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Kaufman EJ, Passman JE, Alur R, Smith R, Osborne A, Scarlet S, Sue K, Wright R, Maine R, Smith N, Holston N, Zhu E, Beard JH. Providing Equitable Surgical Care to Patients in Law Enforcement Custody: A Review. JAMA Surg 2025:2833853. [PMID: 40366700 DOI: 10.1001/jamasurg.2025.1129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2025]
Abstract
Importance Approximately 2 million individuals are incarcerated in the US. Surgical needs increase with age, and an aging prison population means an increasing need for surgical care for incarcerated individuals. Challenges in logistics, privacy, communication, and comorbidities put people in law enforcement custody at risk for suboptimal care and outcomes. Little guidance exists for surgeons seeking to provide equitable care for these patients. Observations No national statistics are available on the need for surgery among incarcerated people. Autopsy data suggest that nearly a quarter of deaths among incarcerated individuals were attributable to causes that could have been treated with surgery, yet few received surgical care before death. Across the spectrum of custody, including police detention, jail, prison, probation, and parole, access to consistent preoperative and postoperative care are major challenges, as is sustaining appropriate levels of privacy and communication. Incarcerated people are often accompanied by guards, preventing privacy. Patients are shackled to hospital beds, restricting mobility. For incarcerated individuals, access to postoperative medication may be curtailed when they return to jail or prison. To be effective advocates for patient-centered care and to achieve the best outcomes, surgeons must remain vigilant to specific barriers to care. Conclusions and Relevance Individuals in law enforcement custody have particular needs regarding communication, surgical planning, and perioperative and postoperative care. Clinicians must remain alert to these challenges and serve as advocates for these marginalized patients, even adjusting their care practices. Professional societies and health systems can bolster care for this marginalized population by developing and disseminating guidelines and pathways for patient-centered surgical care for individuals in law enforcement custody.
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Affiliation(s)
- Elinore J Kaufman
- Department of Surgery, Division of Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Jesse E Passman
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Rucha Alur
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Randi Smith
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Anwar Osborne
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Sara Scarlet
- Department of Surgery, College of Medicine, University of Florida, Gainesville
| | - Kimberly Sue
- Division of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - Rebecca Maine
- Department of Surgery, University of Washington, Seattle
| | | | | | - Emily Zhu
- New York University School of Law, New York
| | - Jessica H Beard
- Department of Surgery, Division of Trauma and Surgical Critical Care, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
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Willems YE, Rezaki AD, Aikins M, Bahl A, Wu Q, Belsky DW, Raffington L. Social determinants of health and epigenetic clocks: Meta-analysis of 140 studies. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2025:2025.05.08.25327207. [PMID: 40385415 PMCID: PMC12083562 DOI: 10.1101/2025.05.08.25327207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 05/20/2025]
Abstract
Social determinants of health are social factors that affect health and survival. Two of the most powerful social determinants are socioeconomic status (SES) and race/ethnicity; people with lower SES or marginalized race/ethnicity tend to experience earlier onset of aging-related diseases and have shorter lifespans. DNA methylation (DNAm) measures of biological aging, often referred to as "epigenetic clocks", are increasingly used to study the social determination of health. However, there are several generations of epigenetic clocks and it remains unclear which are most sensitive to social factors affecting health. Moreover, there is uncertainty about how technical factors, such as the tissue from which DNA is derived or the technology used to measure DNA methylation may affect associations of social determinants with epigenetic clocks. We conducted a pre-registered multi-level meta-analysis of 140 studies, including N = 65,919 participants, encompassing 1,065 effect sizes for associations of SES and racial/ethnic identity with three generations of epigenetic clocks. We found that associations were weakest for the first generation of epigenetic clocks developed to predict age differences between people. Associations were stronger for the second generation of epigenetic clocks developed to predict mortality and health risks. The strongest associations were observed for a third generation of epigenetic clocks, sometimes referred to as "epigenetic speedometers", developed to predict the pace of aging. In studies of children, only the speedometers showed significant associations with SES. Effects of sex and technical factors were minimal and there was no evidence of publication bias.
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Affiliation(s)
- Y E Willems
- Max Planck Research Group Biosocial - Biology, Social Disparities, and Development; Max Planck Institute for Human Development, Berlin, Germany
| | - A D Rezaki
- Max Planck Research Group Biosocial - Biology, Social Disparities, and Development; Max Planck Institute for Human Development, Berlin, Germany
| | - M Aikins
- Max Planck Research Group Biosocial - Biology, Social Disparities, and Development; Max Planck Institute for Human Development, Berlin, Germany
| | - A Bahl
- Robert N Butler Columbia Aging Center and Department of Epidemiology, Columbia University Mailman School of Public Health, New York, USA
| | - Q Wu
- Max Planck Research Group Biosocial - Biology, Social Disparities, and Development; Max Planck Institute for Human Development, Berlin, Germany
| | - D W Belsky
- Robert N Butler Columbia Aging Center and Department of Epidemiology, Columbia University Mailman School of Public Health, New York, USA
| | - L Raffington
- Max Planck Research Group Biosocial - Biology, Social Disparities, and Development; Max Planck Institute for Human Development, Berlin, Germany
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Griffith DM. Antiracism and Health Equity Science: Overcoming Scientific Obstacles to Health Equity. Public Health Rep 2024; 139:288-293. [PMID: 38504480 PMCID: PMC11037222 DOI: 10.1177/00333549241236089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024] Open
Affiliation(s)
- Derek M. Griffith
- Center for Men’s Health Equity, Georgetown University, Washington, DC, USA
- Racial Justice Institute, Georgetown University, Washington, DC, USA
- Department of Health Management and Policy, School of Health, Georgetown University, Washington, DC, USA
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Bamoshmoosh M. Cardiovascular diseases in European ethnic minorities: Beyond the traditional cardiovascular risk factors. World J Cardiol 2024; 16:98-103. [PMID: 38576522 PMCID: PMC10989226 DOI: 10.4330/wjc.v16.i3.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/14/2024] [Accepted: 02/07/2024] [Indexed: 03/21/2024] Open
Abstract
This editorial is intended to be a reflection on cardiovascular disease (CVD) burden in European ethnic minorities. In some European countries, ethnic minority realities, due to their recent appearance, are still to be studied in depth. The experience of several European countries, where the migration processes started earlier, even more than a century ago, can help by being an example. Many studies have shown that major differences in CVD burden exist not only between countries, but also within the same country when considering different social strata and ethnic groups. The CV risk factors underlying heart disease have been well established. Important epidemiological studies have helped us understand that the underlying causes of heart disease as well as the behaviors that can help prevent them are the same. We are now well aware that CVD should be treated by considering a holistic approach. This is why the social determinants (SDs) of health that may worsen the disease burden or that, vice versa, may improve the treatment, and even more significantly, the prognosis of a patient's illness should be taken into consideration. For ethnic minority patients, this holistic, hermeneutic approach is of importance. Several SDs of health that influence CVDs have been identified but their relevance for the health of ethnic minorities has not yet been clearly defined. In some European countries, most ethnic minorities are largely also religious minorities. Only a few studies have evaluated the role of religion, which is an important SD that affects the probability of having CV risk factors and diseases. Adolescents, particularly those belonging to the second generation, seem to be the weak link. If we believe that these young people are really citizens of their country of birth, then a way of recognizing their belonging to the community starts from a will to better understand their condition, in order to assist them while they grow physically and mentally. Thinking about safeguarding the health of this population should be more than a health task, rather a goal of social justice.
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Affiliation(s)
- Mohamed Bamoshmoosh
- Department of Cardiology, University of Science and Technology, Aden 0, Yemen
- Department of Cardiology, Fanfani Clinical Research Institute, Florence 50100, Italy.
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Raffington L. Utilizing epigenetics to study the shared nature of development and biological aging across the lifespan. NPJ SCIENCE OF LEARNING 2024; 9:24. [PMID: 38509146 PMCID: PMC10954727 DOI: 10.1038/s41539-024-00239-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 03/13/2024] [Indexed: 03/22/2024]
Abstract
Recently, biological aging has been quantified in DNA-methylation samples of older adults and applied as so-called "methylation profile scores" (MPSs) in separate target samples, including samples of children. This nascent research indicates that (1) biological aging can be quantified early in the life course, decades before the onset of aging-related disease, (2) is affected by common environmental predictors of childhood development, and (3) shows overlap with "developmental processes" (e.g., puberty). Because the MPSs were computed using algorithms developed in adults, these studies indicate a molecular link between childhood environments, development, and adult biological aging. Yet, if MPSs can be used to connect development and aging, previous research has only traveled one way, deriving MPSs developed in adults and applying them to samples of children. Researchers have not yet quantified epigenetic measures that reflect the pace of child development, and tested whether resulting MPSs are associated with physical and psychological aging. In this perspective I posit that combining measures of biological aging with new quantifications of child development has the power to address fundamental questions about life span: How are development and experience in childhood related to biological aging in adulthood? And what is aging?
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Affiliation(s)
- Laurel Raffington
- Max Planck Research Group Biosocial-Biology, Social Disparities, and Development, Max Planck Institute for Human Development, Lentzeallee 94, 14195, Berlin, Germany.
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Ives CL, Krzyzanowski MC, Marshall VJ, Norris K, Cockburn M, Bentley-Edwards K, Mohottige D, Pollack Porter KM, Dillard D, Eisenberg Y, Jiménez MC, Pérez-Stable EJ, Jones NL, Dayal J, Maiese DR, Williams D, Hendershot TP, Hamilton CM. The PhenX Toolkit: Recommended Measurement Protocols for Social Determinants of Health Research. Curr Protoc 2024; 4:e977. [PMID: 38441413 DOI: 10.1002/cpz1.977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Health disparities are driven by unequal conditions in the environments in which people are born, live, learn, work, play, worship, and age, commonly termed the Social Determinants of Health (SDoH). The availability of recommended measurement protocols for SDoH will enable investigators to consistently collect data for SDoH constructs. The PhenX (consensus measures for Phenotypes and eXposures) Toolkit is a web-based catalog of recommended measurement protocols for use in research studies with human participants. Using standard protocols from the PhenX Toolkit makes it easier to compare and combine studies, potentially increasing the impact of individual studies, and aids in comparability across literature. In 2018, the National Institute on Minority Health and Health Disparities provided support for an initial expert Working Group to identify and recommend established SDoH protocols for inclusion in the PhenX Toolkit. In 2022, a second expert Working Group was convened to build on the work of the first SDoH Working Group and address gaps in the SDoH Toolkit Collections. The SDoH Collections consist of a Core Collection and Individual and Structural Specialty Collections. This article describes a Basic Protocol for using the PhenX Toolkit to select and implement SDoH measurement protocols for use in research studies. © 2024 The Authors. Current Protocols published by Wiley Periodicals LLC. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA. Basic Protocol: Using the PhenX Toolkit to select and implement SDoH protocols.
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Affiliation(s)
- Cataia L Ives
- RTI International, Research Triangle Park, North Carolina
| | | | - Vanessa J Marshall
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Keith Norris
- Department of Medicine, University of California, Los Angeles, California
| | - Myles Cockburn
- Department of Dermatology and Department of Population & Public Health Sciences, University of Southern California, Los Angeles, California
| | - Keisha Bentley-Edwards
- Division of General Internal Medicine, School of Medicine, Duke University, Durham, North Carolina
| | - Dinushika Mohottige
- Institute of Health Equity Research and Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Keshia M Pollack Porter
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Yochai Eisenberg
- Department of Disability and Human Development, University of Illinois at Chicago, Chicago, Illinois
| | - Monik C Jiménez
- Division of Women's Health, Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
| | - Eliseo J Pérez-Stable
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Nancy L Jones
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Jyoti Dayal
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Deborah R Maiese
- RTI International, Research Triangle Park, North Carolina
- Retired consultant
| | - David Williams
- RTI International, Research Triangle Park, North Carolina
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Krzyzanowski MC, Ives CL, Jones NL, Entwisle B, Fernandez A, Cullen TA, Darity WA, Fossett M, Remington PL, Taualii M, Wilkins CH, Pérez-Stable EJ, Rajapakse N, Breen N, Zhang X, Maiese DR, Hendershot TP, Mandal M, Hwang SY, Huggins W, Gridley L, Riley A, Ramos EM, Hamilton CM. The PhenX Toolkit: Measurement Protocols for Assessment of Social Determinants of Health. Am J Prev Med 2023; 65:534-542. [PMID: 36935055 PMCID: PMC10505248 DOI: 10.1016/j.amepre.2023.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 03/02/2023] [Accepted: 03/02/2023] [Indexed: 03/21/2023]
Abstract
INTRODUCTION Social determinants are structures and conditions in the biological, physical, built, and social environments that affect health, social and physical functioning, health risk, quality of life, and health outcomes. The adoption of recommended, standard measurement protocols for social determinants of health will advance the science of minority health and health disparities research and provide standard social determinants of health protocols for inclusion in all studies with human participants. METHODS A PhenX (consensus measures for Phenotypes and eXposures) Working Group of social determinants of health experts was convened from October 2018 to May 2020 and followed a well-established consensus process to identify and recommend social determinants of health measurement protocols. The PhenX Toolkit contains data collection protocols suitable for inclusion in a wide range of research studies. The recommended social determinants of health protocols were shared with the broader scientific community to invite review and feedback before being added to the Toolkit. RESULTS Nineteen social determinants of health protocols were released in the PhenX Toolkit (https://www.phenxtoolkit.org) in May 2020 to provide measures at the individual and structural levels for built and natural environments, structural racism, economic resources, employment status, occupational health and safety, education, environmental exposures, food environment, health and health care, and sociocultural community context. CONCLUSIONS Promoting the adoption of well-established social determinants of health protocols can enable consistent data collection and facilitate comparing and combining studies, with the potential to increase their scientific impact.
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Affiliation(s)
- Michelle C Krzyzanowski
- GenOmics, Bioinformatics, and Translation Research Center, RTI International, Research Triangle Park, North Carolina
| | - Cataia L Ives
- GenOmics, Bioinformatics, and Translation Research Center, RTI International, Research Triangle Park, North Carolina
| | - Nancy L Jones
- National Institute on Minority Health and Health Disparities, NIH, Bethesda, Maryland.
| | - Barbara Entwisle
- Department of Sociology, College of Arts and Sciences, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alicia Fernandez
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, Carolina
| | | | - William A Darity
- Sanford School of Public Policy, Duke University, Durham, North Carolina
| | - Mark Fossett
- Department of Sociology, College of Arts & Sciences, Texas A&M University, College Station, Texas
| | - Patrick L Remington
- Department of Population Health Sciences, University of Wisconsin-Madison College of Medicine and Public Health, Madison, Wisconsin
| | - Maile Taualii
- Center for Integrated Health Care Research, Hawaii Permanente Medical Group, Honolulu, Hawaii
| | - Consuelo H Wilkins
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Eliseo J Pérez-Stable
- National Institute on Minority Health and Health Disparities, NIH, Bethesda, Maryland
| | - Nishadi Rajapakse
- Center for Translation Research & Implementation Science, National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - Nancy Breen
- National Institute on Minority Health and Health Disparities, NIH, Bethesda, Maryland
| | - Xinzhi Zhang
- Center for Translation Research & Implementation Science, National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - Deborah R Maiese
- Division for Research Services, RTI International, Research Triangle Park, North Carolina
| | - Tabitha P Hendershot
- GenOmics, Bioinformatics, and Translation Research Center, RTI International, Research Triangle Park, North Carolina
| | - Meisha Mandal
- GenOmics, Bioinformatics, and Translation Research Center, RTI International, Research Triangle Park, North Carolina
| | - Stephen Y Hwang
- GenOmics, Bioinformatics, and Translation Research Center, RTI International, Research Triangle Park, North Carolina
| | - Wayne Huggins
- GenOmics, Bioinformatics, and Translation Research Center, RTI International, Research Triangle Park, North Carolina
| | - Lauren Gridley
- GenOmics, Bioinformatics, and Translation Research Center, RTI International, Research Triangle Park, North Carolina
| | - Amanda Riley
- GenOmics, Bioinformatics, and Translation Research Center, RTI International, Research Triangle Park, North Carolina
| | - Erin M Ramos
- National Human Genome Research Institute, NIH, Bethesda, Maryland
| | - Carol M Hamilton
- GenOmics, Bioinformatics, and Translation Research Center, RTI International, Research Triangle Park, North Carolina
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Tchounwou PB, Malouhi M, Ofili EO, Fernández-Repollet E, Sarpong DF, Yanagihara R, Aguilera RJ, Ayón C, Chen X, Dasmahapatra A, Gao S, Hinton CV, Holt R, Kolesnichenko V, Powell MD, Merchant F, Redda KK, Roche-Lima A, Shikuma CM, Stevens JJ, Torres JA, Trotter RT, Wachira J, Wang P, Wells KJ, White J, Wu Y. Research Infrastructure Core Facilities at Research Centers in Minority Institutions: Part I-Research Resources Management, Operation, and Best Practices. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16979. [PMID: 36554864 PMCID: PMC9779820 DOI: 10.3390/ijerph192416979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/04/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
Funded by the National Institutes of Health (NIH), the Research Centers in Minority Institutions (RCMI) Program fosters the development and implementation of innovative research aimed at improving minority health and reducing or eliminating health disparities. Currently, there are 21 RCMI Specialized (U54) Centers that share the same framework, comprising four required core components, namely the Administrative, Research Infrastructure, Investigator Development, and Community Engagement Cores. The Research Infrastructure Core (RIC) is fundamentally important for biomedical and health disparities research as a critical function domain. This paper aims to assess the research resources and services provided and evaluate the best practices in research resources management and networking across the RCMI Consortium. We conducted a REDCap-based survey and collected responses from 57 RIC Directors and Co-Directors from 98 core leaders. Our findings indicated that the RIC facilities across the 21 RCMI Centers provide access to major research equipment and are managed by experienced faculty and staff who provide expert consultative and technical services. However, several impediments to RIC facilities operation and management have been identified, and these are currently being addressed through implementation of cost-effective strategies and best practices of laboratory management and operation.
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Affiliation(s)
- Paul B. Tchounwou
- RCMI Center for Health Disparities Research, Jackson State University, Jackson, MS 39217, USA
| | - Mohamad Malouhi
- RCMI Center for Health Disparities Research, Jackson State University, Jackson, MS 39217, USA
| | - Elizabeth O. Ofili
- Department of Clinical and Translational Sciences, Morehouse School of Medicine, Atlanta, GA 30310, USA
| | - Emma Fernández-Repollet
- Department of Pharmacology, School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR 00936, USA
| | - Daniel F. Sarpong
- Office of Health Equity Research, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Richard Yanagihara
- Department of Pediatrics & Department of Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96813, USA
| | - Renato J. Aguilera
- RCMI Border Biomedical Research Center, University of Texas at El Paso, El Paso, TX 79968, USA
| | - Cecilia Ayón
- School of Public Policy, University of California-Riverside, Riverside, CA 92521, USA
| | - Xiaoxin Chen
- RCMI Center for Health Disparities Research, North Carolina Central University, Durham, NC 27707, USA
| | - Asok Dasmahapatra
- RCMI Center for Health Disparities Research, Jackson State University, Jackson, MS 39217, USA
| | - Song Gao
- Center for Biomedical and Minority Health Research, Texas Southern University, Houston, TX 77004, USA
| | - Cimona V. Hinton
- Department of Biological Sciences, Center for Cancer Research and Therapeutic Development, Clark Atlanta University, Atlanta, GA 30314, USA
| | - Robert Holt
- Department of Microbiology and Immunology, Meharry Medical College, Nashville, TN 37208, USA
| | | | - Michael D. Powell
- Department of Clinical and Translational Sciences, Morehouse School of Medicine, Atlanta, GA 30310, USA
| | - Fatima Merchant
- Department of Engineering Technology, College of Technology, University of Houston, Houston, TX 77004, USA
| | - Kinfe K. Redda
- College of Pharmacy and Pharmaceutical Sciences, Florida Agricultural and Mechanical University, Tallahassee, FL 32307, USA
| | - Abiel Roche-Lima
- Department of Pharmacology, School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR 00936, USA
| | - Cecilia M. Shikuma
- Department of Pediatrics & Department of Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96813, USA
| | - Jacqueline J. Stevens
- RCMI Center for Health Disparities Research, Jackson State University, Jackson, MS 39217, USA
| | - Jose A. Torres
- Department of Basic Sciences, Ponce Health Sciences University, Ponce, PR 00716, USA
| | - Robert T. Trotter
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ 86011, USA
| | - James Wachira
- RCMI Center for Urban Health Disparities Research and Innovation, Morgan State University, Baltimore, MD 21251, USA
| | - Paul Wang
- Department of Radiology, Howard University, Washington, DC 20059, USA
| | - Kristen J. Wells
- Department of Psychology, San Diego State University, San Diego, CA 92182, USA
| | - Jason White
- RCMI Center for Biomedical Research, Tuskegee University, Tuskegee, AL 36088, USA
| | - Yanyuan Wu
- Department of Internal Medicine, Charles R. Drew University, Los Angeles, CA 90095, USA
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Hekler E, Anderson CAM, Cooper LA. Is It Time to Restructure the National Institutes of Health? Am J Public Health 2022; 112:965-968. [PMID: 35728037 PMCID: PMC9222466 DOI: 10.2105/ajph.2022.306830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Eric Hekler
- Eric Hekler is with the Herbert Wertheim School of Public Health and Human Longevity Science (HWPSH), Design Lab, and Center for Wireless and Population Health Systems, Qualcomm Institute and HWSPH, University of California, San Diego. Cheryl A. M. Anderson is with the Herbert Wertheim School of Public Health and Human Longevity Science and the Department of Medicine, Division of Nephrology and Hypertension, University of California, San Diego. Lisa A. Cooper is with the Department of Medicine, Johns Hopkins University School of Medicine and the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Cheryl A M Anderson
- Eric Hekler is with the Herbert Wertheim School of Public Health and Human Longevity Science (HWPSH), Design Lab, and Center for Wireless and Population Health Systems, Qualcomm Institute and HWSPH, University of California, San Diego. Cheryl A. M. Anderson is with the Herbert Wertheim School of Public Health and Human Longevity Science and the Department of Medicine, Division of Nephrology and Hypertension, University of California, San Diego. Lisa A. Cooper is with the Department of Medicine, Johns Hopkins University School of Medicine and the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Lisa A Cooper
- Eric Hekler is with the Herbert Wertheim School of Public Health and Human Longevity Science (HWPSH), Design Lab, and Center for Wireless and Population Health Systems, Qualcomm Institute and HWSPH, University of California, San Diego. Cheryl A. M. Anderson is with the Herbert Wertheim School of Public Health and Human Longevity Science and the Department of Medicine, Division of Nephrology and Hypertension, University of California, San Diego. Lisa A. Cooper is with the Department of Medicine, Johns Hopkins University School of Medicine and the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Raffington L, Belsky DW. Integrating DNA Methylation Measures of Biological Aging into Social Determinants of Health Research. Curr Environ Health Rep 2022; 9:196-210. [PMID: 35181865 DOI: 10.1007/s40572-022-00338-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Acceleration of biological processes of aging is hypothesized to drive excess morbidity and mortality in socially disadvantaged populations. DNA methylation measures of biological aging provide tools for testing this hypothesis. RECENT FINDINGS Next-generation DNA methylation measures of biological aging developed to predict mortality risk and physiological decline are more predictive of morbidity and mortality than the original epigenetic clocks developed to predict chronological age. These new measures show consistent evidence of more advanced and faster biological aging in people exposed to socioeconomic disadvantage and may be able to record the emergence of socially determined health inequalities as early as childhood. Next-generation DNA methylation measures of biological aging also indicate race/ethnic disparities in biological aging. More research is needed on these measures in samples of non-Western and non-White populations. New DNA methylation measures of biological aging open opportunities for refining inference about the causes of social disparities in health and devising policies to eliminate them. Further refining measures of biological aging by including more diversity in samples used for measurement development is a critical priority for the field.
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Affiliation(s)
- Laurel Raffington
- Department of Psychology, University of Texas at Austin, Austin, TX, USA
- Population Research Center, The University of Texas at Austin, Austin, TX, USA
| | - Daniel W Belsky
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168th St. Rm 413, New York, NY, 10032, USA.
- Robert N Butler Columbia Aging Center, Columbia University Mailman School of Public Health, New York, NY, USA.
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Meissner HI, Sharma K, Mandal RJ, Garcia-Cazarin M, Wanke KL, Moyer J, Liggins C. NIH Tobacco Research and the Emergence of Tobacco Regulatory Science. Nicotine Tob Res 2022; 24:463-468. [PMID: 34624889 PMCID: PMC8887588 DOI: 10.1093/ntr/ntab205] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/06/2021] [Indexed: 11/13/2022]
Abstract
INTRODUCTION This study explores how the emergence of FDA-funded Tobacco Regulatory Science (TRS) research complements and perhaps influenced the direction of tobacco research supported by NIH. AIMS AND METHODS New NIH- and FDA-funded tobacco projects awarded in fiscal years (FY) 2011-2020 were identified using internal NIH databases of awarded grants. Project abstracts and research aims were coded by the authors to characterize research domains and tobacco products studied. RESULTS Between FY 2011 and 2020, NIH funded 1032 and FDA funded 322 new tobacco projects. For the years and grant activity codes studied, the number of new NIH tobacco projects declined while FDA's increased; combined the number of new projects held steady. Much of NIH research included smoking combustibles (43.7%). The most common products in FDA research were cigarettes (74.8%) and e-cigarettes/ENDS (48.1%). Most NIH (58.6%) and FDA (67.7%) projects included research on the determinants of tobacco use. Another area of apparent overlap was health effects (29.5% NIH and 30.1% FDA). Projects unique to NIH included treatment interventions (33.3%), disease pathology/progression (17.8%) and neurobiology (18.9%). A minority of both NIH and FDA projects included populations particularly vulnerable to tobacco product use. CONCLUSIONS In total, support for new tobacco research supported by NIH and FDA combined remained steady for the time period covered, though there was a concomitant decline in NIH tobacco projects with the increase in FDA-funded TRS projects for the activity codes studied. Despite the apparent overlap in some areas, both NIH and FDA support research that is unique to their respective missions. IMPLICATIONS NIH continues to support tobacco research that falls within and outside of FDA's regulatory authorities. This research still is needed not only to bolster the evidence base for regulatory decisions at the national and state levels, but also to advance a comprehensive scientific agenda that can inform multiple levels of influence on tobacco control, use and addiction. It will be important to continue monitoring FDA-funded TRS and NIH-funded tobacco research portfolios to ensure that the level of support for and focus of the research is sufficient to address the burden of tobacco-related morbidity and mortality.
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Affiliation(s)
- Helen I Meissner
- Office of Disease Prevention, National Institutes of Health, Bethesda MD, USA
| | - Kriti Sharma
- Office of Disease Prevention, National Institutes of Health, Bethesda MD, USA
| | - Rachel J Mandal
- Office of Disease Prevention, National Institutes of Health, Bethesda MD, USA
| | - Mary Garcia-Cazarin
- Office of Disease Prevention, National Institutes of Health, Bethesda MD, USA
| | - Kay L Wanke
- Office of Disease Prevention, National Institutes of Health, Bethesda MD, USA
| | - Jonathan Moyer
- Office of Disease Prevention, National Institutes of Health, Bethesda MD, USA
| | - Charlene Liggins
- Office of Disease Prevention, National Institutes of Health, Bethesda MD, USA
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12
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van den Broek-Altenburg EM, Atherly AJ, Hess S, Benson J. The effect of unobserved preferences and race on vaccination hesitancy for COVID-19 vaccines: implications for health disparities. J Manag Care Spec Pharm 2021; 27:S4-S13. [PMID: 34534008 DOI: 10.18553/jmcp.2021.27.9-a.s4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Reducing the extra burden COVID-19 has on people already facing disparities is among the main national priorities for the COVID-19 vaccine rollout. Early reports from states releasing vaccination data by race show that White residents are being vaccinated at significantly higher rates than Black residents. Public health efforts are being targeted to address vaccine hesitancy among Black and other minority populations. However, health care interventions intended to reduce health disparities that do not reflect the underlying values of individuals in underrepresented populations are unlikely to be successful. OBJECTIVE: To identify key factors underlying the disparities in COVID-19 vaccination. METHODS: Primary data were collected from an online survey of a representative sample of the populations of the 4 largest US states (New York, California, Texas, and Florida) between August 10 and September 3, 2020. Using latent class analysis, we built a model identifying key factors underlying the disparities in COVID-19 vaccination. RESULTS: We found that individuals who identify as Black had lower rates of vaccine hesitancy than those who identify as White. This was true overall, by latent class and within latent class. This suggests that, contrary to what is currently being reported, Black individuals are not universally more vaccine hesitant. Combining the respondents who would not consider a vaccine (17%) with those who would consider one but ultimately choose not to vaccinate (11%), our findings indicate that more than 1 in 4 (28%) persons will not be willing to vaccinate. The no-vaccine rate is highest in White individuals and lowest in Black individuals. CONCLUSIONS: Results suggest that other factors, potentially institutional, are driving the vaccination rates for these groups. Our model results help point the way to more effective differentiated policies. DISCLOSURES: No funding was received for this study. The authors have nothing to disclose.
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Affiliation(s)
| | - Adam J Atherly
- Larner College of Medicine, University of Vermont, Burlington
| | - Stephane Hess
- Choice Modelling Centre and Institute for Transport Studies, University of Leeds, United Kingdom
| | - Jamie Benson
- Larner College of Medicine, University of Vermont, Burlington
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13
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van den Broek-Altenburg EM, Atherly AJ, Hess S, Benson J. Valuing diversity in value assessment: introducing the PhRMA Foundation Health Disparities Challenge Award. J Manag Care Spec Pharm 2021; 27:S2-S3. [PMID: 34534009 PMCID: PMC10408392 DOI: 10.18553/jmcp.2021.27.9-a.s2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
DISCLOSURES:: No funding supported the writing of this article. The author has received grants from BeiGene, Ltd., and Pfizer, Inc., and advisory board fees from PhRMA Foundation.
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Affiliation(s)
| | - Adam J Atherly
- Larner College of Medicine, University of Vermont, Burlington
| | - Stephane Hess
- Choice Modelling Centre and Institute for Transport Studies, University of Leeds, United Kingdom
| | - Jamie Benson
- Larner College of Medicine, University of Vermont, Burlington
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14
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Manson SM. The Role of Culture in Effective Intervention Design, Implementation, and Research: Its Universal Importance. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 21:93-97. [PMID: 31659610 DOI: 10.1007/s11121-019-01065-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This special issue on Promoting Health Equity through Rigorous, Culturally Informed Intervention Science: Innovations with Indigenous Populations in the United States is a welcome addition to the growing recognition that culture is fundamental to effective intervention design, implementation, and research, in this instance among Indigenous peoples of North America and the Pacific. The articles herein summarize some of the priorities, findings, and lessons learned through work conducted by researchers in the National Institutes of Health Intervention Research to Improve Native American Health (IRINAH) consortium. The lessons learned encourage rethinking of the epistemological imperatives of our science; recognizing the rich, important variation in the lived experience of Indigenous peoples; and a greater appreciation for the critical role this experience plays in conceptualizing, designing, and operationalizing effective interventions. In this regard, the authors return us to a nearly 3 decades' old, but largely unrealized commitment by the National Institutes of Health to the thoughtful inclusion of underrepresented racial and ethnic minorities in its sponsored research as a means of improving the clinical and implementation sciences. The findings summarized in this special issue demonstrate the value of such efforts and fit well within existing paradigms that emphasize the importance of culture for maximizing the relevance and impact of this work. Yet the remaining challenge is to promote this agenda in ways that invite others to contribute in equally deliberate and informed ways, and thereby advance the field at large.
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Affiliation(s)
- Spero M Manson
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13055 E. 17th Avenue, Mail Stop F800, Aurora, CO, 80045, USA.
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15
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Yanagihara R, Berry MJ, Carson MJ, Chang SP, Corliss H, Cox MB, Haddad G, Hohmann C, Kelley ST, Lee ESY, Link BG, Noel RJ, Pickrel J, Porter JT, Quirk GJ, Samuel T, Stiles JK, Sy AU, Taira DA, Trepka MJ, Villalta F, Wiese TE. Building a Diverse Workforce and Thinkforce to Reduce Health Disparities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1569. [PMID: 33562262 PMCID: PMC7915161 DOI: 10.3390/ijerph18041569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/20/2021] [Accepted: 02/03/2021] [Indexed: 02/03/2023]
Abstract
The Research Centers in Minority Institutions (RCMI) Program was congressionally mandated in 1985 to build research capacity at institutions that currently and historically recruit, train, and award doctorate degrees in the health professions and health-related sciences, primarily to individuals from underrepresented and minority populations. RCMI grantees share similar infrastructure needs and institutional goals. Of particular importance is the professional development of multidisciplinary teams of academic and community scholars (the "workforce") and the harnessing of the heterogeneity of thought (the "thinkforce") to reduce health disparities. The purpose of this report is to summarize the presentations and discussion at the RCMI Investigator Development Core (IDC) Workshop, held in conjunction with the RCMI Program National Conference in Bethesda, Maryland, in December 2019. The RCMI IDC Directors provided information about their professional development activities and Pilot Projects Programs and discussed barriers identified by new and early-stage investigators that limit effective career development, as well as potential solutions to overcome such obstacles. This report also proposes potential alignments of professional development activities, targeted goals and common metrics to track productivity and success.
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Affiliation(s)
- Richard Yanagihara
- University of Hawaii at Manoa, Honolulu, HI 96813, USA; (M.J.B.); (S.P.C.); (A.U.S.); (D.A.T.)
| | - Marla J. Berry
- University of Hawaii at Manoa, Honolulu, HI 96813, USA; (M.J.B.); (S.P.C.); (A.U.S.); (D.A.T.)
| | - Monica J. Carson
- University of California, Riverside, Riverside, CA 92521, USA; (M.J.C.); (B.G.L.)
| | - Sandra P. Chang
- University of Hawaii at Manoa, Honolulu, HI 96813, USA; (M.J.B.); (S.P.C.); (A.U.S.); (D.A.T.)
| | - Heather Corliss
- San Diego State University, San Diego, CA 92182, USA; (H.C.); (S.T.K.); (J.P.)
| | - Marc B. Cox
- University of Texas at El Paso, El Paso, TX 79968, USA;
| | | | | | - Scott T. Kelley
- San Diego State University, San Diego, CA 92182, USA; (H.C.); (S.T.K.); (J.P.)
| | - Eun Sook Yu Lee
- Florida Agricultural and Mechanical University, Tallahassee, FL 32307, USA;
| | - Bruce G. Link
- University of California, Riverside, Riverside, CA 92521, USA; (M.J.C.); (B.G.L.)
| | - Richard J. Noel
- Ponce Health Sciences University, Ponce, PR 00716, USA; (R.J.N.J.); (J.T.P.)
| | - Julie Pickrel
- San Diego State University, San Diego, CA 92182, USA; (H.C.); (S.T.K.); (J.P.)
| | - James T. Porter
- Ponce Health Sciences University, Ponce, PR 00716, USA; (R.J.N.J.); (J.T.P.)
| | - Gregory J. Quirk
- University of Puerto Rico Medical Sciences Campus, San Juan, PR 00936, USA;
| | | | | | - Angela U. Sy
- University of Hawaii at Manoa, Honolulu, HI 96813, USA; (M.J.B.); (S.P.C.); (A.U.S.); (D.A.T.)
| | - Deborah A. Taira
- University of Hawaii at Manoa, Honolulu, HI 96813, USA; (M.J.B.); (S.P.C.); (A.U.S.); (D.A.T.)
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16
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Wilkins CH, Friedman EC, Churchwell AL, Slayton JM, Jones P, Pulley JM, Kripalani S. A Systems Approach to Addressing Covid-19 Health Inequities. ACTA ACUST UNITED AC 2021. [PMCID: PMC7743893 DOI: 10.1056/cat.20.0374] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Racial and ethnic minorities are dying from Covid-19 at alarmingly high rates, which demands immediate action. Health system leaders cannot allow other priorities to interfere with a commitment to address health inequities. Vanderbilt University Medical Center (VUMC) has embedded strategies to mitigate health inequities in its Covid-19 Command Center. A key strategy is the creation of interactive dashboards, which are reviewed daily and allow disaggregation by race, ethnicity, language, and ZIP Code. Of the first 45,954 patients tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at VUMC, 2,310 had limited English proficiency (LEP). The positivity rate for patients with LEP was 26% compared with 6% for patients with English as a primary language. In addition to alerting local and state health departments of these higher rates, we created multilingual resources, assessed our interpreter services capacity, and engaged trusted community organizations. Early lessons learned at VUMC may help others implement a systems approach and immediately begin addressing Covid-19 health equity.
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Affiliation(s)
- Consuelo H. Wilkins
- Vice President for Health Equity, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Associate Dean for Health Equity, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Professor of Medicine, Division of Geriatric Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elisa C. Friedman
- Assistant Vice President for Community and Population Health Improvement, Office of Health Equity, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - André L. Churchwell
- Chief Diversity Officer, Office of Diversity and Inclusion, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Senior Associate Dean for Diversity Affairs, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Jennifer M. Slayton
- Senior Vice President for Quality, Safety and Risk Prevention, and Chief Quality, Safety and Risk Prevention Officer, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Pam Jones
- Senior Associate Dean, Clinical and Community Partnerships, School of Nursing, Vanderbilt University, Nashville, Tennessee, USA
| | - Jill M. Pulley
- Director, Vanderbilt Institute for Clinical and Translational Research, Vanderbilt Coordinating Center, Nashville, Tennessee, USA
- Research Associate Professor of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sunil Kripalani
- Professor, Department of Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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17
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Balestrery JE, Going H, Pacheco R. Tribal Leadership and Care Services: "Overcoming These Divisions That Keep Us Apart". HEALTH & SOCIAL WORK 2020; 45:165-174. [PMID: 32743644 DOI: 10.1093/hsw/hlaa018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/25/2019] [Accepted: 04/18/2019] [Indexed: 06/11/2023]
Abstract
American Indian and Alaska Native (AI/AN) Peoples are among groups continuing to experience health disparities. Eliminating health disparities, a national priority in the United States, requires addressing structural forces, also known as structural determinants of health. This case study examines linkages between health disparities, structural forces, and colonial trauma relevant to care services and AN Peoples in Alaska. It centers on an Inupiaq Elder with leadership experience in AN tribal care services. Guided by a conceptual lens based on division-unification processes, this study yields the following findings as represented by five in vivo themes: severing of relationship, aftereffects of colonization, striking alliances, overcoming these divisions that keep people apart, and growing together in relationship. Colonial legacies continue to linger and have a multidimensional impact on AI/AN communities, including tribal care services. Healing from colonial trauma requires collective effort among AI/AN Peoples and people from the wider community. Practice implications emphasize trauma-informed approaches to promote reconciliation and a larger collective commitment to reconciliation in a global reality of increasing interdependence.
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Affiliation(s)
- Jean E Balestrery
- Hampton Faculty Fellow, the American Indian/Alaska Native Initiative on Cancer, Spirit of EAGLES, Rochester, MN 55902
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18
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Ma C, Herrmann L, Miner S, Stimpfel AW, Squires A. Home health care services to persons with dementia and language preference. Geriatr Nurs 2020; 41:165-171. [PMID: 31668782 PMCID: PMC9275475 DOI: 10.1016/j.gerinurse.2019.08.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 08/25/2019] [Accepted: 08/30/2019] [Indexed: 11/20/2022]
Abstract
Despite the rapid increase in the number of persons with dementia (PWD) receiving home health care (HHC), little is known of HHC services patterns to PWD of varied backgrounds, including language preference other than English. Analyzing data of 12,043 PWD from an urban home health agency, we found on average PWD received 2.48 skilled visits or 1.88-hour skilled care and 5.81 aide visits or 24.13-hour aide care weekly. Approximately 63% of the skilled visits were from nurses. More non-English preferred PWD received aide visits, compared to English preferred PWD (44% vs. 36%). The type and intensity of HHC services were associated with language preference; when stratified by insurance, non-English preference was still significantly associated with more HHC aide care. Our study indicated that HHC services (both type and amount) varied by language preference and insurance type as an indicator of access disparities was a significant contributor to the observed differences.
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Affiliation(s)
- Chenjuan Ma
- New York University Rory Meyers College of Nursing, 433 First Avenue, New York, NY 10010, United States.
| | - Linda Herrmann
- New York University Rory Meyers College of Nursing, 433 First Avenue, New York, NY 10010, United States
| | - Sarah Miner
- St. John Fisher College Wegmans School of Nursing, 3690 East Ave, Rochester, NY 14618, United States
| | - Amy Witkoski Stimpfel
- New York University Rory Meyers College of Nursing, 433 First Avenue, New York, NY 10010, United States
| | - Allison Squires
- New York University Rory Meyers College of Nursing, 433 First Avenue, New York, NY 10010, United States
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19
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Jarrín OF, Nyandege AN, Grafova IB, Dong X, Lin H. Validity of Race and Ethnicity Codes in Medicare Administrative Data Compared With Gold-standard Self-reported Race Collected During Routine Home Health Care Visits. Med Care 2020; 58:e1-e8. [PMID: 31688554 PMCID: PMC6904433 DOI: 10.1097/mlr.0000000000001216] [Citation(s) in RCA: 255] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Misclassification of Medicare beneficiaries' race/ethnicity in administrative data sources is frequently overlooked and a limitation in health disparities research. OBJECTIVE To compare the validity of 2 race/ethnicity variables found in Medicare administrative data [enrollment database (EDB) and Research Triangle Institute (RTI) race] against a gold-standard source also available in the Medicare data warehouse: the self-reported race/ethnicity variable on the home health Outcome and Assessment Information Set (OASIS). SUBJECTS Medicare beneficiaries over the age of 18 who received home health care in 2015 (N=4,243,090). MEASURES Percent agreement, sensitivity, specificity, positive predictive value, and Cohen κ coefficient. RESULTS The EDB and RTI race variable have high validity for black race and low validity for American Indian/Alaskan Native race. Although the RTI race variable has better validity than the EDB race variable for other races, κ values suggest room for future improvements in classification of whites (0.90), Hispanics (0.87), Asian/Pacific Islanders (0.77), and American Indian/Alaskan Natives (0.44). DISCUSSION The status quo of using "good-enough for government" race/ethnicity variables contained in Medicare administrative data for minority health disparities research can be improved through the use of self-reported race/ethnicity data, available in the Medicare data warehouse. Health services and policy researchers should critically examine the source of race/ethnicity variables used in minority health and health disparities research. Future work to improve the accuracy of Medicare beneficiaries' race/ethnicity data should incorporate and augment the self-reported race/ethnicity data contained in assessment and survey data, available within the Medicare data warehouse.
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Affiliation(s)
- Olga F Jarrín
- Division of Nursing Science, School of Nursing
- Institute for Health, Health Care Policy, and Aging Research
| | | | - Irina B Grafova
- School of Public Health, Rutgers, The State University of New Jersey, New Brunswick, NJ
| | - XinQi Dong
- Institute for Health, Health Care Policy, and Aging Research
| | - Haiqun Lin
- Division of Nursing Science, School of Nursing
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20
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Affiliation(s)
- George A Mensah
- Center for Translation Research and Implementation Science National Heart, Lung, and Blood Institute National Institutes of Health Bethesda MD
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21
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Popejoy AB. Diversity In Precision Medicine And Pharmacogenetics: Methodological And Conceptual Considerations For Broadening Participation. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2019; 12:257-271. [PMID: 31686892 PMCID: PMC6800456 DOI: 10.2147/pgpm.s179742] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 09/12/2019] [Indexed: 01/01/2023]
Abstract
Genome-wide association studies (GWAS) have revealed important links between genetic markers across the human genome and phenotypic traits, including risk factors for disease. Studies have shown that GWAS continue to be overwhelmingly conducted on people of primarily European descent, despite the fact that the vast majority of human genomic variation is present in non-European populations such as those in Africa. To enhance our understanding of diversity in the pharmacogenomics and precision medicine literature, this review provides a window into the representation of biogeographical populations that have been studied for pharmacogenetic traits, such as enzyme metabolism and adverse drug response. Using the Medical Subject Headings (MeSH) ontology search terms in PubMed, studies were identified that are either population-based, or include a description of the study population on the basis of biological or environmental diversity. The results of this scoping review indicate that the majority of relevant papers (>95% of studies tagged in PubMed with MeSH terms “precision medicine” or “pharmacogenetics”, N=23,701) are not annotated with the “population group” MeSH term, suggesting that the majority of studies in this literature are not population-based, or the authors chose not to describe the study population. Among those studies related to pharmacogenetics or precision medicine that are specific to human population groups (N=1006) and were included in the analysis after filtering and screening on eligibility criteria (N=192), the majority of single-population studies included individuals of African, Asian, and European origins, or genetic ancestry. Combining studies of single and multiple populations, 33% involve participants of Asian origin or ancestry; 30% European; 24% African; 10% Hispanic or Latino; and < 3% American Indian or Alaska Native. These data provide a baseline for future comparison, indicating which biogeographic groups have informed the pharmacogenomic knowledgebase specific to diverse human populations. Challenges and potential solutions to improve diversity in the field and in genetics research more broadly are discussed.
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Affiliation(s)
- Alice B Popejoy
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA.,Center for Computational, Evolutionary and Human Genomics (CEHG), Stanford University, Stanford, CA, USA.,Center for Integration of Research on Genetics and Ethics (CIRGE), Stanford University, Stanford, CA, USA
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22
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Kuhlman KR, Urizar GG, Robles TF, Yim IS, Schetter CD. Testing plausible biopsychosocial models in diverse community samples: Common pitfalls and strategies. Psychoneuroendocrinology 2019; 107:191-200. [PMID: 31150964 PMCID: PMC6635037 DOI: 10.1016/j.psyneuen.2019.05.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/24/2019] [Accepted: 05/19/2019] [Indexed: 01/19/2023]
Abstract
It is imperative that research interrogating the biological pathways linking stress processes to health continue to translate the results of basic, preclinical experimental research to diverse and under-represented populations, particularly those at elevated risk for morbidity and mortality. Conducting research within these populations and in community settings involves a number of challenges that ultimately contribute to their rarity and uneven quality in the scientific literature. In this review, we summarize the experiences and insights of members of an expert panel on this topic held at the 2018 meeting of the International Society of Psychoneuroendocrinology in Newport Beach, CA. The goals of the session were to identify challenges and share strategies for testing plausible biopsychosocial models within diverse community samples in order to encourage others and improve future research. The present paper is organized into three themes: 1) Recruitment and retention, 2) Collecting biological samples outside of the laboratory, 3) Data analysis, interpretation, and dissemination. Our goal in composing this overview of the conference session was to share within the field of psychoneuroendocrinology the challenges inherent in translating basic research to community populations.
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Affiliation(s)
- Kate Ryan Kuhlman
- Department of Psychological Science, University of California Irvine, Irvine, California, 92697 USA; Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, California, 90095 USA.
| | - Guido G. Urizar
- Department of Psychology, California State University Long Beach, Long Beach, California, 90840 USA
| | - Theodore F. Robles
- Department of Psychology, University of California Los Angeles, Los Angeles, California, 90095 USA
| | - Ilona S. Yim
- Department of Psychological Science, University of California Irvine, Irvine, California, 92697 USA
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Mensah GA, Jaquish C, Srinivas P, Papanicolaou G, Wei GS, Redmond N, Roberts MC, Nelson C, Aviles-Santa L, Puggal M, Green Parker MC, Minear MA, Barfield W, Fenton KN, Boyce CA, Engelgau MM, Khoury MJ. Emerging Concepts in Precision Medicine and Cardiovascular Diseases in Racial and Ethnic Minority Populations. Circ Res 2019; 125:7-13. [PMID: 31219738 PMCID: PMC6590684 DOI: 10.1161/circresaha.119.314970] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Cardiovascular diseases remain the leading cause of mortality and a major contributor to preventable deaths worldwide. The dominant modifiable risk factors and the social and environmental determinants that increase cardiovascular risk are known, and collectively, are as important in racial and ethnic minority populations as they are in majority populations. Their prevention and treatment remain the foundation for cardiovascular health promotion and disease prevention. Genetic and epigenetic factors are increasingly recognized as important contributors to cardiovascular risk and provide an opportunity for advancing precision cardiovascular medicine. In this review, we explore emerging concepts at the interface of precision medicine and cardiovascular disease in racial and ethnic minority populations. Important among these are the lack of racial and ethnic diversity in genomics studies and biorepositories; the resulting misclassification of benign variants as pathogenic in minorities; and the importance of ensuring ancestry-matched controls in variant interpretation. We address the relevance of epigenetics, pharmacogenomics, genetic testing and counseling, and their social and cultural implications. We also examine the potential impact of precision medicine on racial and ethnic disparities. The National Institutes of Health's All of Us Research Program and the National Heart, Lung, and Blood Institute's Trans-Omics for Precision Medicine Initiative are presented as examples of research programs at the forefront of precision medicine and diversity to explore research implications in minorities. We conclude with an overview of implementation research challenges in precision medicine and the ethical implications in minority populations. Successful implementation of precision medicine in cardiovascular disease in minority populations will benefit from strategies that directly address diversity and inclusion in genomics research and go beyond race and ethnicity to explore ancestry-matched controls, as well as geographic, cultural, social, and environmental determinants of health.
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Affiliation(s)
- George A. Mensah
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Maryland
| | - Cashell Jaquish
- Division of Cardiovascular Sciences, NHLBI, NIH, Bethesda, Maryland
| | - Pothur Srinivas
- Division of Cardiovascular Sciences, NHLBI, NIH, Bethesda, Maryland
| | | | - Gina S. Wei
- Division of Cardiovascular Sciences, NHLBI, NIH, Bethesda, Maryland
| | - Nicole Redmond
- Division of Cardiovascular Sciences, NHLBI, NIH, Bethesda, Maryland
| | | | - Cheryl Nelson
- Division of Cardiovascular Sciences, NHLBI, NIH, Bethesda, Maryland
| | | | - Mona Puggal
- Division of Cardiovascular Sciences, NHLBI, NIH, Bethesda, Maryland
| | - Melissa C. Green Parker
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Maryland
| | - Mollie A. Minear
- Division of Cardiovascular Sciences, NHLBI, NIH, Bethesda, Maryland
| | - Whitney Barfield
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Maryland
| | - Kathleen N. Fenton
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Maryland
| | - Cheryl Anne Boyce
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Maryland
| | - Michael M. Engelgau
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Maryland
| | - Muin J. Khoury
- Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, Georgia
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24
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Abstract
Diabetes is a prevalent condition in the U.S. and worldwide, with expanding impact over time as it affects progressively younger ages as well as older ages as people live longer. Costs of diabetes to those affected and to society as a whole continue to increase. Costs are realized through daily treatment regimens throughout life to control glycemia and other risk factors for complications as diabetes progresses, diabetes complications and disability and their treatments, health care visits and hospitalization, and as indirect costs via lower quality of life and lost productivity. Diagnosing diabetes is key to affording the opportunity to treat diabetes, and diabetes control is key to reducing the risk of complications. Yet the magnitude of undiagnosed diabetes and poor control of diabetes is large. And just as certain subgroups of the population are affected disproportionately by diabetes and diabetes complications, so are they affected disproportionately by undiagnosed diabetes and poor control. This review addresses the epidemiology of undiagnosed diabetes and diabetes control, largely covering their magnitude, demographic variation, trends over time, and predictors. For diabetes control, it focuses on control of A1C, blood pressure, and lipid levels, although there are many other facets of diabetes control and preventive care that also could be examined. The review is based predominantly on data from the National Health and Nutrition Examination Survey (NHANES), a U.S. health survey that includes both an interview and examination component that has been conducted continuously since 1999 and episodically for decades earlier. The interview elicits self-reported health responses pertaining to diabetes and other medical conditions and an examination that measures glycemic indicators, blood pressure, and lipids, which provide much of the material presented herein. Data from other studies are also presented and described.
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Affiliation(s)
- Catherine C Cowie
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
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