Current protests throughout the United States are highlighting the history of marginalization of and discrimination against Black Americans, including 250 years of slavery, 100 years of Jim Crow, high rates of incarceration, and unanswered calls for action after police shootings of unarmed Black Americans. Simultaneously, disparities in Covid-19 infections and deaths are laying bare the underlying structural racism that protestors seek to disrupt.
Introduction Adverse childhood experiences (ACEs) are associated with early mortality and morbidity. This study evaluated the association among ACEs, high-risk health behaviors, and comorbid conditions, as well as the independent effect of ACE components. Methods Data were analyzed on 48,526 U.S. adults from five states in the 2011 Behavioral Risk Factor Surveillance System survey. Exposures included psychological, physical, and sexual forms of abuse as well as household dysfunction such as substance abuse, mental illness, violence, and incarceration. Main outcome measures included risky behaviors and morbidity measures, including binge drinking, heavy drinking, current smoking, high-risk HIV behavior, obesity, diabetes, myocardial infarction, coronary heart disease, stroke, depression, disability due to poor health, and use of special equipment due to disability. Multiple logistic regression assessed the independent relationship between ACE score categories and risky behaviors/comorbidities in adulthood, and assessed the independent relationship between individual ACE components and risky behaviors/comorbid conditions in adulthood controlling for covariates. Results A total of 55.4% of respondents reported at least one ACE and 13.7% reported four or more ACEs. ACE score of ≥ 4 was associated with increased odds for binge drinking, heavy drinking, smoking, risky HIV behavior, diabetes, myocardial infarction, coronary heart disease, stroke, depression, disability due to health, and use of special equipment due to disability. In addition, the individual components had different effects on risky behavior and comorbidities. Conclusions In addition to having a cumulative effect, individual ACE components have differential relationships with risky behaviors, morbidity, and disability in adulthood after controlling for important confounders.
There is strong evidence that race/ethnicity and social determinants of health significantly impact outcomes for patients with diabetes. A better understanding of the mechanisms of these relationships/associations will improve development of cost-effective, culturally tailored programs for patients with diabetes. This article reviews the current state of the literature on the impact of race/ethnicity and social determinants of health on process of care, quality of care and outcomes for diabetes, with particular emphasis on the rural South to give an overview of the state of the literature. The literature review shows that racial/ethnic differences in the clinical outcomes for diabetes, including glycemic, blood pressure, and lipid control, continue to persist. In addition, the literature review shows that the role of social determinants of health on outcomes, and the possible role these determinants play in disparities have largely been ignored. Psychosocial factors, such as self-efficacy, depression, social support, and perceived stress, show consistent associations with self-care, quality of life, and glycemic control. Neighborhood factors, such as food insecurity, social cohesion, and neighborhood aesthetics have been associated with glycemic control. Perceived discrimination has also been associated with self-care and the psychological component of quality of life. Health care professionals need to be skilled in assessing social determinants of health and taking them into consideration in clinical care. In addition, more research is needed to identify the separate and combined impact of race/ethnicity and social determinants of health on process of care, quality of care and outcomes in diabetes, especially in the South, where the burden of disease is particularly high.
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