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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Sex and Ethnicity Data Missing From Many FDA Medical Device Approval Reports

MedicalResearch.com Interview with:

Sanket Dhruva, MD, MHS, FACC Cardiology, VA Connecticut Healthcare System Robert Wood Johnson Foundation Clinical Scholar Yale University

Dr. Dhruva

Sanket Dhruva, MD, MHS, FACC
Cardiology, VA Connecticut Healthcare System
Robert Wood Johnson Foundation Clinical Scholar
Yale University

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

Response: In 2012, Congress passed the Food & Drug Administration (FDA) Safety and Innovation Act, with the goal of increasing enrollment and availability of data in important patient groups such as the elderly, women, and racial and ethnic minorities. In 2014, as mandated by the legislation, the FDA released an Action Plan to address these issues. This Action Plan included the goal of increasing the transparency by posting demographic information of pivotal (or key) clinical trials used to support approval decisions.

We examined how often these data were available in 2015 for all studies used to support approval of all original high-risk medical devices approved in the calendar year following the FDA Action Plan. Examples of these medical devices include stents, bone grafts, heart valves, and spinal cord stimulators. We wanted to understand if age, sex, and race and ethnicity data were available and if the results of clinical studies supporting these medical devices were analyzed to assess if there were differences in safety and effectiveness by these important demographic factors.

Our main findings are that FDA Summaries publicly reported age for 65% of study populations, sex for 66%, and race and/or ethnicity for 51%. Analyses to assess if demographic factors may have impacted device safety and effectiveness were only conducted by age for 9%, by sex for 17%, and by race for 4% of clinical studies.

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Majority of Murdered Women Are Killed By Current or Former Partners

MedicalResearch.com Interview with:

EmikoPetrosky MD M.P.H Science Officer, National Violent Death Reporting System at Centers for Disease Control and Prevention Centers for Disease Control and Prevention Emory University Rollins School of Public Health

Dr. Petrosky

EmikoPetrosky MD M.P.H
Science Officer, National Violent Death Reporting System at Centers for Disease Control and Prevention
Centers for Disease Control and Prevention
Emory University Rollins School of Public Health

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

Response: Homicide is one of the leading causes of death for women aged 44 years and younger. In 2015, 3,519 girls and women died by homicide in the United States.  It is the 5th leading cause of death for women under 45 years age (defining women as 18-44 years of age).

The National Violent Death Reporting System (NVDRS) links together data from death certificates, coroner/medical examiner reports, and law enforcement reports, resulting in more information about the circumstances of death than what is available elsewhere.

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Breastfeeding Rates Increase But Racial Gaps Persist

MedicalResearch.com Interview with:

Dr. Erica H. Anstey PhD Division of Nutrition, Physical Activity and Obesity National Center for Chronic Disease Prevention and Health Promotion  Immunization Services Division National Center for Immunization and Respiratory Diseases CDC

Dr. Anstey

Dr. Erica H. Anstey PhD
Division of Nutrition, Physical Activity and Obesity
National Center for Chronic Disease Prevention and Health Promotion
Immunization Services Division
National Center for Immunization and Respiratory Diseases
CDC

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

Response: The American Academy of Pediatrics (AAP) recommends that infants are breastfed exclusively for about the first 6 months and that breastfeeding continue for at least 12 months, and thereafter for as long as mother and baby desire. Although breastfeeding initiation and duration rates have increased overall in the United States, breastfeeding rates vary by geographic location, socioeconomic, and race/ethnic groups. Breastfeeding initiation and duration have been historically and consistently lower among black infants compared with white and Hispanic infants.

There are many factors that influence a woman’s decision to start and continue breastfeeding. These include knowledge about breastfeeding, cultural and social norms, family and social support, and work and childcare environments. Some barriers to breastfeeding are disproportionately experienced by black women, including earlier return to work, inadequate receipt of breastfeeding information from providers, and lack of access to professional breastfeeding support.

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Overweight, Tall Men Have Greater Risk of Aggressive Prostate Cancer

MedicalResearch.com Interview with:

Aurora Perez-Cornago, PhD Cancer Epidemiology Unit Nuffield Department of Population Health University of Oxford

Dr. Perez-Cornago

Aurora Perez-Cornago, PhD
Cancer Epidemiology Unit
Nuffield Department of Population Health
University of Oxford

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

Response: Greater height and adiposity have been suggested as possible prostate cancer risk factors, but these associations are not clear, probably
because most previous studies have not looked separately at different tumour subtypes.

For this reason, we wanted to look at these associations splitting tumours into subtypes according to tumour stage and histological grade, looking as well at death from prostate cancer.

We found a marked difference in risks looking at low and high risk tumours. Taller men and men with greater adiposity had an elevated of high-grade prostate cancer and prostate cancer death.

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RNA Splicing Variants Linked To Aggressive Prostate Cancer in African Americans

MedicalResearch.com Interview with:

Dr. Norman Lee PhD Professor of Pharmacology and Physiology School of Medicine and Health Sciences George Washington University

Dr. Lee

Dr. Norman Lee PhD
Professor of Pharmacology and Physiology
School of Medicine and Health Sciences
George Washington University

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

Response: There are health disparities when it comes to prostate cancer. The African American population, in general, has a higher prostate cancer incidence and mortality rate compared to other racial groups such as European Americans. A major reason for this disparity is due to socioeconomic factors such as access to health care. There are also biological influences for the disparities, such as specific gene mutations and genetic polymorphisms that are found at a higher incidence in the African American population.

My lab has been studying other potential contributing biological factors in prostate cancer disparities; namely, RNA splicing. RNA splicing is a cellular program that increases the diversity of expressed proteins by regulating which exons are included in an mRNA transcript, leading to mRNA variants encoding slightly different proteins (or isoforms) in different cells, organs, and individuals. One can think of RNA splicing as a form of genetic diversity. What we have found is that the repertoire of mRNA variants can differ in prostate cancer between African and European Americans. We also find that the mRNA variants in African American prostate cancer encode signal transduction proteins that are more oncogenic and resistant to targeted therapies, compared to the variants found in European American prostate cancer.

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Ozone Air Pollution Linked To US Deaths, Even At Levels Below Current Safety Standards

MedicalResearch.com Interview with:
Qian Di, M.S, Doctoral Student
Department of Environmental Health and
Francesca Dominici, Ph.D.
Principal Investigator of this study
Professor of Biostatistics
co-Director of the Harvard Data Science Initiative
Harvard T.H. Chan School of Public Health
Boston, MA

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

Response: The Clean Air Act requires Environmental Protection Agency to set National Ambient Air Quality Standard (NAAQS). Currently the annual NAAQS for PM2.5 is 12 microgram per cubic meter; and there is no annual or seasonal ozone standard. However, is current air quality standard stringent enough to protect human health? This is our main motivation.

We conducted the largest attainable cohort study, including over 60 million Medicare participants, to investigate the association between long-term exposure to ozone/PM2.5 and all-cause mortality.

We found significant harmful effect of PM2.5 even below current NAAQS. Each 10 microgram per cubic meter increase in PM2.5 is associated with 13.6% (95% CI: 13.1%~14.1%) increase in all-cause mortality. For ozone, 10 ppb increase in ozone exposure is associated with 1.1% (95% CI: 1.0%~1.2%) increase in mortality. Also, there is no appreciable level below which mortality risk tapered off. In other words, there is no “safe” level for PM2.5 and ozone.

In other words, if we would reduce the annual average of PM2.5 by just 1 microgram per cubic meter nationwide, we should save 12,000 lives among elder Americans every year; 5 microgram — 63,817 lives every year. Similarly, if we would reduce the annual summer average of ozone by just 1 ppb nationwide, we would save 1,900 lives every year; 5 ppb — 9537 lives.

Besides, we found black people, males and people of low SES are more vulnerable to air pollution.

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Increase In Risk Factors Contribute To More Strokes in Rural Areas

MedicalResearch.com Interview with:

George Howard, Dr.PH PI of the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study Department of Biostatistics University of Alabama at Birmingham Birmingham, AL

Dr. Howard

George Howard, Dr.PH
PI of the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study
Department of Biostatistics
University of Alabama at Birmingham
Birmingham, AL

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

Response: Rural areas have been known to have a higher death rate than urban, and higher death from stroke in rural areas is a major contributor to this disparity.

The goal of the research was to assess if the higher deaths from stroke was because rural people are more likely to have a stroke, or more likely to die from a stroke once it occurs.   This distinction is critically important, since intervention to reduce stroke deaths in rural area would focus on stroke prevention if the former, but would focus on improving stroke care (after the stroke) if the latter.

We found that the higher mortality from stroke appears to be almost completely due to more people having stroke.   As such, we need to focus on efforts to reduce the risk of rural areas.   While there are well-documented differences in stroke care between urban and rural areas, resolving these differences will not be likely reduce the rural excess death from stroke.

It would seem that the higher risk of having a stroke could be due to the observation that those in rural areas are more likely to have major stroke risk factors, including hypertension, diabetes and cigarette smoking; however, the higher prevalence of these risk factors don’t seem to explain the higher risk.   So what causes the higher risk remains a mystery.

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Liver Cancer Incidence and Deaths Rising, With Wide Ethnic Disparities

MedicalResearch.com Interview with:

Farhad Islami, MD PhD  Strategic Director, Cancer Surveillance Research American Cancer Society, Inc. Atlanta, GA 30303

Dr. Islami

Farhad Islami, MD PhD
Strategic Director, Cancer Surveillance Research
American Cancer Society, Inc.
Atlanta, GA 30303

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

Response: Liver cancer is one of the leading causes of cancer death in the United States, accounting for nearly 29,000 deaths per year, with variations in occurrence by race/ethnicity and state.

We examined trends in liver cancer incidence, survival, and mortality in the United States and provided liver cancer mortality rates by race/ethnicity at the national and state level. State-level statistics are particularly important as they can inform state cancer control and prevention planning. We also provided detailed information on prevalence and trends in major risk factors for liver cancer and interventions to prevent or reduce their burden, to make our article a comprehensive yet concise source of information on liver cancer statistics, risk factors, and interventions in the United States.

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Income Disparities Persist In Cardiovascular Risk Factors in the US

MedicalResearch.com Interview with:

Dr. Ayodele Odutayo MD MSc DPhil(pending) Centre For Statistics in Medicine, University of Oxford Resident Physician (PGY1), Post-Doctoral Fellow, Applied Health Research Centre St. Michael’s Hospital, University of Toronto

Dr. Odutayo

Dr. Ayodele Odutayo
MD MSc DPhil(pending)
Centre For Statistics in Medicine,
University of Oxford
Resident Physician (PGY1), Post-Doctoral Fellow,
Applied Health Research Centre
St. Michael’s Hospital,
University of Toronto

 

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

Response: Previously published studies have reported increasing gaps in life expectancy among adults belonging to different socioeconomic strata and suggested that much of this gap was mediated through behavioural and metabolic risk factors.

In this study, we found that from 1999-2014, there was an increasing gap in the control of cardiovascular risk factors between high income adults compared to adults with incomes at or below the poverty line. The proportion of adults at high cardiovascular risk (predicted risk of a cardiovascular event ≥20%), the mean systolic blood pressure and the percentage of current smokers decreased for high income adults but did not change for adults with incomes at or below the poverty line. Notably, the income disparity in these cardiovascular risk factors was not wholly explained by access to health insurance or educational attainment. Trends in the percentage of adults with diabetes and the average total cholesterol level did not vary by income.

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Better Communication Linked To Reduced Racial Disparities in Breast Reconstruction Surgery

MedicalResearch.com Interview with:

Elham Mahmoudi, PhD, MS Section of Plastic Surgery, University of Michigan Medical School Ann Arbor, Michigan

Dr. Mahmoudi

Elham Mahmoudi, PhD, MS
Section of Plastic Surgery, University of Michigan Medical School
Ann Arbor, Michigan

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

Response: About one-third of all women diagnosed with breast cancer undergo mastectomy. In recent years, owing to advancements in screening and treatment, life expectancy after being diagnosed with breast cancer has increased. Research has shown that for patients who undergo mastectomy, breast reconstruction offers many psychological benefits such as improved self-esteem, reduced sexual dysfunction, decreased anxiety, and overall improvement in quality of life. After the passage of the Women’s Health and Cancer Rights Act in 1998, the coverage of post-mastectomy breast reconstruction (PBR) by any type of health insurance became mandatory. However, there are large and widening racial and ethnic disparities in PBR, with White women having a higher rate of PBR than women from other racial and ethnic groups.

In 2011, the State of New York enacted a law mandating that surgeons advise their patients undergoing mastectomy about available breast reconstruction options, insurance coverage, and referral to a plastic surgeon. We evaluated the effect of this law on racial/ethnic disparities in immediate PBR.

Our results did not show any effect on the overall rate of immediate  post-mastectomy breast reconstruction or on disparities between white and African-American women; however, we found that White-Hispanic and White-other racial/ethnic group disparities in immediate PBR were reduced by 9 and 13 percentage points, respectively. This is a substantial reduction in disparity within only a year after the passage of the law, which demonstrates the importance of physician-patient communication.

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Risk of Interval Colorectal Cancer Higher in Blacks Than Whites

MedicalResearch.com Interview with:

Stacey Fedewa PhD Strategic Director, Risk Factors & Screening Surveillance American Cancer Society, Inc. Atlanta, GA 30303

Dr. Fedewa

Stacey Fedewa PhD
Strategic Director, Risk Factors & Screening Surveillance
American Cancer Society, Inc.
Atlanta, GA 30303

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

Response: Screening for colorectal cancer is effective in reducing incidence and mortality by detecting precancerous lesions or cancer at more curable stages. But colorectal cancers can still develop in screened populations, some are missed at the time of screening; others can develop between recommended screenings. Patterns of risk for interval colorectal cancer, defined as cancers that develop after a negative result on colonoscopy, by race/ethnicity are not well known.

The risk for blacks was of interest to us because colorectal incidence and mortality rates in blacks are the highest among any race or ethnicity in the United States. We were also interested to see if quality of colonoscopy, measured by physician’s polyp detection rate, could account for differences.

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Men and African Americans More Likely To Transition to Hypertension At Younger Age

MedicalResearch.com Interview with:

Shakia Hardy, MPH, CPH. PhD

Dr. Hardy

Shakia Hardy, MPH, CPH. PhD
Department of Epidemiology
The University of North Carolina at Chapel Hill

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

Response: Previous studies characterizing blood pressure levels across the life course have relied on prevalence estimates at a given age.

Our study was interested in identifying critical ages at which net transitions between levels of blood pressure occurred. We used data from the National Health and Nutrition Examination Survey (2007-2012) to estimate age-, race-, and sex-specific annual net transition probabilities between ideal blood pressure, prehypertension and hypertension.

We found that African Americans and men were more likely to transition from ideal levels of blood pressure in childhood or early adulthood compared to white Americans and women, which puts them at increased risk of developing prehypertension and hypertension earlier in life.

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Study Finds Statin Use Not Associated With Breast Cancer Prognosis

MedicalResearch.com Interview with:

Amanda Leiter, MD MSCR Medical Resident, Internal Medicine Icahn School of Medicine at Mount Sinai

Dr. Leiter

Amanda Leiter, MD MSCR
Medical Resident, Internal Medicine
Icahn School of Medicine at Mount Sinai

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

Response: Black women are more likely than White women to have breast cancer with poor prognostic features, which cannot be completely explained by differences in screening, treatment and established risk factors for breast cancer mortality. Black women have higher rates of obesity, insulin resistance and dyslipidemia when compared to White women. Prior studies have shown a decreased risk of breast cancer recurrence and improved survival with statin use.

As statins have an association with decreased breast cancer recurrence and potentially improved survival, disparities in statin use between Black and White women with breast cancer are important to investigate. We aimed to elucidate whether or not statin use differs between Black and White women with breast cancer and if racial disparities in breast cancer can be partially explained by differences in statin use.
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Racial Disparities in Genetic Testing of Women With Breast Cancer

MedicalResearch.com Interview with:

Cary P. Gross, MD Section of General Internal Medicine Yale University School of Medicine New Haven, CT

Dr. Cary Gross

Cary P. Gross, MD
Section of General Internal Medicine
Yale University School of Medicine
New Haven, CT

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

Response: Prior work has demonstrated racial and socioeconomic disparities in breast cancer diagnosis, treatment, and outcomes.  As the oncology field has progressed over the past decade, the use of genetic testing to guide treatment decisions is one of the most exciting new developments.

Our team was concerned that these new gene tests, which can offer important benefits, may have the potential to exacerbate disparities further.  That is, if there is unequal access to gene testing among patients for whom it is recommended, then our progress against cancer will not be equitably shared among people of all races and ethnicities.

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Comparison of Posttransplant Dermatologic Diseases by Race

MedicalResearch.com Interview with:
Christina Lee Chung, MD, FAAD
Associate Professor of Dermatology
Director, Center for Transplant Patients
Drexel University College of Medicine

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

Response: It’s long been recognized immunosuppressed organ transplant recipients are at significantly increased risk for skin cancer and other types of skin disease.

But despite advances to improve skin cancer prevention for these patients, little is known about how skin conditions affect African-American, Asian and Hispanic transplant recipients. This is problematic given that, according to the U.S. Department of Health and Human Services, more than half of the 120,000 Americans on the waiting list for organs identify as nonwhite.

We compared medical records of 412 organ transplant recipients — including 154 white patients and 258 nonwhite (black, Asian or Hispanic) — who were referred to the Drexel Dermatology Center for Transplant Patients between 2011 and 2016. As one of the only models of its kind in the country, the center provides post-transplant dermatological care to every patient who is transplanted by and/or followed by the Drexel University and Hahnemann University Hospital Transplant Programs. That means that every patient, regardless of race, is screened annually for skin cancer, which provided a unique dataset for us to analyze.

Two hundred eighty-nine transplant recipients exhibited malignant, infectious or inflammatory conditions during their evaluation, but their primary acute diagnoses differed greatly by race. In 82 white patients, skin cancer was the most common acute problem requiring attention at first visit. Black and Hispanic patients, by contrast, were most often diagnosed with inflammatory or infectious processes, such as fungal infections, warts, eczema, psoriasis, and rashes that required immediate medical attention.

Overall, squamous cell carcinoma in situ was the most common type of skin cancer diagnosed in each racial or ethnic group. But the location of the cancerous lesions again depended on the race of the patient. Most lesions in white and Asian patients occurred in sun-exposed areas of the body, like the scalp, neck, chest and back. For black patients, the lesions were primarily found in the groin.  Moreover, six of the nine lesions found on black patients tested positive for high-risk HPV strains, suggesting an association between the virus and skin cancer for African Americans.

We also provided questionnaires to 66 organ transplant recipients to find out more about the patients’ awareness of skin cancer prevention. Seventy-seven percent of white patients were aware their skin cancer risk was increased, compared to 68 percent of nonwhites. Only 11 percent of nonwhite patients reported having regular dermatologic examinations, compared to 36 percent of whites. Finally, 45 percent of white patients but only 25 percent of nonwhite reported knowing the signs of skin cancer.

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Diabetes Raises Risk of Death From Cancer in Asians

MedicalResearch.com Interview with:

Yu Chen</strong> Associate Professor, Department of Population Health Associate Professor, Department of Environmental Medicine Associate Professor, Department of Medicine NYU Langone School of Medicine

Dr. Yu Chen

Yu Chen PhD MPH
Associate Professor, Department of Population Health
Associate Professor, Department of Environmental Medicine
Associate Professor, Department of Medicine
NYU Langone School of Medicine

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

Response There is increasing evidence of an association between type 2 diabetes and cancer risk. However, previous studies in Asian only considered one or a few cancer types, included only a small number of patients with diabetes, or didn’t control for other important risk factors such as obesity.
We conducted pooled analyses of 19 prospective population-based cohorts included in the Asia Cohort Consortium (ACC), comprising data from over 771,000 individuals in the Asia.

Diabetes was associated with a 26% increased risk of death from any cancer in Asians.
Significant positive associations with diabetes were observed for the risk of death from cancers of the colorectum, liver, bile duct , gallbladder, pancreas, breast, endometrium, ovary, prostate, kidney, thyroid, as well as lymphoma. Diabetes was not statistically significantly associated with the risk of death from cancers of the bladder, cervix, esophagus, stomach, and lung or with leukemia.

MedicalResearch.com: What should readers take away from your report?

Response: Influence of diabetes on the risk of death from overall cancer, digestive cancers and breast cancer is largely similar in Asians and in developed Western countries

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: The findings indicate a potential need for appropriate cancer screening among individuals with diabetes, and a greater emphasis on lifestyle modifications to prevent diabetes and reduce cancer mortality, not only in Western populations, but also in Asians

No disclosures

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

 Chen Y, et al “Association between type 2 diabetes and risk of cancer mortality: a pooled analysis of over 771,000 individuals in the Asia Cohort Consortium” Diabetologia 2017; DOI:10.1007/s00125-017-4229-z.

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

More Medical Research Interviews on MedicalResearch.com

Genetic Variants Tied To Kidney Disease in African Americans

MedicalResearch.com Interview with:

Katalin Susztak MD, PhD Associate Professor of Medicine Perelman School of Medicine University of Pennsylvania Philadelphia, PA 19104

Dr. Susztak

Katalin Susztak MD, PhD
Associate Professor of Medicine
Perelman School of Medicine
University of Pennsylvania
Philadelphia, PA 19104

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

Response: Previous studies showed an association between genetic variants in the APOL1 gene and kidney disease development, but it has not been confidently shown that this genetic variant is actually causal for kidney disease. For this reason we developed a mouse model that recapitulates the human phenotype.

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Membership In Medical Schools’ Honor Society Skews Toward White Students

MedicalResearch.com Interview with:

Dowin Boatright, MD, MBA</strong> Department of Emergency Medicine Yale School of Medicine New Haven, Connecticut Fellow, Robert Wood Johnson Clinical Scholars Program Veterans Affairs Scholar

Dr. Dowin Boatright

Dowin Boatright, MD, MBA
Department of Emergency Medicine
Yale School of Medicine
New Haven, Connecticut
Fellow, Robert Wood Johnson Clinical Scholars Program
Veterans Affairs Scholar

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

Response: Studies have demonstrated racial and ethnic inequities in medicine, including disparities in the receipt of awards, research funding, and promotions. Yet few studies have examined the link between race and ethnicity and opportunities for medical school students.

Our results show that black and Asian medical school students are less likely to be selected for membership in a prestigious medical honor society, Alpha Omega Alpha (AΩA), than white medical school students.

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Health Lifestyle Could Cut Cardiovascular Disease 50% in Chinese

MedicalResearch.com Interview with:

Lu Qi, MD, PhD, FAHA HCA Regents Distinguished Chair and Professor Director, Tulane University Obesity Research Center Department of Epidemiology Tulane University School of Public Health and Tropical Medicine New Orleans, LA 70112

Dr. Lu Qi

Lu Qi, MD, PhD, FAHA
HCA Regents Distinguished Chair and Professor
Director, Tulane University Obesity Research Center
Department of Epidemiology
Tulane University
School of Public Health and Tropical Medicine
New Orleans, LA 70112 

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

Response: Adherence to healthy lifestyle (high physical activity, less smoking, moderate alcohol consumption, healthy diet, and low adiposity) has been related to substantially reduced risk of cardiovascular diseases in large cohorts from the US and Europe, however, similar evidence in Asians such as Chinese is lacking.

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Genetic Variant of p53 Gene May Explain Increased Breast Cancer Risk in African American Women

MedicalResearch.com Interview with:

Maureen E. Murphy, Ph.D. Professor and Program Leader, Molecular and Cellular Oncogenesis Program Associate Vice President for Faculty Affairs Associate Director for Education and Career Development The Wistar Institute Philadelphia, PA 19104

Dr. Murphy

Maureen E. Murphy, Ph.D.
Professor and Program Leader, Molecular and Cellular Oncogenesis Program
Associate Vice President for Faculty Affairs
Associate Director for Education and Career Development
The Wistar Institute
Philadelphia, PA 19104

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

Response: The Murphy group discovered a coding-region variant of the p53 tumor suppressor gene, called Pro47Ser, that exists in individuals of African descent. In previous studies this group reported that this amino acid change reduces the ability of p53 to function as a tumor suppressor.

In this study, African American women from two different large cohorts were assessed for the incidence of the Pro47Ser variant in pre-menopausal breast cancer. A modest but statistically significant association was found between Pro47Ser and pre-menopausal breast cancer.

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Rank, Not Race, Associated with Stroke Outcomes in Military

MedicalResearch.com Interview with:

Matthew D. Holtkamp, D.O. CPT, MC, USA Medical Director, Intrepid Spirit, Traumatic Brain Injury Clinic Staff Neurologist, Department of Medicine Teaching Fellow, Uniformed Services University Carl R. Darnall Army Medical Center Fort Hood, Texas 76544

Dr. Mathew Holtkamp,

Matthew D. Holtkamp, D.O. CPT, MC, USA
Medical Director, Intrepid Spirit, Traumatic Brain Injury Clinic
Staff Neurologist, Department of Medicine
Teaching Fellow, Uniformed Services University
Carl R. Darnall Army Medical Center
Fort Hood, Texas 76544

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

Response: Racial and Socioeconomic disparities in the outcomes of stroke patients is well documented in the US Civilian Healthcare system.

That Healthcare system has wide variations in access to care and in the levels of available care. In contrast, the Military Healthcare system is a single payer system meaning that every member has the same healthcare benefits.

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Cardioprotective Effect of Soy in Japanese May Be Mediated Through Equol

MedicalResearch.com Interview with:

Akira Sekikawa, Ph.D.</strong> Associate professor of epidemiology University of Pittsburgh Graduate School of Public Health

Dr. Sekikawa

Akira Sekikawa, Ph.D.
Associate professor of epidemiology
University of Pittsburgh Graduate School of Public Health

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

Response: We found that Japanese men who are able to produce equol—a substance made by some types of “good” gut bacteria when they metabolize isoflavones (micronutrients found in dietary soy)—have lower levels of a risk factor for heart disease than their counterparts who cannot produce it. All monkeys can produce equol, as can 50 to 70 percent of people in Asian countries. However, only 20 to 30 percent of people in Western countries can.

Scientists have known for some time that isoflavones protect against the buildup of plaque in arteries, known as atherosclerosis, in monkeys, and are associated with lower rates of heart disease in people in Asian countries. It was surprising when a large trial of isoflavones in the U.S. didn’t show the beneficial effects on atherosclerosis.

My colleagues and I recruited 272 Japanese men aged 40 to 49 and performed blood tests to find out if they were producing equol. After adjusting for other heart disease risk factors such as high blood pressure, cholesterol, smoking and obesity as well as dietary intake of isoflavones, we found that the equol-producers had 90-percent lower odds of coronary artery calcification, a predictor of heart disease, than the equol non-producers.

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For African American Women, Breast Cancer Symptoms Worsen During Initial Treatments

MedicalResearch.com Interview with::

Margaret Q. Rosenzweig PhD, CRNP-C, AOCNP, FAAN Acute and Tertiary Care Department University of Pittsburgh School of Nursing

Margaret Rosenzweig

Margaret Q. Rosenzweig PhD, CRNP-C, AOCNP, FAAN
Acute and Tertiary Care Department
University of Pittsburgh School of Nursing

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

Response: A significant survival disparity still exists between African American and non-Hispanic white women diagnosed with breast cancer. There is evidence that symptom incidence, associated distress, and overall cancer-related distress may be unexplored, important contributing factors. The current study was a secondary, exploratory aim from the Attitudes, Communication, Treatment, and Support (ACTS) Intervention to Reduce Breast Cancer Treatment Disparity study, which is a randomized controlled trial of a psychoeducational intervention to encourage acceptance and adherence to chemotherapy compared with usual care for  African American women with breast cancer. The purpose of the current study was to:

1) describe and compare the number of chemotherapy-related symptoms and associated distress among AA women with breast cancer over the course of chemotherapy at 3 time points (at baseline before initiating chemotherapy, midpoint, and at the completion of chemotherapy); and

2) to describe the relationship between the number of chemotherapy-related symptoms and overall cancer distress compared with the ability to receive at least 85% of the prescribed chemotherapy within the prescribed timeframe.

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African American Women Remain Disproportionately Affected By HIV

MedicalResearch.com Interview with:
Donna Hubbard McCree, PhD MPH, RPh
Association Director for Health Equity/Division of HIV/AIDS Prevention
Centers for Disease Control and Prevention 

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

Response: HIV diagnosis rates among women declined 40% between 2005 and 2014 with the largest decline, 42%, occurring in black women. However, in 2015 black women represented 61% of HIV diagnoses among women. Our goal in this analysis was to determine whether the decline resulted in a decrease in the disparities among African American, Hispanic and white women between 2010 and 2014. There is currently not a standard method for measuring HIV-related disparity.

However, for this analysis we used three different measures – the absolute rate difference (the difference between the group with the lowest rate and the group with the highest rate); 2) the diagnosis disparity ratio (the ratio of the difference between the group rate and the overall population rate to the overall rate); and 3) the Index of Disparity (the average of the differences between rates for specific groups and the total rate divided by the total rate, expressed as a percentage). The absolute rate difference between black women and white women decreased annually, from 36.9 in 2010 to 28.3 in 2014. The diagnosis disparity ratio for black women compared to the total population decreased from 1.7 in 2010 to 1.2 in 2014. The Index of Disparity increased during 2010–2011, and then decreased each year during 2012–2014. Although disparities still exist, these findings indicate improvement.

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Asthma Risk Varies Among Hispanic Groups After Relocation to the U.S.

MedicalResearch.com Interview with:

Elina Jerschow, M.D., M.Sc., FAAAAI, FACAAI Associate Professor of Medicine, Allergy/ Immunology Division Director, Drug Allergy Center Montefiore Medical Center The University Hospital for Albert Einstein College of Medicine Bronx, New York 10461

Dr. Elina Jerschow

Elina Jerschow, M.D., M.Sc., FAAAAI, FACAAI
Associate Professor of Medicine, Allergy/ Immunology Division
Director, Drug Allergy Center
Montefiore Medical Center
The University Hospital for Albert Einstein College of Medicine
Bronx, New York 10461

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

Response: Asthma prevalence varies across and within countries, and markedly increased rates of asthma have been observed in recent decades. Recent time-trends may be attributed to increased urbanization and dissemination of a Western lifestyle.

In the US, asthma disproportionally affects African-Americans and Hispanics/Latinos living in urban areas. Among Hispanics/Latinos, asthma prevalence varies from 5.7 % for Mexicans/Mexican-Americans to 16.5% for Puerto Ricans. Besides national background, US nativity, longer duration of US residence, and having one or two parents born in the US have been previously reported as acculturation-related risk factors for asthma in foreign born children. Asthma prevalence was also higher in foreign-born Latinos who relocated to the US as children.

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A1C May Be Less Accurate Measure of Diabetes in African Americans with Common Sickle Cell Trait

MedicalResearch.com Interview with:
Mary E. Lacy, MPH

Department of Epidemiology
Brown University School of Public Health
Providence, RI

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

Response: Hemoglobin A1c (A1C) is a blood test that is used to screen for and monitor diabetes. It measures average blood sugar control over the past 2-3 months.

A person with sickle cell trait is a carrier for sickle cell disease but often doesn’t have any clinical symptoms. African Americans are more likely than Whites to have diabetes and are more likely to have sickle cell trait. In this article we examined if A1C can be interpreted in the same way in people with and without sickle cell trait.

We found that, despite similar results on other measures of blood sugar control, people with sickle cell trait had lower A1C results than people without sickle cell trait. This means that A1C may underestimate diabetes risk in people with sickle cell trait.
We also found that, when using standard A1C cutoffs to screen for disease prevalence, we identified 40% fewer cases of prediabetes and 48% fewer cases of diabetes in individuals with sickle cell trait than in those without sickle cell trait. To me, this finding really underscores the potential clinical impact that the observed underestimation of A1C in those with sickle cell trait could have.

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Multifaceted Interventions Improve Cancer Screening Among Marginalized Groups

MedicalResearch.com Interview with:

Sheila F. Dunn, MD, MSc Scientist, Women's College Research Institute Director, Family Practice Health Centre Staff Physician, Department of Family and Community Medicine Women's College Hospital Associate Professor, Department of Family and Community Medicine University of Toronto

Dr. Sheila Dunn

Sheila F. Dunn, MD, MSc
Scientist, Women’s College Research Institute
Director, Family Practice Health Centre
Staff Physician, Department of Family and Community Medicine
Women’s College Hospital
Associate Professor, Department of Family and Community Medicine
University of Toronto

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

Response: Despite organized cervical and breast cancer screening programs, inequities in screening remain. In Ontario, women who are newcomers, especially those of South Asian and East Asian origin, have much lower screening rates than Canadian-born women.

In order to address these inequities the CARES program used a multi-faceted community-based intervention to increase knowledge and promote cervical and breast cancer screening among newcomer and otherwise marginalized women in Toronto, Ontario, Canada. We reached out to women in the target groups through a network of community agencies. Women attended group educational sessions co-led by peers who spoke their language. Access to screening was facilitated through group screening visits, a visit health bus and on-site Pap smears. Administrative data were used to compare screening after the education date for CARES participants with a control group matched for age, screening status and area of residence.

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Premature Midlife Deaths Increase in US Whites and Native Americans

Dr. Meredith Shiels

Dr. Meredith Shiels

MedicalResearch.com Interview with:
Dr Meredith S Shiels

Division of Cancer Epidemiology and Genetics
National Cancer Institute
Bethesda, MD

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

Response: In most high-income countries, premature death rates have been declining, due to the overwhelming successes of public health efforts to prevent and treat chronic disease. The US is a major outlier, where death rates overall have plateaued, or even increased, as reported recently by our sister agency, the Centers for Disease Control and Prevention. Of particular concern are recent reports of increasing death rates among Americans during mid-life.

To expand upon prior findings, we focused on premature death, which we defined as death occurring between the ages of 25 and 64. We examined finely detailed death certificate data for the entire U.S. population and described changes in death rates during 1999-2014 by cause of death, sex, race, ethnicity, and geography. To provide context to our findings, we compared trends in death rates in the U.S. to England and Wales and Canada.

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Racial Disparities in Use of Cardiac Resynchronization Therapy With ICD

MedicalResearch.com Interview with:

Lucas Marzec MD Instructor of Medicine Section of Cardiac Electrophysiology Division of Cardiology University of Colorado School of Medicine Aurora, CO 80045

Dr. Lucas Marzec

Lucas Marzec MD
Instructor of Medicine
Section of Cardiac Electrophysiology
Division of Cardiology
University of Colorado School of Medicine
Aurora, CO 80045

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

Response: The addition of cardiac resynchronization therapy (CRT) to an implantable cardioverter defibrillator (ICD) reduces the risk of mortality and heart failure events in select patients with left ventricular systolic dysfunction. Given these benefits, it is important to ensure patients who have a guideline recommendation for CRT are considered for this therapy at the time of ICD implantation. Previously, little data were available on the contemporary use of CRT among guideline eligible patients undergoing ICD implantation.
Although ICDs alone reduce the risk of mortality in patients with heart failure and reduced systolic function, prior work shows these devices are not uniformly provided to eligible patients and that rates of ICD implantation vary widely by hospital. Prior to our study, it was unknown whether similar variation in the use of the combination of ICD and CRT (CRT-D) exists.

We analyzed data from the National Cardiovascular Data Registry (NCDR) ICD Registry to identify patient, provider, and hospital characteristics associated with CRT-D use and to determine the extent of hospital level variation in the use of CRT-D among patients eligible for CRT undergoing implantation of an ICD.

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Not All Hispanics Have Same Cardiovascular Risk

MedicalResearch.com Interview with:
Fatima Rodriguez, MD, MPH

Chief Cardiovascular Medicine Fellow
Stanford University

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

Response: Hispanics are the largest minority group in the U.S. Although cardiovascular disease (CVD) is the leading cause of death for Hispanics, most studies exploring disparities focus on Black and White differences. Additionally, Hispanics are often aggregated into one homogenous group, which masks important differences.

There is also an interesting epidemiological phenomenon known as the “Hispanic paradox” that states that although Hispanics have greater risk factors for CVD, they experience lower mortality.

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ACA: Screening Disparities Fall For Mammograms But Not Colonoscopies

MedicalResearch.com Interview with:

Dr. Gregory Cooper, MD Program Director, Gastroenterology, UH Cleveland Medical Center Co-Program Leader for Cancer Prevention and Control, UH Cleveland Medical Center Professor, Medicine, CWRU School of Medicine Co-Program Leader for Cancer Prevention and Control UH Seidman Cancer Center

Dr. Gregory Cooper

Dr. Gregory Cooper, MD
Program Director, Gastroenterology
UH Cleveland Medical Center
Co-Program Leader for Cancer Prevention and Control, UH Cleveland Medical Center
Professor, Medicine, CWRU School of Medicine
Co-Program Leader for Cancer Prevention and Control
UH Seidman Cancer Center

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

Response: The Affordable Care Act, among other features, removed out of pocket expenses for approved preventive services, and this may have served as a barrier to cancer screening in socioeconomically disadvantaged individuals. If so, then the gap in screening between socioeconomic groups should narrow following the ACA.

The main findings of the study were that although in the pre-ACA era, there were disparities in screening, they narrowed only for mammography and not colonoscopy.

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Genetics Magnifies Health Effects of Discrimination

MedicalResearch.com Interview with:

Connie J. Mulligan, PhD Professor, Department of Anthropology University of Florida Gainesville, FL

Dr. Connie J. Mulligan

Connie J. Mulligan, PhD
Professor, Department of Anthropology
University of Florida
Gainesville, FL

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

Response: Lance Gravlee (UF Dept of Anthropology, UF Genetics Institute) started this research over 10 years ago. As a cultural anthropologist, Lance uses ethnographic (open-ended questions) interviews and discovered that over half of the participants in our study talked about experiences of discrimination that happened to people close to them.

As a geneticist (UF Dept of Anthropology, UF Genetics Institute), I came into the project because I was interested in seeing how genetics and sociocultural stressors, like discrimination, interact. In our project, we look at blood pressure because hypertension is a disease that shows racial disparities and also because it is a complex disease that is caused by both genetic and environmental factors (like discrimination).

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17 States Have More White Deaths Than Births

MedicalResearch.com Interview with:

Rogelio Saenz PhD Dean, College of Public Policy University of Texas at San Antonio Senior Fellow

Dr. Rogelio Saenz

Rogelio Saenz PhD
Dean, College of Public Policy
University of Texas at San Antonio
Senior Fellow

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

Response: My colleague, Kenneth M. Johnson, and I conducted research based on mortality and birth data from the Center for Disease Control. These data allow us to assess natural decrease, i.e., greater number of deaths compared to births. We find that 17 states had more white deaths than white births in 2014, the most historically, compared to only four in 2004. We find that the 17 states with white natural decrease tend to have relatively high percentages of their populations being elderly (65 and older), low proportions of women being in childbearing ages (15-44), and relatively low fertility rates.

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Barriers to Healthful Eating Linked to More Rapid Kidney Function Decline

MedicalResearch.com Interview with:

Deidra C. Crews, MD, ScM, FASN, FACP Associate Professor of Medicine, Division of Nephrology Associate Vice Chair for Diversity and Inclusion, Department of Medicine Director, Doctoral Diversity Program Johns Hopkins University School of Medicine Baltimore MD 21224

Dr. Deidra Crews

Deidra C. Crews, MD, ScM, FASN, FACP
Associate Professor of Medicine, Division of Nephrology
Associate Vice Chair for Diversity and Inclusion, Department of Medicine
Director, Doctoral Diversity Program
Johns Hopkins University School of Medicine
Baltimore MD 21224

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

Response: Studies suggest that dietary patterns influence risk of kidney function decline. Barriers may hinder urban African Americans’ following healthful diets that could mitigate their increased risk of kidney function decline.

In this study, we characterized contextual barriers to healthful eating among urban African Africans with hypertension and examined the association of these barriers to kidney function decline over 1 year. We examined the presence of healthy foods in neighborhood stores of study participants.

We also assessed them for food insecurity (the inability to afford nutritionally adequate and safe foods), directly observed and documented the presence of fruits and vegetables in their homes, and examined their fruit and vegetable intake via questionnaire.

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Smoking Deaths Disproportionately Affect Poor and Black Americans

MedicalResearch.com Interview with:
Jane Henley MSPH

Epidemiologist
Division of Cancer Prevention and Control

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

Response: The Surgeon General concluded that cigarette smoking causes at least 12 types of cancer: oral cavity and pharynx, esophagus, stomach, colon and rectum, liver, pancreas, larynx, lung, bronchus and trachea, bladder, kidney and renal pelvis, cervix, and acute myeloid leukemia. Other tobacco products — cigars, chewing tobacco and snuff — and secondhand smoke are also linked to some of these cancers.

MedicalResearch.com: What are the main findings?

Response: We examined rates and trends of new cases and deaths from these cancers using U.S. registry and mortality data from 2004 to 2013. We broke the data down by characteristics that might display disparities — sex, age, race, ethnicity, state, county-level poverty and education, rural/urban continuum, and cancer site.

We found that about 660,000 people were diagnosed with and 343,000 people died each year from these cancers. Rates were higher among men, black men and women, and people in counties with low education or high poverty. Rates ranged by state from a low of 130 cases in Utah (126 in Puerto Rico) to a high of 248 cases in Kentucky. Incidence decreased 1.3 percent per year and mortality decreased faster, at about 1.6 percent per year; decreases were observed across most groups, but not at the same rate. Disparities persist among certain groups with higher rates or slower declines in rates.

We also looked at changes in cancer death rates from 1970 to 2014 and estimated that 1.3 million tobacco-related cancer deaths were averted since 1990, in part because of comprehensive cancer and tobacco control efforts to reduce tobacco use and other cancer risk factors, early detection of cancer, and improvements in cancer treatment.

MedicalResearch.com: What should readers take away from your report?

Response: Further reducing tobacco use can save thousands more people from getting and dying from cancer. Based on current estimates, about 36.5 million people smoke, and about half will die from a smoking related disease, unless programs are implemented to help them quit smoking. Comprehensive cancer and tobacco control programs actions can be done at the state and local level, such as:

• Promoting healthy, tobacco-free environments
• Increasing access to early detection and care for tobacco-related cancers
• Helping cancer survivors who use tobacco quit
• Better assisting communities disproportionately impacted by cancer

And of course, increasing the price of tobacco products and ongoing media campaigns, like Tips from Former Smokers, have a huge impact.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Ongoing surveillance efforts are needed to monitor changes in the number of new cases and deaths from tobacco-related cancers and whether there are differences among communities or groups of people. This work will provide insight into the impact of comprehensive cancer and tobacco control efforts and how to target these efforts in the areas where they’re needed most.

MedicalResearch.com: Is there anything else you would like to add?

Response: You can find more information at https://www.cdc.gov/cancer/tobacco/

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Henley SJ, Thomas CC, Sharapova SR, et al. Vital Signs: Disparities in Tobacco-Related Cancer Incidence and Mortality — United States, 2004–2013. MMWR Morb Mortal Wkly Rep 2016;65:1212–1218. DOI: http://dx.doi.org/10.15585/mmwr.mm6544a3.

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

More Medical Research Interviews on MedicalResearch.com

Increased Aortic Stiffness May Explain Elevated Hypertension Risk in African Americans

MedicalResearch.com Interview with:

Wanpen Vongpatanasin, M.D. Professor of Medicine Norman & Audrey Kaplan Chair in Hypertension Fredric L. Coe Professorship in Nephrolithiasis and Mineral Metabolism Research Director, Hypertension Section, Cardiology Division, UT Southwestern Medical Center Dallas, TX 75390-8586

Dr. Wanpen Vongpatanasin

Wanpen Vongpatanasin, M.D.
Professor of Medicine
Norman & Audrey Kaplan Chair in Hypertension
Fredric L. Coe Professorship in Nephrolithiasis and Mineral Metabolism Research
Director, Hypertension Section,
Cardiology Division,
UT Southwestern Medical Center
Dallas, TX 75390-8586

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

Response: Aortic stiffness is known to be associated with cardiovascular disease, including heart attack, stroke, and heart failure, possibly related to increase afterload to the left ventricle. Previous studies have not directly assessed proximal aortic function among ethnic minorities in the United States. We evaluated the multiethnic, population-based Dallas Heart Study participants (N=2544, 54.2% women, 49.7% Black) who underwent cardiovascular magnetic resonance imaging (CMR) at 1.5 Tesla. Aortic stiffness and characteristic impedance (Zc) were determined from aortic arch PWV and lumen area measurements. Linear regression was used to evaluate ethnic differences in proximal aortic wall stiffness using aortic arch PWV and Zc as dependent variables with and without adjustment for traditional cardiovascular risk factors.

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Minorities Much Less Likely To Have Advance Care Health Planning

MedicalResearch.com Interview with:

Krista Lyn Harrison, PhD Division of Geriatrics School of Medicine University of California San Francisco VA Medical Center San Francisco, CA 94121

Dr. Krista Lyn Harrison

Krista Lyn Harrison, PhD
Division of Geriatrics School of Medicine
University of California
San Francisco VA Medical Center
San Francisco, CA 94121

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

Response: Advance care planning (ACP) is the process of discussing plans and preferences for end-of-life care. It may include completion of advanced directives or a living will and designation of a surrogate decision-maker in a durable power of attorney for health care. There is a growing awareness of the benefits of such discussions for both elders and their families. In absence of these discussions, loved ones are left to guess what the affected individual wanted or may even get mired in unexpected legal issues. But until recently, it was unknown if all races/ethnicities, education levels, and incomes have benefited from efforts to improve engagement in advance care planning, and if these discussions are greater among those in worse health and with a poorer prognosis.

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Preterm Birth Increases in the U.S. for the First Time in Eight Years

MedicalResearch.com Interview with:

Jennifer Howse, Ph.D. President of the March of Dimes Foundation

Dr. Jennifer Howse

Jennifer Howse, Ph.D.
President of the March of Dimes Foundation

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

Response: The March of Dimes Premature Birth Report Card was created in 2007 to raise awareness of the unfair burden of preterm birth in certain communities and geographic areas in the United States. We also want to monitor progress, or lack of it, towards our goal to lower the national preterm birth rate to 8.1 percent by 2020 and to 5.5 percent by 2030. This year’s Report Card finds that, for the first time in eight years, the nation’s preterm birth rate did not decline – it worsened from 9.57 percent of all live births in 2014 to 9.63 percent in 2015, earning the nation a “C” grade. Seven states — Arkansas, Connecticut, Idaho, Nebraska, New Mexico, Utah, and Wisconsin – received worse grades this year than last year on the Report Card. The March of Dimes strives for a world where every baby has a fair chance for a full-term pregnancy and a healthy birth, yet this is not the reality for many mothers and babies. The 2016 Report Card shows that babies in this country have different chances of surviving and thriving simply based on the circumstances of their birth.

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Genetic Mutation Common In Ashkenazi Jews With Lewy Body Dementia

MedicalResearch.com Interview with:

Dr Tamara Shiner MD PhD Specialist in Neurology Neurology Division Tel Aviv Sourasky Medical Centre

Dr Tamara Shiner

Dr Tamara Shiner MD PhD
Specialist in Neurology
Neurology Division
Tel Aviv Sourasky Medical Centre

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

Response: Although in the past believed to be sporadic, there is much emerging evidence for a significant genetic contribution to Dementia with Lewy bodies (DLB). Hetrozygosity for common mutations in the GBA gene have been shown to be more frequent among DLB patients and Parkinson’s disease patients than in the general population.

We found that GBA mutations are in fact exceptionally frequent among Ashkenazi Jewish (AJ) patients with Dementia with Lewy bodies. Our results indicate that one in three of all Ashkenazi DLB patients carry mutations in this specific gene (compared to approximately 6% in the general Ashkenazi Jewish population). We also found that those who carry these mutations have a more severe disease phenotype.

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Breast Cancer Mortality Varies By Latina Subgroups

MedicalResearch.com Interview with:

Bijon Hunt Epidemiologist photographed for Sinai Health System on Wednesday, February 4, 2015 at Mount Sinai Hospital in Chicago, Illinois. Photo credit: Randy Belice

Bijon Hunt

Bijou R. Hunt,  MA
Sinai Urban Health Institute, Sinai Health System
Chicago, IL 

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

Response: Breast cancer is the most commonly diagnosed cancer in Hispanic women, as well as the leading cause of cancer death for this group. Research has shown that there are differences by Hispanic subgroup in various causes of death, including cancer, but we haven’t seen data on breast cancer specifically among Hispanic subgroups. The most important question we wanted to address with this study was: do breast cancer prevalence and mortality vary by Hispanic subgroup?

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Some US Regions and Ethnicities At Greater Risk of Non-Adherence to Blood Pressure Medications

MedicalResearch.com Interview with:

Matthew Ritchey, DPT, PT, OCS, MPH Epidemiologist Division for Heart Disease and Stroke Prevention National Center for Chronic Disease Prevention and Health Promotion

Dr. Matthew Ritchey

Matthew Ritchey, DPT, PT, OCS, MPH
Epidemiologist
Division for Heart Disease and Stroke Prevention
National Center for Chronic Disease Prevention and Health Promotion

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

Response: High blood pressure is a leading cause of heart disease, stroke, kidney disease and death. Unfortunately, almost one in three U.S. adults (around 75 million) has high blood pressure, and nearly half of that group (about 34 million) doesn’t have it under control.

As part of CDC’s ongoing efforts to monitor trends and risk factors contributing to cardiovascular disease, we collaborated with colleagues at the Centers for Medicare and Medicaid Services to look at blood pressure medicine nonadherence among Medicare Part D enrollees ages 65 and over. Being nonadherent means that patients skip doses of their medicine or stop taking it altogether.

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Variable Effects of Dairy, Calcium, Vitamin D on Ovarian Cancer Risk in African–American Women

MedicalResearch.com Interview with:

Bo (Bonnie) Qin, Ph.D. Postdoctoral Scholar Rutgers Cancer Institute of New Jersey New Brunswick, NJ 08903

Dr. Bo Qin

Bo (Bonnie) Qin, Ph.D.
Post-Doctoral Associate
Rutgers Cancer Institute of New Jersey
New Brunswick, NJ 08903

MedicalResearch.com: What is the background for this study?
Response: Ovarian cancer is the leading cause of death from gynecologic cancer in the US. African-American patients diagnosed with ovarian cancer tend to have a worse 5-year survival rate compared to their European-American patients. Therefore, identifying preventive factors in African-Americans women is particularly important.

African Americans tend to consume less calcium and vitamin D from dietary sources, due to a higher prevalence of lactose intolerance, and supplemental intake. Meanwhile, darker color of the skin reduces the synthesis of vitamin D upon sun exposure. They together place African-American women at risk for calcium and vitamin D deficiency. It remains unknown whether calcium, vitamin D, lactose and dairy products are associated with ovarian cancer risk in African-American women and our study aimed to answer this question.

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Pemphigus Incidence Much Higher Among Jews Than Arabs in Northern Israel

MedicalResearch.com Interview with:

Khalaf Kridin, MD Department of Dermatology Rambam Health Care Campus Haifa Israel

Dr. Khalaf Kridin

Khalaf Kridin, MD
Department of Dermatology
Rambam Health Care Campus
Haifa Israel

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

Response: Pemphigus shows an uneven geographic and ethnic distribution. A high incidence of pemphigus was observed in some ethnic groups, namely Ashkenazi Jews and those of Mediterranean origin. This observation has been shown to be strongly related to several HLA-class II genes; HLA-DRB1*04 and HLA-A*10 which have been more frequently found among Ashkenazi Jewish pemphigus patients. We sought to estimate trends in the incidence of pemphigus in northern Israel in the years 2000-2015, in relation to the major ethnic groups who inhabit the same geographic area and exposed to the same environmental elements.

The overall estimated incidence of pemphigus in northern Israel was 7.2 per million inhabitants per year (95% CI, 6.2-8.3). The incidence in the Jewish population was 3-fold higher than that in Arabs; 9.6 vs. 3.2 cases per million per year, respectively, p<0.0001), and higher among women than men; 9 vs. 5.3 cases per million per year, respectively, p<0.0001). Patients of Arab ancestry tend to present with the disease at earlier age, in line with observations from Arab and Mediterranean countries.

A declining trend in the incidence of pemphigus throughout the last 16 years in northern Israel was observed.

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