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Yan G, Nee R, Scialla JJ, Greene T, Yu W, Heng F, Cheung AK, Norris KC. Role of Age and Competing Risk of Death in the Racial Disparity of Kidney Failure Incidence after Onset of CKD. J Am Soc Nephrol 2024; 35:299-310. [PMID: 38254260 PMCID: PMC10914195 DOI: 10.1681/asn.0000000000000300] [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: 07/20/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024] Open
Abstract
SIGNIFICANCE STATEMENT Black adults in the United States have 2-4 times higher incidence of kidney failure than White adults. Yet, the reasons underlying this disparity remain poorly understood. Among 547,188 US veterans with new-onset CKD, according to a new race-free GFR equation, Black veterans had a 2.5-fold higher cumulative incidence of kidney failure, compared with White veterans, in any follow-up period from CKD onset. This disparity resulted from a combination of higher hazards of progression to kidney failure and lower hazards of competing-risk death in Black veterans. Both, in turn, were largely explained by the younger age at CKD onset in Black veterans, underscoring an urgent need to prevent early onset and slow progression of CKD in younger Black adults. BACKGROUND The Black adult population is well known to have higher incidence of kidney failure than their White counterpart in the United States, but the reasons underlying this disparity are unclear. We assessed the racial differences in kidney failure and death from onset of CKD on the basis of the race-free 2021 CKD Epidemiology Collaboration equation and examined the extent to which these differences could be explained by factors at the time of CKD onset. METHODS We analyzed a national cohort consisting of 547,188 US veterans (103,821 non-Hispanic Black and 443,367 non-Hispanic White), aged 18-85 years, with new-onset CKD between 2005 and 2016 who were followed through 10 years or May 2018 for incident kidney failure with replacement therapy (KFRT) and pre-KFRT death. RESULTS At CKD onset, Black veterans were, on average, 7.8 years younger than White veterans. In any time period from CKD onset, the cumulative incidence of KFRT was 2.5-fold higher for Black versus White veterans. Meanwhile, Black veterans had persistently >2-fold higher hazards of KFRT throughout follow-up (overall hazard ratio [95% confidence interval], 2.38 [2.31 to 2.45]) and conversely had 17%-48% decreased hazards of pre-KFRT death. These differences were reduced after accounting for the racial difference in age at CKD onset. CONCLUSIONS The 2.5-fold higher cumulative incidence of kidney failure in Black adults resulted from a combination of higher hazards of progression to kidney failure and lower hazards of the competing risk of death, both of which can be largely explained by the younger age at CKD onset in Black compared with White adults.
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Affiliation(s)
- Guofen Yan
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Robert Nee
- Nephrology Service, Walter Reed National Military Medical Center; Department of Medicine, Uniformed Services University, Bethesda, Maryland
| | - Julia J. Scialla
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia
- Division of Nephrology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Tom Greene
- Division of Biostatistics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Wei Yu
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Fei Heng
- Department of Mathematics and Statistics, University of North Florida, Jacksonville, Florida
| | - Alfred K. Cheung
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Keith C. Norris
- Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
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Reeder NK, Reneker JC, Beech BM, Bruce MA, Heitman E, Norris KC, Talegawkar SA, Thorpe RJ. Adherence to the healthy eating index-2010 and alternative healthy eating index-2010 in relation to metabolic syndrome among African Americans in the Jackson heart study. Public Health Nutr 2024; 27:e74. [PMID: 38361460 PMCID: PMC10966834 DOI: 10.1017/s1368980024000016] [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: 12/07/2022] [Revised: 11/11/2023] [Accepted: 12/21/2023] [Indexed: 02/17/2024]
Abstract
OBJECTIVE The primary objective of this study was to determine whether Healthy Eating Index (HEI) and Alternative Healthy Eating Index (AHEI) scores were associated with incident metabolic syndrome. DESIGN This study is a secondary analysis of data from the Jackson Heart Study. HEI and AHEI scores were divided into quintiles and Cox proportional hazards regression models were analysed for 1864 African American adults free from metabolic syndrome at Exam 1 to examine the incidence of metabolic syndrome by quintile of dietary quality score. SETTING Hinds, Madison and Rankin counties, Mississippi, USA. PARTICIPANTS African American adults, ages 21-94 years, 60·9 % female. RESULTS Over a mean follow-up time of 6·7 years, we observed 932 incident cases of metabolic syndrome. After adjusting for multiple covariates, a higher HEI score at Exam 1 was not associated with the risk of incident metabolic syndrome, except when looking at the trend analysis for the subgroup of adults with two metabolic syndrome components at Exam 1 (P-trend = 0·03). A higher AHEI score at Exam 1 was associated with the risk of incident metabolic syndrome (hazard ratio for those in the highest quintile compared to the lowest: 0·80 (95 % CI: 0·65, 0·99), P-trend = 0·03). CONCLUSION These findings suggest that a dietary pattern that scores higher on the AHEI may help reduce the risk of metabolic syndrome, even for adults who already have two of the minimum of three components required for a diagnosis of metabolic syndrome.
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Affiliation(s)
- Nicole K Reeder
- Department of Food Science, Nutrition, and Health Promotion, Mississippi State University, Mississippi State, MS, USA
| | - Jennifer C Reneker
- Department of Population Health Sciences, University of Mississippi Medical Center, Jackson, MS, USA
| | - Bettina M Beech
- UH Population Health, University of Houston, Houston, TX, USA
| | - Marino A Bruce
- UH Population Health, University of Houston, Houston, TX, USA
- Department of Behavioral and Social Sciences, University of Houston, Tilman J. Fertitta Family College of Medicine, Houston, TX, USA
| | - Elizabeth Heitman
- Program in Ethics in Science and Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Keith C Norris
- Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Sameera A Talegawkar
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Roland J Thorpe
- Hopkins Center for Health Disparities Solutions, Johns Hopkins School of Public Health, 624 N. Broadway, Ste 708, Baltimore, MD, USA
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Essien UR, Agbafe V, Norris KC. Diversifying the Physician Workforce-Reply. JAMA 2024; 331:532-533. [PMID: 38349373 DOI: 10.1001/jama.2023.26185] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Affiliation(s)
- Utibe R Essien
- Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, California
| | | | - Keith C Norris
- Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, California
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Burton BN, Adeola JO, Do VM, Milam AJ, Cannesson M, Norris KC, Lopez NE, Gabriel RA. Differences in the Receipt of Regional Anesthesia Based on Race and Ethnicity in Colorectal Surgery. Jt Comm J Qual Patient Saf 2024:S1553-7250(24)00004-7. [PMID: 38433070 DOI: 10.1016/j.jcjq.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 12/19/2023] [Accepted: 01/02/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Health equity in pain management during the perioperative period continues to be a topic of interest. The authors evaluated the association of race and ethnicity with regional anesthesia in patients who underwent colorectal surgery and characterized trends in regional anesthesia. METHODS Using the American College of Surgeons National Surgical Quality Improvement Program database from 2015 to 2020, the research team identified patients who underwent open or laparoscopic colorectal surgery. Associations between race and ethnicity and use of regional anesthesia were estimated using logistic regression models. RESULTS The final sample size was 292,797, of which 15.6% (n = 45,784) received regional anesthesia. The unadjusted rates of regional anesthesia for race and ethnicity were 15.7% white, 15.1% Black, 12.8% Asian, 29.6% American Indian or Alaska Native, 16.3% Native Hawaiian or Pacific Islander, and 12.4% Hispanic. Black (odds ratio [OR] 0.93, 95% confidence interval [CI] 0.90-0.96, p < 0.001) and Asian (OR 0.76, 95% CI 0.71-0.80, p < 0.001) patients had lower odds of regional anesthesia compared to white patients. Hispanic patients had lower odds of regional anesthesia compared to non-Hispanic patients (OR 0.72, 95% CI 0.68-0.75, p < 0.001). There was a significant annual increase in regional anesthesia from 2015 to 2020 for all racial and ethnic cohorts (p < 0.05). CONCLUSION There was an annual increase in the use of regional anesthesia, yet Black and Asian patients (compared to whites) and Hispanics (compared to non-Hispanics) were less likely to receive regional anesthesia for colorectal surgery. These differences suggest that there are racial and ethnic differences in regional anesthesia use for colorectal surgery.
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Shen JI, Golestaneh L, Norris KC. Federal Regulations and Dialysis-Related Disparities. JAMA 2024; 331:108-110. [PMID: 38193972 DOI: 10.1001/jama.2023.18590] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Affiliation(s)
- Jenny I Shen
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles
- Division of Nephrology and Hypertension, Lundquist Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Ladan Golestaneh
- Department of Medicine/Renal Division, Albert Einstein College of Medicine, Bronx, New York
| | - Keith C Norris
- Division of General Internal Medicine and Health Services Research, Geffen School of Medicine at University of California, Los Angeles
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Hemmige V, Deshpande P, Norris KC, Shen JI, Erickson KF, Johansen KL, Golestaneh L. Geographic Dialysis Facility Density and Early Dialysis Initiation. JAMA Netw Open 2024; 7:e2350009. [PMID: 38170525 PMCID: PMC10765261 DOI: 10.1001/jamanetworkopen.2023.50009] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/29/2023] [Indexed: 01/05/2024] Open
Abstract
Importance The decision of when to start maintenance hemodialysis may be affected by health system-level support for high-intensity care as manifested by area dialysis facility density. Yet an association between early hemodialysis initiation and higher area density of dialysis facilities has not been shown. Objective To examine whether there is an association between area dialysis facility density and earlier dialysis initiation. Design, Setting, and Participants Cross-sectional analysis was conducted of publicly reported claims and geographic-based population data collected in the Medical Evidence files of the US Renal Data System (USRDS), a comprehensive registry of all patients initiating hemodialysis in the US, from calendar years 2011 through 2019. Data were linked to the American Community Survey, using residential zip codes, and then to health service area (HSA) primary care and hospitalization benchmarks, using the Dartmouth Atlas crosswalk. Data were analyzed from November 1, 2021, to August 31, 2023. Exposure Dialysis facility density at the level of HSA (number of dialysis facilities per 100 000 HSA residents) split into 5 categories. Main Outcomes and Measures The odds of hemodialysis initiation at an estimated glomerular filtration rate (eGFR) greater than 10 mL/min/1.73 m2 vs less than or equal to 10 mL/min/1.73 m2. Results Hemodialysis was initiated in a total of 844 466 individuals at 3397 HSAs at a mean (SD) eGFR of 8.9 (3.8) mL/min/1.73 m2. Their mean (SD) age was 63.5 (14.7) years, and 484 346 participants (57.4%) were men. In the HSA category with the highest facility density, individuals were younger (63.3 vs 65.2 years in least-dense HSAs), poorer (mean percent of households living in poverty, 10.4% vs 8.4%), and more commonly had a higher percentage of Black individuals (40.6% vs 11.3%). More individuals in the dialysis-dense HSAs than least-dense HSAs had diabetes (60.1% vs 58.5%) and fewer had access to predialysis nephrology care (60.8% vs 64.1%); the rates of heart failure and immobility varied, but not in a consistent pattern, by HSA dialysis density. The mean (SD) facility density was 4.1 (1.89) centers per 100 000 population in the most dialysis-dense HSAs. Compared with patients in HSAs with a mean of 1.0 per 100 000 population, the odds of hemodialysis initiation at eGFR greater than 10 mL/min/1.73 m2 were 1.07 (95% CI, 1.03-1.11) for patients in the densest HSAs, and compared with HSAs with 0 facilities, the odds of early hemodialysis initiation were 1.06 (95% CI, 1.02-1.10) for patients in the densest HSAs. Conclusions and Relevance In this cross-sectional study of USRDS- and HSA-level data, HSA dialysis density was associated with early hemodialysis initiation.
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Affiliation(s)
- Vagish Hemmige
- Division of Infectious Diseases, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Priya Deshpande
- Division of Nephrology, Mt Sinai School of Medicine, New York, New York
| | - Keith C. Norris
- Department of Medicine, David Geffen School of Medicine, Los Angeles, California
| | - Jenny I. Shen
- Division of Nephrology, Los Angeles County Harbor-UCLA Medical Center, Los Angeles, California
| | | | | | - Ladan Golestaneh
- Division of Nephrology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
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Gutiérrez-Peredo GB, Silva Martins MT, da Silva FA, Lopes MB, Lopes GB, Norris KC, Lopes AA. Self-Reported Fatigue by the Chalder Fatigue Questionnaire and Mortality in Brazilian Hemodialysis Patients: The PROHEMO. Nephron Clin Pract 2023; 148:292-299. [PMID: 38043529 DOI: 10.1159/000533472] [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: 04/12/2023] [Accepted: 08/03/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND The existing data support the Chalder Fatigue Questionnaire (CFQ-11) as a valid instrument to assess fatigue in maintenance hemodialysis (MHD) patients. The objective of this work was to investigate whether self-reported fatigue can serve as an independent prognostic indicator for mortality in MHD patients. METHODS The data are from 233 adult patients enrolled in the cohort "The Prospective Study of the Prognosis of Chronic Hemodialysis Patients" (PROHEMO) developed in Salvador, BA, Brazil. The Brazilian version of the validated CFQ-11 was used to calculate self-reported fatigue. The CFQ-11 scores may range from 0 to 33; higher scores represent more fatigue. Fatigue categories were created based on proposed cut point: absence or mild degree if CFQ-11 scores <4 and moderate to severe if scores ≥4. Cox models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of associations between fatigue and mortality with adjustments for sociodemographic factors, time on dialysis, education, economic class, hemoglobin concentration, diabetes, heart failure, depression, and other psychiatric disorders. RESULTS The mean age was 51.5 ± 2.5 years, 58% were male, and 30% were diabetic. Self-reported moderate to severe fatigue was reported by 71% of patients. The mortality rate was 8.6 cases/100 person-years. Patients with moderate to severe fatigue had a more than threefold mortality rate (HR = 3.07, 95% CI: 1.19, 7.93) compared to patients with absent or mild fatigue, after extensive adjustments for covariates. CONCLUSION The study provides evidence that self-reported fatigue can help identify MHD patients at higher risk of earlier death.
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Affiliation(s)
| | - Márcia Tereza Silva Martins
- Graduate Program in Medicine and Health, Federal University of Bahia, Salvador, Brazil
- Clinic of Renal Disease and Hypertension (CLINIRIM), Salvador, Brazil
| | - Fernanda Albuquerque da Silva
- Graduate Program in Medicine and Health, Federal University of Bahia, Salvador, Brazil
- NEPHRON Clinic, Salvador, Brazil
| | - Marcelo Barreto Lopes
- Graduate Program in Medicine and Health, Federal University of Bahia, Salvador, Brazil
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
- Unit of Clinical Epidemiology and Evidence-Based Medicine, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador, Brazil
| | - Gildete Barreto Lopes
- Graduate Program in Medicine and Health, Federal University of Bahia, Salvador, Brazil
- Unit of Clinical Epidemiology and Evidence-Based Medicine, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador, Brazil
| | - Keith C Norris
- Department of Medicine, University of California, Los Angeles, California, USA
| | - Antonio Alberto Lopes
- Graduate Program in Medicine and Health, Federal University of Bahia, Salvador, Brazil
- Unit of Clinical Epidemiology and Evidence-Based Medicine, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador, Brazil
- Department of Internal Medicine, Federal University of Bahia, Salvador, Brazil
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Ong MK, Norris KC. Advancing equity research in the quality of and access to health care in a post-affirmative action era. Health Serv Res 2023; 58 Suppl 3:281-283. [PMID: 38015864 PMCID: PMC10684033 DOI: 10.1111/1475-6773.14249] [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] [Indexed: 11/30/2023] Open
Affiliation(s)
- Michael K. Ong
- Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of MedicineUniversity of California Los AngelesLos AngelesCaliforniaUSA
- Department of Health Policy and Management, Fielding School of Public HealthUniversity of California Los AngelesLos AngelesCaliforniaUSA
- Center for the Study of Healthcare Innovation, Implementation, and Policy, Veteran Affairs Greater Los Angeles Healthcare SystemLos AngelesCaliforniaUSA
| | - Keith C. Norris
- Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of MedicineUniversity of California Los AngelesLos AngelesCaliforniaUSA
- Office of Equity, Diversity, Inclusion, Department of Medicine, David Geffen School of MedicineUniversity of California Los AngelesLos AngelesCaliforniaUSA
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Duru OK, Mangione CM, Turk N, Chon J, Fu J, Cheng G, Cheng F, Moss A, Frosch D, Jeffers KS, Castellon-Lopez Y, Tseng CH, Maranon R, Norris KC, Moin T. The Effectiveness of Shared Decision-making for Diabetes Prevention: 24- and 36-Month Results From the Prediabetes Informed Decision and Education (PRIDE) Trial. Diabetes Care 2023; 46:2218-2222. [PMID: 37770039 PMCID: PMC10698217 DOI: 10.2337/dc23-0829] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/11/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE We conducted a cluster-randomized, shared decision-making (SDM) trial offering lifestyle change, metformin, or both options, to adults at risk for diabetes in a primary care network (n = 20 practices). RESEARCH DESIGN AND METHODS We used propensity score matching to identify control patients and used electronic health record data to compare weight loss at 24 and 36 months of follow-up and diabetes incidence at 36 months of follow-up. RESULTS In adjusted post hoc analyses, SDM participants (n = 489) maintained modestly greater 24-month weight loss of -3.1 lb and 36-month weight loss of -2.7 lb versus controls (n = 1,430, both comparisons P < 0.001). SDM participants who chose both lifestyle change and metformin sustained weight loss at 36 months of -4.1 lb (P < 0.001 vs. controls). We found no differences in incident diabetes (15% of SDM participants, 14% of control participants; P = 0.64). CONCLUSIONS This is one of the first studies to demonstrate weight loss maintenance up to 36 months after diabetes prevention SDM.
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Affiliation(s)
- O. Kenrik Duru
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Carol M. Mangione
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
- Fielding School of Public Health, University of California, Los Angeles, Los Angeles, Los Angeles, CA
| | - Norman Turk
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Janet Chon
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Jeffery Fu
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Grace Cheng
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Felicia Cheng
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Amanda Moss
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | | | - Kia Skrine Jeffers
- School of Nursing, University of California, Los Angeles, Los Angeles, Los Angeles, CA
| | | | - Chi-Hong Tseng
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Richard Maranon
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Keith C. Norris
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Tannaz Moin
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA
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Koyama AK, Nee R, Yu W, Choudhury D, Heng F, Cheung AK, Norris KC, Cho ME, Yan G. Role of Anemia in Dementia Risk Among Veterans With Incident CKD. Am J Kidney Dis 2023; 82:706-714. [PMID: 37516301 PMCID: PMC10822015 DOI: 10.1053/j.ajkd.2023.04.013] [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: 12/22/2022] [Revised: 03/30/2023] [Accepted: 04/30/2023] [Indexed: 07/31/2023]
Abstract
RATIONALE & OBJECTIVE Although some evidence exists of increased dementia risk from anemia, it is unclear whether this association persists among adults with CKD. Anemia may be a key marker for dementia among adults with CKD, so we evaluated whether anemia is associated with an increased risk of dementia among adults with CKD. STUDY DESIGN Retrospective cohort study. SETTING & PARTICIPANTS The study included 620,095 veterans aged≥45 years with incident stage 3 CKD (estimated glomerular filtration rate [eGFR]<60mL/min/1.73m2) between January 2005 and December 2016 in the US Veterans Health Administration system and followed through December 31, 2018, for incident dementia, kidney failure, or death. EXPOSURE Anemia was assessed based on the average of hemoglobin levels (g/L) during the 2 years before the date of incident CKD and categorized as normal, mild, or moderate/severe anemia (≥12.0, 11.0-11.9,<11.0g/dL, respectively, for women, and≥13.0, 11.0-12.9,<11.0g/dL for men). OUTCOME Dementia and the composite outcome of kidney failure or death. ANALYTICAL APPROACH Adjusted cause-specific hazard ratios were estimated for each outcome. RESULTS At the time of incident CKD, the mean age of the participants was 72 years, 97% were male, and their mean eGFR was 51mL/min per 1.73m2. Over a median 4.1 years of follow-up, 92,306 veterans (15%) developed dementia before kidney failure or death. Compared with the veterans with CKD without anemia, the multivariable-adjusted models showed a 16% (95% CI, 14%-17%) significantly higher risk of dementia for those with mild anemia and a 27% (95% CI, 23%-31%) higher risk with moderate/severe anemia. Combined risk of kidney failure or death was higher at 39% (95% CI, 37%-40%) and 115% (95% CI, 112%-119%) for mild and moderate/severe anemia, respectively, compared with no anemia. LIMITATIONS Residual confounding from the observational study design. Findings may not be generalizable to the broader US population. CONCLUSIONS Anemia was significantly associated with an increased risk of dementia among veterans with incident CKD, underscoring the role of anemia as a predictor of dementia risk. PLAIN-LANGUAGE SUMMARY Adults with chronic kidney disease (CKD) often have anemia. Prior studies among adults in the general population suggest anemia is a risk factor for dementia, though it is unclear whether this association persists among adults with CKD. In this large study of veterans in the United States, we studied the association between anemia and the risk of 2 important outcomes in this population: (1) dementia and (2) kidney failure or death. We found that anemia was associated with a greater risk of dementia as well as risk of kidney failure or death. The study findings therefore emphasize the role of anemia as a key predictor of dementia risk among adults with CKD.
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Affiliation(s)
- Alain K Koyama
- Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Robert Nee
- Walter Reed National Military Medical Center; Uniformed Services University, Bethesda, Maryland
| | - Wei Yu
- University of Virginia, Charlottesville, Virginia
| | - Devasmita Choudhury
- University of Virginia, Charlottesville, Virginia; Virginia-Tech Carilion School of Medicine Medical Center, Roanoke, Virginia; Salem Veterans Affairs Healthcare System, Salem, Virginia
| | - Fei Heng
- University of North Florida, Jacksonville, Florida
| | - Alfred K Cheung
- VA Salt Lake City Healthcare System, Salt Lake City, Utah; University of Utah, Salt Lake City, Utah
| | - Keith C Norris
- University of California-Los Angeles, Los Angeles, California
| | | | - Guofen Yan
- University of Virginia, Charlottesville, Virginia.
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Ferdinand KC, Norris KC, Rodbard HW, Trujillo JM. Humanistic and Economic Burden of Patients with Cardiorenal Metabolic Conditions: A Systematic Review. Diabetes Ther 2023; 14:1979-1996. [PMID: 37751142 PMCID: PMC10597898 DOI: 10.1007/s13300-023-01464-8] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/11/2023] [Indexed: 09/27/2023] Open
Abstract
INTRODUCTION Diabetes is associated with significant economic burden. Moreover, cardiovascular disease (CVD), including heart failure, and chronic kidney disease (CKD) are common comorbidities, leading to premature mortality. We conducted a systematic review to assess the humanistic and economic burden of cardio-renal-metabolic (CRM) conditions in individuals ≥ 18 years with CVD, CKD, and type 2 diabetes mellitus. METHODS We searched Embase® and Medline® databases from 2011 to January 10, 2022 for English publications reporting humanistic and economic burden outcomes from observational studies, real-world evidence, and economic model studies. Intervention and validation studies were excluded. Study quality was assessed using the Newcastle-Ottawa Scale. Abstracts/posters were identified from four conferences (2020-2022). RESULTS Of 1804 studies identified, 22 (including four conference publications) were selected involving 351,296,930 participants (one modeled the US population); eight reported healthcare resource utilization (HCRU), seven only cost data, six HCRU and cost data, one reported quality-of-life data (11/18 and 7/18 had estimated low and medium risk of bias, respectively). Participants were predominantly ≥ 65 years and identified as having White ethnicity. Higher costs and HCRU were observed in patients with all three conditions compared to those with two or none. Urban/metropolitan and insured patients had higher healthcare expenditure and service utilization compared to uninsured and racial/ethnic minority populations. Comorbidities were associated with increased hospitalizations, higher costs, and more emergency department visits. In general, patients identified as having Black ethnicity had low odds of using healthcare services, possibly due to disparities in healthcare access and distrust in the system. Limitations included no adjustment for inflation and a predominance of retrospective studies. CONCLUSIONS This review showed a greater economic burden for patients with CRM conditions, with a clear trend between increasing numbers of comorbidities and increasing healthcare costs/resource use. Comparisons between countries are complicated and the scarcity of evidence from minority racial and ethnic groups and lack of data from non-US geographies warrant further investigation.
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Affiliation(s)
- Keith C Ferdinand
- Cardiology Section, Gerald S. Berenson Endowed Chair in Preventive Cardiology, John W. Deming Department of Medicine, Tulane University School of Medicine, 1430 Tulane Avenue, #8548, New Orleans, LA, 70112, USA.
| | - Keith C Norris
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA
| | | | - Jennifer M Trujillo
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA
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Abstract
This Viewpoint discusses a pathway toward individual, institutional, professional, and societal actions to increase the number of underrepresented individuals in medicine within the medical workforce in a “post–affirmative action” landscape.
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Affiliation(s)
- Utibe R Essien
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Victor Agbafe
- University of Michigan Medical School, Ann Arbor
- Yale Law School, New Haven, Connecticut
| | - Keith C Norris
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles
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Nicholas SB, Daratha KB, Alicic RZ, Jones CR, Kornowske LM, Neumiller JJ, Fatoba ST, Kong SX, Singh R, Norris KC, Tuttle KR. Prescription of guideline-directed medical therapies in patients with diabetes and chronic kidney disease from the CURE-CKD Registry, 2019-2020. Diabetes Obes Metab 2023; 25:2970-2979. [PMID: 37395334 DOI: 10.1111/dom.15194] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 03/07/2023] [Revised: 05/23/2023] [Accepted: 06/05/2023] [Indexed: 07/04/2023]
Abstract
AIM Guideline-directed medical therapy (GDMT) is designed to improve clinical outcomes. The study aim was to assess GDMT prescribing rates and prescribing-persistence predictors in patients with diabetes and chronic kidney disease (CKD) from the Center for Kidney Disease Research, Education, and Hope Registry. MATERIALS AND METHODS Data were obtained from adults ≥18 years old with diabetes and CKD between 1 January 2019 and 31 December 2020 (N = 39 158). Baseline and persistent (≥90 days) prescriptions for GDMT, including angiotensin converting enzyme (ACE) inhibitor/angiotensin receptor blocker (ARB), sodium-glucose cotransporter-2 (SGLT2) inhibitor and glucagon-like peptide 1 (GLP-1) receptor agonist were assessed. RESULTS The population age (mean ± SD) was 70 ± 14 years, and 49.6% (n = 19 415) were women. Baseline estimated glomerular filtration rate (2021 CKD-Epidemiology Collaboration creatinine equation) was 57.5 ± 23.0 ml/min/1.73 m2 and urine albumin/creatinine 57.5 mg/g (31.7-158.2; median, interquartile range). Baseline and ≥90-day persistent prescribing rates, respectively, were 70.7% and 40.4% for ACE inhibitor/ARB, 6.0% and 5.0% for SGLT2 inhibitors, and 6.8% and 6.3% for GLP-1 receptor agonist (all p < .001). Patients lacking primary commercial health insurance coverage were less likely to be prescribed an ACE inhibitor/ARB [odds ratio (OR) = 0.89; 95% confidence interval (CI) 0.84-0.95; p < .001], SGLT2 inhibitor (OR 0.72; 95% CI 0.64-0.81; p < .001) or GLP-1 receptor agonist (OR 0.89; 95% CI 0.80-0.98; p = .02). GDMT prescribing rates were lower at Providence than UCLA Health. CONCLUSIONS Prescribing for GDMT was suboptimal and waned quickly in patients with diabetes and CKD. Type of primary health insurance coverage and health system were associated with GDMT prescribing.
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Affiliation(s)
- Susanne B Nicholas
- Nephrology Division, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Kenn B Daratha
- Providence Medical Research Center, Providence Inland Northwest, Spokane, Washington, USA
| | - Radica Z Alicic
- Providence Medical Research Center, Providence Inland Northwest, Spokane, Washington, USA
- Department of Medicine, University of Washington, Seattle, Spokane, Washington, USA
| | - Cami R Jones
- Providence Medical Research Center, Providence Inland Northwest, Spokane, Washington, USA
| | - Lindsey M Kornowske
- Providence Medical Research Center, Providence Inland Northwest, Spokane, Washington, USA
| | - Joshua J Neumiller
- Providence Medical Research Center, Providence Inland Northwest, Spokane, Washington, USA
- Department of Pharmacotherapy, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington, USA
| | | | | | - Rakesh Singh
- Bayer US, LLC, Medical Affairs, Whippany, Whippany, USA
| | - Keith C Norris
- Nephrology Division, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Katherine R Tuttle
- Providence Medical Research Center, Providence Inland Northwest, Spokane, Washington, USA
- Department of Medicine, University of Washington, Seattle, Spokane, Washington, USA
- Kidney Research Institute, Institute of Translational Health Sciences, University of Washington, Seattle, Washington, USA
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14
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You AS, Norris KC, Kataoka-Yahiro M, Davis J, Page V, Hayashida G, Narasaki Y, Cheng SF, Ng R, Wong LL, Lee LY, Kalantar-Zadeh K, Rhee CM. Racial Disparities in End-Stage Kidney Disease Outcomes among Asians and Native Hawaiians and Other Pacific Islanders across Geographic Residence. Am J Nephrol 2023; 55:115-126. [PMID: 37725913 DOI: 10.1159/000534052] [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: 06/04/2023] [Accepted: 08/24/2023] [Indexed: 09/21/2023]
Abstract
INTRODUCTION While Asian and Native Hawaiian and other Pacific Islander (NHOPI) patients have a high prevalence of kidney disease risk factors, there are sparse data examining their end-stage kidney disease (ESKD) outcomes. As Hawaii has high representation of Asian and NHOPI individuals, we compared their ESKD outcomes based on residence in the mainland USA versus Hawaii/Pacific Islands (PIs). MATERIALS AND METHODS Using United States Renal Data System data, we examined the impact of geographic residence in the mainland versus Hawaii/PIs on race-mortality associations among incident ESKD patients transitioning to dialysis over January 1, 2000-December 31, 2016 using Cox regression. We examined likelihood of post-dialysis kidney transplantation using Cox models and cumulative incidence curves. RESULTS Compared with White patients in the mainland, Asian and NHOPI patients in the mainland had lower mortality: adjusted HRs (95% CIs) 0.67 (0.66-0.67) and 0.72 (0.70-0.73), respectively. When examining Asian and NHOPI patients in Hawaii/PIs, survival benefit was attenuated in Asian and diminished to the null in NHOPI patients (ref: mainland White patients). Cumulative incidence curves comparing Asian, NHOPI, and White patients showed Asian and NHOPI patients in the mainland had the highest likelihood of transplantation, whereas NHOPI and Asian patients in Hawaii/PIs had the lowest likelihood. CONCLUSION In the mainland, Asian and NHOPI patients had lower mortality versus White patients, whereas in Hawaii/PIs, this survival benefit was diminished in Asian and mitigated in NHOPI patients. NHOPI and Asian patients in Hawaii/PIs had less transplantation versus those in the mainland. Further research is needed to uncover factors contributing to differential ESKD outcomes among Asian and NHOPI patients across geographic residence.
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Affiliation(s)
- Amy S You
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine, Orange, California, USA
| | - Keith C Norris
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Merle Kataoka-Yahiro
- Department of Nursing, Nancy Atmospera-Walch School of Nursing, University of Hawaii at Manoa, Honolulu, Hawaii, USA
| | - James Davis
- Office of Biostatistics and Quantitative Health Sciences, John A. Burns School of Medicine, Honolulu, Hawaii, USA
| | - Victoria Page
- National Kidney Foundation-Hawaii, Honolulu, Hawaii, USA
| | - Glen Hayashida
- National Kidney Foundation-Hawaii, Honolulu, Hawaii, USA
| | - Yoko Narasaki
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine, Orange, California, USA
| | - Shiuh Feng Cheng
- Department of Medicine, John A. Burns School of Medicine, Honolulu, Hawaii, USA
| | - Roland Ng
- Department of Medicine, John A. Burns School of Medicine, Honolulu, Hawaii, USA
| | - Linda L Wong
- Department of Surgery, John A. Burns School of Medicine, Honolulu, Hawaii, USA
- Department of Surgery, Queens Medical Center, Honolulu, Hawaii, USA
| | - Lung-Yi Lee
- Department of Surgery, John A. Burns School of Medicine, Honolulu, Hawaii, USA
- Department of Surgery, Queens Medical Center, Honolulu, Hawaii, USA
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine, Orange, California, USA
- Nephrology Section, Tibor Rubin Veterans Affairs Medical Center, Long Beach, California, USA
| | - Connie M Rhee
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine, Orange, California, USA
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15
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April-Sanders AK, Karaboyas A, Yunes M, Norris KC, Dominguez M, Kim RS, Isasi CR, Golestaneh L. Receiving hemodialysis in Hispanic ethnic dense communities is associated with better adherence and outcomes among young patients: a retrospective analysis of the Dialysis Outcomes and Practice Patterns Study. BMC Nephrol 2023; 24:263. [PMID: 37670225 PMCID: PMC10478353 DOI: 10.1186/s12882-023-03297-w] [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: 04/17/2023] [Accepted: 08/11/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Hispanic ethnic density (HED) is a marker of better health outcomes among Hispanic patients with chronic disease. It is unclear whether community HED is associated with mortality risk among ethnically diverse patients receiving maintenance hemodialysis. METHODS A retrospective analysis of patients in the United States cohort of the Dialysis Outcomes and Practice Patterns Study (DOPPS) database (2011-2015) was conducted (n = 4226). DOPPS data was linked to the American Community Survey database by dialysis facility zip code to obtain % Hispanic residents (HED). One way ANOVA and Kruskal Wallis tests were used to estimate the association between tertiles of HED with individual demographic, clinical and adherence characteristics, and facility and community attributes. Multivariable Cox proportional hazards models were used to estimate the mortality hazard ratio (HR) and 95% CIs by tertile of HED, stratified by age; a sandwich estimator was used to account for facility clustering. RESULTS Patients dialyzing in facilities located in the highest HED tertile communities were younger (61.4 vs. 64.4 years), more commonly non-White (62.4% vs. 22.1%), had fewer comorbidities, longer dialysis vintage, and were more adherent to dialysis treatment, but had fewer minutes of dialysis prescribed than those in the lowest tertile. Dialyzing in the highest HED tertile was associated with lower hazard of mortality (HR, 0.86; 95% CI, 0.72-1.00), but this association attenuated with the addition of individual race/ethnicity (HR, 0.92; 95% CI, 0.78-1.09). In multivariable age-stratified analyses, those younger than 64 showed a lower hazard for mortality in the highest (vs. lowest) HED tertile (HR, 0.66; 95% CI, 0.49-0.90). Null associations were observed among patients ≥ 64 years. CONCLUSIONS Treating in communities with greater HED and racial/ethnic integration was associated with lower mortality among younger patients which points to neighborhood context and social cohesion as potential drivers of improved survival outcomes for patients receiving hemodialysis.
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Affiliation(s)
- Ayana K April-Sanders
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, 683 Hoes Lane West Piscataway, 08854, NJ, USA.
| | | | - Milagros Yunes
- Renal Division, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Keith C Norris
- Division of General Internal Medicine and Nephrology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
| | - Mary Dominguez
- Renal Division, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Ryung S Kim
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Ave, 10461, Bronx, NY, USA
| | - Carmen R Isasi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Ave, 10461, Bronx, NY, USA
| | - Ladan Golestaneh
- Renal Division, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
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Garcia-Garcia G, Norris KC, Sahay M, Ulasi II. Editorial: Social determinants of kidney health: a global perspective. Front Nephrol 2023; 3:1260221. [PMID: 37675345 PMCID: PMC10479554 DOI: 10.3389/fneph.2023.1260221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/02/2023] [Indexed: 09/08/2023]
Affiliation(s)
- Guillermo Garcia-Garcia
- Department of Medical Clinics, University of Guadalajara Health Sciences Center, Guadalajara, Mexico
| | - Keith C. Norris
- Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, United States
| | - Manisha Sahay
- Department of Nephrology, Osmania Medical College and Hospital, Hyderabad, India
| | - Ifeoma I. Ulasi
- Department of Medicine, University of Nigeria College of Medicine, Enugu, Nigeria
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17
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Kang D, Huang CX, Yuen AD, Norris KC, Vijayan T. Do hospitals that participate in COVID-19 research differ from non-trial hospitals? A cross-sectional study of US hospitals. Trials 2023; 24:504. [PMID: 37550662 PMCID: PMC10408090 DOI: 10.1186/s13063-023-07450-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/10/2023] [Indexed: 08/09/2023] Open
Abstract
OBJECTIVES To compare hospitals that did and did not participate in clinical trials evaluating potential inpatient COVID-19 therapeutics. METHODS We conducted a cross-sectional study of hospitals participating in trials that were registered on clinicaltrials.gov between April and August 2020. Using the 2019 RAND Hospital Dataset and 2019 American Community Survey, we used logistic regression modeling to compare hospital-level traits including demographic features between trial and non-trial hospitals. RESULTS We included 488 hospitals that were participating in 298 interventional trials and 4232 non-participating hospitals. After controlling for demographic and other hospital traits, we found that teaching status (OR 2.11, 95% CI 1.52-2.95), higher patient acuity (OR 7.48, 4.39, 13.1), and location in the Northeast (OR 1.83, 95% CI 1.18, 2.85) and in wealthier counties (OR: 1.32, 95% CI 1.16-1.51) were associated with increased odds of trial participation, while being in counties with more White residents was associated with reduced odds (OR 0.98, 95% CI 0.98-0.99). CONCLUSIONS Hospitals participating and not participating in COVID-19 inpatient treatment clinical trials differed in many ways, resulting in important implications for the generalizability of trial data.
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Affiliation(s)
- Daniel Kang
- University of Illinois, Urbana Champaign, Champaign, USA.
| | - Cher X Huang
- Department of Medicine, Massachusetts General Hospital, Boston, USA
| | - Alexander D Yuen
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, USA
| | - Keith C Norris
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, USA
| | - Tara Vijayan
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, USA
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Laster M, Kozman D, Norris KC. Addressing Structural Racism in Pediatric Clinical Practice. Pediatr Clin North Am 2023; 70:725-743. [PMID: 37422311 DOI: 10.1016/j.pcl.2023.03.010] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/10/2023]
Abstract
Structural racism is the inequitable allocation of various social determinants of health to different communities. Exposure to this and other discrimination levied from intersectional identities is the primary driver of disproportionately adverse health outcomes for minoritized children and their families. Pediatric clinicians must vigilantly identify and mitigate racism in health care systems and delivery, assess for any impact of patient and family exposure to racism and direct them to appropriate health resources, foster an environment of inclusion and respect, and ensure that all care is delivered through a race-conscious lens with the utmost cultural humility and shared decision-making.
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Affiliation(s)
- Marciana Laster
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA; Division of Pediatric Nephrology, UCLA Department of Pediatrics, 10833 Le Conte Avenue, MDCC A2-383, Los Angeles, CA 90095-1752, USA
| | - Daniel Kozman
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA; UCLA Department of Medicine, Section of Medicine-Pediatrics & Preventive Medicine
| | - Keith C Norris
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA; Division of General Internal Medicine and Health Services Research, UCLA Department of Medicine, 1100 Glendon Avenue, Suite 710, Los Angeles, CA 90024, USA.
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19
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Chambers EC, Norris KC, Levano SR, Golestaneh L. Extreme Heat Can Exacerbate Disproportionate Burden of Severe Kidney Disease in Historically Marginalized Communities: Call to Action. Clin J Am Soc Nephrol 2023; 18:1089-1091. [PMID: 36758149 PMCID: PMC10564337 DOI: 10.2215/cjn.0000000000000113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/26/2023] [Indexed: 02/11/2023]
Affiliation(s)
- Earle C. Chambers
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Keith C. Norris
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Samantha R. Levano
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Ladan Golestaneh
- Nephrology Division, Department of Medicine Albert Einstein College of Medicine, Bronx, New York
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Mansfield LN, Carson SL, Sunku N, Troutt A, Jackson S, Santillan D, Vassar SD, Slaughter D, Kim G, Norris KC, Brown AF. Community-based organization perspectives on participating in state-wide community canvassing program aimed to reduce COVID-19 vaccine disparities in California. BMC Public Health 2023; 23:1356. [PMID: 37452299 PMCID: PMC10349443 DOI: 10.1186/s12889-023-16210-9] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Inequities in COVID-19 vaccine accessibility and reliable COVID-related information disproportionately affected marginalized racial and ethnic communities in the U.S. The Get Out the Vaccine (GOTVax) program, an innovative statewide government-funded COVID-19 vaccine canvassing program in California, aimed to reduce structural barriers to COVID-19 vaccination in high-risk communities with low vaccination rates. GOTVax consisted of a community-academic-government partnership with 34 local trusted community-based organizations' (CBOs) to conduct COVID-19 vaccine outreach, education, and vaccine registration. The purpose of this qualitative evaluation study was to explore the barriers and facilitators of using local CBOs to deploy a geographically, racially, and ethnically diverse state-wide COVID-19 vaccine outreach program. METHODS Semi-structured online interviews were conducted with participating GOTVax CBO leaders from November 2021 to January 2022. Transcripts were analyzed using reflexive thematic analysis. RESULTS Thirty-one of 34 CBOs participated (91% response rate). Identified themes encompassed both facilitators and barriers to program participation. Key facilitators included leveraging trust through recognized entities; promoting empathetic, tailored outreach; and flexibility of milestone-based CBO funding contracts for rapid program implementation. Barriers included navigating community sociopolitical, geographic, and cultural factors; managing canvassers' safety; desiring metrics for self-evaluation of outreach success; mitigating canvassing technology challenges; and concerns of program infrastructure initially limiting outreach. CBOs problem-solved barriers with academic and government partners. CONCLUSIONS Between May and December 2021, the GOTVax program reached over 2 million California residents and registered over 60,000 residents for COVID-19 vaccination. Public health campaigns may improve benefits from leveraging the expertise of community-trusted CBOs and universities by providing flexible infrastructure and funding, allowing CBOs to seamlessly tailor outreach most applicable to local minoritized communities.
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Affiliation(s)
- Lisa N Mansfield
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Savanna L Carson
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Nisha Sunku
- Olive View-UCLA Medical Center, Sylmar, CA, USA
| | - Alana Troutt
- California Government Operations Agency, State of California, Sacramento, CA, USA
- San Francisco Health Plan, San Francisco, California, United States
| | | | | | - Stefanie D Vassar
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Dale Slaughter
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Gloria Kim
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Keith C Norris
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Arleen F Brown
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Olive View-UCLA Medical Center, Sylmar, CA, USA
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Day HD, Benjamin EJ, Lamba S, Norris KC, Pfund C, Soto-Greene ML. Fostering Success and Promoting Professional Development of Clinician Educator Mentees: A Workshop for Mentors. MedEdPORTAL 2023; 19:11321. [PMID: 37383077 PMCID: PMC10293477 DOI: 10.15766/mep_2374-8265.11321] [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] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 03/16/2023] [Indexed: 06/30/2023]
Abstract
Introduction The goal of academic mentoring relationships is to enable the mentee to identify/achieve professional advancement. Although mentors of clinician educators (CEs) must understand the criteria for successful career advancement, few have received formal CE mentor training. Methods The National Research Mentoring Network convened an expert panel to develop a 90-minute module for training CE mentors. This module included individual development plans, case studies involving challenges for CE faculty, and examples of the broadened scope of scholarly activity. The workshop was delivered to 26 participants across four institutions and evaluated by a retrospective pre/post survey. Results Using a 7-point scale (1 = very low, 4 = average, 7 = very high), participants rated the overall quality of their CE mentoring as slightly below average preworkshop (M = 3.9) and as above average postworkshop (M = 5.2, p < .001). Areas of greatest self-perceived change in skills on a 7-point scale (1 = not at all skilled, 4 = moderately skilled, 7 = extremely skilled ) included setting clear expectations of the mentoring relationship (pre M = 3.6, post M = 5.1, p < .001), aligning mentor expectations with those of mentees (pre M = 3.6, post M = 5.0, p < .001), and helping mentees set career goals (pre M = 3.9, post M = 5.4, p < .001). Discussion This module trains CE mentors using an interactive and collective problem-solving approach. Workshop participants better defined demonstrable markers for CE progression with potential to impact tailored guidance for mentees.
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Affiliation(s)
- Hollis D. Day
- Associate Professor, Department of Medicine, Boston Medical Center/Boston University Chobanian & Avedisian School of Medicine
| | - Emelia J. Benjamin
- Professor, Department of Medicine, Boston Medical Center/Boston University Chobanian & Avedisian School of Medicine; Professor, Department of Epidemiology, Boston University School of Public Health
| | - Sangeeta Lamba
- Professor, Department of Emergency Medicine, Rutgers New Jersey Medical School; Vice Chancellor for Diversity and Inclusion, Rutgers Biomedical and Health Sciences
| | - Keith C. Norris
- Professor, Department of Medicine, University of California, Los Angeles
| | - Christine Pfund
- Senior Scientist, Wisconsin Center for Education Research and Institute for Clinical and Translational Science, University of Wisconsin–Madison
| | - Maria L. Soto-Greene
- Professor, Department of Medicine, and Executive Vice Dean, Rutgers New Jersey Medical School
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Norris KC, Williams SF, Nee R. Flattening the Playing Field for Treatment of Diabetic Kidney Disease. Semin Nephrol 2023; 43:151428. [PMID: 37865981 DOI: 10.1016/j.semnephrol.2023.151428] [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: 10/24/2023]
Abstract
Diabetic kidney disease (DKD) remains a major health care issue and is beset with significant racial and ethnic disparities in regard to its incidence, progression, and complication rate. An individual's health is influenced strongly by an array of societal-level factors commonly called the social determinants of health. Among these, DKD is influenced highly by structured resources and opportunities, as well as an individual's socioeconomic status, health insurance status, access to care, education, health literacy, nutrition, green space exposure, level of trust in the medical community, and more. Health equity is considered a state in which everyone has a fair and just opportunity to attain his or her highest level of health. Conversely, health inequities are a consequence of a structured discriminatory system of inequitable allocation of social determinants of health. When this discriminatory system is race-based it is referred to as structural racism, which eventually leads to racial and ethnic health disparities. The further downstream sequela of structural racism, consciously or unconsciously, impacts health systems, providers, and patients, and can lead to disparities in DKD development, progression, and complications. In this article, we explore potential interventions at the societal, health system, and provider levels that can help flatten the playing field and reduce racial and ethnic disparities in DKD.
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Affiliation(s)
- Keith C Norris
- Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA.
| | - Sandra F Williams
- Department of Integrated Medical Science, Florida Atlantic University, Boca Raton, FL
| | - Robert Nee
- Nephrology Service, Walter Reed National Military Medical Center, Department of Medicine, Uniformed Services University, Bethesda, MD
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Eneanya ND, Adingwupu OM, Kostelanetz S, Norris KC, Greene T, Lewis JB, Beddhu S, Boucher R, Miao S, Chaudhari J, Levey AS, Inker LA. Social Determinants of Health and Their Impact on the Black Race Coefficient in Serum Creatinine-Based Estimation of GFR: Secondary Analysis of MDRD and CRIC Studies. Clin J Am Soc Nephrol 2023; 18:446-454. [PMID: 36723299 PMCID: PMC10103283 DOI: 10.2215/cjn.0000000000000109] [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: 09/28/2022] [Accepted: 01/20/2023] [Indexed: 02/02/2023]
Abstract
BACKGROUND The cause for differences in serum creatinine between Black and non-Black individuals incorporated into prior GFR-estimating equations is not understood. We explored whether social determinants of health can account for this difference. METHODS We conducted a secondary analysis of baseline data of the Modification of Diet in Renal Disease and Chronic Renal Insufficiency Cohort studies ( N =1628 and 1423, respectively). Data in both study cohorts were stratified by race (Black versus non-Black). We first evaluated the extent to which the coefficient of Black race in estimating GFR from creatinine is explained by correlations of race with social determinants of health and non-GFR determinants of creatinine. Second, we evaluated whether the difference between race groups in adjusted mean creatinine can be explained by social determinants of health and non-GFR determinants of creatinine. RESULTS In models regressing measured GFR on creatinine, age, sex, and race, the coefficient for Black race was 21% (95% confidence interval, 0.176 to 0.245) in Modification of Diet in Renal Disease and 13% (95% confidence interval, 0.097 to 0.155) in the Chronic Renal Insufficiency Cohort and was not attenuated by the addition of social determinants of health, alone or in combination. In both studies, the coefficient for Black race was larger at lower versus higher income levels. In models, regressing creatinine on measured GFR, age, and sex, mean creatinine was higher in Black versus non-Black participants in both studies, with no effect of social determinants of health. CONCLUSIONS Adjustment for selected social determinants of health did not influence the relationship between Black race and creatinine-based estimated GFR.
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Affiliation(s)
- Nwamaka D. Eneanya
- Department of Medicine, Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ogechi M. Adingwupu
- Department of Medicine, Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | | | - Keith C. Norris
- Department of Medicine, VA Greater Los Angeles Healthcare System, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Tom Greene
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Julia B. Lewis
- Department of Medicine, Division of Nephrology, Vanderbilt University, Nashville, Tennessee
| | - Srinivasan Beddhu
- Department of Internal Medicine, Division of Nephrology & Hypertension, University of Utah Health Sciences, Salt Lake City, Utah
| | - Robert Boucher
- Department of Internal Medicine, Division of Nephrology & Hypertension, University of Utah Health Sciences, Salt Lake City, Utah
| | - Shiyuan Miao
- Department of Medicine, Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - Juhi Chaudhari
- Department of Medicine, Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - Andrew S. Levey
- Department of Medicine, Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - Lesley A. Inker
- Department of Medicine, Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
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Abstract
OBJECTIVE To assess inequities in mortality by race and sex for eight common surgical procedures (elective and non-elective) across specialties in the United States. DESIGN Retrospective cohort study. SETTING US, 2016-18. PARTICIPANTS 1 868 036 Black and White Medicare beneficiaries aged 65-99 years undergoing one of eight common surgeries: repair of abdominal aortic aneurysm, appendectomy, cholecystectomy, colectomy, coronary artery bypass surgery, hip replacement, knee replacement, and lung resection. MAIN OUTCOME MEASURE The main outcome measure was 30 day mortality, defined as death during hospital admission or within 30 days of the surgical procedure. RESULTS Postoperative mortality overall was higher in Black men (1698 deaths, adjusted mortality rate 3.05%, 95% confidence interval 2.85% to 3.24%) compared with White men (21 833 deaths, 2.69%, 2.65% to 2.73%), White women (21 847 deaths, 2.38%, 2.35% to 2.41%), and Black women (1631 deaths, 2.18%, 2.04% to 2.31%), after adjusting for potential confounders. A similar pattern was found for elective surgeries, with Black men showing a higher adjusted mortality (393 deaths, 1.30%, 1.14% to 1.46%) compared with White men (5650 deaths, 0.85%, 0.83% to 0.88%), White women (4615 deaths, 0.82%, 0.80% to 0.84%), and Black women (359 deaths, 0.79%, 0.70% to 0.88%). This 0.45 percentage point difference implies that mortality after elective procedures was 50% higher in Black men compared with White men. For non-elective surgeries, however, mortality did not differ between Black men and White men (1305 deaths, 6.69%, 6.26% to 7.11%; and 16 183 deaths, 7.03%, 6.92% to 7.14%, respectively), although mortality was lower for White women and Black women (17 232 deaths, 6.12%, 6.02% to 6.21%; and 1272 deaths, 5.29%, 4.93% to 5.64%, respectively). These differences in mortality appeared within seven days after surgery and persisted for up to 60 days after surgery. CONCLUSIONS Postoperative mortality overall was higher among Black men compared with White men, White women, and Black women. These findings highlight the need to understand better the unique challenges Black men who require surgery face.
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Affiliation(s)
- Dan P Ly
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Mariah B Blegen
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- National Clinician Scholars Program, UCLA, Los Angeles, CA, USA
| | - Melinda M Gibbons
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Keith C Norris
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Yusuke Tsugawa
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA 90024, USA
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Nee R, Yuan CM, Narva AS, Yan G, Norris KC. Overcoming barriers to implementing new guideline-directed therapies for chronic kidney disease. Nephrol Dial Transplant 2023; 38:532-541. [PMID: 36264305 PMCID: PMC9976771 DOI: 10.1093/ndt/gfac283] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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: 06/25/2022] [Indexed: 11/13/2022] Open
Abstract
For the first time in many years, guideline-directed drug therapies have emerged that offer substantial cardiorenal benefits, improved quality of life and longevity in patients with chronic kidney disease (CKD) and type 2 diabetes. These treatment options include sodium-glucose cotransporter-2 inhibitors, nonsteroidal mineralocorticoid receptor antagonists and glucagon-like peptide-1 receptor agonists. However, despite compelling evidence from multiple clinical trials, their uptake has been slow in routine clinical practice, reminiscent of the historical evolution of angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker use. The delay in implementation of these evidence-based therapies highlights the many challenges to optimal CKD care, including: (i) clinical inertia; (ii) low CKD awareness; (iii) suboptimal kidney disease education among patients and providers; (iv) lack of patient and community engagement; (v) multimorbidity and polypharmacy; (vi) challenges in the primary care setting; (vii) fragmented CKD care; (viii) disparities in underserved populations; (ix) lack of public policy focused on health equity; and (x) high drug prices. These barriers to optimal cardiorenal outcomes can be ameliorated by a multifaceted approach, using the Chronic Care Model framework, to include patient and provider education, patient self-management programs, shared decision making, electronic clinical decision support tools, quality improvement initiatives, clear practice guidelines, multidisciplinary and collaborative care, provider accountability, and robust health information technology. It is incumbent on the global kidney community to take on a multidimensional perspective of CKD care by addressing patient-, community-, provider-, healthcare system- and policy-level barriers.
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Affiliation(s)
- Robert Nee
- Nephrology Service, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Department of Medicine, Uniformed Services University, Bethesda, MD, USA
| | - Christina M Yuan
- Nephrology Service, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Department of Medicine, Uniformed Services University, Bethesda, MD, USA
| | - Andrew S Narva
- College of Agriculture, Urban Sustainability and Environmental Studies, University of the District of Columbia, Washington, DC, USA
| | - Guofen Yan
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Keith C Norris
- Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
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Cohen-Winans S, Heitman E, Bruce MA, Thorpe RJ, Norris KC, Newton RL, Beech BM. Abstract P440: Household Physical Activity is Not Associated With Hypertension Among African Americans: The Jackson Heart Study. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p440] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Introduction:
Hypertension (HTN) develops at a disproportionately higher rate among African Americans compared to any other racial group. Substantial evidence indicates that aerobic exercise mitigates HTN. However, only 41% of African Americans report meeting leisure-time aerobic exercise recommendations, the lowest percentage compared to other racial groups. Household activities have been reported as the most common, daily PA among African Americans compared to occupational and leisure-time PA. Household activities, such as major cleaning and caretaking, are a type of light-to-moderate intensity PA that is associated with blood pressure (BP) reductions. Among African Americans, women report higher levels of household tasks than men.
Hypothesis:
We assessed the hypothesis that the association between household PA and HTN among African Americans varies by sex.
Methods:
The JHS is a longitudinal, community-based, observational study among African Americans residing in Jackson, Mississippi’s tri-county area. Of the 5,306 African American participants from JHS’s Exam 1, 1,419 had missing data on key variables, leaving a total of 3,887 for the analytic sample. HTN, the outcome variable, was defined using JNC-7’s standards, systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90mmHg, given that baseline data was collected between 2000-04. Household PA, the primary independent variable, was categorized as high or low frequency. PA was assessed at the baseline, in-home interview using the 30-item JHS PA Survey, which is a modification of the Baecke and Atherosclerosis Risk in the Community activity questionnaires. Sociodemographic characteristics, cardiovascular disease risk factors, and area-level factors were included as covariates. Total sample and sex-stratified multivariable logistic regression models were estimated to examine the association between household PA and HTN using STATA/SE Version 16.
Results:
Approximately 55% of the sample had HTN and 65.6% reported low frequency household PA. A significant difference in HTN status was found. The proportion of those with HTN was lower for those reporting high frequency household PA than the corresponding percentage for low frequency household PA (OR = 0.78, 95% CI: 0.69-0.90). A greater percentage of individuals under age 50 reported high frequency household PA. This association did not hold in the adjusted models. Household PA was not related to HTN (OR = 0.90, 95% CI: 0.74-1.09). The interaction term between household PA and sex was not associated with HTN (OR = 1.06, 95% CI: 0.77-1.44). Age was a confounder that attenuated the association.
Conclusions:
In conclusion, we found that household activities are not associated with HTN; however, this type of light-to-moderate intensity PA may be beneficial for improving BP among African Americans, especially among those who are otherwise physically inactive.
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Rizk JG, Streja E, Wenziger C, Shlipak MG, Norris KC, Crowley ST, Kalantar-Zadeh K. Serum Creatinine-to-Cystatin-C Ratio as a Potential Muscle Mass Surrogate and Racial Differences in Mortality. J Ren Nutr 2023; 33:69-77. [PMID: 34923112 DOI: 10.1053/j.jrn.2021.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 08/03/2021] [Revised: 11/02/2021] [Accepted: 11/22/2021] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES Serum creatinine-based estimated glomerular filtration rate equations and muscle mass are powerful markers of health and mortality risk. However, the serum creatinine-to-cystatin-C ratio may be a better indicator of health status. The objective of this study was to describe the relationship between creatinine-to-cystatin-C ratio and all-cause mortality when stratifying patients as per race and as per chronic kidney disease status. METHODS This was a retrospective cohort study examining black and nonblack US veterans between October 2004 and September 2019, with baseline cystatin C and creatinine data from those not on dialysis during the study period. Veterans were divided into four creatinine-to-cystatin-C ratio groups: <0.75, 0.75-<1.00, 1.0-<1.25, and ≥1.25. The primary outcome of interest was all-cause mortality subsequent to the cystatin C laboratory measure. RESULTS Among 22,316 US veterans, the mean (± standard deviation) age of the cohort was 67 ± 14 years, 5% were female, 82% were nonblack, and 18% were black. The proportion of black veterans increased across creatinine-to-cystatin-C ratio groups. In the fully adjusted model, compared with the reference (creatinine-to-cystatin-C ratio: 1.00-<1.25), a creatinine-to-cystatin-C ratio <0.75 had the highest mortality risk among both black and nonblack veterans (nonblack: hazard ratio [HR] [95% confidence interval {CI}]: 3.01 [2.78-3.26] and black: 4.17 [3.31-5.24]). A creatinine-to-cystatin-ratio ≥1.25 was associated with lower death risk than the referent in both groups (nonblack: HR [95% CI]: 0.89 [0.80-0.99] and black: HR [95% CI]: 0.55 [0.45-0.69]). However, there was a significant difference in the effect by race (Wald's P-value: <0.01). CONCLUSIONS Higher creatinine-to-cystatin-C ratios indicate better health status and are strongly associated with lower mortality risk regardless of the kidney function level, and the relation was similar for both black and nonblack veterans, but with different strengths of effect across racial groups. Thereby, use of a fixed race coefficient in estimating kidney function may be biased.
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Affiliation(s)
- John G Rizk
- Department of Pharmaceutical Health Services Research, University of Maryland, Baltimore, MD
| | - Elani Streja
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA; Division of Nephrology, Tibor Rubin VA Medical Center, Long Beach, CA.
| | - Cachet Wenziger
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA; Division of Nephrology, Tibor Rubin VA Medical Center, Long Beach, CA
| | - Michael G Shlipak
- Kidney Health Research Collaborative, Department of Medicine, University of California San Francisco and San Francisco VA Medical Center, San Francisco, CA
| | | | | | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA; Division of Nephrology, Tibor Rubin VA Medical Center, Long Beach, CA
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Madievsky R, Vu A, Cheng F, Chon J, Turk N, Krueger A, Krong J, Maranon R, Liu S, Han CS, Norris KC, Mangione C, Page J, Thomas S, Duru OK, Moin T. A randomized controlled trial of a shared decision making intervention for diabetes prevention for women with a history of gestational diabetes mellitus: The Gestational diabetes Risk Attenuation for New Diabetes (GRAND study). Contemp Clin Trials 2023; 124:107007. [PMID: 36384219 PMCID: PMC10642368 DOI: 10.1016/j.cct.2022.107007] [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: 07/20/2022] [Revised: 10/14/2022] [Accepted: 11/10/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a risk factor for the development of type 2 diabetes. Metformin and lifestyle change through a Diabetes Prevention Program (DPP) are equally effective in preventing diabetes in patients with a GDM history, so women can choose a strategy based on their preferences. This study aims to test whether shared decision making (SDM) can help women with a history of GDM increase adoption of evidence-based strategies and lose weight to lower their risk of incident diabetes in real-world settings. METHODS This pragmatic randomized controlled trial (RCT) will test the effectiveness of SDM for diabetes prevention among 310 overweight/obese women with a history of GDM and prediabetes from two large health care systems (n = 155 from UCLA Health and n = 155 from Intermountain Healthcare). The primary outcome is the proportion of participants who lose ≥5% body weight at 12 months. Secondary outcomes include uptake of DPP and/or metformin and other patient-reported outcomes such as patient activation and health-related quality of life. Rates of GDM in a subsequent pregnancy will be an exploratory outcome. A descriptive analysis of costs related to SDM implementation will also be conducted. CONCLUSION This is the first RCT to examine the effectiveness of SDM on weight loss, lifestyle change and/or metformin use, and other patient-reported outcomes in participants with a GDM history at risk of developing diabetes. TRIAL REGISTRATION ClinicalTrials.gov, NCT03766256. Registered on 6 December 2018.
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Affiliation(s)
- Ruth Madievsky
- Department of Medicine, Division of General Internal Medicine-Health Services Research, University of California, 1100 Glendon Ave STE 850, Los Angeles, CA 90024, USA.
| | - Amanda Vu
- Department of Medicine, Division of General Internal Medicine-Health Services Research, University of California, 1100 Glendon Ave STE 850, Los Angeles, CA 90024, USA.
| | - Felicia Cheng
- Department of Medicine, Division of General Internal Medicine-Health Services Research, University of California, 1100 Glendon Ave STE 850, Los Angeles, CA 90024, USA.
| | - Janet Chon
- Department of Medicine, Division of General Internal Medicine-Health Services Research, University of California, 1100 Glendon Ave STE 850, Los Angeles, CA 90024, USA.
| | - Norman Turk
- Department of Medicine, Division of General Internal Medicine-Health Services Research, University of California, 1100 Glendon Ave STE 850, Los Angeles, CA 90024, USA.
| | - Ashley Krueger
- Healthcare Delivery Institute, Office of Research, Intermountain Healthcare, 5026 S. State St, Murray, UT 84107, USA.
| | - Jacob Krong
- Healthcare Delivery Institute, Office of Research, Intermountain Healthcare, 5026 S. State St, Murray, UT 84107, USA.
| | - Richard Maranon
- Department of Medicine, Division of General Internal Medicine-Health Services Research, University of California, 1100 Glendon Ave STE 850, Los Angeles, CA 90024, USA.
| | - Sandra Liu
- Department of Medicine, Division of General Internal Medicine-Health Services Research, University of California, 1100 Glendon Ave STE 850, Los Angeles, CA 90024, USA.
| | - Christina S Han
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, 200 Medical Plaza, Suite 430, Los Angeles, CA 90095, USA.
| | - Keith C Norris
- Department of Medicine, Division of General Internal Medicine-Health Services Research, University of California, David Geffen School of Medicine at UCLA, 1100 Glendon Ave STE 850, Los Angeles, CA 90024, USA.
| | - Carol Mangione
- Department of Medicine, Division of General Internal Medicine-Health Services Research, University of California, David Geffen School of Medicine at UCLA, 1100 Glendon Ave STE 850, Los Angeles, CA 90024, USA; Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA, USA.
| | - Jessica Page
- Department of Maternal-Fetal Medicine, Intermountain Healthcare. Department of Maternal-Fetal Medicine, University of Utah Health, 8th Ave & C St E, Salt Lake City, UT 84143, USA.
| | - Samuel Thomas
- Department of Internal Medicine, Intermountain Healthcare, 5121 Cottonwood St, Murray, UT 84017, USA.
| | - O Kenrik Duru
- Department of Medicine, Division of General Internal Medicine-Health Services Research, University of California, David Geffen School of Medicine at UCLA, 1100 Glendon Ave STE 850, Los Angeles, CA 90024, USA.
| | - Tannaz Moin
- Department of Medicine, Division of General Internal Medicine-Health Services Research, University of California, 1100 Glendon Ave STE 850, Los Angeles, CA 90024, USA; HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA; Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, UCLA, Los Angeles, CA 90024, USA.
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Lopes MB, Silveira-Martins MT, Albuquerque da Silva F, Silva LF, Silva-Martins MT, Matos CM, Kraychete AC, Norris KC, James SA, Lopes AA. Race and Mortality in Hemodialysis Patients in Brazil. Kidney Med 2022; 4:100557. [DOI: 10.1016/j.xkme.2022.100557] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Olabisi OA, Nicholas SB, Norris KC. Race, Ancestry, and Genetic Risk for Kidney Failure. Am J Kidney Dis 2022; 80:801-804. [PMID: 36100174 PMCID: PMC10832888 DOI: 10.1053/j.ajkd.2022.08.008] [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] [Received: 07/01/2022] [Accepted: 08/31/2022] [Indexed: 02/02/2023]
Affiliation(s)
- Opeyemi A Olabisi
- Department of Medicine, Duke Molecular Physiology Institute, Duke University, Durham, North Carolina
| | - Susanne B Nicholas
- Department of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Keith C Norris
- Department of Medicine, University of California, Los Angeles, Los Angeles, California.
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31
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Booker R, Holmes ME, Newton RL, Norris KC, Thorpe RJ, Carnethon MR. Compositional analysis of movement behaviors' association on high-sensitivity c-reactive protein: the Jackson heart study. Ann Epidemiol 2022; 76:7-12. [PMID: 36210008 PMCID: PMC9879574 DOI: 10.1016/j.annepidem.2022.09.009] [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: 06/28/2022] [Revised: 09/22/2022] [Accepted: 09/29/2022] [Indexed: 01/28/2023]
Abstract
PURPOSE Movement behaviors (i.e. physical activity [PA], sedentary behavior [SB], and sleep) are intrinsically codependent, an issue resolved using compositional data analysis (CoDA). High-sensitivity C-reactive protein (hs-CRP) is a nonspecific inflammatory marker positively associated with cardiovascular diseases and affected by movement behaviors. Examine the relation between movement behaviors using CoDA and how time reallocation between two movement behaviors was associated with hs-CRP concentration. METHODS The Jackson Heart Study was designed to investigate cardiovascular disease risk factors among African American participants in the Jackson, MS area. PA and sleep were self-reported with SB calculated as the remaining time in the day. RESULTS The median untransformed hs-CRP concentration was 0.28 mg·dL-1 (interquartile range; 0.11, 0.61). Reallocating 15 minutes of PA with SB, the hypothetical change in log hs-CRP concentration was 0.08 mg·dL-1 (95% CIs; 0.04, 0.11) greater than the average log hs-CRP concentration. Substituting 15 minutes of SB or sleep with PA was associated with a hypothetical change in log hs-CRP concentration difference of -0.05 mg·dL-1 (-0.08, -0.03) and -0.06 mg·dL-1 (-0.08, -0.03), respectively. Reallocations between SB and sleep were not associated with the hypothetical difference in log hs-CRP concentration. CONCLUSIONS Modeling estimates suggest replacing 15 minutes of SB with PA is associated with lower inflammation.
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Affiliation(s)
- Robert Booker
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | - Megan E Holmes
- Department of Kinesiology, Mississippi State University, Mississippi State, MS
| | | | - Keith C Norris
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Roland J Thorpe
- Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, John Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Crews DC, Patzer RE, Cervantes L, Knight R, Purnell TS, Powe NR, Edwards DP, Norris KC. Designing Interventions Addressing Structural Racism to Reduce Kidney Health Disparities: A Report from a National Institute of Diabetes and Digestive and Kidney Diseases Workshop. J Am Soc Nephrol 2022; 33:2141-2152. [PMID: 36261301 PMCID: PMC9731627 DOI: 10.1681/asn.2022080890] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 01/06/2023] Open
Abstract
Structural racism embodies the many ways in which society fosters racial discrimination through "mutually reinforcing inequitable systems" that limit access to resources and opportunities that can promote health and well being among marginalized communities. To achieve health equity, and kidney health equity more specifically, structural racism must be eliminated. In February 2022, the National Institute of Diabetes and Digestive and Kidney Diseases convened the "Designing Interventions that Address Structural Racism to Reduce Kidney Health Disparities" workshop, which was aimed at describing the mechanisms through which structural racism contributes to health and health care disparities for people along the continuum of kidney disease and identifying actionable opportunities for interventional research focused on dismantling or addressing the effects of structural racism. Participants identified six domains as key targets for interventions and future research: (1) apply an antiracism lens, (2) promote structural interventions, (3) target multiple levels, (4) promote effective community and stakeholder engagement, (5) improve data collection, and (6) advance health equity through new health care models. There is an urgent need for research to develop, implement, and evaluate interventions that address the unjust systems, policies, and laws that generate and perpetuate inequities in kidney health.
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Affiliation(s)
- Deidra C. Crews
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rachel E. Patzer
- Department of Epidemiology, Rollins School of Public Health and School of Medicine, Emory University, Atlanta, Georgia
- Department of Surgery, School of Medicine, Emory University, Atlanta, Georgia
| | - Lilia Cervantes
- Division of Hospital Medicine and General Internal Medicine, University of Colorado School of Medicine, Denver, Colorado
| | - Richard Knight
- American Association of Kidney Patients, Tampa, Florida
- College of Business, Bowie State University, Bowie, Maryland
| | - Tanjala S. Purnell
- Departments of Epidemiology and Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Neil R. Powe
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California
| | | | - Keith C. Norris
- Department of Medicine, University of California Los Angeles, Los Angeles, California
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Vu A, Nicholas SB, Waterman AD, Madievsky R, Cheng F, Chon J, Fu JY, Mangione CM, Norris KC, Duru OK. "Positive Kidney Health": Implementation and design of a pharmacist-led intervention for patients at risk for development or progression of chronic kidney disease. J Am Pharm Assoc (2003) 2022; 63:681-689. [PMID: 36593152 DOI: 10.1016/j.japh.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 11/06/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Patients with early chronic kidney disease (CKD) or underlying risk factors are often unaware of their kidney test results, common causes of CKD, and ways to lower risk of disease onset/progression. OBJECTIVE To test feasibility of a pharmacist-led intervention targeting patient education and risk factors in patients with early CKD and those at risk for CKD. PRACTICE DESCRIPTION Ambulatory care pharmacists in community-based primary care clinics delivered kidney health education, ordered labs, and recommended medication adjustments. PRACTICE INNOVATION We identified patients with a moderate rate of decline (≥2 mL/min/1.73 m2 per year) in estimated glomerular filtration (eGFR) at-risk for CKD or early stage CKD. An interactive workbook was designed to teach patients about kidney test results and self-management of risk factors including hypertension, type 2 diabetes, cigarette smoking, and chronic oral nonsteroidal anti-inflammatory drug use. EVALUATION METHODS Outcomes included visit uptake, completion of annual albuminuria screening, and initiation of guideline-directed medications for CKD. Patients were surveyed pre- and post-intervention for kidney health knowledge and perceptions regarding pharmacist-provided information. RESULTS Our sample of 20 participants had a mean eGFR of 59 mL/min/1.73 m2 and the mean eGFR decline was -4.6 mL/min/1.73 m2 per year. There were 47 visits during the pilot period from February 2021 to October 2021. Thirteen patients were missing albuminuria screening within 12 months; 2 of 9 patients with resulting labs had new microalbuminuria and were started on renoprotective medications. Patients had improved understanding of their kidney function test results and most did not consider the information scary or confusing. CONCLUSION Barriers to enrollment included fewer participants with multiple risk factors for CKD. The pharmacists were able to engage patients in learning the importance of monitoring and self-management of kidney health. A collaborative practice agreement may enhance a similar intervention that includes initiation of renoprotective medications.
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Purnell TS, Bignall ONR, Norris KC. Centering Anti-Racism and Social Justice in Nephrology Education to Advance Kidney Health Equity. J Am Soc Nephrol 2022; 33:1981-1984. [PMID: 36316090 PMCID: PMC9678029 DOI: 10.1681/asn.2022040432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Tanjala S. Purnell
- Departments of Epidemiology and Surgery, Johns Hopkins Schools of Public Health and Medicine, Baltimore, Maryland
- ASN Health Care Justice Committee, American Society of Nephrology, Washington, DC
| | - O. N. Ray Bignall
- ASN Health Care Justice Committee, American Society of Nephrology, Washington, DC
- Division of Nephrology and Hypertension, Department of Pediatrics, Nationwide Children’s Hospital and The Ohio State University College of Medicine, Columbus, Ohio
| | - Keith C. Norris
- ASN Health Care Justice Committee, American Society of Nephrology, Washington, DC
- Division of General Internal Medicine and Health Services Research, University of California Los Angeles, Los Angeles, California
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Saju R, Castellon-Lopez Y, Turk N, Moin T, Mangione CM, Norris KC, Vu A, Maranon R, Fu J, Cheng F, Duru OK. Differences in Weight Loss by Race and Ethnicity in the PRIDE Trial: a Qualitative Analysis of Participant Perspectives. J Gen Intern Med 2022; 37:3715-3722. [PMID: 35469358 PMCID: PMC9037581 DOI: 10.1007/s11606-022-07521-5] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 03/28/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Many Diabetes Prevention Program (DPP) translation efforts have been less effective for underresourced populations. In the cluster-randomized Prediabetes Informed Decision and Education (PRIDE) trial, which evaluated a shared decision-making (SDM) intervention for diabetes prevention, Hispanic and non-Hispanic Black participants lost less weight than non-Hispanic White participants at 12-month follow-up. OBJECTIVE To explore perspectives about weight loss from PRIDE participants of different racial and ethnic groups. PARTICIPANTS Sample of participants with prediabetes who were randomized to the PRIDE intervention arm (n=24). APPROACH We conducted semi-structured interviews within three groups stratified by DPP participation and % weight loss at 12 months: (DPP+/WL+, enrolled in DPP and lost >5% weight; DPP+/WL-, enrolled in DPP and lost <3% weight; DPP-/WL-, did not enroll in DPP and lost <3% weight). Each group was further subdivided on race and ethnicity (non-Hispanic Black (NHB), non-Hispanic White (NHW), Hispanic). Interviews were conducted on Zoom and transcripts were coded and analyzed with Dedoose. KEY RESULTS Compared to NHW participants, Hispanic and NHB participants more often endorsed weight loss barriers of limited time to make lifestyle changes due to long work and commute hours, inconvenient DPP class locations and offerings, and limited disposable income for extra weight loss activities. Conversely, facilitators of weight loss regardless of race and ethnicity included retirement or having flexible work schedules; being able to identify convenient DPP classes; having a strong, positive support system; and purchasing supplementary resources to support lifestyle change (e.g., gym memberships, one-on-one activity classes). CONCLUSIONS We found that NHB and Hispanic SDM participants report certain barriers to weight loss more commonly than NHW participants, particularly barriers related to limited disposable income and/or time constraints. Our findings suggest that increased lifestyle change support and flexible program delivery options may be needed to ensure equity in DPP reach, participant engagement, and outcomes.
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Affiliation(s)
- Rintu Saju
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Yelba Castellon-Lopez
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Family Medicine, University of California, Los Angeles, CA, USA
| | - Norman Turk
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA
| | - Tannaz Moin
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA
- VA Greater Los Angeles Health System and HSR&D Center for Study of Healthcare Innovation, Implementation & Policy, University of California, Los Angeles, CA, USA
- Division of Endocrinology, Diabetes & Metabolism, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Carol M Mangione
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA
- Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Keith C Norris
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA
| | - Amanda Vu
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA
| | - Richard Maranon
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA
| | - Jeffery Fu
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA
| | - Felicia Cheng
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA
| | - O Kenrik Duru
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA.
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Jones M, Hoague D, Spriggs R, Catalan E, Adams N, Watkins T, Tripati A, Norris KC. Establishing a Framework for Sustainable Community Action Research. Ethn Dis 2022; 32:333-340. [PMID: 36388858 PMCID: PMC9590601 DOI: 10.18865/ed.32.4.333] [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] [Indexed: 12/29/2022] Open
Abstract
Community-based participatory research/community-partnered participatory research (CBPR/CPRR) is viewed as a critical approach for improving health and addressing inequities found in under-resourced communities by pairing community partners and academic partners to address health and environmental concerns. This article aims to amplify the potential of the current CBPR/CPPR models through insights learned from the underserved community of Watts in south central Los Angeles. We discuss our framework that shifts the primary academic focus in the community-academia partnership from individual investigators and/or research groups to the academic institution to generate sustainable partnerships. We summarize the Community Action Research Engagement (CARE) Framework as a new set of recommended tenets to expand CBPR/CPPR. This framework can provide guidance for how universities can catalyze: 1) building trust; 2) facilitating knowledge; 3) advancing solutions; and 4) fostering mentorship in the context of leveraging a university's position to address the root causes of community inequities and thus create more sustained partnerships that achieve greater impact within their surrounding communities.
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Affiliation(s)
- Malcolm Jones
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, Address correspondence to Malcom Jones, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA;
| | - Danielle Hoague
- Institute of the Environment and Sustainability, University of California, Los Angeles, CA
| | - Raenita Spriggs
- Center for Diverse Leadership in Science, University of California, Los Angeles, CA
| | - Elijah Catalan
- Institute of the Environment and Sustainability, University of California, Los Angeles, CA
| | - Naomi Adams
- Institute of the Environment and Sustainability, University of California, Los Angeles, CA
| | - Timothy Watkins
- Watts Labor Community Action Committee, University of California, Los Angeles, CA
| | - Aradhna Tripati
- Center for Diverse Leadership in Science, University of California, Los Angeles, CA
| | - Keith C. Norris
- Division of General Internal Medicine-Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA
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Mansfield LN, Carson SL, Castellon-Lopez Y, Casillas A, Morris D, Ntekume E, Barron J, Norris KC, Brown AF. Exploring Perspectives on Establishing COVID-19 Vaccine Confidence in Black Communities. Ethn Dis 2022; 32:341-350. [PMID: 36388857 PMCID: PMC9590598 DOI: 10.18865/ed.32.4.341] [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] [Indexed: 12/29/2022] Open
Abstract
Objective To explore factors influencing COVID-19 vaccine decision-making among Black adults at high-risk for COVID-19 infection. Despite effective treatment and vaccination availability, Black Americans continue to be disproportionately impacted by COVID-19. Design Setting and Participants Using community-engaged qualitative methods, we conducted virtual, semi-structured focus groups with Black residents in Los Angeles County before widespread vaccine rollout. Recruitment occurred through local community partners. Main Outcome Measures Themes and subthemes on factors for vaccine confidence and accessibility. Methods As part of a larger study exploring COVID-19 vaccine decision-making factors among multiethnic groups, two-hour virtual focus groups were conducted between December 15, 2020 and January 27, 2021. Transcripts were analyzed using reflexive thematic analysis. Results Three focus groups were conducted with 17 Black participants, who were primarily female (n=15), residents of high-poverty zip codes (n=11) and employed full-time (n=6). Black-specific considerations for vaccine confidence and accessibility include: 1) reduced confidence in COVID-19 vaccines due to historical government inaction and racism (existing health inequities and disparities are rooted in racism; historical unethical research practices); 2) misunderstanding of Black communities' vaccine concerns ("vaccine hesitancy" as an inaccurate label to describe vaccine skepticism; ignorance to root causes of vaccine skepticism); and 3) recognizing and building on resources (community agency to address COVID-19 vaccine needs adequately). Conclusions Vaccination campaigns should improve understanding of underlying vaccination concerns to improve vaccine outreach effectiveness and should partner with, provide resources to, and invest in local, trusted Black community entities to improve COVID-19 vaccination disparities.
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Affiliation(s)
- Lisa N. Mansfield
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, Address correspondence to Lisa Mansfield, PhD, RN, Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA;
| | - Savanna L. Carson
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Yelba Castellon-Lopez
- Department of Family Medicine, UCLA David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Alejandra Casillas
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - D’Ann Morris
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Ejiro Ntekume
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Juan Barron
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Keith C. Norris
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Arleen F. Brown
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA,Olive View-UCLA Medical Center, Sylmar, CA
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Tuttle KR, Jones CR, Daratha KB, Koyama AK, Nicholas SB, Alicic RZ, Duru OK, Neumiller JJ, Norris KC, Ríos Burrows N, Pavkov ME. Incidence of Chronic Kidney Disease among Adults with Diabetes, 2015-2020. N Engl J Med 2022; 387:1430-1431. [PMID: 36239650 DOI: 10.1056/nejmc2207018] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [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] [Indexed: 11/19/2022]
Affiliation(s)
| | | | | | | | | | | | - O Kenrik Duru
- David Geffen School of Medicine at UCLA, Los Angeles, CA
| | | | - Keith C Norris
- David Geffen School of Medicine at UCLA, Los Angeles, CA
| | | | - Meda E Pavkov
- Centers for Disease Control and Prevention, Atlanta, GA
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Burrows NR, Koyama AK, Choudhury D, Yu W, Pavkov ME, Nee R, Cheung AK, Norris KC, Yan G. Age-Related Association between Multimorbidity and Mortality in US Veterans with Incident Chronic Kidney Disease. Am J Nephrol 2022; 53:652-662. [PMID: 36209732 PMCID: PMC10880036 DOI: 10.1159/000526254] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/05/2022] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Mortality is an important long-term indicator of the public health impact of chronic kidney disease (CKD). We investigated the role of individual comorbidities and multimorbidity on age-specific mortality risk among US veterans with new-onset CKD. METHODS The cohort included 892,005 veterans aged ≥18 years with incident CKD stage 3 between January 2004 and April 2018 in the US Veterans Health Administration (VHA) system and followed until death, December 2018, or up to 10 years. Incident CKD was defined as the first-time estimated glomerular filtration rate (eGFR) was <60 mL/min/1.73 m2 for >3 months. Comorbidities were ascertained using inpatient and outpatient clinical records in the VHA system and Medicare claims. We estimated death rates for any cardiovascular disease (CVD, a composite of 6 CVD conditions) and 15 non-CVD comorbidities, and adjusted risks of death (hazard ratio [HR], 95% confidence interval [CI]) overall and by age group at CKD incidence. RESULTS At CKD incidence, the mean age was 72 years, and 97% were male; the mean eGFR was 52 mL/min/1.73 m2, and 95% had ≥2 comorbidities (median, 4) in addition to CKD. During a median follow-up of 4.5 years, among the 16 comorbidities, CVD was associated with the highest relative risk of death in younger veterans (HR 1.96 [95% CI: 1.61-2.37] in ages 18-44 years and HR 1.66 [1.63-1.70] in ages 45-64 years). Dementia was associated with the highest relative risk of death among older veterans (HR 1.71 [1.68-1.74] in ages 65-84 years and HR 1.69 [1.65-1.73] in ages 85-100 years). The additive effect of multimorbidity on risk of death was stronger in younger than older veterans. Compared to having 1 or no comorbidity at CKD onset, the risk of death with ≥5 comorbidities was >7-fold higher among veterans aged 18-44 years and >2-fold higher among veterans aged 85-100 years. CONCLUSION The large burden of comorbidities in US veterans with newly identified CKD places them at the risk of premature death. Compared with older veterans, younger veterans with multiple comorbidities, particularly with CVD, at CKD onset are at an even higher relative risk of death.
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Affiliation(s)
- Nilka Ríos Burrows
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alain K. Koyama
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Devasmita Choudhury
- VA Salem Medical Center, Salem, VA, USA
- University of Virginia School of Medicine, Charlottesville, VA, USA
- Virginia-Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Wei Yu
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Meda E. Pavkov
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Robert Nee
- Nephrology Service, Walter Reed National Military Medical Center; Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA
| | - Alfred K. Cheung
- Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah, USA
- Division of Nephrology & Hypertension, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Keith C. Norris
- Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Guofen Yan
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, USA
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Nicholas SB, Norris KC. Heart Disease and Kidney Failure in the Black Community. Mayo Clin Proc 2022; 97:1764-1765. [PMID: 36202487 DOI: 10.1016/j.mayocp.2022.08.011] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 08/25/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Susanne B Nicholas
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Keith C Norris
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA.
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Nicholas SB, Norris KC. Race, Biomarkers, and Cardiovascular Disease in Patients With Chronic Kidney Disease. J Am Heart Assoc 2022; 11:e026998. [PMID: 36102224 PMCID: PMC9683640 DOI: 10.1161/jaha.122.026998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Keith C. Norris
- Department of MedicineUniversity of California, Los AngelesLos AngelesCA
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Bruce MA, Beech BM, Kermah D, Bailey S, Phillips N, Jones HP, Bowie JV, Heitman E, Norris KC, Whitfield KE, Thorpe RJ. Religious service attendance and mortality among older Black men. PLoS One 2022; 17:e0273806. [PMID: 36054189 PMCID: PMC9439243 DOI: 10.1371/journal.pone.0273806] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 08/16/2022] [Indexed: 11/18/2022] Open
Abstract
Religious institutions have been responsive to the needs of Black men and other marginalized populations. Religious service attendance is a common practice that has been associated with stress management and extended longevity. The objective of this study was to examine the relationship between religious service attendance and all-cause mortality among Black men 50 years of age and older. Data for this study were from NHANES III (1988–1994). The analytic sample (n = 839) was restricted to participants at least 50 years of age at the time of interview who self-identified as Black and male. Mortality was the primary outcome for this study and the NHANES III Linked Mortality File was used to estimate race-specific, non-injury-related death rates using a probabilistic matching algorithm, linked to the National Death Index through December 31, 2015, providing up to 27 years follow-up. The primary independent variable was religious service attendance, a categorical variable indicating that participants attended religious services at least weekly, three or fewer times per month, or not at all. The mean age of participants was 63.6±0.3 years and 36.4% of sample members reported that they attended religious services one or more times per week, exceeding those attending three or fewer times per month (31.7%), or not at all (31.9%). Cox proportional hazard logistic regression models were estimated to determine the association between religious service attendance and mortality. Participants with the most frequent religious service attendance had a 47% reduction of all-cause mortality risk compared their peer who did not attend religious services at all (HR 0.53, CI 0.35–0.79) in the fully adjusted model including socioeconomic status, non-cardiovascular medical conditions, health behaviors, social support and allostatic load. Our findings underscore the potential salience of religiosity and spirituality for health in Black men, an understudied group where elevated risk factors are often present.
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Affiliation(s)
- Marino A. Bruce
- Faith, Justice and Health and Men’s Health Collaboratories, University of Houston Population Health, University of Houston, Houston, TX, United States of America
- Department of Behavioral and Social Science, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX, United States of America
- Department of Health Systems and Population Health Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX, United States of America
- Program for Research on Men’s Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- * E-mail:
| | - Bettina M. Beech
- Faith, Justice and Health and Men’s Health Collaboratories, University of Houston Population Health, University of Houston, Houston, TX, United States of America
- Department of Behavioral and Social Science, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX, United States of America
- Department of Health Systems and Population Health Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX, United States of America
- Program for Research on Men’s Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Dulcie Kermah
- Charles R. Drew University School of Medicine and Science, Los Angeles, CA, United States of America
| | - Shanelle Bailey
- Charles R. Drew University School of Medicine and Science, Los Angeles, CA, United States of America
| | - Nicole Phillips
- Department of Microbiology, Immunology and Genetics, University of North Texas Health Science Center, Fort Worth, TX, United States of America
| | - Harlan P. Jones
- Department of Microbiology, Immunology and Genetics, University of North Texas Health Science Center, Fort Worth, TX, United States of America
| | - Janice V. Bowie
- Faith, Justice and Health and Men’s Health Collaboratories, University of Houston Population Health, University of Houston, Houston, TX, United States of America
- Program for Research on Men’s Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Elizabeth Heitman
- Faith, Justice and Health and Men’s Health Collaboratories, University of Houston Population Health, University of Houston, Houston, TX, United States of America
- Program Ethics in Science and Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Keith C. Norris
- Faith, Justice and Health and Men’s Health Collaboratories, University of Houston Population Health, University of Houston, Houston, TX, United States of America
- Program for Research on Men’s Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Keith E. Whitfield
- Program for Research on Men’s Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- University of Nevada-Las Vegas, Las Vegas, Nevada, United States of America
| | - Roland J. Thorpe
- Faith, Justice and Health and Men’s Health Collaboratories, University of Houston Population Health, University of Houston, Houston, TX, United States of America
- Program for Research on Men’s Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
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Yan G, Nee R, Scialla JJ, Greene T, Yu W, Cheung AK, Norris KC. Estimation of Black-White Disparities in CKD Outcomes: Comparison Using the 2021 Versus the 2009 CKD-EPI Creatinine Equations. Am J Kidney Dis 2022; 80:423-426. [PMID: 35007626 PMCID: PMC10118241 DOI: 10.1053/j.ajkd.2021.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 12/03/2021] [Indexed: 01/27/2023]
Affiliation(s)
- Guofen Yan
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia.
| | - Robert Nee
- Nephrology Service, Walter Reed National Military Medical Center, Bethesda, Maryland; Department of Medicine, Uniformed Services University, Bethesda, Maryland
| | - Julia J Scialla
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia; Division of Nephrology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Tom Greene
- Division of Biostatistics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Wei Yu
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Alfred K Cheung
- Division of Nephrology & Hypertension, Department of Internal Medicine, University of Utah, Salt Lake City, Utah; Renal Section, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah
| | - Keith C Norris
- Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
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Booker R, Beech BM, Bruce MA, Thorpe RJ, Norris KC, Heitman E, Newton RL, Holmes ME. The Association of Sedentary Behavior and Physical Activity with Different Measurements of Metabolic Syndrome: The Jackson Heart Study. Am J Lifestyle Med 2022. [DOI: 10.1177/15598276221118044] [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] [Indexed: 11/16/2022] Open
Abstract
Purpose: Cross-sectional investigation of the association of sedentary behavior and physical activity with metabolic syndrome (MetS) among the African American participants in the Jackson Heart Study (JHS). Methods: Prevalence, number of individual components, and MetS severity z-score (MetS-Z) were examined. MetS was classified using ATP-III thresholds. MetS-Z was calculated using sex-, race-, and ethnicity-specific formulas. Sedentary behavior and physical activity were calculated from the JHS Physical Activity Cohort survey (JPAC). Associations between sedentary behavior and physical activity with MetS were assessed by logistic, negative binomial, and ordinary least squares regressions. Results: The mean participant age ( N = 3370) was 61.7 ± 11.9 years and most were female (63.9%). Among all participants, 60.5% were classified with MetS. Overall MetS-Z was moderately high (.31 ± 1.07). Most waking hours were sedentary, with just under 40 daily minutes of self-reported physical activity. Physical activity was associated with lower prevalence of MetS, the number of individual components, and MetS-Z score ( p < .05). Sedentary behavior was not associated with MetS in any fully adjusted models ( p > .05). Conclusions: Physical activity was associated with lower cardiometabolic risk, irrespective of sedentary behavior. Further studies are needed to better understand why no relation was found between sedentary behavior and cardiometabolic risk in this cohort of African American adults.
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Affiliation(s)
- Robert Booker
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA (RB); University of Houston Population Health, University of Houston, Houston, TX, USA (BMB); Department of Health Systems and Population Health Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX, USA (BMB, MAB); Program for Research on Men’s Health, Hopkins Center for Health Disparities Solutions, John Hopkins Bloomberg School of Public Health, Baltimore, MD,
| | - Bettina M. Beech
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA (RB); University of Houston Population Health, University of Houston, Houston, TX, USA (BMB); Department of Health Systems and Population Health Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX, USA (BMB, MAB); Program for Research on Men’s Health, Hopkins Center for Health Disparities Solutions, John Hopkins Bloomberg School of Public Health, Baltimore, MD,
| | - Marino A. Bruce
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA (RB); University of Houston Population Health, University of Houston, Houston, TX, USA (BMB); Department of Health Systems and Population Health Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX, USA (BMB, MAB); Program for Research on Men’s Health, Hopkins Center for Health Disparities Solutions, John Hopkins Bloomberg School of Public Health, Baltimore, MD,
| | - Roland J. Thorpe
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA (RB); University of Houston Population Health, University of Houston, Houston, TX, USA (BMB); Department of Health Systems and Population Health Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX, USA (BMB, MAB); Program for Research on Men’s Health, Hopkins Center for Health Disparities Solutions, John Hopkins Bloomberg School of Public Health, Baltimore, MD,
| | - Keith C. Norris
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA (RB); University of Houston Population Health, University of Houston, Houston, TX, USA (BMB); Department of Health Systems and Population Health Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX, USA (BMB, MAB); Program for Research on Men’s Health, Hopkins Center for Health Disparities Solutions, John Hopkins Bloomberg School of Public Health, Baltimore, MD,
| | - Elizabeth Heitman
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA (RB); University of Houston Population Health, University of Houston, Houston, TX, USA (BMB); Department of Health Systems and Population Health Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX, USA (BMB, MAB); Program for Research on Men’s Health, Hopkins Center for Health Disparities Solutions, John Hopkins Bloomberg School of Public Health, Baltimore, MD,
| | - Robert L. Newton
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA (RB); University of Houston Population Health, University of Houston, Houston, TX, USA (BMB); Department of Health Systems and Population Health Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX, USA (BMB, MAB); Program for Research on Men’s Health, Hopkins Center for Health Disparities Solutions, John Hopkins Bloomberg School of Public Health, Baltimore, MD,
| | - Megan E. Holmes
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA (RB); University of Houston Population Health, University of Houston, Houston, TX, USA (BMB); Department of Health Systems and Population Health Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX, USA (BMB, MAB); Program for Research on Men’s Health, Hopkins Center for Health Disparities Solutions, John Hopkins Bloomberg School of Public Health, Baltimore, MD,
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Guerrero LR, Seeman T, McCreath H, Maccalla NMG, Norris KC. Understanding the context and appreciating the complexity of evaluating the Diversity Program Consortium. New Dir Eval 2022; 2022:11-20. [PMID: 37538950 PMCID: PMC10399618 DOI: 10.1002/ev.20506] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
The National Institutes of Health (NIH) made a sizeable investment in developing a scientific approach to understanding how to best increase diversity in the NIH-funded workforce by fostering inclusive excellence at a national scale through the Diversity Program Consortium (DPC). This chapter provides an overview of the context in which the consortium-wide evaluation study has taken place to provide readers with an understanding of its level of complexity. This evaluation effort is the first large-scale, national, systemic, longitudinal evaluation of harmonized interventions focused on undergraduate biomedical research training programs in the history of the NIH and the National Institute of General Medical Sciences.
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Affiliation(s)
| | - Teresa Seeman
- University of California San Diego, La Jolla, California, USA
| | | | | | - Keith C Norris
- University of California San Diego, La Jolla, California, USA
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Nicholas SB, Ford CL, Norris KC. Race, ancestry, and genetic risk for kidney failure. Cell Rep Med 2022; 3:100726. [PMID: 35977464 PMCID: PMC9418843 DOI: 10.1016/j.xcrm.2022.100726] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Susanne B Nicholas
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Chandra L Ford
- Department of Community Health Sciences, University of California, Los Angeles School of Public Health, Los Angeles, CA, USA; Center for the Study of Racism, Social Justice & Health, University of California, Los Angeles School of Public Health, Los Angeles, CA, USA
| | - Keith C Norris
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA; Center for the Study of Racism, Social Justice & Health, University of California, Los Angeles School of Public Health, Los Angeles, CA, USA.
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Castellon-Lopez YM, Carson SL, Mansfield L, Garrison NA, Barron J, Morris D, Ntekume E, Vassar SD, Norris KC, Brown AF, Casillas A. "The System Doesn't Let Us in"-A Call for Inclusive COVID-19 Vaccine Outreach Rooted in Los Angeles Latinos' Experience of Pandemic Hardships and Inequities. Int J Environ Res Public Health 2022; 19:5785. [PMID: 35627322 PMCID: PMC9141159 DOI: 10.3390/ijerph19105785] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/23/2022] [Accepted: 05/05/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Latino adults in Los Angeles have experienced disproportionate cases, deaths, and socioeconomic impacts from the COVID-19 pandemic. This qualitative study aimed to explore community perspectives on readiness for COVID-19 vaccination and to identify culturally tailored vaccine outreach strategies. METHODS We conducted virtual focus groups with Los Angeles County Latino/a residents via Zoom between December 2020 to January 2021, as the first COVID-19 vaccines were receiving Emergency Use Authorization (EUA). Focus groups were facilitated in Spanish and English by bilingual members of the research team. Discussions were analyzed via Atlas.ti software using reflexive thematic analysis. RESULTS Three focus groups (n = 15; four to six people each; two Spanish focus groups; one English) were conducted. Thematic findings centered on Latino COVID-19 vaccine equity: (1) Disproportionate infection risk due to essential worker status and socioeconomic burdens, misinformation, and familial or cultural tensions (2) Concerns for inequitable vaccine access due to immigration fears and limited healthcare access, and (3) A need for community-centered COVID-19 vaccine outreach and access. CONCLUSIONS Our study on early Latino adult reactions to vaccine roll-out suggests the need for outreach strategies centering on validating community hardships, combating dis-/misinformation through trusted sources, and addressing socio-economic needs impacted by the pandemic.
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Affiliation(s)
- Yelba M. Castellon-Lopez
- Department of Family Medicine, UCLA David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Savanna L. Carson
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA; (S.L.C.); (L.M.); (N.A.G.); (J.B.); (D.M.); (E.N.); (S.D.V.); (K.C.N.); (A.F.B.); (A.C.)
| | - Lisa Mansfield
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA; (S.L.C.); (L.M.); (N.A.G.); (J.B.); (D.M.); (E.N.); (S.D.V.); (K.C.N.); (A.F.B.); (A.C.)
| | - Nanibaa’ A. Garrison
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA; (S.L.C.); (L.M.); (N.A.G.); (J.B.); (D.M.); (E.N.); (S.D.V.); (K.C.N.); (A.F.B.); (A.C.)
- Institute for Society & Genetics, College of Letters and Science, University of California, Los Angeles, CA 90095, USA
- Institute for Precision Health, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Juan Barron
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA; (S.L.C.); (L.M.); (N.A.G.); (J.B.); (D.M.); (E.N.); (S.D.V.); (K.C.N.); (A.F.B.); (A.C.)
| | - D’Ann Morris
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA; (S.L.C.); (L.M.); (N.A.G.); (J.B.); (D.M.); (E.N.); (S.D.V.); (K.C.N.); (A.F.B.); (A.C.)
| | - Ejiro Ntekume
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA; (S.L.C.); (L.M.); (N.A.G.); (J.B.); (D.M.); (E.N.); (S.D.V.); (K.C.N.); (A.F.B.); (A.C.)
| | - Stefanie D. Vassar
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA; (S.L.C.); (L.M.); (N.A.G.); (J.B.); (D.M.); (E.N.); (S.D.V.); (K.C.N.); (A.F.B.); (A.C.)
| | - Keith C. Norris
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA; (S.L.C.); (L.M.); (N.A.G.); (J.B.); (D.M.); (E.N.); (S.D.V.); (K.C.N.); (A.F.B.); (A.C.)
| | - Arleen F. Brown
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA; (S.L.C.); (L.M.); (N.A.G.); (J.B.); (D.M.); (E.N.); (S.D.V.); (K.C.N.); (A.F.B.); (A.C.)
- Olive View-UCLA Medical Center, Sylmar, CA 91342, USA
| | - Alejandra Casillas
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA; (S.L.C.); (L.M.); (N.A.G.); (J.B.); (D.M.); (E.N.); (S.D.V.); (K.C.N.); (A.F.B.); (A.C.)
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Thomas Tobin CS, Gutiérrez Á, Norris KC, Thorpe RJ. Discrimination, Racial Identity, and Hypertension Among Black Americans Across Young, Middle, and Older Adulthood. J Gerontol B Psychol Sci Soc Sci 2022; 77:1990-2005. [PMID: 35512278 PMCID: PMC9683505 DOI: 10.1093/geronb/gbac068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 07/01/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Substantial evidence documents the protective role of racial identity-or the meaning and significance that individuals attribute to race-among Black Americans, yet the impact of racial identity on physical health outcomes beyond young adulthood is unclear. To clarify the extent to which racial identity remains influential for physical health across the life course, this study investigated (a) the direct associations between discrimination, racial identity, and hypertension, (b) whether racial identity buffered the negative effects of discrimination, and (c) the extent to which these patterns varied among young (21-35), middle-aged (36-49), and older (>50) Black adults. METHODS Data from the Nashville Stress and Health Study (N = 627) were used to examine two identity dimensions: "racial centrality" (i.e., importance of Black identity to one's sense of self) and "closeness to other Black people" (COBP). Modified Poisson models estimated relationships between racial identity, discrimination, and hypertension. Interactions determined whether racial identity moderated the discrimination-hypertension association within and across age groups. RESULTS High centrality and moderate COBP were directly linked to elevated hypertension odds among young adults, but lower odds among older adults; racial identity was not directly associated with hypertension among middle-aged adults. Results also indicated that racial identity conditioned the discrimination-hypertension relationship in distinct ways across age groups. DISCUSSION Findings underscore the significance of racial identity as sources of both psychosocial vulnerability and resilience for minority aging. Clinicians and public health professionals should consider racial identity beyond young adulthood to promote healthy aging via hypertension management among Black Americans.
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Affiliation(s)
- Courtney S Thomas Tobin
- Department of Community Health Sciences, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Ángela Gutiérrez
- Address correspondence to: Ángela Gutiérrez, PhD, MPH, Department of Social Medicine, Heritage College of Osteopathic Medicine, Ohio University, Irvine 128B 57 West Oxbow Trail, 1 Ohio University Drive, Athens, OH 45701-2979, USA. E-mail:
| | - Keith C Norris
- Divisions of Nephrology and General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Roland J Thorpe
- Program for Research on Men’s Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Tobin CST, Gutiérrez Á, Erving CL, Norris KC, Thorpe RJ. When Resilience Becomes Risk: A Latent Class Analysis of Psychosocial Resources and Allostatic Load Among African American Men. Am J Mens Health 2022; 16:15579883221104272. [PMID: 35758236 PMCID: PMC9244943 DOI: 10.1177/15579883221104272] [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] [Indexed: 11/27/2022] Open
Abstract
There is a well-established link between psychosocial risks and psychological health among African American (AA) men. Yet, the psychosocial sources and physical health consequences of resilience (i.e., the ability to maintain good health despite adversity) remain underexplored. Using data from 283 AA men in the Nashville Stress and Health Study, the present study investigated the links between psychosocial resilience and allostatic load (AL), a biological indicator of physiological dysregulation. Latent class analysis (LCA) identified distinct resilience profiles comprising eight psychosocial resources across four categories: coping strategies, sense of control, racial identity, and social support. Analysis of variance (ANOVA) tests determined significant class differences in men’s AL scores. LCA results confirm a four-class model was the best fit: Class 1 (high resources, 32%), Class 2 (high coping but low control, 13%), Class 3 (low resources but high racial identity, 20%), and Class 4 (low resources but high mastery, 34%). Results reveal lower AL (better health) among Classes 1 (m = 0.35) and 4 (m = 0.31) and higher AL (worse health) among Classes 2 (m = 0.44) and 3 (m = 0.44). Findings indicate that the “quality” rather than the “quantity” of psychosocial resources matters for physical health among AA men, as positive health outcomes were observed among both low- and high-resource classes. Results suggest different resource combinations produce distinct patterns of resilience among AA men and underscore the need to further elucidate complex resilience processes among this population.
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Affiliation(s)
- Courtney S Thomas Tobin
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Ángela Gutiérrez
- Department of Social Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
| | - Christy L Erving
- Department of Sociology, University of Texas at Austin, Austin, TX, USA
| | - Keith C Norris
- Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Roland J Thorpe
- Program for Research on Men's Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Laster M, Norris KC. Equitable Transplantation: A Modifiable Risk Factor for Disparities in Mortality in ESKD. J Am Soc Nephrol 2022; 33:1240-1241. [PMID: 35365573 PMCID: PMC9257812 DOI: 10.1681/asn.2022030273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Marciana Laster
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Keith C Norris
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
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