Journal of Racial and Ethnic Health Disparities

Provisional U.S. national COVID-19 mortality data for the year 2020 analyzed by the CDC in March 2021 indicated that non-Hispanic Asians fared markedly better overall than other racial/ethnic minority groups-and marginally better than non-Hispanic Whites-in terms of age-adjusted mortality rates. However, Asians in the United States are composed of diverse array of origin subgroups with highly varying social, economic, and environmental experiences, which influence health outcomes. As such, lumping all Asians together into a single category can mask meaningful health disparities among more vulnerable Asian subgroups. To date, there has not been a national-level analysis of COVID-19 mortality outcomes between Asian subgroups. Utilizing final multiple cause of death data for 2020 and population projections from the U.S. Census Bureaus Current Population Survey Annual Social and Economic Supplement for 2020, crude and age-adjusted national COVID-19 mortality rates, both overall and stratified by sex, were calculated for the six major single-race Asian origin subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese) and a catch-all seventh category that comprises the remaining Asian subgroups (Other Asians), contrasting them to the corresponding mortality rates of other racial/ethnic groups. A substantially more nuanced picture emerges when disaggregating Asians into its diverse origin subgroups and stratifying by sex, with Filipino males and Asian males outside of the six major Asian subgroups in particular experiencing markedly higher age-adjusted mortality rates than their White male counterparts, whether comparisons were restricted to their non-Hispanic subsets or not. During the COVID-19 pandemic and in the post-pandemic recovery, it is imperative not to overlook the health needs of vulnerable Asian populations. Public health strategies to mitigate the effects of COVID-19 must avoid viewing Asians as a monolithic entity and recognize the heterogeneous risk profiles within the U.S. Asian population.

BackgroundExcess death for Black people compared with White people is a measure of health equity. We sought to determine the excess deaths under the age of 65 (<65) for Black people in the United States (US) over the most recent 20-year period. We also compared the excess deaths for Black people with a cause of death that is traditionally reported. MethodsWe used the Center of Disease Control (CDC) WONDERs Multiple Cause of Death 1999-2019 dataset to report age-adjusted mortality rates among non-Hispanic Black (Black) and non-Hispanic White (White) people and to calculate annual age-adjusted <65 excess deaths for Black people from 1999-2019. We measured the difference in mortality rates between Black and White people and the 20-year and 5-year trends using linear regression. We compared age-adjusted <65 excess deaths for Black people to the primary causes of death among <65 Black people in the US. ResultsFrom 1999 to 2019, the age-adjusted mortality rate for Black men was 1,186 per 100,000 and for White men was 921 per 100,000, for a difference of 265 per 100,000. The age-adjusted mortality rate for Black women was 802 per 100,000 and for White women was 664 per 100,000, for a difference of 138 per 100,000. While the gap for men and women is less than it was in 1999, it has been increasing among men since 2014. These differences have led to many Black people dying before age 65. In 1999, there were 22,945 age-adjusted excess deaths among Black women <65 and in 2019 there were 14,444--deaths that would not have occurred had their risks been the same as those of White women. Among Black men, 38,882 age-adjusted excess <65 deaths occurred in 1999 and 25,850 in 2019. When compared to the top 5 causes of deaths among <65 Black people, death related to disparities would be the highest mortality rate among both <65 Black men and women. CommentIn the US, over the recent 20-year period, disparities in mortality rates resulted in between 61,827 excess deaths in 1999 and 40,294 excess deaths in 2019 among <65 Black people. The race-based disparity in the US was the leading cause of death among <65 Black people. Societal commitment and investment in eliminating disparities should be on par with those focused on other leading causes of death such as heart disease and cancer.

Many Asian American (AA) subgroups experience disproportionate rates of cardiometabolic (CMB) conditions, yet the contextual drivers of these disparities remain unclear. Little is known about the role of Asian residential segregation, often conceptualized as Asian enclaves, with limited prior work largely ignoring region of origin and nativity. Using six years of population-based survey data from New York City (N>6,000 AAs) linked with multiple sources of community data, we examine how residence in ethnicity-specific enclaves relates to CMB risks (obesity, hypertension, and diabetes), whether these associations differ by nativity, and the extent to which neighborhood socioeconomic conditions, the built environment, social cohesion, and institutional support account for observed associations. Our combined concentration-based and spatial clustering analysis identified five East Asian enclaves and six South Asian enclaves, with no geographic overlap between the two. Logistic regression analyses show that residence in an East Asian enclave was associated with lower odds of obesity (OR=0.63), while residence in a South Asian enclave was linked to higher odds of diabetes (OR=1.42) and hypertension (OR=1.46). These associations were present only among foreign-born individuals. After adjusting for neighborhood characteristics, the lower obesity risk in East Asian enclaves persisted, while elevated risks in South Asian enclaves were partly reduced. Both suggest a role for unmeasured enclave factors, including cultural and food environments. Our findings challenge the view that Asian enclaves are monolithically health-promoting and redirects scholarly attention toward disaggregated approaches to investigating AA health disparities.

From 1999 to 2020, disparities in all-cause age-adjusted mortality rates between Black and White Non-Hispanic Americans decreased then stagnated and increased. Consistent improvement in racial disparities were made for cancer, HIV, and sepsis regardless of all-cause trends. In contrast, conditions like heart disease and external causes of death mirrored the overall trends.

Objectives. To investigate self-reported discrimination and concern for physical assault due to the COVID-19 pandemic among disaggregated Asian subgroups in the US. Methods. We conducted a nationwide survey to assess self-reported discrimination and concern for physical assault due to COVID-19 across racial/ethnic groups, including diverse subgroups of Asians. Results. Chinese respondents experienced the largest change (15% increase) in proportion of respondents reporting discrimination from 2019 to 2020 (P<.01). Chinese, Korean, Japanese, Vietnamese, and Other API showed up to 3.9 times increased odds of self-reported racial/ethnic discrimination due to COVID-19 and, with the addition of Filipino, experienced up to 5.4 times increased odds of concern for physical assault due to COVID-19 compared to Whites. Conclusions. Our study is the first to examine self-reported discrimination and concern for physical assault due to COVID-19 in subgroups of Asian Americans, finding that East (Chinese, Korean, Japanese) and Southeast (Vietnamese, Filipino) Asian Americans have been disproportionately affected. Future studies should disaggregate Asian subgroups to fully understand experiences of discrimination in diverse populations in the US.

BackgroundCardiometabolic conditions are among the leading causes of maternal mortality in the US. The American Heart Association (AHA) Lifes Essential 8TM (LE8) provides an actionable summary measure for assessing cardiovascular health. MethodsWe conducted a cross-sectional analysis of National Health and Nutrition Examination Survey (NHANES) data among ever-pregnant adults from 2011 through March 2020. The exposure of interest was race/ethnicity. Primary outcomes included LE8 scores (health outcome and lifestyle metrics). We fitted survey-weighted linear and multinomial logistic regression models, examining racial and ethnic disparities by LE8 scores and each metric separately, adjusting for confounders. ResultsAmong 2,208 ever-pregnant adults, the mean age was 52.0 {+/-} 19.64 years. Non- Hispanic (NH) Black adults had lower mean LE8 scores (57.20 95%CI: 55.96, 58.44) compared to NH White (62.85 95% CI: 61.39, 64.30), Mexican/Hispanic (62.26, 95%CI 60.86, 63.66), and NH Asian adults (65.83 95% CI: 63.47, 68.19). After adjusting for confounders, NH Black adults had significantly lower overall LE8 scores than NH White adults ({beta} = -0.09, 95% CI: -0.12, -0.06), with lower scores for blood pressure ({beta} = -0.25, 95% CI: -0.32, -0.18) and BMI ({beta} = -0.21, 95% CI: -0.30, -0.11). Mexican/Hispanic adults were less likely to be in the high LE8 score category (Quartile 3) compared to NH White adults (PRR: 1.32, 95% CI: 0.92 1.91) and had lower physical activity scores ({beta} = -0.38, 95% CI: -0.55, -0.21). NH Asian adults had lower scores for physical activity ({beta} = -0.76, 95% CI: -1.10, -0.4) but higher scores for BMI ({beta} = 0.31, 95% CI: 0.23, 0.40). ConclusionNH Black, Hispanic ever-pregnant adults had a higher prevalence of adverse cardiometabolic outcomes. Focused interventions are needed to address these disparities and improve maternal cardiometabolic health, per AHAs LE8 goals. Clinical PerspectiveO_ST_ABSWhat Is New?C_ST_ABSO_LIThe Lifes Essential 8 (LE8) score provides a comprehensive and actionable tool for assessing cardiovascular health in ever-pregnant adults, offering clinicians a standardized method to identify and stratify cardiovascular risk. C_LIO_LISignificant racial and ethnic disparities exist in LE8 scores among ever- pregnant adults, with NH Black women consistently showing lower scores across various components, indicating a higher burden of cardiovascular risk factors. C_LIO_LIHigher education levels and socioeconomic status are strongly associated with better LE8 scores, highlighting the importance of addressing social determinants of health in cardiovascular risk management. C_LI What Are the Clinical Implications?O_LILE8 score can be used alongside existing risk assessment tools to better identify women at high risk for cardiometabolic complications during pregnancy. This allows for earlier intervention and potentially improved maternal health outcomes. C_LIO_LIFor women identified with lower LE8 scores, early intervention becomes crucial. C_LIO_LIPreconception care programs can help optimize their cardiovascular health before pregnancy by promoting healthy diets, physical activity, and weight management. C_LIO_LIThe link between lower LE8 scores and lower socioeconomic status underscores the importance of addressing social determinants of health. C_LI

ImportanceAmid efforts in the United States to promote health equity, there is a need to assess progress in reducing excess deaths and years of potential life lost (YPLL) among Black people compared with White people. ObjectiveTo evaluate trends in excess mortality and YPLL among Black people compared with White people. DesignSerial cross-sectional. SettingNational data from the Centers for Disease Control and Prevention, 1999-2020 ParticipantsNon-Hispanic White and non-Hispanic Black people ExposuresRace as documented in the death certificates. Main outcomes and measuresExcess age-adjusted all-cause and disease-specific mortality rate (per 100,000 individuals) and YPLL among Black people compared with White people. ResultsFrom 1999 to 2020, the total number of excess deaths was 658,356 and 1,154,108 among Black females and males, representing 34,938,070 and 47,005,048 excess YPLL among Black females and males. The excess deaths and YPLL were largest among infants and non-elderly adults. Heart disease had the most excess deaths. From 1999, the age-adjusted excess mortality rate declined at an annual average of -9.0 (95% CI: -10.0, -8.0; P<0.001) until 2015 among Black women and at an annual average of -16.3 (95% CI: -20.9, -11.6; P<0.001) until 2012 among Black men, followed by no significant change until 2019 in either group. From 2019 to 2020, excess deaths increased from 90.4 to 192 per 100,000 Black women and from 209.8 to 395 per 100,000 Black men, reaching rates approximating those of 1999. The trends in rates of excess YPLL followed a similar pattern. Conclusions and relevanceOver a recent 22-year period, Black people in the US lost more than 80 million years of life when compared with White people. After a period of progress, improvements stalled, and most gains were eliminated in 2020. KEY POINTSO_ST_ABSQuestionC_ST_ABSHow many excess deaths and years of potential life lost (YPLL) for Black people, compared with White people, occurred in the United States from 1999 through 2020? FindingsBased on Centers for Disease Control and Prevention data, excess deaths and YPLL persisted throughout the period, with initial progress followed by little improvement, and then worsening in 2020 to about 1999 levels. Black people had 1.8 million excess deaths and over 80 million YPLL over the study period. MeaningAfter initial progress, excess mortality and YPLL among Black people stagnated and then worsened, indicating a need for new approaches.

Cardiovascular disease (CVD) remains a leading cause of premature mortality in the Caribbean, with particularly high rates from stroke and hypertensive heart disease. While global outcomes have improved, CVD-related mortality in the Caribbean remains elevated. This study examined sex-specific CVD mortality, risk factors, and health policy indicators across non-Latin Caribbean nations, using data from the 2019 PAHO Enlace Portal and comparing results to North America (United States and Canada). Despite North Americans exhibiting more overall risky CVD behaviors, CVD mortality was higher in the Non-Latin Caribbean compared to North America (196.7 vs. 122.6 deaths per 100,000). Total-to-HDL cholesterol ratios were significantly higher in the Caribbean, both in men (4.01 vs. 3.63; p < 0.0001) and women (3.82 vs. 3.01; p < 0.0001), indicating reduced cardioprotective effects of HDL. Hypertensive heart disease mortality was significantly higher in Caribbean women compared to North American women (p < .01), with a similar but non-significant trend in men. Caribbean men also had significantly higher rates of undiagnosed hypertension compared to North American men (47.6% vs. 20.8%; p < .001). NCD policy implementation across the Caribbean was inconsistent, with major gaps in CVD drug therapy access, alcohol advertising restrictions, NCD planning, and surveillance systems. These findings underscore the urgent need for regional investment in prevention, policy enforcement, and culturally relevant strategies to reduce CVD disparities and improve health outcomes in the Caribbean.

PurposeGender identity and sexual orientation are essential factors that must be incorporated into health research to ensure we unearth comprehensive and inclusive insights about the healthcare needs and experiences of diverse people. Despite the calls for more focus on sex and gender in health research, scant attention has been paid to gender identity or sexual orientation. Past research found that 0.35% of Canadian Institutes of Health Research (CIHR) grant abstracts mentioned studying lesbian, gay, bisexual, transgender, queer and/or Two-Spirit (2S/LGBTQ+)-specific health outcomes. However, the nature of that research was not explored. MethodsHere we examine the publicly available database of grant abstracts funded by CIHR from 2009-2020 to analyze what type of 2S/LGBTQ+-specific health outcomes would be studied. ResultsWe found that 58% of awarded grant abstracts mentioned studying sexually transmitted diseases, the majority of which were on human immunodeficiency virus (HIV). Less than 7% of funded 2S/LGBTQ+ grant abstracts mentioned studying cisgender women. Almost 40% mentioned including trans women/girls, and 30% mentioned including trans men/ boys. None of the studies examined mentioned work with the Two-Spirit community. ConclusionThese results reflect larger social and health inequities that require structural level changes in research to support lesbian, bisexual and queer womens health.

As the uses and needs for heart transplants around the world continue to rise, its vital to investigate how the recent boom in demand comparative to availability affects racial and ethnic groups, especially in the representation in heart transplant waitlists and recipients. Here, comparisons between the racial/ethnic representation in heart transplant waitlists and recipients at heart transplant centers through the Scientific Registry for Transplant Recipients (SRTR) are drawn, comparative to the racial/ethnic representation in the location that these centers are located. Findings point towards the overrepresentation of White individuals in both waitlists and recipients, and underrepresentation in all other ethnic minorities --except African Americans-- in waitlists and recipients comparative to their demographic representation in the location of the centers. This difference in representation is largest for Hispanics/Latinos and those that the SRTR classify as "Other". Though just a snapshot of representation between 07/01/2019 and 06/30/2020, this may point to various systemic issues in the accessibility of care of minorities, especially during the COVID-19 pandemic, that need to be addressed as the general populous ages and heart transplants are increasingly relied upon as a treatment for cardiovascular conditions and failure.

BACKGROUNDPrior studies reported large decreases in US life expectancy during 2020 as a result of the COVID-19 pandemic, disproportionately affecting Hispanic and Black populations and vastly exceeding the average change in life expectancy in other high-income countries. Life expectancy estimates for 2021 have not been reported. This study estimated changes in life expectancy during 2019-2021 in the US population, in US racial/ethnic groups, and in 21 peer countries. The study compared outcomes across five US racial/ethnic groups and is the first to estimate changes in life expectancy during the pandemic in non-Hispanic American Indian/Alaska Native and Asian populations. METHODSUS and peer country death data for 2019-2021 were obtained from the National Center for Health Statistics, the Human Mortality Database, and overseas statistical agencies. The 21 peer countries included Australia, Austria, Belgium, Canada, Denmark, England and Wales, Finland, France, Germany, Israel, Italy, Netherlands, New Zealand, Northern Ireland, Norway, Portugal, Scotland, South Korea, Spain, Sweden, and Switzerland. Life expectancy was calculated for 2019 and 2020 and estimated for 2021 using a previously validated modeling method. RESULTSUS life expectancy decreased from 78.85 years in 2019 to 76.98 years in 2020 and 76.44 years in 2021, a net loss of 2.41 years. In contrast, peer countries averaged a smaller decrease in life expectancy between 2019 and 2020 (0.55 years) and a 0.26-year increase between 2020 and 2021, widening the gap in life expectancy between the United States and peer countries to more than five years. The decrease in US life expectancy was highly racialized: whereas the largest decreases in 2020 occurred among non-Hispanic (NH) American Indian/Alaska Native, Hispanic, NH Black, and NH Asian populations, in 2021 the largest decreases occurred in the NH White population. DISCUSSIONThe US mortality experience during 2020 and 2021 was more severe than in peer countries, deepening a US disadvantage in health and survival that has been building for decades. Over the two-year period between 2019 and 2021, US NH American Indian/Alaska Native, Hispanic, and NH Black populations experienced the largest losses in life expectancy, reflecting the ongoing legacy of systemic racism as well as inadequacies in the US handling of the pandemic. The crossover in racialized outcomes between 2020 and 2021, in which the NH White population experienced the largest decreases, likely has multiple explanations.

ObjectiveTo conduct a longitudinal analysis of incidence of self-reported hypertension and blood pressure measurements among foreign-born Hispanics by age of migration, compared to US-born populations. MethodsThe sample was drawn from 2002-2018 of the Health and Retirement Study and included 22,909 individuals. Subsets of this sample were used to conduct a longitudinal analysis of the incidence of hypertension and mean blood pressure measurements. ResultsForeign-born Hispanic women migrating at age 40 and older had a greater incidence of hypertension and a greater increase in systolic blood pressure as they aged compared to US-born Whites. DiscussionIn contrast to the Hispanic Paradox that suggests better health among Hispanic immigrants despite lower socioeconomic status, this was not observed among older Hispanic immigrants for hypertension. Furthermore, older Hispanic women who migrated later in life had a greater incidence of hypertension and greater increases in systolic blood pressure as they aged compared to US-born White women.

BackgroundAlmost every medical professional organization supports abortion access. Meanwhile, federal and state-level policies continue to erode abortion-related healthcare. Physicians are instrumental to abortion access, and their evidence-based attitudes could significantly influence public understanding. However, most studies of physician attitudes about abortion focus on specific subgroups. A study of abortion attitudes among a broader population of clinicians is important for at least three reasons. First, results could provide insights and strategies to improve access and reduce stigma at academic medical centers and beyond. Second, findings could explain discrepancies between expressions of support for abortion by the medical community and the inability or unwillingness of the same community to provide sufficient access to abortion services. Third, gauging the climate of opinion among physicians in a politically contested state is likely to be informative given that most abortion-related judicial decisions will occur in state-versus federal-level courts, and physician attitudes could potentially influence public policy. ObjectiveTo use leading survey methodologies to assess abortion-related attitudes among all physicians at the largest academic medical center in a politically contested Midwestern state. Study DesignInvestigators developed a cross-sectional survey to gauge abortion-related knowledge, attitudes, and practices. The universitys survey research center disseminated the survey to all 1,357 physician faculty members of the school of medicine and public health using a web and mail mixed-mode methodology (67% response rate). Analyses included chi-squared tests and binary logistic regression models of support for abortion procedures and willingness to consult in abortion care. ResultsAcross more than 20 specialties and all sociodemographic categories, physicians reported strong support for abortion. Majorities expressed support for medication (81%) and surgical abortion (80%), that abortion should be legal in all or most cases (88%), and that a state law banning abortion would make womens health worse (91%). While nearly all physicians (94%) care for women of reproductive age, most (69%) reported no opportunity to participate in abortion care and fewer than half (44%) knew whom to contact to refer a patient for abortion care. Female physicians and those who considered their expertise relevant to abortion were more supportive, while physicians of color and highly religious physicians were less supportive. Few physicians reported participating in any aspect of abortion care (14%), though nearly two-thirds were willing to consult in such care (65%). Those with relevant expertise were more willing to consult, while physicians of color and highly religious physicians were less willing. While most physicians said they support unrestricted access to abortion (63%) and the efforts of abortion providers (70%) "a lot," a majority perceived relatively less support among their professional peers, revealing a climate of pluralistic ignorance. ConclusionsDespite overwhelming support for abortion among this population, participation in any aspect of abortion care is remarkably low. Physicians across all disciplines need clear training and guidelines on how to refer patients for abortion care, and abortion should be normalized and integrated into mainstream medicine. Given professional organizations support of abortion and physicians cultural influence, these results can be used to inform public policy regarding abortion access.

Initial surveillance data suggests a disproportionately high number of deaths among Black patients with COVID-19. However, high-risk comorbidities are often over-represented in the Black population, and understanding whether the disparity is entirely secondary to them is essential. We performed a retrospective cohort study using real-time analysis of electronic medical records (EMR) of patients from multiple healthcare organizations in the United States. Our results showed that Black patients with COVID-19 have a significantly higher risk of mortality, hospitalization, and invasive mechanical ventilation compared to White patients. The incremental risk of poor outcomes in Blacks persists despite accounting for a higher prevalence of comorbidities. This may point to the disparities in socioeconomic determinants of health affecting Blacks and the need for an improvement in the care of this vulnerable population.

ObjectivesLoneliness and social isolation pose significant risks for an individuals physical, mental, and social health including higher incidence of cardiovascular disease (CVD), poorer patient reported outcomes, and earlier mortality compared to those not experiencing loneliness or social isolation. The objective of this study was to assess loneliness and social and emotional support among adults aged 18 years and older who have CVD in the US. DesignUsing the 2023 Behavioral Risk Factor Surveillance Systems social determinants and health equity module, we examined the distribution of US adults with CVD, compared the prevalence of CVD by Hispanic ethnicity, and conducted multivariable logistic regressions assessing the relationship of independent variables with loneliness and social and emotional support. ResultsThe proportion of adults with CVD who felt lonely sometimes, usually, and always was 44.6%. Hispanic adults who felt lonely (56.3% vs. 43.0%; P<0.0001) and did not receive needed social and emotional support (13.7% vs. 9.8%; P=0.0162) experienced a higher prevalence of CVD than their non-Hispanic adult counterparts who felt lonely and did not receive needed social and emotional support. Adults with CVD who reported rarely or never receiving needed social and emotional support (odds ratio [OR]: 1.42; confidence interval [CI]: 1.14-1.77) had 42% higher odds of feeling lonely, compared to adults who indicated receiving social and emotional support sometimes, usually, or always. Among Hispanic adults with CVD, widowed/divorced/separated adults (OR: 2.30; CI: 1.46-3.61), urban residents (OR: 2.14; CI: 1.05-4.36), and unemployed adults (OR: 3.26; CI: 1.93-5.51) had higher odds of feeling lonely compared to married, rural, and employed adults. ConclusionThis study demonstrates significant disparities in loneliness and social and emotional support in CVD among US adults, with Hispanics experiencing a disadvantage in both outcomes. Future studies should examine strategies to improve social connection for those experiencing disparities.

BackgroundEarly data from the COVID-19 pandemic suggests that the disease has had a disproportionate impact on communities of color causing higher infection and mortality rates within those communities. MethodsThis study used demographic data from the 2018 US census estimates, mortality data from the Cook County Medical Examiners office, and testing results from the Illinois Department of Public Health to perform both bivariate and multivariate regression analyses to explore the role race plays in COVID-19 outcomes at the individual and community levels. ResultsPrincipal findings show that: 1) while Black Americans make up 22% of Cook Countys population, they account for 36% of the countys COVID-19 related deaths; 2) the average age of death from COVID-19 is seven years younger for minorities compared to Non-Hispanic White (White) decedents; 3) minorities were more likely than Whites to have seven of the top 10 co-morbidities at death; 4) residents of predominantly minority areas were twice as likely to test positive for COVID-19 (p = 0.0001, IRR 1.94, 95% CI 1.50, 2.50) than residents of predominantly White areas; and 5) residents of predominantly minority areas were 1.43 times more likely to die of COVID-19 than those in predominantly White areas (p = 0.03). ConclusionsThere are notable differences in COVID-19 related outcomes between racial and ethnic groups at individual and community levels. We hope that this study will scientifically illustrate the health disparities experienced by communities of color and help to address the underlying systemic inequalities still prevalent within our country.

Asian Americans are a diverse and significant group within the United States and encompass a wide range of social demographics. Research on social determinants of hypertension within this population is limited, despite a notable burden of illness. Asian American attendees at health fairs held in Monterey Park and Rosemead, California in Los Angeles County were surveyed on various social demographics and screened for presence of hypertension outcomes. Logistic regression modeling was employed to determine major demographic contributors to the prevalence of prehypertensive or higher outcomes, ultimately finding that health fair location was a significant predictor (OR: 3.41; 95% CI: 1.54, 7.58; P-Value: 0.003). Further analysis of only attendees exhibiting prehypertensive or higher outcomes showed a significant distribution in the conditional distribution of education levels between Monterey Park and Rosemead attendees. Study findings uncover further areas for research into both Asian American and Chinese American populations and contribute to an overall gap in research within these demographic groups.

In June 2022, the U.S. Supreme Court overturned Roe v Wade. Half of states now face proposed or in-effect abortion bans, which affect the ability of obstetrics and gynecology (ObGyn) residency programs to provide abortion training. Prior to the Supreme Court decision, we surveyed ObGyn residents at all four programs in Wisconsin and Minnesota to assess residents attitudes toward abortion, desire to learn about abortion, and intentions about providing abortion care in their future practice. We found that participants overwhelmingly support abortion, find the issue to be important, and plan to incorporate abortion into future practice. The reversal of Roe v Wade and its impact on access to abortion training may have implications for ObGyn residency recruitment and training, related career decision-making, and future workforce.

BackgroundDescriptive study of Japanese sexual and gender minority (SGM) population with national representativeness have not been conducted. We sought to estimate the proportion of the Japanese SGM, and to describe those demographic, socioeconomic, and health-related variables. MethodsUtilizing data on a nationwide cross-sectional internet survey from September 12th to October 19th, 2022, we conducted a comprehensive descriptive study by applying inverse probable weighting method for national representativeness. Participants self-reported as heterosexual, homosexual, bisexual, or gender minority (GM) and responded to questions on various demographic, socioeconomic, and health-related concerns. FindingsAmong Japanese adults, 4.8% identified as homosexuals, 1.3% as bisexuals, and 3.8% as GMs. SGMs were less likely to be married/partnered compared to heterosexuals, though a certain proportion were in opposite-sex marriages/partnerships. SGMs had lower household equivalent income, insurance coverage, home ownership, current smoking rates, good self-rated health, and full COVID-19 vaccination rates. They also exhibited higher rates of substance use, severe psychological distress, feelings of loneliness, and fear of COVID-19 compared to heterosexuals. When divided by assigned sex at birth, SGM males had poorer employment status, lower academic attainment, and higher body mass index compared to their heterosexual counterparts, while SGM females showed opposite trends. InterpretationDifferences in demographic, socioeconomic, and health status between heterosexuals and SGMs underscore the need for targeted health policies and interventions to address health disparities among Japanese SGMs. Additionally, these results suggest that directly applying Western health policies to the Japanese context may not always be appropriate. FundingFunded by the Japan Society for the Promotion of Science, the Research Support Program to Apply the Wisdom of the University to tackle COVID-19 Related Emergency Problems, University of Tsukuba, and Health Labour Sciences Research Grantand the Japan Agency for Medical Research and Development.

Background: Little is known about risk factors for COVID-19 outcomes, particularly across diverse racial and ethnic populations in the United States. Methods: In this prospective cohort study, we followed 3,086 COVID-19 patients hospitalized on or before April 13, 2020 within an academic health system in New York (The Mount Sinai Health System) until June 2, 2020. Multivariable logistic regression was used to evaluate demographic, clinical, and laboratory factors as independent predictors of in-hospital mortality. The analysis was stratified by self-reported race and ethnicity. Findings: A total of 3,086 COVID-19 patients were hospitalized, of whom 680 were excluded (78 due to missing race or ethnicity data, 144 were Asian, and 458 were of other unspecified race/ethnicity). Of the 2,406 patients included, 892 (37.1%) were Hispanic, 825 (34.3%) were black, and 689 (28.6%) were white. Black and Hispanic patients were younger than White patients (median age 67 and 63 vs. 73, p<0.001 for both), and they had different comorbidity profiles. Older age and baseline hypoxia were associated with increased mortality across all races. There were suggestive but non-significant interactions between Black race and diabetes (p=0.09), and obesity (p=0.10). Among inflammatory markers associated with COVID-19 mortality, there was a significant interaction between Black race and interleukin-1-beta (p=0.04), and a suggestive interactions between Hispanic ethnicity and procalcitonin (p=0.07) and interleukin-8 (p=0.09). Interpretation: In this large, racially and ethnically diverse cohort of COVID-19 patients in New York City, we identified similarities and important differences across racial and ethnic groups in risk factors for in-hospital mortality.