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Sheshadri A, Rajaram R, Baugh A, Castro M, Correa AM, Soto F, Daniel CR, Li L, Evans SE, Dickey BF, Vaporciyan AA, Ost DE. Association of Preoperative Lung Function with Complications after Lobectomy Using Race-Neutral and Race-Specific Normative Equations. Ann Am Thorac Soc 2024; 21:38-46. [PMID: 37796618 PMCID: PMC10867917 DOI: 10.1513/annalsats.202305-396oc] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 10/04/2023] [Indexed: 10/07/2023] Open
Abstract
Rationale: Pulmonary function testing (PFT) is performed to aid patient selection before surgical resection for non-small cell lung cancer (NSCLC). The interpretation of PFT data relies on normative equations, which vary by race, but the relative strength of association of lung function using race-specific or race-neutral normative equations with postoperative pulmonary complications is unknown. Objectives: To compare the strength of association of lung function, using race-neutral or race-specific equations, with surgical complications after lobectomy for NSCLC. Methods: We studied 3,311 patients who underwent lobectomy for NSCLC and underwent preoperative PFT from 2001 to 2021. We used Global Lung Function Initiative equations to generate race-specific and race-neutral normative equations to calculate percentage predicted forced expiratory volume in 1 second (FEV1%). The primary outcome of interest was the occurrence of postoperative pulmonary complications within 30 days of surgery. We used unadjusted and race-adjusted logistic regression models and least absolute shrinkage and selection operator analyses adjusted for relevant comorbidities to measure the association of race-specific and race-neutral FEV1% with pulmonary complications. Results: Thirty-one percent of patients who underwent surgery experienced pulmonary complications. Higher FEV1, whether measured with race-neutral (odds ratio [OR], 0.98 per 1% change in FEV1% [95% confidence interval (CI), 0.98-0.99]; P < 0.001) or race-specific (OR, 0.98 per 1% change in FEV1% [95% CI, 0.98-0.98]; P < 0.001) normative equations, was associated with fewer postoperative pulmonary complications. The area under the receiver operator curve for pulmonary complications was similar for race-adjusted race-neutral (0.60) and race-specific (0.60) models. Using least absolute shrinkage and selection operator regression, higher FEV1% was similarly associated with a lower rate of pulmonary complications in race-neutral (OR, 0.99 per 1% [95% CI, 0.98-0.99]) and race-specific (OR, 0.99 per 1%; 95% CI, 0.98-0.99) models. The marginal effect of race on pulmonary complications was attenuated in all race-specific models compared with all race-neutral models. Conclusions: The choice of race-specific or race-neutral normative PFT equations does not meaningfully affect the association of lung function with pulmonary complications after lobectomy for NSCLC, but the use of race-neutral equations unmasks additional effects of self-identified race on pulmonary complications.
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Affiliation(s)
| | | | - Aaron Baugh
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco, California; and
| | - Mario Castro
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Kansas Medical Center, Kansas City, Missouri
| | | | | | | | - Liang Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Plasencia G, Gupta R, Kaalund K, Martinez-Bianchi V, Gonzalez-Guarda R, Thoumi A. Systemic Racism Affecting Latinx Population Health During the COVID-19 Pandemic and Beyond: Perspectives of Latinx Community Health Workers and Community-Based Organization Leaders. Health Equity 2023; 7:715-721. [PMID: 38025654 PMCID: PMC10659010 DOI: 10.1089/heq.2023.0193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction The purpose of this study is to identify forms of systemic racism experienced by Latinx communities in North Carolina during the COVID-19 pandemic as identified by Latinx community health workers (CHWs) and community-based organization (CBO) leaders. Methods We conducted three focus groups in July 2022 (N=16). We performed qualitative analysis of data using an iterative inductive approach of the original language in Dedoose. Results Four central themes emerged: (1) Access to resources for Latinx individuals; (2) Immediate, transitional, and future fears; (3) Benefits of CHWs; and (4) Lessons learned. Discussion Institutional and state policies often do not involve community members, such as CHWs and CBO leaders, at the start of the development process, leading to ineffective interventions that perpetuate health disparities and systemic racism. Health Equity Implications Community-informed policy recommendations can improve alignment of community and policy priorities to create more effective interventions to address systemic racism and promote health equity.
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Affiliation(s)
- Gabriela Plasencia
- Duke Department of Family Medicine & Community Health, Duke University, Durham, North Carolina, USA
- Latinx Advocacy Team & Interdisciplinary Network for COVID-19 (LATIN-19), Durham, North Carolina, USA
- Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina, USA
| | - Rohan Gupta
- Duke University, Durham, North Carolina, USA
| | - Kamaria Kaalund
- Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina, USA
| | - Viviana Martinez-Bianchi
- Duke Department of Family Medicine & Community Health, Duke University, Durham, North Carolina, USA
- Latinx Advocacy Team & Interdisciplinary Network for COVID-19 (LATIN-19), Durham, North Carolina, USA
| | - Rosa Gonzalez-Guarda
- Latinx Advocacy Team & Interdisciplinary Network for COVID-19 (LATIN-19), Durham, North Carolina, USA
- Duke University School of Nursing, Durham, North Carolina, USA
| | - Andrea Thoumi
- Duke Department of Family Medicine & Community Health, Duke University, Durham, North Carolina, USA
- Latinx Advocacy Team & Interdisciplinary Network for COVID-19 (LATIN-19), Durham, North Carolina, USA
- Duke-Margolis Center for Health Policy, Duke University, Washington, District of Columbia, USA
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Erickson T, Daftary K, Quan VL, Chovatiya R. Capturing the Diversity of Dermatology-What's in a Name? Am J Clin Dermatol 2023; 24:675-680. [PMID: 37328613 DOI: 10.1007/s40257-023-00800-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 06/18/2023]
Abstract
As research related to skin of color (SOC) in dermatology continues to grow, it is increasingly important to precisely define terminology. The terms 'SOC', 'race', and 'ethnicity' are frequently used to analyze differences in dermatologic disease onset, severity, and outcomes. These terms are used interchangeably, are ill-defined across research studies, and frequently conflate biologic and socially constructed categories. SOC has been thought to represent differing degrees of pigment or melanin in the skin, however skin pigment is quite variable among races and ethnicities. Furthermore, certain individuals with less skin pigment may socially consider themselves to be SOC, while the inverse is also true. Fitzpatrick skin phototype classifications in SOC dermatology, while commonly used as an objective measure of diversity, also present with numerous limitations and inaccuracies. We seek to highlight strengths and weaknesses of the current terminology used in SOC dermatology and recommend a more holistic understanding of reported differences, including a framework reflective of upstream socioeconomic, environmental, and historical factors that may be most relevant to reported associations.
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Affiliation(s)
- Taylor Erickson
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N St Clair St, Suite 1600, Chicago, IL, 60611, USA
| | - Karishma Daftary
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N St Clair St, Suite 1600, Chicago, IL, 60611, USA
| | - Victor L Quan
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N St Clair St, Suite 1600, Chicago, IL, 60611, USA
| | - Raj Chovatiya
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N St Clair St, Suite 1600, Chicago, IL, 60611, USA.
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Reid MR, Danguecan AN, Colindres I, Witherspoon D, Rubinstein TB, Drenkard C, Knight AM, Cunningham NR. An ecological approach to understanding and addressing health inequities of systemic lupus erythematosus. Lupus 2023; 32:612-624. [PMID: 36922154 DOI: 10.1177/09612033231164637] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Systemic Lupus Erythematosus (SLE) is a complex chronic autoimmune disease disproportionally afflicting women and, in particular, American Indian/Alaska Native, Black, and Hispanic women. These groups of women have significantly worse SLE-related health outcomes which are partially attributable to their exposure to marginalizing and interconnecting social issues like racism, sexism, economic inequality, and more. Although these groups of women have higher rates of SLE and though it is well known that they are at risk of exposure to marginalizing social phenomena, relatively little SLE literature explicitly links and addresses the relationship between marginalizing social issues and poor SLE-health outcomes among these women. Therefore, we developed a community-engaged partnership with two childhood-SLE diagnosed women of color to identify their perspectives on which systemic issues impacted on their SLE health-related outcomes. Afterward, we used Cochrane guidelines to conduct a rapid review associated with these identified issues and original SLE research. Then, we adapted an ecological model to illustrate the connection between systems issues and SLE health outcomes. Finally, we provided recommendations for ways to research and clinically mitigate SLE health inequities.
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Affiliation(s)
- Mallet R Reid
- Department of Family Medicine, College of Human Medicine, 3078Michigan State University, Grand Rapids, MI, USA
| | - Ashley N Danguecan
- Division of Rheumatology, 7979The Hospital for Sick Children, Toronto, ON, Canada
| | | | | | - Tamar B Rubinstein
- Albert Einstein College of Medicine, Children's Hospital at Montefiore, New York, NY, USA
| | | | - Andrea M Knight
- Division of Rheumatology, 7979The Hospital for Sick Children, Toronto, ON, Canada
| | - Natoshia R Cunningham
- Department of Family Medicine, College of Human Medicine, 3078Michigan State University, Grand Rapids, MI, USA
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Unexplored Challenges of Minoritized Microbiologists in Academia. Appl Environ Microbiol 2022; 88:e0151422. [PMID: 36394343 PMCID: PMC9746294 DOI: 10.1128/aem.01514-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The scientific community is making significant efforts to be inclusive and to promote diversity and equity. The microbial sciences are not the exception, and organizations, such as the American Society for Microbiology (ASM), are implementing strategic plans to advance these initiatives. However, one unexplored topic is whether the recruitment of minoritized microbiologists should use tailored programs for the success of trainees and faculty. Some challenges and opportunities are presented for consideration while developing recruitment, retention, and advancement programs in the microbial sciences.
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Solomon SR, Atalay AJ, Osman NY. Diversity Is Not Enough: Advancing a Framework for Antiracism in Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:1513-1517. [PMID: 34292192 DOI: 10.1097/acm.0000000000004251] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Medical students, residents, and faculty have begun to examine and grapple with the legacy and persistence of structural racism in academic medicine in the United States. Until recently, the discourse and solutions have largely focused on augmenting diversity across the medical education continuum through increased numbers of learners from groups underrepresented in medicine (UIM). Despite deliberate measures implemented by medical schools, residency programs, academic institutions, and national organizations, meaningful growth in diversity has not been attained. To the contrary, the UIM representation among medical trainees has declined or remained below the representation in the general population. Inequities continue to be observed in multiple domains of medical education, including grading, admission to honor societies, and extracurricular obligations. These inequities, alongside learners' experiences and calls for action, led the authors to conclude that augmenting diversity is necessary but insufficient to achieve equity in the learning environment. In this article, the authors advance a 4-step framework, built on established principles and practices of antiracism, to dismantle structural racism in medical education. They ground each step of the framework in the concepts and skills familiar to medical educators. By drawing parallels with clinical reasoning, medical error, continuous quality improvement, the growth mindset, and adaptive expertise, the authors show how learners, faculty, and academic leaders can implement the framework's 4 steps-see, name, understand, and act-to shift the paradigm from a goal of diversity to a stance of antiracism in medical education.
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Affiliation(s)
- Sonja R Solomon
- S.R. Solomon is instructor of medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Alev J Atalay
- A.J. Atalay is instructor of medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Nora Y Osman
- N.Y. Osman is assistant professor of medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Roberts LW. Advancing Equity in Academic Medicine. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:771-772. [PMID: 34031293 DOI: 10.1097/acm.0000000000004068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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