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(Click for frequent words.) 71 disparities 68 Inequalities 68 Disparity 64 Inequities 62 ethnic disparities 61 Ethnic Disparities 61 racial disparities 60 Racial Disparities 59 socioeconomic disparities 58 Health Disparities 58 Racial disparities 57 inequalities 57 gender disparities 57 Ethnic Differences 57 socioeconomic inequalities 56 disparity 55 Racial Health Disparities 55 Comorbidities 55 Differences 54 Racial Gap 54 Achievement Gaps 54 Inequality 54 Racial Disparity 54 Underrepresented 53 Ethnic Health Disparities 53 Physician Shortage 53 geographic disparities 53 Healthcare Disparities 52 Biases 52 Racial disparity 52 inequities 51 Surgical Outcomes 51 Nursing Shortage 51 Subgroups 50 Gender Gap 50 Depressive Symptoms 50 glaring inequalities 50 Breast Cancer Mortality 50 Prevent Obesity 50 Gender Differences 50 Racial Differences 50 Screening Mammography 50 Ethnicities 50 Gender Disparities 50 Gaps 50 Doctor Shortage 50 Racial Divide 50 Gender Bias 50 Gender Inequality 50 Diverse Populations 50 Ethnic Diversity 50 Obesity Rates 50 Kidney Donors 49 Gap Persists 49 Growing Epidemic 49 Reduce Disparities 49 Wage Gap 49 Inequity 49 Complexities 49 Underserved Populations 49 Racial Diversity 49 Changing Demographics 49 Genetic Variation 49 Racial Ethnic Disparities 49 Preterm Births 49 Mental Illnesses 49 Laryngeal Cancer 49 Socioeconomic Status 49 Ethnic Approaches 49 Premature Birth 49 Diabetes Epidemic 49 Innovative Approaches 49 Digital Divide 49 Determinants 49 Vary Widely 49 Problems 49 Fibromyalgia Pain 49 Skin Cancers 48 Breast Tumors 48 EHR Adoption 48 inequality 48 racial disparity 48 Preterm Delivery 48 Insulin Sensitivity 48 Unequal Treatment 48 Survival Rates 48 Illicit Drug Use 48 Secondhand Smoke Exposure 48 Vaccination Rates 48 Childhood Asthma 48 Surgical Procedures 48 Chronic Diseases 48 Teacher Shortage 48 Colon Polyps 48 Iron Deficiency 48 Breast Cancers 48 racial disproportionality 48 Issues Surrounding 48 Infant Mortality Rates 48 Minority Populations 48 Alarming Rise 48 HIV Infections 47 Challenges Confronting 47 Genetic Variations 47 Gene Mutations 47 Unintended Pregnancy 47 Nurse Shortage 47 Disparity Between 47 Heterogeneity 47 Disproportionately 47 Health Disparities Research 47 Race Ethnicity 47 Kidney Transplants 47 Income Inequality 47 gender inequalities 47 Culturally Diverse 47 Medication Adherence 47 Substance Use 47 Bloodstream Infections 47 Cholesterol Levels 47 Stereotype Threat 47 Correlates 47 Teen Births 47 Root Causes 47 Rapidly Increasing 47 racial disparities persist 47 Discrepancy 47 Study Sheds Light 47 Masculinities 47 gender disparity 47 Pesticide Exposure 47 Randomized Trials 47 Mortality Rates 47 Gender Imbalance 47 Achievement Gap 47 Prevent Child 47 Inefficiencies 47 Prostate Cancer Survival 46 Worker Shortage 46 Rate Declines 46 Treating Depression 46 Cancer Incidence 46 Malpractice Lawsuits 46 Commonalities 46 Discrepancies 46 Bridging Gaps 46 Dementia Risk 46 Sleep Disturbances 46 Antisocial Behavior 46 Long Term Survival 46 Life Expectancy 46 MRSA Infections 46 Discrimination 46 Poverty 46 Related Illnesses 46 Hospitalization Rates 46 Unequal Treatment Confronting Racial 46 Teen Pregnancies 46 Cultural Competence 46 Blood Clot Risk 46 Antipsychotic Medications 46 Kidney Function 46 NCI Surveillance Epidemiology 46 Issues Affecting 46 Gaps Remain 46 researcher Kathleen Merikangas 46 Genes Linked 46 Needlestick Injuries 46 Breast Carcinoma 46 Deficiencies 46 Varies Widely 46 Dropout Rates 46 Chronically Ill 46 Different Cultures 46 Gene Linked 46 Inhalant Abuse 46 Salt Intake 46 Medication Errors 46 ethnicity socioeconomic status 46 Genes Associated 46 Comorbid 46 stark inequalities 46 Ischemic Heart Disease 46 Infant Mortality 45 Yeast Infections 45 Genetic Variant 45 Reduce Unnecessary 45 Contraceptive Use 45 Marginalisation 45 Asthma Attacks 45 Moderate Drinking 45 Node Negative 45 Stress Levels 45 uninsurance 45 Vulnerable Populations 45 Prognostic Factors 45 Homeownership Opportunities 45 Breast Ovarian Cancer 45 Antidepressants Linked 45 Graduation Rates 45 Genetic Variants 45 AI AN 45 Spending Patterns 45 Premature Deaths 45 Antidepressant Use 45 Disturbing Trend 45 Wildfire Threat 45 Reimbursement Issues 45 Calcium Intake 45 Privacy Breaches 45 Kidney Transplantation 45 Minority Health Disparities 45 Complication Rates 45 Chronic Lyme Disease 45 Alternative Approaches 45 AIDS Epidemic 45 Functional Outcomes 45 Promote Healthy Lifestyles 45 Dropout Rate 45 Educational Attainment 45 Misconceptions About 45 Vitamin D Levels 45 Disconnect Between 45 Highly Educated 45 socioeconomic status 45 Medical Malpractice Claims 45 glaring disparities 45 Exacerbations 45 Sexual Satisfaction 45 Bone Fracture 45 Racial Attitudes 45 Disenrollment 45 Child Mortality 45 Racial Segregation 45 phytoestrogen intake 45 Intimate Partner 45 Inequitable 45 differences 45 Behavior Problems 45 Trend Toward 45 Teacher Evaluations 45 Risk Behavior 45 Patient Populations 45 Gut Bacteria 45 inequity 45 Voter Apathy 45 Resolving Conflicts 45 Methamphetamine Abuse 45 Victimization 45 Negative Consequences 45 Correlation Between 45 Mortality Rate 44 Partisan Divide 44 Cervical Disease 44 Childhood Vaccinations 44 Racial 44 Whooping Cough Outbreak 44 Diagnosis Treatment 44 Dropout Crisis 44 Sleep Problems 44 Medical Malpractice Reform 44 Randomized Controlled Trials 44 Lung Cancer Deaths 44 Increased Scrutiny 44 Ethnic Profiling 44 Hip Fracture Risk 44 Prematurity 44 Egg Freezing 44 racial inequalities 44 Unintended Pregnancies 44 RAND Study Finds 44 Organ Rejection 44 ER Visits 44 Rheumatoid Arthritis Patients 44 Helps Determine 44 Adverse Outcomes 44 Educational Settings 44 Drug Resistant TB 44 Suicidal Ideation 44 Genetic Markers 44 gender inequity 44 Stressors 44 Stigmatization 44 Ovary Removal 44 Post Menopausal 44 Underserved 44 Clot Risk 44 Student Loan Default 44 Child Abuse Deaths 44 Violent Behavior 44 Chronic Cough 44 Suicidal Behavior 44 Gene Variants 44 Imbalances 44 Improving Patient Safety 44 Unique Challenges 44 Sexual Function 44 Gene Mutation 44 Flu Vaccine Shortage 44 Childhood Immunizations 44 Misdiagnosis 44 Stress Fractures 44 Syphilis Cases 44 Chartbook 44 Significant Reduction 44 Child Abuse Cases 44 Maternal Mortality 44 Maternal Deaths 44 Peanut Allergy 44 Oral Anticoagulants 44 Gender Gaps 44 Predict Prostate Cancer 44 Racial Identity 44 Contradictions 44 Abuse Neglect 44 Flu Outbreaks 44 Socioeconomics 44 Heart Bypass Surgery 44 Attitudes Towards 44 Overdose Deaths 44 comorbid conditions 44 Study Compares 44 Vitamin D Deficiency 44 Silent Epidemic 44 Premature Births 44 Trends Affecting 44 Unmet 44 Tradeoffs 44 Issues 44 Risky Behavior 44 Protein Linked 44 Maximizing Efficiency 44 medically underserved communities 44 Genes Influence 44 Remains Steady 44 Adolescent Obesity 43 Tuberculosis Cases 43 Overestimate 43 Dense Breasts 43 Cognitive Functioning 43 Healthy Behaviors 43 Causes Consequences 43 Inflationary Pressures 43 Gendered 43 Cost Effectiveness 43 Risky Behaviors 43 Preterm Labor 43 Mental Distress 43 Rates Decline 43 Antipsychotic Drugs 43 Non Communicable Diseases 43 Improve Quality 43 Anxiety Depression 43 Hardships 43 Staph Infections 43 Budget Shortfalls 43 socioeconomic 43 Inferiority 43 Lymph Nodes 43 Ethnicity 43 Racism 43 Partisan Politics 43 Fracture Risk 43 Asymmetries 43 Prostate Cancer Detection 43 Gene Variation 43 Racial Ethnic 43 Negative Effects 43 Misperceptions 43 Turbulent Economy 43 Improve Patient Safety 43 Unnatural Causes 43 Achieve Meaningful Use 43 Romantic Relationships 43 Recidivism 43 Ageing Population 43 Skin Infections 43 Shortfalls 43 Demographic shifts 43 Genetic Defect 43 obesity sedentary lifestyle 43 Often Misdiagnosed 43 Increasing Importance 43 Demographic Trends 43 Viral Suppression 43 Attitudes Toward 43 Views Differ 43 Stillbirths 43 Substance Dependence 43 Patient Satisfaction 43 Aneuploidy 43 Budget Woes 43 Sociodemographic 43 Treatable 43 Latent tensions 43 Localized Prostate Cancer 43 Aggressive Behavior 43 Sociocultural 43 Male Fertility 43 Workplace Stress 43 Dental caries 43 Cancer Recurrence 43 Nation SWAN 43 Educational attainment 43 Study Uncovers 43 Injustices 43 Standardized Tests 43 Traffic Congestion 43 Dramatic Increase 43 Unmet Need 43 Job Satisfaction 43 Antihypertensive 43 Marginalization 43 Prevalence Estimates 43 Survey Findings 43 Growing Importance 43 Study Reinforces 43 Rare Genetic 43 Eye Infections 43 Abusive Relationships 43 Biological Clocks 43 Diagnoses 43 Underachievement 43 racial inequities 43 Statin Drugs 43 Issues Impacting 43 Benefits Outweigh 43 Cytogenetic 43 Disaffection 43 Shortcomings 43 Organ Donations 43 Osteoporosis Drugs 43 Cohort Consortium 42 Budget Cuts Threaten 42 Malpractice Suits 42 Gender inequality 42 Cognitive Function 42 socioeconomically disadvantaged 42 Vigorous Exercise 42 Health Inequalities 42 Undocumented Students 42 Striking Balance 42 Illiteracy 42 Off Shoring 42 Nutritional Status 42 Imbalance 42 More Susceptible 42 Variability 42 Lag Behind 42 Misplaced Priorities 42 Stem Cell Breakthrough 42 Foreclosure Crisis 42 Early Puberty 42 Critical Shortage 42 Shoulder Pain 42 Stress Hormone 42 Gender inequalities 42 Emphasizes Need 42 Radiation Exposure 42 Early Diagnosis 42 Prostate Cancer Recurrence 42 Improve Patient 42 Blood Pressure Drugs 42 Helps Predict 42 racial inequity 42 Patient Throughput 42 Study Explores 42 Social Behaviour 42 Study Shows Significant 42 Maternal Infant 42 Blood Clotting 42 Bicultural 42 Panel Examines 42 Improve Maternal 42 Obstetric Fistula 42 perinatal outcomes 42 Untapped Potential 42 Spending Priorities 42 Environmental Impacts 42 Political Impasse 42 Clogged Arteries 42 Transplant Patients 42 Ethnic Groups 42 Erase Racism 42 socioeconomic status SES 42 Antibiotic Resistant 42 Trans Fatty Acids 42 Colorblindness 42 comorbid illnesses 42 Strongly Linked 42 Weakening Economy 42 Trade Offs 42 Growing Steadily 42 Study Assesses 42 Indians Alaska Natives 42 Structural Changes 42 Funding Shortfall 42 Respiratory Illness 42 Smoking Bans 42 Study Examines 42 Peanut Allergies 42 Drug Resistant Tuberculosis 42 Generational Divide 42 Challenges 42 Vitamin D Linked 42 Sexual Desire 42 Fragility 42 Removing Barriers 42 Increased Risk 42 educational attainment 42 Enhancing Competitiveness 42 Rate Drops 42 metabolic dysregulation 42 Food Cravings 42 Breast Cancer Screening 42 Jobless Aid 42 Acne Drug 42 Antibiotic Use 42 Pregnancy Complication 42 Certain Cancers 42 Multiethnic 42 Industrialized Countries 42 Per Capita Income 42 Underrepresented minorities 42 Cultural Competency 42 Ethical Dilemmas 42 Moral Imperative 42 Female Genital Cutting 42 Improving Efficiency 42 Genetic Mutation 42 Sustained Growth 42 Rising Faster Than 42 Asthma Medication 42 Unfairness 42 Intervention Trial 42 Cognitive Problems 42 Cost Avoidance 42 Study Identifies 42 Waiting Lists 42 Swine Flu Outbreak 42 Prolongs Life 42 Budget Shortfall 42 Owned Firms 42 Low Wage 42 Challenges Loom 42 Findings Reveal 42 Acculturation 42 Frictions 42 Personality Traits 42 Genetic Testing 42 Play Crucial Role 42 Hepatitis C Virus Infection 42 Median Household 42 Coping Strategies 42 Political Instability 42 Better Outcomes 42 Potentially Fatal 42 nonmetropolitan 42 subgroups 42 socioeconomic statuses 42 Mental Decline 42 Similar schisms 41 Embrace Diversity 41 maldistribution 41 Entitlement Programs 41 Serious Flaws 41 Adversely Affects 41 Outcome Measures 41 seminomas 41 Debunking Myths 41 Pediatric Patients 41 Virginity Pledges 41 Breast Biopsies 41 Childhood Trauma 41 Remain Unclear 41 Weak Economy 41 infant mortality 41 Iodine Deficiency 41 Abstinence Programs 41 Drug Importation 41 Bigger Problem 41 Long Term Homelessness 41 Teen Pregnancy Rates 41 Heroin Addiction 41 Lupus Drug 41 Genetic Mutations 41 Gender Parity 41 Heat Related Illnesses 41 Prevalent 41 Guidelines Issued 41 Graduation Rate 41 Immune Cell 41 Medicare Reimbursement 41 Complicated Grief 41 Genetic Makeup 41 Obesity 41 Cancer Biomarkers 41 Improving Patient 41 Birth Rate 41 Challenges Ahead 41 Liver Toxicity 41 Employer Sponsored 41 Ills 41 Prolong Life 41 Growing Trend 41 Ethnic Fairness 41 Pressing Issues 41 Congruence 41 Rationed 41 Colorectal Cancer Risk 41 Affluence 41 Play Pivotal Role 41 Racial Preferences 41 occupational segregation 41 Bias Suit 41 Issues Relating 41 Prevalence 41 Help Predict 41 Pothole Problem 41 Economic Hardship 41 Confronting Racism 41 Quitting Smoking 41 Budget Cuts Could 41 Debate Intensifies 41 Birth Weight 41 Grad Rates 41 Statistical Methods 41 Drug Overdoses 41 Rate Soars 41 Sleep Habits 41 Minimum Wage Hikes 41 atherothrombotic disease 41 Slowdown Concern 41 Water Scarcity 41 Psychological Effects 41 Privileged Son 41 Differently Than 41 Heart Defects 41 Diagnostic Accuracy 41 Unequal 41 Training Effectiveness 41 Clinically Significant 41 Economically Disadvantaged 41 gaps 41 Impediments 41 Common Pitfalls 41 Gender 41 Asthma Sufferers 41 Their Respective 41 Low Voter Turnout 41 Male Infertility 41 Advocates Applaud 41 Giftedness 41 Conflicts 41 Fruits Veggies 41 Child ren 41 SF #v# 41 Suboptimal 41 Meth Addiction 41 Provides Insights 41 Catheter Related Bloodstream Infections 41 generalized epidemics 41 Eliminate Health Disparities 41 H#N# Flu Cases 41 Survival Rate 41 Mitigate Risks 41 Aortic Aneurysms 41 Workplace Productivity 41 Gender Discrimination 41 Underserved Markets 41 Pain Meds 41 Undiagnosed 41 Skills Shortage 41 menstrual irregularity 41 Drug Coated Stents 41 systemic mastocytosis SM 41 Lung Transplants 41 Study Debunks 41 Mortality 41 Etiology 41 Psychodynamic Psychotherapy 41 Study Analyzes 41 Racial Bias 41 Economic Woes 41 sociodemographic 41 Generational Differences 41 Supply Chain Efficiency 41 Physical Inactivity 41 psychiatric comorbidity 41 Premium Hikes 41 Ethanol Blends 41 Jail Overcrowding 41 Childhood Cancers 41 comorbid disorders 41 Breast Exams 41 Biopharmaceutical Industry 41 Moral Issues 41 Crisis Impacts 41 Mental disorders 41 Prehypertension 41 Minority Serving Institutions 41 Economic Impacts 41 educational attainments 41 Breathing Problems 40 Gets Flak 40 Gender Disparity 40 Cigna 4Q Profit 40 Politicization 40 Cause Mortality 40 Organizational Culture 40 Modifiable 40 noncommunicable diseases 40 Op Ed Contributors 40 Overcome Barriers 40 Reduced Costs 40 socioeconomic inequality 40 Unfulfilled Promise 40 Hears Testimony 40 Can Be Prevented 40 Technological Advances 40 Often Overlooked 40 Parvaz detention 40 Domestic Violence Victims 40 Postpartum Depression 40 Drug Makers 40 Incidence 40 Widening Gap 40 HIV HCV coinfected 40 Ailment 40 Complications 40 Worklessness 40 Highlight Importance 40 Approach Needed 40 Adversely Affect 40 Challenges Faced 40 Mature Workforce 40 Deepening Crisis 40 Fertility Treatments 40 overrepresentation 40 Promote Gender Equality 40 Improved Outcomes 40 Transit Ridership 40 Subprime Loans 40 RPGEH 40 Foreclosure Process 40 Underscore Need 40 S. aureus colonization 40 ethnically diverse populations 40 Blood Clots 40 Credit Card Debts 40 widening chasm 40 Alcohol Related 40 Difficult Situation 40 Alarming Increase 40 Cites Flaws 40 Talent Shortage 40 demographic subgroups 40 Could Save Lives 40 May Have Peaked 40 Collaborative Approach 40 Adult Acne 40 Inclusiveness 40 Workforce Shortage 40 Despite Economic Downturn 40 Prescription Drug Coverage 40 CSHCN 40 Ballot Measures 40 underrepresentation 40 Positively Impact 40 Shows Slight 40 Lipid Levels 40 Marijuana Prohibition 40 FAA Computer Glitch 40 Showed Significant 40 Isotope Shortage 40 Glass Ceiling 40 Adverse Impact 40 Measles Deaths 40 Opportunities Exist 40 Extra Pounds 40 Malnourishment 40 Improving 40 Uncorrected 40 Advocacy Groups 40 visceral metastases 40 Maximizing Your 40 journal Ethnicity 40 Vaccine Shortage 40 Felicia Knaul 40 Consumer Preferences 40 Reduce Operational 40 Dramatic Decline 40 Perpetuates 40 Woes Remain 40 Critical Success Factors 40 Resistant TB 40 Realignments 40 Socioeconomic 40 Secondhand Smoke 40 Emphasizes Importance 40 Psychological Stress 40 Dr. Mark Olfson 40 Drought Conditions 40 Childhood Vaccines 40 vitamin D inadequacy 40 Ear Infections 40 Forced Marriages 40 Arrhythmias 40 Suicide Attempts 40 Francine Grodstein 40 Divergences 40 Critical Perspectives 40 Mumps Outbreak 40 Success Depends 40 Across Disciplines 40 Comorbidity 40 Deferrals 40 Cost Efficiencies 40 socioeconomic deprivation 40 Poses Serious 40 Segregated Schools 40 sociodemographic characteristics 40 Influences 40 Sotomayor Nomination 40 Suggests Ways 40 acute subacute 40 quintiles 40 comorbidities 40 Humanitarian Crisis 40 Biological Basis 40 Still Lags 40 ANCOVA 40 Gender Roles 40 Slower Rate 40 Inflation Pressures 40 adverse perinatal 40 postpartum mental illness 40 Non communicable Diseases 40 Serving Institutions 40 Osteoarthritis Pain 40 FOR AN OPEN 40 Biotech Crops 40 Qualms 40 Debilitating 40 Lags Behind 40 HRQL 40 Med Mal 40 Underlies 40 Recurrences 40 Diverse Workforce 40 Skin Infection 40 Risks 40 Nonprofit Sector 40 Stigmas 40 Geographies 40 Hindrances 40 Spending Restraint 40 medically underserved populations 40 Disease Severity 40 Eliminating Health Disparities 40 Disadvantage 40 Thyroid nodules 40 Challenging Economy 40 Demographics 40 Binge Eating 40 Flu Deaths 40 Improves Quality 40 Childhood Obesity 40 Language Barriers 40 Tax Burdens 40 Genetic Discrimination 40 Brain Learns 40 Barbara Starfield 40 Behaviors 40 Flu Cases 40 Rate Climbs 40 Advanced Proficient 40 Overestimated 40 Schiavo Autopsy 40 Preexisting 40 Ambivalence 40 statistically significant correlations 40 Experts Urge 40 Retention Strategies 40 Avian Flu Vaccine 40 Hospitalizations 40 Abstinence Only 40 racial biases 40 Holistic Approach 40 Religious Belief 40 Challenges Posed 40 Anticancer Activity 40 Teen Pregnancy Rate 40 Racial Wealth 40 Pedestrian Deaths 40 Poverty Inequality 40 Breast Cancer Stem Cells 40 Panel Mulls 40 Comprehensive Approach 40 Panel Advises 40 unequal 40 Equalizing 39 AAPIs 39 Deepening Recession 39 Detecting Breast Cancer 39 Ethnicity Race 39 Prejudices 39 Preventable 39 Ailing Economy 39 Violence 39 Sour Economy 39 histological subtypes 39 Tight Budgets 39 Reprogrammed 39 Aging Populations 39 morbidities 39 Neurological disorders 39 Interest Rate Cuts 39 Differs 39 Hidden Costs 39 Pregnancy Outcomes 39 Drug Resistant Staph 39 Unpaid Bills 39 Cholesterol Drugs 39 English proficiency LEP 39 Managing Stress 39 Rapidly Evolving 39 Being Debated 39 Study Underscores 39 adenomatous polyps 39 Shifts Toward 39 Overcoming Barriers 39 Infertility Treatments 39 Carries Risks 39 Dementia Diagnosis 39 Device Helps 39 Interpersonal Violence 39 micropolitan statistical areas 39 Hormone Imbalance 39 Changing Patterns 39 Inadequacy 39 patient centeredness 39 Faring Better Than 39 Honor Killings 39 Improvements Needed 39 Stereotyping 39 Benefits 39 Budget Impasse 39 Welfare Recipients 39 Staffing Levels 39 Mental Problems 39 Heritability 39 Exacerbate 39 sociodemographic factors 39 Racial Tensions 39 Dyslipidemia 39 Declines 39 Poll Indicates 39 Trajectories 39 NWLC 39 Quantifiable 39 Bill Clears Hurdle 39 Employee Confidence 39 CLINICAL PHARMACOLOGY 39 Folic Acid Fortification 39 Motorcycle Fatalities 39 Deep Venous Thrombosis 39 Pap Smears 39 Menopausal Symptoms 39 Native Hawaiian Pacific Islander 39 Treatment Algorithm 39 receiving antiretroviral therapy 39 maternal morbidity 39 Pre Exposure Prophylaxis 39 Unionization 39 Colorectal Adenomas 39 Aids Epidemic 39 Invasive Procedures 39 Saves Money 39 Impacts 39 gender biases 39 Reduce Deficit 39 Shaky Economy 39 chronic undernourishment 39 Government Shutdown Looms 39 Economists React 39 Cholera Epidemic 39 Sexually Transmitted Infection 39 Growing Problem 39 equals Gillibrand 39 Significant Improvements 39 Childhood Obesity Epidemic 39 #:#-#,# CrossRef Medline [002] 39 Flu Shot Shortage 39 Intersex Fish 39 Accidental Deaths 39 maternal neonatal 39 Downward Trend 39 persistent racial disparities