Ethnic and Racial Disparities in Medicare Annual Wellness Visit Utilization

MedicalResearch.com Interview with:

Kim Lind, PhD, MPH Research Fellow Centre for Health Systems and Safety Research Australian Institute of Health Innovation Macquarie University, NSW 

Dr. Lind

Kim Lind, PhD, MPH
Research Fellow
Centre for Health Systems and Safety Research
Australian Institute of Health Innovation
Macquarie University, NSW

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The Medicare Annual Wellness Visit (AWV) is a preventive care visit that was introduced in 2011 as part of the Patient Protection and Affordable Care Act. Prior to this, the only preventive care exam covered by Medicare was the Welcome to Medicare Visit, which is only available for people in their first year of Medicare enrolment. The AWV is available each year to beneficiaries without co-payment to people who are past their first year of Medicare enrolment. The AWV focuses on prevention and early detection of disease.

Racial disparities in healthcare utilization and health outcomes have been well documented in the US. Prior expansions of Medicare coverage have had varied effects on reducing disparities. For example, in 2001 Medicare began to cover colorectal cancer screening which reduced racial disparities for some minority groups with respect to screening rates and improved early detection.

Expanding coverage of preventive care for people on Medicare may help reduce disparities in health outcomes, but we first needed to know if people were using the Medicare Annual Wellness Visit. Our goal was to assess AWV utilization rates and determine if utilization differed by race or ethnicity. We analyzed a nationally representative database of Medicare beneficiaries (the Medicare Current Beneficiary Survey) that included self-reported race, ethnicity, income and education, linked to Medicare claims.

We found that Medicare Annual Wellness Visit use was low but increased from 2011 to 2013. We also found that people on Medicare who self-identified as belonging to a racial or ethnic minority group had lower AWV utilization rates than non-Hispanic white people. People with lower income or education, and people living in rural areas had lower Medicare Annual Wellness Visit utilization.  Continue reading

Minority-Based Lung Cancer Screening Found High Rates of Cancer

MedicalResearch.com Interview with:

Mary Pasquinelli, MS, APRN Doctor of Nursing Practice Candidate (2018) Lung Cancer Screening Program Director Advanced Practice Nurse, Pulmonary and Medical Oncology Department of Medicine Chicago, Il 60612

Mary Pasquinelli

Mary Pasquinelli, MS, APRN
Doctor of Nursing Practice Candidate (2018)
Lung Cancer Screening Program Director
Advanced Practice Nurse
Pulmonary and Medical Oncology
Department of Medicine
Chicago, Il 60612 

MedicalResearch.com: What is the background for this study? What are the main findings?

 Response: We performed a retrospective analysis of our lung cancer-screening program.

Our program included individuals from a predominantly minority inner city population including Federal Qualified Health Centers.

The main findings were that our screening program found a higher rate of positive screens and lung cancer in our initial screens than that compared to the National Lung Screening Trial.

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More Medicaid Enrollees Receiving Treatment for Opioid Use Disorder, But Disparities Remain

MedicalResearch.com Interview with:

Bradley D. Stein MD PhD Senior Physician Policy Researcher Pittsburgh Office Rand Corporation

Dr. Stein

Bradley D. Stein MD PhD
Senior Physician Policy Researcher
Pittsburgh Office
Rand Corporation

MedicalResearch.com: What is the background for this study?

Response: Increasing use of medication treatment for individuals with opioid use disorders, with medications like methadone and buprenorphine, is a critical piece of the nation’s response to the opioid crisis. Buprenorphine was approved by the FDA in 2002 for treatment of opioid use disorders, but there was little information about to what extent buprenrophine’s approval increased the number of Medicaid-enrollees who received medication treatment in the years following FDA approval nor to what extent receipt of such treatment was equitable across communities.

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African Americans Less Likely To Be Treated With Statins

MedicalResearch.com Interview with:

Michael G. Nanna, MD Fellow, Division of Cardiology Duke University Medical Center Durham, NC

Dr. Nanna

Michael G. Nanna, MD
Fellow, Division of Cardiology
Duke University Medical Center
Durham, NC

MedicalResearch.com: What is the background for this study?

Response: We know that African Americans are at higher risk for cardiovascular disease than white patients. We also know that African American individuals have been less likely to receive statin therapy compared to white individuals in the past. However, the reasons underlying these racial differences in statin treatment are poorly understood. We set out to determine if African American individuals in contemporary practice are treated less aggressively than whites and, if so, we wanted to investigate potential reasons why this might be the case.

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American Indian 8th Grade Students Have High Rates of Substance Abuse

MedicalResearch.com Interview with:
Randall C. Swaim, Ph.D.
Senior Research Scientist and Director
Linda R. Stanley, Ph.D.
Senior Research Scientist

Tri-Ethnic Center for Prevention Research
Department of Psychology
Colorado State University                          

MedicalResearch.com: What is the background for this study?

Response: American Indian adolescents consistently report the highest levels of substance use compared with other US racial/ethnic groups. The harm associated with these high rates of use include higher risk of developing a substance use disorder, more alcohol-related problems, including alcohol-attributable death, and other negative outcomes such as school failure. These findings point to the importance of continuing to monitor this group, particularly given changing trends in perceived harmfulness of illicit substances as new statutes alter access to medical and recreational use of cannabis.

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How Much US Life is Lost to Police Violence?

MedicalResearch.com Interview with:
“police” by istolethetv is licensed under CC BY 2.0Anthony L. Bui, MPH

M.D. Candidate, David Geffen School of Medicine at UCLA
Matthew M. Coates, MPH
Associate, Harvard Medical School, Department of Global Health and Social Medicine
Ellicott C. Matthay, MPH
Ph.D. Candidate, Division of Epidemiology, University of California, Berkeley School of Public Health

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Protests after recent deaths from encounters with law enforcement, the Black Lives Matter movement, and activism over social media platforms have raised the profile of the problem of police violence. Several studies have suggested that the public health community has a duty to address these deaths as a public health problem. These studies have also pointed out that although there is a lack of officially reported statistics on police violence, other journalistic and crowd-sourced efforts such as “The Counted” from The Guardian, FatalEncounters.org, U.S. Police Shootings Database, KilledbyPolice.net, and Mapping Police Violence have relatively complete documentation of deaths from police violence.

To help frame the issue as a public health problem, we calculated years of life lost (YLLs) attributed to deaths from encounters with law enforcement. YLLs are, a metric that measures premature deaths, by age, gender, and race/ethnicity. To do this, we followed established methods, subtracting the age of each death from a corresponding standard life expectancy. For example, if an individual who died at age 25 had a life expectancy of 75, their YLL would be 50.  Continue reading

Specific Types of Inflammation Tied to Cardiovascular Disease

MedicalResearch.com Interview with:

Dr. Karl T. Kelsey, MD, MOH Professor of Epidemiology and Pathology and Laboratory Medicine Fellow, Collegium Ramazzini Providence, R.I. 02912

Dr. Kelsey

Dr. Karl T. Kelsey, MD, MOH
Professor of Epidemiology and Pathology and Laboratory Medicine
Fellow, Collegium Ramazzini
Providence, R.I. 02912

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: ​There is a large literature suggesting that the ratio of neutrophils to lymphocytes (the neutrophil to lymphocyte ratio or NLR) in the peripheral blood at the time of diagnosis is robustly predictive ​of outcome in acute cardiovascular disease.

We were curious to know if the peripheral blood profile and this ratio was a feature of the disease process, since, to our knowledge, this had not been investigated in a prospective study.  Hence, we used the resources of 2 prospective studies to assess this question, the Jackson Heart Study and the Normative Aging Study.  In both cases, the NLR predicted all cause mortality and, in the Jackson Heart Study, where we had well adjudicated outcomes, the NLR predicted various specific cardiovascular outcomes as well. Interestingly, the outcome was also modified by a well known genetic polymorphism of African origin that results in a relative neutropenia.

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Do Blacks Still Get More Opioid Prescriptions?

MedicalResearch.com Interview with:

Matthew A. Davis, MPH, PhD Assistant Professor Department of Systems, Populations and Leadership University of Michigan

Dr. Davis

Matthew A. Davis, MPH, PhD
Assistant Professor
Department of Systems, Populations and Leadership
University of Michigan

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The premise for the study was based on prior work that demonstrated that the likelihood of being prescribed an opioid differs according to a patient’s race and ethnicity.  Collectively this work has shown that Non-Hispanic Whites are more likely to receive opioids than other groups for pain.

We decided to look at trends in the prescribing of different pain medications over the last 16 years to see if we could detect any differences in prescribing patterns among racial and ethnic groups.  To do so we used national health data for a large sample of Americans who live with significant pain.

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Racial Disparities in Post-Procedure ED Visits and Hospitalizations

MedicalResearch.com Interview with:

Dr-Hillary-J-Mull

Hillary J. Mull, PhD, MPP
Center for Healthcare Organization and Implementation Research
Veterans Affairs (VA) Boston Healthcare System
Department of Surgery, Boston University School of Medicine
Boston, Massachusetts

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Little is known about outpatient procedures that can be considered invasive but are not conducted in a surgical operating room. These procedures are largely neglected by quality or patient safety surveillance programs, yet they are increasingly performed as technology improves and the U.S. population gets older.

We assessed the rate of invasive procedures across five specialties, urology, podiatry, cardiology, interventional radiology and gastroenterology in the Veterans Health Administration between fiscal years 2012 and 2015. Our analysis included examining the rates of post procedure emergency department visits and hospitalizations within 14 days and the key patient, procedure or facility characteristics associated with these outcomes. We found varying rates of post procedure ED visits and hospitalizations across the specialties with podiatry accounting for a high volume of invasive outpatient care but the lowest rate of postoperative utilization (1.8%); in contrast, few of the procedures were in interventional radiology, but the postoperative utilization rate was the highest at 4.7%. In a series of logistic regression models predicting post procedure healthcare utilization for each specialty, we observed significantly higher odds of post procedural outcomes for African American patients compared to white patients.

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Dark Skin Tones May Be Underrepresented in Medical Textbooks

MedicalResearch.com Interview with:

Patricia Louie, MA PhD Student, Department of Sociology University of Toronto Toronto, ON, Canada

Patricia Louie

Patricia Louie, MA
PhD Student, Department of Sociology
University of Toronto
Toronto, ON, Canada 

MedicalResearch.com: What is the background for this study?

 

Response: While most physicians believe that they treat patients equally, research shows that racial inequality pervades the U.S. health care system (Feagin and Bennefield 2014; Williams 2012). Because these inequities persist even after demographic and other socio-economic differences are taken into consideration scholars have started to look at the representation of race in the medical curriculum. The idea is that medical curriculum creates both implicit and explicit connections between race and disease. We build on this body of work by investigating the representation of race (White, Black and Person of Color) and skin tone (light, medium and dark) in the images of four preclinical anatomy textbooks – Atlas of Human AnatomyBates’ Guide to Physical Examination & History Taking, Clinically Oriented Anatomy, and Gray’s Anatomy for Students.  Skin tone is important.

The majority of medical imagery consists of decontextualized images of body parts where skin tone, which may be related to disease presentation, is the only phenotypical marker. If doctors associate light skin tones with White patients, this may also influence how doctors think about who is a “typical” patient, particularly for the type of disease that is shown in that image.

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How Does Hip-Hop/Rap Music Influence Molly/Ecstasy Use in African Americans?

MedicalResearch.com Interview with:

Khary Rigg, Ph.D. Assistant Professor Department of Mental Health Law & Policy University of South Florida

Dr. Rigg

Khary Rigg, Ph.D.
Assistant Professor
Department of Mental Health Law & Policy
University of South Florida 

MedicalResearch.com: What is the background for this study?

Response: Over the past two decades, the demographic profile of MDMA (ecstasy/molly) users has changed. In particular, African American MDMA use has risen in some cities. One possible explanation of this new trend is the drug’s recent popularity (as molly) in hip-hop/rap (HHR) music. Several top rappers endorse the drug as a way to have fun or get women “loose.” There are currently no studies, however, that investigate the extent to which African American MDMA users listen to. hip-hop/rap music or the influence that these pro-MDMA messages have on their use of the drug.

This study used survey and interview data to identify the extent to which hip-hop/rap music is listened to by African American MDMA users and assess the perceived influence of HHR music on their decision to begin using.

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Medicaid Expansion Linked To Decreased Infant Mortality, Especially Among African Americans

MedicalResearch.com Interview with:

Chintan Bhatt  MBBS, MPH    (HE/HIM/HIS) Department of Health Promotion & Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University Miami Fl 

Dr. Bhatt

Chintan Bhatt  MBBS, MPH    (HE/HIM/HIS)
Department of Health Promotion & Disease Prevention,
Robert Stempel College of Public Health and Social Work,
Florida International University
Miami Fl 

MedicalResearch.com: What is the background for this study?

Response: Women and children are disproportionately affected by the uncertainty around medical health insurance rising in the United States. The Patient Protection and Affordable Care Act was implemented on Jan 1st, 2014, since then the uninsured rate decreased considerably, especially in women aged 18 to 64 years. ACA revised and expanded Medicaid eligibility. Under the law, all U.S. citizens and legal residents with income up to 133% of the poverty line, including adults without dependent children, would qualify for coverage in any state that participated in the Medicaid program. Because of the large proportion of maternal, infant, and child health care and preventive services funded by Medicaid. The purpose of our study was to examine the potential effect of Medicaid expansion on infant mortality rates by comparing infant mortality rate trends in states and Washington D.C. by Medicaid expansion acceptance or decline.

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How Much DASH Diet is Required To Reduce Uric Acid?

MedicalResearch.com Interview with:
“Blood Pressure” by Bernard Goldbach is licensed under CC BY 2.0Stephen P. Juraschek, MD, PhD

Instructor of Medicine
Beth Israel Deaconess Medical Center/Harvard Medical School 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Recent evidence suggests that the DASH diet is associated with lower uric acid levels and lower risk of gout. Furthermore, a secondary analysis of the DASH trial showed that complete replacement of a typical American diet with the DASH diet lowered uric acid levels. However, it is unknown if partial replacement of a typical American diet with DASH foods might lower uric acid.

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Increased Diabetes Risk in African Americans Explained by Greater Obesity Rates

MedicalResearch.com Interview with:

Michael P. Bancks, PhD Northwestern University Chicago, Illinois 

Dr. Bancks

Michael P. Bancks, PhD
Northwestern University
Chicago, Illinois 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We know that the disparity in diabetes between black and white youth and young adults is growing, but the reasons why are unclear. We also know that traditional risk factors for diabetes, such as obesity and low socioeconomic status, are more common among blacks as compared with whites.

Our study describes how the unequal rates of these traditional diabetes risk factors explain or account for the higher rates of diabetes among blacks.

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Breast Cancer Survival Remains Lower For Black Women

MedicalResearch.com Interview with:
“Family Weekend 2014-Breast Cancer Walk” by Nazareth College is licensed under CC BY 2.0
Dr. Jacqueline Miller, MD
Division of Cancer Prevention and Control
CDC 

MedicalResearch.com: What efforts have proven successful in reducing racial disparities like these?

Response: While some racial disparities will exist due to differences in tumor types, improving early diagnosis and providing specific treatment based on tumor characteristics in a timely fashion would result in reducing breast cancer disparities.

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Disparities in Ovarian Cancer Survival in the United States

MedicalResearch.com Interview with:

The Centers for Disease Control and Prevention CDC image

Site of Ovarian Cancer CDC image

Dr. Sherri Stewart, PhD
Division of Cancer Prevention and Control
CDC

MedicalResearch.com: What do women most need to know about ovarian cancer detection and treatment?

Response: There is no effective test to detect ovarian cancer at an early stage where treatment is most likely to be effective.  Many women mistakenly believe that the Pap test can detect ovarian cancer, but it does not. The Pap test is recommended only for the detection of cervical cancer.

 Recognizing early symptoms of ovarian cancer and seeking timely care may help lead to detection of the cancer at an earlier stage, where treatment is likely to be more effective.  Symptoms – such  as abdominal and back pain, feeling full quickly after eating, and frequent urination – are often present among women with ovarian cancer.  Women should talk with their doctors if they experience any of these symptoms for 2 weeks or longer and the symptoms persist or worsen.

If a woman is diagnosed with ovarian cancer, she should seek treatment from a gynecologic oncologist, a physician specially trained to treat ovarian cancer.  Ovarian cancer patients who have been treated by gynecologic oncologists have been shown to survive longer than those treated by other physicians.           Continue reading

Black Men and Women Continue To Have Lower Colon Cancer Survival Rates

MedicalResearch.com Interview with:

“Large Colon Cancer Arising in Adenoma” by Ed Uthman is licensed under CC BY 2.0

“Large Colon Cancer Arising in Adenoma” by Ed Uthman

Dr. Arica White PhD MPH
Division of Cancer Prevention and Control
CDC

MedicalResearch.com: What is the likelihood of reaching the 80% CRC screening rate goal by next year?

Response: As of 2016, 67% of adults age 50-75 years reported being up-to-date with colorectal cancer screening. The 80% by 2018 initiative represented an aspirational goal that public health, non-profit, and community-based organizations will continue to strive for regardless of the outcome in 2018.

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Cocaine Overdoses Rising Especially Among African Americans

MedicalResearch.com Interview with:
“Cocaine” by Nightlife Of Revelry is licensed under CC BY 2.0Dr. Dave Thomas PhD

Health Scientist Administrator
National Institute on Drug Abuse 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: At the National Institute on Drug Abuse, we support research on all forms of drug use, and are aware that cocaine misuse is on the rise.  We are aware that various forms of drug use can have greater prevalence by race, sex, age and other population characteristics.

The main finding of this paper is that cocaine overdose rates are on the rise and that that the group hit hardest is the non-Hispanic black population.

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Insurance Coverage, Tumor Types Linked to Black-White Survival Disparity Among Younger Colorectal Cancer Patients

MedicalResearch.com Interview with:

Helmneh M. Sineshaw, MD, MPH American Cancer Society Atlanta, GA 30303

Dr. Sineshaw

Helmneh M. Sineshaw, MD, MPH
American Cancer Society
Atlanta, GA 30303

MedicalResearch.com: What is the background for this study?

Response: Colorectal cancer (CRC) is the third most commonly diagnosed cancer in both men and women in the United Sates. Although overall CRC incidence and mortality rates are decreasing in the United States, rates are increasing in the younger population. Notwithstanding these patterns, CRC incidence and mortality rates continue to be higher in blacks than in whites. Although black-white survival disparity among patients with colorectal cancer is well documented in the literature and multiple factors have been proposed as potential contributors, the contributions of differences in demographic characteristics, insurance type, comorbidity, tumor presentation, and treatment receipt to the racial disparity in survival among nonelderly CRC patients are unknown.

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Prevalence of Autism Spectrum Disorders Lower in Black and Hispanic Children

MedicalResearch.com Interview with:

Maureen Durkin, PhD, DrPH Professor and Interim Chair Department of Population Health Sciences University of Wisconsin School of Medicine and Public Health Madison, WI

Prof. Durkin

Maureen Durkin, PhD, DrPH
Professor and Interim Chair
Department of Population Health Sciences
University of Wisconsin School of Medicine and Public Health
Madison, WI 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Previous studies of the prevalence of autism spectrum disorder (ASD) among children in the U.S. have found two consistent patterns.  One is a higher prevalence among white non-Hispanic children than among black non-Hispanic or Hispanic children.  The other is a positive socioeconomic gradient, meaning that ASD prevalence in the U.S. is found to increase with increasing income and other indicators of socioeconomic status.

One of the findings of this new study is that the racial and ethnic differences in autism spectrum disorder prevalence are not explained by socioeconomic factors, because even after adjusting for socioeconomic factors, ASD prevalence was found to be significantly lower in black and Hispanic children than in white non-Hispanic children.  Another finding is that the gap in ASD prevalence between children of high and low socioeconomic status did not change over time between 2002 and 2010, though the overall prevalence of ASD more than doubled during this period.

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Poor and Racial Minorities Have Worse Home Health Care Outcomes

MedicalResearch.com Interview with:

MedicalResearch.com Interview with: Karen Joynt Maddox, MD, MPH Washington University School of Medicine Saint Louis MO

Dr. Joynt-Maddox

Karen Joynt Maddox, MD, MPH
Washington University School of Medicine
Saint Louis MO

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Home health is one of the fastest-growing sectors in Medicare, and the setting of a new federal value-based payment program, yet little is known about disparities in clinical outcomes among Medicare beneficiaries receiving home health care.

We found that beneficiaries who were poor or Black had worse clinical outcomes in home health care than their peers. These individuals were generally more likely to have unplanned hospitalizations, readmissions, and emergency department visits. Under Home Health Value-Based Purchasing, these patterns should be tracked carefully to ensure the program helps close the gaps rather than widening them.

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Racial Gap in Survival After In-Hospital Cardiac Arrest Nearly Closed

MedicalResearch.com Interview with:
Dr. Lee Joseph, MD, MS

Postdoctoral fellow at University of Iowa
Division of Cardiovascular Diseases
Department of Internal Medicine
University of Iowa Carver College of Medicine
Iowa City

MedicalResearch.com: What is the background for this study?

Response: In-hospital cardiac arrest (IHCA) is common and affects more than 200,000 patients every year. Although survival for in-hospital cardiac arrest has improved in recent years, marked racial differences in survival are present. A previous study showed that black patients with in-hospital cardiac arrest have 27% lower chance of surviving an in-hospital cardiac arrest due to a shockable rhythm compared to white patients. Moreover, lower survival in black patients was largely attributable to the fact that black patients were predominantly treated in lower quality hospitals compared to white patients.  In other words, racial disparities in survival are closely intertwined with hospital quality, and this has been borne out in multiple other studies as well

In this study, we were interested in determining whether improvement in in-hospital cardiac arrest survival that has occurred in recent years benefited black and white patients equally or not? In other words, have racial differences in survival decreased as overall survival has improved. If so, what is the mechanism of that improvement? And finally, did hospitals that predominantly treat black patients make the greatest improvement in survival?

To address these questions, we used data from the Get With The Guidelines-Resuscitation, a large national quality improvement registry of in-hospital cardiac arrest that was established by the American Heart Association in the year 2000. Participating hospitals submit rich clinical data on patients who experience in-hospital cardiac arrest. Over the last 17 years, the registry has grown markedly and currently includes information on >200,000 patients from > 500 hospitals. The primary purpose is quality improvement. But it has also become an important resource to conduct research into the epidemiology and outcomes associated with in-hospital cardiac arrest.

Using data from the Get With the Guidelines-Resuscitation, we identified 112,139 patients at 289 hospitals between 2000-2014. Approximately 25% of the patients were of black race and the remainder were white patients. We constructed two-level hierarchical regression models to estimate yearly risk adjusted survival rates in black and white patients and examined how survival differences changed over time both on an absolute and a relative scale.

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Colorectal Cancer Deaths Rising Among Younger White Adults

MedicalResearch.com Interview with:

Rebecca Siegel, MPH Strategic Director, Surveillance Information Services American Cancer Society, Inc. 250 Williams St. Atlanta, GA 30303

Rebecca Siegel

Rebecca Siegel, MPH
Strategic Director, Surveillance Information Services
American Cancer Society, Inc.
250 Williams St.
Atlanta, GA 30303

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Colorectal cancer (CRC) incidence rates have been increasing in people under 55 since at least the mid-1990s, despite rapid declines in older age groups. We analyzed mortality data covering over 99% of the US population and found that death rates for CRC in adults under 55 have been increasing over the past decade of data (2004-2014) by 1% per year, in contrast to rapid declines in previous years. This indicates that the increase in incidence is not solely increased detection due to more colonoscopy use, but a true increase in disease occurrence that is of sufficient magnitude to outweigh improvements in survival because of better treatment for colorectal cancer.

The second major finding was that the rise in death rates was confined to whites, among whom death rates rose by 1.4% per year, for an overall increase of 14%. In blacks, the colorectal cancer death rate declined slowly during the entire study period (1970-2014). This racial disparity is consistent with incidence, but in contrast to trends for major risk factors for CRC, like obesity, which has increased across all racial and ethnic groups. This means that the obesity epidemic is probably not wholly responsible for the increase in disease.

Third major finding was that CRC death rates are increasing in people in their early 50s, for whom screening has been recommended for decades. This was particularly surprising since CRC screening has a two-fold impact on death rates by both preventing cancer and detecting it early when treatment is more effective. Rising death rates in this age group likely reflects lower screening rates in ages 50-54 than 55+ — 46% vs 67% in 2015, probably because of delayed initiation of screening.

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Cardiovascular Fat in Women at Midlife Varies By Race and Body Shape

MedicalResearch.com Interview with:

Samar R. El Khoudary, PhD, MPH, BPharm, FAHA Associate Professor, Epidemiology PITT Public Health Epidemiology Data Center University of Pittsburgh Pittsburgh, PA 15260 

Dr. El Khoudary

Samar REl KhoudaryPhDMPH, BPharm, FAHA
Associate Professor, Epidemiology
PITT Public Health
Epidemiology Data Center
University of Pittsburgh
Pittsburgh, PA 15260  

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Heart fat is associated with greater coronary heart disease risk. Postmenopausal women have greater heart fat volumes than premenopausal women, and the association between specific heart fat depots and calcification in the coronary arteries is more pronounced after menopause. Race, central adiposity, and visceral adiposity are important factors that could impact heart fat volumes.

We evaluated whether racial differences in heart fat volumes and in their associations with central (abdominal visceral fat) and general adiposity (as measured by body mass index [BMI]) exist in midlife women. Our study included 524 women from the Study of Women’s Health Across the Nation (SWAN) (mean age: 51 years; 62% White and 38% Black) who had data on heart fat volumes, abdominal visceral fat and BMI.

After accounting for the potential health effects of lifestyle and socioeconomic factors we found that midlife Black women had less heart fat volumes than white women and not surprisingly, the more fat a women carries overall, the higher her risk for a fatty heart. However, white women with higher BMI had significantly more heart fat, as measured by a CT scan, than black women with the same BMI. For black women, the levels of heart fat were greater if they carried more fat in their midsection, as measured by a cross-sectional CT scan, compared with white women with the same volume of fat in their midsection. The results echo the findings we have reported previously in midlife men and published at the International Journal of Obesity (2015) 39, 488–494.
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Disadvantaged Neighborhoods Help Explain Some Of Alzheimer’s Disease Racial Disparities

MedicalResearch.com Interview with:

Amy Kind, M.D., Ph.D. Associate Professor, Division of Geriatrics Director, Department of Medicine Health Services and Care Research Program University of Wisconsin School of Medicine and Public Health and Associate Director- Clinical Geriatrics Research, Education and Clinical Center (GRECC) William S. Middleton Veteran’s Affairs Hospital

Dr. Amy Kind

Amy Kind, M.D., Ph.D.
Associate Professor, Division of Geriatrics
Director, Department of Medicine Health Services and Care Research Program
University of Wisconsin School of Medicine and Public Health and
Associate Director- Clinical
Geriatrics Research, Education and Clinical Center (GRECC)
William S. Middleton Veteran’s Affairs Hospital

MedicalResearch.com: What is the background for this study? What are the main findings?

Background: Dementia due to Alzheimer’s Disease (AD) disproportionately impacts racial/ethnic minorities and the socioeconomically disadvantaged—populations often exposed to neighborhood disadvantage. Neighborhood disadvantage is associated with education, health behaviors and mortality. Health improves with moving to less disadvantaged neighborhoods (Ludwig, Science 2012). Although studies have linked neighborhood disadvantage to diseases like diabetes and cancer, little is known about its effect on development of dementia.

Objective:  To examine the association between neighborhood disadvantage, baseline cognition, and CSF biomarkers of Alzheimer’s Disease among participants in the WRAP study, comprising a cohort of late-middle-aged adults enriched for parental family history of AD.

Methods:  We created and validated neighborhood-level quantifications of socioeconomic contextual disadvantage for the full US—over 34 million Zip+4 codes—employing the latest American Community Survey and Census data. This metric–the Area Deprivation Index (ADI)–incorporates poverty, education, housing and employment indicators; predicts disparity-related health outcomes; and is employed by Maryland and Medicare through our provision. We used standard techniques to geocode all WRAP subjects with a documented address (N= 1479). WRAP participants were ranked into deciles of neighborhood disadvantage, by ADI. Baseline cognitive function (indexed by factor scores) and CSF biomarker outcomes for levels of Aβ42 and P-tau181 (n=153 with CSF samples) were examined by neighborhood disadvantage decile.

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