Author Interviews, Diabetes, JAMA, Race/Ethnic Diversity, University of Pennsylvania / 20.12.2021
Diabetes: Racial, Ethnic, and Socioeconomic Inequities in GLP-1 RA Drug Use
MedicalResearch.com Interview with:
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Dr. Eberly[/caption]
Lauren A. Eberly, MD, MPH
Clinical Fellow, Cardiovascular Medicine
Perelman School of Medicine
Cardiovascular Division, Perelman School of Medicine
Center for Cardiovascular Outcomes, Quality, and Evaluative Research,
Cardiovascular Center for Health Equity and Social Justice,
Leonard Davis Institute of Health Economics
University of Pennsylvania, Philadelphia
MedicalResearch.com: What is the background for this study?
Response: Racial inequities are pervasive in our country, and cardiovascular therapeutics with proven benefit have been shown to be underutilized among Black and Latinx patients.
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), a recommended treatment option for glycemic control in patients with diabetes, have recently emerged as a cardioprotective therapy as multiple large randomized clinical trials have shown they prevent cardiovascular events among patients with Type 2 Diabetes (T2D), particularly patients with established atherosclerotic cardiovascular disease (ASCVD). Given this, they are now recommended therapy for patients with diabetes and established or high risk of ASCVD.
Given the known inequitable utilization of other therapies, along with the known higher burden of diabetes and cardiovascular disease among Black patients, the aim of this study was to evaluate the uptake of GLP-1 RA as well as for inequities in utilization.
Dr. Eberly[/caption]
Lauren A. Eberly, MD, MPH
Clinical Fellow, Cardiovascular Medicine
Perelman School of Medicine
Cardiovascular Division, Perelman School of Medicine
Center for Cardiovascular Outcomes, Quality, and Evaluative Research,
Cardiovascular Center for Health Equity and Social Justice,
Leonard Davis Institute of Health Economics
University of Pennsylvania, Philadelphia
MedicalResearch.com: What is the background for this study?
Response: Racial inequities are pervasive in our country, and cardiovascular therapeutics with proven benefit have been shown to be underutilized among Black and Latinx patients.
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), a recommended treatment option for glycemic control in patients with diabetes, have recently emerged as a cardioprotective therapy as multiple large randomized clinical trials have shown they prevent cardiovascular events among patients with Type 2 Diabetes (T2D), particularly patients with established atherosclerotic cardiovascular disease (ASCVD). Given this, they are now recommended therapy for patients with diabetes and established or high risk of ASCVD.
Given the known inequitable utilization of other therapies, along with the known higher burden of diabetes and cardiovascular disease among Black patients, the aim of this study was to evaluate the uptake of GLP-1 RA as well as for inequities in utilization.
Dr. Deshmukh[/caption]
Ashish A. Deshmukh, PhD, MPH
Associate Professor, Management, Policy & Community Health
Associate Director, Center for Health Services Research
Co-director, Clinical Analytics and Decision Science Lab
UTHealth School of Public Health
Houston, TX 77030
MedicalResearch.com: What is the background for this study?
Response: Oropharyngeal cancer is the most common cancer caused by human papillomavirus (HPV) in the United States (US). We know from previous studies that oropharyngeal cancer to be one of the fastest rising cancers in the US. However, trends (i.e., extent of change) in incidence rates among men and women in all 50 US states and trends according to tumor diagnostic characteristics (i.e., stage, size) have not been comprehensively studied. In addition, no prior study evaluated contemporary trends in oropharyngeal cancer mortality (death) rates in the US. Our study provides a comprehensive picture of oropharyngeal cancer incidence and mortality (according to age, stage, tumor size, and state of residence) in all 50 states and DC.
Jiawen Liu[/caption]
Jiawen Liu, PhD student
Department of Civil & Environmental Engineering
University of Washington
MedicalResearch.com: What is the background for this study?
Response: As previous literature has documented, racial/ethnic minority populations and lower-income populations in the US often experience higher-than-average burdens of air pollution and its associated health impacts.
The disparities vary by pollutant, location, and time. In 2014, Clark et al. found higher average NO2 exposure for nonwhites than for whites and for below-poverty-level than for above-poverty-level. Clark et al. (2017) expanded research for NO2 exposure by race-ethnicity and socioeconomic status to 2000 and 2010 and found that absolute racial-ethnic disparities decreased over time while relative racial-ethnic disparities persisted.
Dr. Ooi Eng Eong[/caption]
Professor Ooi Eng Eong
Programme in Emerging Infectious Diseases
Duke-NUS Medical School
Professor, Saw Swee Hock School of Public Health
National University of Singapore
Co-director, Viral Research And Experimental Medicine Centre
MedicalResearch.com: What is the background for this study?
Response: The emergence of Zika virus as a cause of fetal developmental disorder, or congenital Zika syndrome (CZS), mirrors the impact of congenital rubella syndrome on public health. Congenital rubella syndrome was controlled through the development of a live attenuated rubella virus vaccine that, when given to young children, elicited long-lasting immunity that protected against rubella well into adulthood.
Indeed, live viral vaccines cause subclinical infection to elicit immunity that approaches those that develop following wild-type viral infection. However, the boundary between attenuated and virulent Zika virus has not been clearly defined, making development of any live attenuated Zika virus vaccine risky.
Shuchi Anand, MD MS (she/her)
Assistant Professor in Medicine
Director, Center for Tubulointerstitial Kidney Disease
Stanford University School of Medicine
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: A majority of people on dialysis who completed vaccination as of September 2021 have had a decline in antibody response to levels that would render them vulnerable to infection. Antibody response immediately after vaccination and circulating antibody response is strongly associated with risk for breakthrough after the initial vaccination series.
Dr. Mapara[/caption]
Markus Y Mapara, MD
Professor of Medicine
Director of the Blood and Marrow Transplantation
Columbia University Medical Center
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Sickle cell disease is caused by a point mutation in the beta-globin gene of hemoglobin resulting in the production of abnormal hemoglobin which leads to formation of sickle-shaped RBC under conditions of low oxygen. Sickle cell disease affects about 100,000 patients in the US which are predominantly African American. The only curative approach is to perform an allogeneic bone marrow transplant which is however fraught with significant treatment-related risks if a matched sibling donor is not available.
The current study describes the successful application of a novel gene therapy to treat patients with sickle cell disease. The strategy is based on a gene-addition approach to introduce the genetic information for a Hemoglobin F-like molecule termed HgAT87Q into hematopoietic stem cells. The expression of this novel hemoglobin prevents polymerization of HgbS and has now been demonstrated to prevent the occurrence of vaso-occlusive pain crises in sickle cell disease patients.
Dr. Thakrar[/caption]
Ashish Thakrar, MD
Internal Medicine & Addiction Medicine
National Clinician Scholars Program
University of Pennsylvania
MedicalResearch.com: What is the background for this study?
Response: About 1.8 million Americans are currently incarcerated, more than any other country in the world per capita. Of those 1.8 million, about 1 in 7 suffers from opioid addiction, putting them at high risk of overdose and death, particularly in the weeks following release.
Opioid use disorder is a treatable condition, particularly with the medications buprenorphine or methadone, but historically, prisons and jails have not offered treatment. Over the past five years, a few states and municipalities have enacted policies to provide access for OUD treatment. We examined whether these policies were actually improving access to treatment.
Dr. van Dalen[/caption]
Jan Willem van Dalen, PhD
Department of Neurology
Donders Institute for Brain, Behaviour and Cognition
Radboud University Medical Centre Nijmegen
Department of Neurology
The Netherlands3Department of Public and Occupational Health
Amsterdam UMC, University of Amsterdam, Amsterdam
MedicalResearch.com: What is the background for this study?
Response: Although high systolic blood pressure in midlife has consistently been reported as a condition that increases the risk of developing dementia in old age, reports regarding this relationship in older people have been inconsistent. One potential reason for this, is that the relationship between systolic blood pressure and dementia in later life may be U-shaped, meaning that both individuals with low and with high systolic blood pressure are at increased incident dementia risk.
This study combined data from several longitudinal cohort studies specifically designed to study incident dementia in older people, to investigate whether these U-shaped relationships exist, and in which age ranges they appear. We included more than 16,500 people aged 60 and older, with over 2,700 incident dementia cases.
Also, we aimed to investigate whether these observational associations might be caused by confounding, differences in mortality, or result from opposite relationships between certain subgroups of individuals.
Dr. Cabana[/caption]
Michael Cabana, M.D., M.A., M.P.H
Professor of Pediatrics
Albert Einstein College of Medicine.
Physician-in-chief , Children's Hospital at Montefiore
Chair of the Department of Pediatrics
Albert Einstein College of Medicine
Member, U.S. Preventive Services Task Force
MedicalResearch.com: What is the background for this study and recommendation statement?
Response: Dental caries, also known as cavities or tooth decay, is the most common chronic disease in children in the United States and can develop in any child whose teeth have come in. Many young children under five years old do not visit a dentist, so the Task Force reviewed the latest evidence on how primary care clinicians can help prevent tooth decay in young children.
The Task Force’s research led to two important findings: all young children whose teeth have come in should have fluoride varnish applied by their clinician, and all children six months and older whose water supply doesn’t contain enough fluoride should receive fluoride supplements. Both approaches can help prevent cavities in kids.
The Task Force also determined that there is not enough evidence to recommend for or against screening for tooth decay in the primary care setting for children under five. This is consistent with the Task Force’s 2014 recommendation on dental caries.
Dr. Lee[/caption]
Cecilia S. Lee, MD, MS
Associate Professor,Director, Clinical Research
Department of Ophthalmology
Harborview Medical Center
University of Washington Seattle, WA
MedicalResearch.com: What is the background for this study?
Response: Cataract is a natural aging process of the eye and affects the majority of older adults who are at risk for dementia. Sensory loss, including vision and hearing, is of interest to the research community as a possible risk factor for dementia, and also as a potential point of intervention. Because cataract surgery improves visual function, we hypothesized that older people who undergo cataract surgery may have a decreased risk of developing Alzheimer disease and dementia.
We used the longitudinal data from an ongoing, prospective, community based cohort, Adult Changes in Thought (ACT) study. The ACT study includes over 5000 participants to date who are dementia free at recruitment and followed until they develop Alzheimer disease or dementia. We had access to their extensive medical history including comprehensive ophthalmology visit data. We investigated whether cataract surgery was associated with a decreased risk of developing Alzheimer disease and dementia.
Dr. Smyth[/caption]
Professor Andrew Smyth MB, BCh, BAO, MMedSc, MRCPI, PhD
Professor of Clinical Epidemiology
NUI Galway
Director of the HRB-Clinical Research Facility Galway
Consultant Nephrologist at Galway University Hospitals
MedicalResearch.com: What is the background for this study?
Response: We know that there are multiple medium to long-term risk factors for stroke, as people with conditions such as hypertension (high blood pressure) or diabetes mellitus (high blood glucose levels) and those with risk factors (such as smoking, obesity, poor diet quality and others) are at increased risk of stroke. However, we still find it difficult to predict who will have a stroke.
We were interested in exploring if short-term exposures to anger or emotional upset or a period of heavy physical exertion might lead to, or ‘trigger’ a stroke. We looked at this previously for myocardial infarction (heart attack) in a study called INTERHEART. Some smaller studies have looked at this before, with less people experiencing a stroke and often confined to one country or geographical region. Here, in INTERSTROKE, we included over 13,000 people who had a stroke and asked about the one hour period before the onset of the stroke and also about the same period on the day before.
Dr. Dalton[/caption]
Kristine Dalton PhD FAAO, FBCLA
School of Optometry & Vision Science
University of Waterloo
Waterloo, Canada
MedicalResearch.com: What is the background for this study?
Response: Dynamic visual acuity refers to the ability to detect and perceive small details in objects that are moving relative to an observer. Dynamic visual acuity is a complex visual function, that involves a number of different aspects of vision, including detecting the target, moving the eyes appropriately to observe the target, and processing the visual information from the target in the brain to interpret what we are seeing. What makes dynamic visual acuity so interesting to study, is that as a visual function, it appears to play an important role in a number of real-world situations, including playing sports, driving, and piloting, and it may provide us more information about how the visual system is functioning compared to the more traditional, static vision tests alone.
Previous research has demonstrated that consumption of caffeine has been shown to benefit physiological, psychomotor, and cognitive performance. More recently there has been an increased interest in studying the impacts of caffeine on the vision system, however the impact of caffeine on dynamic visual acuity has not been studied. This study was designed to address this limitation in the literature, particularly because dynamic visual acuity appears to be such an important visual function for real-world activities.
Dr. Dickerman[/caption]
Dr. Barbra Dickerman, PhD
CAUSALab investigator and instructor
Department of Epidemiology
Harvard T.H. Chan School of Public Health
MedicalResearch.com: What is the background for this study?
Response: Early randomized trials showed that the BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) vaccines were both remarkably effective at preventing symptomatic disease, when comparing each vaccine with no vaccine. However, head-to-head comparisons of these vaccines have been lacking, leaving open the question of which vaccine is more effective.
In this study, we analyzed the VA’s high-quality databases in a way that emulated the design of the hypothetical trial that would have answered this question. Specifically, we used the findings from the original trials to benchmark our methods and then extended them to provide novel evidence for the comparative effectiveness of these two vaccines in a real-world setting and across diverse subgroups and different time periods.
Dr. Shiou Liang[/caption]
Wee Shiou Liang, PhD
Associate Professor | Health and Social Sciences, Singapore Institute of Technology
Faculty | Geriatric Education and Research Institute
Singapore
MedicalResearch.com: What is the background for this study?
Response: This study was funded by Singapore’s Ministry of Health Geriatric Education and Research Institute.
We randomly recruited 500+ adults aged 21-90+ from the residential town of Yishun. We performed detailed assessments of physical and cognitive performance, body composition using DEXA, and participants also provided information on their levels and frequencies of physical activities (PA) including recreational PA/exercise, commuting, housework and other occupational related PA. The demographics of the sample of participants is the same as that of Singapore in terms of age and ethnic composition. Comparing the results of those aged 21-<65 and those >=65 years, only around a third (36%; 90) of those in the younger group and only around half (48%;116) of those in the older age group, met guidelines recommended physical activity quota exclusively from recreational PA/exercise. But nearly two thirds (61% younger; 152 and 66% older; 159) met this target exclusively through housework.