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Madden EB, Hindorff LA, Bonham VL, Akintobi TH, Burchard EG, Baker KE, Begay RL, Carpten JD, Cox NJ, Di Francesco V, Dillard DA, Fletcher FE, Fullerton SM, Garrison NA, Hammack-Aviran CM, Hiratsuka VY, Hildreth JEK, Horowitz CR, Hughes Halbert CA, Inouye M, Jackson A, Landry LG, Kittles RA, Leek JT, Limdi NA, Lockhart NC, Ofili EO, Pérez-Stable EJ, Sabatello M, Saulsberry L, Schools LE, Troyer JL, Wilfond BS, Wojcik GL, Cho JH, Lee SSJ, Green ED. Advancing genomics to improve health equity. Nat Genet 2024:10.1038/s41588-024-01711-z. [PMID: 38684898 DOI: 10.1038/s41588-024-01711-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 03/08/2024] [Indexed: 05/02/2024]
Abstract
Health equity is the state in which everyone has fair and just opportunities to attain their highest level of health. The field of human genomics has fallen short in increasing health equity, largely because the diversity of the human population has been inadequately reflected among participants of genomics research. This lack of diversity leads to disparities that can have scientific and clinical consequences. Achieving health equity related to genomics will require greater effort in addressing inequities within the field. As part of the commitment of the National Human Genome Research Institute (NHGRI) to advancing health equity, it convened experts in genomics and health equity research to make recommendations and performed a review of current literature to identify the landscape of gaps and opportunities at the interface between human genomics and health equity research. This Perspective describes these findings and examines health equity within the context of human genomics and genomic medicine.
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Affiliation(s)
- Ebony B Madden
- Office of the Director, National Human Genome Research Institute, Bethesda, MD, USA.
| | - Lucia A Hindorff
- Office of the Director, National Human Genome Research Institute, Bethesda, MD, USA
| | - Vence L Bonham
- Office of the Director, National Human Genome Research Institute, Bethesda, MD, USA
| | - Tabia Henry Akintobi
- Department of Community Health and Preventative Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Esteban G Burchard
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA, USA
| | | | - Rene L Begay
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - John D Carpten
- Comprehensive Cancer Center, City of Hope, Duarte, CA, USA
| | - Nancy J Cox
- Vanderbilt Genetics Institute, Vanderbilt University, Nashville, TN, USA
| | | | - Denise A Dillard
- Department of Medical Education and Clinical Sciences, Washington State University College of Medicine, Seattle, WA, USA
| | - Faith E Fletcher
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | | | - Nanibaa' A Garrison
- Institute for Society and Genetics, University of California, Los Angeles, Los Angeles, CA, USA
- Institute for Precision Health, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
- Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | | | - Vanessa Y Hiratsuka
- Center for Human Development, University of Alaska Anchorage, Anchorage, AK, USA
| | | | | | - Chanita A Hughes Halbert
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Michael Inouye
- Department of Public Health and Primary Care, University of Cambridge Victor Phillip Dahdaleh Heart and Lung Research Institute, Cambridge, UK
| | - Amber Jackson
- Office of the Director, National Human Genome Research Institute, Bethesda, MD, USA
| | - Latrice G Landry
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Jeff T Leek
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA, USA
| | - Nita A Limdi
- Department of Neurology, University of Alabama, Birmingham School of Medicine, Birmingham, AL, USA
| | - Nicole C Lockhart
- Office of the Director, National Human Genome Research Institute, Bethesda, MD, USA
| | - Elizabeth O Ofili
- Department of Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | | | - Maya Sabatello
- Center for Precision Medicine and Genomics, Columbia University, New York, NY, USA
- Department of Medical Humanities and Ethics, Columbia University, New York, NY, USA
| | - Loren Saulsberry
- Department of Public Health Sciences, The University of Chicago, Chicago, IL, USA
| | | | - Jennifer L Troyer
- Office of the Director, National Human Genome Research Institute, Bethesda, MD, USA
| | | | - Genevieve L Wojcik
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Judy H Cho
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sandra S-J Lee
- Department of Medical Humanities and Ethics, Columbia University, New York, NY, USA
| | - Eric D Green
- Office of the Director, National Human Genome Research Institute, Bethesda, MD, USA
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Teruel Camargo J, Smith JT, Rodriquez EJ, Pérez-Stable EJ. Advancing Aging Research through a Health Disparities Perspective. J Gerontol A Biol Sci Med Sci 2024:glae082. [PMID: 38502828 DOI: 10.1093/gerona/glae082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Indexed: 03/21/2024] Open
Abstract
The proportion of older adults in the U.S. is growing, and the older adult population is also becoming increasingly diverse. However, there are limited data on the aging process and older adults in underserved populations. Equitable participation in research studies on aging, the research workforce, and the healthcare workforce is critical to improve health outcomes for the entire U.S. population. Health disparities frameworks offer researchers and healthcare professionals the tools to develop and evaluate aging research that addresses all levels of analysis and domains of influence. Although there have been efforts to diversify the healthcare and research workforce, significant disparities in representation remain. In this perspective, we discuss existing aging health disparities, health disparities frameworks to use as tools to better conduct aging research, methods to enhance the proportion of underrepresented populations in aging research, and the current gaps in as well as efforts to enhance the diversity of the healthcare and research workforces.
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Affiliation(s)
- Juliana Teruel Camargo
- Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jessica T Smith
- Division of Intramural Research, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - Erik J Rodriquez
- Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Eliseo J Pérez-Stable
- Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
- Office of the Director, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
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Morgan LB, Rodriquez EJ, Juarez JJ, Pérez-Stable EJ. Black Race Matters in the Latino Population. Am J Public Health 2024; 114:270-275. [PMID: 38382028 PMCID: PMC10882392 DOI: 10.2105/ajph.2023.307452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Affiliation(s)
- LaKendra Beard Morgan
- LaKendra Beard Morgan is a medical student at Howard University College of Medicine, Washington, DC. Erik J. Rodriquez is with the Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD. Jordan J. Juarez is a medical student at Temple University School of Medicine, Philadelphia, PA, and was completing a research year at Division of Intramural Research, National Heart, Lung, and Blood Institute. Eliseo J. Pérez-Stable is with the National Institute on Minority Health and Health Disparities, and the Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health
| | - Erik J Rodriquez
- LaKendra Beard Morgan is a medical student at Howard University College of Medicine, Washington, DC. Erik J. Rodriquez is with the Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD. Jordan J. Juarez is a medical student at Temple University School of Medicine, Philadelphia, PA, and was completing a research year at Division of Intramural Research, National Heart, Lung, and Blood Institute. Eliseo J. Pérez-Stable is with the National Institute on Minority Health and Health Disparities, and the Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health
| | - Jordan J Juarez
- LaKendra Beard Morgan is a medical student at Howard University College of Medicine, Washington, DC. Erik J. Rodriquez is with the Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD. Jordan J. Juarez is a medical student at Temple University School of Medicine, Philadelphia, PA, and was completing a research year at Division of Intramural Research, National Heart, Lung, and Blood Institute. Eliseo J. Pérez-Stable is with the National Institute on Minority Health and Health Disparities, and the Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health
| | - Eliseo J Pérez-Stable
- LaKendra Beard Morgan is a medical student at Howard University College of Medicine, Washington, DC. Erik J. Rodriquez is with the Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD. Jordan J. Juarez is a medical student at Temple University School of Medicine, Philadelphia, PA, and was completing a research year at Division of Intramural Research, National Heart, Lung, and Blood Institute. Eliseo J. Pérez-Stable is with the National Institute on Minority Health and Health Disparities, and the Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health
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Zuckerman G, Kamke K, Sabado-Liwag M, Pérez-Stable EJ, El-Toukhy S. Noncigarette Tobacco Product Use Among Smoking-Susceptible and Nonsusceptible Adolescent Never Smokers, 2009-2021. J Adolesc Health 2024; 74:466-478. [PMID: 38099902 PMCID: PMC10872544 DOI: 10.1016/j.jadohealth.2023.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 08/23/2023] [Accepted: 09/12/2023] [Indexed: 02/05/2024]
Abstract
PURPOSE Examine trends in noncigarette tobacco use among smoking susceptible and nonsusceptible adolescents from 2009-2021. METHODS Data came from cross-sectional samples of the National Youth Tobacco Survey (N = 183,198). Using Pierce's smoking susceptibility scale, participants were classified as either susceptible or nonsusceptible to cigarette smoking. Their use of noncigarette tobacco products was classified into four mutually exclusive categories: nonuse, noncigarette combustibles use, noncombustibles use, and noncigarette combustibles and noncombustibles dual use. We produced covariate-adjusted predicted marginal proportions of noncigarette tobacco use for 12 National Youth Tobacco Survey years, which were entered into Joinpoint trend analysis software to determine (a) trends in noncigarette tobacco use from 2009-2021 using the average annual percent changes (AAPCs) and (b) changes in each time segment using the average percent change. Models were fitted by smoking susceptibility, sex, and race/ethnicity. RESULTS Nonuse was lower among susceptible (vs. nonsusceptible) adolescents whereas noncigarette tobacco use was higher. Trends show significant declines in nonuse (nonsusceptible: AAPC = -0.3%) and noncigarette combustibles use (susceptible: AAPC = -12%) between 2009-2021, increases in noncombustibles use (susceptible: AAPC = 18%, nonsusceptible: AAPC = 19%) between 2009 and 2019, and steadiness in dual use. Parallel trends were observed when stratified by sex and race/ethnicity with notable increases in noncombustibles use among females and Latinos. DISCUSSION Noncigarette tobacco use differed by smoking susceptibility. Observed trends, especially when stratified by sex and race/ethnicity, raise concerns about tobacco use disparities among females and Latinos. Smoking susceptibility can help identify at-risk adolescents for current or future tobacco use.
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Affiliation(s)
- Gabrielle Zuckerman
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Rockville, Maryland
| | - Kristyn Kamke
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Rockville, Maryland
| | - Melanie Sabado-Liwag
- Department of Public Health, California State University-Los Angeles, Los Angeles, California
| | - Eliseo J Pérez-Stable
- Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Sherine El-Toukhy
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Rockville, Maryland.
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Bianchi DW, Brennan PF, Chiang MF, Criswell LA, D'Souza RN, Gibbons GH, Gilman JK, Gordon JA, Green ED, Gregurick S, Hodes RJ, Kilmarx PH, Koob GF, Koroshetz WJ, Langevin HM, Lorsch JR, Marrazzo JM, Pérez-Stable EJ, Rathmell WK, Rodgers GP, Rutter JL, Simoni JM, Tromberg BJ, Tucci DL, Volkow ND, Woychik R, Zenk SN, Kozlowski E, Peterson RS, Ginsburg GS, Denny JC. The All of Us Research Program is an opportunity to enhance the diversity of US biomedical research. Nat Med 2024; 30:330-333. [PMID: 38374344 DOI: 10.1038/s41591-023-02744-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Affiliation(s)
- Diana W Bianchi
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | | | - Michael F Chiang
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lindsey A Criswell
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Rena N D'Souza
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
| | - Gary H Gibbons
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - James K Gilman
- Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Joshua A Gordon
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Eric D Green
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Susan Gregurick
- Office of Data Science Strategy, National Institutes of Health, Bethesda, MD, USA
| | - Richard J Hodes
- National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Peter H Kilmarx
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - George F Koob
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Walter J Koroshetz
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Helene M Langevin
- National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD, USA
| | - Jon R Lorsch
- National Institute of General Medical Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Jeanne M Marrazzo
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Eliseo J Pérez-Stable
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - W Kimryn Rathmell
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Griffin P Rodgers
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Joni L Rutter
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Jane M Simoni
- Offices of the Director and Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD, USA
| | - Bruce J Tromberg
- National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, USA
| | - Debara L Tucci
- National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD, USA
| | - Nora D Volkow
- National Institute of Drug Abuse, National Institutes of Health, Bethesda, MD, USA
| | - Rick Woychik
- National Institute of Environmental Health Sciences, National Institutes of Health, Durham, NC, USA
| | - Shannon N Zenk
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
| | - Elyse Kozlowski
- All of Us Research Program, National Institutes of Health, Bethesda, MD, USA
| | - Rachele S Peterson
- All of Us Research Program, National Institutes of Health, Bethesda, MD, USA
| | - Geoffrey S Ginsburg
- All of Us Research Program, National Institutes of Health, Bethesda, MD, USA
| | - Joshua C Denny
- All of Us Research Program, National Institutes of Health, Bethesda, MD, USA.
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Mendez I, Strassle PD, Rodriquez EJ, Ponce S, Le R, Green A, Martinez E, Pérez-Stable EJ, Nápoles AM. Racial and ethnic disparities in the association between financial hardship and self-reported weight change during the first year of the pandemic in the U.S. Int J Equity Health 2024; 23:12. [PMID: 38254081 PMCID: PMC10804602 DOI: 10.1186/s12939-023-02093-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/30/2023] [Indexed: 01/24/2024] Open
Abstract
Studies have shown that financial hardship can impact weight change; however, it is unclear what the economic impact of the COVID-19 pandemic has had on weight change in U.S. adults, or whether racial-ethnic groups were impacted differentially. We estimated the association between financial hardship and self-reported weight change using data from the cross-sectional COVID-19's Unequal Racial Burden (CURB) survey, a nationally representative online survey of 5,500 American Indian/Alaska Native, Asian, Black/African American, Latino (English- and Spanish-speaking), Native Hawaiian/Pacific Islander, White, and multiracial adults conducted from 12/2020 to 2/2021. Financial hardship was measured over six domains (lost income, debt, unmet general expenses, unmet healthcare expenses, housing insecurity, and food insecurity). The association between each financial hardship domain and self-reported 3-level weight change variable were estimated using multinomial logistic regression, adjusting for sociodemographic and self-reported health. After adjustment, food insecurity was strongly associated with weight loss among American Indian/Alaska Native (aOR = 2.18, 95% CI = 1.05-4.77), Black/African American (aOR = 1.77, 95% CI = 1.02-3.11), and Spanish-speaking Latino adults (aOR = 2.32, 95% CI = 1.01-5.35). Unmet healthcare expenses were also strongly associated with weight loss among Black/African American, English-speaking Latino, Spanish-speaking Latino, and Native Hawaiian/Pacific Islander adults (aORs = 2.00-2.14). Other domains were associated with weight loss and/or weight gain, but associations were not as strong and less consistent across race-ethnicity. In conclusion, food insecurity and unmet healthcare expenses during the pandemic were strongly associated with weight loss among racial-ethnic minority groups. Using multi-dimensional measures of financial hardship provides a comprehensive assessment of the effects of specific financial hardship domains on weight change among diverse racial-ethnic groups.
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Affiliation(s)
- Izabelle Mendez
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland), USA.
| | - Paula D Strassle
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland), USA
| | - Erik J Rodriquez
- Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland), USA
- Office of the Director, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland), USA
| | - Stephanie Ponce
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland), USA
| | - Randy Le
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland), USA
| | - Alexis Green
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland), USA
| | - Emma Martinez
- Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland), USA
| | - Eliseo J Pérez-Stable
- Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland), USA
- Office of the Director, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland), USA
| | - Anna M Nápoles
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland), USA
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Gibbons GH, Pérez-Stable EJ. Harnessing the Power of Community-Engaged Research. Am J Public Health 2024; 114:S7-S11. [PMID: 38207272 PMCID: PMC10785163 DOI: 10.2105/ajph.2023.307528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2023] [Indexed: 01/13/2024]
Affiliation(s)
- Gary H Gibbons
- Eliseo J. Pérez-Stable is the director of the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD. Gary H. Gibbons is the director of the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Eliseo J Pérez-Stable
- Eliseo J. Pérez-Stable is the director of the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD. Gary H. Gibbons is the director of the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
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Juarez JJ, Khalid MU, Ulloa BA, Romero CM, Maruthi R, Shah D, Chang E, Shafi I, Lakhter V, Zhao H, Rodriquez EJ, Pérez-Stable EJ, Bashir R. Racial and ethnic disparities in inferior vena cava filter placement for deep vein thrombosis in the United States. J Vasc Surg Venous Lymphat Disord 2024; 12:101683. [PMID: 37708935 DOI: 10.1016/j.jvsv.2023.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/30/2023] [Accepted: 08/28/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE We sought to determine whether racial and ethnic disparities existed in inferior vena cava (IVC) filter (IVCF) placement rates among Black and Latino patients for the treatment of acute proximal lower extremity (LE) deep vein thrombosis (DVT) in the United States from 2016 to 2019. METHODS We performed a retrospective review of National Inpatient Sample data to identify adult patients with a primary discharge diagnosis of acute proximal LE DVT from January 2016 to December 2019, including self-reported patient race and ethnicity. IVCF placement rates were identified using International Classification of Diseases, 10th revision, codes. Weighted multivariable logistic regression was used to compare IVCF use by race and ethnicity. The regression model was adjusted for patient demographics (ie, sex, primary payer, quartile classification of household income), hospital information (ie, region, location, teaching status, bed size), weekend admission, and clinical characteristics (ie, modified Charlson comorbidity index, hypertension, atrial fibrillation, diabetes mellitus type 2, congestive heart failure, dyslipidemia, coronary artery disease, smoking, obesity, alcohol abuse, chronic kidney disease, pulmonary embolism, malignancy, contraindications to anticoagulation, including other major bleeding). RESULTS Of 134,499 acute proximal LE DVT patients, 18,909 (14.1%) received an IVCF. Of the patients who received an IVCF, 12,733 were White (67.3%), 3563 were Black (18.8%), and 1679 were Latino (8.9%). IVCF placement decreased for all patient groups between 2016 and 2019. After adjusting for the U.S. population distribution, the IVCF placement rates were 11 to 12/100,000 persons for Black patients, 7 to 8/100,000 persons for White patients, and 4 to 5/100,000 persons for Latino patients. The difference in IVCF placement rates was statistically significant between patient groups (Black patients vs White patients, P < .05; Black patients vs Latino patients, P < .05; Latino patients vs White patients, P < .05). CONCLUSIONS This nationwide study showed that Black patients have higher IVCF placement rates compared with White and Latino patients. Given the known long-term complications and uncertain benefits of IVCFs, coupled with the 2010 U.S. Food and Drug Administration safety warning regarding adverse patient events for these devices, proactive measures should be taken to address this disparity among the Black patient population to promote health equity. Future work should assess whether clinician bias might be perpetuating this disparity.
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Affiliation(s)
- Jordan J Juarez
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA; Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Muhammad U Khalid
- Department of Vascular Medicine, Miller Family Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Bianca A Ulloa
- Medical Scientist Training Program, Albert Einstein College of Medicine, Bronx, NY
| | - Carlos M Romero
- Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Rohit Maruthi
- Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Devrat Shah
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Eric Chang
- Division of Cardiovascular Diseases, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Irfan Shafi
- Division of Cardiovascular Medicine, Wayne State University, Detroit Medical Center, Detroit, MI
| | - Vladimir Lakhter
- Division of Cardiovascular Diseases, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Huaqing Zhao
- Center for Biostatistics and Epidemiology, Department of Biomedical Education and Data Science, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Erik J Rodriquez
- Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Eliseo J Pérez-Stable
- Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD; Office of the Director, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
| | - Riyaz Bashir
- Division of Cardiovascular Diseases, Lewis Katz School of Medicine at Temple University, Philadelphia, PA.
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9
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Ives CL, Krzyzanowski MC, Marshall VJ, Norris K, Cockburn M, Bentley-Edwards K, Mohottige D, Pollack Porter KM, Dillard D, Eisenberg Y, Jiménez MC, Pérez-Stable EJ, Jones NL, Dayal J, Maiese DR, Williams D, Hendershot TP, Hamilton CM. The PhenX Toolkit: Recommended Measurement Protocols for Social Determinants of Health Research. Curr Protoc 2024; 4:e977. [PMID: 38441413 DOI: 10.1002/cpz1.977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Health disparities are driven by unequal conditions in the environments in which people are born, live, learn, work, play, worship, and age, commonly termed the Social Determinants of Health (SDoH). The availability of recommended measurement protocols for SDoH will enable investigators to consistently collect data for SDoH constructs. The PhenX (consensus measures for Phenotypes and eXposures) Toolkit is a web-based catalog of recommended measurement protocols for use in research studies with human participants. Using standard protocols from the PhenX Toolkit makes it easier to compare and combine studies, potentially increasing the impact of individual studies, and aids in comparability across literature. In 2018, the National Institute on Minority Health and Health Disparities provided support for an initial expert Working Group to identify and recommend established SDoH protocols for inclusion in the PhenX Toolkit. In 2022, a second expert Working Group was convened to build on the work of the first SDoH Working Group and address gaps in the SDoH Toolkit Collections. The SDoH Collections consist of a Core Collection and Individual and Structural Specialty Collections. This article describes a Basic Protocol for using the PhenX Toolkit to select and implement SDoH measurement protocols for use in research studies. © 2024 The Authors. Current Protocols published by Wiley Periodicals LLC. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA. Basic Protocol: Using the PhenX Toolkit to select and implement SDoH protocols.
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Affiliation(s)
- Cataia L Ives
- RTI International, Research Triangle Park, North Carolina
| | | | - Vanessa J Marshall
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Keith Norris
- Department of Medicine, University of California, Los Angeles, California
| | - Myles Cockburn
- Department of Dermatology and Department of Population & Public Health Sciences, University of Southern California, Los Angeles, California
| | - Keisha Bentley-Edwards
- Division of General Internal Medicine, School of Medicine, Duke University, Durham, North Carolina
| | - Dinushika Mohottige
- Institute of Health Equity Research and Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Keshia M Pollack Porter
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Yochai Eisenberg
- Department of Disability and Human Development, University of Illinois at Chicago, Chicago, Illinois
| | - Monik C Jiménez
- Division of Women's Health, Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
| | - Eliseo J Pérez-Stable
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Nancy L Jones
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Jyoti Dayal
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Deborah R Maiese
- RTI International, Research Triangle Park, North Carolina
- Retired consultant
| | - David Williams
- RTI International, Research Triangle Park, North Carolina
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Pérez-Stable EJ, Webb Hooper M. The Pillars of Health Disparities Science-Race, Ethnicity, and Socioeconomic Status. JAMA Health Forum 2023; 4:e234463. [PMID: 38127587 DOI: 10.1001/jamahealthforum.2023.4463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
This Viewpoint examines the importance of race and ethnicity and socioeconomic status as the pillars of health disparities science.
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Affiliation(s)
- Eliseo J Pérez-Stable
- Office of the Director, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Monica Webb Hooper
- Office of the Director, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
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11
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Abstract
Health equity is the aspirational assurance of optimal health for all. Synonymous with fair and just opportunities for physical and mental health, equity work reflects intentional efforts to remove access barriers and allocate high-quality, need-based resources. Health equity is not possible without meaningful reductions in disparities-and evaluating progress goes further to describe, assess, and continuously evaluate fairness and social justice within structures, community contexts, and healthcare. The National Institute on Minority Health and Health Disparities (NIMHD) has a longstanding and deep commitment to advancing health equity. This article describes efforts in two specific areas: workforce diversity, equity, and inclusion (DEI) and scientific initiatives. We also summarize five actionable strategies for health equity promotion in health psychology-relevant research and practice, including increasing workforce DEI, inclusive research participation, cultural competence and humility, applying community-engaged research principles, and going beyond "do no harm." Meaningful equity work often requires major shifts in approaches, dedicated resources, and targeted efforts toward social justice. The current emphasis on addressing health disparities and understanding the structural factors underlying them presents unequivocal opportunities for changes in clinical practice and research. NIMHD seeks to support innovative health psychology and behavioral medicine research with the potential to transform health via effective and equitable interventions/treatments, systems changes, and policies. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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12
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Krzyzanowski MC, Ives CL, Jones NL, Entwisle B, Fernandez A, Cullen TA, Darity WA, Fossett M, Remington PL, Taualii M, Wilkins CH, Pérez-Stable EJ, Rajapakse N, Breen N, Zhang X, Maiese DR, Hendershot TP, Mandal M, Hwang SY, Huggins W, Gridley L, Riley A, Ramos EM, Hamilton CM. The PhenX Toolkit: Measurement Protocols for Assessment of Social Determinants of Health. Am J Prev Med 2023; 65:534-542. [PMID: 36935055 PMCID: PMC10505248 DOI: 10.1016/j.amepre.2023.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 03/02/2023] [Accepted: 03/02/2023] [Indexed: 03/21/2023]
Abstract
INTRODUCTION Social determinants are structures and conditions in the biological, physical, built, and social environments that affect health, social and physical functioning, health risk, quality of life, and health outcomes. The adoption of recommended, standard measurement protocols for social determinants of health will advance the science of minority health and health disparities research and provide standard social determinants of health protocols for inclusion in all studies with human participants. METHODS A PhenX (consensus measures for Phenotypes and eXposures) Working Group of social determinants of health experts was convened from October 2018 to May 2020 and followed a well-established consensus process to identify and recommend social determinants of health measurement protocols. The PhenX Toolkit contains data collection protocols suitable for inclusion in a wide range of research studies. The recommended social determinants of health protocols were shared with the broader scientific community to invite review and feedback before being added to the Toolkit. RESULTS Nineteen social determinants of health protocols were released in the PhenX Toolkit (https://www.phenxtoolkit.org) in May 2020 to provide measures at the individual and structural levels for built and natural environments, structural racism, economic resources, employment status, occupational health and safety, education, environmental exposures, food environment, health and health care, and sociocultural community context. CONCLUSIONS Promoting the adoption of well-established social determinants of health protocols can enable consistent data collection and facilitate comparing and combining studies, with the potential to increase their scientific impact.
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Affiliation(s)
- Michelle C Krzyzanowski
- GenOmics, Bioinformatics, and Translation Research Center, RTI International, Research Triangle Park, North Carolina
| | - Cataia L Ives
- GenOmics, Bioinformatics, and Translation Research Center, RTI International, Research Triangle Park, North Carolina
| | - Nancy L Jones
- National Institute on Minority Health and Health Disparities, NIH, Bethesda, Maryland.
| | - Barbara Entwisle
- Department of Sociology, College of Arts and Sciences, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alicia Fernandez
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, Carolina
| | | | - William A Darity
- Sanford School of Public Policy, Duke University, Durham, North Carolina
| | - Mark Fossett
- Department of Sociology, College of Arts & Sciences, Texas A&M University, College Station, Texas
| | - Patrick L Remington
- Department of Population Health Sciences, University of Wisconsin-Madison College of Medicine and Public Health, Madison, Wisconsin
| | - Maile Taualii
- Center for Integrated Health Care Research, Hawaii Permanente Medical Group, Honolulu, Hawaii
| | - Consuelo H Wilkins
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Eliseo J Pérez-Stable
- National Institute on Minority Health and Health Disparities, NIH, Bethesda, Maryland
| | - Nishadi Rajapakse
- Center for Translation Research & Implementation Science, National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - Nancy Breen
- National Institute on Minority Health and Health Disparities, NIH, Bethesda, Maryland
| | - Xinzhi Zhang
- Center for Translation Research & Implementation Science, National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - Deborah R Maiese
- Division for Research Services, RTI International, Research Triangle Park, North Carolina
| | - Tabitha P Hendershot
- GenOmics, Bioinformatics, and Translation Research Center, RTI International, Research Triangle Park, North Carolina
| | - Meisha Mandal
- GenOmics, Bioinformatics, and Translation Research Center, RTI International, Research Triangle Park, North Carolina
| | - Stephen Y Hwang
- GenOmics, Bioinformatics, and Translation Research Center, RTI International, Research Triangle Park, North Carolina
| | - Wayne Huggins
- GenOmics, Bioinformatics, and Translation Research Center, RTI International, Research Triangle Park, North Carolina
| | - Lauren Gridley
- GenOmics, Bioinformatics, and Translation Research Center, RTI International, Research Triangle Park, North Carolina
| | - Amanda Riley
- GenOmics, Bioinformatics, and Translation Research Center, RTI International, Research Triangle Park, North Carolina
| | - Erin M Ramos
- National Human Genome Research Institute, NIH, Bethesda, Maryland
| | - Carol M Hamilton
- GenOmics, Bioinformatics, and Translation Research Center, RTI International, Research Triangle Park, North Carolina
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Ding YC, Song H, Adamson AW, Schmolze D, Hu D, Huntsman S, Steele L, Patrick CS, Tao S, Hernandez N, Adams CD, Fejerman L, Gardner K, Nápoles AM, Pérez-Stable EJ, Weitzel JN, Bengtsson H, Huang FW, Neuhausen SL, Ziv E. Profiling the Somatic Mutational Landscape of Breast Tumors from Hispanic/Latina Women Reveals Conserved and Unique Characteristics. Cancer Res 2023; 83:2600-2613. [PMID: 37145128 PMCID: PMC10390863 DOI: 10.1158/0008-5472.can-22-2510] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 02/16/2023] [Accepted: 05/02/2023] [Indexed: 05/06/2023]
Abstract
Somatic mutational profiling is increasingly being used to identify potential targets for breast cancer. However, limited tumor-sequencing data from Hispanic/Latinas (H/L) are available to guide treatment. To address this gap, we performed whole-exome sequencing (WES) and RNA sequencing on 146 tumors and WES of matched germline DNA from 140 H/L women in California. Tumor intrinsic subtype, somatic mutations, copy-number alterations, and expression profiles of the tumors were characterized and compared with data from tumors of non-Hispanic White (White) women in The Cancer Genome Atlas (TCGA). Eight genes were significantly mutated in the H/L tumors including PIK3CA, TP53, GATA3, MAP3K1, CDH1, CBFB, PTEN, and RUNX1; the prevalence of mutations in these genes was similar to that observed in White women in TCGA. Four previously reported Catalogue of Somatic Mutations in Cancer (COSMIC) mutation signatures (1, 2, 3, 13) were found in the H/L dataset, along with signature 16 that has not been previously reported in other breast cancer datasets. Recurrent amplifications were observed in breast cancer drivers including MYC, FGFR1, CCND1, and ERBB2, as well as a recurrent amplification in 17q11.2 associated with high KIAA0100 gene expression that has been implicated in breast cancer aggressiveness. In conclusion, this study identified a higher prevalence of COSMIC signature 16 and a recurrent copy-number amplification affecting expression of KIAA0100 in breast tumors from H/L compared with White women. These results highlight the necessity of studying underrepresented populations. SIGNIFICANCE Comprehensive characterization of genomic and transcriptomic alterations in breast tumors from Hispanic/Latina patients reveals distinct genetic alterations and signatures, demonstrating the importance of inclusive studies to ensure equitable care for patients. See related commentary by Schmit et al., p. 2443.
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Affiliation(s)
- Yuan Chun Ding
- Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, California
| | - Hanbing Song
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Aaron W. Adamson
- Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, California
| | - Daniel Schmolze
- Department of Pathology, City of Hope Medical Center, Duarte, California
| | - Donglei Hu
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Scott Huntsman
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Linda Steele
- Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, California
| | - Carmina S. Patrick
- Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, California
| | - Shu Tao
- Integrative Genomics Shared Resource, Beckman Research Institute of City of Hope, Duarte, California
| | - Natalie Hernandez
- Western University of Health Sciences College of Graduate Nursing, Pomona, California
| | | | - Laura Fejerman
- Department of Public Health Sciences and Comprehensive Cancer Center, University of California Davis, Davis, California
| | - Kevin Gardner
- Department of Pathology and Cell Biology, Columbia University Irvine Medical Center, New York, New York
| | - Anna María Nápoles
- Division of Intramural Research, National Institute on Minority and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | | | | | - Henrik Bengtsson
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California
| | - Franklin W. Huang
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, California
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California
- Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, California
- Institute for Human Genetics, University of California, San Francisco, San Francisco, California
- Chan Zuckerberg Biohub, San Francisco, California
- Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Susan L. Neuhausen
- Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, California
| | - Elad Ziv
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California
- Institute for Human Genetics, University of California, San Francisco, San Francisco, California
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Kendrick P, Kelly YO, Baumann MM, Compton K, Blacker BF, Daoud F, Li Z, Mouhanna F, Nassereldine H, Schmidt C, Sylte DO, Force LM, Hay SI, Rodriquez EJ, Mensah GA, Nápoles AM, Pérez-Stable EJ, Murray CJ, Mokdad AH, Dwyer-Lindgren L. The burden of stomach cancer mortality by county, race, and ethnicity in the USA, 2000-2019: a systematic analysis of health disparities. Lancet Reg Health Am 2023; 24:100547. [PMID: 37600165 PMCID: PMC10435837 DOI: 10.1016/j.lana.2023.100547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/14/2023] [Accepted: 06/16/2023] [Indexed: 08/22/2023]
Abstract
Background There are persistent disparities in stomach cancer mortality among racial-ethnic groups in the USA, but the extent to which these patterns vary geographically is not well understood. This analysis estimated age-standardised mortality for five racial-ethnic groups, in 3110 USA counties over 20 years, to describe spatial-temporal variations in stomach cancer mortality and disparities between racial-ethnic groups. Methods Redistribution methods for insufficient cause of death codes and validated small area estimation methods were applied to death registration data from the US National Vital Statistics System and population data from the US National Center for Health Statistics to estimate annual stomach cancer mortality rates. Estimates were stratified by county and racial-ethnic group (non-Latino and non-Hispanic [NL] American Indian or Alaska Native [AIAN], NL Asian or Pacific Islander [Asian], NL Black [Black], Latino or Hispanic [Latino], and NL White [White]) from 2000 to 2019. Estimates were corrected for misreporting of racial-ethnic group on death certificates using published misclassification ratios. We masked (ie, did not display) estimates for county and racial-ethnic group combinations with a mean annual population of less than 1000; thus, we report estimates for 3079 (of 3110) counties for the total population, and 474, 667, 1488, 1478, and 3051 counties for the AIAN, Asian, Black, Latino, and White populations, respectively. Findings Between 2000 and 2019, national age-standardised stomach cancer mortality was lowest among the White population in every year. Nationally, stomach cancer mortality declined for all racial-ethnic groups across this time period, with the most rapid declines occurring among the Asian (percent decline 48.3% [45.1-51.1]) and Black populations (42.6% [40.2-44.6]). Mortality among the other racial-ethnic groups declined more moderately, decreasing by 36.7% (35.3-38.1), 35.1% (32.2-37.7), and 31.6% (23.9-38.0) among the White, Latino, and AIAN populations, respectively. Similar patterns were observed at the county level, although with wide geographic variation. In 2019, a majority of counties had higher mortality rates among minoritised racial-ethnic populations compared to the White population: 81.1% (377 of 465 counties with unmasked estimates for both racial-ethnic groups) among the AIAN population, 88.2% (1295 of 1469) among the Latino population, 99.4% (663 of 667) among the Asian population, and 99.9% (1484 of 1486) among the Black population. However, the size of these disparities ranged widely across counties, with the largest range from 0.3 to 17.1 among the AIAN population. Interpretation Stomach cancer mortality has decreased substantially across populations and geographies in the USA. However, disparities in stomach cancer mortality among racial-ethnic groups are widespread and have persisted over the last two decades. Local-level data are crucial to understanding the scope of this unequal burden among minoritised groups in the USA. Funding National Institute on Minority Health and Health Disparities; National Heart, Lung, and Blood Institute; National Cancer Institute; National Institute on Aging; National Institute of Arthritis and Musculoskeletal and Skin Diseases; Office of Disease Prevention; and Office of Behavioral and Social Sciences Research, National Institutes of Health (contract #75N94019C00016).
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Gaston SA, Strassle PD, Alhasan DM, Pérez-Stable EJ, Nápoles AM, Jackson CL. Financial hardship, sleep disturbances, and their relationship among men and women in the United States during the COVID-19 pandemic. Sleep Health 2023; 9:551-559. [PMID: 37280141 PMCID: PMC10239652 DOI: 10.1016/j.sleh.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/18/2023] [Accepted: 04/26/2023] [Indexed: 06/08/2023]
Abstract
OBJECTIVE In the United States (US), the health and financial consequences of COVID-19 have disproportionately impacted women and minoritized racial-ethnic groups. Yet, few US studies have investigated financial hardship during the COVID-19 pandemic and sleep health disparities. Our objective was to investigate associations between financial hardship and sleep disturbances during the COVID-19 pandemic by gender and race and ethnicity in the United States. METHODS We used the nationally representative COVID-19's Unequal Racial Burden cross-sectional survey data collected among 5339 men and women from 12/2020 to 2/2021. Participants reported financial hardship (eg, debt, employment/work loss) since the pandemic began and completed the Patient-Reported Outcomes Management Information System Short Form 4a for sleep disturbances. Prevalence ratios (PRs) and 95% confidence intervals were estimated using adjusted, weighted Poisson regression with robust variance. RESULTS Most (71%) participants reported financial hardship. Prevalence of moderate to severe sleep disturbances was 20% overall, higher among women (23%), and highest among American Indian/Alaska Native (29%) and multiracial adults (28%). Associations between financial hardship and moderate to severe sleep disturbances (PR = 1.52 [95% confidence interval: 1.18, 1.94]) did not differ by gender but varied by race and ethnicity: associations were strongest among Black/African American (PR = 3.52 [1.99,6.23]) adults. CONCLUSIONS Both financial hardship and sleep disturbances were prevalent, and their relationships were strongest among certain minoritized racial-ethnic groups, particularly Black/African American adults. Interventions that alleviate financial insecurity may reduce sleep health disparities.
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Affiliation(s)
- Symielle A Gaston
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina, USA
| | - Paula D Strassle
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA
| | - Dana M Alhasan
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina, USA
| | - Eliseo J Pérez-Stable
- Office of the Director, National Institute on Minority Health and Health Disparities and the Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Anna M Nápoles
- Office of the Scientific Director, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA
| | - Chandra L Jackson
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina, USA; Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA.
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16
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Lee ARS, Rodriquez EJ, Gallo LC, Giachello AL, Isasi CR, Perreira KM, Daviglus ML, Kaplan RC, Talavera GA, Pérez-Stable EJ, Oren E. Acculturation level and change in cigarette consumption behaviors among diverse Hispanics/Latinos: the Hispanic Community Health Study/Study of Latinos. Ann Epidemiol 2023; 84:33-40. [PMID: 37164291 PMCID: PMC11027575 DOI: 10.1016/j.annepidem.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 04/24/2023] [Accepted: 05/05/2023] [Indexed: 05/12/2023]
Abstract
PURPOSE To study associations between language acculturation level and changes in cigarette consumption among the diverse and growing U.S.-based Hispanic/Latino population and inform culturally tailored smoking prevention and cessation strategies. METHODS In the Hispanic Community Health Survey/Study of Latinos cohort, we used cigarette consumption behaviors at baseline (2008-2011) and follow-up (2014-2017) and a modified Short Acculturation Scale for Hispanics (SASH) language subscale to measure associations of language acculturation (unidimensional) with changes in cigarette consumption and quitting rates. Weighted multivariable linear and logistic regressions were stratified by daily (n = 1397) and nondaily (n = 633) smoking, and either sex, educational attainment, or migration status. RESULTS Smokers at baseline (n = 2030) on average were aged 42 years old (SE = 0.5) with a mean SASH-language score of 2.3 (SE = 0.1; range = 1-5), indicating more Spanish language use. Among male daily smokers, we observed increases in smoked cigarettes-per-day (CPD) with unit increases in SASH-language score (1.08, 95% CI: 0.24-1.92). Associations with acculturation trended toward greater increases in CPD and lower odds of quitting as educational attainment increased. CONCLUSIONS Language acculturation level is an important determinant for increased smoking behaviors, particularly among men. Our findings are significant in informing smoking reduction programs for the Hispanic/Latino population.
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Affiliation(s)
- Adrienne R S Lee
- School of Public Health, Division of Epidemiology, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182; Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093.
| | - Erik J Rodriquez
- Division of Intramural Research, National Heart, Lung, and Blood Institute, 10 Center Drive, Room 9D58, Bethesda, MD
| | - Linda C Gallo
- Department of Psychology, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182
| | - Aida L Giachello
- Department of Preventive Medicine, Northwestern University, 680 N Lake Shore Dr, Chicago, IL 60611
| | - Carmen R Isasi
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461
| | - Krista M Perreira
- Department of Social Medicine, University of North Carolina at Chapel Hill, 333 S. Columbia Street, Chapel Hill, NC 27599
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, 1819 W. Polk Street, Chicago, IL 60612
| | - Robert C Kaplan
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461; Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109
| | - Gregory A Talavera
- Department of Psychology, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182
| | - Eliseo J Pérez-Stable
- Division of Intramural Research, National Heart, Lung, and Blood Institute, 10 Center Drive, Room 9D58, Bethesda, MD; Office of the Director, National Institute on Minority Health and Health Disparities, National Institutes of Health, 6707 Democracy Boulevard, Bethesda, MD 20892
| | - Eyal Oren
- School of Public Health, Division of Epidemiology, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182
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Lawrence WR, Freedman ND, McGee-Avila JK, Berrington de González A, Chen Y, Emerson MA, Gee GC, Haozous EA, Haque AT, Inoue-Choi M, Jackson SS, Lord B, Nápoles AM, Pérez-Stable EJ, Vo JB, Williams F, Shiels MS. Trends in Mortality From Poisonings, Firearms, and All Other Injuries by Intent in the US, 1999-2020. JAMA Intern Med 2023; 183:849-856. [PMID: 37399025 PMCID: PMC10318548 DOI: 10.1001/jamainternmed.2023.2509] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/30/2023] [Indexed: 07/04/2023]
Abstract
Importance Although deaths due to external causes are a leading cause of mortality in the US, trends over time by intent and demographic characteristics remain poorly understood. Objective To examine national trends in mortality rates due to external causes from 1999 to 2020 by intent (homicide, suicide, unintentional, and undetermined) and demographic characteristics. External causes were defined as poisonings (eg, drug overdose), firearms, and all other injuries, including motor vehicle injuries and falls. Given the repercussions of the COVID-19 pandemic, US death rates for 2019 and 2020 were also compared. Design, Setting, and Participants Serial cross-sectional study using national death certificate data obtained from the National Center for Health Statistics and including all external causes of 3 813 894 deaths among individuals aged 20 years or older from January 1, 1999, to December 31, 2020. Data analysis was conducted from January 20, 2022, to February 5, 2023. Exposures Age, sex, and race and ethnicity. Main Outcomes and Measures Trends in age-standardized mortality rates and average annual percentage change (AAPC) in rates calculated by intent (suicide, homicide, unintentional, and undetermined), age, sex, and race and ethnicity for each external cause. Results Between 1999 and 2020, there were 3 813 894 deaths due to external causes in the US. From 1999 to 2020, poisoning death rates increased annually (AAPC, 7.0%; 95% CI, 5.4%-8.7%). From 2014 to 2020, poisoning death rates increased the most among men (APC, 10.8%; 95% CI, 7.7%-14.0%). During the study period, poisoning death rates increased in all the racial and ethnic groups examined; the most rapid increase was among American Indian and Alaska Native individuals (AAPC, 9.2%; 95% CI, 7.4%-10.9%). During the study period, death rates for unintentional poisoning had the most rapid rate of increase (AAPC, 8.1%; 95% CI, 7.4%-8.9%). From 1999 to 2020, firearm death rates increased (AAPC, 1.1%; 95% CI, 0.7%-1.5%). From 2013 to 2020, firearm mortality increased by an average of 4.7% annually (95% CI, 2.9%-6.5%) among individuals aged 20 to 39 years. From 2014 to 2020, mortality from firearm homicides increased by an average of 6.9% annually (95% CI, 3.5%-10.4%). From 2019 to 2020, mortality rates from external causes accelerated further, largely from increases in unintentional poisoning, and homicide due to firearms and all other injuries. Conclusions and Relevance Results of this cross-sectional study suggest that from 1999 to 2020, death rates due to poisonings, firearms, and all other injuries increased substantially in the US. The rapid increase in deaths due to unintentional poisonings and firearm homicides is a national emergency that requires urgent public health interventions at the local and national levels.
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Affiliation(s)
- Wayne R. Lawrence
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Neal D. Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Jennifer K. McGee-Avila
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Amy Berrington de González
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, United Kingdom
| | - Yingxi Chen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Marc A. Emerson
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill
| | - Gilbert C. Gee
- Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles
| | - Emily A. Haozous
- Pacific Institute for Research and Evaluation, Albuquerque, New Mexico
| | - Anika T. Haque
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Maki Inoue-Choi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Sarah S. Jackson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Brittany Lord
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Anna M. Nápoles
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Eliseo J. Pérez-Stable
- Office of the Director, National Institute on Minority Health and Health Disparities, Bethesda, Maryland
| | - Jacqueline B. Vo
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Faustine Williams
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Meredith S. Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
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Saint-Fort L, Rodriquez EJ, Pérez-Stable EJ, Billieux J. Self-reported health among immigrants in Luxembourg: insights from a nationally representative sample. Z Gesundh Wiss 2023; 31:1059-1069. [PMID: 37581100 PMCID: PMC10424771 DOI: 10.1007/s10389-021-01648-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 08/25/2021] [Indexed: 10/20/2022]
Abstract
Aim Although immigrants account for nearly half of Luxembourg's population, few studies have investigated differences in self-reported health by nationality in Luxembourg. Our study aimed to explore the association between nationality and self-reported health in Luxembourg. Subject and methods Cross-sectional data from the 2015-2016 Panel Socio-Economique Liewen zu Lëtzebuerg (PSELL3) were used. Nationalities included Luxembourger, Portuguese, French, Italian, Belgian and German. Multivariable logistic regression analyses examined the association between nationality and three self-reported health measures: general health status, limitation in activity due to a health problem, and living with a chronic illness or condition. Results Of 8084 participants, 65% were Luxembourgers, 20% were Portuguese, and the remaining 15% were French, Italian, Belgian, or German. Italian nationals were more likely to report fair, poor, or very poor health [aOR = 1.54; 95% CI = 1.07, 2.22] and Portuguese nationals demonstrated both higher odds of fair, poor, or very poor health [aOR = 1.57; 95% CI = 1.28, 1.92] and limitation in activity [aOR = 1.32; 95% CI = 1.07, 1.64] compared to Luxembourgers. However, Portuguese nationals were also less likely to report living with a chronic illness [aOR = 0.79; 95% CI = 0.63, 0.98]. In education-stratified models, primary-educated Portuguese nationals were more likely to report fair, poor, or very poor health [aOR = 1.78, 95% CI = 1.36, 1.92] and limitation in activity [aOR = 1.36, 95% CI = 1.04, 1.79], but not less likely to report living with a chronic illness. Conclusions Nationality and education level should be considered in future studies concerning self-reported health in Luxembourg. Further research is needed to examine disparities in self-reported health among Portuguese and Italian nationals.
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Affiliation(s)
- Launick Saint-Fort
- Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
- Department of Surgery, Division of Trauma and Acute Care Surgery, Penn Medicine Lancaster General Health,, Lancaster, PA, USA
| | - Erik J. Rodriquez
- Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - Eliseo J. Pérez-Stable
- Office of the Director, National Institute on Minority Health and Health Disparities, Bethesda, MD, USA
| | - Joël Billieux
- Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland
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19
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LaVeist TA, Pérez-Stable EJ, Richard P, Anderson A, Isaac LA, Santiago R, Okoh C, Breen N, Farhat T, Assenov A, Gaskin DJ. The Economic Burden of Racial, Ethnic, and Educational Health Inequities in the US. JAMA 2023; 329:1682-1692. [PMID: 37191700 DOI: 10.1001/jama.2023.5965] [Citation(s) in RCA: 41] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Importance Health inequities exist for racial and ethnic minorities and persons with lower educational attainment due to differential exposure to economic, social, structural, and environmental health risks and limited access to health care. Objective To estimate the economic burden of health inequities for racial and ethnic minority populations (American Indian and Alaska Native, Asian, Black, Latino, and Native Hawaiian and Other Pacific Islander) and adults 25 years and older with less than a 4-year college degree in the US. Outcomes include the sum of excess medical care expenditures, lost labor market productivity, and the value of excess premature death (younger than 78 years) by race and ethnicity and the highest level of educational attainment compared with health equity goals. Evidence Review Analysis of 2016-2019 data from the Medical Expenditure Panel Survey (MEPS) and state-level Behavioral Risk Factor Surveillance System (BRFSS) and 2016-2018 mortality data from the National Vital Statistics System and 2018 IPUMS American Community Survey. There were 87 855 survey respondents to MEPS, 1 792 023 survey respondents to the BRFSS, and 8 416 203 death records from the National Vital Statistics System. Findings In 2018, the estimated economic burden of racial and ethnic health inequities was $421 billion (using MEPS) or $451 billion (using BRFSS data) and the estimated burden of education-related health inequities was $940 billion (using MEPS) or $978 billion (using BRFSS). Most of the economic burden was attributable to the poor health of the Black population; however, the burden attributable to American Indian or Alaska Native and Native Hawaiian or Other Pacific Islander populations was disproportionately greater than their share of the population. Most of the education-related economic burden was incurred by adults with a high school diploma or General Educational Development equivalency credential. However, adults with less than a high school diploma accounted for a disproportionate share of the burden. Although they make up only 9% of the population, they bore 26% of the costs. Conclusions and Relevance The economic burden of racial and ethnic and educational health inequities is unacceptably high. Federal, state, and local policy makers should continue to invest resources to develop research, policies, and practices to eliminate health inequities in the US.
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Affiliation(s)
- Thomas A LaVeist
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Eliseo J Pérez-Stable
- Office of the Director, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Patrick Richard
- Health Services Administration, F. Edward Hebert School of Medicine, Preventive Medicine & Biostatistics, Uniformed Services University, Bethesda, Maryland
| | - Andrew Anderson
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | | | - Riley Santiago
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | | | - Nancy Breen
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Tilda Farhat
- Office of Science Policy, Planning, Evaluation, and Reporting, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Assen Assenov
- Office of Science Policy, Planning, Evaluation, and Reporting, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Darrell J Gaskin
- Hopkins Center for Health Disparities Solutions, Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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Abstract
This article is a commentary on the publication titled, Strategic Directions in Prevention Intervention Research to Advance Health Equity, by R. C. Boyd et al.
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Affiliation(s)
- Eliseo J Pérez-Stable
- Office of the Director, National Institute on Minority Health and Health Disparities, National Institutes of Health, 6707 Democracy Boulevard, Suite 800, Bethesda, MD, 20892-5465, USA.
| | - Erik J Rodriquez
- Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
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21
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Haque AT, Berrington de González A, Chen Y, Haozous EA, Inoue-Choi M, Lawrence WR, McGee-Avila JK, Nápoles AM, Pérez-Stable EJ, Taparra K, Vo JB, Freedman ND, Shiels MS. Cancer mortality rates by racial/ethnic groups in the United States, 2018-2020. J Natl Cancer Inst 2023:7131083. [PMID: 37074947 DOI: 10.1093/jnci/djad069] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/02/2023] [Accepted: 04/15/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Starting in 2018, national death certificates included a new racial classification system that accounts for multiple-race decedents and separates Native Hawaiian and Pacific Islander (NHPI) individuals from Asian individuals. We estimated cancer death rates across updated racial/ethnic categories, sex, and age. METHODS Age-standardized U.S. cancer mortality rates and rate ratios from 2018-2020 among ≥20-year-olds were estimated with national death certificate data by race/ethnicity, sex, age, and cancer site. RESULTS In 2018, there were approximately 597,000 cancer deaths, 598,000 in 2019, and 601,000 in 2020. Among men, cancer death rates were highest in Black men (298.2/100,000; n = 105,632), followed by White (250.8; n = 736,319), American Indian/Alaska Native (AI/AN) (249.2; n = 3,376), NHPI (205.6; n = 1,080), Latino (177.2; n = 66,167), and Asian (147.9; n = 26,591) men. Among women, Black women had the highest cancer death rates (206.5/100,000; n = 104,437), followed by NHPI (192.1; n = 1,141), AI/AN (189.9; n = 3,239), White (183.0; n = 646,865), Latina (128.4; n = 61,579), and Asian women (111.4; n = 26,396). The highest death rates by age group occurred among NHPI individuals aged 20-49 years, and Black individuals aged 50-69 and ≥70 years. Asian individuals had the lowest cancer death rates across age groups. Compared to Asian individuals, total cancer death rates were 39% higher in NHPI men and 73% higher in NHPI women. CONCLUSIONS There were striking racial/ethnic disparities in cancer death rates during 2018-2020. Separating NHPI and Asian individuals revealed large differences in cancer mortality between two groups that were previously combined in vital statistics data.
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Affiliation(s)
- Anika T Haque
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | | | - Yingxi Chen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Emily A Haozous
- Southwest Center, Pacific Institute for Research and Evaluation, Albuquerque, New Mexico, United States
| | - Maki Inoue-Choi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Wayne R Lawrence
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Jennifer K McGee-Avila
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Anna M Nápoles
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD, United States
| | - Eliseo J Pérez-Stable
- Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD, United States
| | - Kekoa Taparra
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, CA, United States
| | - Jacqueline B Vo
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Neal D Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Meredith S Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
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22
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Bayly JE, Panigrahi A, Rodriquez EJ, Gallo LC, Perreira KM, Talavera GA, Estrella ML, Daviglus ML, Castaneda SF, Bainter SA, Chambers EC, Savin KL, Loop M, Pérez-Stable EJ. Corrigendum to "Perceived neighborhood factors, health behaviors, and related outcomes in the Hispanic Community Health Study/Study of Latinos" [Preventive Medicine 2022 Nov;164:107267. Epub 2022 Sep 20]. Prev Med 2023; 169:107470. [PMID: 36890068 PMCID: PMC10069008 DOI: 10.1016/j.ypmed.2023.107470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Affiliation(s)
- Jennifer E Bayly
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, United States of America.
| | - Asmi Panigrahi
- Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States of America.
| | - Erik J Rodriquez
- Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States of America.
| | - Linda C Gallo
- Department of Psychology, San Diego State University, CA, United States of America.
| | - Krista M Perreira
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, United States of America.
| | - Gregory A Talavera
- Department of Psychology, San Diego State University, CA, United States of America.
| | - Mayra L Estrella
- Department of Epidemiology, Human Genetics & Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, TX, United States of America.
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, IL, United States of America.
| | - Sheila F Castaneda
- Department of Psychology, San Diego State University, CA, United States of America.
| | - Sierra A Bainter
- Department of Psychology, University of Miami, FL, United States of America.
| | - Earle C Chambers
- Department of Family and Social Medicine, Albert Einstein College of Medicine, NY, United States of America.
| | - Kimberly L Savin
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, United States of America.
| | - Matthew Loop
- Department of Biostatistics, University of North Carolina School of Public Health, Chapel Hill, NC, United States of America.
| | - Eliseo J Pérez-Stable
- Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States of America; Office of the Director, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, United States of America.
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23
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Doose M, Camargo MC, Artiles L, Johnson JA, Das R, Sidhu SK, Solís-Sanabria C, Pérez-Stable EJ, Avilés-Santa ML. Synergizing health research on non-communicable diseases among U.S. Hispanic/Latino and Latin American populations across the Hemisphere. The Lancet Regional Health - Americas 2023; 20:100479. [PMID: 37025463 PMCID: PMC10070124 DOI: 10.1016/j.lana.2023.100479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 03/31/2023]
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24
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Isasi CR, Gallo LC, Cai J, Gellman MD, Xie W, Heiss G, Kaplan RC, Talavera GA, Daviglus ML, Pirzada A, Wassertheil-Smoller S, Llabre MM, Youngblood ME, Schneiderman N, Pérez-Stable EJ, Napoles AM, Perreira KM. Economic and Psychosocial Impact of COVID-19 in the Hispanic Community Health Study/Study of Latinos. Health Equity 2023; 7:206-215. [PMID: 37007686 PMCID: PMC10061327 DOI: 10.1089/heq.2022.0211] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2023] [Indexed: 03/29/2023] Open
Abstract
Objectives To examine the prevalence and correlates of economic hardship and psychosocial distress experienced during the initial phase of the coronavirus disease 2019 (COVID-19) pandemic in a large cohort of Hispanic/Latino adults. Methods The Hispanic Community Health Study/Study of Latinos (HCHS/SOL), an ongoing multicenter study of Hispanic/Latino adults, collected information about COVID-19 illness and psychosocial and economic distress that occurred during the pandemic (N=11,283). We estimated the prevalence of these experiences during the initial phase of the pandemic (May 2020 to May 2021) and examined the prepandemic factors associated with pandemic-related economic hardship and emotional distress using multivariable log linear models with binomial distributions to estimate prevalence ratios. Results Almost half of the households reported job losses and a third reported economic hardship during the first year of the pandemic. Pandemic-related household job losses and economic hardship were more pronounced among noncitizens who are likely to be undocumented. Pandemic-related economic hardship and psychosocial distress varied by age group and sex. Contrary to the economic hardship findings, noncitizens were less likely to report pandemic-related psychosocial distress. Prepandemic social resources were inversely related to psychosocial distress. Conclusions The study findings underscore the economic vulnerability that the pandemic has brought to ethnic minoritized and immigrant populations in the United States, in particular noncitizens. The study also highlights the need to incorporate documentation status as a social determinant of health. Characterizing the initial economic and mental health impact of the pandemic is important for understanding the pandemic consequences on future health. Clinical Trial Registration Number: NCT02060344.
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Affiliation(s)
- Carmen R. Isasi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Linda C. Gallo
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Jianwen Cai
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Marc D. Gellman
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Wenyi Xie
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Gerardo Heiss
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Robert C. Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Gregory A. Talavera
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Martha L. Daviglus
- Institute for Minority Health Research, University of Illinois Chicago, Chicago, Illinois, USA
| | - Amber Pirzada
- Institute for Minority Health Research, University of Illinois Chicago, Chicago, Illinois, USA
| | - Sylvia Wassertheil-Smoller
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Maria M. Llabre
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Marston E. Youngblood
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Neil Schneiderman
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Eliseo J Pérez-Stable
- National Institute on Minority Health and Health Disparities and Division of Intramural Research, National Heart, Lung and Blood Institute, Bethesda, Maryland, USA
| | - Anna M. Napoles
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA
| | - Krista M. Perreira
- Department of Social Medicine, UNC School of Medicine, Chapel Hill, North Carolina, USA
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25
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Steiling K, Kathuria H, Echieh CP, Ost DE, Rivera MP, Begnaud A, Celedón JC, Charlot M, Dietrick F, Duma N, Fong KM, Ford JG, Gould MK, Holguin F, Pérez-Stable EJ, Tanner NT, Thomson CC, Wiener RS, Wisnivesky J. Research Priorities for Interventions to Address Health Disparities in Lung Nodule Management: An Official American Thoracic Society Research Statement. Am J Respir Crit Care Med 2023; 207:e31-e46. [PMID: 36920066 PMCID: PMC10037482 DOI: 10.1164/rccm.202212-2216st] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Background: Lung nodules are common incidental findings, and timely evaluation is critical to ensure diagnosis of localized-stage and potentially curable lung cancers. Rates of guideline-concordant lung nodule evaluation are low, and the risk of delayed evaluation is higher for minoritized groups. Objectives: To summarize the existing evidence, identify knowledge gaps, and prioritize research questions related to interventions to reduce disparities in lung nodule evaluation. Methods: A multidisciplinary committee was convened to review the evidence and identify key knowledge gaps in four domains: 1) research methodology, 2) patient-level interventions, 3) clinician-level interventions, and 4) health system-level interventions. A modified Delphi approach was used to identify research priorities. Results: Key knowledge gaps included 1) a lack of standardized approaches to identify factors associated with lung nodule management disparities, 2) limited data evaluating the role of social determinants of health on disparities in lung nodule management, 3) a lack of certainty regarding the optimal strategy to improve patient-clinician communication and information transmission and/or retention, and 4) a paucity of information on the impact of patient navigators and culturally trained multidisciplinary teams. Conclusions: This statement outlines a research agenda intended to stimulate high-impact studies of interventions to mitigate disparities in lung nodule evaluation. Research questions were prioritized around the following domains: 1) need for methodologic guidelines for conducting research related to disparities in nodule management, 2) evaluating how social determinants of health influence lung nodule evaluation, 3) studying approaches to improve patient-clinician communication, and 4) evaluating the utility of patient navigators and culturally enriched multidisciplinary teams to reduce disparities.
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Juarez JJ, Khalid MU, Ulloa B, Romero CM, Maruthi R, Chang E, Shafi I, Lakhter V, Zhao H, Pérez-Stable EJ, Bashir R. RACIAL AND ETHNIC DISPARITIES IN INFERIOR VENA CAVA FILTER PLACEMENT FOR DEEP VEIN THROMBOSIS IN THE UNITED STATES. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02534-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Abstract
This study assesses racial and ethnic differences in overall burden of firearm-related mortality and in change in firearm-related mortality among youths from 1999 to 2020.
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Affiliation(s)
- Leonardo Mariño-Ramírez
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland
| | - I. King Jordan
- School of Biological Sciences, Georgia Institute of Technology, Atlanta
| | - Anna María Nápoles
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland
| | - Eliseo J. Pérez-Stable
- Office of the Director, National Institute on Minority Health and Health Disparities, Bethesda, Maryland
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Woychik RP, Bianchi DW, Gibbons GH, Glass RI, Gordon JA, Pérez-Stable EJ, Zenk SN. The NIH Climate Change and Health Initiative and Strategic Framework: addressing the threat of climate change to health. Lancet 2022; 400:1831-1833. [PMID: 36343650 PMCID: PMC10105972 DOI: 10.1016/s0140-6736(22)02163-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Richard P Woychik
- National Institute of Environmental Health Sciences, Durham, NC 27709, USA.
| | - Diana W Bianchi
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Gary H Gibbons
- National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | | | | | | | - Shannon N Zenk
- National Institute of Nursing Research, Bethesda, MD, USA
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Pérez-Stable EJ, Hodes RJ, Schwetz TA. An NIH Response to COVID-19 That Engages Communities and Scientists. Am J Public Health 2022; 112:S844. [PMID: 36446062 PMCID: PMC9707713 DOI: 10.2105/ajph.2022.307118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Webb Hooper M, Compton WM, Walsh ER, Hodes RJ, Pérez-Stable EJ. Harnessing the Power of Community-Engaged Science to Facilitate Access and Uptake of COVID-19 Testing: RADx-UP. Am J Public Health 2022; 112:S854-S857. [PMID: 36446064 PMCID: PMC9707707 DOI: 10.2105/ajph.2022.307105] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Monica Webb Hooper
- Monica Webb Hooper and Eliseo J. Pérez-Stable are with the National Institute on Minority Health and Health Disparities, National Institutes of Health (NIH), Bethesda, MD. Wilson M. Compton is with the National Institute on Drug Abuse, NIH. Elizabeth R. Walsh is with the Office of the Director, NIH. Richard J. Hodes is with the National Institute on Aging, NIH
| | - Wilson M Compton
- Monica Webb Hooper and Eliseo J. Pérez-Stable are with the National Institute on Minority Health and Health Disparities, National Institutes of Health (NIH), Bethesda, MD. Wilson M. Compton is with the National Institute on Drug Abuse, NIH. Elizabeth R. Walsh is with the Office of the Director, NIH. Richard J. Hodes is with the National Institute on Aging, NIH
| | - Elizabeth R Walsh
- Monica Webb Hooper and Eliseo J. Pérez-Stable are with the National Institute on Minority Health and Health Disparities, National Institutes of Health (NIH), Bethesda, MD. Wilson M. Compton is with the National Institute on Drug Abuse, NIH. Elizabeth R. Walsh is with the Office of the Director, NIH. Richard J. Hodes is with the National Institute on Aging, NIH
| | - Richard J Hodes
- Monica Webb Hooper and Eliseo J. Pérez-Stable are with the National Institute on Minority Health and Health Disparities, National Institutes of Health (NIH), Bethesda, MD. Wilson M. Compton is with the National Institute on Drug Abuse, NIH. Elizabeth R. Walsh is with the Office of the Director, NIH. Richard J. Hodes is with the National Institute on Aging, NIH
| | - Eliseo J Pérez-Stable
- Monica Webb Hooper and Eliseo J. Pérez-Stable are with the National Institute on Minority Health and Health Disparities, National Institutes of Health (NIH), Bethesda, MD. Wilson M. Compton is with the National Institute on Drug Abuse, NIH. Elizabeth R. Walsh is with the Office of the Director, NIH. Richard J. Hodes is with the National Institute on Aging, NIH
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Bayly JE, Panigrahi A, Rodriquez EJ, Gallo LC, Perreira KM, Talavera GA, Estrella ML, Daviglus ML, Castaneda SF, Bainter SA, Chambers EC, Savin KL, Loop M, Pérez-Stable EJ. Perceived neighborhood factors, health behaviors, and related outcomes in the Hispanic Community Health Study/Study of Latinos. Prev Med 2022; 164:107267. [PMID: 36150447 PMCID: PMC9691577 DOI: 10.1016/j.ypmed.2022.107267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 08/31/2022] [Accepted: 09/17/2022] [Indexed: 11/16/2022]
Abstract
Hispanic/Latino populations may experience significant neighborhood disadvantage, but limited research has explored whether these factors affect their health behaviors. Associations between perceived neighborhood factors at Visit 1 and health behaviors and related outcomes at Visit 2 in the Hispanic Community Health Study/Study of Latinos were evaluated. Multivariable logistic regression assessed cross-sectional and longitudinal relationships between perceived neighborhood social cohesion (NSC, 5 items), and neighborhood problems (NP, 7 items), with cancer screening, current smoking, excessive/binge drinking, hypertension, obesity, physical activity, and poor diet by gender and birthplace. NSC and NP scores were converted into quartiles. Mean age of participants was 42.5 years and 62.1% were women. Perceived NP, but not perceived NSC, differed by gender (p < 0.001). In unstratified models, no significant associations were observed between perceived NSC and any health behavior, whereas greater perceived NP was associated with less adherence to colon cancer screening (moderate level: aOR = 0.68, 95% CI = 0.51, 090) and more physical activity (very high level: aOR = 1.34, 95% CI = 1.06, 1.69) compared to low perceived NP. Women with moderate perceived NP, versus low NP, had a lower odds of colon cancer screening at Visit 1 (aOR = 0.62, 95% CI = 0.43, 0.91) and higher odds of mammogram adherence at Visit 2 (aOR = 2.86, 95% CI = 1.44, 5.68). Men with high perceived NP had a higher odds of excessive or binge drinking at Visit 2 (aOR = 1.99, 95% CI = 1.19, 3.31). We conclude that perceived NP were significantly related to health behaviors among HCHS/SOL individuals. Perceptions of neighborhood environment may be considered modifiable factors of structural neighborhood environment interventions.
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Affiliation(s)
- Jennifer E Bayly
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, United States of America.
| | - Asmi Panigrahi
- Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States of America.
| | - Erik J Rodriquez
- Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States of America.
| | - Linda C Gallo
- Department of Psychology, San Diego State University, CA, United States of America.
| | - Krista M Perreira
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, United States of America.
| | - Gregory A Talavera
- Department of Psychology, San Diego State University, CA, United States of America.
| | - Mayra L Estrella
- Department of Epidemiology, Human Genetics & Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, TX, United States of America.
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, IL, United States of America.
| | - Sheila F Castaneda
- Department of Psychology, San Diego State University, CA, United States of America.
| | - Sierra A Bainter
- Department of Psychology, University of Miami, FL, United States of America.
| | - Earle C Chambers
- Department of Family and Social Medicine, Albert Einstein College of Medicine, NY, United States of America.
| | - Kimberly L Savin
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, United States of America.
| | - Matthew Loop
- Department of Biostatistics, University of North Carolina School of Public Health, Chapel Hill, NC, United States of America.
| | - Eliseo J Pérez-Stable
- Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States of America; Office of the Director, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, United States of America.
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Morgan BL, Stern MC, Pérez-Stable EJ, Hooper MW, Fejerman L. Adding a One Health approach to a research framework for minority health and health disparities. eLife 2022; 11:76461. [PMID: 35796544 PMCID: PMC9262385 DOI: 10.7554/elife.76461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 06/28/2022] [Indexed: 11/24/2022] Open
Abstract
The National Institute on Minority Health and Health Disparities (NIMHD) has developed a framework to guide and orient research into health disparities and minority health. The framework depicts different domains of influence (such as biological and behavioral) and different levels of influence (such as individual and interpersonal). Here, influenced by the “One Health” approach, we propose adding two new levels of influence – interspecies and planetary – to this framework to reflect the interconnected nature of human, animal, and environmental health. Extending the framework in this way will help researchers to create new avenues of inquiry and encourage multidisciplinary collaborations. We then use the One Health approach to discuss how the COVID-19 pandemic has exacerbated health disparities, and show how the expanded framework can be applied to research into health disparities related to antimicrobial resistance and obesity.
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Affiliation(s)
- Brittany L Morgan
- Department of Public Health Sciences, University of California, Davis, Davis, United States.,Center for Animal Disease Modeling and Surveillance (CADMS), Department of Veterinary Medicine, University of California, Davis, Davis, United States
| | - Mariana C Stern
- Departments of Preventive Medicine and Urology, Keck School of Medicine of USC, Los Angeles, United States.,Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, United States
| | - Eliseo J Pérez-Stable
- Office of the Director, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, United States
| | - Monica Webb Hooper
- Office of the Director, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, United States
| | - Laura Fejerman
- Department of Public Health Sciences, University of California, Davis, Davis, United States.,Comprehensive Cancer Center, University of California, Davis, Davis, United States
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Singhal SK, Byun JS, Yan T, Yancey R, Caban A, Gil Hernandez S, Bufford S, Hewitt SM, Winfield J, Pradhan JS, Mustkov V, McDonald JA, Pérez-Stable EJ, Napoles AM, Vohra N, De Siervi A, Yates C, Davis MB, Yang M, Tsai YC, Weissman AM, Gardner K. Protein expression of the gp78 E3-ligase predicts poor breast cancer outcome based on race. JCI Insight 2022; 7:157465. [PMID: 35639484 PMCID: PMC9310521 DOI: 10.1172/jci.insight.157465] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 05/20/2022] [Indexed: 11/17/2022] Open
Abstract
Women of African ancestry suffer higher rates of breast cancer mortality compared to all other groups in the United States. Though the precise reasons for these disparities remain unclear, many recent studies have implicated a role for differences in tumor biology. Using an epitope-validated antibody against the endoplasmic reticulum-associated degradation (ERAD) E3 ubiquitin ligase, gp78, we show that elevated levels of gp78 in patient breast cancer cells predict poor survival. Moreover, high levels of gp78 are associated with poor outcomes in both ER-positive and ER-negative tumors, and breast cancers expressing elevated amounts of gp78 protein are enriched in gene expression pathways that influence cell cycle, metabolism, receptor-mediated signaling, and cell stress response pathways. In multivariate analysis adjusted for subtype and grade, gp78 protein is an independent predictor of poor outcomes in women of African ancestry. Furthermore, gene expression signatures, derived from patients stratified by gp78 protein expression, are strong predictors of recurrence and pathological complete response in retrospective clinical trial data and share many common features with gene sets previously identified to be overrepresented in breast cancers based on race. These findings implicate a prominent role for gp78 in tumor progression and offer new insights into our understanding of racial differences in breast cancer outcomes.
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Affiliation(s)
- Sandeep K Singhal
- Department of Pathology, University of North Dakota, Grand Forks, United States of America
| | - Jung S Byun
- Intramural Research Program, National Institutes of Minority Health and Health Disparities, Bethesda, United States of America
| | - Tingfen Yan
- Intramural Research Program, National Institutes of Minority Health and Health Disparities, Bethesda, United States of America
| | - Ryan Yancey
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, United States of America
| | - Ambar Caban
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, United States of America
| | - Sara Gil Hernandez
- Intramural Research Program, National Institutes of Minority Health and Health Disparities, Bethesda, United States of America
| | - Sediqua Bufford
- Masters of Science Biotechnology, Morehouse School of Medicine, Atlanta, United States of America
| | - Stephen M Hewitt
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, United States of America
| | - Joy Winfield
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, United States of America
| | - Jaya Sarin Pradhan
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, United States of America
| | - Vesco Mustkov
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, United States of America
| | - Jasmine A McDonald
- Department of Epidemiology, Columbia University Medical Center, New York, United States of America
| | - Eliseo J Pérez-Stable
- Intramural Research Program, National Institutes of Minority Health and Health Disparities, Bethesda, United States of America
| | - Anna Maria Napoles
- Intramural Research Program, National Institutes of Minority Health and Health Disparities, Bethesda, United States of America
| | - Nasreen Vohra
- Brody School of Medicine, East Carolina University, Greenville, United States of America
| | - Adriana De Siervi
- Directora del Laboratorio de Oncología Molecular y Nuevos Blancos Terapéut, CONICET, Buenos Aiers, Argentina
| | - Clayton Yates
- Department of Biology and Center for Cancer Research, Tuskegee University, Tuskegee, United States of America
| | - Melissa B Davis
- Department of Surgery (Breast Surgery & Oncology), Weill Cornell Medicine, New York, United States of America
| | - Mei Yang
- Laboratory of Protein Dynamics and Signaling, National Cancer Institute, Frederick, United States of America
| | - Yien Che Tsai
- Laboratory of Protein Dynamics and Signaling, National Cancer Institute, Frederick, United States of America
| | - Allan M Weissman
- Laboratory of Protein Dynamics and Signaling, National Cancer Institute, Frederick, United States of America
| | - Kevin Gardner
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, United States of America
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Abstract
Racial and ethnic disparities in healthcare and health outcomes are longstanding. The real-time emergence of COVID-19 disparities has heightened the public and scientific discourse about structural inequities contributing to the greater risk of morbidity and mortality among racial and ethnic minority populations and other underserved groups. A key aspect of assuring health equity is addressing social determinants that lead to adverse health outcomes among minoritized groups. This article presents an exploratory social determinants of health (SDOH) conceptual framework for understanding racial and ethnic COVID-19 disparities, including factors related to health and healthcare, socioeconomics, and environmental determinants. The model also illustrates the backdrop of structural racism and discrimination, which directly affect health and COVID-19 exposure risk, and thus transmission, infection, and death. We also describe a special SDOH collection in the PhenX Toolkit (consensus measures for Phenotypes and eXposures), which includes established measures to promote standardization of assessment and the use of common data elements in research contexts. The use of common constructs, measures, and data elements are important for data integration, understanding the causes of health disparities, and evaluating interventions to reduce them. Substandard SDOH are among the primary drivers of health disparities-and scientific approaches to address these key concerns require identification and leveled alignment with the root causes. The overarching goal of this discussion is to broaden the consideration of mechanisms by which populations with health disparities face additional SARS-CoV-2 exposure risks, and to encourage research to develop interventions to reduce SDOH-associated disparities in COVID-19 and other conditions and behaviors.
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Affiliation(s)
- Monica Webb Hooper
- Office of the Director, National Institute on Minority Health and Health Disparities (NIMHD), National Institutes of Health (NIH)
| | - Vanessa Marshall
- Office of the Director, National Institute on Minority Health and Health Disparities (NIMHD), National Institutes of Health (NIH)
| | - Eliseo J Pérez-Stable
- Office of the Director, National Institute on Minority Health and Health Disparities (NIMHD), National Institutes of Health (NIH)
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Affiliation(s)
- Eliseo J Pérez-Stable
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Erik J Rodriquez
- Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
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Shiels MS, Haque AT, Haozous EA, Albert PS, Almeida JS, García-Closas M, Nápoles AM, Pérez-Stable EJ, Freedman ND, Berrington de González A. Racial and Ethnic Disparities in Excess Deaths During the COVID-19 Pandemic, March to December 2020. Ann Intern Med 2021; 174:1693-1699. [PMID: 34606321 PMCID: PMC8489677 DOI: 10.7326/m21-2134] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Although racial/ethnic disparities in U.S. COVID-19 death rates are striking, focusing on COVID-19 deaths alone may underestimate the true effect of the pandemic on disparities. Excess death estimates capture deaths both directly and indirectly caused by COVID-19. OBJECTIVE To estimate U.S. excess deaths by racial/ethnic group. DESIGN Surveillance study. SETTING United States. PARTICIPANTS All decedents. MEASUREMENTS Excess deaths and excess deaths per 100 000 persons from March to December 2020 were estimated by race/ethnicity, sex, age group, and cause of death, using provisional death certificate data from the Centers for Disease Control and Prevention (CDC) and U.S. Census Bureau population estimates. RESULTS An estimated 2.88 million deaths occurred between March and December 2020. Compared with the number of expected deaths based on 2019 data, 477 200 excess deaths occurred during this period, with 74% attributed to COVID-19. Age-standardized excess deaths per 100 000 persons among Black, American Indian/Alaska Native (AI/AN), and Latino males and females were more than double those in White and Asian males and females. Non-COVID-19 excess deaths also disproportionately affected Black, AI/AN, and Latino persons. Compared with White males and females, non-COVID-19 excess deaths per 100 000 persons were 2 to 4 times higher in Black, AI/AN, and Latino males and females, including deaths due to diabetes, heart disease, cerebrovascular disease, and Alzheimer disease. Excess deaths in 2020 resulted in substantial widening of racial/ethnic disparities in all-cause mortality from 2019 to 2020. LIMITATIONS Completeness and availability of provisional CDC data; no estimates of precision around results. CONCLUSION There were profound racial/ethnic disparities in excess deaths in the United States in 2020 during the COVID-19 pandemic, resulting in rapid increases in racial/ethnic disparities in all-cause mortality between 2019 and 2020. PRIMARY FUNDING SOURCE National Institutes of Health Intramural Research Program.
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Affiliation(s)
- Meredith S Shiels
- National Cancer Institute, Rockville, Maryland (M.S.S., A.T.H., P.S.A., J.S.A., M.G., N.D.F., A.B.D.)
| | - Anika T Haque
- National Cancer Institute, Rockville, Maryland (M.S.S., A.T.H., P.S.A., J.S.A., M.G., N.D.F., A.B.D.)
| | - Emily A Haozous
- Pacific Institute for Research and Evaluation, Albuquerque, New Mexico (E.A.H.)
| | - Paul S Albert
- National Cancer Institute, Rockville, Maryland (M.S.S., A.T.H., P.S.A., J.S.A., M.G., N.D.F., A.B.D.)
| | - Jonas S Almeida
- National Cancer Institute, Rockville, Maryland (M.S.S., A.T.H., P.S.A., J.S.A., M.G., N.D.F., A.B.D.)
| | - Montserrat García-Closas
- National Cancer Institute, Rockville, Maryland (M.S.S., A.T.H., P.S.A., J.S.A., M.G., N.D.F., A.B.D.)
| | - Anna M Nápoles
- National Institute on Minority Health and Health Disparities, Bethesda, Maryland (A.M.N., E.J.P.)
| | - Eliseo J Pérez-Stable
- National Institute on Minority Health and Health Disparities, Bethesda, Maryland (A.M.N., E.J.P.)
| | - Neal D Freedman
- National Cancer Institute, Rockville, Maryland (M.S.S., A.T.H., P.S.A., J.S.A., M.G., N.D.F., A.B.D.)
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María Nápoles A, Stewart AL, Strassle PD, Quintero S, Bonilla J, Alhomsi A, Santana-Ufret V, Maldonado AI, Pérez-Stable EJ. Racial/ethnic disparities in intent to obtain a COVID-19 vaccine: A nationally representative United States survey. Prev Med Rep 2021; 24:101653. [PMID: 34868830 PMCID: PMC8627375 DOI: 10.1016/j.pmedr.2021.101653] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 10/16/2021] [Accepted: 11/25/2021] [Indexed: 12/17/2022] Open
Abstract
Black, Latino, Pacific Islander, and American Indian/Alaska Native adults are more likely than White adults to experience SARS-CoV-2-related infections, hospitalizations, and mortality. We assessed intent to be vaccinated and concerns among 7 U.S. racial/ethnic groups (1,000 Black/African American, 500 American Indian/Alaska Native, 1,000 Asian, 1,000 Latino (500 English- and 500 Spanish-speaking), 500 Pacific Islander, 500 multiracial, and 1,000 White adults) in a cross-sectional online survey conducted December 2020-February 2021, weighted to be nationally representative within groups. Intent to be vaccinated was ascertained with: "If a COVID-19 vaccine becomes available, how likely are you to get vaccinated?" (not at all/slightly/moderately/very/extremely likely). Respondents identified which concerns would keep them from being vaccinated: cost, not knowing where, safety, effectiveness, side-effects, and other. Multinomial logistic regression models assessed associations of race/ethnicity with odds of being extremely/very/moderately, slightly likely to be vaccinated (ref = not at all), controlling for demographics and health. Overall, 30% were extremely likely, 22% not at all likely, and 48% unsure. Compared to White respondents, American Indian/Alaska Native (Adjusted Odds Ratio (AOR) = 0.66, 95% CI, 0.47-0.92) and Black/African American (AOR = 0.54, 95% CI, 0.41-0.72) respondents were less likely, and Asian (AOR = 2.21, 95% CI, 1.61-3.02) and Spanish-speaking Latino respondents (AOR = 3.74, 95% CI, 2.51-5.55) were more likely to report being extremely likely to be vaccinated. Side-effects (52%) and safety (45%) were overriding concerns. Intent and vaccination rates are changing rapidly; these results constitute a comprehensive baseline for ongoing vaccination efforts among U.S. racial and ethnic groups.
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Affiliation(s)
- Anna María Nápoles
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, 9000 Rockville Pike, Building 3, Floor 5, Room E08, Bethesda, MD 20892, USA
| | - Anita L. Stewart
- University of California San Francisco, Institute for Health & Aging, Center for Aging in Diverse Communities, 490 Illinois Street, 12th floor, Box 0646, San Francisco, CA 94158, USA
| | - Paula D. Strassle
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, 9000 Rockville Pike, Building 3, Floor 5, Room E08, Bethesda, MD 20892, USA
| | - Stephanie Quintero
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, 9000 Rockville Pike, Building 3, Floor 5, Room E08, Bethesda, MD 20892, USA
| | - Jackie Bonilla
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, 9000 Rockville Pike, Building 3, Floor 5, Room E08, Bethesda, MD 20892, USA
| | - Alia Alhomsi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, 9000 Rockville Pike, Building 3, Floor 5, Room E08, Bethesda, MD 20892, USA
| | - Veronica Santana-Ufret
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, 9000 Rockville Pike, Building 3, Floor 5, Room E08, Bethesda, MD 20892, USA
| | - Ana I. Maldonado
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, 9000 Rockville Pike, Building 3, Floor 5, Room E08, Bethesda, MD 20892, USA
| | - Eliseo J. Pérez-Stable
- National Institute on Minority Health and Health Disparities, National Institutes of Health, 6707 Democracy Blvd., Building 2, Room 800, Bethesda, MD 20817, USA
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Rodriquez EJ, Coreas SI, Gallo LC, Isasi CR, Salazar CR, Bandiera FC, Suglia SF, Perreira KM, Hernandez R, Penedo F, Talavera GA, Daviglus ML, Pérez-Stable EJ. Allostatic load, unhealthy behaviors, and depressive symptoms in the Hispanic Community Health Study/Study of Latinos. SSM Popul Health 2021; 16:100917. [PMID: 34660875 PMCID: PMC8502772 DOI: 10.1016/j.ssmph.2021.100917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 09/02/2021] [Accepted: 09/05/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The Environmental Affordances Model (EAM) proposes that the effects of chronic stress on depression are moderated by unhealthy behaviors and race/ethnicity. The unique social structures and contexts of Hispanics/Latinos in the U.S. may influence such relationships. This study evaluated whether unhealthy behaviors weakened the relationship between allostatic load, a measure of chronic stress, and future elevated depressive symptoms among Hispanic Community Health Study/Study of Latinos participants. METHODS Longitudinal data (2008-2011 and 2014-2017) from 11,623 participants were analyzed. The exposure was allostatic load, an index of twelve established biomarkers categorized using clinically relevant cut points, at Visit 1. Elevated depressive symptoms were operationalized as a score of ≥10 (out of 30) on the CES-D 10 at Visit 2. An index of unhealthy behaviors, with one point each for cigarette smoking, excessive/binge drinking, sedentary behavior, and poor diet quality at Visit 1, was examined as an effect modifier. Multivariable logistic regression, in the overall sample and among Mexicans specifically and adjusted for demographic characteristics and elevated depressive symptoms at Visit 1, was used to model allostatic load, unhealthy behavior index (range: 0-4), and their interaction in relation to elevated depressive symptoms at Visit 2. RESULTS Overall, greater allostatic load was associated with higher odds of elevated depressive symptoms after at least 6 years (aOR = 1.06, 95% CI = 1.01, 1.10). Overall, individuals with greater allostatic load and an unhealthy behavior index = 1, compared to those with an unhealthy behavior index = 0, had lower odds of elevated depressive symptoms at follow-up (aβ = -0.065, 95% CI = -0.12, -0.007). CONCLUSIONS The relationship between chronic stress and depression was partially moderated among Hispanics/Latinos who engaged in unhealthy behavior, which may have reduced their risk of elevated depressive symptoms given more chronic stress.
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Affiliation(s)
- Erik J. Rodriquez
- Division of Intramural Research; National Heart, Lung, And Blood Institute; 3 Center Drive, Bethesda, MD, 20892-0311, USA
| | - Saida I. Coreas
- Division of Intramural Research; National Heart, Lung, And Blood Institute; 3 Center Drive, Bethesda, MD, 20892-0311, USA
| | - Linda C. Gallo
- Department of Psychology, San Diego State University, 780 Bay Boulevard Suite 200, Chula Vista, CA, 91910, USA
| | - Carmen R. Isasi
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Christian R. Salazar
- UC Irvine Institute for Memory Impairment and Neurological Disorders, University of California, Irvine, 3227 Biological Sciences III, Irvine, CA, 92697, USA
| | - Frank C. Bandiera
- Division of Behavioral and Social Research, National Institute on Aging, 31 Center Drive, Bethesda, MD, 20892-2292, USA
| | - Shakira F. Suglia
- Rollins School of Public Health, Emory University, 201 Dowman Drive, Atlanta, GA, 30322, USA
| | - Krista M. Perreira
- School of Medicine, University of North Carolina, 333 South Columbia Street, Chapel Hill, NC, 27599-7240, USA
| | - Rosalba Hernandez
- School of Social Work, University of Illinois at Urbana-Champaign, 1010 West Nevada Street, Urbana, IL, 61801, USA
| | - Frank Penedo
- Department of Psychology, University of Miami, Flipse Building, 5th Floor, 5665 Ponce de Leon Blvd, Coral Gables, Florida, 33146, USA
| | - Gregory A. Talavera
- Division of Health Promotion and Behavioral Science, Graduate School of Public Health, San Diego State University, 9245 Sky Park Court, Suite 100 / HH 138, San Diego, CA, 92123-4311, USA
| | - Martha L. Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, 1819 West Polk Street Suite 246, Chicago, IL, 60612, USA
| | - Eliseo J. Pérez-Stable
- Division of Intramural Research; National Heart, Lung, And Blood Institute; 3 Center Drive, Bethesda, MD, 20892-0311, USA,Corresponding author. Division of Intramural Research; National Heart, Lung, And Blood Institute; 3 Center Drive, Bethesda, MD, 20892-0311, USA.
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40
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Webb Hooper M, Nápoles AM, Pérez-Stable EJ. No Populations Left Behind: Vaccine Hesitancy and Equitable Diffusion of Effective COVID-19 Vaccines. J Gen Intern Med 2021; 36:2130-2133. [PMID: 33754319 PMCID: PMC7985226 DOI: 10.1007/s11606-021-06698-5] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/03/2021] [Indexed: 11/03/2022]
Abstract
Racial/ethnic minority communities are experiencing an undue burden from coronavirus disease 2019 (COVID-19), and the availability of Food and Drug Administration (FDA) authorized vaccines is critical for improving population health. National surveys assessing vaccination willingness and reports of vaccination administration by race/ethnicity indicate at least two areas that warrant attention: elevated vaccine hesitancy among African American and Latino adults, and the need to ensure equitable access to vaccination. COVID-19 vaccine hesitancy is not uniform within racial/ethnic minority populations; yet, given the disproportionate impact, understandable distrust, and widespread misinformation, there is an imperative to overcome challenges associated with vaccination willingness and uptake, as well as implementation and access. This Perspective discusses the complexity of drivers for each of these areas, which include individual, community, and structural factors. It also highlights two initiatives at the National Institutes of Health. One is focused on addressing misinformation and distrust through academic-community partnerships, and the other on community-engaged behavioral interventions to address the population-specific reasons for COVID-19 vaccine hesitancy, support informed decision-making, and promote equitable access among populations with health disparities. For the foreseeable future, proactive and persistent efforts around COVID-19 mitigation strategies, including vaccination, will remain of paramount importance for health equity.
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Affiliation(s)
- Monica Webb Hooper
- Office of the Director, National Institute on Minority Health and Health Disparities (NIMHD), National Institutes of Health (NIH), Bethesda, MD, USA.
| | - Anna María Nápoles
- Office of the Scientific Director, National Institute on Minority Health and Health Disparities (NIMHD), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Eliseo J Pérez-Stable
- Office of the Director, National Institute on Minority Health and Health Disparities (NIMHD), National Institutes of Health (NIH), Bethesda, MD, USA
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41
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Coreas SI, Rodriquez EJ, Rahman SG, El-Toukhy S, Compton WM, Blanco C, Kimmel HL, Pérez-Stable EJ. Smoking Susceptibility and Tobacco Media Engagement Among Youth Never Smokers. Pediatrics 2021; 147:peds.2020-017921. [PMID: 33941582 PMCID: PMC8331193 DOI: 10.1542/peds.2020-017921] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/05/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Susceptibility to future smoking among youth never smokers has not changed in the past 20 years, although experimental cigarette smoking has decreased. We assessed how smoking susceptibility and tobacco industry-related marketing influenced smoking initiation. METHODS Four waves (2013-2018) of the Population Assessment of Tobacco and Health Study data were analyzed among youth aged 12 to 17 years at wave 1 who completed wave 4. Susceptibility was assessed by 4 items (openness to curiosity, try soon, try in the next year, and if your best friend offered) and categorized into 4 levels (0 = definitely no to all; 1 = yes to 1; 2 = yes to 2; and 3 + 4 = yes to 3 or 4 susceptibility items). Multivariable logistic regression evaluated how susceptibility levels, electronic cigarette use, and tobacco-related media activity predicted future experimental (≥1 puff), current (past 30 days), or established (≥100 cigarettes) smoking. RESULTS Among 8899 never smokers at wave 1, 16.4% became experimental smokers, 7.6% current smokers, and 1.8% established smokers at wave 4. Black and Latino/a youth were less likely to experiment. Youth who endorsed 3 or 4 susceptibility items at wave 1 were more likely to be experimental (adjusted odds ratio [aOR] = 6.0; confidence interval [CI] = 4.8-7.4), current (aOR = 4.2; CI = 3.2-5.4), or established (aOR = 4.4; CI = 2.4-7.9) smokers at wave 4. Exposure to tobacco marketing, using tobacco-related apps, seeing social media content posted about tobacco, and ever use of electronic cigarettes also predicted experimental smoking. CONCLUSIONS Smoking susceptibility and exposure to tobacco industry-related marketing were predictive of cigarette smoking. Clinicians should consider screening adolescents for smoking susceptibility and tobacco-related media exposure.
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Affiliation(s)
- Saida I. Coreas
- Division of Intramural Research, National Heart,
Lung, and Blood Institute
| | - Erik J. Rodriquez
- Division of Intramural Research, National Heart,
Lung, and Blood Institute
| | - Sana G. Rahman
- Division of Intramural Research, National Institute
on Minority Health and Health Disparities, and
| | - Sherine El-Toukhy
- Division of Intramural Research, National Institute
on Minority Health and Health Disparities, and
| | - Wilson M. Compton
- National Institute on Drug Abuse, National Institutes
of Health, Bethesda, Maryland
| | - Carlos Blanco
- National Institute on Drug Abuse, National Institutes
of Health, Bethesda, Maryland
| | - Heather L Kimmel
- National Institute on Drug Abuse, National Institutes
of Health, Bethesda, Maryland
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42
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Wheeler SE, Peck Palmer OM, Greene DN, Park JY, Winston-McPherson G, Amukele TK, Pérez-Stable EJ. Examining Laboratory Medicine's Role in Eliminating Health Disparities. Clin Chem 2021; 66:1266-1271. [PMID: 32888006 DOI: 10.1093/clinchem/hvaa174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/29/2020] [Indexed: 11/13/2022]
Affiliation(s)
- Sarah E Wheeler
- Assistant Professor of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA.,Medical Director of UPMC Mercy and UPMC Children's Hospital Automated Testing Laboratories, Associate Director of UPMC Presbyterian Clinical Immunopathology Laboratory, Pittsburgh, PA
| | - Octavia M Peck Palmer
- Associate Professor of Pathology, Critical Care Medicine and Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, PA.,Medical Director, UPMC Presbyterian and Shadyside Automated Testing Laboratories, Pittsburgh, PA
| | - Dina N Greene
- Technical Director, Kaiser Permanente Washington Laboratories, Portland, OR.,Clinical Associate Professor University of Washington, Department of Laboratory Medicine, Seattle, WA
| | - Jason Y Park
- Associate Professor of Pathology and the Eugene McDermott Center for Human Growth and Development, UT Southwestern Medical School, Dallas, TX
| | | | - Timothy K Amukele
- Associate Professor of Pathology Johns Hopkins School of Medicine, Chief of Pathology Clinical Laboratories, Johns Hopkins Bayview Medical Center, Baltimore, MD
| | - Eliseo J Pérez-Stable
- Director of the National Institute on Minority Health and Health Disparities (NIMHD), National Institutes of Health, Bethesda, MD
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Abstract
Ethn Dis. 2021;31(Suppl 1):289-292;doi:10.18865/ed.31.S1.289
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Affiliation(s)
- Eliseo J. Pérez-Stable
- Office of the Director, National Institute on Minority Health and Health Disparities (NIMHD), National Institutes of Health (NIH)
| | - Monica Webb Hooper
- Office of the Director, National Institute on Minority Health and Health Disparities (NIMHD), National Institutes of Health (NIH)
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44
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Liu NH, Wu C, Pérez-Stable EJ, Muñoz RF. Longitudinal Association Between Smoking Abstinence and Depression Severity in Those With Baseline Current, Past, and No History of Major Depressive Episode in an International Online Tobacco Cessation Study. Nicotine Tob Res 2021; 23:267-275. [PMID: 32149344 DOI: 10.1093/ntr/ntaa036] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 02/13/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION We use multilevel modeling to parse out the effects of time-varying smoking abstinence and baseline depression (history and severity) on depression severity over 1 year. AIMS AND METHODS Participants were 1000 smokers recruited worldwide for an online randomized controlled tobacco cessation trial. We examined whether changes in depression severity over time were associated with self-reported 7-day point prevalence smoking status assessed at 1-, 3-, 6-, and 12-month follow-up (FU) using baseline major depressive episode (MDE) history and baseline depression severity as time-invariant covariates. We present depression severity means and smoking abstinence at each FU. RESULTS Regardless of concurrent abstinence status, baseline MDE history was significantly related to depression severity over time: those reporting a past MDE had worse depressive symptoms over time compared with those reporting no MDE history. Baseline depression severity interacted significantly with time-varying abstinence status: for every 1-unit increase in baseline scores on the Center for Epidemiological Studies-Depression Scale (CES-D), individuals who were smoking at FU reported CES-D scores that were 0.17 points higher than those who were abstinent. In this context, nicotine dependence, gender, age, or marital status did not affect depression severity. CONCLUSIONS In the context of cessation, having an MDE history plays a significant role in the trajectory of depression severity over the course of 1 year, regardless of abstinence status. Abstinence is related to lower depressive symptoms at each FU, and this effect was stronger at higher levels of baseline depression severity. IMPLICATIONS This study indicates that depressive symptoms are not exacerbated among individuals who are quitting smoking at 1-, 3-, 6-, and 12-month FUs. Depression severity is worse with a baseline history of MDE. Further, those with high baseline depression severity who continue smoking have worse depressive symptoms throughout a 1-year period compared with their abstinent counterparts.
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Affiliation(s)
- Nancy H Liu
- Department of Psychology, University of California, Berkeley, Berkeley, CA.,Department of Psychiatry, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, CA
| | - Chaorong Wu
- Institute for Clinical and Translational Science, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Eliseo J Pérez-Stable
- Division of Intramural Research, National Heart, Lung, and Blood Institute, and National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
| | - Ricardo F Muñoz
- Department of Psychology, Palo Alto University, Palo Alto, CA.,Department of Psychiatry, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, CA
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Kaplan RC, Baldoni PL, Strizich GM, Pérez-Stable EJ, Saccone NL, Peralta CA, Perreira KM, Gellman MD, Williams-Nguyen JS, Rodriguez CJ, Lee DJ, Daviglus M, Talavera GA, Lash JP, Cai J, Franceschini N. Current Smoking Raises Risk of Incident Hypertension: Hispanic Community Health Study-Study of Latinos. Am J Hypertens 2021; 34:190-197. [PMID: 32968788 DOI: 10.1093/ajh/hpaa152] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 08/28/2020] [Accepted: 09/22/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Hypertension has been implicated as a smoking-related risk factor for cardiovascular disease but the dose-response relationship is incompletely described. Hispanics, who often have relatively light smoking exposures, have been understudied in this regard. METHODS We used data from a 6-year follow-up study of US Hispanic adults aged 18-76 to address the dose-response linking cigarette use with incident hypertension, which was defined by measured blood pressure above 140/90 mm Hg or initiation of antihypertensive medications. Adjustment was performed for potential confounders and mediators, including urinary albumin-to-creatinine ratio which worsened over time among smokers. RESULTS Current smoking was associated with incident hypertension, with a threshold effect above 5 cumulative pack-years of smoking (vs. never smokers, hazard ratio for hypertension [95% confidence interval] of 0.95 [0.67, 1.35] for 0-5 pack-years, 1.47 [1.05, 2.06] for 5-10 pack-years, 1.40 [1.00, 1.96] for 10-20 pack-years, and 1.34 [1.09, 1.66] for ≥20 pack-years, P = 0.037). In contrast to current smokers, former smokers did not appear to have increased risk of hypertension, even at the highest cumulative pack-years of past exposure. CONCLUSIONS The results confirm that smoking constitutes a hypertension risk factor in Hispanic adults. A relatively modest cumulative dose of smoking, above 5 pack-years of exposure, raises risk of hypertension by over 30%. The increased hypertension risk was confined to current smokers, and did not increase further with higher pack-year levels. The lack of a smoking-hypertension association in former smokers underscores the value of smoking cessation.
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Affiliation(s)
- Robert C Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Pedro L Baldoni
- Department of Biostatistics, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Garrett M Strizich
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Eliseo J Pérez-Stable
- National Institute on Minority Health and Health Disparities, Bethesda, Maryland, USA
| | - Nancy L Saccone
- Division of Biology and Biomedical Sciences, Washington University, St. Louis, Missouri, USA
| | - Carmen A Peralta
- Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Krista M Perreira
- Department of Social Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Marc D Gellman
- Department of Psychology, University of Miami, Miami, Florida, USA
| | | | - Carlos J Rodriguez
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - David J Lee
- Department of Public Health Sciences, University of Miami, Coral Gables, Florida, USA
| | - Martha Daviglus
- Department of Medicine, University of Illinois-Chicago, Chicago, Illinois, USA
| | - Gregory A Talavera
- School of Public Health, San Diego State University, San Diego, California, USA
| | - James P Lash
- Department of Medicine, University of Illinois-Chicago, Chicago, Illinois, USA
| | - Jianwen Cai
- Department of Biostatistics, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Nora Franceschini
- Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
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St Helen G, Benowitz NL, Ko J, Jacob P, Gregorich SE, Pérez-Stable EJ, Murphy SE, Hecht SS, Hatsukami DK, Donny EC. Differences in exposure to toxic and/or carcinogenic volatile organic compounds between Black and White cigarette smokers. J Expo Sci Environ Epidemiol 2021; 31:211-223. [PMID: 31406274 PMCID: PMC7012700 DOI: 10.1038/s41370-019-0159-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 05/23/2019] [Indexed: 06/01/2023]
Abstract
OBJECTIVE It is unclear why Black smokers in the United States have elevated risk of some tobacco-related diseases compared to White smokers. One possible causal mechanism is differential intake of tobacco toxicants, but results across studies are inconsistent. Thus, we examined racial differences in biomarkers of toxic volatile organic compounds (VOCs) present in tobacco smoke. METHOD We analyzed baseline data collected from 182 Black and 184 White adult smokers who participated in a randomized clinical trial in 2013-2014 at 10 sites across the United States. We examined differences in urinary levels of ten VOC metabolites, total nicotine equivalents (TNE), and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), controlling for covariates such as cigarettes per day (CPD), as well as differences in VOCs per TNE to assess the extent to which tobacco exposure, and not metabolic factors, accounted for racial differences. RESULTS Concentration of metabolites of acrolein, acrylonitrile, ethylene oxide, and methylating agents were significantly higher in Blacks compared to Whites when controlled for covariates. Other than the metabolite of methylating agents, VOCs per TNE did not differ between Blacks and Whites. Concentrations of TNE/CPD and VOCs/CPD were significantly higher in Blacks. Menthol did not contribute to racial differences in VOC levels. CONCLUSIONS For a given level of CPD, Black smokers likely take in higher levels of acrolein, acrylonitrile, and ethylene oxide than White smokers. Our findings are consistent with Blacks taking in more nicotine and toxicants per cigarette smoked, which may explain their elevated disease risk relative to other racial groups.
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Affiliation(s)
- Gideon St Helen
- Clinical Pharmacology Research Program, Division of Cardiology, Zuckerberg San Francisco General Hospital, Department of Medicine, University of California, San Francisco, CA, USA.
- Center for Tobacco Control Research and Education (CTCRE), University of California, San Francisco, CA, USA.
| | - Neal L Benowitz
- Clinical Pharmacology Research Program, Division of Cardiology, Zuckerberg San Francisco General Hospital, Department of Medicine, University of California, San Francisco, CA, USA
- Center for Tobacco Control Research and Education (CTCRE), University of California, San Francisco, CA, USA
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA, USA
| | - Jennifer Ko
- Clinical Pharmacology Research Program, Division of Cardiology, Zuckerberg San Francisco General Hospital, Department of Medicine, University of California, San Francisco, CA, USA
| | - Peyton Jacob
- Clinical Pharmacology Research Program, Division of Cardiology, Zuckerberg San Francisco General Hospital, Department of Medicine, University of California, San Francisco, CA, USA
- Center for Tobacco Control Research and Education (CTCRE), University of California, San Francisco, CA, USA
| | - Steven E Gregorich
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Eliseo J Pérez-Stable
- Division of Intramural Research, National Heart, Lung and Blood Institute and Office of the Director, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Sharon E Murphy
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Stephen S Hecht
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Dorothy K Hatsukami
- Masonic Cancer Center, Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - Eric C Donny
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Zavala VA, Bracci PM, Carethers JM, Carvajal-Carmona L, Coggins NB, Cruz-Correa MR, Davis M, de Smith AJ, Dutil J, Figueiredo JC, Fox R, Graves KD, Gomez SL, Llera A, Neuhausen SL, Newman L, Nguyen T, Palmer JR, Palmer NR, Pérez-Stable EJ, Piawah S, Rodriquez EJ, Sanabria-Salas MC, Schmit SL, Serrano-Gomez SJ, Stern MC, Weitzel J, Yang JJ, Zabaleta J, Ziv E, Fejerman L. Cancer health disparities in racial/ethnic minorities in the United States. Br J Cancer 2021; 124:315-332. [PMID: 32901135 PMCID: PMC7852513 DOI: 10.1038/s41416-020-01038-6] [Citation(s) in RCA: 392] [Impact Index Per Article: 130.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 07/16/2020] [Accepted: 08/03/2020] [Indexed: 02/06/2023] Open
Abstract
There are well-established disparities in cancer incidence and outcomes by race/ethnicity that result from the interplay between structural, socioeconomic, socio-environmental, behavioural and biological factors. However, large research studies designed to investigate factors contributing to cancer aetiology and progression have mainly focused on populations of European origin. The limitations in clinicopathological and genetic data, as well as the reduced availability of biospecimens from diverse populations, contribute to the knowledge gap and have the potential to widen cancer health disparities. In this review, we summarise reported disparities and associated factors in the United States of America (USA) for the most common cancers (breast, prostate, lung and colon), and for a subset of other cancers that highlight the complexity of disparities (gastric, liver, pancreas and leukaemia). We focus on populations commonly identified and referred to as racial/ethnic minorities in the USA-African Americans/Blacks, American Indians and Alaska Natives, Asians, Native Hawaiians/other Pacific Islanders and Hispanics/Latinos. We conclude that even though substantial progress has been made in understanding the factors underlying cancer health disparities, marked inequities persist. Additional efforts are needed to include participants from diverse populations in the research of cancer aetiology, biology and treatment. Furthermore, to eliminate cancer health disparities, it will be necessary to facilitate access to, and utilisation of, health services to all individuals, and to address structural inequities, including racism, that disproportionally affect racial/ethnic minorities in the USA.
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Affiliation(s)
- Valentina A Zavala
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Paige M Bracci
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - John M Carethers
- Departments of Internal Medicine and Human Genetics, and Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Luis Carvajal-Carmona
- University of California Davis Comprehensive Cancer Center and Department of Biochemistry and Molecular Medicine, School of Medicine, University of California Davis, Sacramento, CA, USA
- Genome Center, University of California Davis, Davis, CA, USA
| | | | - Marcia R Cruz-Correa
- Department of Cancer Biology, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Melissa Davis
- Division of Breast Surgery, Department of Surgery, NewYork-Presbyterian/Weill Cornell Medical Center, New York, NY, USA
| | - Adam J de Smith
- Center for Genetic Epidemiology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Julie Dutil
- Cancer Biology Division, Ponce Research Institute, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Jane C Figueiredo
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Rena Fox
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Kristi D Graves
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Scarlett Lin Gomez
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Andrea Llera
- Laboratorio de Terapia Molecular y Celular, IIBBA, Fundación Instituto Leloir, CONICET, Buenos Aires, Argentina
| | - Susan L Neuhausen
- Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, CA, USA
| | - Lisa Newman
- Division of Breast Surgery, Department of Surgery, NewYork-Presbyterian/Weill Cornell Medical Center, New York, NY, USA
- Interdisciplinary Breast Program, New York-Presbyterian/Weill Cornell Medical Center, New York, NY, USA
| | - Tung Nguyen
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Julie R Palmer
- Slone Epidemiology Center at Boston University, Boston, MA, USA
| | - Nynikka R Palmer
- Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA, USA
| | - Eliseo J Pérez-Stable
- Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
- Office of the Director, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Sorbarikor Piawah
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Erik J Rodriquez
- Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Stephanie L Schmit
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Silvia J Serrano-Gomez
- Grupo de investigación en biología del cáncer, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Mariana C Stern
- Departments of Preventive Medicine and Urology, Keck School of Medicine of USC, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Jeffrey Weitzel
- Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, CA, USA
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Jun J Yang
- Department of Pharmaceutical Sciences, Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jovanny Zabaleta
- Department of Pediatrics and Stanley S. Scott Cancer Center LSUHSC, New Orleans, LA, USA
| | - Elad Ziv
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Laura Fejerman
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
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Abu-Rmeileh NME, Alderete E, Husseini A, Livaudais-Toman J, Pérez-Stable EJ. Country and gender differences in the association between violence and cigarette smoking among youth. Confl Health 2020; 14:87. [PMID: 33317610 PMCID: PMC7734849 DOI: 10.1186/s13031-020-00332-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 11/30/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Exposure to violence in youth may be associated with substance use and other adverse health effects. This study examined cigarette smoking in two middle-income areas with different levels and types of exposure to violence. METHODS Association of exposure to verbal and physical violence with cigarette smoking in the West Bank oPt (2008) and in Jujuy Argentina (2006) was examined using cross-sectional surveys of 14 to 17-year old youth in 7th to 10th grade using probabilistic sampling. RESULTS Violence exposure rates were more than double for Palestinian girls (99.6% vs. 41.2%) and boys (98.7% vs. 41.1%) compared with Argentinians. The rate of current cigarette smoking was significantly higher among Argentinian girls compared with Palestinian girls (33.1% vs. 7.1%, p < 0.001). Exposure to verbal violence from family and to physical violence increased the odds of current cigarette smoking, respectively, among Argentinian girls (aOR = 1.3, 95% CI = 1.0-1.7; aOR = 2.5, 95%CI = 1.7-3.8), Palestinian girls (aOR 2.2, 95%CI = 1.1-2.4; aOR = 2.0, 95%CI = 1.1-3.6) and Argentinian boys (aOR = 1.5, 95%CI = 1.1-2.0; aOR = 2.2, 95%CI = 1.6-3.0), but not among Palestinian boys. CONCLUSION Findings highlight the importance of producing context and gender specific evidence from exposure to violence, to inform and increase the impact of targeted smoking prevention strategies.
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Affiliation(s)
- Niveen M. E. Abu-Rmeileh
- Institute of Community and Public Health- Birzeit University, West Bank, Occupied Palestinian Territory (oPt), Birzeit, Palestine
| | - Ethel Alderete
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Universidad Nacional de Jujuy, Instituto de Ciencia y Tecnología Regional (ICTER), Jujuy, Argentina
| | - Abdullatif Husseini
- Institute of Community and Public Health- Birzeit University, West Bank, Occupied Palestinian Territory (oPt), Birzeit, Palestine
| | - Jennifer Livaudais-Toman
- Division of General Internal Medicine, Department of Medicine, at the University of California, San Francisco, USA
| | - Eliseo J. Pérez-Stable
- Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, USA
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El-Toukhy S, Méndez A, Collins S, Pérez-Stable EJ. Barriers to Patient Portal Access and Use: Evidence from the Health Information National Trends Survey. J Am Board Fam Med 2020; 33:953-968. [PMID: 33219074 PMCID: PMC7849369 DOI: 10.3122/jabfm.2020.06.190402] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 06/03/2020] [Accepted: 07/01/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Patient access to their medical records through patient portals (PPs) facilitates information exchange and provision of quality health care. Understanding factors that characterize patients with limited access to and use of PPs is needed. METHODS Data were from the 2017-2018 Health Information National Trends Survey 5, Cycles 1 and 2, a nationally representative survey of US adults ≥ 18 years old (n = 6789). Weighted multivariate logistic regressions modeled the associations between patient characteristics and access to, facilitators of use, and use of PPs and their functions. RESULTS Individuals without (vs with) a regular doctor (adjusted odds ratio [aOR], 0.4; CI, 0.3-0.5) or health insurance (aOR, 0.4; CI, 0.2-0.7), those with high school (aOR 0.4; CI, 0.3-0.5) or with vocational/some college (aOR, 0.5; CI, 04.-0.7) education (vs college/postgraduate), or those with limited English proficiency (vs those who speak English very well) (aOR, 0.7; CI, 0.5-0.9) were less likely to report accessing their personal medical records. Women (vs men) were more likely to report accessing their medical records (aOR, 1.5; CI, 1.2-1.8). Similar patterns were found for PPs access and facilitators of use. Less consistent associations emerged between patient characteristics and use of PP functionalities. CONCLUSIONS PP access and use are low. Having a primary care clinician, patient's educational attainment, and being a woman were factors associated with PP access and use, but not race/ethnicity. Once access was achieved, use of PP functionalities was generally uniform across demographic segments. Facilitating PP access and use among all patient populations is warranted.
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Affiliation(s)
- Sherine El-Toukhy
- From the Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD (SET); Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (SET, AM); School of Medicine, Indiana University, Indianapolis (AM); School of Medicine, Emory University, Atlanta, GA (SC); Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (EJPS); Office of the Director, National Institute on Minority Health and Health Disparities, Bethesda, MD (EJPS).
| | - Alejandra Méndez
- From the Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD (SET); Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (SET, AM); School of Medicine, Indiana University, Indianapolis (AM); School of Medicine, Emory University, Atlanta, GA (SC); Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (EJPS); Office of the Director, National Institute on Minority Health and Health Disparities, Bethesda, MD (EJPS)
| | - Shavonne Collins
- From the Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD (SET); Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (SET, AM); School of Medicine, Indiana University, Indianapolis (AM); School of Medicine, Emory University, Atlanta, GA (SC); Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (EJPS); Office of the Director, National Institute on Minority Health and Health Disparities, Bethesda, MD (EJPS)
| | - Eliseo J Pérez-Stable
- From the Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD (SET); Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (SET, AM); School of Medicine, Indiana University, Indianapolis (AM); School of Medicine, Emory University, Atlanta, GA (SC); Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (EJPS); Office of the Director, National Institute on Minority Health and Health Disparities, Bethesda, MD (EJPS)
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50
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Bisogno LS, Yang J, Bennett BD, Ward JM, Mackey LC, Annab LA, Bushel PR, Singhal S, Schurman SH, Byun JS, Nápoles AM, Pérez-Stable EJ, Fargo DC, Gardner K, Archer TK. Ancestry-dependent gene expression correlates with reprogramming to pluripotency and multiple dynamic biological processes. Sci Adv 2020; 6:6/47/eabc3851. [PMID: 33219026 PMCID: PMC7679169 DOI: 10.1126/sciadv.abc3851] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 10/02/2020] [Indexed: 05/10/2023]
Abstract
Induced pluripotent stem cells (iPSCs) can be derived from differentiated cells, enabling the generation of personalized disease models by differentiating patient-derived iPSCs into disease-relevant cell lines. While genetic variability between different iPSC lines affects differentiation potential, how this variability in somatic cells affects pluripotent potential is less understood. We generated and compared transcriptomic data from 72 dermal fibroblast-iPSC pairs with consistent variation in reprogramming efficiency. By considering equal numbers of samples from self-reported African Americans and White Americans, we identified both ancestry-dependent and ancestry-independent transcripts associated with reprogramming efficiency, suggesting that transcriptomic heterogeneity can substantially affect reprogramming. Moreover, reprogramming efficiency-associated genes are involved in diverse dynamic biological processes, including cancer and wound healing, and are predictive of 5-year breast cancer survival in an independent cohort. Candidate genes may provide insight into mechanisms of ancestry-dependent regulation of cell fate transitions and motivate additional studies for improvement of reprogramming.
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Affiliation(s)
- Laura S Bisogno
- Chromatin and Gene Expression Section, Epigenetics and Stem Cell Biology Laboratory, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Jun Yang
- Chromatin and Gene Expression Section, Epigenetics and Stem Cell Biology Laboratory, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Brian D Bennett
- Integrative Bioinformatics, Epigenetics and Stem Cell Biology Laboratory, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - James M Ward
- Integrative Bioinformatics, Epigenetics and Stem Cell Biology Laboratory, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Lantz C Mackey
- Chromatin and Gene Expression Section, Epigenetics and Stem Cell Biology Laboratory, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Lois A Annab
- Chromatin and Gene Expression Section, Epigenetics and Stem Cell Biology Laboratory, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Pierre R Bushel
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Sandeep Singhal
- Department of Pathology, Department of Computer Science, University of North Dakota, Grand Forks, ND, USA
| | - Shepherd H Schurman
- Clinical Research Unit, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Jung S Byun
- Division of Intramural Research, Office of the Scientific Director, National Institute on Minority Health and Health Disparities, Bethesda, MD, USA
| | - Anna María Nápoles
- Division of Intramural Research, Office of the Scientific Director, National Institute on Minority Health and Health Disparities, Bethesda, MD, USA
| | - Eliseo J Pérez-Stable
- Division of Intramural Research, Office of the Scientific Director, National Institute on Minority Health and Health Disparities, Bethesda, MD, USA
- Division of Intramural Research, National Heart, Lung and Blood Institute, Bethesda, MD, USA
| | - David C Fargo
- Office of Scientific Computing, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Kevin Gardner
- Division of Intramural Research, Office of the Scientific Director, National Institute on Minority Health and Health Disparities, Bethesda, MD, USA
- Department of Pathology and Cell Biology, Columbia University Medical Center, Columbia University, New York, NY, USA
| | - Trevor K Archer
- Chromatin and Gene Expression Section, Epigenetics and Stem Cell Biology Laboratory, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA.
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