Sex and racial disparities in non-alcoholic fatty liver disease-related cardiovascular events: National inpatient sample analysis (2019)

BACKGROUND Non-alcoholic fatty liver disease(NAFLD)increases cardiovascular disease(CVD)risk irrespective of other risk factors.However,large-scale cardiovascular sex and race differences are poorly understood.AIM To investigate the relationship between NAFLD and major cardiovascular and cerebrovascular events(MACCE)in subgroups using a nationally representative United States inpatient sample.METHODS We examined National Inpatient Sample(2019)to identify adult hospitalizations with NAFLD by age,sex,and race using ICD-10-CM codes.Clinical and demographic characteristics,comorbidities,and MACCE-related mortality,acute myocardial infarction(AMI),cardiac arrest,and stroke were compared in NAFLD cohorts by sex and race.Multivariable regression analyses were adjusted for sociodemographic characteristics,hospitalization features,and comorbidities.RESULTS We examined 409130 hospitalizations[median 55(IQR 43-66)years]with NFALD.NAFLD was more common in females(1.2%),Hispanics(2%),and Native Americans(1.9%)than whites.Females often reported non-elective admissions,Medicare enrolment,the median age of 55(IQR 42-67),and poor income.Females had higher obesity and uncomplicated diabetes but lower hypertension,hyperlipidemia,and complicated diabetes than males.Hispanics had a median age of 48(IQR 37-60),were Medicaid enrollees,and had non-elective admissions.Hispanics had greater diabetes and obesity rates than whites but lower hypertension and hyperlipidemia.MACCE,all-cause mortality,AMI,cardiac arrest,and stroke were all greater in elderly individuals(P<0.001).MACCE,AMI,and cardiac arrest were more common in men(P<0.001).Native Americans(aOR 1.64)and Asian Pacific Islanders(aOR 1.18)had higher all-cause death risks than whites.CONCLUSION Increasing age and male sex link NAFLD with adverse MACCE outcomes;Native Americans and Asian Pacific Islanders face higher mortality,highlighting a need for tailored interventions and care.

Bridging the gap: Addressing disparities in hepatitis C screening, access to care, and treatment outcomes

Hepatitis C virus(HCV)is a significant public health challenge globally,with substantial morbidity and mortality due to chronic liver disease.Despite the availability of highly effective and well-tolerated direct-acting antiviral therapies,widespread disparities remain in hepatitis C screening,access to treatment,linkage to care,and therapeutic outcomes.This review article synthesizes evi-dence from various studies to highlight the multifactorial nature of these dispari-ties,which affects ethnic minorities,people with lower socioeconomic status,in-dividuals with substance use disorders,and those within correctional facilities.The review also discusses policy implications and targeted strategies needed to overcome barriers and ensure equitable care for all individuals with HCV.Recom-mendations for future research to address gaps in knowledge and evaluation of the effectiveness of interventions designed to reduce disparities are provided.

Disparities in the impact of economic well-being on self-esteem in adulthood:Race and ethnicity

BACKGROUND Most studies have defined economic well-being as socioeconomic status,with little attention given to whether other indicators influence self-esteem.Little is known about racial/ethnic disparities in the relationship between economic wellbeing and self-esteem during adulthood.AIM To explore the impact of economic well-being on self-esteem in adulthood and differences in the association across race/ethnicity.METHODS The current study used data from the National Longitudinal Survey of Youth 1979.The final sample consisted of 2267 African Americans,1425 Hispanics,and 3678 non-Hispanic Whites.Ordinary linear regression analyses and logistic regression analyses were conducted.RESULTS African Americans and Hispanics were more likely to be in poverty in comparison with non-Hispanic Whites.More African Americans were unemployed than Whites.Those who received fringe benefits,were more satisfied with jobs,and were employed were more likely to have higher levels of self-esteem.Poverty was negatively associated with self-esteem.Interaction effects were found between African Americans and job satisfaction predicting self-esteem.CONCLUSION The role of employers is important in cultivating employees’self-esteem.Satisfactory outcomes or feelings of happiness from the workplace may be more important to non-Hispanic Whites compared to African Americans and Hispanics.

Disparities in Prevalence and Determinants of Hypertension amongst Bamiléké Adults Residing in Two Different Agroecological Zones of Cameroon

Background: Cardiovascular diseases such as hypertension (HTN) are one of the main causes of death in Cameroon. This study aimed at assessing prevalence disparities and determinants of hypertension amongst Bamiléké adults residing in two different agroecological zones of Cameroon. Methods: A cross-sectional and descriptive survey was conducted among Bamiléké population living in the Highlands zone (Western region) and in the Monomodal Rainforest zone (Littoral region) of Cameroon from August 2016 to August 2017. Participants (962) were aged at least 20 years old. Data on sociodemographic, hemodynamic, anthropometric, and biochemical parameters and lifestyle of the participants were collected. Results: Results obtained revealed that 34.2% were hypertensive and those residing in the highland zone were more affected than those living in the monomodal rainforest zone (44.5% vs 22.9%). The different subtypes of HTN (Isolated systolic hypertension (14.1%), isolated diastolic hypertension (7.2%) and Systo-diastolic hypertension (23.3%)) were also more prevalent in the Highlands Zone. The most prevalent stage of HTN was pre-HTN (31.5%). However, people living in the monomodal rainforest zone were more affected by pre-HTN compared to Bamiléké living in the highland zone (33.6% vs. 29.6%). Results also showed that high consumption (≥ 3 times/week) of carbohydrate- and fat-rich foods, ageing, obesity, and marital status were associated with high blood pressure in both agroecological zones. Besides, secondary education (OR = 0.68;95% CI: 0.42 - 0.99) in the Highlands Zone and high (≥3 times/week) vegetable consumption (OR = 0.66;95% CI: 0.44 - 0.98) in the Monomodal Rainforest Zone had a protective effect on elevated blood pressure of population. Conclusion: There is a disparity in the prevalence of hypertension and some of its determinants among Bamiléké adults residing in different agroecological zones. This work highlights the need to advocate for local and ethno-cultural health policies to prevent, diagnose and manage hypertension.

Digital Disparities:How Artificial Intelligence Can Facilitate Anti-Black Racism in the U.S.Healthcare Sector

This paper delves into the intricate interplay between artificial intelligence(AI)systems and the perpetuation of Anti-Black racism within the United States medical industry.Despite the promising potential of AI to enhance healthcare outcomes and reduce disparities,there is a growing concern that these technologies may inadvertently/advertently exacerbate existing racial inequalities.Focusing specifically on the experiences of Black patients,this research investigates how the following AI components:medical algorithms,machine learning,and natural learning processes are contributing to the unequal distribution of medical resources,diagnosis,and health care treatment of those classified as Black.Furthermore,this review employs a multidisciplinary approach,combining insights from computer science,medical ethics,and social justice theory to analyze the mechanisms through which AI systems may encode and reinforce racial biases.By dissecting the three primary components of AI,this paper aims to present a clear understanding of how these technologies work,how they intersect,and how they may inherently perpetuate harmful stereotypes resulting in negligent outcomes for Black patients.Furthermore,this paper explores the ethical implications of deploying AI in healthcare settings and calls for increased transparency,accountability,and diversity in the development and implementation of these technologies.Finally,it is important that I prefer the following paper with a clear and concise definition of what I refer to as Anti-Black racism throughout the text.Therefore,I assert the following:Anti-Black racism refers to prejudice,discrimination,or antagonism directed against individuals or communities of African descent based on their race.It involves the belief in the inherent superiority of one race over another and the systemic and institutional practices that perpetuate inequality and disadvantage for Black people.Furthermore,I proclaim that this form of racism can be manifested in various ways,such as unequal access to opportunities,resources,education,employment,and fair treatment within social,economic,and political systems.It is also pertinent to acknowledge that Anti-Black racism is deeply rooted in historical and societal structures throughout the U.S.borders and beyond,leading to systemic disadvantages and disparities that impact the well-being and life chances of Black individuals and communities.Addressing Anti-Black racism involves recognizing and challenging both individual attitudes and systemic structures that contribute to discrimination and inequality.Efforts to combat Anti-Black racism include promoting awareness,education,advocacy for policy changes,and fostering a culture of inclusivity and equality.

Are there sex-based disparities in cataract surgery?

AIM:To investigate sex-based differences in the occurrence of intra-operative and post-operative complications and associated visual outcomes following cataract surgery.METHODS:This was a retrospective study of patients who had phacoemulsification cataract surgery at the University of Colorado School of Medicine.Data collected included the patient’s health history,ocular comorbidities,operative and post-operative complications,and the post-operative best corrected visual acuity(BCVA).The data were analyzed using univariate and multivariable logistic regression with generalized estimating equations to account for the correlation of some patients having two eyes included in the study.RESULTS:A total of 11977 eyes from 7253 patients were included in the study.Ocular comorbidities differed by sex,with males having significantly higher percentages of traumatic cataracts(males 0.7%vs females 0.1%),prior ocular surgery(6.7%vs 5.5%),and mature cataracts(2.8%vs 1.9%).Conversely,females had significantly higher rates of pseudoexfoliation(2.0%vs 3.2%).In unadjusted analysis,males had higher rates of posterior capsular rupture(0.8%vs 0.4%)and vitreous loss(1.0%vs 0.6%),but this difference was not significant after adjustment for confounders.Males had a significantly increased risk of post-operative retinal detachment,but in multivariable analysis this was no longer significant.Males were significantly less likely to undergo post-operative neodymium-doped yttrium aluminum garnet(Nd:YAG)laser capsulotomy for posterior capsule opacification(OR=0.8,95%CI=0.7-0.9,P=0.0005).The BCVA was slightly worse for males pre-operatively;but post-operatively,both sexes exhibited similar visual acuity of Snellen equivalent 20/25.CONCLUSION:The study finds that in a cohort of patients presenting for cataract surgery,sex differences exist in pre-operative comorbidities and surgical characteristics that contribute to higher rates of some complications for males.However,observed surgical complication rates exhibit almost no difference by sex after adjusting for pre-operative differences and post-operative BCVA is similar between sexes.

Gastric Cancer Disparities in the United States: Overcoming the Barriers

In this narrative review, we highlight the disparities in the incidence and mortality of gastric cancer across various racial and ethnic populations in the United States (US). Despite the low and decreasing trend in the incidence of gastric cancer in the US, the incidence remains significantly high among Asian and Hispanic Americans, showing a striking racial and ethnic disparity. The low survival rate of gastric cancer further accentuates the magnitude of this disparity. In addition, there is a marked funding disparity among different cancers in the US, reflecting the significantly lower level of support for cancers, such as gastric cancer, which are more prevalent in minority populations, compared to the cancers more prevalent among non-Hispanic Whites (NHW). Moreover, the economic burden from health disparities remains high. Although studies from the US and Asia suggest that screening for stomach cancer may be cost-effective, there is no currently available guideline for scree-ning high-risk populations in the US. A multidimensional framework involving the community, physicians, and policymakers is proposed to tackle these gastric cancer disparities and to develop population-based screening and surveillance programs to reduce the burden of gastric cancer.

How Does E-Commerce Policy Affect Consumption Disparities of Rural Households?-Evidence from China

In the context of China’s ongoing efforts to promote countryside revitalization and facilitate domestic economic circulation,it is of great significance to reduce the consumption disparity among rural households and unleash the consumption potential in the countryside.Based on data from China Family Panel Studies,this paper adopts a staggered difference-in-differences method to assess the impact of the e-commerce to enter rural areas on the consumption disparity among rural households.Findings:the comprehensive demonstration work of promoting e-commerce to enter rural areas has reduced the consumption disparity among rural households through the following mechanisms.Firstly,this policy initiative has mitigated the consumption-inhibiting effect on rural household consumption due to the local market size and external market accessibility by promoting the distribution of consumer goods to villages.Secondly,this policy initiative has also increased the agricultural income of rural households and reduced their consumption disparity by distributing farm produce to cities and enhancing the agricultural income of rural households.Moreover,the work is characterized by inclusive growth and is not susceptible to the“elite capture”phenomenon.

Gender disparities and woman-specific trends in Barrett’s esophagus in the United States:An 11-year nationwide populationbased study

BACKGROUND Barrett's esophagus(BE)is a known premalignant precursor to esophageal adenocarcinoma(EAC).The prevalence rates continue to rise in the United States,but many patients who are at risk of EAC are not screened.Current practice guidelines include male gender as a predisposing factor for BE and EAC.The population-based clinical evidence regarding female gender remains limited.AIM To study comparative trends of gender disparities in patients with BE in the United States.METHODS A nationwide retrospective study was conducted using the 2009-2019 National Inpatient Sample(NIS)database.Patients with a primary or secondary diagnosis code of BE were identified.The major outcome of interest was determining the gender disparities in patients with BE.Trend analysis for respective outcomes for females was also reported to ascertain any time-based shifts.RESULTS We identified 1204190 patients with BE for the study period.Among the included patients,717439(59.6%)were men and 486751(40.4%)were women.The mean age was higher in women than in men(67.1±0.4 vs 66.6±0.3 years,P<0.001).The rate of BE per 100000 total NIS hospitalizations for males increased from 144.6 in 2009 to 213.4 in 2019(P<0.001).The rate for females increased from 96.8 in 2009 to 148.7 in 2019(P<0.001).There was a higher frequency of obesity among women compared to men(17.4%vs 12.6%,P<0.001).Obesity prevalence among females increased from 12.3%in 2009 to 21.9%in 2019(P<0.001).A lower prevalence of smoking was noted in women than in men(20.8%vs 35.7%,P<0.001).However,trend analysis showed an increasing prevalence of smoking among women,from 12.9%in 2009 to 30.7%in 2019(P<0.001).Additionally,there was a lower prevalence of alcohol abuse,Helicobacter pylori(H.pylori),and diabetes mellitus among females than males(P<0.001).Trend analysis showed an increasing prevalence of alcohol use disorder and a decreasing prevalence of H.pylori and diabetes mellitus among women(P<0.001).CONCLUSION The prevalence of BE among women has steadily increased from 2009 to 2019.The existing knowledge concerning BE development has historically focused on men,but our findings show that the risk in women is not insignificant.

Survival benefits and disparities in radiation therapy for elderly patients with pancreatic ductal adenocarcinoma

BACKGROUND Older patients represent a unique subgroup of the cancer patient population,for which the role of cancer therapy requires special consideration.However,the outcomes of radiation therapy(RT)in elderly patients with pancreatic ductal adenocarcinoma(PDAC)are not well-defined in the literature.AIM To explore the use and effectiveness of RT in the treatment of elderly patients with PDAC in clinical practice.METHODS Data from patients with PDAC aged≥65 years between 2004 and 2018 were collected from the Surveillance,Epidemiology,and End Results database.Multivariate logistic regression analysis was performed to determine factors associated with RT administration.Overall survival(OS)and cancer-specific survival(CSS)were evaluated using the Kaplan–Meier method with the log-rank test.Univariate and multivariate analyses with the Cox proportional hazards model were used to identify prognostic factors for OS.Propensity score matching(PSM)was applied to balance the baseline characteristics between the RT and non-RT groups.Subgroup analyses were performed based on clinical characteristics.RESULTS A total of 12245 patients met the inclusion criteria,of whom 2551(20.8%)were treated with RT and 9694(79.2%)were not.The odds of receiving RT increased with younger age,diagnosis in an earlier period,primary site in the head,localized disease,greater tumor size,and receiving chemotherapy(all P<0.05).Before PSM,the RT group had better outcomes than did the non-RT group[median OS,14.0 vs 6.0 mo;hazard ratio(HR)for OS:0.862,95%confidence interval(CI):0.819–0.908,P<0.001;and HR for CSS:0.867,95%CI:0.823–0.914,P<0.001].After PSM,the survival benefit associated with RT remained comparable(median OS:14.0 vs 11.0 mo;HR for OS:0.818,95%CI:0.768–0.872,P<0.001;and HR for CSS:0.816,95%CI:0.765–0.871,P<0.001).Subgroup analysis revealed that the survival benefits(OS and CSS)of RT were more significant in patients aged 65 to 80 years,in regional and distant stages,with no surgery,and receiving chemotherapy.CONCLUSION RT improved the outcome of elderly patients with PDAC,particularly those aged 65 to 80 years,in regional and distant stages,with no surgery,and who received chemotherapy.Further prospective studies are warranted to validate our results.

Racial and gender-based disparities and trends in common psychiatric conditions in liver cirrhosis hospitalizations:A ten-year United States study

BACKGROUND Chronic liver disease is associated with various neuropsychiatric conditions.There are currently no large studies assessing and comparing the prevalence of psy-chiatric illnesses based on patient profiles and the etiology of cirrhosis.AIM To examine the trends of hospitalizations among psychiatric conditions in cirrhosis.METHODS We used the National Inpatient Sample database 2016-2019 for the primary diagnosis of liver cirrhosis.The outcomes included the prevalence,trends,and associations of psychiatric diagnoses in these hospitalizations.Chi-square for categorical variables and the Wilcoxon rank test for continuous variables were utilized.RESULTS The prevalence of generalized anxiety disorder(GAD)in liver cirrhosis hospitalizations increased from 0.17%in 2009 to 0.92%in 2019(P<0.001).The prevalence of depression increased from 7%in 2009 to 12%in 2019(P<0.001).Attention deficit hyperactivity disorder(ADHD)prevalence increased from 0.06%to 0.24%.The prevalence of schizophrenia increased from 0.59%to 0.87%(P<0.001).Schizoaffective disorder prevalence increased from 0.10%to 0.35%(P<0.001).Posttraumatic stress disorder(PTSD)prevalence displayed increasing trends from 0.36%in 2009 to 0.93%in 2019(P<0.001).The prevalence of suicidal ideation increased from 0.23%to 0.56%in 2019.Cirrhosis related to alcoholic liver disease[adjusted odds ratios(aOR)1.18,95%CI 1.08-1.29,P<0.001]and non-alcoholic fatty liver disease(NAFLD)(aOR 1.14,95%CI 1.01-1.28,P=0.025)was associated with depression more than other causes.Alcohol-and NAFLD-associated cirrhosis had a stronger link to psychiatric disorders.Females had a higher association with GAD(aOR 2.56,95%CI 2.14-3.06,P<0.001),depression(aOR 1.78,95%CI 1.71-1.84,P<0.001),bipolar disorder(aOR 1.64,95%CI 1.52-1.77,P<0.001]and chronic fatigue(aOR 2.31,95%CI 1.31-4.07,P<0.001)when compared to males.Blacks,Hispanics,and Asian/Native Americans had a significantly lower association with GAD,depression,bipolar disorder,PTSD,and ADHD when compared to the white race.CONCLUSION The prevalence of psychiatric comorbidities in liver cirrhosis hospitalizations has increased over the last decade.Females had a higher association with psychiatric disorders compared to males.Blacks,Hispanics,and Asian/Native Americans had lower associations with psychiatric comorbidities compared to the white race.

Global health disparities in vulnerable populations of psychiatric patients during the COVID-19 pandemic

The coronavirus disease 2019 pandemic affects psychiatric patients disproportionately compared to the general population.In this narrative review,we examine the impact of the pandemic on significant global health disparities affecting vulnerable populations of psychiatric patients:People of diverse ethnic background and color,children with disabilities,sexual and gender minorities,pregnant women,mature adults,and those patients living in urban and rural communities.The identified disparities cause worsened mental health outcomes placing psychiatric patients at higher risk for depression,anxiety and posttraumatic stress disorder symptoms.Those psychiatric patients who are ethnic minorities display barriers to care,including collective trauma and structural racism.Sexual and gender minorities with mental illness face discrimination and limited access to treatment.Pregnant women with psychiatric diagnoses show higher exposure to domestic violence.Children with disabilities face a higher risk of worsening behavior.Mature adults with psychiatric problems show depression due to social isolation.Psychiatric patients who live in urban communities face pollutants and overcrowding compared to those living in rural communities,which face limited access to telehealth services.We suggest that social programs that decrease discrimination,enhance communal resilience,and help overcome systemic barriers of care should be developed to decrease global health disparities in vulnerable population.

Disparities in esophageal cancer incidence and esophageal adenocarcinoma mortality in the United States over the last 25-40 years

BACKGROUND Esophageal carcinoma presents as 2 types,esophageal adenocarcinoma(EAC)and esophageal squamous cell carcinoma(ESCC)with the frequency of both changing in the United States(US).AIM To investigate EAC/ESCC incidence time trends among the 3 main US racial groups and investigate trends in US EAC survival by ethnicity.METHODS Twenty-five years(1992-2016)of data from SEER 13 program was analyzed to compare incidence trends in EAC and ESCC between non-Hispanic whites(nHW),non-Hispanic Blacks(nHB)and Hispanics(Hisp)using SEERStat®.In addition,SEER 18 data,from 1975-2015,on EAC in the US was analyzed to evaluate racial disparities in incidence and survival using SEERStat®and Ederer II method.RESULTS In the 3 major US ethnic groups,age-adjusted incidence of ESCC has declined while EAC has continued to rise from 1992-2016.Of note,in Hisp,the EAC incidence rate increased while ESCC decreased from 1992 to 2016,resulting in EAC as the predominant esophageal cancer subtype in this group since 2011,joining nHW.Furthermore,although ESCC remains the predominant tumor in nHB,the difference between ESCC and EAC has narrowed dramatically over 25 years.EAC survival probabilities were worse in all minority groups compared to nHw.CONCLUSION Hisp have joined nHW as US ethnic groups more likely to have EAC than ESCC.Of note,EAC incidence in nHB is increasing at the highest rate nationally.Despite lower EAC incidence in all minority groups compared to nHW,these populations have decreased survival compared to nHW.

Racial/ethnic disparities in hepatocellular carcinoma treatment and survival in California, 1988-2012

AIM To describe racial/ethnic differences in treatment and survival among liver cancer patients in a populationbased cancer registry.METHODS Invasive cases of primary hepatocellular carcinoma, n = 33270, diagnosed between January 1, 1988-December 31, 2012 and reported to the California Cancer Registry were analyzed by race/ethnicity, age, gender, geographical region, socio-economic status, time period of diagnosis, stage, surgical treatment, and survival. Patients were classified into 15 racial/ethnic groups: non-Hispanic White(White, n = 12710), Hispanic(n = 8500), Chinese(n = 2723), non-Hispanic Black(Black, n = 2609), Vietnamese(n = 2063), Filipino(n = 1479), Korean(n = 1099), Japanese(n = 658), American Indian/Alaskan Native(AIAN, n = 281), Laotian/Hmong (n = 244), Cambodian(n = 233), South Asian(n = 190), Hawai`ian/Pacific Islander(n = 172), Thai(n = 95), and Other Asian(n = 214). The main outcome measures were receipt of surgical treatment, and cause-specific and all-cause mortality.RESULTS After adjustment for socio-demographic characteristics, time period, and stage of disease, compared to Whites, Laotian/Hmong [odds ratio(OR) = 0.30, 95%CI: 0.17-0.53], Cambodian(OR = 0.65, 95%CI: 0.45-0.96), AIAN(OR = 0.66, 95%CI: 0.46-0.93), Black(OR = 0.76, 95%CI: 0.67-0.86), and Hispanic(OR = 0.78, 95%CI: 0.72-0.84) patients were less likely, whereas Chinese(OR = 1.58, 95%CI: 1.42-1.77), Koreans(OR = 1.45, 95%CI: 1.24-1.70), Japanese(OR = 1.41, 95%CI: 1.15-1.72), and Vietnamese(OR = 1.26, 95%CI: 1.12-1.42) were more likely to receive surgical treatment. After adjustment for the same covariates and treatment, cause-specific mortality was higher for Laotian/Hmong [(hazard ratio(HR) = 1.50, 95%CI: 1.29-1.73)], Cambodians(HR = 1.35, 95%CI: 1.16-1.58), and Blacks(HR = 1.07, 95%CI: 1.01-1.13), and lower for Chinese(HR = 0.82, 95%CI: 0.77-0.86), Filipinos(HR = 0.84, 95%CI: 0.78-0.90), Vietnamese(HR = 0.85, 95%CI: 0.80-0.90), Koreans(HR = 0.90, 95%CI: 0.83-0.97), and Hispanics(HR = 0.91, 95%CI: 0.88-0.94); results were similar for all-cause mortality.CONCLUSION Disaggregated data revealed substantial racial/ethnic differences in liver cancer treatment and survival, demonstrating the need for development of targeted interventions to mitigate disparities.

Health Disparities among the Western, Central and Eastern Rural Regions of China after a Decade of Health Promotion and Disease Prevention Programming

Summary： Health disparities between the western, central and eastern regions of rural China, and the impact of national health improvement policies and programming were assessed. A total of 400 counties were randomly sampled. ANOVA and Logistic regression modeling were employed to estimate differ- ences in health outcomes and determinants. Significant differences were found between the western, central and eastern rural regions in community infrastructure and health outcomes. From 2000 to 2010, health indicators in rural China were improved significantly, and the infant mortality rate （IMR）, mater- nal mortality rate （MMR） and under 5 mortality rate （U5MR） had fallen by 62.79%, 71.74% and 61.92%, respectively. Central rural China had the greatest decrease in IMR （65.05%）; whereas, western rural China had the greatest reduction in MMR （72.99%） but smallest reduction in U5MR （57.36%）. Despite these improvements, Logistic regression analysis showed regional differences in key health outcome indicators （odds ratios）： IMR （central： 2.13; western： 5.31）, U5MR （central： 2.25; western： 5.69）, MMR （central： 1.94; western： 3.31）, and prevalence of infectious diseases （central： 1.62; western： 3.58）. The community infrastructure and health outcomes of the western and central rural regions of China have been improved markedly during the first decade of the 21st century. However, health dis- parities still exist across the three regions. National efforts to increase per capita income, community empowerment and mobilization, community infrastructure, capacity of rural health facilities, and health literacy would be effective policy options to attain health equity.

Colorectal cancer disparities: Issues, controversies and solutions

Colorectal cancer(CRC)is the second leading cause of cancer related deaths in the United States.There are significant differences in CRC incidence and mortality by race with the highest burden occurring among blacks.The underlying factors contributing to CRC disparities are multiple and complex.Studies have suggested that a higher prevalence of putative risk factors for CRC,limited access to healthcare services,lower utilization of healthcare resources and increased biological susceptibilities contribute to this disparity by race.This article reviews the factors associated with the disproportionally higher burden of CRC among blacks;addresses the controversies regarding the age to begin CRC screening and the screening modality to use for blacks;and proffers solutions to eliminate CRC disparity by race.

Racial and ethnic disparities in gastric cancer outcomes: More important than surgical technique?

Racial and ethnic disparities in cancer care are major public health concerns and their identification is necessary to develop interventions to eliminate these disparities. We and others have previously observed marked disparities in gastric cancer outcomes between Eastern and Western patients. These disparities have long been attributed to surgical technique and extent of lymphadenectomy. However, more recent evidence suggests that other factors such as tumor biology, environmental factors such as Helicobacter pylori infection and stage migration may also significantly contribute to these observed disparities. We review the literature surrounding disparities in gastric cancer and provide data pertaining to potential contributing factors.

Disparities in colonoscopy utilization for lower gastrointestinal bleeding in rural vs urban settings in the United States

BACKGROUND Lower gastrointestinal bleeds(LGIB)is a very common inpatient condition in the United States.Gastrointestinal bleeds have a variety of presentations,from minor bleeding to severe hemorrhage and shock.Although previous studies investigated the efficacy of colonoscopy in hospitalized patients with LGIB,there is limited research that discusses disparities in colonoscopy utilization in patients with LGIB in urban and rural settings.AIM To investigate the difference in utilization of colonoscopy in lower gastrointestinal bleeding between patients hospitalized in urban and rural hospitals.METHODS This is a retrospective cohort study of 157748 patients using National Inpatient Sample data and the Healthcare Cost and Utilization Project provided by the Agency for Healthcare Research and Quality.It includes patients 18 years and older hospitalized with LGIB admitted between 2010 and 2016.This study does not differentiate between acute and chronic LGIB and both are included in this study.The primary outcome measure of this study was the utilization of colonoscopy among patients in rural and urban hospitals admitted for lower gastrointestinal bleeds;the secondary outcome measures were in-hospital mortality,length of stay,and costs involved in those receiving colonoscopy for LGIB.Statistical analyses were all performed using STATA software.Logistic regression was used to analyze the utilization of colonoscopy and mortality,and a generalized linear model was used to analyze the length of stay and cost.RESULTS Our study found that 37.9%of LGIB patients at rural hospitals compared to approximately 45.1%at urban hospitals received colonoscopy,(OR=0.730,95%CI:0.705-0.7,P>0.0001).After controlling for covariates,colonoscopies were found to have a protective association with lower inhospital mortality[OR=0.498,95%CI:0.446-0.557,P<0.0001],but a longer length of stay by 0.72 d(95%CI:0.677-0.759 d,P<0.0001)and approximately$2199 in increased costs.CONCLUSION Although there was a lower percentage of LGIB patients that received colonoscopies in rural hospitals compared to urban hospitals,patients in both urban and rural hospitals with LGIB undergoing colonoscopy had decreased in-hospital mortality.In both settings,benefit came at a cost of extended stay,and higher total costs.

SPATIAL-TEMPORAL ANALYSIS OF REGIONAL DISPARITIES OF INTERNET DEVELOPMENT IN CHINA

This paper attempts to summarize the disparities of Internet development in China spatially-temporally. The major objective is to measure the differences between Eastern, Central and Western China. Methods of map presentation, correlation, Lorenz curve, Gini Coefficient and location quotient analysis arc conducted in this study. For convenience, the indicator of regional Internet development is simplified as the number of domain names registered under. CN in each province. The data used are collected from the semi-annual surveys of the Statistical Survey Report on the Intrenet Development in China since 1999. There are several findings: 1) The number of domain names in each province (city) declines gradually from the east to the west. 2) The gap between the highest growth provinces (cities) and the lowest ones is rather large. 3) Although the absolute differences between the eastern, central and western China have been enlarged, the relative differences in each province (city) have remained constant. 4) Provinces (cities) are classified into three types according to location quotient changes, namely, rising type, changeless type and declining type. Compared with industrial and economic growth, Internet sector in the eastern and western China is relatively ascending, while that in the central China is descending. 5) The number of domain names at provincial level is not statistically consistent with GDP.

Are we leveling the playing field？ Trends and disparities in sports participation among sexual minority youth in Canada

Purpose: Sports participation and physical fitness are widely beneficial for young people, yet activity levels among young people are declining.Despite growing popular media attention on the participation of sexual minority(e.g., lesbian, gay, and bisexual) youth in sports and various campaigns to improve the often homophobic climate of sports, there is limited evidence that sexual minority youth participate in sports. Our aim was to provide a current portrait of sports participation among 3 groups of sexual minority youth(e.g., lesbian, gay, and bisexual) in British Columbia, Canada, as well as to document population trends.Methods: Pooled population-level data from British Columbia, Canada(n = 99,373) were used to examine trends and disparities in sports participation among sexual minority and heterosexual youth. Age-adjusted logistic regression models were used to examine changes in participation over time and disparities in participation over time(1998—2013).Results: We found an overall decline in sports participation and physical activity(PA) for all youth. Sexual minority students were less likely to participate in formal sports(with a coach) and informal sports(without a coach) compared with their heterosexual peers. The disparity in participating in informal sports between heterosexual and sexual minority youth has narrowed over time for some sexual orientation groups, whereas the disparity in participating in formal sports has widened over time in some cases.Conclusion: This study provides a comprehensive examination of sports participation among sexual minority youth over the past 15 years.Despite changing societal attitudes and laudable efforts to reduce homophobia in sports, results suggest that there are continued barriers to participation for sexual minority youth. Further research is needed to understand the factors that limit sports participation for these youth and to inform program development. PA is critical to lifelong health and well-being, and thus continued efforts are needed to increase the sports participation of sexual minority youth in particular.