.06-1.44,P=0.007).CONCLUSION Postmenopausal patients with MHO are at risk of MACCE,especially black patients and those with lower incomes.Larger prospective studies can demystify MHO’s impact on cardiovascular outcomes among postmenopausal women.
基金Guangdong Major Project of Basic and Applied Basic Research(2020B0301030004)National Natural Science Foun-dation of China(U2142205,42075173)+1 种基金Meteorological Joint Fund of the Guangdong Basic and Applied Basic Research Foundation(2024A1515510011)Special Fund for Forecast Review and Summary of China Meteorological Administration(FPZJ2025-096).
文摘Based on daily precipitation data from 192 observation stations in South China during the pre-flood period(April-June)from 1965 to 2016,this study analyzed the spatiotemporal variations of the heavy precipitation concentration index(Q index).The results showed that the intensity of heavy precipitation exhibited an increasing trend across most regions of South China.The multi-year mean Q index for the stations ranged from 0.3 to 0.6,with an overall average of 0.375.Notably,significant upward trends in both the heavy precipitation and Q index were observed in the inland and western mountainous areas of South China,indicating a higher flood risk in these regions.Moreover,an analysis of precipitation duration showed that 2-day heavy rainfall events are increasing in the inland areas,western mountains,and eastern Guangdong,while 3-day and 4-day heavy rainfall events steadily increased primarily in coastal areas,with 3-day events also increasing in eastern Guangzhou.The observed rise of heavy precipitation during the pre-flood period across the western mountainous areas,eastern Guangdong,and southeastern coastal areas of South China is mainly attributed to an increase in long-duration heavy precipitation.
文摘BACKGROUND Barrett's esophagus(BE)is a known premalignant precursor to esophageal adenocarcinoma(EAC).The prevalence rates continue to rise in the United States,but many patients who are at risk of EAC are not screened.Current practice guidelines include male gender as a predisposing factor for BE and EAC.The population-based clinical evidence regarding female gender remains limited.AIM To study comparative trends of gender disparities in patients with BE in the United States.METHODS A nationwide retrospective study was conducted using the 2009-2019 National Inpatient Sample(NIS)database.Patients with a primary or secondary diagnosis code of BE were identified.The major outcome of interest was determining the gender disparities in patients with BE.Trend analysis for respective outcomes for females was also reported to ascertain any time-based shifts.RESULTS We identified 1204190 patients with BE for the study period.Among the included patients,717439(59.6%)were men and 486751(40.4%)were women.The mean age was higher in women than in men(67.1±0.4 vs 66.6±0.3 years,P<0.001).The rate of BE per 100000 total NIS hospitalizations for males increased from 144.6 in 2009 to 213.4 in 2019(P<0.001).The rate for females increased from 96.8 in 2009 to 148.7 in 2019(P<0.001).There was a higher frequency of obesity among women compared to men(17.4%vs 12.6%,P<0.001).Obesity prevalence among females increased from 12.3%in 2009 to 21.9%in 2019(P<0.001).A lower prevalence of smoking was noted in women than in men(20.8%vs 35.7%,P<0.001).However,trend analysis showed an increasing prevalence of smoking among women,from 12.9%in 2009 to 30.7%in 2019(P<0.001).Additionally,there was a lower prevalence of alcohol abuse,Helicobacter pylori(H.pylori),and diabetes mellitus among females than males(P<0.001).Trend analysis showed an increasing prevalence of alcohol use disorder and a decreasing prevalence of H.pylori and diabetes mellitus among women(P<0.001).CONCLUSION The prevalence of BE among women has steadily increased from 2009 to 2019.The existing knowledge concerning BE development has historically focused on men,but our findings show that the risk in women is not insignificant.
文摘BACKGROUND Non-alcoholic fatty liver disease(NAFLD)increases cardiovascular disease(CVD)risk irrespective of other risk factors.However,large-scale cardiovascular sex and race differences are poorly understood.AIM To investigate the relationship between NAFLD and major cardiovascular and cerebrovascular events(MACCE)in subgroups using a nationally representative United States inpatient sample.METHODS We examined National Inpatient Sample(2019)to identify adult hospitalizations with NAFLD by age,sex,and race using ICD-10-CM codes.Clinical and demographic characteristics,comorbidities,and MACCE-related mortality,acute myocardial infarction(AMI),cardiac arrest,and stroke were compared in NAFLD cohorts by sex and race.Multivariable regression analyses were adjusted for sociodemographic characteristics,hospitalization features,and comorbidities.RESULTS We examined 409130 hospitalizations[median 55(IQR 43-66)years]with NFALD.NAFLD was more common in females(1.2%),Hispanics(2%),and Native Americans(1.9%)than whites.Females often reported non-elective admissions,Medicare enrolment,the median age of 55(IQR 42-67),and poor income.Females had higher obesity and uncomplicated diabetes but lower hypertension,hyperlipidemia,and complicated diabetes than males.Hispanics had a median age of 48(IQR 37-60),were Medicaid enrollees,and had non-elective admissions.Hispanics had greater diabetes and obesity rates than whites but lower hypertension and hyperlipidemia.MACCE,all-cause mortality,AMI,cardiac arrest,and stroke were all greater in elderly individuals(P<0.001).MACCE,AMI,and cardiac arrest were more common in men(P<0.001).Native Americans(aOR 1.64)and Asian Pacific Islanders(aOR 1.18)had higher all-cause death risks than whites.CONCLUSION Increasing age and male sex link NAFLD with adverse MACCE outcomes;Native Americans and Asian Pacific Islanders face higher mortality,highlighting a need for tailored interventions and care.
文摘Hepatitis C virus(HCV)is a significant public health challenge globally,with substantial morbidity and mortality due to chronic liver disease.Despite the availability of highly effective and well-tolerated direct-acting antiviral therapies,widespread disparities remain in hepatitis C screening,access to treatment,linkage to care,and therapeutic outcomes.This review article synthesizes evi-dence from various studies to highlight the multifactorial nature of these dispari-ties,which affects ethnic minorities,people with lower socioeconomic status,in-dividuals with substance use disorders,and those within correctional facilities.The review also discusses policy implications and targeted strategies needed to overcome barriers and ensure equitable care for all individuals with HCV.Recom-mendations for future research to address gaps in knowledge and evaluation of the effectiveness of interventions designed to reduce disparities are provided.
文摘BACKGROUND Most studies have defined economic well-being as socioeconomic status,with little attention given to whether other indicators influence self-esteem.Little is known about racial/ethnic disparities in the relationship between economic wellbeing and self-esteem during adulthood.AIM To explore the impact of economic well-being on self-esteem in adulthood and differences in the association across race/ethnicity.METHODS The current study used data from the National Longitudinal Survey of Youth 1979.The final sample consisted of 2267 African Americans,1425 Hispanics,and 3678 non-Hispanic Whites.Ordinary linear regression analyses and logistic regression analyses were conducted.RESULTS African Americans and Hispanics were more likely to be in poverty in comparison with non-Hispanic Whites.More African Americans were unemployed than Whites.Those who received fringe benefits,were more satisfied with jobs,and were employed were more likely to have higher levels of self-esteem.Poverty was negatively associated with self-esteem.Interaction effects were found between African Americans and job satisfaction predicting self-esteem.CONCLUSION The role of employers is important in cultivating employees’self-esteem.Satisfactory outcomes or feelings of happiness from the workplace may be more important to non-Hispanic Whites compared to African Americans and Hispanics.
文摘Background: Cardiovascular diseases such as hypertension (HTN) are one of the main causes of death in Cameroon. This study aimed at assessing prevalence disparities and determinants of hypertension amongst Bamiléké adults residing in two different agroecological zones of Cameroon. Methods: A cross-sectional and descriptive survey was conducted among Bamiléké population living in the Highlands zone (Western region) and in the Monomodal Rainforest zone (Littoral region) of Cameroon from August 2016 to August 2017. Participants (962) were aged at least 20 years old. Data on sociodemographic, hemodynamic, anthropometric, and biochemical parameters and lifestyle of the participants were collected. Results: Results obtained revealed that 34.2% were hypertensive and those residing in the highland zone were more affected than those living in the monomodal rainforest zone (44.5% vs 22.9%). The different subtypes of HTN (Isolated systolic hypertension (14.1%), isolated diastolic hypertension (7.2%) and Systo-diastolic hypertension (23.3%)) were also more prevalent in the Highlands Zone. The most prevalent stage of HTN was pre-HTN (31.5%). However, people living in the monomodal rainforest zone were more affected by pre-HTN compared to Bamiléké living in the highland zone (33.6% vs. 29.6%). Results also showed that high consumption (≥ 3 times/week) of carbohydrate- and fat-rich foods, ageing, obesity, and marital status were associated with high blood pressure in both agroecological zones. Besides, secondary education (OR = 0.68;95% CI: 0.42 - 0.99) in the Highlands Zone and high (≥3 times/week) vegetable consumption (OR = 0.66;95% CI: 0.44 - 0.98) in the Monomodal Rainforest Zone had a protective effect on elevated blood pressure of population. Conclusion: There is a disparity in the prevalence of hypertension and some of its determinants among Bamiléké adults residing in different agroecological zones. This work highlights the need to advocate for local and ethno-cultural health policies to prevent, diagnose and manage hypertension.
文摘This paper delves into the intricate interplay between artificial intelligence(AI)systems and the perpetuation of Anti-Black racism within the United States medical industry.Despite the promising potential of AI to enhance healthcare outcomes and reduce disparities,there is a growing concern that these technologies may inadvertently/advertently exacerbate existing racial inequalities.Focusing specifically on the experiences of Black patients,this research investigates how the following AI components:medical algorithms,machine learning,and natural learning processes are contributing to the unequal distribution of medical resources,diagnosis,and health care treatment of those classified as Black.Furthermore,this review employs a multidisciplinary approach,combining insights from computer science,medical ethics,and social justice theory to analyze the mechanisms through which AI systems may encode and reinforce racial biases.By dissecting the three primary components of AI,this paper aims to present a clear understanding of how these technologies work,how they intersect,and how they may inherently perpetuate harmful stereotypes resulting in negligent outcomes for Black patients.Furthermore,this paper explores the ethical implications of deploying AI in healthcare settings and calls for increased transparency,accountability,and diversity in the development and implementation of these technologies.Finally,it is important that I prefer the following paper with a clear and concise definition of what I refer to as Anti-Black racism throughout the text.Therefore,I assert the following:Anti-Black racism refers to prejudice,discrimination,or antagonism directed against individuals or communities of African descent based on their race.It involves the belief in the inherent superiority of one race over another and the systemic and institutional practices that perpetuate inequality and disadvantage for Black people.Furthermore,I proclaim that this form of racism can be manifested in various ways,such as unequal access to opportunities,resources,education,employment,and fair treatment within social,economic,and political systems.It is also pertinent to acknowledge that Anti-Black racism is deeply rooted in historical and societal structures throughout the U.S.borders and beyond,leading to systemic disadvantages and disparities that impact the well-being and life chances of Black individuals and communities.Addressing Anti-Black racism involves recognizing and challenging both individual attitudes and systemic structures that contribute to discrimination and inequality.Efforts to combat Anti-Black racism include promoting awareness,education,advocacy for policy changes,and fostering a culture of inclusivity and equality.
文摘The coronavirus disease 2019 pandemic affects psychiatric patients disproportionately compared to the general population.In this narrative review,we examine the impact of the pandemic on significant global health disparities affecting vulnerable populations of psychiatric patients:People of diverse ethnic background and color,children with disabilities,sexual and gender minorities,pregnant women,mature adults,and those patients living in urban and rural communities.The identified disparities cause worsened mental health outcomes placing psychiatric patients at higher risk for depression,anxiety and posttraumatic stress disorder symptoms.Those psychiatric patients who are ethnic minorities display barriers to care,including collective trauma and structural racism.Sexual and gender minorities with mental illness face discrimination and limited access to treatment.Pregnant women with psychiatric diagnoses show higher exposure to domestic violence.Children with disabilities face a higher risk of worsening behavior.Mature adults with psychiatric problems show depression due to social isolation.Psychiatric patients who live in urban communities face pollutants and overcrowding compared to those living in rural communities,which face limited access to telehealth services.We suggest that social programs that decrease discrimination,enhance communal resilience,and help overcome systemic barriers of care should be developed to decrease global health disparities in vulnerable population.
基金Supported by a Research to Prevent Blindness challenge grant to the Department of Ophthalmology,University of Colorado,and by NIH/NCATS Colorado CTSA Grant Number UL1 TR002535.
文摘AIM:To investigate sex-based differences in the occurrence of intra-operative and post-operative complications and associated visual outcomes following cataract surgery.METHODS:This was a retrospective study of patients who had phacoemulsification cataract surgery at the University of Colorado School of Medicine.Data collected included the patient’s health history,ocular comorbidities,operative and post-operative complications,and the post-operative best corrected visual acuity(BCVA).The data were analyzed using univariate and multivariable logistic regression with generalized estimating equations to account for the correlation of some patients having two eyes included in the study.RESULTS:A total of 11977 eyes from 7253 patients were included in the study.Ocular comorbidities differed by sex,with males having significantly higher percentages of traumatic cataracts(males 0.7%vs females 0.1%),prior ocular surgery(6.7%vs 5.5%),and mature cataracts(2.8%vs 1.9%).Conversely,females had significantly higher rates of pseudoexfoliation(2.0%vs 3.2%).In unadjusted analysis,males had higher rates of posterior capsular rupture(0.8%vs 0.4%)and vitreous loss(1.0%vs 0.6%),but this difference was not significant after adjustment for confounders.Males had a significantly increased risk of post-operative retinal detachment,but in multivariable analysis this was no longer significant.Males were significantly less likely to undergo post-operative neodymium-doped yttrium aluminum garnet(Nd:YAG)laser capsulotomy for posterior capsule opacification(OR=0.8,95%CI=0.7-0.9,P=0.0005).The BCVA was slightly worse for males pre-operatively;but post-operatively,both sexes exhibited similar visual acuity of Snellen equivalent 20/25.CONCLUSION:The study finds that in a cohort of patients presenting for cataract surgery,sex differences exist in pre-operative comorbidities and surgical characteristics that contribute to higher rates of some complications for males.However,observed surgical complication rates exhibit almost no difference by sex after adjusting for pre-operative differences and post-operative BCVA is similar between sexes.
文摘In this narrative review, we highlight the disparities in the incidence and mortality of gastric cancer across various racial and ethnic populations in the United States (US). Despite the low and decreasing trend in the incidence of gastric cancer in the US, the incidence remains significantly high among Asian and Hispanic Americans, showing a striking racial and ethnic disparity. The low survival rate of gastric cancer further accentuates the magnitude of this disparity. In addition, there is a marked funding disparity among different cancers in the US, reflecting the significantly lower level of support for cancers, such as gastric cancer, which are more prevalent in minority populations, compared to the cancers more prevalent among non-Hispanic Whites (NHW). Moreover, the economic burden from health disparities remains high. Although studies from the US and Asia suggest that screening for stomach cancer may be cost-effective, there is no currently available guideline for scree-ning high-risk populations in the US. A multidimensional framework involving the community, physicians, and policymakers is proposed to tackle these gastric cancer disparities and to develop population-based screening and surveillance programs to reduce the burden of gastric cancer.
基金National Natural Science Foundation of China(NSFC)Youth Project“Research on Household Debt Behavior and Its Impact on Economic Inequality in the Context of Common Prosperity”(Grant No.72203136),the Youth Project of the Guangdong Planning Office of Philosophy and Social Science(GDPOPSS)“E-commerce Development and Consumption Disparity of Rural Households:Theoretical Mechanism,Empirical Test and Policy Optimization”(Grant No.GD24YYJ27).
文摘In the context of China’s ongoing efforts to promote countryside revitalization and facilitate domestic economic circulation,it is of great significance to reduce the consumption disparity among rural households and unleash the consumption potential in the countryside.Based on data from China Family Panel Studies,this paper adopts a staggered difference-in-differences method to assess the impact of the e-commerce to enter rural areas on the consumption disparity among rural households.Findings:the comprehensive demonstration work of promoting e-commerce to enter rural areas has reduced the consumption disparity among rural households through the following mechanisms.Firstly,this policy initiative has mitigated the consumption-inhibiting effect on rural household consumption due to the local market size and external market accessibility by promoting the distribution of consumer goods to villages.Secondly,this policy initiative has also increased the agricultural income of rural households and reduced their consumption disparity by distributing farm produce to cities and enhancing the agricultural income of rural households.Moreover,the work is characterized by inclusive growth and is not susceptible to the“elite capture”phenomenon.
文摘AIM To describe racial/ethnic differences in treatment and survival among liver cancer patients in a populationbased cancer registry.METHODS Invasive cases of primary hepatocellular carcinoma, n = 33270, diagnosed between January 1, 1988-December 31, 2012 and reported to the California Cancer Registry were analyzed by race/ethnicity, age, gender, geographical region, socio-economic status, time period of diagnosis, stage, surgical treatment, and survival. Patients were classified into 15 racial/ethnic groups: non-Hispanic White(White, n = 12710), Hispanic(n = 8500), Chinese(n = 2723), non-Hispanic Black(Black, n = 2609), Vietnamese(n = 2063), Filipino(n = 1479), Korean(n = 1099), Japanese(n = 658), American Indian/Alaskan Native(AIAN, n = 281), Laotian/Hmong (n = 244), Cambodian(n = 233), South Asian(n = 190), Hawai`ian/Pacific Islander(n = 172), Thai(n = 95), and Other Asian(n = 214). The main outcome measures were receipt of surgical treatment, and cause-specific and all-cause mortality.RESULTS After adjustment for socio-demographic characteristics, time period, and stage of disease, compared to Whites, Laotian/Hmong [odds ratio(OR) = 0.30, 95%CI: 0.17-0.53], Cambodian(OR = 0.65, 95%CI: 0.45-0.96), AIAN(OR = 0.66, 95%CI: 0.46-0.93), Black(OR = 0.76, 95%CI: 0.67-0.86), and Hispanic(OR = 0.78, 95%CI: 0.72-0.84) patients were less likely, whereas Chinese(OR = 1.58, 95%CI: 1.42-1.77), Koreans(OR = 1.45, 95%CI: 1.24-1.70), Japanese(OR = 1.41, 95%CI: 1.15-1.72), and Vietnamese(OR = 1.26, 95%CI: 1.12-1.42) were more likely to receive surgical treatment. After adjustment for the same covariates and treatment, cause-specific mortality was higher for Laotian/Hmong [(hazard ratio(HR) = 1.50, 95%CI: 1.29-1.73)], Cambodians(HR = 1.35, 95%CI: 1.16-1.58), and Blacks(HR = 1.07, 95%CI: 1.01-1.13), and lower for Chinese(HR = 0.82, 95%CI: 0.77-0.86), Filipinos(HR = 0.84, 95%CI: 0.78-0.90), Vietnamese(HR = 0.85, 95%CI: 0.80-0.90), Koreans(HR = 0.90, 95%CI: 0.83-0.97), and Hispanics(HR = 0.91, 95%CI: 0.88-0.94); results were similar for all-cause mortality.CONCLUSION Disaggregated data revealed substantial racial/ethnic differences in liver cancer treatment and survival, demonstrating the need for development of targeted interventions to mitigate disparities.
文摘Summary： Health disparities between the western, central and eastern regions of rural China, and the impact of national health improvement policies and programming were assessed. A total of 400 counties were randomly sampled. ANOVA and Logistic regression modeling were employed to estimate differ- ences in health outcomes and determinants. Significant differences were found between the western, central and eastern rural regions in community infrastructure and health outcomes. From 2000 to 2010, health indicators in rural China were improved significantly, and the infant mortality rate （IMR）, mater- nal mortality rate （MMR） and under 5 mortality rate （U5MR） had fallen by 62.79%, 71.74% and 61.92%, respectively. Central rural China had the greatest decrease in IMR （65.05%）; whereas, western rural China had the greatest reduction in MMR （72.99%） but smallest reduction in U5MR （57.36%）. Despite these improvements, Logistic regression analysis showed regional differences in key health outcome indicators （odds ratios）： IMR （central： 2.13; western： 5.31）, U5MR （central： 2.25; western： 5.69）, MMR （central： 1.94; western： 3.31）, and prevalence of infectious diseases （central： 1.62; western： 3.58）. The community infrastructure and health outcomes of the western and central rural regions of China have been improved markedly during the first decade of the 21st century. However, health dis- parities still exist across the three regions. National efforts to increase per capita income, community empowerment and mobilization, community infrastructure, capacity of rural health facilities, and health literacy would be effective policy options to attain health equity.
文摘Colorectal cancer(CRC)is the second leading cause of cancer related deaths in the United States.There are significant differences in CRC incidence and mortality by race with the highest burden occurring among blacks.The underlying factors contributing to CRC disparities are multiple and complex.Studies have suggested that a higher prevalence of putative risk factors for CRC,limited access to healthcare services,lower utilization of healthcare resources and increased biological susceptibilities contribute to this disparity by race.This article reviews the factors associated with the disproportionally higher burden of CRC among blacks;addresses the controversies regarding the age to begin CRC screening and the screening modality to use for blacks;and proffers solutions to eliminate CRC disparity by race.
文摘Racial and ethnic disparities in cancer care are major public health concerns and their identification is necessary to develop interventions to eliminate these disparities. We and others have previously observed marked disparities in gastric cancer outcomes between Eastern and Western patients. These disparities have long been attributed to surgical technique and extent of lymphadenectomy. However, more recent evidence suggests that other factors such as tumor biology, environmental factors such as Helicobacter pylori infection and stage migration may also significantly contribute to these observed disparities. We review the literature surrounding disparities in gastric cancer and provide data pertaining to potential contributing factors.
