Author Interviews, Brigham & Women's - Harvard, Nutrition, Race/Ethnic Diversity / 04.11.2015

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. (more…)
Anesthesiology, Author Interviews, Orthopedics, Race/Ethnic Diversity / 26.10.2015

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. (more…)
Author Interviews, Brigham & Women's - Harvard, JAMA, Prostate Cancer, Race/Ethnic Diversity, Surgical Research / 23.10.2015

MedicalResearch.com Interview with: Dr. Quoc-Dien Trinh MD Assistant 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. (more…)
Author Interviews, Cost of Health Care, Race/Ethnic Diversity / 13.10.2015

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. (more…)
Author Interviews, NIH, OBGYNE, Pediatrics / 01.10.2015

Dr. Louis Germaine Buck Senior Investigator and Director of the Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) National Institutes of Health MedicalResearch.com Interview with: Dr. Germaine Louis Buck PhD Senior Investigator and Director of the Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) National Institutes of Health   Medical Research: What is the background for this study? What are the main findings? Dr. Germaine Buck: We wanted to develop intrauterine standards for ultrasound measured fetal growth, given that none currently exist for contemporary U.S. pregnant women.  Moreover, we wanted to determine if a single standard would be possible for monitoring all pregnant women, or if the standard needed to be tailored to pregnant women’s race/ethnicity.  This added step attempted to address the equivocal data about whether or not race/ethnicity is an important determinant of optimal fetal growth. Analyzing data from 1,737 low risk pregnant women with uncomplicated pregnancies who had 5 ultrasounds done at targeted times during pregnancy, we found significant differences in estimated fetal weight across the 4 maternal race/ethnic groups.  These differences were apparent beginning about 16 weeks gestation and continuing throughout pregnancy.  The differences in these curves were apparent when assessing infant’s birthweight, as well.  Overall, estimated fetal weights while women were pregnant were highest for White mothers followed by Hispanic, Asian, and Black mothers.  A 245 gram difference in estimated fetal weight was observed at 39 weeks gestation between pregnant White and Black women.  This pattern was then observed for measured birth weight, with highest birthweights for White then Hispanic, Asian, and Black infants. Other differences emerged by maternal race/ethnicity for individual fetal measurements:  longest bone (femur & humerus) lengths were observed for Black fetuses emerging at 10 weeks gestation, larger abdominal circumference for White fetuses emerging at 16 weeks gestation, larger head circumference for White fetuses emerging at 21 weeks gestation, and larger biparietal diameter for White fetuses emerging at 27 weeks gestation in comparison to other groups. The race/ethnic differences in fetal size were highly significant and across gestation.  If a single White standard was used for estimating fetal weight for non-White fetuses in pregnant women, between 5% and 15% of their fetuses would have been misclassified as being in the <5th percentile of estimated fetal weight. (more…)
Author Interviews, Education, Race/Ethnic Diversity / 25.09.2015

MedicalResearch.com Interview with: Meng-Yun Lin, MPH PhD candidate Department of Health Policy & Management Boston University School of Public Health Boston MA  02118 Medical Research: What is the background for this study? What are the main findings? Response: Racial and ethnic disparities in health care are widely documented, however the process by which they occur is not fully understood. One potential mechanism is through the process of treatment decision making, and racial/ethnic variations in that communication process. Thus, the goal of this study was to examine racial/ethnic differences in the types of information communicated by physicians regarding their rationale for recommendations for care, using national data collected from a diverse group of respondents. We found that Americans’ experiences with information communicated by physicians regarding rationale behind treatment recommendations vary on some dimensions by race and ethnicity. In general, Blacks and Hispanics receive less information from their doctors than non-minorities do regarding the rationale for treatment decision-making. Specially, Blacks’ and Hispanics’ doctors less often cited their own experiences, or scientific research as a reason for treatment recommendations. Our findings suggest differences in key elements of shared decision making are evident in the care of racial/ethnic minorities. (more…)
Author Interviews, Blood Pressure - Hypertension, JACC, NYU, Race/Ethnic Diversity / 22.09.2015

Gbenga Ogedegbe, MD, MS, MPH FACP Professor of Population Health and Medicine Director, Division of Health and Behavior Director, Center for Healthful Behavior Change Vice Dean, NYU College of Global Public Health NYU Langone School of Medicine Department of Population Health New York, NY 10016MedicalResearch.com Interview with: Gbenga Ogedegbe, MD, MS, MPH FACP Professor of Population Health and Medicine Director, Division of Health and Behavior Director, Center for Healthful Behavior Change Vice Dean,  NYU College of Global Public Health NYU Langone School of Medicine Department of Population Health New York, NY 10016 Medical Research: What is the background for this study? Dr. Ogedebge: Evidence from clinical trials have previously indicated that a common blood pressure medication, angiotensin-converting-enzyme (ACE) inhibitors, (when prescribed as first line treatment) may not provide the same benefits in blacks compared to whites. However blacks are grossly underrepresented in these studies, despite the fact they have disproportionately higher rates of hypertension-related morbidity and mortality than whites. Thus, we chose to study this particular question because it allows us to evaluate this evidence in a large population of hypertensive black patients who receive care in a real-world practice setting. This study evaluates racial differences in cardiovascular outcomes and mortality between hypertensive black and white patients whose treatment was initiated with angiotensin-converting-enzyme (ACE) inhibitors, outside of a clinical trial.  ACE inhibitors are one of several classes of drugs commonly prescribed to individuals with hypertension to prevent deaths, heart attack, kidney failure, heart failure and stroke. (more…)
Author Interviews, Breast Cancer, Brigham & Women's - Harvard, Genetic Research, Journal Clinical Oncology, Race/Ethnic Diversity / 20.09.2015

Aditya Bardia MBBS, MPH Attending Physician, Massachusetts General Hospital Cancer Center, Assistant Professor, Harvard Medical School Boston, MA 02114MedicalResearch.com Interview with: Aditya Bardia MBBS, MPH Attending Physician, Massachusetts General Hospital Cancer Center, Assistant Professor, Harvard Medical School Boston, MA 02114   Medical Research: What is the background for this study? What are the main findings? Response:  Multiple studies have consistently shown that African American women with cancer, including breast cancer, have worse outcomes than Caucasian counterparts. While socioeconomic issues, including access to care plays an important role, the contribution of tumor biology has been less clear. In this study, utilizing exome sequencing data, we linked the racial distribution of primary breast cancer with tumor genotypic traits, including somatic mutations, gene-expression profiles and intra-tumor heterogeneity. We observed that in addition to having a higher prevalence of triple negative breast cancer than Caucasian women (something that has been documented in the literature), African American women had a significantly higher prevalence of TP53 mutations, TNBC basal-like 1 and mesenchymal stem-like tumors, and intratumor genetic heterogeneity, and all of which suggest more aggressive tumor biology, suggesting that differences in tumor genomic profile contribute, at least partly, to the known racial disparity in survival between African Americans and Caucasians breast cancer patients. (more…)
Author Interviews, Blood Pressure - Hypertension, Heart Disease, Race/Ethnic Diversity, Women's Heart Health / 16.09.2015

MedicalResearch.com Interview with: Carmen De Miguel, PhD | Postdoctoral Scholar Section of Cardio-Renal Physiology and Medicine Department of Medicine | Division of Nephrology UAB | The University of Alabama at Birmingham Medical Research: What is the background for this study? Dr. De Miguel: It is known that obesity is a major risk for cardiovascular disease and that cardiovascular disease is more prevalent in the African American population. Specifically, female African Americans have an exceptionally high risk of developing cardiovascular disease. Obesity is known to contribute to the development of diabetes, hypertension, heart disease, etc. All these diseases have in common persistent low-grade inflammation, and we also know that signs of inflammation can be observed in patients with cardiovascular disease years before the disease is diagnosed. A better understanding of the differences within ethnicities regarding the development of cardiovascular disease is needed and will lead to the development of better therapies targeted to each population. Based on all of this knowledge, we hypothesized that obesity would lead to different changes in the immune system of male and female, Caucasian and African American teenagers (14-20 year old). Medical Research: What are the main findings? Dr. De Miguel: We found differences in the immune cell profile in white and black teenagers, and within gender in the African American subjects. We believe that monitoring these differences could be used to recognize at an earlier stage those individuals that are at-risk of developing cardiovascular disease in the future, and this could allow for preventive therapies that would reduce such risk. Specifically, we found that obese white teenagers decrease the numbers of T cells (a kind of immune cell) in the circulation (blood) compared to African American teenagers, which indicates that they have less systemic inflammation than the African Americans subjects in response to obesity. Within the African American subjects, we found that obese males had smaller numbers of T cytotoxic cells (CD8+ cells, a specific kind of T cell) and smaller numbers of activated T cytotoxic cells than lean males, what tells us that obese males are trying to decrease their inflammation levels. However, obese African American females do not decrease those levels, so their inflammation remains elevated. We think that the fact that they do not decrease the activation of T cytotoxic cells (CD8+ cells) could be important in explaining the high risk that black females have of developing cardiovascular disease later in life. (more…)
Author Interviews, JAMA, Pain Research, Pediatrics, Race/Ethnic Diversity, Surgical Research / 14.09.2015

Monika Goyal, MD Pediatric emergency medicine Children’s National Hospital Washington, DC MedicalResearch.com Interview with: Monika Goyal, MD Pediatric emergency medicine Children’s National Hospital Washington, DC Medical Research: What is the background for this study? What are the main findings? Dr. Goyal: Appendicitis is a painful surgical condition and adequate analgesia, particularly with opioids, are considered one of the mainstays of management. We found that almost half of all children diagnosed with appendicitis did not receive any analgesia. Furthermore, among the patients that did receive analgesia, there were marked racial differences with black children having lower rates of opioid medication receipt than white children, even after we took pain scores or acuity level into account. (more…)
Author Interviews, Compliance, Race/Ethnic Diversity / 19.08.2015

Louanne Bakk, Ph.D. Assistant Professor Director, Institute on Innovative Aging Policy and Practice School of Social Work The University at Buffalo Buffalo, NY 14260 MedicalResearch.com Interview with: Louanne Bakk, Ph.D Assistant Professor Director, Institute on Innovative Aging Policy and Practice School of Social Work The University at Buffalo Buffalo, NY  14260 Medical Research: What is the background for this study? What are the main findings? Dr. Bakk: Medicare Part D reduces out-of-pocket health care costs and increases access to medications.  While overall the benefit has facilitated the purchase of medications, cost sharing exists and be particularly difficult for more vulnerable populations.  Racial and gender disparities in cost-related nonadherence (CRN)  exist under Medicare Part D plans.  However, it was unknown whether the impact of the coverage gap on older Blacks and females.  This study examined whether the Medicare Part D coverage gap directly and indirectly affects the relationship between race, gender, and CRN. Racial differences in cost-related nonadherence were largely driven by reaching the coverage gap.  In other words, the gap appears to be more difficult for older Blacks than Whites.  Additionally, both reaching and not reaching the coverage gap, poorer health and having a lower income were associated with cost-related nonadherence . (more…)
Author Interviews, Heart Disease, Race/Ethnic Diversity / 22.07.2015

Dr. Sumeet Chugh MD Pauline and Harold Price Professor of Cardiac Electrophysiology Associate director of the Cedars-Sinai Heart InstituteMedicalResearch.com Interview with: Dr. Sumeet Chugh MD Pauline and Harold Price Professor of Cardiac Electrophysiology Associate director of the Cedars-Sinai Heart Institute Medical Research: What is the background for this study? What are the main findings? Response: Research studies performed in the past 2 decades suggest that there is a higher burden of sudden cardiac arrest in black americans compared to whites. However there are no studies that explore the reasons for this phenomenon. Our study confirmed that these observations hold true in the current era. There are two additional novel findings. Firstly, we uncovered the disturbing fact that blacks are significantly younger than whites at the time of their cardiac arrest. The majority of blacks are under the age of 65 and the majority of whites were over 65. Furthermore, blacks who suffered sudden cardiac arrest were more likely to have diabetes, high blood pressure and chronic kidney disease. (more…)
Author Interviews, Breast Cancer, Journal Clinical Oncology, Race/Ethnic Diversity / 21.07.2015

Helmneh Sineshaw, MD, MPH Senior Epidemiologist, Health Services Researcher American Cancer Society, Inc Atlanta, GA 30303MedicalResearch.com Interview with: Helmneh Sineshaw, MD, MPH Senior Epidemiologist, Health Services Researcher American Cancer Society, Inc Atlanta, GA 30303 MedicalResearch: What is the background for this study? Dr. Sineshaw: Male breast cancer is a rare disease, and its incidence rate is increasing. Younger black men have a higher breast cancer incidence than their white counterparts. Although black/white disparities in treatment receipt and survival among women with breast cancer have been widely documented in the literature, there have been few similar studies in men with breast cancer. Previous studies were based on smaller sample size, older databases, or using data from elderly patients. (more…)
AHA Journals, Author Interviews, Lipids, Race/Ethnic Diversity / 25.06.2015

Carlos J. Rodriguez, MD, MPH Division of Public Health Sciences Department of Medicine Wake Forest School of Medicine Winston‐Salem, NC 27152MedicalResearch.com Interview with: Carlos J. Rodriguez, MD, MPH Division of Public Health Sciences Department of Medicine Wake Forest School of Medicine Winston‐Salem, NC 27152 MedicalResearch: What prompted you to study cholesterol in the Latino population? Please explain in detail. Dr. Rodriguez: Early in my career I noted that there were race-ethnic differences in the cholesterol profile between hispanics, african americans and non-hispanic whites. Hispanics are the largest ethnic minority group in the us yet prior studies of cholesterol in hispanics were relatively small, lacked adequate representation of diverse hispanic background groups for comparisons, and were not necessarily representative of nor generalizable to the hispanic population. The hispanic/latino adults in the hispanic community health study / study of latinos helped filled this critical gap. MedicalResearch: What do you think are the most significant findings from your study? What could have the greatest clinical implications and applications? Dr. Rodriguez: Several findings are important: less than half of those with high cholesterol were aware of their condition; less than a third of those with high cholesterol were being treated; and  among those receiving treatment, only two-thirds had cholesterol concentrations that were adequately controlled. (more…)
Author Interviews, Heart Disease, Race/Ethnic Diversity / 22.06.2015

MedicalResearch.com Interview with: Dr. Mary Vaughan Sarrazin Ph.D. Associate Professor University of Iowa Roy and Lucille Carver College of Medicine, and Iowa City VA Medical Center, Center for Comprehensive Access & Delivery Research and Evaluation (CADRE) Iowa City, IA Dr. Rajesh Kabra MD Division of Cardiology, Department of Internal Medicine University of Tennessee Health Science Center, Memphis, Tennessee MedicalResearch: What is the background for this study? What are the main findings? Response: Atrial fibrillation is associated with high risk of stroke and death. It is not known if these outcomes are different in whites, blacks and Hispanics. In our study of over 500,000 Medicare patients over the age of 65 years with newly diagnosed atrial fibrillation, we noted that compared to whites, blacks and Hispanics had a higher risk of mortality (46% and 11% higher respectively) and stroke (66% and 21% respectively). However after correcting for other co-morbidities and illnesses, the risk of mortality was the same in all the races; the higher risk of stroke was decreased in blacks and eliminated in Hispanics. This suggests that in blacks and Hispanics, atrial fibrillation is a marker for higher mortality and identifies patients at higher risk of death. (more…)
Author Interviews, Breast Cancer, JAMA, Race/Ethnic Diversity, Surgical Research, University Texas / 21.06.2015

Isabelle Bedrosian, M.D., F.A.C.S. Associate Professor, Department of Surgical Oncology, Division of Surgery, Medical Director, Nellie B. Connelly Breast Center The University of Texas MD Anderson Cancer Center, Houston, TXMedicalResearch.com Interview with: Isabelle Bedrosian, M.D., F.A.C.S. Associate Professor, Department of Surgical Oncology, Division of Surgery, Medical Director, Nellie B. Connelly Breast Center The University of Texas MD Anderson Cancer Center, Houston, TX Medical Research: What is the background for this study? What are the main findings? Dr. Bedrosian: There have been a number of reports on the rates of Breast Conserving Therapy (BCT) and mastectomy among women with early stage breast cancer. These reports have been discordant, with some suggesting that index mastectomy rates have increased and others suggestion Breast Conserving Therapy rates have actually increased. We hypothesized that these differences in reporting may be due to data source (ie tertiary referral centers vs population based studies) and turned to the NCDB, which captures 70% of cancer cases in the US and as such provides us with the most comprehensive overview on patient treatment patterns. (more…)
Author Interviews, Nutrition, PLoS, Race/Ethnic Diversity, Vanderbilt / 14.06.2015

MedicalResearch.com Interview with: Wei Zheng, MD, PhD, Professor of Medicine Anne Potter Wilson Chair in Medicine Director, Vanderbilt Epidemiology Center and Danxia Yu, PhD Research Fellow Vanderbilt Epidemiology Center Vanderbilt University School of Medicine Nashville, TN, 37203 Medical Research: What is the background for this study? What are the main findings? Response: The Dietary Guidelines for Americans (DGA) provide the most authoritative advice in the US about healthy eating. Higher adherence to the DGA, reflected by a higher Healthy Eating Index (HEI) score, has been found to be associated with lower risk of developing or dying from chronic diseases (e.g. diabetes, cardiovascular disease, and certain cancers) in several US studies. However, these studies recruited mostly non-Hispanic white individuals and middle to high income Americans. It has been reported that racial/ethnical background and socioeconomic status may influence food choices and diet quality. However, no previous study has adequately evaluated the association between adherence to the DGA and risk of death due to diseases in racial/ethnical minorities and low-income Americans. Therefore, it is uncertain whether the health benefits of adherence to the current DGA can be generalized to these underserved populations. We analyzed diet and mortality data from the Southern Community Cohort Study (SCCS), a large, prospective cohort study including approximately 85,000 American adults, 40-79 years old, enrolled from 12 southeastern states between 2002 and 2009. Two-thirds of the SCCS participants were African-American and more than half reported an annual household income <$15,000. During a mean follow-up of 6.2 years, we identified 6,906 deaths in the SCCS, including 2,244 from cardiovascular disease, 1,794 from cancer, and 2,550 from other diseases. Using multivariate analysis methods, we found that participants in the top 20% of the HEI score (highest adherence to the DGA) had only about 80% of the risk of death due to any diseases compared with those in the bottom 20% of the HEI score. This protective association was found regardless of sex, race and income levels. (more…)
Author Interviews, Heart Disease, JACC, NIH, Race/Ethnic Diversity / 31.05.2015

Dr. Samson Y. Gebreab, Ph.D., M.Sc. Lead Study Author and Research Scientist National Human Genome Research Institute Bethesda, MarylandMedicalResearch.com Interview with: Dr. Samson Y. Gebreab, Ph.D., M.Sc. Lead Study Author and Research Scientist National Human Genome Research Institute Bethesda, Maryland Medical Research: What is the background for this study? Dr. Gebreab: It is well known that African Americans hold a commanding lead in cardiovascular disease (CVD) mortality and morbidity compared to whites and other ethnic groups.  Furthermore, the risk for developing CVD begins early in life and extends over a lifecourse.  Previous studies have indicated the influence of both childhood and adult socioeconomic status (SES) on CVD risk. However, the impact of lifecourse socioeconomic status (both childhood and adulthood) on CVD risk in African American population is not fully understood.  The purpose of our study was to investigate the associations of different measures of lifecourse socioeconomic status with cardiovascular disease risk in African Americans and whether the associations were modified by sex and/ or age after controlling for known cardiovascular disease risk factors.  We analyzed 10-year follow-up data of African American adults who were participating in Jackson Heart Study, Jackson, MS. Medical Research: What are the main findings? Dr. Gebreab: Our findings highlights that among those of lower socioeconomic status,  women and younger (<=50 years old)  African Americans are at increased risk of CVD, including heart disease and stroke compared to their counterparts of higher socioeconomic status groups.          African American women in the lowest socioeconomic status, had more than twice the risk of developing cardiovascular disease than those in the highest socioeconomic status group.          African Americans of 50 years and younger in the lowest socioeconomic status group had more than three times higher risk of experiencing a cardiovascular disease event than those in the highest socioeconomic status group. (more…)
Author Interviews, OBGYNE, Pediatrics, Race/Ethnic Diversity / 22.05.2015

Katherine Jones, M.A. Research Associate, Department of Research The American College of Obstetricians and Gynecologists Department of Psychology, American UniversityMedicalResearch.com Interview with: Katherine Jones, M.A. Research Associate, Department of Research The American College of Obstetricians and Gynecologists Department of Psychology, American University Medical Research: What is the background for this study? What are the main findings? Response:  It is well evidenced that breastfeeding is highly advantageous for the mother, child, and society. Benefits to breastfeeding may be significantly larger for minority women as they are disproportionately affected by numerous adverse health outcomes. The benefits of breastfeeding may help mitigate some of these negative health consequences, and thus, also bridge larger gaps in racial and ethnic health disparities. This article aimed to review the literature on racial and ethnic disparities in breastfeeding rates and practices, conduct a systematic review of breastfeeding interventions, address barriers to breastfeeding among minority women, and provide obstetrician-gynecologists (ob-gyns) with recommendations on how they can help improve rates among minority women. Overall, racial and ethnic minority women continue to have lower breastfeeding rates than white women in the United States, with African American women having the lowest rates of breastfeeding initiation and continuation among to all women. Minority women report several unique barriers to breastfeeding, including lack of access to information that promotes and supports breastfeeding, lack of work and cultural acceptance and support, language and literacy barriers, acculturation, and historical, sociopolitical, and economic challenges. Results from the systematic review of breastfeeding interventions among minority women indicated that breastfeeding-specific clinic appointments, enhanced breastfeeding programs, group prenatal education, peer counseling, and hospital policy changes significantly improve breastfeeding initiation, duration, and exclusivity. (more…)
Author Interviews, Mental Health Research, Pediatrics, Race/Ethnic Diversity / 20.05.2015

Jeff Bridge, Ph.D Center for Innovation in Pediatric Practice Principal Investigator The Research Institute at Nationwide Children's HospitalMedicalResearch.com Interview with: Jeff Bridge, Ph.D Center for Innovation in Pediatric Practice Principal Investigator The Research Institute at Nationwide Children's Hospital Medical Research: What is the background for this study? Dr. Bridge: Suicide is a leading cause of death among children younger than 12 years. Suicide rates in this age group have remained steady overall for the past 20 years, but this is the first national study to observe higher suicide rates among black children compared to white children. Little is known about the epidemiology of suicide in this age group, as prior research has typically excluded children younger than 10 years old and investigated trends only within specific older age groups. Medical Research: What are the main findings? Dr. Bridge: We found that suicide ranked 14th as a cause of death among 5- to 11-year old black children in 1993-97 but rose to 9th in 2008-12. For white children, suicide ranked 12th in 1993-97 and 11th in 2008-12. Rates have remained stable in Hispanic and non-Hispanic children. The findings in this study highlight an emerging racial disparity in the epidemiology of childhood suicide. (more…)
AHA Journals, Author Interviews, Depression, Duke, Heart Disease, Race/Ethnic Diversity / 24.04.2015

Dr. Robert J. Mentz MD Assistant Professor of Medicine Director, Duke University Cooperative Cardiovascular Society Advanced Heart Failure and Cardiac Transplantation Duke University Medical Center Duke Clinical Research InstituteMedicalResearch.com Interview with: Dr. Robert J. Mentz MD Assistant Professor of Medicine Director, Duke University Cooperative Cardiovascular Society Advanced Heart Failure and Cardiac Transplantation Duke University Medical Center Duke Clinical Research Institute Medical Research: What is the background for this study? What are the main findings? Dr. Mentz: Previous studies have shown that depression is associated with worse outcomes in heart failure patients; however, most of these prior studies were conducted in primarily white patient populations. The impact of depressive symptoms on outcomes specifically in blacks with heart failure has not been well studied. We used data from the HF-ACTION trial of exercise training in heart failure patients, which collected data on depressive symptoms via the Beck Depression Inventory (BDI-II), to assess the association between depressive symptoms and outcomes in black patients as compared with white patients. We found that in blacks with heart failure, baseline symptoms of depression and worsening of symptoms over time were both associated with increased all-cause mortality/hospitalization. (more…)
Author Interviews, Depression, JAMA, Race/Ethnic Diversity, University of Michigan / 11.04.2015

Addie Weaver PhD Research Investigator and LEO Adjunct Lecturer School of Social Work University of MichiganMedicalResearch.com Interview with: Addie Weaver PhD Research Investigator and LEO Adjunct Lecturer School of Social Work University of Michigan Medical Research: What is the background for this study? What are the main findings? Dr. Weaver: The mental health of both African Americans and rural Americans has been understudied. Though depression is one of the most common, debilitating mental illnesses among women, very little is known about depression among African American women living in rural areas of the United States. In fact, much of what we know about rural women's depression in general is based on research conducted with community samples, as limited epidemiolgical research includes large enough samples of both African American respondents and rural respondents to assess potentially important subgroup differences by urbanicity (e.g., urban, suburban, rural) and race. Our study used the National Survey of American Life, the first and only nationally representative survey of African Americans, to examine the interaction of urbanicity and race/ethnicity on Major Depressive Disorder and mood disorder prevalence among African American and non-Hispanic white women residing in the South. We found that rural residence has a differential effect on depression and mood disorder for African American women and non-Hispanic white women. Overall, African American women living in rural areas experienced significantly lower odds of meeting criteria for lifetime and 12-month Major Depressive Disorder and lifetime and 12-month mood disorder than urban African American women. Conversely, non-Hispanic white women residing in rural areas had significantly higher odds of meeting criteria for lifetime and 12-month Major Depressive and lifetime and 12-month mood disorder when compared to rural African American women, and had significantly higher prevalence rates of 12-month Major Depressive Disorder and 12-month mood disorder than urban non-Hispanic white women. All analyses controlled for age, education level, household income, and marital status, suggesting that the urbanicity differences were not due to resource disparities often experienced by individuals residing in rural communities. (more…)
Author Interviews, HIV, Race/Ethnic Diversity / 31.03.2015

MedicalResearch.com Interview with: Catherine R. Lesko, MPH Department of Epidemiology UNC School of Global Public Health Chapel Hill, NC Medical Research: What is the background for this study? What are the main findings? Response: There is a lot of evidence out there that HIV-infected minorities, and in particular, African Americans, experience higher morbidity and mortality than do their white, HIV-infected counterparts. This study looked at whether there were still differences in mortality among treated, HIV-infected adults, which was a crude attempt to control for differences in access to HIV-testing, HIV-care, and antiretroviral therapy - all things previously shown to contribute to racial disparities among people infected with HIV. Even among people who had initiated HIV therapy, we still found that black patients had a 10-year risk of mortality that was 8 percentage points greater than white patients. Hispanic patients did marginally better than white patients, but not as much better as their non-HIV-infected counterparts. (more…)
Author Interviews, Cancer Research, Dermatology, Race/Ethnic Diversity, UCSD / 24.03.2015

MedicalResearch.com Interview with: Arisa Ortiz, MD, FAAD Assistant Clinical Professor Director, Laser and Cosmetic Dermatology Senior author: Brian Jiang, MD and First author Tiffany Loh, BS Department of Dermatology UC San Diego Medical Research: What is the background for this study? What are the main findings? Response: Non-melanoma skin cancers (NMSCs) are the most common type of malignancy in the United States, affecting an estimated 3.5 million people each year. Previous perception has remained that skin cancer risk in Hispanics and Asians is lower than that of Caucasians. However, despite historically lower rates of skin cancer, in recent years, the incidence of skin cancer in these groups has reportedly been increasing in the United States. As Hispanics and Asians constitute two of the most rapidly expanding ethnic groups in the US, the rise in NMSCs in these populations is particularly concerning. The finding from our study were as follows: Hispanic patients were significantly younger than Caucasians and Asians (p=0.003, 0.023 respectively). The majority of Non-melanoma skin cancers in Caucasians occurred in men, while this gender ratio was reversed for both Hispanics and Asians. There were significantly more cases of Non-melanoma skin cancers occurring in the “central face” area in Hispanics. Race was not a significant predictor for specific NMSC type (BCC or SCC). (more…)
Author Interviews, Brigham & Women's - Harvard, JAMA, Race/Ethnic Diversity, Surgical Research / 18.03.2015

Dr. Adil Haider, MD, MPH Kessler Director of the Center for Surgery and Public Health (CSPH) at Brigham and Women’s HospitalMedicalResearch.com Interview with: Dr. Adil Haider, MD, MPH Kessler Director of the Center for Surgery and Public Health (CSPH) at Brigham and Women’s Hospital Medical Research: What is the background for this study? Response: Disparities in the quality of care received by minority and low-income patients have been reported for years across multiple medical conditions, types of care, and institutions.  To determine whether clinicians’ unconscious race and/or social class biases correlated with a lower quality of care for minority patients and those of lower socioeconomic status, my colleagues and I conducted a web-based survey among 215 physicians at an academic, level one trauma center. Participants were asked to review eight clinical vignettes, and then respond to three questions about management of care after each. Following their response, a test known as an Implicit Association Test (IAT Test) was used to assess any unconscious preferences. Medical Research: What are the main findings? Response: We found that race and class biases, as measured by response time to a standardized Implicit Association Test, had no relationship to the way that patients were clinically treated. Whether the lack of association found between implicit bias and decision making in this study represents a true lack of association or the failure of clinical vignettes to capture the nuances of how implicit biases translate into management decisions remains unclear. Existing biases might influence the quality of care received by minority patients and those of lower socioeconomic status in real-life clinical encounters. (more…)
Author Interviews, Genetic Research, Race/Ethnic Diversity / 17.03.2015

Jay S. Kaufman, Ph.D Canada Research Chair in Health Disparities Department of Epidemiology, Biostatistics, and Occupational Health McGill University Montreal, Quebec CANADAMedicalResearch.com Interview with: Jay S. Kaufman, Ph.D Canada Research Chair in Health Disparities Department of Epidemiology, Biostatistics, and Occupational Health McGill University Montreal, Quebec Canada Medical Research: What is the background for this study? What are the main findings? Response: Published scientific articles speculate frequently about genetic predispositions in different racial groups as explanations for observed disease disparities.  They infer this from the higher rates observed in racial minorities, even after adjusting for some social and behavioral measures.  Taking the example of the racial disparity between blacks and whites in cardiovascular diseases (stroke, heart attack, heart failure, hypertension, etc), ours is the first published study to review all of the existing results from GWAS (genome-wide association studies) to see if they provide any support for this commonly stated position.  To date, they do not.  We performed an electronic literature search through the PubMed database to identify review articles and meta-analyses related to genetic risk factors for cardiovascular disease in samples that included populations of European and African ancestries. We focused our search on the 7-year period from January 1, 2007 to January 1, 2014, which corresponded to the rapid proliferation of large pooled GWAS activity. This search strategy yielded 197 review articles or meta-analyses.  68 of these articles contained relevant data, but very few reported significant associations in both racial groups, with just 3 variants meeting study-specific significance criteria. For most outcomes, there were too few estimates for quantitative summarization, but when summarization was possible, racial group did not contribute to heterogeneity. Most associations reported from genome-wide searches were small, difficult to replicate, and in no consistent direction that favored one racial group or another. (more…)
Author Interviews, CDC, HIV, Race/Ethnic Diversity, Sexual Health / 05.03.2015

MedicalResearch.com Interview with: Cyprian Wejnert Center For Disease Control MedicalResearch: What is the background for this study? What are the main findings? Cyprian Wejnert: Men who have sex with men (MSM) remain the risk group most severely affected by HIV in the United States, accounting for approximately two-thirds of new infections each year.  Understanding racial and age disparities among MSM is critical to tailor effective prevention efforts. Our study examined data from CDC’s National HIV Behavioral Surveillance system (NHBS) from 20 U.S. cities. We assessed changes in HIV prevalence, awareness of infection, and risk behavior among MSM, by age and race, from 2008 to 2011, finding that: o   Among black Men who have sex with men, 30 percent were HIV-infected overall, and 1 in 5 black MSM aged 18-24 were infected with HIV. Compared to 14 percent and 4 percent among white MSM. o   In all age groups younger than 40 years, black Men who have sex with men were significantly more likely to be HIV-positive compared to all other racial/ethnic groups. o   Disparities in HIV prevalence between black and white MSM were greatest among the youngest MSM, and increased between 2008 and 2011. o   Black MSM were less likely to be aware of their infection than their white counterparts (54 vs. 86 percent). o   Black Men who have sex with men did not report higher levels of condomless sex overall or condomless sex with partners of discordant or unknown HIV status. (more…)
Author Interviews, CDC, Gender Differences, HIV, Race/Ethnic Diversity / 05.03.2015

MedicalResearch.com Interview with: Dr. Ndidi Nwangwu-Ike Center Disease Control MedicalResearch: What is the background for this study? What are the main findings? Response: CDC data has shown encouraging signs of a decrease in new HIV infections among black women in recent years.  However, African American women continue to be far more affected by HIV than women of any other race or ethnicity, with a rate of new infection 20 times that of white women and nearly five times that of Hispanic women.  Ensuring people with HIV are diagnosed and remain in care is key to controlling HIV in the nation. When used consistently, antiretroviral medication can keep HIV controlled at very low levels in the body (known as viral suppression), allowing people with HIV to live longer, healthier lives and reducing the likelihood they will transmit HIV to others. Our study finds that viral suppression among women diagnosed with HIV is low, with young women and black women the least likely to achieve viral suppression. Specifically, we found that: o   Of women newly diagnosed with HIV in 2012, 83 percent were linked to care within three months of diagnosis. o   Retention in care varied by age and race/ethnicity; overall, just over half of women (52 percent) diagnosed and living with HIV in 2011 received ongoing HIV care. o   Overall, only 44 percent of women diagnosed and living with HIV in 2011 had a suppressed viral load. (more…)
Author Interviews, Cancer Research, JAMA, Race/Ethnic Diversity, Vanderbilt / 24.02.2015

Dr. Wei Zheng, MD, PhD Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TennesseeMedicalResearch.com Interview with: Dr. Wei Zheng, MD, PhD Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee   Medical Research: What is the background for this study? What are the main findings? Dr. Wei Zheng: Substantial progress has been made in the diagnosis and treatment of cancer, resulting in a steady improvement in cancer survival. However, the degree of improvement by age, race and sex remains unclear. We quantified the differences in the improvement of cancer survival by race, age, and sex over the last two decades. We used cancer diagnosis and follow-up data from more than 1 million cancer patients, collected in nine SEER registries, to investigate trends in improved survival for seven major cancers in the United States by age, race, and sex between 1990 and 2010. We found that elderly patients experienced a smaller improvement in survival for cancers of the colon/rectum, breast, prostate, lung, and liver than their younger counterparts. In particular, the age-related disparities were most pronounced for those cancers with the greatest advancements in diagnosis and treatment over the past two decades, including cancers of colon/rectum, breast and prostate. African Americans experienced poorer survival than whites for all cancers. Because of a greater improvement in prostate cancer survival in African Americans than for whites, the racial difference in the survival of this cancer decreased during the study period. For ovarian cancer, however, the survival rate declined in African Americans but slightly increased in whites, leading to a wider racial gap in the survival of this deadly cancer. No apparent disparities in survival improvement by sex were noted. (more…)
Author Interviews, Connective Tissue Disease, Emory, Kidney Disease, Race/Ethnic Diversity / 20.02.2015

Laura Plantinga, PhD Assistant Professor Division of Renal Medicine, Department of Medicine Emory University School of Medicine Atlanta, GA 30322MedicalResearch.com Interview with: Laura Plantinga, PhD Assistant Professor Division of Renal Medicine, Department of Medicine Emory University School of Medicine Atlanta, GA 30322 Medical Research: What is the background for this study? What are the main findings? Dr. Plantinga: Quality of care for end-stage renal disease (ESRD), which is treated with dialysis or kidney transplantation, is a high priority for the U.S. healthcare system, given universal coverage of these services. However, quality of ESRD care remains relatively unexplored in lupus patients, who have multiple providers and may have greater access to care. We found that, overall, nearly three-quarters of U.S. ESRD patients with lupus had pre-ESRD nephrology care and about 20% of lupus patients on dialysis were waitlisted for kidney transplant per year; however, fewer than one-quarter of those who started on dialysis had a permanent vascular access in place, which is associated with better outcomes than a temporary catheter. Furthermore, patients who were black or Hispanic were nearly a third less likely to have pre-ESRD care and were also less likely to be placed on the kidney transplant waitlist in the first year of dialysis than white patients. Having Medicaid or no insurance at the start of ESRD were both associated with lower likelihood of quality ESRD care by all measures, despite universal Medicare coverage after the start of ESRD. While there was geographic variation in quality of ESRD care, patterns were not consistent across quality measures. (more…)