Purpose: The purpose of this study is to examine the disparities in visual impairment, annual eye care visits, and eyeglass affordability by race/ethnicity and associated covariates among the United States (U.S.) adult population.

Method: The combined sample size of six years’ NHIS data was 199,622, which represented 241,555,788 U.S. adults population each year. The prevalence of were standardized to the 2014 U.S. Census population. Multivariable logistic regression models were built to calculate adjusted odds ratios to find the potential explanations for the disparities. Weighted least squares linear regression was used to estimate the linear trends of the prevalence.

Results: For adults age ≥18, there were significant disparities in the prevalence of self-reported visual impairment (VI) and eye care utilization between different racial and ethnic groups. Associated covariates each carried an independent association with the disparities and provided some understanding in racial and ethnic disparities. There was no trend of visual impairment, but an increasing trend of annual eye doctor visits and a decreasing trend of being unable to afford eyeglasses during the past six years.

Conclusions: There were disparities in visual impairment and eye care utilization among U.S. adults by race and ethnicity. The associated covariates contributed to racial and ethnic disparities. There was an increasing trend of annual eye doctor visits and a decreasing trend of being unable to afford eyeglasses among the U.S. adults. More research is imperative to understand the underlying reasons and mechanisms. Innovative interventions are needed to reduce unnecessary vision loss among high-risk groups.

Clinical inertia is defined as a delay in intensifying medical treatment despite the fact that patients have not met clinical goals for control of their medical conditions. Little is known about clinical inertia among racial/ethnic minority groups with type 2 diabetes mellitus. This analysis uses three constructs—Access, Beliefs/Preferences, Communication—represented by the proxies of insurance status, race/ethnicity minority status, and English language fluency status—to evaluate the effect of race/ethnicity on clinical inertia in diabetes outcomes. This study was an observational retrospective review of a database of outpatient medical visits from January 2012 to December 2014. The database was organized to analyze clinical inertia for these patients, which was defined as the time to medication intensification after having a HbA1C greater than the target HbA1C≥8%. English-fluent patients were found to have greater odds of receiving medication intensification during a given time period, supporting the idea that non-English-fluent patients may be disproportionately affected by clinical inertia.

The Health Resources and Services Administration (HRSA) supports Community Health Centers (CHCs) which serve a large population of patients with Limited English Proficiency (LEP) through annual grants. The focus of this work is to review how CHCs with a high percentage of LEP patients perform in one disparity seen in the literature and an outcome measure in the HRSA database: cervical cancer screening. The LEP disparity was evaluated to determine how well CHCs with higher percentages of LEPs perform in cervical cancer screening rates and if they compare with national screening rates for all CHCs in the United States. Additional independent variables were included with LEP as covariates: rural residence (for California only), racial or ethnic identity, proximity to federal poverty level, and uninsured status. Descriptive statistics and regression models were completed for both California and all U.S. CHC, using cervical cancer screening as the dependent variable. As additional analysis, rural and non-rural California CHCs were compared through logistic regression (bivariate). For California CHCs, the final logistic model attained through backward selection contained Hispanic/Latino and LEP for the outcome of Cervical Cancer Screenings. For all U.S. CHCs, the multivariate model contained three variables: American Indian / Alaska Native, LEP, and Uninsured. Rural CHCs in California were significant for a decrease in Cervical Cancer Screening and LEP, an increase of 5% in the American Indian / Alaska Native (AI/AN) population, and other significant differences to Non-Rural CHCs. The results support an association of LEP with cervical cancer screenings at community health centers. Community health centers’ cervical cancer screening rates were not equivalent across state (California) and national numbers. Cervical cancer screening rates were also different when comparing rural and non-rural regions in the secondary analysis. In summary, this study emphasized how community health centers performance in screening were considerably behind national rates. The significant LEP independent variable in the two final multivariate models suggests the need to pursue further work using an un-suppressed database to better quantify the impact of LEP status on a health outcome such as cervical cancer screening at community health centers.

Diabetes mellitus (DM) is a chronic condition that can be debilitating to the health and lifestyle of a patient. A patient’s inability to control their blood sugar can have devastating consequences for the individual, family, community, and society in general. Maintaining good overall control of one’s blood glucose levels is a multilayered and multifaceted endeavor that involves patient commitment, medical providers' direction, and familial and community support. With the onset of the COVID-19 pandemic, the systems that support these patients seem to have affected their ability to see their medical team and their diabetic health. Most of the research investigates the effect of the COVID-19 virus on diabetic patients or the effectiveness of self-management with diabetes, but there is no research confirming the reduction in medical visits and deterioration of meeting the diabetic outcome indices used to measure successful diabetes management. This cohort study uses McNemar Chi-Square Tests and Binary Logistic Regression Analysis with a Confidence Interval of 95% to analyze data extracted from the OMOP Database of type 2 diabetic adult patients between the ages of 18 and 75 years, who were diagnosed before March 2019 with two or more ambulatory visits to the UCI Medical Clinic, from March 2019 to February 2022. A total of 5,185 T2DM adult patients were selected from the UCI Health database that met the criteria. The HEDIS Comprehensive Diabetes Care Measure was used as the criteria for good compliance. There were 5 measures considered for diabetes outcomes, these are Screening for Glycosylated Hemoglobin (HbA1c/A1c), good compliance of less than 8.0%, poor compliance of greater than 9%, a Blood Pressure (BP) level of less than 140/90 mmHg and yearly retinal eye examination is considered a yes/ no option if the patient has this examination done within the year of the study. Nephropathy was not considered in this study because it was removed from the list of requirements in the Comprehensive Diabetes Care Measures. Based on the statistical analysis, differences in differences analysis were performed over the five sets of data. The results showed, from 2019 to 2020, there was a significant change in compliance of overall HbA1c less than 8% (p>.001), HbA1c Screening, poor compliance of overall HbA1c >9% (p>.001), BP <140/90mmHg (p>.001), and retinal eye examination (p>.001). This change did not recover from 2020 to 2021, except in Retinal Eye Examination. The change in BP is representative of the absence of patients from doctors’ visits and there was a 26% drop in HbA1c screen from 2019 to 2020. There was also a significance in these changes based on racial-ethnic profile, sex, and age. Future studies would be encouraged to identify mechanisms to prevent these gaps from occurring in the future when an event like a pandemic creates a scarcity of resources.

Latinos represent one of the fastest growing populations in the United States, with distinct health behaviors and health outcomes compared to their non-Latino counterparts. This group also experiences more noted deteriorations in health as the time spent in the U.S. increases. In addition, Latino adults are diagnosed with chronic medical conditions such as diabetes at higher rates than any other ethnic group. Simultaneously, more Latino patients report symptoms of depression, however, they are less likely to receive any form of treatment despite studies indicating that pharmacotherapy and psychotherapy are effective in impacting the improvement of psychosocial outcomes and depressive symptoms. The purpose of this study was to investigate the role of acculturation in the low rates of utilization of mental health services in Latinos with type 2 diabetes and depressive symptoms at federally qualified health centers in Southern California. Specific aims addressed in this investigation included determining whether acculturation level was associated with individual reports of depressive symptoms after controlling for potential confounding variables and assessing whether levels of acculturation were correlated with low rates of utilization of mental health services in Latinos with clinically meaningful levels of depressive symptoms.

This was a cross-sectional study using data from the Reducing Racial/Ethnic Disparities in Diabetes: The Coached Care (R2D2C2) Project. Participants were 749 individuals recruited from diverse outpatient clinics affiliated with an academic center in Southern California. Participants were Latino, mostly Mexican-American, adults with type 2 diabetes. A logistic regression analysis was used to examine the association between acculturation levels and reports of depressive symptomatology and mental health service utilization. Results demonstrated that, after controlling for socioeconomic status, individuals with lower acculturation were less likely to report depressive symptoms and, among those with depression, were less likely to report have seen a mental health provider. There was also no association, however, between acculturation and the documentation of diagnosis of depression/anxiety or the prescription of medications to treat those conditions. The effects of acculturation on reports of depressive symptoms and mental health utilization cannot be explained by socioeconomic factors alone. Therefore, the underlying causes for the lower level of depressive symptoms reported by less acculturated individuals with diabetes, and the discrepancy between provider recognition of depression and patient-reported mental health service utilization in these patients, warrants further investigation.

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Colorectal cancer is a leading cause of cancer related deaths in United States for both men and women. Despite the availability of various screening tests, the screening rate remains low, especially among the Hispanic population. This randomized pragmatic trial study compares the effectiveness of a combination of mailed package, including a pre-paid fecal immunochemical testing (FIT) kit, with automated and live phone call reminders to mailed package only. The control group received only mailed packages, whereas the intervention group received automated and live phone calls after the mail delivery. Patient data were collected from the electronic healthcare record from a primary care clinic within a federally qualified health center in Orange County, CA. Our results showed that the intervention group had a significantly more FIT returns than the control group. The results also suggested that many patients may not be available through phone calls.