MedicalResearch.com Interview with:
Karin H Humphries,MBA, DSc |Scientific Director
BC Centre for Improved Cardiovascular HealthUBC-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.
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MedicalResearch.com 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.
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MedicalResearch.com Interview with:
Tanjala S. Purnell, PhD MPH
Assistant Professor, Transplant Surgery and Epidemiology
Johns Hopkins University School of MedicineMedical 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:
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.
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.
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.
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.
MedicalResearch.com Interview with:
Adam T. Hirsh PhD
Assistant Professor, Psychology
Indiana University
Indianapolis, INMedical 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.
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MedicalResearch.com 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 27157Medical 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.
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MedicalResearch.com Interview with:
Michael Yudell, PhD, MPH
Chair & Associate Professor
Drexel University School of Public HealthCommunity 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.
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MedicalResearch.com 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.
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MedicalResearch.com 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 SurgeryMedical 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.
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More on Dermatology on MedicalResearch.comMedicalResearch.com 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.
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More on Heart Disease on MedicalResearch.comMedicalResearch.com Interview with:
John Nance, MD
Division of Cardiovascular Imaging, Department of Radiology and Radiological Science
Medical University of South Carolina
Charleston, South CarolinaMedical 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…)
More on Racial Disparities in Health Care on MedicalResearch.comMedicalResearch.com 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.
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MedicalResearch.com 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 UniversityMedical 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.
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MedicalResearch.com Interview with: Benjamin A. Rybicki, Ph.D
Department of Public Health Sciences
Henry Ford Health System
Detroit, MIMedical 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.
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MedicalResearch.com 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.
MedicalResearch.com 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.
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MedicalResearch.com 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.
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MedicalResearch.com 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, MIMedical 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.
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Medical research.com 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.
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MedicalResearch.com 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 20857Medical 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.
MedicalResearch.com 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.
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MedicalResearch.com 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.
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MedicalResearch.com 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.
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MedicalResearch.com Interview with:
Joan C. Han, MD
Director, Pediatric Obesity Program, Le Bonheur Children’s Hospital
Associate Professor, Division of Pediatric Endocrinology
Department of Pediatrics, University of Tennessee Health Science Center
Memphis, TN 38103
Medical Research: What is the background for this study? What are the main findings?
Dr. Han: Obesity has become a world-wide epidemic. Our research group studies the genetic factors that contribute to the development of obesity. Brain-derived neurotrophic factor (BDNF) is a protein that plays a key role in regulating appetite. We found that a common genetic variant of the BDNF gene is associated with lower expression of this gene in the hypothalamus, a region of the brain that controls energy balance. The mechanism of this reduced gene expression appears to be due to diminished binding of the transcription factor hnRNPD0B. We also observed that this genetic variant is associated with higher body mass index and higher body fat in children and adults. The obesity-predisposing variant of the BDNF gene occurs more commonly in people of African-American or Hispanic backgrounds, which could have important clinical implications given the higher rates of obesity in these populations.
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MedicalResearch.com Interview with:
Bindu Kalesan PhD MPH
Director
Evan’s Center for Translational Epidemiology and
Comparative Effectiveness Research
Assistant Professor of Medicine
Preventive Medicine & Epidemiology
Department of Medicine
Boston University School of Medicine
Boston, MA 02118Medical Research: What is the background for this study? What are the main findings?
Dr. Kalesan: Firearm injuries are one of the 3 major causes of death in children in the US. for every 7 pediatric firearm deaths there are 8 children non-fatally injured by a gun. Those that survive will live with disability and severe morbidity. From our earlier studies, we found that this burden of survivorship and injury is different according to race/ethnicity. There is also evidence that Injury related hospitalizations are also associated low-income households and neighborhoods. In the background of gun (violence) control, frequently comparisons are drawn between firearm injuries and motor vehicle accidents.
In this study we use nationally representative hospitalization data and compared pediatric firearm-related hospitalization and pedestrian motor vehicle accident hospitalizations to assess whether the risk of firearm related hospitalizations among minorities varies depending on the neighborhood they live.
We found that black children were at substantially greater risk of firearm hospitalization as compared to pedestrian motor vehicle hospitalization. This greater risk of firearm hospitalization among black children persisted across neighborhoods. Simply put, the risk of firearm hospitalization versus pedestrian motor vehicle hospitalization among black children was high, regardless of whether they lived in low income or high income neighborhoods.We also found that all minority race children (black, Hispanic and other race) as compared to white children were at a greater likelihood of homicide-firearm hospitalization than of pedestrian motor vehicle hospitalization and all minority race children were significantly less likely to be hospitalized for unintentional firearm than pedestrian injuries in comparison to white children. Therefore, overall we found a minority race disadvantage regardless of whether they lived in high and low-income neighborhoods.
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MedicalResearch.com Interview with:
Daniel (Dong) Wang Doctoral Student
Departments of Nutrition and Epidemiology
Harvard T. H. Chan School of Public Health
Boston, MA 02115
Medical Research: What is the background for this study? What are the main findings?
Response: Over the past more than one decade, many changes related to nutrition and food supply have happened and therefore influence individuals' dietary behaviors and ultmately dietary quality. Also, the changes in dietary quality may impact the disease burden, measured by avoided major chronic disease cases and premature deaths. Therefore, in this study, we were trying to understand
1) how the dietary quality in US population changed from 1999 to 2012, and
2) how changes in dietary quality over time impacted disease and premature death.
The quality of the US diet, measured by the Alternate Healthy Eating Index, improved modestly from 39.9 to 48.2 from 1999 through 2012, but the dietary quality of US population remains far from optimal (the optimal score is 110). There is huge room existing for further improvements. We also found that even the modest improvements in dietary quality that we observed contributed to substantial reductions in disease burden, which is measured by avoided disease cases and premature deaths. We estimated that healthier eating habits cumulatively prevented 1.1 million premature deaths over the 14 years, and the difference in dietary quality between 1999 and 2012 resulted in 12.6% fewer type 2 diabetes cases, 8.6% fewer cardiovascular disease cases, and 1.3% fewer cancer cases. Among different key components of healthy diets, despite a large reduction in consumption of trans fat, as well as a relatively large reduction in sugary beverages, most key components of healthy diets showed only modest or no improvements. The improvement in dietary quality was greater among persons with higher socioeconomic status and healthier body weight. African Americans had the poorest dietary quality, which was accounted for by lower incomes and education. The gaps in dietary quality persisted or even widened from 1999 to 2012.
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MedicalResearch.com Interview with:
Jashvant Poeran MD PhD
Assistant Professor
Dept. of Population Health Science & Policy
Icahn School of Medicine at Mount Sinai
New York, NY
Medical Research: What is the background for this study?
Dr. Poeran: Neuraxial anesthesia and peripheral nerve blocks are two techniques for regional anesthesia for hip and knee replacements. Compared to general anesthesia, these two regional anesthesia techniques are increasingly seen as ‘higher quality care’ as a growing number of studies show that patients have better outcomes after surgery when regional anesthesia is used. However, less is known about the factors that influence the process of anesthetic care. This is important information because the choice for regional anesthesia might affect outcomes after hip and knee replacement surgery. We therefore used a large national database of health claims of hip and knee replacement procedures to study if specific patient subgroups were less likely to receive regional anesthesia.
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MedicalResearch.com Interview with:
Dr. Simple Singh MD
Epidemiologist
Division of Cancer Prevention and Control
CDCMedical Research: What is the background for this study? Dr. Singh: This report provides official federal statistics on the occurrence of cancer for 2011 and trends for 1999–2011 as reported by CDC and the National Cancer Institute (NCI). Cancer incidence data are from population-based cancer registries that participate in CDC’s National Program of Cancer Registries (NPCR) and NCI’s Surveillance, Epidemiology, and End Results (SEER) program reported as of November 2013. Cancer mortality data are from death certificate information reported to state vital statistics offices in 2013 and compiled into a national file for the entire United States by CDC’s National Center for Health Statistics’ (NCHS) National Vital Statistics System (NVSS). This report is a part of the first-ever Summary of Notifiable Noninfectious Conditions and Disease Outbreaks — United States, which encompasses various surveillance years but is being published in 2015.
Medical Research: What are the main findings?
Dr. Singh: In 2011, approximately 1.5 million invasive cancers were diagnosed in the United States, an annual incidence rate of 451 cases per 100,000 persons. In the same year, approximately 576,000 persons died of cancer nationally, an annual death rate of 169 deaths per 100,000 persons.
Cancer incidence and death rates increase with age.
Overall, 54% of cancer cases and 69% of cancer deaths in 2011 occurred among persons aged ≥65 years.
Among men in 2011, blacks had the highest cancer incidence and death rates in the United States, and American Indians/Alaska Natives and Asians/Pacific Islanders had the lowest cancer incidence and death rates.
Among women in 2011, whites had the highest cancer incidence rates and blacks had the highest cancer death rates. American Indians/ Alaska Natives had the lowest cancer incidence rates, and Asians/Pacific Islanders had the lowest cancer death rates.
By state, overall (all cancer sites combined) cancer incidence rates in 2011 ranged from 374 to 509 cases per 100,000 persons, and overall cancer death rates ranged from 126 to 201 deaths per 100,000 persons.
Four cancer sites accounted for half of all cases diagnosed in 2011, including 209,292 prostate cancers, 220,097 female breast cancers, 207,339 lung and bronchus cancers (110,322 among men and 97,017 among women), and 135,260 colon and rectum cancers (70,099 among men and 65,161 among women). These four sites also accounted for half of cancer deaths in 2011, including 156,953 lung cancer deaths, 51,783 colon and rectum cancer deaths, 40,931 female breast cancer deaths, and 27,970 prostate cancer deaths.
During 1999–2011, cancer incidence rates declined from 485 cancer cases per 100,000 population in 1999 to 444 cases in 2011. Although lung cancer incidence declined steadily among men from 1999 to 2011, it increased among women from 1999 to 2005 and has since declined from 2005 to 2011. Prostate cancer incidence declined from 170 cases per 100,000 men in 1999 to 128 cases in 2011. Colorectal cancer incidence declined from 57 cases per 100,000 persons in 1999 to 40 cases in 2011. Female breast cancer incidence declined from 135 cases per 100,000 women in 1999 to 121 cases in 2005, increased to 125 cases in 2009, and declined again to 122 cases in 2011. During 1999–2011, cancer death rates declined from 201 deaths per 100,000 persons in 1999 to 169 deaths in 2011; during the same period, death rates declined for each of the top four cancers.
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MedicalResearch.com Interview with:
Dr. Quoc-Dien Trinh MDAssistant Professor of Surgery
Harvard Medical School
Brigham and Women's Hospital
Boston, MA 02115
Medical Research: What is the background for this study? What are the main findings?
Dr.Trinh: Blacks who undergo radical prostatectomy, e.g. surgical removal of the prostate for cancer, are more likely to experience complications, emergency room visits, readmissions compared to their non-hispanic White counterparts. As a result, the 1-year costs of care for Blacks is significantly higher than non-hispanic Whites. Interestingly, despite these quality of care concerns, the survival of elderly Blacks and Whites undergoing prostatectomy is the same.
Medical Research: What should clinicians and patients take away from your report?Dr. Trinh: A possible interpretation of our findings is that the biological differences in tumor aggressiveness among Blacks (e.g. Blacks have more aggressive prostate cancer than Whites) may have been exaggerated, and that the perceived gap in survival is a result of lack of access or cultural perceptions with regard to surgical care for prostate cancer or other factors that differentiate who makes it to the operating table.
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MedicalResearch.com Interview with:
Jeffrey Rhoades, Ph.D.
Agency for Healthcare Research and Quality
Medical Research: What is the background for this study?
Dr. Rhoades: The Medical Expenditure Panel Survey (MEPS) – Household Component (HC) which began in 1996 and is administered annually collects data from a sample of families and individuals in selected communities across the United States, drawn from a nationally representative subsample of households that participated in the prior year's National Health Interview Survey (conducted by the National Center for Health Statistics).
During the household interviews, MEPS collects detailed information for each person in the household on the following: demographic characteristics, health conditions, health status, use of medical services, charges and source of payments, access to care, satisfaction with care, health insurance coverage, income, and employment.
The panel design of the survey, which features several rounds of interviewing covering two full calendar years, makes it possible to determine how changes in respondents' health status, income, employment, eligibility for public and private insurance coverage, use of services, and payment for care are related.
Medical Research: What are the main findings?
Dr. Rhoades: In 2013, Hispanics were more likely to be uninsured for the entire year or sometime during the year than other racial/ethnic groups.
In 2013, persons living in the South and West regions were more likely to be uninsured for the entire year or sometime during the year than people living in the Northeast or Midwest.
Approximately 50 percent of individuals with the lowest hourly wage (less than $10 per hour) were uninsured sometime during the year in 2013. This fraction decreased with increasing wages.
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MedicalResearch.com Interview with:
Harry H. Yoon, MD
Mayo Clinic
Rochester, MN 55905
Medical Research: What is the background for this study? What are the main findings?
Dr. Yoon: In the U.S., the survival of patients with colon cancer is known to differ by race, with individuals of black race having worse outcomes than those of white race.
However, it has been difficult to tease apart why the differences in survival exist.
It is generally believed that social or other non-biologic factors (eg, decreased access to care, suboptimal treatment) contribute to the discrepancy. It’s also known that differences in the general medical condition of patients could affect how long a patient lives.
However, it is unknown whether there are race-based differences in the biology of colon tumors themselves. This biology can be reflected in the genetic composition of tumors, as well as by whether and how quickly the cancer returns after the patient has undergone surgery and chemotherapy.
In addition, it is unknown whether race-based differences in biology may be related to the age of the patient at the time of diagnosis. Blacks with colorectal cancer typically have an earlier age of onset than whites do.
A major barrier to addressing these questions are that there are very few large populations of colon cancer patients where everyone had the same disease stage and received uniform treatment, and where patients were monitored for years afterward specifically to see whether the cancer returned. It is much harder to measure whether cancer has returned (ie, cancer recurrence), as compared to simply knowing whether a patient is alive or dead. This difference is important, because knowing about cancer recurrence sheds more light on cancer biology than only knowing about patient survival, since many factors unrelated to cancer biology (eg., heart disease) can affect whether a person is alive or dead.
The most reliable data on cancer recurrence (not just patient survival) generally comes from patients who have enrolled in a clinical trial. In the Alliance N0147 trial, all patients had the same cancer stage (ie, stage III), underwent surgery and received standard of care chemotherapy (ie, “FOLFOX”) after surgery. Patients had uniform, periodic monitoring after chemotherapy to see if the cancer returned.
In other words, examining racial outcomes in this cohort largely eliminates some of the key factors (eg, decreased access to care, suboptimal treatment) that are believed to contribute to racial discrepancies, and provides a unique opportunity to determine if differences in cancer biology between races may exist.
This study was done to see if colon cancers are genetically different based on race, and whether race-based differences exist in cancer recurrence rates.
The study found that tumors from whites, blacks, and Asians were different in terms of the frequency of mutations in two key cancer-related genes, BRAF and KRAS. Tumors from whites were twice as likely to have mutated BRAF (14% in whites compared to 6% in Asians and 6% in blacks). Tumors from blacks had the highest frequency of KRAS mutations (44% in blacks compared to 28% in Asians and 35% in whites). Tumors from Asians were the mostly likely to have normal copies of both genes (67% in Asians compared to 50% in blacks and 51% in whites).
Next, the study found that the colon cancers among blacks had more than double the risk of cancer recurrence, compared to whites. However, this discrepancy was only evident among young patients (ie, aged less than 50 years). Almost 50% of younger black patients experienced colon cancer recurrence within 5 years, compared to ~30% of black patients over age 50, or compared to white or Asian patients regardless of age. The worse outcome among young blacks remained evident even after adjusting for many potential confounding factors, such as tumor grade, the number of malignant nodes, or the presence of BRAF or KRASmutations. Because this question was examined in a clinical trial cohort of uniform stage and treatment, the role of multiple important potential confounders was diminished.
To our knowledge, this is the first report indicating that colon cancers from young black individuals have a higher chance of relapsing after surgery and chemotherapy, compared to those from white individuals.
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