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Reproducing Race, an ethnography of pregnancy and birth at a large New York City public hospital, explores the role of race in the medical setting. Khiara M. Bridges investigates how race--commonly seen as biological in the medical world--is socially constructed among women dependent on the public healthcare system for prenatal care and childbirth. Bridges argues that race carries powerful material consequences for these women even when it is not explicitly named, showing how they are marginalized by the practices and assumptions of the clinic staff. Deftly weaving ethnographic evidence into broader discussions of Medicaid and racial disparities in infant and maternal mortality, Bridges shines new light on the politics of healthcare for the poor, demonstrating how the \"medicalization\" of social problems reproduces racial stereotypes and governs the bodies of poor women of color.

Examining trans- healthcare as a key site through which struggles for health and justice take shape Over the past two decades, medical and therapeutic approaches to transgender patients have changed radically, from treating a supposed pathology to offering gender-affirming care. Based on ethnographic fieldwork in New York City and Buenos Aires, Care without Pathology moves across the Americas to show how trans- health activists have taken on the project of depathologization. In New York, Christoph Hanssmann examines activist attempts to overturn bans on using public health dollars to fund trans- health care. In Argentina, he traces how trans- activists marshaled medical statistics and personal biographies to reveal state violence directed against trans- people and travestis. Hanssmann also demonstrates the importance of understanding transphobia in the broader context of gendered racism, ableism, and antipoverty, arguing for the rise of a thoroughly coalition-based mass mobilization. Care without Pathology highlights the distributive arguments activists made to access state funding for health care, combating state arguments that funding trans- health care is too specialized, too expensive, and too controversial. Hanssmann situates trans- health as a crucible within which sweeping changes are taking place-with potentially far-reaching effects on the economic and racial barriers to accessing care.

Prior research has suggested that gender differences in physicians' salaries can be accounted for by the tendency of women to enter primary care fields and work fewer hours. However, in examining starting salaries by gender of physicians leaving residency programs in New York State during 1999-2008, we found a significant gender gap that cannot be explained by specialty choice, practice setting, work hours, or other characteristics. The unexplained trend toward diverging salaries appears to be a recent development that is growing over time. In 2008, male physicians newly trained in New York State made on average $16,819 more than newly trained female physicians, compared to a $3,600 difference in 1999. [PUBLICATION ABSTRACT]

Background African American/Black and Hispanic persons living with HIV (AABH-PLWH) in the U.S. evidence insufficient engagement in HIV care and low uptake of HIV antiretroviral therapy, leading to suboptimal clinical outcomes. The present qualitative study used critical race theory, and incorporated intersectionality theory, to understand AABH-PLWH’s perspectives on the mechanisms by which structural racism; that is, the macro-level systems that reinforce inequities among racial/ethnic groups, influence health decisions and behaviors. Methods Participants were adult AABH-PLWH in New York City who were not taking antiretroviral therapy nor well engaged in HIV care ( N  = 37). Participants were purposively sampled for maximum variation from a larger study, and engaged in semi-structured in-depth interviews that were audio-recorded and professionally transcribed verbatim. Data were analyzed using a systematic content analysis approach. Results We found AABH-PLWH experienced HIV care and medication decisions through a historical and cultural lens incorporating knowledge of past and present structural racism. This contextual knowledge included awareness of past maltreatment of people of color in medical research. Further, these understandings were linked to the history of HIV antiretroviral therapy itself, including awareness of the first HIV antiretroviral regimen; namely, AZT (zidovudine) mono-therapy, which was initially prescribed in unacceptably high doses, causing serious side effects, but with only modest efficacy. In this historical/cultural context, aspects of structural racism negatively influenced health care decisions and behavior in four main ways: 1) via the extent to which healthcare settings were experienced as overly institutionalized and, therefore, dehumanizing; 2) distrust of medical institutions and healthcare providers, which led AABH-PLWH to feel pressured to take HIV antiretroviral therapy when it was offered; 3) perceptions that patients are excluded from the health decision-making process; and 4) an over-emphasis on antiretroviral therapy compared to other non-HIV related priorities. We found that although participants were located at the intersection of multiple social categories (e.g., gender, social class, AABH race/ethnicity), race/ethnicity and social class were described as primary factors. Conclusions Critical race theory proved useful in uncovering how macro-level structural racism affects individual-level health decisions and behaviors. HIV clinical settings can counter-balance the effects of structural racism by building “structural competency,” and interventions fostering core self-determination needs including autonomy may prove culturally appropriate and beneficial for AABH-PLWH.

Background Length of hospital stay (LOS) for hip fracture treatments is associated with mortality. In addition to patient demographic and clinical factors, hospital and payer type may also influence LOS, and thus mortality, among hip fracture patients; accordingly, outcome disparities between groups may arise from where patients are treated and from their health insurance type. The purpose of this study was to examine if where hip fracture patients are treated and how they pay for their care is associated with outcome disparities between patient groups. Specifically, we examined whether LOS differed between patients treated at safety-net and non-safety-net hospitals and whether LOS was associated with patients’ insurance type within each hospital category. Methods A sample of 48,948 hip fracture patients was extracted from New York State’s Statewide Planning and Research Cooperative System (SPARCS), 2014–2016. Using means comparison and X 2 tests, differences between safety-net and non-safety-net hospitals on LOS and patient characteristics were examined. Relationships between LOS and hospital category (safety-net or non-safety-net) and LOS and insurance type were further evaluated through negative binomial regression models. Results LOS was statistically ( p  ≤ 0.001) longer in safety-net hospitals (7.37 days) relative to non-safety-net hospitals (6.34 days). Treatment in a safety-net hospital was associated with a LOS that was 11.7% ( p = 0.003) longer than in a non-safety-net hospital. Having Medicaid was associated with a longer LOS relative to having commercial health insurance. Conclusion Where hip fracture patients are treated is associated with LOS and may influence outcome disparities between groups. Future research should examine whether outcome differences between safety-net and non-safety-net hospitals are associated with resource availability and hospital payer mix.

Immigrant mental health issues, especially depression in relation to discrimination and acculturation, are reported to be serious problems in the United States. The current study examines the prevalence of depressive symptoms among Korean immigrants in New York City (NYC) and its relation to self-reported discrimination and acculturation. A sample of 304 Korean immigrants residing in NYC completed a survey utilizing the Center for Epidemiologic Studies Depression Scale—Korean version, Discrimination Scale, and Acculturation Stress Scale. Results indicated that 13.2% of the sample population demonstrated some symptoms of depression and that variable such as living alone, marital status, education, years in US and income impact high depression scores. Results also indicate that higher self-reported exposure to discrimination and lower self-reported language proficiency were related to higher depressive symptoms. In a regression analysis, discrimination and English language proficiency were significant predictors of depression, but acculturation stress was not significantly related to depression.

Introduction Spinal neurotrauma (sNT), including spinal cord injury (SCI), poses a significant public health challenge with a variety of downstream sequelae. During the COVID-19 pandemic, Elmhurst, Queens in New York City (NYC) was an initial hotspot dubbed the “epicenter of the epicenter” of the crisis, necessitating large-scale adjustments in healthcare resource allocation. This study aimed to analyze the impact of the COVID-19 pandemic on sNT incidence, severity, and outcomes in this geographical area in light of these stressors. Methods sNT admissions to NYC Health + Hospitals/Elmhurst, a Level 1 trauma center, during the first 26 weeks of 2019, 2020, and 2021 were retrospectively analyzed. Data were grouped into three periods: Group 1, the pre-pandemic baseline (1/1/19–6/30/19 and 1/1/20–2/29/20); Group 2, the first COVID-19 wave in NYC (3/1/20–6/30/20); and Group 3, which included the beginning of the second COVID-19 wave in NYC (1/1/21–6/30/21). Univariate analyses were conducted to examine potential associations between variables with clinically significant variables (p < 0.05) included in binary logistic regression analysis. Results Analysis of 232 sNT patients (median age 62 [40, 80] years; mean admissions/week 2.9 ± 1.8) demonstrated no statistically significant differences in age (H = 0.46; p = 0.25), sex (χ 2  = 2.22; p = 0.06), or ethnicity (χ 2  = 17.10; p = 0.16) across groups. Average weekly admission rates for Groups 1–3 were 2.9 ± 1.6, 2.4 ± 1.8, and 3.3 ± 1.9, respectively (p = 0.24). Uninsured patients decreased from 5.7 to 0%, while Medicaid coverage increased from 25.5 to 35.9% (p = 0.003) during the pandemic. Binary logistic regression dichotomized by discharge outcome demonstrated that each additional year of age decreased the odds of a good outcome by approximately 6% (OR = 0.94; 95% CI 0.92, 0.96; p < 0.001). Admission injury severity score (ISS) (OR = 0.91; 95% CI 0.864, 0.962; p < 0.001) and GCS score (OR = 1.20; 95% CI 1.07, 1.34; p < 0.001) were both significantly associated with discharge outcome. While it did not reach statistical significance, there was a trend towards poorer outcomes for those with public health insurance (Medicaid/Medicare) coverage (OR = 0.77; 95% CI 0.59, 1.02; p = 0.07). However, group designation, patient sex, COVID-19 status, and need for neurosurgical intervention were not associated with outcome (p > 0.05). Conclusion Despite the immense strain on healthcare resources in Elmhurst, Queens during the COVID-19 pandemic, neurosurgical intervention and outcomes for sNT patients did not appear to be significantly affected. While discharge outcomes were primarily influenced by injury severity, there was a statistical trend towards poorer outcomes in those with public health insurance.

Quality report cards have become common in many health care markets. This study evaluates their effectiveness by examining the impact of the New York State (NYS) Cardiac Surgery Reports on selection of cardiac surgeons. The analyses compares selection of surgeons in 1991 (pre-report publication) and 1992 (post-report publication). We find that the information about a surgeon's quality published in the reports influences selection directly and diminishes the importance of surgeon experience and price as signals for quality. Furthermore, selection of surgeons for black patients is as sensitive to the published information as is the selection for white patients.

Differences in the source of care could contribute to racial and ethnic disparities in health status. This study looks at a major metropolitan area and examines racial and ethnic differences in the use of high-volume hospitals for 17 services for which there is a documented positive volume-outcome relationship. Focusing on the hospitalizations of New York City area residents in the periods 1995—1996 and 2001—2002, we found, after controlling for socioeconomic characteristics, insurance coverage, proximity of residence to a high-volume hospital, and paths to hospitalization, that minority patients were significantly less likely than whites to be treated at high-volume hospitals for most volume-sensitive services. The largest disparities were between blacks and whites for cancer surgeries and cardiovascular procedures.

Few researchers have studied how lesbians choose health and mental health care providers. Using a series of studies, the Lesbian Health Care Project of Western New York gathered region-specific information concerning lesbians' preferences and decision making. This article reports on community focus groups in which 33 working class, middle class, African American, young, and older lesbians, as well as lesbians who frequent bars, reported that decision making was based on their past experiences and their hopes for high quality care. They encountered a continuum of provider reactions that helped shape their decisions. The continuum and consisted of five categories: homophobia, heterosexism, tolerance, lesbian sensitivity, and lesbian affirmation. Each category is discussed and examples are provided.