Health disparities refer to differences between groups of people. These differences can affect how frequently a disease affects a group, how many people get sick, or how often the disease causes death.
Many different populations are affected by disparities. These include
Source: National Cancer Institute (NIH)
Nurs Outlook. 2025 Jul 1;73(5):102467. doi: 10.1016/j.outlook.2025.102467. Online ahead of print.
ABSTRACT
BACKGROUND: Non-Hispanic Black pregnant individuals utilize up to 50% less labor epidural analgesia compared to non-Hispanic White individuals.
PURPOSE: This Outlook and Perspectives aims to evaluate the factors contributing to racial differences in the utilization of labor epidural analgesia.
METHODS: Literature on scientific evidence regarding racial disparities in maternal outcomes and labor pain management was reviewed and summarized.
FINDINGS: We identified that trust issues with healthcare and providers, ineffective patient-provider communication, and perceived mistreatment and discrimination contribute to these disparities in labor pain management.
DISCUSSION: Further research is needed to develop strategies to enhance birthing experiences for Black individuals, including improving patient-provider communication and providing accurate, culturally sensitive patient education on labor pain management.
PMID:40602011 | DOI:10.1016/j.outlook.2025.102467
J Surg Res. 2025 Jul 1;312:236-243. doi: 10.1016/j.jss.2025.05.025. Online ahead of print.
ABSTRACT
INTRODUCTION: Primary hyperparathyroidism (PHPT) is associated with significant patient morbidity, including increased risk of fractures, nephrolithiasis, and cardiovascular events. Parathyroidectomy remains an underutilized therapy, particularly among historically disadvantaged populations. We sought to better understand the association social determinants, as measured by neighborhood advantage, have on particular steps of the diagnostic and treatment pathway for PHPT to better identify targets for intervention.
METHODS: We performed a retrospective analysis of all patients ≥18 y of age with an elevated calcium value (>10.2 mg/dL), and without a prior diagnosis of PHPT, secondary or tertiary hyperparathyroidism, or kidney failure, between January 1, 2021 and January 1, 2023. Patients' neighborhood advantage was stratified using the Area Deprivation Index to create three cohorts-disadvantaged, moderate, advantaged. The rates of repeat calcium check, parathyroid hormone (PTH) evaluation, specialist referral, and parathyroidectomy were compared.
RESULTS: A total of 6749 patients with hypercalcemia were identified, and 3976 (58.9%) met inclusion criteria. Repeat calcium was checked for 3646 (91.7%) of patients, and PTH checked in only 872 patients (57.5% of patients with repeat hypercalcemia). There was no difference in repeat calcium (P = 0.53) or PTH evaluation (P = 0.18) by neighborhood advantage. Significant differences were noted in rate of specialist evaluation (74.9% advantaged, 66.3% moderate, 59.8% disadvantaged, P < 0.01).
CONCLUSIONS: Referral to specialist is the step that contributed most to disparities in treatment rates of PHPT. Interventions addressing both individual- and community-level barriers, particularly in the transition of care from primary care to specialists, are needed to increase access to parathyroidectomy and further health equity.
PMID:40602008 | DOI:10.1016/j.jss.2025.05.025
J Clin Neurophysiol. 2025 Jul 2. doi: 10.1097/WNP.0000000000001187. Online ahead of print.
ABSTRACT
PURPOSE: Intraoperative neuromonitoring (IONM) is a valuable tool to monitor the neural axis during various procedures and guide intervention aimed at managing operative complications. The literature lacks large scale data on trends and demographic disparities in IONM use in the United States.
METHODS: Data were abstracted from the 2008-2021 National Inpatient Sample. Hospitalizations for neurosurgical (spinal, craniotomy, carotid artery, cranial/peripheral nerve), cardiac/vascular, and head/neck/thyroid procedures were identified and stratified by IONM use. Logistic regression models were estimated to assess disparities and trends in IONM use. Multivariable models adjusted for patient- and facility-level characteristics.
RESULTS: From 2008 to 2021, the rate of IONM use increased significantly in neurosurgical (3.69% to 18.62%, p < 0.001) and cardiac/vascular procedures (0.018% to 0.6%, p < 0.001). IONM use for head/neck/thyroid procedures increased steadily until 2014 and then declined (p < 0.001). Compared with hospitalizations of White patients, Black (aOR = 0.87, 95% CI: 0.81-0.94) and Hispanic (aOR = 0.88, 95% CI: 0.81-0.96) patients were associated with lower odds of IONM use during craniotomy. Lower incomes (0-25th quartile) were associated with lower odds of IONM use in both spinal (aOR = 0.83, 95% CI: 0.78-0.88) and craniotomy procedures (aOR = 0.78, 95% CI: 0.72-0.85).
CONCLUSIONS: There is a growing demand for IONM to enhance the safety of various procedures, indicating a need for neurologists and technologists with this expertise. In addition, we found significant racial/ethnic and socioeconomic disparities in IONM use. These findings can be valuable for health care administrators and policymakers to address disparities in the access to IONM.
PMID:40601961 | DOI:10.1097/WNP.0000000000001187
Glob Public Health. 2025 Dec;20(1):2525960. doi: 10.1080/17441692.2025.2525960. Epub 2025 Jul 2.
ABSTRACT
Equitable access to healthcare is essential for achieving Universal Health Coverage (UHC) and improving health outcomes. This cross-sectional study examines patients' perceived access to healthcare services in the West Bank, providing insights into patients' perceptions of health disparities. Data were collected using stratified convenient sampling of 486 chronic patients at governmental primary healthcare centers in three governorates. A 5-points Likert scale questionnaire was used, based on the '6A' dimensions for healthcare access: affordability, acceptability, accommodation, accessibility, availability, and awareness. The overall healthcare access mean score was 3.29 (SD = 0.46), with only 38.5% of participants reporting satisfactory access levels. Only acceptability (mean =3.75, SD = 0.55), and awareness (mean = 3.66, SD = 0.61) dimensions demonstrated significantly positive perceptions. Bivariate analysis identified income as the main significant determinant for access disparities (Kruskal-Wallis Test χ²= 75.9, p < 0.001). Place of residency, education and income significantly contributed to the disparities within the different access dimensions. The findings highlight significant challenges in healthcare access in the West Bank, particularly regarding services availability and financial affordability. These barriers extremely affect vulnerable populations, exacerbating existing health inequities and undermining efforts toward UHC. The findings emphasise the urgent need for policy interventions to address financial protection, expand service availability, and strengthen healthcare provision.
PMID:40601916 | DOI:10.1080/17441692.2025.2525960
J Osteopath Med. 2025 Jul 3. doi: 10.1515/jom-2024-0151. Online ahead of print.
ABSTRACT
CONTEXT: Existing studies have analyzed gender and race representation among otolaryngology - head and neck surgery (OHNS) applicants and residents in the United States. Further analysis by graduate medical degree type does not currently exist.
OBJECTIVES: The objective of this study was to identify and compare gender and racial disparities in osteopathic (Doctor of Osteopathic Medicine [DO]) and allopathic (Doctor of Medicine [MD]) OHNS applicants and residents.
METHODS: Cross-sectional analysis of sex and racial characteristics of DO and MD OHNS applicants and residents from 2015 to 2023 obtained from the American Association of Medical Colleges (AAMC) and Electronic Residency Application Service (ERAS) data were performed. Differences between the aggregate proportions of applicants and corresponding residents at Accreditation Council of Graduate Medical Education (ACGME)-accredited OHNS programs by graduate medical degree were evaluated utilizing chi-square tests with Yates' continuity correction.
RESULTS: The proportion of White MD, Asian MD, and White DO residents increased compared to their corresponding applicant pools (ACGME 0.535, ERAS 0.615; Δ + 0.080; 95 % confidence interval [CI], 0.059-0.101; p<0.001), (ACGME 0.212, ERAS 0.236; Δ + 0.024; 95 % CI, 0.006-0.042; p<0.001), and (American Osteopathic Association [AOA] 0.661, ERAS 0.809; Δ + 0.148; 95 % CI, 0.032-0.159; p<0.01), respectively. Compared to MD residents, there were increased proportions of White (ERAS 0.615, ERAS 0.809; Δ -0.193; 95 % CI, -0.129 to -0.060; p<0.001) and male (ERAS 0.593, ERAS 0.685; Δ -0.092; 95 % CI, -0.080 to -0.013; p=0.01) DO residents.
CONCLUSIONS: Findings suggest that gender and racial discrepancies exist between DO and MD representation in OHNS. Further research is encouraged to examine the explanation for these differences and improve representation of the DO surgeon in otolaryngology.
PMID:40601827 | DOI:10.1515/jom-2024-0151
Community Health Equity Res Policy. 2025 Jul 2:2752535X251352995. doi: 10.1177/2752535X251352995. Online ahead of print.
ABSTRACT
BackgroundCervical cancer disproportionally burdens Hispanic immigrant communities in the United States, despite its preventable nature and curability when detected early. These persistent disparities represent a "wicked problem," characterized by contested evidence, fragmented data, and a politicized health policy environment.MethodsThis study uses Tarrant County, Texas-a high-disparity urban region-as a case study to explore how multilevel governance structures shape immigrant health inequities. Drawing on the concept of wicked problems and the political determinants of health (PDoH) framework, we analyze archival data through a policy science lens to examine how electoral, legal, and institutional forces perpetuate barriers to life-saving care for immigrant women.ResultsFour key themes emerged from our analysis: (1) a reactive political environment that amplifies exclusion, (2) decision-making shaped by legal ambiguity, (3) passive enforcement of immigration policies through institutional design, and (4) blame-shifting between public and private healthcare systems. These dynamics collectively sustain health disparities by limiting access to preventive care and delaying treatment among immigrant populations.ConclusionFindings demonstrate that cervical cancer disparities are not solely the result of individual health behaviors but are produced and sustained by structural and political forces. Addressing these disparities requires interdisciplinary partnerships and place-based strategies that confront the institutional barriers embedded in local governance. We call for strategic alliances among researchers, community stakeholders, and policymakers to foster shared accountability and develop responsive, equity-driven policies for addressing cervical cancer and other preventable conditions in immigrant communities.
PMID:40601765 | DOI:10.1177/2752535X251352995
PLoS One. 2025 Jul 2;20(7):e0326668. doi: 10.1371/journal.pone.0326668. eCollection 2025.
ABSTRACT
Understanding disparities in the prevalence of Post COVID-19 Condition (PCC) amongst vulnerable populations is crucial to improving care and addressing intersecting inequities. This study aims to develop a comprehensive framework for integrating social determinants of health (SDOH) into PCC research by leveraging natural language processing (NLP) techniques to analyze disparities and variations in SDOH representation within PCC case reports. Following construction of a PCC Case Report Corpus, comprising over 7,000 case reports from the LitCOVID repository, a subset of 709 reports were annotated with 26 core SDOH-related entity types using pre-trained named entity recognition (NER) models, human review, and data augmentation to improve quality, diversity and representation of entity types. An NLP pipeline integrating NER, natural language inference (NLI), trigram and frequency analyses was developed to extract and analyze these entities. Both encoder-only transformer models and RNN-based models were assessed for the NER objective. Fine-tuned encoder-only BERT models outperformed traditional RNN-based models in generalizability to distinct sentence structures and greater class sparsity, achieving a macro F1-score of 0.72 and macro AUC of 0.99 on a held-out generalization set. Exploratory analysis revealed variability in entity richness, with prevalent entities like condition, age, and access to care, and under-representation of sensitive categories like race and housing status. Trigram analysis highlighted frequent co-occurrences among entities, including age, gender, and condition. The NLI objective (entailment and contradiction analysis) showed attributes like "Experienced violence or abuse" and "Has medical insurance" had high entailment rates (82.4%-80.3%), while attributes such as "Is female-identifying," "Is married," and "Has a terminal condition" exhibited high contradiction rates (70.8%-98.5%). Our results highlight the effectiveness of transformer-based NER in extracting SDOH information from case reports. However, the findings also expose critical gaps in the representation of marginalized groups within PCC-related academic case reports, e.g., across gender, insurance status, and age. This work underscores the need for standardized SDOH documentation and inclusive reporting practices to enable more equitable research and inform future health policy and AI model development.
PMID:40601702 | DOI:10.1371/journal.pone.0326668
JAMA Netw Open. 2025 Jul 1;8(7):e2518569. doi: 10.1001/jamanetworkopen.2025.18569.
ABSTRACT
IMPORTANCE: There is a disproportionately high rate of overdose deaths immediately following an emergency department (ED) visit for opioid overdose. Thus, an improved understanding of disparities in ED treatment and referral is vital. Racial and ethnic disparities in access to naloxone and buprenorphine have been described in the outpatient setting but prevalence in the ED setting remains understudied.
OBJECTIVE: To examine racial and ethnic disparities in treatment referral rates in ED patients with opioid overdose.
DESIGN, SETTING, AND PARTICIPANTS: This is a secondary analysis of a prospective consecutive cohort from the Toxicology Investigators Consortium (TOXIC) Fentalog Study from September 21, 2020, to November 11, 2023. Ten hospital sites were a part of the TOXIC network and participants included ED patients in aged 18 years or older with opioid overdose. Data were analyzed from December 2022 to March 2025.
EXPOSURES: Patient race, ethnicity, sex, and other demographic and clinical factors of interest.
MAIN OUTCOMES AND MEASURES: Study outcomes included the proportion of patients receiving a referral to outpatient addiction care and the proportion receiving a naloxone kit or prescription or buprenorphine prescription at discharge. Descriptive statistics were tabulated, and χ2 and multivariable logistic regression analyses were used to evaluate for differences by race, ethnicity, sex, and other demographic and clinical variables.
RESULTS: In this study, 1683 patients met all inclusion criteria (mean [SD] age, 42.5 [14.5] years; 1221 males [72.6%]; 461 females [27.4%]; 447 Black patients [26.6%]; 63 Hispanic patients [4.3%]; 867 White patients [51.5%]). Of the 1683 included patients, 299 (17.8%) received a referral for outpatient treatment, 713 (42.4%) received a naloxone kit or prescription, and 141 (8.4%) received a buprenorphine prescription. Compared with White patients, Black patients had a decreased adjusted odds ratio (aOR) of outpatient treatment referral (aOR, 0.67; 95% CI, 0.47-0.97). Hospital admission was also associated with increased adjusted odds of outpatient treatment referral (aOR, 3.13; 95% CI, 2.34-4.20). Geographic variation was associated with all primary and secondary outcomes.
CONCLUSIONS AND RELEVANCE: In this study, Black patients were less likely to receive outpatient referrals for OUD. These findings underscore the need for targeted interventions to address racial disparities in ED care for OUD, particularly in enhancing referral processes.
PMID:40601317 | DOI:10.1001/jamanetworkopen.2025.18569
JAMA Netw Open. 2025 Jul 1;8(7):e2518826. doi: 10.1001/jamanetworkopen.2025.18826.
ABSTRACT
IMPORTANCE: Neighborhood characteristics may be independently associated with survival after acute myocardial infarction (AMI).
OBJECTIVE: To examine the association of living in a marginalized neighborhood with mortality and care for younger AMI survivors (aged <65 years) in a universal health care system.
DESIGN, SETTING, AND PARTICIPANTS: Population-based retrospective cohort using clinical and administrative databases in Ontario, Canada. Participants were younger patients hospitalized for their first AMI who received invasive evaluation and survived to 7 days after discharge between April 1, 2010, and March 1, 2019. Statistical analysis was performed between May 27, 2022, and March 31, 2025.
EXPOSURES: Neighborhood marginalization, a metric comprising material deprivation, residential instability, and dependency.
MAIN OUTCOMES AND MEASURES: All-cause death, all-cause hospitalizations, and subsequent AMIs. Proportional hazards regression models were used to quantify the association of marginalization with outcomes over 3 years.
RESULTS: Among 65 464 AMI patients (median age, 56 [IQR, 50-61] years; 22.9% female), increasing neighborhood marginalization was associated with higher rates of mortality beginning 30 days after discharge and persisting over time. At 3 years, mortality rates ranged from 2.2% in the least marginalized neighborhood quintile (Q1) to 5.2% in the most marginalized (Q5). Adjusted hazard ratios for mortality over 3 years of follow-up were significantly higher in patients from marginalized neighborhoods and ranged from 1.13 (95% CI, 0.95-1.35) in Q2 to 1.52 (95% CI, 1.29-1.80) in Q5. Over 1 year, differences were observed between Q1 and Q5 in visits to primary care physicians (Q1, 96.1%; Q5, 91.6%) and cardiologists (Q1, 88.0%; Q5, 75.7%), as well as diagnostic testing.
CONCLUSIONS AND RELEVANCE: In this cohort study of younger AMI survivors with universal health care, living in marginalized neighborhoods was associated with adverse outcomes. The observed differences in health service utilization among marginalized patients warrant further investigation to better understand the underlying structural and systemic factors.
PMID:40601315 | DOI:10.1001/jamanetworkopen.2025.18826
J Racial Ethn Health Disparities. 2025 Jul 2. doi: 10.1007/s40615-025-02517-3. Online ahead of print.
ABSTRACT
Asian Americans and Pacific Islanders are among the fastest-growing racial groups in the United States but remain underrepresented in cancer research, leading to gaps in understanding their cancer risks and outcomes. This study examines cancer mortality trends among Asian Americans and Pacific Islanders from 1999 to 2020 using Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) data. Age-adjusted mortality rates (AAMR) per 100,000 individuals and average annual percent change (AAPC) were analyzed with Joinpoint Regression. Overall cancer AAMR significantly declined from 188.68 (95% Confidence Interval [CI], 184.49-192.88) to 138.85 (95% CI, 136.9-140.8) per 100,000 individuals, with an AAPC of -1.44 (95% CI, -1.53, -1.34). Lung cancer (21.94%), colon cancer (7.40%), and pancreatic cancer (7.09%) were the leading causes of cancer death. Men had higher AAMR than women (188.75 [95% CI, 187.78-189.72] vs. 136.01 [95% CI, 135.31-136.71] per 100,000 individuals). The highest AAMR were observed in the West (172.95 [95% CI, 172.16-173.74] per 100,000 individuals) and rural areas (175.34 [95% CI, 172.00-178.68] per 100,000 individuals). Despite declining mortality, Asian Americans and Pacific Islanders experienced slower reductions in mortality compared to other racial groups, with disparities persisting across sex, geography, and urbanization. Targeted prevention efforts, improved screening, and culturally tailored interventions are essential to address these gaps and improve outcomes.
PMID:40601164 | DOI:10.1007/s40615-025-02517-3