Shervin Assari; Mona Darvishi; Arash Rahmani; Seyedeh Mohaddeseh Khatami; Izadrad Najand; Babak Najand; Hossein Zare
Abstract
Background: The broad scientific community generally associates high socioeconomic status (SES) with better health. However, the protective effects of high educational attainment on health may be weaker for racial and ethnic minorities than non-Latino White individuals. It is important to study whether ...
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Background: The broad scientific community generally associates high socioeconomic status (SES) with better health. However, the protective effects of high educational attainment on health may be weaker for racial and ethnic minorities than non-Latino White individuals. It is important to study whether this difference holds for chronic pain among Black and Latino individuals.Objectives: To compare the association between educational attainment and chronic pain in the US, considering the racial and ethnic background of individuals.Methods: The current study used baseline data from the Population Assessment of Tobacco and Health (PATH-Adults) study. All participants were 18+years old. A total number of 28204 Non-Latino, Latino, White, and Black individuals were enrolled. The outcome was chronic pain treated as a continuous measure. The predictor was educational attainment. Moderators were race and ethnicity.Results: Our linear regressions in the pooled sample showed that higher educational attainment was associated with a lower level of chronic pain; however, this association was weaker for Latinos and Blacks compared to non-Latino and White individuals. Our stratified models also showed that higher educational attainment was more consistently associated with a lower level of chronic pain for non-Latino White individuals than racial and ethnic minorities.Conclusion: The presumed protective effect of educational attainment against chronic pain among individuals varies between different racial and ethnic groups. Future research should test the role of stressful jobs and working conditions in weakening the protective effects of SES against chronic pain for Blacks and Latinos compared to non-Latino White individuals.
Shervin Assari; Babak Najand; Ali Ayoubian
Abstract
Background: Age is a major determinant of chronic respiratory disease (CRD). This is important because CRD have a main role in shaping morbidity and mortality of individuals and populations. However, less research is done on whether age-related changes in development of CRD differ across diverse racial ...
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Background: Age is a major determinant of chronic respiratory disease (CRD). This is important because CRD have a main role in shaping morbidity and mortality of individuals and populations. However, less research is done on whether age-related changes in development of CRD differ across diverse racial groups.Objectives: Using a conceptual model that considers race as a proxy of racism rather than genetics and attributing racial differences to sociological rather than biological differences, this study was conducted to explore racial differences in the effects of age on CRD. Based on Marginalization-related Diminished Returns (MDRs) framework, we expect diminished relevance of risk and resources for marginalized people due to racism, segregation, and social stratification.Methods: Using data from baseline PATH-Adults data, we included 23761 adults. The independent variable was age treated as a categorical variable. The primary outcome was presence of any CRD including asthma, bronchitis, emphysema, and chronic obstructive pulmonary disease (COPD). Sex and education were the covariates. Race, as a proxy of racism, was the moderator. To analyze the data, we used logistic regression mode with and without interaction term between age and race.Results: Higher age was associated with higher odds of CRD, while sex, and socioeconomic status (SES) was controlled. In line with the MDRs framework, the positive association between age and CRD was weaker for Black than White adults.Conclusion: Under racism, age loses some of its effect as a major determinant of CRD across racialized groups.
Shervin Assari; Babak Najand; Ronald Mincy; Cleopatra Caldwell
Abstract
Background: High income is a protective factor against suicidality for children, youth, and adults, however, recent research has documented weaker health effects of high income for Black than White individuals, a pattern also called marginalization-related diminished returns (MDRs).Objectives: In this ...
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Background: High income is a protective factor against suicidality for children, youth, and adults, however, recent research has documented weaker health effects of high income for Black than White individuals, a pattern also called marginalization-related diminished returns (MDRs).Objectives: In this study, we tested racial variation in the association between high income and suicidality in a national sample of 9-10-year-old Black and White American children.Methods: This cross-sectional study used data from the Adolescent Brain Cognitive Development (ABCD) study, which included 7298 White or Black children between the ages of 9 and 10. Of all the participants, 5652 were White and 1646 were Black. The predictor variable was family income, treated as a continuous measure. Race was the moderator. The outcome variable was suicidality, treated as a dummy variable, reflecting any positive suicidal thoughts or behaviors endorsed over the lifecourse. Covariates included sex, age, family structure (parental marital status), parental education, trauma, history of depression, neighborhood poverty, and family conflict. Logistic regression was used for data analysis.Results: Overall, family income was inversely associated with children’s suicidality, net of all covariates. A statistically significant interaction was found between race and family income, suggesting that the inverse association between family income and suicidality is weaker in Black than White children.Conclusion: The observed weaker association between income and suicidality in Black than White children suggests that family income does not provide the same protection against suicidality for Black as White children. Due to racism, income and some other socioeconomic status indicators show weaker than expected health effects on Black families in the US.
Shervin Assari
Abstract
Background: Perceived discrimination (PD) is a risk factor of suicidal thoughts and behaviors (STB) for children, youth, and adults. However, it is unknown whether the association between PD and STB frequency differs between African American (AA) and Non-Hispanic White children.Objectives: In this study, ...
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Background: Perceived discrimination (PD) is a risk factor of suicidal thoughts and behaviors (STB) for children, youth, and adults. However, it is unknown whether the association between PD and STB frequency differs between African American (AA) and Non-Hispanic White children.Objectives: In this study, we compared AA and non-Latino White children for the association between PD and STB frequency in a national sample of 9-10-year-old American children.Methods: This cross-sectional study used data from the Adolescent Brain Cognitive Development (ABCD) study, which included 7883 non-Latino White or AA children between the ages of 9 and 10. The predictor variable was frequency of PDs. Race was the moderator. The outcome variable was STB frequency, treated as a count variable, reflecting positive STB items endorsed over the life-course. Covariates included sex, age, marital status, household income, parental education, parental employment, trauma, and economic difficulties. Poisson regression was used for data analysis.Results: Of all the participants, 5994 were non-Latino Whites, and 1889 were AAs. Overall, PD frequency was positively associated with STB frequency. A statistically significant interaction was found between race and PD, suggesting that the association between PD and STB frequency is weaker in AA than non-Latino White children.Conclusion: The observed weaker association between PDs frequency and STB frequency in AA than non-Latino White children suggests that PD may be a less salient risk factor of STB frequency for AA than non-Latino White children. Researchers should explore factors other than PD for suicide prevention of AA children in the US.
Shervin Assari
Abstract
Background: As shown by Minorities’ Diminished Returns (MDRs), ethnic minorities show weaker than expected effects of education level on health outcomes. However, this pattern is better demonstrated for health behaviors and health care utilization than satisfaction with care. Additionally, more ...
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Background: As shown by Minorities’ Diminished Returns (MDRs), ethnic minorities show weaker than expected effects of education level on health outcomes. However, this pattern is better demonstrated for health behaviors and health care utilization than satisfaction with care. Additionally, more is known about MDRs in African Americans than the Latino population. Thus, there is a need to study MDRs of education on healthcare satisfaction in highly educated African American and Latino individuals. Objectives: We tested ethnic differences in the association between education level and satisfaction with healthcare among American adults. Methods: The National Health Interview Survey (2015) included 24,835 adults who were Latino, non-Latino, African American, or White. The independent variable was education level. The dependent variable was satisfaction with healthcare. Age, gender, marital status, employment, region, physical health (self-rated health, and chronic diseases, body mass index), and mental health (psychological distress) were the covariates. Ethnicity was the moderator. Logistic regression was used for data analysis. Results: Higher education level was associated with higher satisfaction with healthcare in White but not African Americans. In the pooled sample, African American ethnicity showed a significant statistical interaction with education level suggesting a significantly smaller effect of high educational attainment on satisfaction with healthcare for African Americans than White adults. A similar interaction could not be found for Latino ethnicity, suggesting that education similarly enhances healthcare satisfaction for Latino and non-Latino adults. Conclusion: High education level boosts satisfaction with healthcare for Whites but not African Americans.
Shervin Assari
Abstract
Most of what we know about the coronavirus disease 2019 (COVID-19) is limited to the severe acute respiratory syndrome, epidemiology, fatality, and acute care. However, infection with COVID-19 may also involve the central nervous system (CNS), which may or may not be due to a multi-organ injury. Our ...
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Most of what we know about the coronavirus disease 2019 (COVID-19) is limited to the severe acute respiratory syndrome, epidemiology, fatality, and acute care. However, infection with COVID-19 may also involve the central nervous system (CNS), which may or may not be due to a multi-organ injury. Our aim in this paper is to briefly summarize the main aspects of the growing literature on neurological manifestations of the COVID-19 infection. As such, after mentioned some general background on the economic and medical pandemic on the populations, the healthcare system, and the society, we summarize some common aspects of the published literature on neurological manifestations of the COVID-19 infection. We also highlight the existing gaps in the literature, which requires additional work. The most common neurological manifestation of COVID-19 infection is the olfactory deficit. However, it is still unknown if it is inflammatory or degenerative in nature. Still, the incidence of neurological involvement, and also mechanisms and their treatments are unknown. This literature is predominantly composed of opinions and reviews rather than original articles, so the patients’ data are not used for a majority of the studies. Multi-center studies that not only conduct chest CT or MRI but also brain CT or MRI are needed. Randomized trials are still required on the management of acute and chronic neurological conditions due to COVID-19 infection. Cohort studies may also determine the natural history of the conditions and factors that are prognostic. Furthermore, while disparities in COVID-19 infections are known, inequalities in neurological manifestations are unknown. Besides, the efficacy of specific treatments on CNS involvement is still unknown. We will discuss the health care needs of patients with chronic neurological conditions. We end the paper with a few recommendations for practice and research.
Shervin Assari
Abstract
Background: Prostate cancer screening is more commonly utilized by highly educated people. As shown by marginalization-related diminished returns (MDRs), the effects of socioeconomic status (SES) such as education on the health outcomes are considerably smaller for ethnic minorities than for Whites. ...
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Background: Prostate cancer screening is more commonly utilized by highly educated people. As shown by marginalization-related diminished returns (MDRs), the effects of socioeconomic status (SES) such as education on the health outcomes are considerably smaller for ethnic minorities than for Whites. The role of MDRs as a source of ethnic health disparities is, however, still unknown. Objectives: The current study had two aims: first, to explore the association between years of schooling and having taken a prostate-specific antigen (PSA) test among men in the US, and second, to explore ethnic differences in this association. Methods: This study was a secondary analysis of data from the National Health Interview Survey (NHIS-2015). The data of 5,053 men aged 55 years or older who were either Latino, non-Latino, African–American, or White were analyzed. Years of schooling was the independent variable. The dependent variable was taking a PSA test sometime during one’s lifetime. Age, region, and employment were the control variables. Ethnicity was the focal moderating variable. Binary logistic regression was used for data analysis. Results: A higher number of years of schooling was associated with higher odds of having taken a PSA test, net of all confounders. Ethnicity showed a significant statistical interaction with years of schooling on having taken a PSA test. This interaction was suggestive of a smaller slope for Latino men than non-Latino men. White and African American men did not show differential effects of years of schooling on having taken a PSA test. Conclusion: Similar to the MDRs patterns in other domains, non-Latino White men show more health gain from their years of schooling than Latino men. Highly educated Latino men still need programs to encourage their use of prostate cancer screening.
Shervin Assari
Abstract
Background: The literature on Minorities’ Diminished Returns (MDRs) have shown worse than expected health of the members of racial and ethnic minority groups particularly Blacks. Theoretically, this effect can be in part due to weaker effects of educational attainment on preventive care and disease ...
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Background: The literature on Minorities’ Diminished Returns (MDRs) have shown worse than expected health of the members of racial and ethnic minority groups particularly Blacks. Theoretically, this effect can be in part due to weaker effects of educational attainment on preventive care and disease management in highly educated racial and ethnic minorities. Objectives: The current study explored the racial and ethnic differences in the effect of baseline educational attainment on % adherance to the routine physician visits among middle-aged and older adults in the US. Methods: This is a prospective study with 24 years of follow up. The Health and Retirement Study (HRS: 1992-2016) included 10 880 middle-aged and older adults who were Hispanic, non-Hispanic, Black or White. The independent variable was educational attainment. The dependent variable was adherance to the routine physician visits (%). Age, gender, marital status, income, health behaviors (smoking and drinking) and health (depression, self-rated health, and chronic diseases) were the covariates. Race and ethnicity were the focal moderators. Linear regression was used for data analysis. Results: Overall, higher educational attainment was associated with higher % of adherance to the routine physician visits over the course of follow-up, net of all confounders. Race showed a significant statistical interaction with educational attainment suggesting of a smaller effect of high education attainment on % adherance to the routine physician visits for Black than White middle-aged and older adults. Similar interaction could not be found for the comparison of Hispanic and non-Hispanic middle-aged and older adults. Conclusion: Educational attainment is associated with a larger increase in preventive and disease management doctor visits for White than Black middle-aged and older adults. This is a missed opportunity to improve the health of highly educated middle-aged and older adults. It is not race/ethnicity or class that shapes health behaviors but race/ethnicity and class that shape people’s pro-health behaviors. At least some of the racial health disparities is not due to low SES but diminished returns of SES.
Shervin Assari; Mohsen Bazargan
Abstract
Background: The Minorities’ Diminished Returns (MDRs) theory suggests that the health effect of educational attainment is considerably smaller for members of racial and ethnic minority groups than for Whites. Objective: The current study explored the racial and ethnic differences in the association ...
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Background: The Minorities’ Diminished Returns (MDRs) theory suggests that the health effect of educational attainment is considerably smaller for members of racial and ethnic minority groups than for Whites. Objective: The current study explored the racial and ethnic differences in the association between educational attainment and Breast Physical Exam (BPE) among women in the U.S. Methods: The National Health Interview Survey (NHIS 2015) included 12 510 women who were Hispanic or non-Hispanic Black or White people. The independent variable was the level of educational attainment. The dependent variable was lifetime BPE. Age, region, marital status, and employment were the covariates. Race and ethnicity were the focal moderators. Logistic regressions were used for data analysis. Results: Overall, higher educational attainment was associated with higher odds of BPE, net of all confounders (odds ratio [OR]=1.11, 95% CI=1.09-1.13). Ethnicity showed a significant statistical interaction with educational attainment on BPE (OR=0.96, 95% CI=0.93-1.00), which was suggestive of a smaller effect of high education attainment on BPE for Hispanic than non-Hispanic women. The same interaction could not be found for the comparison of White and Black women (OR = 0.98, 95% CI =0.94-1.02). Conclusion: In line with other domains, non-Hispanic White women show a larger amount of health gain from their educational attainment than Hispanic women. It is not ethnicity or class but ethnicity and class that shapes how people engage in pro-health behaviors. This result may help hospitals and healthcare systems to better reduce health disparities in their target populations.
Shervin Assari; Mohsen Bazargan
Abstract
Background: As suggested by the Minorities’ Diminished Returns (MDRs) theory, educational attainment shows a weaker protective effect for racial and ethnic minority groups compared to non-Hispanic Whites. This pattern, however, is never shown for hospitalization risk. Objectives: This cross-sectional ...
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Background: As suggested by the Minorities’ Diminished Returns (MDRs) theory, educational attainment shows a weaker protective effect for racial and ethnic minority groups compared to non-Hispanic Whites. This pattern, however, is never shown for hospitalization risk. Objectives: This cross-sectional study explored racial and ethnic variations in the association between educational attainment and hospitalization in the United States. Methods: Data came from the National Health Interview Survey (NHIS 2015). The total sample was 28,959 American adults. Independent variables was educational attainment. The main outcome was hospitalization during the last 12 months. Age, gender, employment, marital status, region, obesity, and number of cardiovascular conditions were covariates. Race and ethnicity were the effect modifiers. Logistic regression models were utilized to analyze the data. Results: From all participants, 16.2% were Black and 11.6% were Hispanic with a mean age of 51 years. Overall, higher education levels were associated with lower odds of hospitalization, independent of all confounders. Educational attainment showed significant interactions with race (odds ratio [OR] =1.04, 95% CI = 1.01-1.08) and ethnicity (OR = 1.04, 95% CI =1.01-1.07) on hospitalization, indicating smaller protective effects of educational attainment on hospitalization of Hispanics and Blacks than non-Hispanic Whites. Conclusion: The protective effects of educational attainment on population health are smaller for Blacks and Hispanics compared to non-Hispanic Whites. To prevent health disparities, the diminished returns of educational attainment should be minimized for racial and ethnic minorities. To do so, there is a need for innovative and bold economic, public, and social policies that do not limit themselves to equalizing socioeconomic status, but also help minorities leverage their available resources and gain tangible outcomes.