Racial/ethnic inequities in the associations of allostatic load with all-cause and cardiovascular-specific mortality risk in U.S. adults

Non-Hispanic blacks have higher mortality rates than non-Hispanic whites whereas Hispanics have similar or lower mortality rates than non-Hispanic blacks and whites despite Hispanics' lower education and access to health insurance coverage. This study examines whether allostatic load, a proxy for cumulative biological risk, is associated with all-cause and cardiovascular (CVD)-specific mortality risks in US adults; and whether these associations vary with race/ethnicity and further with age, sex and education across racial/ethnic groups. Data from the third National Health and Nutritional Examination Survey (NHANES III, 1988-1994) and the 2015 Linked Mortality File were used for adults 25 years or older (n = 13,673 with 6,026 deaths). Cox proportional hazards regression was used to estimate the associations of allostatic load scores (2 and >= 3 relative to <= 1) with a) all-cause and b) CVD-specific mortality risk among NHANES III participants before and after controlling for selected characteristics. Allostatic load scores are associated with higher all-cause and CVD-specific mortality rates among U.S. adults aged 25 years or older, with stronger rates observed for CVD-specific mortality. All-cause mortality rates for each racial/ethnic group differed with age and education whereas for CVD-specific mortality rates, this difference was observed for sex. Our findings of high allostatic load scores associated with all-cause and CVD-specific mortality among US adults call attention to monitor conditions associated with the allostatic load's biomarkers to identify high-risk groups to help monitor social inequities in mortality risk, especially premature mortality

The Burden of Chronic Health Conditions among Iraqi Refugees in Michigan

The vast majority of refugees in Michigan is from Iraq, and yet the health status of this population is not well defined. The purpose of this study was to describe chronic disease prevalence of Iraqi refugees and examine associations between sociodemographic characteristics and chronic disease. This study reviewed medical charts of 613 Iraqi refugees to examine the association between demographic characteristics and chronic conditions. The dependent variables were body mass index, non-fasting blood glucose, and history of hypertension and diabetes. The independent variables were birth place, age, sex, and smoking history. Men were 3.99 times (95% CI=1.88, 8.48) as likely as women to have abnormal non-fasting blood glucose levels. Compared to never smokers, former smokers were 3.19 times (95% CI=1.11, 9.13) as likely to have a history of diabetes. The findings will be used to develop tailored prevention interventions to prevent chronic conditions among refugees

Racial/Ethnic Disparities in All-Cause Mortality in U.S. Adults: The Effect of Allostatic Load

The allostatic score increased the risk of all-cause mortality. Moreover, this increased risk was observed for adults younger than 65 years of age regardless of their race/ethnicity. Thus, allostatic score may be a contributor to premature death in the U.S

Nativity Status and Patient Perceptions of the Patient-Physician Encounter: Results From the Commonwealth Fund 2001 Survey on Disparities in Quality of Health Care

Background: Although racial and ethnic differences in healthcare have been extensively documented in the United States, little attention has been paid to the quality of health care for the foreign-born population in the United States. Objectives: This study examines the association between patient perceptions of the patient-physician interaction and nativity status. Research Design: Cross-sectional telephone survey. Subjects: A total of 6674 individuals (US-born ≤ 5156; foreign-born ≤ 1518) 18 years of age and older. Measures: Seven questions measuring the quality of patient-physician interactions. Results: Of the 7 outcome variables examined in the unadjusted logistic regression model, only 2 remained statistically significant in the fully adjusted model. For both the total sample and for Asians only, compared with US-born, foreign-born individuals were at greater odds [total sample, odds ratio (OR) ≤ 1.43; 95% confidence interval (CI) ≤ 1. 01ĝ€ 2.04; Asians, OR ≤ 3.25; 95% CI ≤ 1.18ĝ€ 8.95] of reporting that their physician did not involve them in their care as much as they would have liked. Compared with US-born Asians, foreign-born Asians were at greater odds of reporting that their physician did not spend as much time with them as they would have liked (OR ≤ 4.19; 95% CI ≤ 1.68ĝ€ 10.46). Discussion: Findings from our study suggest that we should not only track disparities by race and ethnicity but also by nativity status

Disparities in Health Insurance Among Middle Eastern and North African American Children in the US

Objective: To estimate and compare the proportion of foreign-born Middle Eastern/North African (MENA) children without health insurance, public, or private insurance to foreign- and US-born White and US-born MENA children. Methods: Using 2000 to 2018 National Health Interview Survey data (N = 311 961 children) and 2015 to 2019 American Community Survey data (n = 1 892 255 children), we ran multivariable logistic regression to test the association between region of birth among non-Hispanic White children (independent variable) and health insurance coverage types (dependent variables). Results: In the NHIS and ACS, foreign-born MENA children had higher odds of being uninsured (NHIS OR = 1.50, 95%CI = 1.10-2.05; ACS OR = 2.11, 95%CI = 1.88-2.37) compared to US-born White children. In the ACS, foreign-born MENA children had 2.11 times higher odds (95%CI = 1.83-2.45) of being uninsured compared to US-born MENA children. Conclusion: Our findings have implications for the health status of foreign-born MENA children, who are currently more likely to be uninsured. Strategies such as interventions to increase health insurance enrollment, updating enrollment forms to capture race, ethnicity, and nativity can aid in identifying and monitoring key disparities among MENA children

Cognitive limitations among Middle Eastern and North African immigrants

Objectives: To estimate and compare the prevalence of cognitive limitations among Middle Eastern and North African (MENA) immigrants compared to US- and foreign-born non-Hispanic Whites from Europe (including Russia/former USSR) and examine differences after controlling for risk factors. Methods: Cross-sectional data using linked 2000-2017 National Health Interview Survey and 2001–2018 Medical Expenditure Panel Survey data (ages \u3e=65 years, n = 24,827) were analyzed. Results: The prevalence of cognitive limitations was 17.3% among MENA immigrants compared to 9.6% and 13.6% among USand foreign-born non-Hispanic Whites from Europe. MENA immigrants had higher odds (OR = 1.88; 95% CI = 1.06–3.34) of reporting a cognitive limitation than US-born non-Hispanic Whites after controlling for age, sex, education, hearing loss, hypertension, depression, social isolation, and diabetes. Discussion: To further examine cognitive health among the MENA aging population, policy changes are needed to identify this group that is often absent from research because of their federal classification as non-Hispanic Whites

Screening and follow-up for depression among Arab Americans

BACKGROUND: The authors compared proportions and associations of depression screening, major depression, and follow-up care of Arab Americans compared to non-Hispanic whites, non-Hispanic blacks, Asians, and Hispanics. METHODS: Administrative data was electronically abstracted from a large health system in metropolitan Detroit among 97,918 adult patients in 2014 and 2015. A valid and reliable surname list was used to identify Arab Americans. Using chi-squares, we examined the relationship between race/ethnicity and depression screening, major depression, and follow-up care. We calculated odds ratios (OR) and 95% confidence intervals (CI) to examine the relationship between the main independent variable of race/ethnicity and the dependent variables of depression screening and major depression while controlling for confounders. RESULTS: Arab American women were 23% less likely to be screened for depression compared to non-Hispanic white women (OR = 0.77; 95% CI = 0.70, 0.86). The age- and sex-adjusted proportions of major depression were 5.5% for Arab Americans compared to 7.0% for Hispanics, 6.0% for non-Hispanic blacks, 5.9% for non-Hispanic whites, and 1.5% for Asians. Arab Americans with major depression were less likely to follow up with a behavioral specialist and more likely to follow up with a primary care physician compared to other racial and ethnic groups. CONCLUSIONS: Our study adds to the discourse on depression care among Arab Americans by highlighting the existing disparities related to adequate screening and appropriate management of depression. Future studies should include information about the influences of acculturation, culture, stigma, family, and religion on depression care