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.

Alzheimer's Disease and Related Dementias Diagnosis in the United States Among US-Born and Foreign-Born White, Black, Hispanic, and Asian Older Adults.

Timely clinical diagnosis of Alzheimer's disease and related dementias (ADRD) is important for resource allocation, mitigating safety concerns, and improving quality of life. While studies have examined ADRD diagnosis disparities by race/ethnicity, few include its intersection with nativity. Our aims were to (1) estimate the odds of diagnosed ADRD among US- and foreign-born racial/ethnic groups compared to US-born White older adults and (2) make comparisons by nativity within each racial/ethnic group. We linked 2000-2017 National Health Interview Survey (NHIS) and 2001-2018 Medical Expenditure Panel Survey (MEPS) data (65 + years; n = 38,033). Race/ethnicity and nativity were measured using NHIS data. Diagnosed ADRD was determined using ICD-9 (290/294/331/797) or ICD-10 (F01/F03/G30/G31) billing codes created from self-reports during MEPS household interviews. Bivariate and multivariable analyses were adjusted for covariates based on Anderson's behavioral model of health services use. US-born Black (OR = 1.74; 95% CI = 1.48-2.05), Hispanic (OR = 1.62; 95% CI = 1.14-2.29), and foreign-born Hispanic (OR = 1.63; 95% CI = 1.24-2.15) older adults, but not foreign-born Black or Asian older adults, had higher odds of diagnosed ADRD compared to US-born White older adults after adjusting for age and sex. After additional adjustment for education, health insurance, usual source of care, and chronic conditions, only US-born Black older adults continued to show higher odds (OR = 1.54; 95% CI = 1.27-1.87) of diagnosed ADRD compared to US-born White older adults. There were no differences in ADRD diagnosis by nativity within each racial/ethnic group. Findings highlight the need for including nativity in studies comparing racial/ethnic groups to Whites to fully capture the ADRD burden among US-born Black older adults.

Modifiable Risk Factors for Alzheimer's Disease and Related Dementias Among Middle Eastern and North African Immigrants to the United States.

Background and Objectives: Modifiable risk factors across the life course play a role in the development of Alzheimer's disease and related dementias (ADRD). Studies have identified racial and ethnic disparities in ADRD risk factors. Few studies have explored the epidemiology of ADRD risk among Middle Eastern and North African (MENA) Americans, largely due to their classification as White in US national health surveys. Our aim was to estimate ADRD risk factors among MENA immigrants compared to US- and foreign-born non-Hispanic White adults. Research Design and Methods: We linked cross-sectional 2000-2017 National Health Interview Survey and 2001-2018 Medical Expenditure Panel Survey data (N = 108 695; age ≥ 18 years). Modifiable risk factors for ADRD that were evaluated (yes or no) included less than ninth grade education, hearing loss, traumatic brain injury, hypertension, alcohol use, obesity, smoking, depressive symptoms, marital status, physical inactivity, and diabetes. Bivariate analysis and multivariable logistic regression were conducted. Regression models were adjusted by age and sex. Results: Compared to US-born White adults, MENA immigrants had higher odds of reporting less than 9th grade education (OR = 1.93; 95% CI = 1.17-3.21) and psychological health concerns (OR = 1.28; 95% CI = 1.06-1.56). Compared to foreign-born White adults, MENA immigrants had higher odds of diabetes (OR = 1.48; 95% CI = 1.06-2.08) and psychological health concerns (OR = 1.24; 95% CI = 1.01-1.54). Discussion and Implications: The findings provide the first comprehensive look at potentially modifiable risk factors for ADRD among MENA immigrants based on a life course model. Without a racial/ethnic identifier for MENA individuals on a national level, ADRD risk factors among US-born MENA adults and MENA immigrants cannot be examined. More research is needed to explore these risk factors by life stage (early, midlife, and late) to further determine ADRD risk and prevention strategies for MENA Americans.

Maternal and Perinatal Health Disparities Among Middle Eastern and North African Women and Children in the United States.

INTRODUCTION: Few studies have evaluated the health of Middle Eastern and North African (MENA) women and children in the United States. Objectives were to determine the odds of well-visits, preventive behaviors during pregnancy, and low birthweight among foreign-born non-Hispanic MENA women and children compared to their US- and foreign-born non-Hispanic White counterparts after adjusting for covariates (hereafter, reported as MENA and White). METHODS: We analyzed 2000-2018 National Health Interview Survey data (411,709 women, 311,961 children). Outcomes included well-woman visits (past 12 months); dentist visits (past 6 months) and current smoking among pregnant women; and low, moderately low, and very low birthweight among children. Covariates included age, family income, and health insurance for children. Education and marital status were also evaluated among women. RESULTS: Over half (53.4%) of foreign-born MENA women were of childbearing age (ages 18-45) compared to 47.7% US-born and 43.2% foreign-born White women. The odds of completing a well-women visit were 0.73 times lower (95% CI = 0.38-0.89) among foreign-born MENA women compared to US-born White women after adjusting for age, education, and marital status. There was no statistically significant difference in dental visits between groups. No foreign-born MENA pregnant women reported current smoking. Foreign-born MENA children had higher odds of low (OR = 1.65; 95% CI = 1.16-2.35) and moderately low birthweight (OR = 1.78; 95% CI = 1.19-2.66) compared to US-born White children in adjusted models. DISCUSSION: MENA women and children are classified as White by the federal government. Our results highlight that the health of foreign-born MENA women and children differ from their White counterparts.

Diabetes Among Racial and Ethnically Diverse Older Adults in the United States with Cognitive Limitations.

Diabetes is one of the most common coexisting conditions among adults with cognitive limitations. Complexities of diabetes care present challenges for older adults and their caregivers. Few studies have evaluated disparities in the prevalence of coexisting diabetes among older adults with cognitive limitations by race/ethnicity and nativity. Our objectives were to (1) estimate the odds of coexisting diabetes among US- and foreign-born racial/ethnic groups compared to US-born non-Hispanic White older adults and (2) compare US- and foreign-born older adults within each racial/ethnic group. We linked and analyzed 2000-2017 National Health Interview Survey and 2001-2018 Medical Expenditure Panel Survey data among older adults with cognitive limitations (ages ≥ 65 years, n = 4688). The overall prevalence of coexisting diabetes among older adults with cognitive limitations was 30.3%. Among older adults with cognitive limitations and after adjusted for age, sex, education, and risk factors for diabetes and cognitive limitations, non-Hispanic Black (US-born OR = 1.56, 95%CI = 1.23-1.98; foreign-born OR = 2.69, 95%CI = 1.20-6.05) and Hispanic (US-born OR = 2.13, 95%CI = 1.34-3.40; foreign-born OR = 2.02, 95%CI = 1.49-2.72) older adults had higher odds of coexisting diabetes compared to US-born non-Hispanic Whites. There were no differences in the odds of coexisting diabetes among foreign-born non-Hispanic Black and Hispanic adults compared to US-born counterparts. Findings suggest a large potential burden of coexisting diabetes among this growing populations of US- and foreign-born racially/ethnically diverse older adults with cognitive limitations. Future studies are needed to examine how diabetes self-efficacy, treatment, and monitoring are impacted by cognitive limitations and determine ways to improve care in collaboration with caregivers and healthcare providers.

Suitability of Middle Eastern and North African immigrant minimal reporting category for Arab immigrant health research in the national health interview survey.

Studies of Middle Eastern immigrants using national data, with and without African immigrants, have provided important discoveries on the health of this group. However, they do not directly measure health among Arab immigrants. It is yet to be determined whether using a Middle Eastern and North African (MENA) classification can represent the health needs of Arab immigrants. The objective of this study was to assess if MENA immigrant health reflects the same patterns found in previous research focusing on Arab immigrant health. We used multiple years of data from the National Health Interview Survey in alignment with each former study methodology to compare our findings with four previous research studies. The independent variable was region of birth among non-Hispanic Whites. The dependent variables were chronic diseases, women's preventive health behaviors, men's preventive health behaviors, and cigarette smoking. Logistic regression was conducted to determine the odds of each outcome for MENA immigrants compared to US-born Whites. Then, adjusted 95% confidence intervals representing the more inclusive MENA immigrant categorization were compared to previous studies among Arab immigrants. Chronic conditions, women's and men's preventive health behaviors and cigarette smoking did not differ whether the MENA or Arab definition was used. However, statistically significant differences were observed between MENA and Arab immigrants regarding bachelor's degree or higher, not employed and years in the US. The MENA category reflects the Arab immigrant experience, even though it includes a wider set of origins, some of which are not Arab. Including a MENA identifier on future data collections will both represent Arab Americans, as well as identify this population as distinct from Whites to better represent and track health disparities.

Politically related stress and low-birth-weight infants among Arab, Asian, Hispanic, non-Hispanic Black, and non-Hispanic White women in Michigan.

BACKGROUND: Despite the high cost of low birth weight and the persistent challenge of racial inequities affecting the Arab American community, there has been limited research to identify and examine risk factors for these inequities with validated data on Arab American ethnicity and recent population stressors. OBJECTIVES: This study examined whether the 2016 presidential election is associated with low birth weight among non-Hispanic White, Arab American, Hispanic, and non-Hispanic Black women. DESIGN: This population-based study of singleton births in Michigan (2008-2017) used an algorithm to identify mothers who were of Arab descent. METHODS: We used logistic regression to estimate odds ratios and 95% confidence intervals for the association between race/ethnicity and the odds of low birth weight. We examined whether these associations differed before and after the 2016 presidential election and according to maternal education. RESULTS: There were 1,019,738 births, including 66,272 (6.5%) classified as low birth weight. The odds of having a low-birth-weight infant were higher among all minority women compared to non-Hispanic White women. The association was similar before and after the 2016 presidential election and stronger among women with higher levels of education. CONCLUSION: This is the first study to estimate low birth weight among Arab American women in the context of political events. There are opportunities for future studies to discuss this issue in depth.

Suspected Undiagnosed ADRD Among Middle Eastern and North African Americans.

ADRD underdiagnosis among minority populations is well-established and known to be more prevalent among women. Yet, it remains unclear if these patterns exist among adults of Middle Eastern and North African (MENA) descent. We estimated ADRD underdiagnosis among adults of MENA descent and other US- and foreign-born non-Hispanic Whites and compared sex-stratified results. We linked 2000-2017 National Health Interview Survey and 2001-2018 Medical Expenditure Panel Survey data (ages > = 65 years, n = 23,981). Undiagnosed ADRD was suspected if participants reported cognitive limitations without corresponding ADRD diagnosis. Undiagnosed ADRD was highest among adults of MENA descent (15.8%) compared to non-Hispanic Whites (US-born = 8.1%; foreign-born = 11.8%). Women of MENA descent had 2.52 times greater odds (95% CI = 1.31-4.84) of undiagnosed ADRD compared to US-born White women after adjusting for risk factors. This study contributes the first national estimates of undiagnosed ADRD among adults of MENA descent. Continued research is needed to facilitate policy changes that more comprehensively address health disparities and related resource allocation.

Suspected undiagnosed ADRD among Middle Eastern and North African Americans.

Background ADRD underdiagnosis among minority populations is well-established and known to be more prevalent among women. Yet, it remains unclear if these patterns exist among Middle Eastern and North African (MENA) adults. We estimated ADRD underdiagnosis among MENA and other US- and foreign-born non-Hispanic Whites and compared sex-stratified results. Methods We linked 2000-2017 National Health Interview Survey and 2001-2018 Medical Expenditure Panel Survey data (ages > = 65 years, n = 23,981). Undiagnosed ADRD was suspected if participants reported cognitive limitations without corresponding ADRD diagnosis. Results Undiagnosed ADRD was highest among MENA adults (15.8%) compared to non-Hispanic Whites (US-born = 8.1%; foreign-born = 11.8%). MENA women had 2.52 times greater odds (95% CI = 1.31-4.84) of undiagnosed ADRD compared to US-born White women after adjusting for risk factors. Discussion This study contributes the first national estimates of undiagnosed ADRD among MENA adults. Continued research is needed to facilitate policy changes that more comprehensively address health disparities and related resource allocation.

The Disproportionate Burden of COVID-19 Cases among Arab Americans.

Racial and ethnic disparities in COVID-19 cases are pervasive. Some minority, immigrant, and marginalized groups, such as Arab Americans, have been excluded from the research. This population confronts barriers to health care, discrimination, and other factors that may affect understanding, testing, and treatment as it relates to COVID-19. Arab Americans are unique compared to Hispanic, non-Hispanic black, and Asians because Arab Americans do not have a specific ethnic identifier and are classified as non-Hispanic white. Given these issues, this study will estimate COVID-19 cases and examine associations among Arab Americans compared to Hispanic, non-Hispanic black, non-Hispanic white, and Asian adults. Data from the Michigan Disease Surveillance System (March 2020-July 2021), the American Community Survey (2015-2019), and an Arab/Chaldean surname algorithm were used. Chi-square tests were used to determine statistically significant differences between groups. Logistic regression was used to estimate age-adjusted and sex-stratified proportions among Arab Americans compared to non-Hispanic whites before and after adjusting for age and sex. Approximately 17% of Arab Americans tested positive for COVID-19 compared to 11.32% of Hispanics, 9.80% of non-Hispanic blacks, 7.50% of non-Hispanic whites, and 4.24% of Asians. Arab Americans had 2.63 (95% CI: 2.59, 2.66) times greater odds of testing positive for COVID-19 compared to non-Hispanic whites. When Arab Americans were disaggregated from non-Hispanic whites, alarming patterns in COVID-19 cases were observed for Arab Americans. To accurately represent the burden of COVID-19 among Arab Americans, this population needs to have an ethnic identifier that informs appropriate health policy decisions and practice.

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 >=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 US- and 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.

The Burden of and Factors Associated with Age-Related Eye Diseases in Arab American Adults.

To estimate the age- and sex-adjusted proportions of cataract, diabetic retinopathy, glaucoma, and macular degeneration among the Arab American community, a notably understudied minority that is aggregated under whites. The Arab American Eye Study is a multicenter retrospective chart review involving 10 years of electronic medical records (1/1/2010 through 1/1/2020). The study sample included 1390 Arab Americans and 4950 whites 45 years of age and older, totaling 6340 subjects. Arab Americans were identified using an Arab American name algorithm. Subjects with race variables other than white or Arab American or those under age 45 were excluded from the study. Age- and sex-adjusted proportions of cataract, diabetic retinopathy, glaucoma, and macular degeneration were determined. Odds ratios with 95% confidence intervals were used to examine the association between race/ethnicity and eye diseases. Of the 6340 participants (4950 whites and 1390 Arab Americans), males comprised 46.3% and the median age group was 55-64 years. Arab Americans displayed higher age- and sex-adjusted proportions of cataracts (45.4% versus 40.7%), dry age-related macular degeneration (10% versus 8.9%), glaucoma (8% vs 6%), and diabetic retinopathy (11.7% versus 4.2%). Fully adjusted logistic regression revealed that Arab Americans were 19% more likely to have cataracts (OR 1.19; 95% CI 1.05, 1.35) and 272% more likely to have diabetic retinopathy (OR 2.72; 95% CI 2.17; 3.41). Results from the Arab American Eye Study suggest that the burden of cataract and diabetic retinopathy is significantly higher among Arab Americans in comparison to whites.

Cognitive Disability Among Arab Americans by Nativity Status and Arrival Year: Lack of Evidence for the Healthy Migrant Effect.

Limited research exists on cognitive disabilities among Arab Americans, especially as it relates to arrival year among the foreign-born. The objectives of this study were to estimate the age- and sex-adjusted prevalence and associations of cognitive disability by (1) nativity status and (2) arrival year (pre-1991, 1991-2000, 2001-2013, and 2014-2018). We analyzed 11 years (2008-2018) of data from the American Community Survey (ACS) Public Use Microdata Samples (weighted n = 264,086; ages ≥ 45 years). Weighted means, percentages, age- and sex-adjusted prevalence estimates, and logistic regression results (crude and adjusted) were calculated. Among all Arab Americans, the age- and sex-adjusted prevalence of cognitive disability was 6.5%. The prevalence was lower for US-born (4.0%) compared to foreign-born (6.0%) (p-value < 0.0001). In logistic regression results, foreign-born Arab Americans were more likely to have a cognitive disability compared to US-born Arab Americans after adjusting for age and sex (OR = 1.41; 95% CI = 1.24, 1.61). Among foreign-born, Arab Americans arriving in 2014 or later had a lower prevalence of cognitive disability (3.4%) compared to all other arrival years at approximately 4.7%. With those arriving prior to 1991 as the reference category, those arriving between 1991 and 2000 were more likely to report a cognitive disability (OR = 1.05; 95% CI = 1.00, 1.08). However, those arriving between 2014 and 2018 were less likely to report a cognitive disability (OR = 0.81; 95% CI = 0.73, 0.88). These findings challenge the universality of the "healthy migrant effect" and highlight the relevance of socioeconomic disparities for Arab American cognitive health.

Email Patient-Provider Communication and Cancer Screenings Among US Adults: Cross-sectional Study.

BACKGROUND: The growth of electronic medical records and use of patient portals have allowed for patients and health care providers to communicate via email and direct messaging between health care visits. Email patient-provider communication (PPC) may enhance traditional face-to-face PPC by allowing patients to ask questions, receive clear explanations, engage in shared decision-making, and confirm their understanding between in-person visits. Despite increasing trends in the use of email PPC since the early 2000s, few studies have evaluated associations between email PPC and the uptake of preventive services. OBJECTIVE: The objective of this study was to determine associations between the use of email PPC and the likelihood of undergoing breast, cervical, and colon cancer screenings among adults who have received health care in the past 12 months. METHODS: Secondary, cross-sectional data from the 2011-2015 National Health Interview Survey were combined and analyzed. For each cancer screening, inclusion criteria were based on the age of screening recommendations and prior history of cancer diagnosis (n=35,912 for breast, n=48,512 for cervical, and n=45,884 for colon). The independent variable was whether adults used email PPC in the past 12 months (yes or no). The dependent variables were whether (1) women (aged ≥40 years) received a mammogram in the past 12 months; (2) women (aged 21-65 years) received a Pap test in the past 12 months; and (3) individuals (aged ≥50 years) received a colon cancer screening in the past 12 months. Bivariate and multivariable logistic regression analyses were conducted. RESULTS: Adults who reported receiving all three cancer screenings in the past 12 months were more likely to be non-Hispanic White; be married or living with a partner; have a bachelor's degree or higher education level; have health insurance coverage; and perceive their health as excellent, very good, or good (all P<.001). Men were more likely to receive colon cancer screenings than women (P<.001). Multivariable logistic regression models showed women who used email to communicate with their health care providers had greater odds of receiving breast (odds ratio [OR] 1.32, 95% CI 1.20-1.44) and cervical (OR 1.11, 95% CI 1.02-1.20) cancer screenings than women who did not use email PPC. Adults who used email to communicate with their health care providers had 1.55 times greater odds (95% CI 1.42-1.69) of receiving a colon cancer screening than those who did not use email PPC. CONCLUSIONS: Our results demonstrate that email PPC is a marker of increased likelihood of adults completing age-appropriate cancer screenings, particularly breast, cervical, and colon cancer screenings. More research is needed to examine other factors related to the reasons for and quality of email PPC between patients and health care providers and determine avenues for health education and intervention to further explore this association.

Prevalence of Self-reported Cognitive Impairment Among Arab American Immigrants in the United States.

BACKGROUND AND OBJECTIVES: Studies evaluating self-reported cognitive impairment among Arab American immigrants have not been conducted. Our objective was 2-fold: (a) to estimate and compare the age- and sex-adjusted prevalence of self-reported cognitive impairment between Arab American immigrants and U.S.- and immigrant non-Hispanic Whites, non-Hispanic Blacks, Hispanics and non-Hispanic Asians and (b) to examine associations between race, ethnicity, nativity status, and cognitive impairment among Arab American immigrants and non-Hispanic Whites (U.S.- and foreign-born) after controlling for explanatory factors. RESEARCH DESIGN AND METHODS: We used 18 years (2000-2017) of National Health Interview Survey data (n = 228 985; ages ≥ 45 years). Weighted percentages, prevalence estimates, and multivariable logistic regression models were calculated. RESULTS: The age- and sex-adjusted prevalence of self-reported cognitive impairment was significantly higher among Arab American immigrants (9.7%) compared to U.S.-born and non-Hispanic White immigrants (~7.4%). DISCUSSION AND IMPLICATIONS: This is the first study to indicate that ethnic disparities in self-reported cognitive impairment may extend to Arab American immigrants. Additional studies need to be conducted to better understand the prevalence of cognitive impairment.

The influence of patient-provider communication on cancer screenings differs among racial and ethnic groups.

Our study aimed to estimate how associations between adults' perceptions of specific domains of PPC quality and their likelihood of receiving cancer screenings differed by race and ethnicity. We analyzed 2011-2015 Medical Expenditure Panel Survey (MEPS) data. Samples included 7337 women ages 50-74 (breast), 13,276 women ages 21-65 (cervical), and 9792 adults ages ≥50 years (colorectal). To examine individual domains of PPC quality (independent variables), adults reported how often providers: listened; showed respect; spent enough time; explained things; gave specific instructions; and demonstrated health literate practices (gave clear instructions and asked them to "teach-back" how they will follow instructions). Dependent variables were breast, cervical, and colorectal cancer screenings. Multivariable logistic regression was used to evaluate the odds of receiving cancer screenings using a composite measure of PPC quality and separate domains. Hispanic and non-Hispanic black adults who reported their providers always demonstrated PPC quality had higher odds of receiving colorectal cancer screenings compared to those whose providers did not. Adults' perceptions of whether or not their provider gave them specific instructions increased their odds of receiving breast (Hispanics OR = 1.65, 95% CI = 1.09, 2.51; non-Hispanic blacks OR = 1.54, 95% CI = 1.06, 2.24) and colorectal (non-Hispanic whites OR = 1.37, 95% CI = 1.13, 1.66; Hispanics OR = 1.29, 95% CI = 1.01, 1.66; non-Hispanic blacks OR = 1.92, 95% CI = 1.39, 2.65) cancer screenings. Non-Hispanic Asian women who reported their health care providers demonstrated "teach-back" had higher odds (OR = 2.25; 95% CI = 1.10, 4.62) of receiving cervical cancer screenings. Efforts to improve cancer screenings should focus on training providers to demonstrate health literate practices to improve cancer screenings.

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 Influence of Patient-Provider Communication on Cancer Screening.

Few studies have examined how different qualities and modes (face-to-face vs electronic) of patient-provider communication (PPC) influence cancer screening uptake. Our objective was to determine whether receiving a breast, cervical, and colorectal cancer screening is influenced by (1) qualities of face-to-face and (2) the use of e-mail PPC. We analyzed Health Information National Trends Survey 4, cycles 1 to 4 data. To assess qualities of face-to-face PPC, adults reported how often physicians spent enough time with them, explained so they understood, gave them a chance to ask questions, addressed feelings and emotions, involved them in decisions, confirmed understanding, and helped them with uncertainty. Adults reported whether they used e-mail PPC. We used multivariable logistic regression to evaluate the odds of receiving cancer screenings based on face-to-face and e-mail PPC. Adults whose health-care providers involved them in decision-making had highest odds of receiving breast (odds ratio [OR] = 1.38; 95% confidence interval [CI] = 1.11-1.71), cervical (OR = 1.30; 95% CI = 1.06-1.60), and colorectal (OR = 1.25; 95% CI = 1.03-1.51) cancer screenings. No significant associations were observed between e-mail PPC and cancer screenings. More research is needed to explore this association.

Diabetes Management Among Arab Americans Who Sought Care at a Large Metropolitan Hospital System in Michigan.

To estimate and compare the management of diabetes among Arab, Asian, non-Hispanic Black, and non-Hispanic Whites attending a large health system in metropolitan Detroit. Data were electronically abstracted for 6622 adult patients with diabetes. Dependent variables were uptake of A1c testing and results, LDL-C testing and results, and eye examination frequency. The independent variable was race/ethnicity. Logistic regression models were used to examine the association between Arab Americans and non-Hispanic Whites for each of the dependent variables while controlling for confounders. Arab Americans were 38% more likely than non-Hispanic Whites to report an A1c > 7% (OR 1.38; 95% CI 1.03, 1.87). Arab Americans were 62% less likely to receive an eye exam compared to non-Hispanic Whites (OR 1.62; 95% CI 1.21, 2.17). Population based studies about diabetes management among Arab Americans will facilitate tailored interventions aimed at preventing/delaying diabetes complications and reducing premature mortality due to diabetes.

Attitudes towards health research participation: a qualitative study of US Arabs and Chaldeans.

BACKGROUND: The Arab Muslim and Chaldean Christian American community is unified by language but culturally diverse. Researchers are challenged to engage the Arab/Chaldean community to meet immigrant health needs. Arabs/Chaldeans are identified as white in clinical data sets making it difficult to identify health behaviours and patterns unique to the community. OBJECTIVES: To explore the views of members of the Arab/Chaldean community, including researchers and the lay public, regarding health research participation and the role of clinicians, researchers and community leaders in the research process. METHODS: A qualitative study of Arab and Chaldean adults and researchers conducted in a US community with a large Arab/Chaldean population. Five semi-structured focus group discussions were triangulated with five in-depth semi-structured interviews with Arab or Chaldean primary care researchers. Responses were audio-recorded and transcribed verbatim. Transcripts were coded and thematically analysed, and findings confirmed with community representatives. RESULTS: Three themes were identified: (i) research expectations: risks and benefits; (ii) health care environment: clinicians as recruiters and (iii) research participations: risks and benefits. Themes captured concerns with social relationships, reputation or trust and the cost and benefit of research participation. In the Arab/Chaldean community, institutional and political fears and distrust are amplified. Respect for physicians, teachers and faith leaders connected with or recruiting for studies enhances likelihood of research participation. CONCLUSION: Clinical researchers should address the cultural and immigration histories of Arab/Chaldean research participants. Studies that maximize trust will minimize participation bias and lay the groundwork for improved health. Institutional, sociocultural and personal factors require a pre-study phase to engage and educate participants.