Browsing by Subject "Disparities"
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Item Open Access A longitudinal study of convergence between Black and White COVID-19 mortality: A county fixed effects approach.(Lancet regional health. Americas, 2021-09) Lawton, Ralph; Zheng, Kevin; Zheng, Daniel; Huang, ErichBackground
Non-Hispanic Black populations have suffered much greater per capita COVID-19 mortality than White populations. Previous work has shown that rates of Black and White mortality have converged over time. Understanding of COVID-19 disparities over time is complicated by geographic changes in prevalence, and some prior research has claimed that regional shifts in COVID-19 prevalence may explain the convergence.Methods
Using county-level COVID-19 mortality data stratified by race, we investigate the trajectory of Black and White per capita mortality from June 2020-January 2021. We use a county fixed-effects model to estimate changes within counties, then extend our models to leverage county-level variation in prevalence to study the effects of prevalence versus time trajectories in mortality disparities.Findings
Over this period, cumulative mortality rose by 61% and 90% for Black and White populations respectively, decreasing the mortality ratio by 0.4 (25.8%). These trends persisted when a county-level fixed-effects model was applied. Results revealed that county-level changes in prevalence nearly fully explain changes in mortality disparities over time.Interpretation
Results suggest mechanisms underpinning convergence in Black/White mortality are not driven by fixed county-level characteristics or changes in the regional dispersion of COVID-19, but instead by changes within counties. Further, declines in the Black/White mortality ratio over time appear primarily linked to county-level changes in COVID-19 prevalence rather than other county-level factors that may vary with time. Research into COVID-19 disparities should focus on mechanisms that operate within-counties and are consistent with a prevalence-disparity relationship.Funding
This work was supported by the National Center for Advancing Translational Sciences [E.H.: UL1TR002553].Item Open Access Item Open Access Call to action: Understanding the differences in the use of SGLT-2 inhibitors and GLP-1 receptor agonists.(American journal of preventive cardiology, 2023-03) Khedagi, Apurva; Hoke, Cara; Kelsey, Michelle; Coviello, Andrea; Jones, W Schuyler; Jackson, Larry R; Patel, Manesh R; McGarrah, Rob W; Pagidipati, Neha J; Shah, Nishant PCardiovascular disease remains one of the most prominent global health problems and has been demonstrated to disproportionally affect certain communities. Despite an increasing collective effort to improve health inequalities, a multitude of disparities continue to affect cardiovascular outcomes. Among the most prominent disparities within cardiovascular disease prevention are with the use and distribution of sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide 1 (GLP-1) receptor agonists. Several landmark trials have demonstrated the efficacy of these novel agents, not only in cardiovascular disease prevention among those with diabetes, but also in heart failure and chronic kidney disease. However, the use of these agents remains limited by disparities in certain racial/ethnic, sex, and socioeconomic groups. This review works to highlight and understand these differences on the use and prescribing patterns of pivotal agents in cardiovascular disease prevention, SGLT-2 inhibitors and GLP-1 agonists. Our aim is to enrich understanding and to inspire efforts to end disparities in cardiovascular morbidity and mortality due to race, sex and income inequality.Item Open Access Changing the landscape of non-small cell lung cancer disparities.(Journal of cancer biology, 2021-01) Odera, Joab O; Abo, Muthana Al; Patierno, Steven R; Clarke, Jeffrey M; Freedman, Jennifer AIn the United States, lung and bronchus cancers are the second most common types of cancer and are responsible for the largest number of deaths from cancer, with African Americans suffering disproportionately from lung and bronchus cancers. This disparity likely results from a complex interplay among social, psycho-social, lifestyle, environmental, health system, and biological determinants of health. Toward improving outcomes for lung cancer patients of all races and ethnicities and mitigating lung cancer disparities, in this commentary, we bring forward biological factors that contribute to lung cancer disparities, efforts to identify, functionally characterize, and modulate novel ancestry-related RNA splicing-related targets in lung cancer for precision intervention, and translational and clinical research needs to improve outcomes for lung cancer patients of all races and ethnicities and mitigate lung cancer disparities.Item Open Access Ethnoracial differences for caregiving burden in Parkinson's disease.(Parkinsonism & related disorders, 2023-11) Bayram, Ece; Liu, Hongliang; Luo, Sheng; Di Luca, Daniel G; Skipworth, Michael; Damron Solomon, Lisa; Dahodwala, Nabila; Litvan, IreneIntroduction
Caregivers play an important role in Parkinson's disease (PD) treatment, especially as the disease progresses. As the symptom profile and needs of people with PD (PwP) differ across ethnoracial groups, whether caregiving needs also differ for different ethnoracial groups should be investigated.Methods
Data were obtained from the Parkinson's Foundation funded Parkinson's Outcomes Project for PwP identifying as Hispanic (n = 495), non-Hispanic Asian (n = 170), non-Hispanic Black (n = 162), or non-Hispanic White (n = 7687). Cross-sectional and longitudinal total Multidimensional Caregiver Strain Index (MCSI) and domain-specific scores for caregiving burden were compared across the ethnoracial groups. Effect of demographics and clinical variables, interaction of these variables with ethnoracial groups for caregiver burden was assessed.Results
Care partners of PwP identifying as non-Hispanic Asian experienced the most burden. PwP identifying as non-Hispanic White were oldest, yet their care partners experienced the least burden. Care partners of PwP identifying as non-Hispanic Asian experienced more burden in physical and social domains, care partners of PwP identifying as Hispanic experienced more burden in financial and elder demanding/manipulative domains. Over time, burden increased similarly across the ethnoracial groups. Effect of frequency of falls, hospital admission, neuropsychiatric disorder and social support on burden over time differed across the groups.Conclusion
PwP from different ethnoracial groups can experience different levels of caregiving burden. Predictors for caregiving burden, such as social support and falls can have different impacts based on ethnicity and race. Caregiver needs should also be assessed and culturally competent support should be provided to benefit all affected by PD.Item Open Access IL-10, IL-15, IL-17, and GMCSF levels in cervical cancer tissue of Tanzanian women infected with HPV16/18 vs. non-HPV16/18 genotypes.(Infect Agent Cancer, 2015) Vidal, Adriana C; Skaar, David; Maguire, Rachel; Dodor, Seyram; Musselwhite, Laura W; Bartlett, John A; Oneko, Olola; Obure, Joseph; Mlay, Pendo; Murphy, Susan K; Hoyo, CathrineBACKGROUND: Despite comparable screening rates for precancerous lesions, higher incidence and mortality related to cervical cancer in minority women persists. Recent evidence suggests that minority women with precancerous cervical lesions harbor a wider range of human papillomavirus (HPV) genotypes, many of these distinct from HPV16/18, those most commonly found in Caucasian women. The goal of the analysis was to determine if inflammatory cytokines and chemokines varied by HPV 16/18 versus other genotypes in cervical cancer tissues from Tanzanian women. METHODS: HPV genotypes and concentrations of chemokines and cytokines were measured from homogenized fresh tumor tissue of thirty-one women with invasive cervical cancer (ICC). Risk factors for cervical cancer including age, parity, hormonal contraceptive use and cigarette smoking were obtained by questionnaire. Generalized linear models were used to evaluate differences between chemokines/cytokine levels in women infected with HPV16/18 and those infected with other HPV genotypes. RESULTS: After adjusting for age, parity and hormonal contraceptives, IL-17 was found significantly more frequently in invasive cervical cancer samples of women infected with HPV16/18 compared to women infected with other HPV genotypes (p = 0.033). In contrast, higher levels for granular macrophage colony-stimulating factor (p = 0.004), IL-10 (p = 0.037), and IL-15 (p = 0.041) were found in ICC tissues of women infected with genotypes other than HPV16/18 when compared to those of women infected with HPV16/18. CONCLUSIONS: While the small sample size limits inference, our data suggest that infection with different HPV genotypes is associated with distinct pro-inflammatory cytokine expression profiles; whether this explains some of the racial differences observed in cervical cancer is still unclear. Future studies are needed to confirm these findings.Item Open Access Psychobiological, Clinical, and Sociocultural Factors that Influence Black Women to Seek, Initiate, and Complete Treatment for Infertility: A Mixed Methods Study(2020) Cebert, MorineBlack women in the U.S. have twice the prevalence of infertility (14%) than non-Hispanic white women (7%) yet are twice as less likely to seek initial evaluation for infertility. Disparities in infertility treatment use among Black women are crucial to address in order to promote health and wellness in this population. Childbearing is a culturally central component of Black families and Black women with infertility experience notable alterations to their self and gender identity, high levels of isolation, silence, and negative medical experiences related to their fertility status. Despite these negative experiences among Black women, the literature fails to highlight reasons for lower uptake of infertility treatment beyond highlighting the sociodemographic characteristics of those who seek, initiate, and complete treatment as mainly affluent, highly educated, and older Non-Hispanic White women. Research on the health seeking process for Black women with infertility is scarce and provide incomplete understanding of their reproductive experiences. Since little is known about what factors influence the processes of seeking, initiating, and completing treatment for infertility for Black women, the purpose of this dissertation was to generate knowledge of the multi-dimensional influences that Black women may experience during the their journey to family building.
The aim of this dissertation study was to understand the psychobiological, clinical, and sociocultural factors that influence Black women’s decisions to seek, initiate, and complete the recommended treatment plan for infertility within three different chapters. Chapter 2 reviewed the state of the science regarding the psychobiological, clinical, and sociocultural factors that influenced women in the U.S to seek treatment for their infertility symptoms and experiences. Chapter 3 analyzed and described psychobiological, clinical, and social data collected from a retrospective cohort chart review that examined 391 Black women who sought a reproductive endocrinology evaluation and determined what factors influenced initiation and completion of the recommended treatment plan for infertility. In, Chapter 4, quantitative data from Chapter 3 was merged with qualitative data from 13 semi-structured interviews in a convergent parallel mixed methods study to provide a comprehensive understanding of what psychobiological, clinical, and sociocultural experiences influenced Black women to seek and initiate treatment for infertility.
Psychobiological, clinical, and sociocultural factors are associated with seeking, initiating, and completing infertility treatment among Black women. Multi-dimensional barriers across these domains influence the entire health seeking process for women causing delays in access, reduced uptake in treatment, and ultimate completion of treatment. Black women would benefit from future research that target modifiable factors by way of intervention development and policy modifications that increase safe, affordable, and culturally sensitive access to reproductive endocrinology services to reduce these disparities affecting Black women with infertility.
Item Open Access Racial-ethnic differences in health-related quality of life among adults and children with glomerular disease.(Glomerular diseases, 2021-08) Krissberg, Jill R; Helmuth, Margaret E; Almaani, Salem; Cai, Yi; Cattran, Daniel; Chatterjee, Debanjana; Gbadegesin, Rasheed A; Gibson, Keisha L; Glenn, Dorey A; Greenbaum, Laurence A; Iragorri, Sandra; Jain, Koyal; Khalid, Myda; Kidd, Jason M; Kopp, Jeffrey B; Lafayette, Richard; Nestor, Jordan G; Parekh, Rulan S; Reidy, Kimberly J; David T Selewski; John Sperati, C; Tuttle, Katherine R; Twombley, Katherine; Vasylyeva, Tetyana L; Weaver, Donald Jack; Wenderfer, Scott E; O'Shaughnessy, Michelle MIntroduction
Disparities in health-related quality of life (HRQOL) have been inadequately studied in patients with glomerular disease. The aim of this study was to identify relationships between race/ethnicity, socioeconomic status, disease severity, and HRQOL in an ethnically and racially diverse cohort of patients with glomerular disease.Methods
Cure Glomerulonephropathy (CureGN) is a multinational cohort study of patients with biopsy-proven glomerular disease. Associations between race/ethnicity and HRQOL were determined by the following: 1. Missed school or work due to kidney disease; 2. Responses to Patient Reported Outcomes Measurement Information System (PROMIS) questionnaires. We adjusted for demographics, socioeconomic status, and disease characteristics using multivariable logistic and linear regression.Results
Black and Hispanic participants had worse socioeconomic status and more severe glomerular disease than White or Asian participants. Black adults missed work or school most frequently due to kidney disease (30% versus 16-23% in the other three groups, p=0.04), and had the worst self-reported global physical health (median score 44.1 versus 48.0-48.2, p<0.001) and fatigue (53.8 versus 48.5-51.1, p=0.002), compared to other racial/ethnic groups. However, these findings were not statistically significant with adjustment for socioeconomic status and disease severity, both of which were strongly associated with HRQOL in adults. Among children, disease severity but not race/ethnicity or socioeconomic status were associated with HRQOL.Conclusions
Among patients with glomerular disease enrolled in CureGN, the worse HRQOL reported by Black adults was attributable to lower socioeconomic status and more severe glomerular disease. No racial/ethnic differences in HRQOL were observed in children.