Ethnic differences in oral health and use of dental services:cross-sectional study using the 2009 Adult Dental Health Survey

Background Oral health impacts on general health and quality of life, and oral diseases are the most common non-communicable diseases worldwide. Non-White ethnic groups account for an increasing proportion of the UK population. This study explores whether there are ethnic differences in oral health and whether these are explained by differences in sociodemographic or lifestyle factors, or use of dental services. Methods We used the Adult Dental Health Survey 2009 to conduct a cross-sectional study of the adult general population in England, Wales and Northern Ireland. Ethnic groups were compared in terms of oral health, lifestyle and use of dental services. Logistic regression analyses were used to determine whether ethnic differences in fillings, extractions and missing teeth persisted after adjustment for potential sociodemographic confounders and whether they were explained by lifestyle or dental service mediators. Results The study comprised 10,435 (94.6 %) White, 272 (2.5 %) Indian, 165 (1.5 %) Pakistani/Bangladeshi and 187 (1.7 %) Black participants. After adjusting for confounders, South Asian participants were significantly less likely, than White, to have fillings (Indian adjusted OR 0.25, 95 % CI 0.17-0.37; Pakistani/Bangladeshi adjusted OR 0.43, 95 % CI 0.26-0.69), dental extractions (Indian adjusted OR 0.33, 95 % CI 0.23-0.47; Pakistani/Bangladeshi adjusted OR 0.41, 95 % CI 0.26-0.63), and <20 teeth (Indian adjusted OR 0.31, 95 % CI 0.16-0.59; Pakistani/Bangladeshi adjusted OR 0.22, 95 % CI 0.08-0.57). They attended the dentist less frequently and were more likely to add sugar to hot drinks, but were significantly less likely to consume sweets and cakes. Adjustment for these attenuated the differences but they remained significant. Black participants had reduced risk of all outcomes but after adjustment for lifestyle the difference in fillings was attenuated, and extractions and tooth loss became non-significant. Conclusions Contrary to most health inequalities, oral health was better among non-White groups, in spite of lower use of dental services. The differences could be partially explained by reported differences in dietary sugar

Racism as a determinant of health: a systematic review and meta-analysis

Despite a growing body of epidemiological evidence in recent years documenting the health impacts of racism, the cumulative evidence base has yet to be synthesized in a comprehensive meta-analysis focused specifically on racism as a determinant of health. This meta-analysis reviewed the literature focusing on the relationship between reported racism and mental and physical health outcomes. Data from 293 studies reported in 333 articles published between 1983 and 2013, and conducted predominately in the U.S., were analysed using random effects models and mean weighted effect sizes. Racism was associated with poorer mental health (negative mental health: r = -.23, 95% CI [-.24,-.21], k = 227; positive mental health: r = -.13, 95% CI [-.16,-.10], k = 113), including depression, anxiety, psychological stress and various other outcomes. Racism was also associated with poorer general health (r = -.13 (95% CI [-.18,-.09], k = 30), and poorer physical health (r = -.09, 95% CI [-.12,-.06], k = 50). Moderation effects were found for some outcomes with regard to study and exposure characteristics. Effect sizes of racism on mental health were stronger in cross-sectional compared with longitudinal data and in non-representative samples compared with representative samples. Age, sex, birthplace and education level did not moderate the effects of racism on health. Ethnicity significantly moderated the effect of racism on negative mental health and physical health: the association between racism and negative mental health was significantly stronger for Asian American and Latino(a) American participants compared with African American participants, and the association between racism and physical health was significantly stronger for Latino(a) American participants compared with African American participants.<br /

A randomized controlled trial to improve heart failure disparities: the Mālama Puʻuwai (caring for heart) Study

Marjorie K Leimomi Mala&nbsp;Mau,1 Eunjung Lim,1 Joseph Keawe&lsquo;aimoku Kaholokula,1 Taylor MU Loui,1 Yongjun Cheng,1 Todd B Seto1,2 1Department of Native Hawaiian Health, University of Hawai&lsquo;i at Mānoa, John A. Burns School of Medicine, 2Queens Heart Physician Practice, Queens Medical Center, Honolulu, HI, USA Objective/Background: To conduct a randomized controlled trial to test the efficacy of a culturally tailored heart failure (HF) education program, to reduce HF hospital readmissions and/or cardiovascular disease death (HF outcomes) among Native Hawaiian and Other Pacific Islander (NHOPI) patients with HF. Methods: One hundred fifty HF patients aged &ge;21 years, NHOPI race, and discharged to home were enrolled and randomized to the Mālama Puʻuwai Program (MPP) or the usual care (UC). The MPP group received a culturally tailored HF program, and the UC received similar standard HF education materials. Clinical and health behavior data were measured at baseline and 12 months. HF outcomes were monitored throughout the entire study period. Two-sample t-test, chi-square, and Cox proportional hazard modeling assessed the efficacy of intervention (MPP or UC) on HF outcomes using an intention-to-treat approach. A sensitivity post hoc analysis was performed on patients who completed the full intervention (n=127). Results: Overall, 69% were men, mean age 54.4&plusmn;13.4 years, 62% were Native Hawaiian, and 24% reported methamphetamine use. More UC participants reported methamphetamine use (32% vs. 16%), hypertension (81% vs. 63%), but less myocardial infarction (27% vs. 48%). HF outcomes were higher in UC (31%) compared with MPP (19%) with higher risk for HF outcomes (hazard ratio [HR] 1.74; 95% CI: 0.89&ndash;3.40). Sensitivity post hoc analysis of intervention compliance revealed that UC was at significantly higher risk for HF outcomes than MPP (HR 2.83; 95% CI: 1.19&ndash;6.72). Conclusions: Culturally tailored HF programs have the potential to reduce HF outcomes among compliant minority patients with HF such as NHOPI. Keywords: cardiomyopathy, Native Hawaiian, Pacific Islander, heart failure outcomes, culturally tailored education program&nbsp