Author Interviews, Colon Cancer, Gastrointestinal Disease, Race/Ethnic Diversity / 26.05.2016 Interview with: Robert Wong, M.D., M.S. Attending Physician, Gastroenterology & Hepatology Director, GI Education & Research Highland Hospital I A member of Alameda Health System Oakland, CA What is the background for this study? What are the main findings? Dr. Wong:  Colorectal cancer is a leading cause of morbidity and mortality in the United States. Early diagnosis through implementation of effective screening and surveillance programs leads to earlier staged tumor at time of diagnosis, which increases the treatment opportunities and improves overall survival. However, disparities in access to effective screening and surveillance can impair timely diagnosis and lead to advanced disease, limited treatment options and poor outcomes. The current study evaluated race/ethnicity-specific disparities in colorectal cancer epidemiology at a large urban safety net hospital and observed African American patients had significantly more advanced cancer stage at the time of diagnosis. Our study observed that African Americans were over 5 times more likely to have advanced stage 3-4 colon cancer at time of diagnosis compared with non-Hispanic white patients with colon cancer. While these findings are likely multifactorial, it sheds important light on race/ethnicity-specific disparities in colorectal cancer epidemiology and helps target future education and research to improve outcomes. (more…)
Author Interviews, Hepatitis - Liver Disease, Race/Ethnic Diversity / 24.05.2016 Interview with: Dr. Patricia Jones MD Medicine, Division of Hepatology Sylvester Comprehensive Cancer Center University of Miami Miller School of Medicine Miami, Florida, United States What is the background for this study? What are the main findings? Dr. Jones: This study reviewed 999 patients diagnosed with hepatocellular carcinoma in a diverse American population over the past ten years. The main findings were that Blacks had reduced survival, only 301 days, when comparison to Whites (534.5 days) and Hispanics (437 days) after being diagnosed with liver cancer. This was adjusted for insurance status, chemotherapy and gender and the findings still persisted. We found that Blacks present at later stages, when the tumor is too large for some of the treatments that we would like to offer, such as liver transplant. (more…)
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, JAMA, Race/Ethnic Diversity / 16.05.2016 Interview with: Benjamin D. Sommers, MD, PhD Assistant Professor of Health Policy & Economics Harvard T. H. Chan School of Public Health / Brigham & Women's Hospital Boston, MA 02115  Molly E. Frean Data Analyst Department of Health Policy and Management Harvard T.H. Chan School of Public Health Boston, MA 02115 What is the background for this study? Dr. Sommers: We conducted this study in an effort to see how Native Americans have fared under the Affordable Care Act. In addition to the law's expansion of coverage via Medicaid and tax credits for the health insurance marketplaces, the law also provided support for Native Americans’ health care specifically through continued funding of the Indian Health Service (IHS). We sought to see how both health insurance coverage patterns and IHS use changed in the first year of the law's implementation. (more…)
AHA Journals, Author Interviews, Race/Ethnic Diversity, Stroke / 12.05.2016 Interview with: Lucas Ramirez, M.D Resident Physician | LAC-USC Medical Center USC Keck School of Medicine | Class of 2013 What is the background for this study? What are the main findings? Dr. Ramirez: Prior studies have shown differences in stroke rates in certain geographical regions among age and racial groups. Few studies have analyzed these differences on a national level.  Our study found that nationally, stroke hospitalization have decreased, though among blacks and young age groups, they have increased. (more…)
Author Interviews, Heart Disease, JACC, Race/Ethnic Diversity / 09.05.2016 Interview with: Alan S. Go, MD, chief of Cardiovascular and Metabolic Conditions Research at the Kaiser Permanente Northern California Division of Research Jamal S. Rana, MD, PhD, cardiologist at Kaiser Permanente Oakland Medical Center and adjunct investigator with the Division of Research What is the background for this study? Response: In 2013, the American College of Cardiology and American Heart Association published the Pooled Cohort risk equation for estimating the likelihood of atherosclerotic cardiovascular disease events. However, the equation was developed from several groups of enrolled volunteers primarily conducted in the 1990s with limited ethnic diversity and age range, so its accuracy may vary in current community-based populations. To determine whether the risk equation might be improved by being recalibrated in “real world” clinical care, we examined a large, multi-ethnic, community-based population of Kaiser Permanente members in Northern California whose cholesterol levels and other clinical measures could theoretically trigger a discussion about whether to consider starting cholesterol-lowering therapy based on estimated risk using the ACC/AHA Pooled Cohort tool. The study followed a population of 307,591 men and women aged 40 to 75 years old, including non-Hispanic whites, non-Hispanic blacks, Asian, Pacific Islanders and Hispanics, from 2008 through 2013 and had complete five-year follow-up. The study population did not include patients with diabetes, prior atherosclerotic cardiovascular disease or prior use of lipid-lowering therapy such as statins, as the application of this risk tool is meant for primary prevention of heart disease and stroke. (more…)
AACR, Author Interviews, Cancer Research, Lung Cancer, Race/Ethnic Diversity, Surgical Research / 02.05.2016 Interview with: Asal Mohamadi Johnson, PhD, MPH Assistant Professor of Epidemiology, Integrative Health Science Stetson University DeLand, FL 32723 What is the background for this study? Dr. Johnson: Public health research is primarily focused on neighborhood poverty and racial disparities by illustrating differences between white and black individuals or communities. For example, it has been established that African Americans have higher cancer mortality rates and are less likely to receive appropriate treatment that whites. What we wanted to know in this study was the impact of living in segregated areas apart from other area level characteristics such as poverty or education. Instead of solely looking at health disparities between whites and black patients, our study focused on differences in survival among black patients with early stage Non-Small Cell Lung Cancer (NSCLC) living in different levels of neighborhood segregation. (more…)
Author Interviews, CDC, OBGYNE, Race/Ethnic Diversity / 29.04.2016 Interview with: Lisa Romero DrPH, MPH  Division of Reproductive Health National Center for Chronic Disease Prevention and Health Promotion CDC What is the background for this study? What are the main findings? Dr. Romero: Since 2006, teen birth rates have fallen almost half among Hispanic and black teens; dropping the national teen birth rate to an all-time low. While dramatic declines among Hispanic and black teens have helped reduce gaps, birth rates remain twice as high for these teens nationally compared to white teens, and more than three times as high in some states. Data also highlight the role socioeconomic conditions play, finding that higher unemployment and lower income and education are more common in communities with the highest teen birth rates, regardless of race. This research highlights the importance of teen pregnancy prevention interventions that address socioeconomic conditions like unemployment and lower education levels, for reducing disparities in teen births rates. State and community leaders can use local data to better understand teen pregnancy in their communities and to direct programs and resources to areas with the greatest need.  To generate these findings, we analyzed national- and state-level data from the National Vital Statistics System (NVSS) to examine trends in births to American teens aged 15 to 19 years between 2006 and 2014. County-level NVSS data for 2013 and 2014 offer a point-in-time picture of local birth rates. To better understand the relationship between key social and economic factors and teen birth rates, researchers examined data from the American Community Survey between 2010 and 2014. (more…)
Author Interviews, CDC, Lyme, Race/Ethnic Diversity / 08.03.2016 Interview with: Christina Nelson, MD, MPH, FAAP Medical Epidemiologist Centers for Disease Control and Prevention Division of Vector-Borne Diseases | Bacterial Diseases Branch Fort Collins, CO What is the background for this study? What are the main findings? Dr. Nelson: Since Lyme disease is a nationally notifiable disease, state and local health departments collect reports of Lyme disease cases in their jurisdictions then share this data with CDC. This surveillance data is very informative and can be used to track disease patterns. Hispanics comprise roughly 45% of the U.S. workforce in outdoor jobs such as grounds maintenance, farming, fishing, and forestry, so they potentially have an increased risk of Lyme disease. Since information on Lyme disease in Hispanics is very limited, we decided to look into this topic further by analyzing surveillance data. (more…)
AHA Journals, Author Interviews, Gender Differences, Heart Disease, Race/Ethnic Diversity, Women's Heart Health / 26.02.2016 Interview with: Karin H Humphries, MBA, DSc | Scientific Director BC Centre for Improved Cardiovascular Health UBC-HSF Professor in Women's Cardiovascular Health Vancouver, BC Medical Research: What is the background for this study? Response: Prior studies have shown that among patients with obstructive coronary artery disease (CAD), women have higher short- and long-term mortality rates as compared to men. Furthermore, a few studies have highlighted the existence of ethnic differences in the incidence of acute myocardial infarction (AMI) and outcomes following an AMI event. However, the joint contribution of sex and ethnicity on outcomes of patients with obstructive  coronary artery disease remains unknown. Our primary objective was to extend these findings by examining the joint impact of sex and ethnicity on long-term adverse outcomes of all patients with angiographic evidence of obstructive CAD presenting with myocardial ischemia. Our study included a population-based cohort of patients ≥ 20 years of age who underwent coronary angiography for acute coronary syndromes (ACS) or stable angina in British Columbia, Canada with angiographic evidence of ≥ 50% stenosis in any epicardial artery. (more…)
Author Interviews, JACC, Metabolic Syndrome, OBGYNE, Race/Ethnic Diversity, Women's Heart Health / 26.02.2016 Interview with: Catherine J. Vladutiu, PhD, MPH Research Assistant Professor, Department of Obstetrics & Gynecology Adjunct Assistant Professor, Department of Epidemiology Chapel Hill, NC Medical Research: What is the background for this study? Dr. Vladutiu: During pregnancy, women experience physiological changes and are at risk of pregnancy-related complications, some of which are associated with a higher risk of cardiovascular health outcomes in later life.  Physiologic adaptations occurring across successive pregnancies may be associated with an even higher risk of adverse cardiovascular outcomes. Previous studies have found an association between higher parity (i.e., number of live births) and the metabolic syndrome (MetS). However, no studies have examined this association in a Hispanic/Latina population. Hispanic women have a higher prevalence of the MetS than non-Hispanic women.  Latinos are also the fastest growing minority population in the U.S. and Hispanic/Latina women report higher fertility and birth rates than their non-Hispanic counterparts. (more…)
Author Interviews, Johns Hopkins, Kidney Disease, Race/Ethnic Diversity, Transplantation / 26.02.2016 Interview with: Tanjala S. Purnell, PhD MPH Assistant Professor, Transplant Surgery and Epidemiology Johns Hopkins University School of Medicine  Medical Research: What is the background for this study? Dr. Purnell:  Kidney transplantation (KT) is the best treatment for most patients with end stage renal disease (ESRD), offering longer life expectancy and improved quality of life than dialysis treatment. Despite these benefits, previous reports suggest that black KT recipients experience poorer outcomes, such as higher kidney rejection and patient death, than white KT recipients. Our team wanted to examine whether this disparity has improved in recent decades. We hypothesized that advances in immunosuppression and post- kidney transplantation  management might differentially benefit black KT recipients, who were disproportionately burdened by immunological barriers, and contribute to reduced racial disparities in kidney transplantation outcomes. Medical Research: What are the main findings? Dr. Purnell: 
  1. From 1990 to 2012, 5-year failure rates of the transplanted kidney after Deceased Donor Kidney Transplantation (DDKT) decreased from 51.4% to 30.6% for blacks and from 37.3% to 25.0% for whites; 5-year failure after Living Donor Kidney Transplantation (LDKT) decreased from 37.4% to 22.2% for blacks and from 20.8% to 13.9% for whites.
  2. Among DDKT recipients in the earliest group of patients, blacks were 39% more likely than whites to experience 5-year failure, but this disparity narrowed to 10% in the most recent group.
  3. Among LDKT recipients in the earliest group, blacks were 53% more likely than whites to experience 5-year failure, but this disparity narrowed to 37% in the most recent group.
  4. There were no statistically significant differences in 1-year or 3-year failure rates of transplanted kidneys after LDKT or DDKT in the most recent groups.
Author Interviews, Pain Research, Race/Ethnic Diversity / 24.02.2016 Interview with: Adam T. Hirsh PhD Assistant Professor, Psychology Indiana University Indianapolis, IN  Medical Research: What is the background for this study? What are the main findings? Dr. Hirsh: Pain is highly prevalent and is a major cause of disability. How patients cope with pain affects how much pain they feel and how much that pain interferes with their lives. Compared to White individuals, Black individuals experience greater pain across a number of clinical conditions, as well as in response to experimentally-delivered stimuli. These race differences may be due to differences in pain-related coping. We conducted a meta-analysis of clinical and experimental studies (including 2,719 Black and 3,770 White adults) to quantify race differences in the overall use of pain coping strategies as well as specific coping strategies. The results indicated that, compared to White individuals, Black individuals used pain coping strategies more frequently overall. In particular, Black individuals more frequently used strategies that involved praying and catastrophizing, whereas White individuals more frequently used strategies that involved task persistence. These results suggest that Black individuals use coping strategies more frequently, specifically strategies associated with poorer pain outcomes. (more…)
Author Interviews, Gender Differences, Race/Ethnic Diversity, Stroke, Wake Forest / 20.02.2016 Interview with: Cheryl Bushnell, MD, MHS Professor of Neurology Director, Wake Forest Baptist Stroke Center Wake Forest Baptist Health Medical Center Boulevard Winston Salem, NC  27157  Medical Research: What is the background for this study? What are the main findings? Dr. Bushnell: The catalyst for the study was to see if comorbidities and the management of them might influence functional status.  But, we pre-specified gender and race because we knew these could be important predictors of outcome.  As it turns out, the results of our analysis did, in fact, show that gender and race were the most significant predictors of poor functional outcome. Medical Research: What should clinicians and patients take away from your report? Dr. Bushnell: The take-home message is that women and minorities have poorer functional outcome after stroke, but the reasons for this outcome need to be further explored.  Our model showed that we only explained 31% of the variance in SIS-16 with gender, race/ethnicity, and stroke severity, so unmeasured factors are extremely important.  We could speculate from this dataset and other published data that women may be more likely to have functional deficits prior to stroke, be unmarried/widowed, live alone, or institutionalized after stroke.  Non-white stroke survivors may have poorer access to care, have multiple strokes, and more comorbidities. (more…)
Author Interviews, Genetic Research, Race/Ethnic Diversity, Science / 15.02.2016 Interview with: Michael Yudell, PhD, MPH Chair & Associate Professor Drexel University School of Public Health Community Health and Prevention Philadelphia, PA 19104 Medical Research: What is the background for this study? Dr. Yudell: We came together as a group of scholars from the natural sciences, social sciences, and humanities to address what we believe is a long-standing challenge: how to improve the study of human genetic diversity without recapitulating the controversial and problematic concept of race. We believe that the cross-disciplinary focus of our work—an examination of the historical, biological, and sociological aspects of the race concept—can shed new light on the long-standing debate about the use of the race concept in genetics research. We believe modern genetics remains stuck in a paradox: that on the one hand race is a tool to elucidate human genetic diversity, and on the other hand race is believedthree main concerns to be a poorly defined marker of that diversity and an imprecise proxy for the relationship between ancestry and genetics. This paradox is rooted in the nature of the field: it dates back to the evolutionary geneticist Theodosius Dozhansky, who in the 1930s redefined race in his work on what was known as biology’s evolutionary synthesis (the synthesis of population genetics with Darwinian thought). For much of his career, Dobzhansky believed race to be a useful tool to elucidate human genetic diversity. But by the end of his career he became worried that the study of human diversity had “floundered in confusion and misunderstanding” and was concerned over the nonscientific misuse of the term. He, like we and many others in genetics, anthropology, and the social sciences, have called on the field to devise better methods to improve the study of human genetic diversity. Can the race concept in genetics elucidate the relationship between humans and their evolutionary history, between humans and their health? In the wake of the human genome project the answer seemed to be a pretty resounding “no.” In 2004, for example, Francis Collins, then head of the National Human Genome Research Institute and now Director of the National Institutes of Health called race a “flawed” and “weak” concept and argued that science needed to move beyond race. Yet, as our paper highlights, the use of race persist in genetics, despite voices like Collins, like Craig Venter—leaders in the field of genomics-who have called on the field to move beyond it. They, of course, were not the first to do, but we hope they are among the last. We believe it is time to revisit this century-long debate and bring biologists, social scientists, and scholars from the humanities together in a to find better ways to study the ever-important subject of human diversity. (more…)
Author Interviews, CDC, HIV, Race/Ethnic Diversity / 10.02.2016 Interview with: Sharoda Dasgupta, PhD, MPH  US Public Health Service and Epidemic Intelligence Service Officer CDC Medical Research: What is the background for this study? Dr. Dasgupta: Roughly 1.2 million people in the United States are living with HIV, and about 40,000 diagnoses occur each year, according to the most recent CDC data. According to national estimates published by CDC, African Americans remain disproportionately affected by the virus. African Americans represent 12 percent of the U.S. population but accounted for almost 50 percent of HIV diagnoses in 2014. Some signs have emerged that HIV is loosening its grip on the African American community, but persistent disparities are prolonging HIV transmission. Antiretroviral therapy (ART) improves clinical outcomes for people living with HIV and reduces their risk of transmitting the virus to others. Racial and ethnic disparities in HIV care, however, limit access to ART, which perpetuates disparities in survival and HIV transmission. Although previous studies have mostly analyzed HIV care by race and ethnicity during a single year, the purpose of this study was to better understand how people living with HIV remain in care over a longer period in time – and whether their retention in care differed by race and ethnicity.  Medical Research: What are the main findings? Dr. Dasgupta: This analysis focused on 12 U.S. jurisdictions that reported comprehensive HIV lab results to CDC from January 2010 – December 2013. They represent approximately 25 percent of HIV diagnoses in 2010. The findings demonstrate yet another persistent disparity that prolongs the epidemic among African Americans. Only 38 percent of African Americans received consistent HIV care from 2011 – 2013, compared with 49% of whites and 50% of Latinos. Additionally, African American males were less likely to receive consistent medical care than African American females (35 percent and 44 percent, respectively). Among African Americans, receiving consistent HIV care was highest among those whose HIV infections were attributable to heterosexual contact. Those who received consistent HIV medical care for three years were considered consistently retained in care. (more…)
Author Interviews, Brigham & Women's - Harvard, Johns Hopkins, Race/Ethnic Diversity, Surgical Research / 29.01.2016 Interview with: Adil H. Haider, MD, MPH Kessler Director for the Center for Surgery and Public Health Brigham and Women's Hospital Harvard Medical School, and the Harvard T.H. Chan School of Public Health Deputy Editor of JAMA SurgeryAdil H. Haider, MD, MPH Kessler Director for the Center for Surgery and Public Health Brigham and Women's Hospital  Harvard Medical School, and the Harvard T.H. Chan School of Public Health Deputy Editor of JAMA Surgery  Medical Research: What is the background for this study? Dr. Haider: Racial/Ethnic disparities have been identified in multiple surgical fields. They are thought to be caused by a complex interplay of patient-, provider-, and systems-level factors. As healthcare professionals, providers play a key role in the care and outcomes that patients experience. However, despite published research about the existence of disparities, it remains unknown the extent to which surgeons perceive that racial/ethnic disparities exist. Medical Research: What are the main findings? Dr. Haider: In a pilot study designed to assess the extent to which US surgeons report awareness of racial/ethnic disparities, only 36.6% agreed that racial/ethnic disparities exist in healthcare. Even fewer, 11.6% acknowledged that disparities were present in their hospital or clinic, and a mere 4.7% reported disparities in their personal practice. (more…)
Author Interviews, Melanoma, Race/Ethnic Diversity / 21.01.2016

More on Dermatology on Interview with: Dr. Jennifer A. Stein MD PhD Associate Professor Department of Ronald O. Perelman Department of Dermatology NYU Langone Medical Center Medical Research: What is the background for this study? What are the main findings? Dr. Stein: Although acral melanoma is not a common cancer, it is the most common form of melanoma in African Americans. There is low awareness about acral melanoma, and it tends to get detected later and is more often fatal than other types of melanoma. Our study looked at awareness of and the prevalence of pigmented lesions on the hands and feet. People with darker skin were more likely to have a pigmented lesion on their soles or palms than people with lighter skin. We found that more than half of the people in the study were not aware that they had a pigmented lesion on their feet. Our study found that most pigmented lesions on the hands and feet are benign, and that an imaging technique called dermsocopy can be used to distinguish benign from malignant acral lesions. (more…)
Author Interviews, Heart Disease, Race/Ethnic Diversity, Radiology / 15.01.2016

More on Heart Disease on Interview with: John Nance, MD Division of Cardiovascular Imaging, Department of Radiology and Radiological Science Medical University of South Carolina Charleston, South Carolina  Medical Research: What is the background for this study? What are the main findings? Dr. Nance: There are known ethnic and racial disparities in the burden, morbidity, and mortality of cardiovascular disease. The causes, of course, are multifactorial, and range from genetic differences to healthcare access issues. Our goal was to further explore these differences by utilize a dataset encompassing black and white patients who had undergone a coronary CT angiogram for the assessment of acute chest pain. We compared various measures of myocardial morphology and function, namely myocardial mass, interventricular septal wall thickness, left ventricular inner diameter in diastole and systole, and ejection fraction. We found that black patients had significantly higher myocardial mass than whites despite adjusting for age, gender, body mass index, and hypertension. Likewise, the septal wall was thicker in black patients. Interestingly, ejection fraction was slightly lower in black patients, but this finding was not statistically significant.  (more…)
Author Interviews, Cleveland Clinic, OBGYNE, Race/Ethnic Diversity / 15.01.2016

More on Racial Disparities in Health Care on Interview with: Emily A. DeFranco, D.O., M.S. Associate Professor Maternal-Fetal Medicine Center for Prevention of Preterm Birth, Perinatal Institute Cincinnati Children's Hospital Medical Center University of Cincinnati College of Medicine Department of Obstetrics and Gynecology Medical Sciences Building, Room 4553B Cincinnati, OH Medical Research: What is the background for this study? Dr. DeFranco: The Infant Mortality Rate in the state of Ohio is higher than many other states.  Additionally, there is a large disparity in the IMR with black infants impacted to a higher degree compared to white infants. For this reason, we are particularly interested in identifying factors that contribute to this disparity in order to identify potential areas where public health efforts can be focused. We know that preterm birth is a major contributor to infant mortality, and that all babies born alive prior to 23 weeks of gestational age, i.e. "previable", die after birth and contribute to the infant mortality rate.  In this study, we wanted to assess whether black women are more likely to have early preterm births at less than 23 weeks, and if so whether that may be part of the explanation of why black mothers are at higher risk of experiencing an infant mortality. Medical Research: What are the main findings? Dr. DeFranco: In this study, we found that black mothers were more likely to deliver than white mothers  at very early preterm gestational ages, less than 23 weeks.  We also found that the earlier the delivery, the larger the disparity with black mothers being at higher risk for the earliest deliveries compared to white mothers.  From this data, we estimated that in Ohio, 44% of all infant mortality in black mothers is caused by previable preterm birth, whereas only 28% of infant mortality in white mothers is attributed to the same cause.  We concluded that very early preterm birth in black mothers is a large contributor to the racial disparity observed in the infant mortality dilemma here in Ohio. (more…)
Author Interviews, Gender Differences, Mental Health Research, Race/Ethnic Diversity / 07.01.2016 Interview with: Silvia Sara Canetto, Ph.D., Professor Faculty in the Department of Psychology, and Affiliate Faculty in the Center for Women's Studies and Gender Research, Department of Ethnic Studies, and in the Human Development and Family Studies Department Colorado State University  Medical Research: What is the background for this study? Dr. Canetto: In the United States, older men of European descent (so called white men) have significantly higher suicide rates than any other demographic group. For example, their suicide rates are significantly higher than those of older men of African, Latino or Indigenous descent, as well as relative to older women across ethnicities. Behind these facts there is a cultural story, not just individual journeys of psychological pain and despair. Colorado State University’s Silvia Sara Canetto has spent a large portion of her research career seeking to uncover cultural stories of suicide. A professor in the College of Natural Sciences’ Department of Psychology, Canetto adds a new chapter to that story in an article recently published in the journal Men and Masculinities. The article features a critical review of theories and research on suicide among older men. (more…)
Author Interviews, Prostate Cancer, Race/Ethnic Diversity / 04.01.2016 Interview with: Benjamin A. Rybicki, Ph.D Department of Public Health Sciences Henry Ford Health System Detroit, MI  Medical Research: What is the background for this study? What are the main findings? Dr. Rybicki: Inflammation of the prostate gland—prostatitis—is a complex and heterogeneous condition. Two separate meta-analyses have estimated about a 60% increased risk of prostate cancer associated with clinical prostatitis.  Most prostatitis, however, is asymptomatic and not fully captured in prevalence surveys. In fact, over 50% of surgical prostate specimens demonstrate some histological evidence of chronic inflammation, which has been generally shown to decrease risk of prostate cancer. The race of a patient may also be a factor as far as how inflammation influences prostate cancer risk. African American men are at greater risk for prostate cancer and demonstrate higher levels of circulating prostate specific antigen (PSA), which can confound the relationship between inflammation and prostate cancer. In adjusted analyses, African American men with clinical chronic prostatitis had a significant 53% decreased risk of prostate cancer compared with African American men without prostatitis. Clinical prostatitis did not significantly increase prostate cancer risk in white men overall, but it was associated with a significant 3.5-fold increased risk in those who had no evidence of histologic prostatic inflammation. In addition, the investigators found that clinical prostatitis increased prostate cancer risk nearly 3-fold in white men with a low PSA velocity and nearly 2-fold in white men with more frequent PSA testing. PSA level and PSA density did not significantly modify the effect of clinical prostatitis on prostate cancer risk. (more…)
Author Interviews, CDC, Pediatrics, Race/Ethnic Diversity / 22.12.2015 Interview with: Kim Van Naarden Braun, Ph.D. Epidemiologist Developmental Disabilities Branch National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention Atlanta, GA  30341 Medical Research: What is the background for this study? What are the main findings? Dr. Van Naarden Braun: Over the past five decades, remarkable improvements have been made in obstetric and neonatal care resulting in significant declines in infant mortality both in the US and abroad, particularly for infants born premature and very low birthweight. Successes in neonatal survival have been met by concerns that the occurrence of developmental disabilities, most notably cerebral palsy, would increase. By monitoring changes over time in the prevalence of cerebral palsy, we can try to understand the impact of these advances further. Our recently published study reported that the birth prevalence of cerebral palsy has not decreased from the mid-1980’s to early 2000’s. The study also looked at whether the birth prevalence over time differed for children with cerebral palsy who were in certain racial and ethnic groups, had certain birth characteristics, or had other developmental disabilities and found that:
  • The birth prevalence of children with cerebral palsy with moderate to severe intellectual disability decreased about 2.6% each year from 1985 to 2002.
  • Birth prevalence of cerebral palsy among black children was higher than among white and Hispanic children, and this higher prevalence continued over the 17-year period.
  • Overall, there was no change over time in cerebral palsy birth prevalence among children born at certain birthweights or gestational age, but there were some differences when looking at these factors in different racial/ethnic groups.
Author Interviews, Emory, Race/Ethnic Diversity, Social Issues / 22.12.2015 Interview with: Abigail Sewell PhD Assistant Professor of Sociology Emory University Medical Research: What is the background for this study? Dr. Sewell: Ethnoracial minorities report poorer quality of care than do whites. However, one key dimension of health care quality - trust in one's personal physician - indicates mixed associations with race. This study examines five dimensions of the patient-physician relationship independently of each other to identify the aspects of health care where minorities feel most alienated from their doctors. Medical Research: What are the main findings? Dr. Sewell: The results of the study show that Blacks and Latinos are less likely to believe that their doctors really care about them as a person than are Whites. (more…)
Author Interviews, Leukemia, Race/Ethnic Diversity, Stanford / 14.12.2015 Interview with: Manali Patel, MD, MPH Instructor in the Division of Oncology Department of Medicine Stanford University School of Medicine Researcher at the Clinical Excellence Research Center and the Primary Care and Outcomes Research Group at Stanford Staff oncologist at the Veterans Administration and a researcher in the Palo Alto Veterans Administration Health Services & Research Development group.  Medical Research: What is the background for this study? Dr. Patel: Racial and ethnic disparities in Acute Leukemia are well documented in the literature but the reasons underlying the disparities remain largely unknown. In our previous work, we demonstrated mortality disparities for minorities with Acute Myeloid Leukemia despite favorable prognostic demographic and molecular factors. We have also shown that differences in receipt of treatment may partially explain a large component of these disparities. The purpose of this study is to determine how socioeconomic status factors influence  mortality from Acute Leukemia using a population-based novel linked dataset of the Surveillance Epidemiology and End Results Database and the National Longitudinal Mortality Study. Medical Research: What are the main findings? Dr. Patel:  We found a total of 121 patients with Acute Lymphoid Leukemia and 438 patients with Acute Myeloid Leukemia in the linked dataset.  After adjusting for socioeconomic status factors, there were increased risk of mortality among Hispanic and decreased risk of mortality among Asian Pacific Islander patients as compared with non-Hispanic white patients in Acute Lymphocytic Leukemia.  Among patients with Acute Myeloid Leukemia, we found no associations of mortality by race/ethnicity and socioeconomic status. (more…)
Author Interviews, Race/Ethnic Diversity, University of Michigan / 13.12.2015 Interview with: Shervin Assari, MD, MPH Faculty, research investigator Department of Psychiatry and Center for Research on Ethnicity, Culture, and Health University of Michigan School of Public Health University of Michigan Ann Arbor, MI  Medical Research: What is the background for this study? What are the main findings? Dr. Assari: Literature has consistently shown that a single question that asks individuals to rate their health strongly predicts risk of mortality net of traditional risk factors. Our study shows that self rated health that very well predicts risk of death over a 25 year for Whites does not have any predictive value for Blacks. The results are important because Blacks have a worse self rated health and also shorter life expectancy in the United States, but those 2 health problems have weaker link among Blacks as Whites. (more…)
Author Interviews, OBGYNE, Race/Ethnic Diversity / 30.11.2015

Medical Interview with: Rada K. Dagher, Ph.D. Assistant Professor University of Maryland School of Public Health Department of Health Services Administration College Park, MD 20742 MedicalResearch: What is the background for this study? Dr. Dagher: In the United States, 51% of all pregnancies are unintended, and these happen disproportionately among racial and ethnic minorities. For example, in 2008, rates of unintended pregnancies were 69% among African American women, 56% among Hispanic women, and 40% among White women. Our study utilized 2006-2010 data from a nationally representative dataset, the National Survey of Family Growth, to investigate the reasons behind these racial/ethnic disparities. MedicalResearch: What are the main findings of this study? Dr. Dagher: The main findings of this study are as follows. Age and marital status differences explained both racial and ethnic disparities, where being single and younger than 20 years old at the time of conception contributed to the differences in unintended pregnancy between African American and White women, and between Hispanic and White women. However, there were also unique factors explaining the differences in unintended pregnancy between African Americans and Whites (respondent’s mother’s age at first birth, income, and insurance status) and the differences between Hispanics and Whites (U.S. born status and educational level). These findings provide support for culturally-tailored public health interventions that target at-risk groups of women such as younger, unmarried, lower income, lower educated, non-U.S. born women and those with public insurance, in order to reduce racial/ethnic disparities in unintended pregnancy. MedicalResearch: What should clinicians and patients take away from your report? Dr. Dagher: Our findings suggest that interventions to reduce racial and ethnic differences in unintended pregnancy should take into account multiple factors at multiple levels of influence. For example, at the policy level, the Affordable Care Act has mandated that health plans cover women’s preventative health care, including contraceptives, without cost sharing. Thus, primary care providers could educate their patients about these new policy provisions and encourage them to take advantage of them, especially patients at higher risk of unintended pregnancy such as women who are younger than 20, unmarried, non-U.S. born, have lower income, and those with public insurance. (more…)
AHRQ, Author Interviews, Heart Disease, Race/Ethnic Diversity / 24.11.2015 Interview with: Kamila B. Mistry, PhD MPH Senior Advisor, Child Health and Quality Improvement Agency for Healthcare Research and Quality US Department of Health and Human Services Rockville, MD 20857  Medical Research: What is the background for this study? What are the main findings? Dr. Mistry: This study, conducted by researchers at the Agency for Healthcare Research and Quality (AHRQ), was seeking to explore what impact the Affordable Care Act (ACA) may have on the nation’s well-documented racial/ethnic disparities in insurance coverage, access to medical care, and preventive services utilization. We used pre-ACA (2005-2010) household data from AHRQ’s Medical Expenditure Panel Survey to examine patterns of coverage, access, and utilization, by race/ethnicity, for nonelderly adults who are targeted by ACA coverage expansion provisions.

Our analysis found that racial/ethnic minorities were disproportionately represented among groups targeted by the ACA. We also found that targeted groups had lower rates of coverage, access, and preventive services utilization, and some racial/ethnic disparities were widest within these groups.

Author Interviews, Brigham & Women's - Harvard, JAMA, Pancreatic, Race/Ethnic Diversity, Surgical Research / 18.11.2015 Interview with: Jason S. Gold MD FACS Chief of Surgical Oncology, VA Boston Healthcare System Assistant Professor of Surgery, Harvard Medical School Brigham and Women’s Hospital Medical Research: What is the background for this study? Dr. Gold: Pancreas cancer is a lethal disease. While advances in the best available care for pancreas cancer are desperately needed, improvements can be made in addressing disparities in care. This study aimed to evaluate associations of social and demographic variables with the utilization of surgical resection as well as with survival after surgical resection for early-stage pancreas cancer. Medical Research: What are the main findings? Dr. Gold: The main findings are the following: 1:     We found that less than half of patients with early-stage pancreas cancer undergo resection in the United States. Interestingly, the rate of resection has not changed with time during the eight-year study period. 2.  We also found significant disparities associated with the utilization of surgical resection for early-stage pancreas cancer in the United States. African American patients, Hispanic patients, single patients, and uninsured patients were significantly less likely to have their tumors removed. There were regional variations in the utilization of surgical resection as well. Patients in the Southeast were significantly less likely to have a pancreas resection for cancer compared to patients in the Northeast. 3. Among the patients who underwent surgical resection for early-stage pancreas cancer, we did not see significant independent associations with survival for most of the social and demographic variables analyzed. Surprisingly, however, patients from the Southeast had worse long-term survival after pancreas cancer resection compared to those in other regions of the United States even after adjusting for other variables. (more…)
AACR, Author Interviews, CDC, Colon Cancer, Race/Ethnic Diversity / 18.11.2015 Interview with: Hannah K. Weir, PhD, MSc Senior Epidemiologist CDC Medical Research: What is the background for this study? What are the main findings? Dr. Weir: Colorectal cancer (CRC) is one of the leading causes of cancer related deaths in the United States. We know that the risk of dying from colorectal cancer  is not the same across all communities – people living in poorer communities have a higher risk of dying from colorectal cancer than people living in wealthier, better educated communities. In this study, we estimated the number of potentially avoidable CRC deaths between 2008 and 2012 in poorer communities.  Then we estimated the value of lost productivity that resulted from these deaths. Lost productivity includes the value of future lost salaries, wages, and the value to household activities such as cooking, cleaning, and child care. We focused on the age group 50 to 74 years because this is the age group where routine CRC screening is recommended. We estimated that more than 14,000 CRC deaths in poorer communities could have been avoided and that these CRC deaths resulted in a nearly $6.5 billion dollars loss in productivity. This is tragic - for the person who died, their family and for their community. This loss in productivity contributes to the economic burden of these already disadvantaged communities. (more…)
AACR, Author Interviews, NIH, Nutrition, Ovarian Cancer, Race/Ethnic Diversity / 13.11.2015 Interview with: Bo (Bonnie) Qin, PhD Postdoctoral associate at Rutgers Cancer Institute of New Jersey Medical Research: What is the background for this study? What are the main findings? Response:  Ovarian cancer is among the top five causes of cancer death among women in the US. Compared to white women, African-American women tend to have a worse 5-year survival rate of ovarian cancer. It highlights a critical need for identifying preventive factors in African Americans, particularly through dietary modification, which is relatively low cost and low risk compared to medical treatments. We found that adherence to an overall healthy dietary pattern i.e. Alternate Healthy Eating Index (AHEI)-2010 may reduce ovarian cancer risk in African-American women, and particularly among postmenopausal women. Adherence to the current Dietary Guidelines for Americans i.e. Healthy Eating Index-2010, were also strongly associated with reduced risk of ovarian cancer among postmenopausal African-American women. (more…)