PRAXIS; CRITICAL RACE THEORY IN PRACTICE
Does historic redlining—a form of structural racism—affect survival in young people with cancer?
Study finds higher mortality rates among patients living in neighborhoods previously denied mortgages due to racial demographics.
A recent study indicates that children and young adults with cancer face an elevated risk of dying if they live in previously redlined neighborhoods—residential areas marked in the 1920s–1930s by lenders as undesirable for mortgage loans due to their racial demographics. The findings are published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society.
Historic redlining prevented Black households and other communities of color from accessing home mortgages for many years, leading to economic disadvantage and racial segregation. Although historic redlining has been linked to poor health outcomes, including mortality in people with adult-onset cancers, its relationship with survival in pediatric, adolescent, and young adult individuals with cancer is unknown.
To investigate, Kristine Karvonen, MD, MS, of the Fred Hutchinson Cancer Center in Seattle, and her colleagues analyzed a U.S. cancer registry to identify all new cancer diagnoses in people under age 40 living in Seattle and Tacoma, Washington, between 2000 and 2019.
Among 4,355 young individuals diagnosed with cancer, the percentage of people alive at 5 years was lower among those residing in redlined neighborhoods compared with those in other neighborhoods (85.1% versus 90.3%). Survival differences persisted at 10 years (81.1% versus 88.1%). After adjusting for other influencing factors, people in redlined neighborhoods had a 32% higher risk of dying than those in other neighborhoods.
“This study agrees with previous research that living in an area that was previously redlined nearly a century ago is associated with poor outcomes for patients with cancer today and adds young patients with cancer as a population at risk. Therefore, our study names racism as a potential driver of outcomes for young patients with cancer,” said Dr. Karvonen. “In light of our findings of increased mortality experienced by redlined individuals, an important next question is how these disparities arise, as mechanisms will be key to informing future interventions. Additionally, further studies are needed to build upon this historical example and examine more proximal measures of structural racism relevant to patients today.”
Additional information
NOTE: The information contained in this release is protected by copyright. Please include journal attribution in all coverage. A free abstract of this article will be available via the CANCER Newsroom upon online publication. For more information or to obtain a PDF of any study, please contact: Sara Henning-Stout, newsroom@wiley.com
Full Citation:
“Historical redlining and survival among children, adolescents, and young adults with cancer diagnosed between 2000-2019 in Seattle and Tacoma, Washington.” Kristine A. Karvonen, David R. Doody, Dwight Barry, Kira Bona, Lena E. Winestone, Abby R. Rosenberg, Jason A. Mendoza, Stephen M. Schwartz, and Eric J. Chow. CANCER; Published Online: January 27, 2025 (DOI: 10.1002/cncr.35677).
URL Upon Publication: http://doi.wiley.com/10.1002/cncr.35677
Author Contact: media@fredhutch.org
About the Journal
CANCER is a peer-reviewed publication of the American Cancer Society integrating scientific information from worldwide sources for all oncologic specialties. The objective of CANCER is to provide an interdisciplinary forum for the exchange of information among oncologic disciplines concerned with the etiology, course, and treatment of human cancer. CANCER is published on behalf of the American Cancer Society by Wiley and can be accessed online. Follow CANCER on X @JournalCancer and Instagram @ACSJournalCancer, and stay up to date with the American Cancer Society Journals on LinkedIn.
About Wiley
Wiley is one of the world’s largest publishers and a trusted leader in research and learning. Our industry-leading content, services, platforms, and knowledge networks are tailored to meet the evolving needs of our customers and partners, including researchers, students, instructors, professionals, institutions, and corporations. We empower knowledge-seekers to transform today’s biggest obstacles into tomorrow’s brightest opportunities. For more than two centuries, Wiley has been delivering on its timeless mission to unlock human potential. Visit us at Wiley.com. Follow us on Facebook, X, LinkedIn and Instagram.
Journal
Cancer
Article Title
Historical redlining and survival among children, adolescents, and young adults with cancer diagnosed between 2000-2019 in Seattle and Tacoma, Washington
Article Publication Date
27-Jan-2025
COVID-19 pandemic and racial and ethnic disparities in long-term nursing home stay or death following hospital discharge
JAMA Network Open
About The Study:
Older adults hospitalized with sepsis experienced an approximately 50% reduction in long-term nursing home stay or death over a 5-year period before the pandemic in this cross-sectional study. These results suggest that during the pandemic, all individuals, regardless of race and ethnicity, experienced increased long-term nursing home stay or death compared with before the pandemic.
Corresponding Author: To contact the corresponding author, Laurent G. Glance, MD, email laurent_glance@urmc.rochester.edu.
To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/
(doi:10.1001/jamanetworkopen.2024.56816)
Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.
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About JAMA Network Open: JAMA Network Open is an online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.
Journal
JAMA Network Open
Communities of color face greater barriers in accessing opioid medications for pain management
Weill Cornell Medicine
Non-white communities had significantly less access to opioid medications commonly prescribed for moderate to severe pain than white communities over the decade beginning in 2011, according to a study by Weill Cornell Medicine researchers.
The findings, published Jan. 21 in Pain, stretched across all socioeconomic groups, and suggest that communities of color may be especially vulnerable to the unintended consequences of efforts to reduce unsafe use of opioid analgesics.
From 2011 to 2021, prescription opioid use dropped by about 50% across the United States as a likely sign of attempts to reduce overuse of the drugs, previous studies found. However, these declines coincided with neighborhood pharmacies and healthcare settings also carrying fewer opioid medications, likely making it harder for people to fill prescriptions needed for pain management. For some, that may have required traveling longer distances to get the medication they need or not getting the drugs at all, the authors suggested.
The study, led by Dr. Allison Ju-Chen Hu, postdoctoral associate of population health sciences, and Dr. Yuhua Bao, professor of population health sciences at Weill Cornell Medicine, examined access to opioid medication across communities based on their racial and ethnic makeup.
The research team analyzed data from the Drug Enforcement Administration from 2011 to 2021 that reported community distribution of morphine, oxycodone and hydrocodone. Combined, these drugs made up 70% of opioid prescriptions in the United States in 2017. The team analyzed communities defined by 3-digit zip-codes in all 50 states and the District of Columbia. The communities were classified as “majority white” or “majority non-white” based on whether 50% or more of the residents self-reported as non-Hispanic white. The authors also used the Social Deprivation Index to measure the socioeconomic status of each community.
Their analysis showed that there was an overall 40% to 45% lower per-capita distribution of commonly prescribed opioids in majority non-white communities as compared with majority white communities. “While opioid distributions were higher among communities with greater socioeconomic deprivation, differences between majority white and majority non-white communities persisted across all levels,” the authors reported. This inadequate access to opioid analgesics in majority non-white communities may delay treatment even when it’s considered “clinically appropriate,” they wrote.
“Our findings highlight concerns that racially and ethnically minoritized communities, especially the most deprived communities, may have consistently experienced inadequate access to effective pain management amid rapid declines in opioid analgesics during this time,” the authors concluded.
Journal
Pain
Article Publication Date
24-Jan-2025
Biased language common in birthing people’s electronic health records, Columbia Nursing study says
Columbia University Irving Medical Center
NEW YORK, NY (January 23, 2025) -- Language that conveys stigma is common in clinicians’ notes on laboring and birthing people, Columbia University School of Nursing researchers report this month in the Journal of Obstetric, Gynecologic & Neonatal Nursing (JOGNN).
The study appears in a January 2025 special issue of JOGNN, “Women’s Mental Health Across the Life Course.” Veronica Barcelona, PhD, an assistant professor at Columbia Nursing, will participate in an accompanying webinar on Tuesday, January 28, 2025, at 2 p.m. Central Time.
Studies show Black patients’ medical records are more likely to contain biased language than white patients’ records, which could contribute to worse health care, Barcelona and her colleagues note in the report. While implicit bias and racism are known contributors to worse perinatal outcomes among Black people, they add, to date most research on clinicians’ use of stigmatizing language has been in non-maternity settings.
To better understand bias in medical records for birthing patients, Barcelona and her colleagues analyzed 1,771 clinical and labor birthing notes from 2017 for two large hospitals, identifying 10 categories of stigmatizing and non-stigmatizing language.
The most common category of stigmatizing language directed against patients were unjustified descriptions of social and behavioral risks, for example referring to suspected or actual substance use, domestic violence, or teen pregnancy, identified in 22.4% of the notes. Patients were called difficult in 7.2% of notes, while 5.2% of the notes included power or privilege language, for example mentioning a patient’s husband’s job at a prominent financial institution.
Other stigmatizing categories occurring less frequently included language indicating unilateral, authoritarian decision making (4%), questioning patient credibility (2.9%), and clinician disapproval (1.1%).
The authors defined two categories of non-stigmatizing language: positive or preferred language, for example using words like “endorses” or “reports” to convey a patient’s point of view, identified in 10.8% of the notes; and language indicating patients exercising autonomy for birth, seen in 0.8%.
“Implications of this work extend beyond the research context,” Barcelona and her colleagues write. “We aim to improve clinical documentation that reflects each person’s autonomy, is patient-centered, and demonstrates respect to achieve the ultimate goal of developing more inclusive and equitable health care practices for all in the perinatal period.”
Barcelona’s Columbia Nursing co-authors include postdoctoral associate Jihye Scroggins, PhD; doctoral students Danielle Scharp, MS, and Sarah Harkins, BS; and Associate Professor Maxim Topaz, PhD.
The study was funded with a grant from the Columbia University Data Science Institute Seed Funds Program and a grant from the Gordon and Betty Moore Foundation.
About Columbia University School of Nursing
Columbia University School of Nursing is advancing nursing education, research, and practice to advance health for all. As one of the top nursing schools in the country, we offer direct-entry master’s degrees, advanced nursing, and doctoral programs with the goal of shaping and setting standards for nursing everywhere. And, as a top recipient of NIH research funding, we address health disparities for under-resourced populations and advance equitable health policy and delivery.
Through our expansive network of clinical collaborations in New York City and around the world —including our dedicated faculty practice, the ColumbiaDoctors Nurse Practitioner Group — we cultivate a culture of innovation and diversity and champion a community-centered approach to care. Across the Columbia Nursing community, we encourage active listening, big thinking, and bold action, so that, together, we’re moving health forward.
Columbia University School of Nursing is part of Columbia University Irving Medical Center, which also includes the Columbia University Vagelos College of Physicians and Surgeons, the Mailman School of Public Health, and the College of Dental Medicine.
Journal
Journal of Obstetric Gynecologic & Neonatal Nursing
DOI
Study reveals how sex and racial disparities in weight loss surgery have changed over 20 years
A new study by Mass General Brigham investigators shows persistent racial disparities and growing sex disparities between patients who discussed and received weight loss surgery between 2000 and 2020
Brigham and Women's Hospital
- Racial disparities decreased slightly, but sex disparities increased significantly over 20-year period
- Fewer Black people and men underwent weight loss surgery than other racial groups and women, respectively
A new study by Mass General Brigham investigators shows persistent racial disparities and growing sex disparities between patients who discussed and received weight loss surgery between 2000 and 2020. Using artificial intelligence to analyze the medical records of more than 120,000 patients with obesity, researchers found that Black people were less likely than non-Black people to undergo metabolic and bariatric surgery (MBS) – even though both groups were equally likely to discuss it with health care providers. In addition, men were both less likely to discuss and receive MBS than women. These findings, published in Annals of Surgery Open, highlight the need for interventions that encourage patients from all backgrounds to progress from discussion to utilization of MBS.
“As a clinician, I often see patients who could potentially benefit from MBS but who aren’t aware of this treatment option. Patients who discuss MBS are much more likely to undertake it and lose weight,” said corresponding author Alexander Turchin, MD, MS, director of Quality in Diabetes at the Division of Endocrinology, Diabetes and Hypertension at Brigham and Women’s Hospital (BWH), a founding member of the Mass General Brigham healthcare system. “Our findings indicate that we need to improve these conversations and identify barriers to undergoing surgery once it has been discussed.”
Obesity is a growing public health crisis in the United States, affecting more than 40% of all adults and nearly 50% of Black Americans. Although MBS is considered the most effective long-term treatment for severe obesity, research by other investigators at Mass General Brigham has shown a decline in bariatric surgery as prescriptions for GLP-1 drugs have surged. In addition, prior research has shown that fewer Black and male patients undertake MBS than other racial groups and female patients, respectively. However, it has been unclear how these differences change between patient visits to care providers and over time.
Using an artificial intelligence tool, the research team examined electronic health records of 122,487 adults with class 2 obesity and higher who received care at Mass General Brigham between 2000 and 2022. They determined that most patients (74%) first explored MBS with primary care physicians and that annual patient-provider MBS discussions increased from 3.2% to 10% during the 20-year study period. Of the 11,094 (9.1%) patients who discussed MBS with care providers, 1,348 (12.2%) progressed to surgery.
While Black and non-Black patients had comparable MBS discussion rates, only 8.4% of Black patients proceeded with surgery, compared to 12.6% of patients from other racial or ethnic groups. Men were significantly less likely to discuss MBS with providers and were much less likely to progress to surgery than women (7.6% versus 14.6%). The researchers also demonstrated that racial differences in MBS progression decreased over the study period, while sex disparities increased during the same time.
The authors propose many reasons that could underlie the observed racial and sex disparities, including heightened medical mistrust and disproportionate social pressure to lose weight. They also note that their analysis was limited to a single health care system in Massachusetts and might not be representative of the entire U.S. population.
“Providers need to ensure that patients have all the available information to make decisions about obesity treatments,” said Turchin. “Future studies will be required to understand how the advent of new medications to treat obesity such as GLP-1 agonists impacts patient-provider discussions about MBS.”
Authorship: In addition to Turchin, Mass General Brigham authors include Benjamin Grobman, Liyun He, Zhou Lan, Abdelrahman Nimeri, and Caroline Apovian.
Disclosures: Turchin reported research grants from Eli Lilly and consulting fees from Novo Nordisk and Proteomics International Laboratories. Additional author disclosures can be found in the paper.
Funding: This research was funded in part by Patient-Centered Outcomes Research Institute (ME-2019C1-15328).
Paper cited: Grobman B et al. “Race and Sex Disparities in Metabolic / Bariatric Surgery over 20 Years: a Cohort Study” Annals of Surgery Open DOI: 10.1097/AS9.0000000000000540
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About Mass General Brigham
Mass General Brigham is an integrated academic health care system, uniting great minds to solve the hardest problems in medicine for our communities and the world. Mass General Brigham connects a full continuum of care across a system of academic medical centers, community and specialty hospitals, a health insurance plan, physician networks, community health centers, home care, and long-term care services. Mass General Brigham is a nonprofit organization committed to patient care, research, teaching, and service to the community. In addition, Mass General Brigham is one of the nation’s leading biomedical research organizations with several Harvard Medical School teaching hospitals. For more information, please visit massgeneralbrigham.org.
Journal
Annals of Surgery Open
Method of Research
Data/statistical analysis
Subject of Research
People
Article Title
Race and Sex Disparities in Metabolic / Bariatric Surgery over 20 Years: a Cohort Study
Article Publication Date
15-Jan-2025
COI Statement
Turchin reported research grants from Eli Lilly and consulting fees from Novo Nordisk and Proteomics International Laboratories. Additional author disclosures can be found in the paper.
Prevalence of and inequities in poor mental health across 3 US surveys
JAMA Network Open
About The Study:
This survey study documents increasingly prevalent poor mental health from 2011 to 2022 across multiple U.S. health surveys, with notable prevalence differences in Behavioral Risk Factor Surveillance System and National Survey on Drug Use and Health vs National Health Interview Survey. Inequities in these outcomes by age, sex, and racial and ethnic group were often sizeable and changed over time in distinct ways, consistent with findings in prior literature.
Corresponding Author: To contact the corresponding author, Rita Hamad, MD, PhD, email rhamad@hsph.harvard.edu.
To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/
(doi:10.1001/jamanetworkopen.2024.54718)
Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.
Embed this link to provide your readers free access to the full-text article This link will be live at the embargo time
Journal
JAMA Network Open
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