Cancer Pain in Relation to Metropolitan Area Segregation and Nursing Home Racial and Ethnic Composition.
Cancer Pain in Relation to Metropolitan Area Segregation and Nursing Home Racial and Ethnic Composition.
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DOI：
10.1016/j.jamda.2020.02.001
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发表时间：
2020-09
影响因子：
7.6
通讯作者：
Lapane KL
中科院分区：
文献类型：
--
作者：
Jesdale BM;Mack DS;Forrester SN;Lapane KL
评估癌症居民的疼痛报告与大都市区隔离和新罕布什尔州种族/民族构成的关系。横断面研究。 12,096 个美国 NH 中的 383,757 名新入院的患有癌症的黑人 (B)、西班牙裔 (H) 或白人 (W) 居民（2011-2013 年）使用最小数据集 3.0，通过自我报告或使用疼痛管理来确定过去 5 天的疼痛。泰尔熵指数是衡量大都市区隔离程度的指标，分为[高（高达 0.20）、极高（0.20-0.30）或极端（0.30-0.53）]。不同种族隔离水平下的疼痛患病率有所下降[黑人：高：77%，非常高：75%，极端：72%；西班牙裔：高：79%，非常高：77%，极端：70%；白色：高：80%，非常高：77%，极端：74%）]。在极度隔离的地区，所有居民记录疼痛的可能性均低于最低水平（调整后的患病率：B：可能性较低 4.6%，95% 置信区间 (CI)：3.1%−6.1%；H：可能性较低 6.9%，95% CI：4.2%−9.6%；W：可能性较低 7.4%，95% CI：6.5%−8.2%）隔离区域。在所有种族隔离水平上，以白人为主 (>80%) 的 NH 居民（B 或 W）比以黑人为主 (> 50%) 的 NH 居民（B 或 W）更频繁地记录到疼痛，或者以白人为主的 NH 居民（H 或 W）比以西班牙裔为主 (> 50%) 的 NH 更频繁地记录到疼痛。我们观察到，在种族/民族隔离程度较高的大都市地区，疼痛记录减少。这可能是由于 NH 之间的资源分配不公平、居民与提供者之间的同理心、提供者隐性偏见、居民信任和其他因素造成的。这项研究发现，在种族隔离程度较高的大都市地区，患有癌症的黑人、西班牙裔和白人疗养院居民报告疼痛的频率较低，这可能反映了资源分配的不平等。
To estimate pain reporting among residents with cancer in relation to metropolitan area segregation and NH racial/ethnic composition. Cross-sectional study. 383,757 newly admitted Black (B), Hispanic (H), or White (W) residents with cancer in 12,096 US NHs (2011–2013) Using the Minimum Data Set 3.0, pain in past 5 days was determined by self-report or use of pain management. Theil’s entropy index, a measure of metropolitan area segregation, was categorized [high (up to 0.20), very high (0.20–0.30), or extreme (0.30–0.53)]. Pain prevalence decreased across segregation level [Black: high: 77%, very high: 75%, extreme: 72%; Hispanic: high: 79%, very high: 77%, extreme: 70%; White: high: 80%, very high: 77%, extreme: 74%)]. In extremely segregated areas, all residents were less likely to have recorded pain (adjusted prevalence ratios: B: 4.6% less likely, 95% Confidence interval (CI): 3.1%−6.1%; H: 6.9% less likely, 95% CI: 4.2%−9.6%; W: 7.4% less likely, 95% CI: 6.5%−8.2%) than in the least segregated areas. At all segregation levels, pain was recorded more frequently for residents (B or W) in predominantly White (>80%) NHs than in mostly Black (>50%) NHs or residents (H or W) in predominantly White NHs than mostly Hispanic (>50%) NHs. We observed decreased pain recording in metropolitan areas with greater racial/ethnic segregation. This may occur through the inequitable distribution of resources between NHs, resident-provider empathy, provider implicit bias, resident trust, and other factors. This study finds that Black, Hispanic, and White nursing home residents with cancer report pain less frequently in more segregated metropolitan areas, potentially reflecting unequal resource distribution.
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影响因子：
5.4
作者：
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通讯作者：
Chang, Virginia W.
影响因子：
120.7
作者：
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通讯作者：
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影响因子：
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DOI：
10.1016/j.ssmph.2017.10.006
发表时间：
2018-04
期刊：
SSM - population health
影响因子：
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通讯作者：
Williams DR
影响因子：
9.7
作者：
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Mor, V