Abstract 17339: Racial and Ethnic Minority Groups Are Under-Represented and Under-Reported in Guideline-Informing Heart Failure Clinical Trials

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Gerardo Gamino ◽  
Justin T Parizo ◽  
David Scheinker ◽  
Fatima Rodriguez
Keyword(s):  
Heart Failure ◽  
Clinical Trials ◽  
Ethnic Diversity ◽  
Minority Groups ◽  
Clinical Care ◽  
Evidence Base ◽  
Asian Race ◽  
Ethnic Subgroups ◽  
Race Ethnicity ◽  
Racial Ethnic

Introduction: Racial/ethnic diversity in clinical trials is essential to ensure that our evidence base reflects the population. We assessed the extent of reporting and representation of race/ethnicity in heart failure (HF) clinical trials referenced in the contemporary ACC/AHA HF guidelines. Methods: All randomized trials referenced in the 2013 ACC/AHA Heart Failure Guidelines and the 2017 Focused Update were included. The prevalence of reporting of race/ethnicity, the proportions of racial/ethnic subgroups enrolled, and subgroup analysis based on intervention type - pharmacologic, device, and other - were evaluated. Results: We identified 256 trials (545 233 subjects) published between 1950 and 2018. Among these, only 95 reported any race/ethnicity (37.1%), 94 reported white race (36.7%), 58 reported black race (22.7%), 16 reported Hispanic ethnicity (6.3%), and 23 reported Asian race (9.0%). In trials reporting white, black, Hispanic, and Asian race/ethnicity respectively, 76.4% (n = 299 153 of 299872) of patients were white, 11.7% (n = 25 274 of 215 905) of patients were black, 11.2% (n = of 8863 of 79 097) of patients were Hispanic, and 10.5% (n = 14925 of 141 504) of patients were Asian. Comparison of trial population proportions with US Census population demonstrates over-representation of white subjects, and under-representation of Hispanic and black subjects (Figure). Stratification by intervention type demonstrated that no device trials referenced in the guidelines report black or Asian race, and just one reported Hispanic race. Conclusions: Trials that dictate clinical care of patients with HF through informing contemporary ACC/AHA HF guidelines under-represent black and Hispanic populations. Additionally, 2/3rds of trials fail to report any race/ ethnicity at all. There is a need for guideline and practice-informing clinical trials to adequately represent all populations, and to provide clinicians the data they need to assess generalizability.

Health information Websites: characteristics of US users by race and ethnicity

2007 ◽  
Vol 13 (6) ◽  
pp. 298-302 ◽  
Author(s):  
E A Miller ◽  
D M West ◽  
M Wasserman
Keyword(s):  
African Americans ◽  
Health Information ◽  
Race And Ethnicity ◽  
Minority Groups ◽  
Opinion Survey ◽  
Ethnic Subgroups ◽  
Race Ethnicity ◽  
The Relationship ◽  
Racial Ethnic ◽  
Website Use

We conducted a national public opinion survey of adults aged 18 years or older in the continental US to determine their use of health Websites. Of the 928 individuals contacted, 868 (94%) reported their race/ethnicity. More non-Hispanic Whites reported using the Internet (34%) than African Americans (31%) and Hispanics (20%). We used logistic regression to estimate adjusted odds ratios describing the relationship between Website usage and covariates across the racial/ethnic subgroups. Whereas better perceived health was associated with greater Website use among Hispanics and Whites, stronger health literacy was associated with greater use among Hispanics. No African American or Hispanic respondent aged 65 years or older reported going online. The relationship between education and use was more than twice as strong for African Americans and Hispanics than other groups. That some minority groups are less likely to use the World Wide Web for health information may further compound existing disparities. One place where this problem may be addressed is in the nation's schools.

Evolution of natriuretic peptide biomarkers in heart failure: Implications for clinical care and clinical trials

2018 ◽  
Vol 254 ◽  
pp. 215-221 ◽  
Author(s):  
Nicolas Vodovar ◽  
Alexandre Mebazaa ◽  
James L. Januzzi ◽  
Gillian Murtagh ◽  
Wendy Gattis Stough ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Trials ◽  
Natriuretic Peptide ◽  
Clinical Care

Racial/Ethnic Diversity and Economy - A Broad Overview of U.S. Counties, 2000-2014

2020 ◽  
Vol 11 (2) ◽  
pp. 18-41
Author(s):  
Madhuri Sharma
Keyword(s):  
Ethnic Diversity ◽  
Household Income ◽  
Distribution Patterns ◽  
Policy Implications ◽  
Median Household Income ◽  
Inertia Effects ◽  
Race Ethnicity ◽  
Racial Ethnic ◽  
County Scale ◽  
Scale Data

This article explores the relationships between diversity, its components, and their change with economic health at the scale of counties, using major economic characteristics such as change in population, labor-force participation, employment and unemployment, and median household income (overall and by race/ethnicity). Tract-scale and county-scale data from the National Historical Geographic Information System are used to compute diversity scores and its components, to visually analyze the spatial distribution patterns. Correlations & stepwise regression models suggest that diversity-2000 associates positively with greater diversity (overall and among non-whites) in 2014, but negatively with a change in diversity (overall, and non-white). While median household income associates with a positive change in diversity, those for Blacks associate negatively with change in diversity, largely supporting the inertia effects of Black presence as an ‘unattractive' factor. Unemployment associates with diversity & change/non-white-diversity, suggesting unemployment likely prevalent among whites. This has huge socio-economic and politics-based policy implications.

Current and Historical Trends in Diversity by Race, Ethnicity, and Sex Within the US Pathology Physician Workforce

2020 ◽  
Vol 154 (4) ◽  
pp. 450-458
Author(s):  
Marissa J White ◽  
Rhea J Wyse ◽  
Alisha D Ware ◽  
Curtiland Deville
Keyword(s):  
Ethnic Diversity ◽  
Rate Of Change ◽  
Physician Workforce ◽  
Underrepresented Minority ◽  
Historical Trends ◽  
Alaskan Native ◽  
Gender Parity ◽  
The Us ◽  
Race Ethnicity ◽  
Racial Ethnic

Abstract Objectives This study assessed historical and current gender, racial, and ethnic diversity trends within US pathology graduate medical education (GME) and the pathologist workforce. Methods Data from online, publicly available sources were assessed for significant differences in racial, ethnic, and sex distribution in pathology trainees, as well as pathologists in practice or on faculty, separately compared with the US population and then each other using binomial tests. Results Since 1995, female pathology resident representation has been increasing at a rate of 0.45% per year (95% confidence interval [CI], 0.29-0.61; P < .01), with pathology now having significantly more females (49.8%) compared to the total GME pool (45.4%; P < .0001). In contrast, there was no significant trend in the rate of change per year in black or American Indian, Alaskan Native, Native Hawaiian, and Pacific Islander (AI/AN/NH/PI) resident representation (P = .04 and .02). Since 1995, underrepresented minority (URM) faculty representation has increased by 0.03% per year (95% CI, 0.024-0.036; P < .01), with 7.6% URM faculty in 2018 (5.2% Hispanic, 2.2% black, 0.2% AI/AN/NH/PI). Conclusions This assessment of pathology trainee and physician workforce diversity highlights significant improvements in achieving trainee gender parity. However, there are persistent disparities in URM representation, with significant underrepresentation of URM pathologists compared with residents.

Economic Growth Potentials and Race/Ethnicity in Tennessee

2021 ◽  
pp. 1119-1142
Author(s):  
Madhuri Sharma
Keyword(s):  
Ethnic Diversity ◽  
Community Survey ◽  
Creative Class ◽  
Regression Analyses ◽  
North East ◽  
The North ◽  
Education And Health ◽  
Central Regions ◽  
Race Ethnicity ◽  
Racial Ethnic

This article establishes relationships between racial/ethnic diversity, segregation, and employment-by-industry-types in the counties of Tennessee. Using the American Community Survey and NAICS data, diversity scores, entropy indices, and location quotients for major-employment are computed for Tennessee's 95 counties. Cartographic analysis, followed by correlations, principal components and regression analyses help establish the above relationships. The north-east and west-central regions of Tennessee have concentration in primary-sectors of economy whereas counties with concentration in creative-class economy (e.g., Williamson, Davidson) have higher presence of Asians, and with greater human capital (education). Simultaneously, these are also the most segregated despite being diverse. Counties with higher diversity and higher share of African-Americans are segregated, despite having employment concentration in diverse set of industries. Enormous growth potentials exist in the sectors of education and health-care which can help Tennessee revitalize its economy.

scholarly journals How to design and set up a clinical trial part 1: the research question

2019 ◽  
Vol 12 (3) ◽  
pp. 111-116
Author(s):  
Amarpreet Atwal ◽  
Philip E Benson
Keyword(s):  
Clinical Trial ◽  
Clinical Trials ◽  
Clinical Relevance ◽  
Clinical Care ◽  
Research Question ◽  
Relevant Information ◽  
Evidence Base ◽  
Human Participants ◽  
Set Up

Data from clinical trials involving human participants are essential in establishing an evidence base about the safety and effectiveness of our treatments. This first article describes the steps involved in designing and setting up a clinical trial, from establishing the research question(s) to searching the literature. Acquiring some knowledge about how to set up a clinical trial will allow the conscientious clinician to use the most relevant information to provide the highest possible standards of clinical care for his/her patients. CPD/Clinical Relevance: Even if a clinician is not, has never been, nor is ever planning to be involved in research, he/she should understand and be able to interpret the data from clinical trials.

Worshiping across the Color Line: The Influence of Congregational Composition on Whites’ Friendship Networks and Racial Attitudes

2018 ◽  
Vol 5 (1) ◽  
pp. 100-114 ◽  
Author(s):  
Edward C. Polson ◽  
Kevin D. Dougherty
Keyword(s):  
Ethnic Groups ◽  
Ethnic Diversity ◽  
Ethnic Composition ◽  
Friendship Networks ◽  
Color Line ◽  
Recent Scholarship ◽  
Multiracial Congregations ◽  
Race Ethnicity ◽  
American Society ◽  
Racial Ethnic

Religious participation has reinforced the color line in American society for generations. Despite rising racial and ethnic diversity across U.S. communities, most Americans continue to belong to congregations composed primarily of others from their own racial/ethnic groups. Yet recent scholarship suggests that the presence of multiple racial or ethnic groups in the same congregation is increasing. The authors examine how the racial/ethnic composition of U.S. congregations is related to white attenders’ friendship networks and comfort with other racial/ethnic groups (i.e., blacks, Hispanics, and Asians). Using national survey data, the authors find that whites in multiracial congregations report more diverse friendship networks and higher levels of comfort with nonwhites than do whites in nonmultiracial congregations. However, the influence of worshipping with another race/ethnicity seems to be most pronounced for whites in congregations with Hispanics. Moreover, neighbors and friends of other races have more impact on whites’ friendship networks and attitudes than do congregations. The authors discuss implications of these findings for understanding U.S. intergroup relations and the potential of congregations to address the color line.

A Review of the Validity of Juvenile Risk Assessment Across Race/Ethnicity

2018 ◽  
Author(s):  
Christina Campbell ◽  
William Miller
Keyword(s):  
Risk Assessment ◽  
Decision Making ◽  
Ethnic Minorities ◽  
Minority Groups ◽  
Critical Role ◽  
The United States ◽  
Risk Assessments ◽  
Assessment Instruments ◽  
Race Ethnicity ◽  
Racial Ethnic

Juvenile risk assessment instruments have provided juvenile courts with the opportunity to make standardized decisions concerning sentences and intervention needs. Risk assessments have replaced the reliance on professional decision-making practices in which court officials relied on their hunches or previous experience to determine what to do with youth once they became involved in corrections. A primary goal of juvenile risk assessment is to improve case management and help courts focus resources on juveniles who exhibit the greatest intervention needs. Further, juvenile risk assessments play a critical role in estimating which juveniles will likely reoffend by identifying factors that increase the propensity of future offending. Although some researchers believe that the implementation of standardized juvenile risk assessments is a good strategy for reducing biased decision-making for racial/ethnic minorities, other researchers have called into question the extent to which risk assessments overestimate risk for certain juveniles, especially those in minority groups who have a history of being marginalized due to their race, culture, or ethnicity. This article provides an overview of how well juvenile risk assessment instruments predict future delinquency across race and ethnicity. The review suggests that in general, risk assessments do a good job in predicting recidivism across racial/ethnic groups for diverse populations inside and outside the United States. However, there is still some room for improvement concerning the assessment of risk and needs for ethnic minorities. In addition, while there are some studies that do not report the predictive validity of risk assessment scores across race/ethnicity, risk assessments overall seem to be a promising effort to correctly classify and/or identify juveniles who are at greatest risk for future recidivism.

scholarly journals Conducting clinical trials in heart failure during (and after) the COVID-19 pandemic: an Expert Consensus Position Paper from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)

2020 ◽  
Vol 41 (22) ◽  
pp. 2109-2117 ◽  
Author(s):  
Stefan D Anker ◽  
Javed Butler ◽  
Muhammad Shahzeb Khan ◽  
William T Abraham ◽  
Johann Bauersachs ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Trials ◽  
European Society ◽  
Clinical Care ◽  
Position Paper ◽  
Adverse Outcomes ◽  
Web Based ◽  
Effective Care ◽  
America South ◽  
European Society Of Cardiology

Abstract The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has important implications for the safety of participants in clinical trials and the research staff caring for them and, consequently, for the trials themselves. Patients with heart failure may be at greater risk of infection with COVID-19 and the consequences might also be more serious, but they are also at risk of adverse outcomes if their clinical care is compromised. As physicians and clinical trialists, it is our responsibility to ensure safe and effective care is delivered to trial participants without affecting the integrity of the trial. The social contract with our patients demands no less. Many regulatory authorities from different world regions have issued guidance statements regarding the conduct of clinical trials during this COVID-19 crisis. However, international trials may benefit from expert guidance from a global panel of experts to supplement local advice and regulations, thereby enhancing the safety of participants and the integrity of the trial. Accordingly, the Heart Failure Association of the European Society of Cardiology on 21 and 22 March 2020 conducted web-based meetings with expert clinical trialists in Europe, North America, South America, Australia, and Asia. The main objectives of this Expert Position Paper are to highlight the challenges that this pandemic poses for the conduct of clinical trials in heart failure and to offer advice on how they might be overcome, with some practical examples. While this panel of experts are focused on heart failure clinical trials, these discussions and recommendations may apply to clinical trials in other therapeutic areas.

Utilization of a multisite financial reimbursement program to promote racial/ethnic diversity and inclusion in therapeutic cancer clinical trials: The iMPACT Study.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 85-85
Author(s):  
Hala Borno ◽  
Sylvia Zhang ◽  
Elena Nieves ◽  
Dana Dornsife ◽  
Robert G. Johnson ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Low Socioeconomic Status ◽  
Ethnic Diversity ◽  
Phone Call ◽  
Cancer Clinical Trials ◽  
Impact Study ◽  
Low Socioeconomic ◽  
Diversity And Inclusion ◽  
The Impact ◽  
Racial Ethnic

85 Background: A lack of racial/ethnic diversity among cancer therapeutic clinical trial (TCT) participants remains a critical problem. The significance of costs, both direct and indirect, associated with cancer TCT participation are increasingly understood. Here, we report findings observed in the IMproving Patient Access to Cancer clinical Trials (IMPACT) study, a pilot feasibility study investigating the feasibility and efficacy of offering a financial reimbursement program (FRP) during cancer TCT discussion with or without additional outreach in improving enrollment and diversity. Methods: Participants for this study were recruited at two Comprehensive Cancer Centers (CCCs) from April to September 2019. Patients were randomized 1:1 to receive a brochure about a FRP at time of consent for a TCT or receive brochure and outreach through a scripted follow-up phone call regarding the FRP. Results: No difference in TCT enrollment was observed between study arms. Among 170 patients approached to participate, 132 (78%) provided consent. The participant mean age was 57 years old (std dev = 14 years). Among participants 57% were male and 49% were white. The remaining major racial/ethnic groups were Black (5%) Asian (13%) and Hispanic (26%). The proportion of non-whites was greater among IMPACT study (43%) compared to CCC TCT (28%) participants. Among FRP participants, 24% reported a household income < $25,000 and 14% from $25,001 to $56,000. Conclusions: This study observed that offering an FRP as part of TCT discussion is feasible and effective at CCCs. An outreach phone call is not required in order to influence enrollment in TCT. FRP recipients are racially/ethnically diverse and low socioeconomic status.

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