scholarly journals Predictors of Population Awareness of Cancer Genetic Tests: Implications for Enhancing Equity in Engaging in Cancer Prevention and Precision Medicine

2021 ◽  
pp. 1699-1708
Author(s):  
Veda N. Giri ◽  
Ayako Shimada ◽  
Amy E. Leader
Keyword(s):  
Precision Medicine ◽  
Cancer Genetics ◽  
Ethnic Disparities ◽  
College Education ◽  
Population Based ◽  
Categorical Variables ◽  
Cancer Information ◽  
Modifiable Factors ◽  
The Impact ◽  
Hispanic White

PURPOSE Racial and ethnic disparities in genetic awareness (GA) can diminish the impact of personalized cancer treatment and risk assessment. We assessed factors predictive of GA in a diverse population–based sample to inform awareness strategies and reduce disparities in genetic testing. METHODS A cross-sectional study was conducted from July 2019 to August 2019, with the survey e-mailed to 7,575 adult residents in southeastern Pennsylvania and New Jersey. Constructs from National Cancer Institute Health Information and National Trends Survey assessed cancer attitudes or beliefs, health literacy, and numeracy. Characteristics were summarized with mean ± standard deviation for numeric variables and frequency counts and percentages for categorical variables. Comparison of factors by race or ethnicity (non-Hispanic White and non-Hispanic Black) and sex was conducted by t-tests, chi-square, or Fisher's exact tests. Multivariate logistic regression models were conducted to identify factors independently predictive of GA. RESULTS Of 1,557 respondents, data from 940 respondents (the mean age was 45 ± 16.2 years, 35.5% males, and 23% non-Hispanic Blacks) were analyzed. Factors associated with higher GA included female gender ( P < .001), non-Hispanic White ( P < .001), college education ( P < .001), middle-higher income ( P < .001), stronger belief in genetic basis of cancer ( P < .001), lower cancer fatalism ( P = .004), motivation for cancer information ( P < .001), and higher numeracy ( P = .002). On multivariate analysis, college education (odds ratio [OR] 1.79; 95% CI, 1.22 to 2.63), higher motivation for cancer information (OR 1.56; 95% CI, 1.17 to 2.09), stronger belief in genetics of cancer (OR 2.21; 95% CI, 1.48 to 3.30), and higher medical literacy (OR 2.21; 95% CI, 1.34 to 3.65) predicted greater GA. CONCLUSION This population-based study conducted in the precision medicine era identified novel modifiable factors, importantly perceptions of cancer genetics and medical literacy, as predictive of GA, which informs strategies to promote equitable engagement in genetically based cancer care.

scholarly journals Anemia and functional capacity in elderly Brazilian hospitalized patients

2013 ◽  
Vol 29 (7) ◽  
pp. 1322-1332 ◽  
Author(s):  
Raquel de Macedo Bosco ◽  
Elisa Priscila Souza Assis ◽  
Renata Rosseti Pinheiro ◽  
Luiza Cristina Viana de Queiroz ◽  
Leani S. M. Pereira ◽  
...  
Keyword(s):  
Activities Of Daily Living ◽  
Functional Capacity ◽  
Daily Living ◽  
Strong Association ◽  
Population Based ◽  
Categorical Variables ◽  
Fisher Exact Test ◽  
Cross Sectional ◽  
Belo Horizonte ◽  
The Impact

This study evaluated the association between anemia and physical functional capacity in a cross-sectional population-based sample of 709 hospitalized elderly patients aged 60 years and over admitted to the Madre Teresa Hospital, Belo Horizonte, State of Minas Gerais, Brazil. The Mann-Whitney or "t" test, and chi-square or Fisher exact test were used for quantitative and categorical variables, respectively, and hierarchical binary logistic regression was used to identify significant predictors. The presence of anemia was found in 30% of participants and was significantly associated with decreased functionality according to the two measures which were used - ADL (activities of daily living) and IADL (instrumental activities of daily living). Anemia was also independently associated with older age. The results of this study demonstrate a strong association between the presence of anemia and lower levels of functional capacity. Further investigations are needed to assess the impact of anemia treatment on the functionality and independence of older people.

scholarly journals Placement on COVID-19 Units Does Not Increase Seroconversion Rate of Pediatric Graduate Medical Residents

2021 ◽  
Vol 9 ◽  
Author(s):  
Timothy Crisci ◽  
Samuel Arregui ◽  
Jorge Canas ◽  
Jenaya Hooks ◽  
Melvin Chan ◽  
...  
Keyword(s):  
Seroconversion Rate ◽  
Population Based ◽  
Immunoglobulin M ◽  
Medical Residents ◽  
Categorical Variables ◽  
Fisher Exact Test ◽  
Continuous Variables ◽  
Cross Sectional ◽  
Graduate Medical ◽  
The Impact

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its associated disease COVID-19 (coronavirus disease 2019) has presented graduate medical education (GME) training programs with a unique set of challenges. One of the most pressing is how should hospital systems that rely on graduate medical residents provide appropriate care for patients while protecting trainees. This question is of particular concern as healthcare workers are at high risk of SARS-CoV-2 exposure.Objective: This cross-sectional study sought to assess the impact of hospital COVID-19 patient placement on pediatric graduate medical residents by comparing rates of SARS-CoV-2 seroconversion rates of residents who worked on designated COVID-19 teams and those who did not.Methods: Forty-four pediatric and medicine–pediatric residents at Riley Children's Hospital (Indianapolis, IN) were tested for SARS-CoV-2 immunoglobulin M (IgM) and IgG seroconversion in May 2020 using enzyme-linked immunosorbent assays (Abnova catalog no. KA5826), 2 months after the first known COVID-19 case in Indiana. These residents were divided into two groups: those residents who worked on designated COVID-19 teams, and those who did not. Groups were compared using χ2 or Fisher exact test for categorical variables, and continuous variables were compared using Student t testing.Results: Forty-four of 104 eligible residents participated in this study. Despite high rates of seroconversion, there was no difference in the risk of SARS-CoV-2 seroconversion between residents who worked on designated COVID-19 teams (26% or 8/31) and those who did not (31% or 4/13). Eleven of 44 residents (25%) tested positive for SARS-CoV-2 IgG, whereas only 5/44 (11.4%) tested positive for SARS-CoV-2 IgM, without a detectable difference between exposure groups.Conclusion: We did not observe a difference in SARS-CoV-2 seroconversion between different exposure groups. These data are consistent with growing evidence supporting the efficacy of personal protective equipment. Further population-based research on the role of children in transmitting the SARS-CoV-2 virus is needed to allow for a more evidence-based approach toward managing the COVID-19 pandemic.

Abstract WMP53: Sex Differences n Long-term Mortality and Disability After Stroke: The International Stroke Outcomes Study

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Hoang T Phan ◽  
Mathew J Reeves ◽  
Leigh Blizzard ◽  
Amanda Thrift ◽  
Dominique Cadilhac ◽  
...  
Keyword(s):  
Sex Differences ◽  
Population Based ◽  
Stroke Severity ◽  
Related Factors ◽  
Post Stroke ◽  
Modifiable Factors ◽  
Mortality Rate Ratio ◽  
The Impact

Introduction: It is uncertain why women suffer worse long-term outcomes after stroke than men. We examined sex differences in mortality and disability 1 and 5 years after stroke and identified factors contributing to these differences. Methods: Individual patient data pooling study of incident strokes (ischemic and hemorrhagic) from 1987-2013 obtained from 12 population-based cohorts from Australasia, Europe, South America and the Caribbean. Data on socio-demographics, stroke-related factors and pre-stroke health were obtained for each patient and harmonized between studies. Poisson modelling estimated the mortality rate ratio (MRR) for women compared to men at 1 year (12 studies) and 5 years (7 studies) post-stroke. Log binomial regression estimated the relative risk (RR) of poor outcome (modified Rankin scale>2 or Barthel Index <20) for women compared to men at 1 year (9 studies) and 5 years (6 studies) after stroke. Multivariable models were adjusted for potential confounders including age, pre-stroke dependency, stroke severity and comorbidities. Results: A total of 16557 first-ever-stroke patients with follow-up data to 1 year and 12,839 with follow-up to 5 years were included. The pooled crude mortality was greater in women than men at 1-year (MRR 1.37 95% CI 1.27-1.48) and 5 years (MRR 1.25 95% CI 1.13-1.39). However, these sex differences were reversed after adjustment for confounders at both 1 year (MRR 0.94 95% CI 0.82-1.06) and 5-years post stroke (MRR 0.74 95% CI 0.66-0.84). Similarly, the pooled crude RR for disability after stroke was greater in women than men at 1-year (RR 1.28 95% CI 1.17-1.39 and 5-year (RR 1.32 95% CI 1.18-1.47), but these sex differences disappeared after adjustment at both 1 year (RR 1.08 95%CI 0.98-1.18) and 5-years post stroke (RR 1.08 95% CI 0.97-1.20). The key contributors to worse outcomes in women were greater age, pre-stroke dependency, severe strokes and atrial fibrillation (AF, mortality only) compared with men. Conclusion: Worse outcomes in women were mostly due to age and potentially modifiable factors of stroke severity and AF providing potential targets to reduce the impact of stroke in women.

scholarly journals Race/ethnicity in systemic AL amyloidosis: perspectives on disease and outcome disparities

2020 ◽  
Vol 10 (11) ◽  
Author(s):  
Andrew Staron ◽  
Lawreen H. Connors ◽  
Luke Zheng ◽  
Gheorghe Doros ◽  
Vaishali Sanchorawala
Keyword(s):  
Minority Groups ◽  
Ethnic Disparities ◽  
Sociodemographic Factors ◽  
Al Amyloidosis ◽  
Advocacy Groups ◽  
Disease Characteristics ◽  
Race Ethnicity ◽  
The Impact ◽  
Racial Ethnic ◽  
Hispanic White

Abstract In marked contrast to multiple myeloma, racial/ethnic minorities are underrepresented in publications of systemic light-chain (AL) amyloidosis. The impact of race/ethnicity is therefore lacking in the narrative of this disease. To address this gap, we compared disease characteristics, treatments, and outcomes across racial/ethnic groups in a referred cohort of patients with AL amyloidosis from 1990 to 2020. Among 2416 patients, 14% were minorities. Non-Hispanic Blacks (NHBs) comprised 8% and had higher-risk sociodemographic factors. Hispanics comprised 4% and presented with disproportionately more BU stage IIIb cardiac involvement (27% vs. 4–17%). At onset, minority groups were younger in age by 4–6 years. There was indication of more aggressive disease phenotype among NHBs with higher prevalence of difference between involved and uninvolved free light chains >180 mg/L (39% vs. 22–33%, P = 0.044). Receipt of stem cell transplantation was 30% lower in Hispanics compared to non-Hispanic White (NHWs) on account of sociodemographic and physiologic factors. Although the age/sex-adjusted hazard for death among NHBs was 24% higher relative to NHWs (P = 0.020), race/ethnicity itself did not impact survival after controlling for disease severity and treatment variables. These findings highlight the complexities of racial/ethnic disparities in AL amyloidosis. Directed efforts by providers and advocacy groups are needed to expand access to testing and effective treatments within underprivileged communities.

scholarly journals Bridging the implementation and information gap on cancer prevention and survivorship in Europe: results from the iPAAC Joint Action

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
R De Angelis ◽  
S Lipponen
Keyword(s):  
Public Health ◽  
Cancer Survivors ◽  
Cancer Prevention ◽  
Joint Action ◽  
Cancer Registries ◽  
Population Based ◽  
Joint Analysis ◽  
Cancer Information ◽  
Science And Policy ◽  
The Impact

Abstract Background About 40% of cancers are preventable and of those cancers about 50% are due to tobacco. Cancer prevention and early detection can reduce remarkably cancer burden and inequalities with effective strategies from the European Code Against Cancer. A better use of registries data can help to bridge the existing information gaps on cancer survivors, a dramatically growing population challenging the sustainability of public health systems in Europe. Methods Policy implementation through collaborative efforts based on cancer registry data, comprehensive policies and innovations. Promotion of standards and methods to facilitate systematic delivery of comparable indicators on cancer survivors by country in Europe. Results In cancer prevention known effective measures require European-wide comprehensive action. Population-based cancer screening programmes need continuous quality assurance and follow-up. Prevalence of short- and long-term survivors derived from a joint European dataset (EUROCARE-6, 29 countries) show that differences in survivorship are wide, consistently with demography, incidence and survival patterns. Breast, colorectal and prostatic cancers are the most frequent among all cancer survivors. Conclusions Collaboration across fields of science and policy sectors is needed to boost cancer prevention. Cancer survivors are a growing heterogeneous population to be monitored in public health to support Health Technology Assessment and survivors' care planning. Key messages Priority actions are developed within iPAAC Joint Action to encourage effective policies and implementation. Joint analysis of standardised European datasets strengthens the impact of cancer registries information. Indicators on cancer prevalence should be systematically integrated in the European Cancer Information System (ECIS).

scholarly journals The Impact of Communicating Uncertainty on Public Responses to Precision Medicine Research

2021 ◽  
Author(s):  
Chelsea L Ratcliff ◽  
Bob Wong ◽  
Jakob D Jensen ◽  
Kimberly A Kaphingst
Keyword(s):  
Precision Medicine ◽  
Scientific Data ◽  
Individual Characteristics ◽  
News Article ◽  
Scientific Uncertainty ◽  
Scientific Impact ◽  
Medicine Research ◽  
Precision Medicine Research ◽  
The Impact ◽  
Hispanic White

Abstract Background Precision medicine research depends upon recruiting large and diverse participant cohorts to provide genetic, environmental, and lifestyle data. How prospective participants react to information about this research, including depictions of uncertainty, is not well understood. Purpose The current study examined public responses to precision medicine research, focusing on reactions toward (a) uncertainty about the scientific impact of sharing data for research, and (b) uncertainty about the privacy, security, or intended uses of participant data. Methods U.S. adults (N = 674; 51.9% male; 50% non-Hispanic white; Mage = 42.23) participated in an online experimental survey. Participants read a manipulated news article about precision medicine research that conveyed either certainty or uncertainty of each type (scientific, data). Participants then rated their attitudes toward the research, trust in the researchers, and willingness to join a cohort. We tested direct and mediated paths between message condition and outcomes and examined individual characteristics as moderators. Results Overall attitudes were positive and a majority of participants (65%) reported being somewhat or very likely to participate in precision medicine research if invited. Conveying uncertainty of either type had no overall main effect on outcomes. Instead, those who reported perceiving greater uncertainty had lower attitudes, trust, and willingness to join, while those with more tolerance for uncertainty, support for science, and scientific understanding responded favorably to the scientific uncertainty disclosure. Conclusions Findings suggest responses to precision medicine research uncertainty are nuanced and that successful cohort enrollment may be well-supported by a transparent approach to communicating with prospective participants.

Abstract P087: Ethnic and Educational Disparities in Morbid Obesity Among Employees of a Large Healthcare Organization: The Baptist Health South Florida Employee Study

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Chukwuemeka U Osondu ◽  
Ehimen C Aneni ◽  
Adnan Younus ◽  
Maribeth Rouseff ◽  
Sankalp Das ◽  
...  
Keyword(s):  
Morbid Obesity ◽  
Educational Attainment ◽  
Ethnic Disparities ◽  
College Education ◽  
Educational Status ◽  
Healthcare Organization ◽  
South Florida ◽  
Eligibility Criteria ◽  
Post Graduate ◽  
The Impact

Background: Ethnic differences in obesity are well documented; however, the epidemiological evidence of the impact of socioeconomic and educational status on its relationship is sparse. We sought to assess the impact of educational attainment, as a proxy of socioeconomic status, on the association between ethnicity and morbid obesity (MO) among employees of Baptist Health South Florida (BHSF), a large nonprofit healthcare organization. Methods: Data was collected from employees participating in an annual Health Risk Assessment in 2014. Educational attainment was self-reported while weight, height and other biometric measures were measured in person. MO was categorized using eligibility criteria for bariatric surgery as outlined by the 1991 NIH consensus guidelines for surgery for the obese. Results: Data was collected for 9361 participants (mean age 42.8 ± 12.1 years, 74% females, 63% Hispanic). Overall, 7% meet criteria for MO (Non-Hispanic White [NHW]: 5%; Hispanics: 6%; Non-Hispanic Black [NHB]: 12%). A lower education was associated with a greater prevalence of morbid obesity (Post graduate/ professional: 4.2%; completed college: 5.2%; some college or lower: 9.8%) The highest (18%) and lowest (4%) prevalence of MO were observed in NHB with some college education or lower (SCL), and in Hispanics with post-graduate or professional educational (PG) attainment respectively. Among PG, compared to NHW, the odd ratios (95% CI) for presence of MO among NHB was 1.3 (0.6 - 2.5). Conversely, the respective MO risk for NHB vs. NHW was 4 fold higher (2.5 - 6.4) among those with SCL. Interaction of ethnicity and educational attainment for predicting MO was significant (p <0.05) adjusting for age and sex. Conclusion: Underlying differences in educational status significantly impact ethnic disparities in morbid obesity. The co-existing influence of education and racial disparities should be jointly addressed to maximize yield of future wellness efforts aimed at optimizing CV health.

Abstract 119: The Impact of Medicare Part D on Racial/Ethnic Disparities in Cardiovascular Medication Adherence among the Elderly

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Mustafa Hussein ◽  
Teresa M Waters ◽  
David K Solomon ◽  
Lawrence M Brown
Keyword(s):  
Medication Adherence ◽  
Beta Blockers ◽  
Ethnic Disparities ◽  
Medicare Part D ◽  
The Elderly ◽  
Part D ◽  
The Impact ◽  
Racial Ethnic ◽  
Hispanic White ◽  
Post Period

Objective: Although Medicare Part D has improved medication adherence among the elderly, its effect on adherence disparities remains unknown. We sought to estimate the impact of Part D on the racial/ethnic disparities in adherence to cardiovascular (CV) medications among Medicare seniors. Approach: We analyzed annual data (2002-2010) from the Medical Expenditure Panel Survey (MEPS) on Medicare recipients (65+, “treated” group) and the near-elderly (60-64, control group), who were white, black, or Hispanic, and used ACE inhibitors/Angiotensin receptor blockers, statins, beta blockers, calcium channel blockers, or diuretics. Pooled 2002-2005 and 2007-2010 data covered the pre- and post-Part D periods, respectively. Drug class-specific and average overall adherence were measured over survey year as the proportion of days covered (PDC), then dichotomized at an 80% PDC threshold. Since MEPS had no days’ supply data before 2010, we derived refill days’ supply from dispensed quantities and validated it in 2010 sample. In survey-adjusted logistic regressions, we estimated Part D impact on disparities using a difference-in-difference-in-difference interaction term of race, post period, and treatment group. Following the Institute of Medicine, we differentiated between racial differences in adherence due to variations in demographics, health status, and beliefs across groups, and the inequitable disparities created by the differentials in socioeconomic position, experience with the healthcare system, and discrimination. Empirically, we used a rank-and-replace procedure to replace minority distributions of demographic and health characteristics with their white counterparts. Disparities were then computed as the adjusted adherence differences relative to whites. Findings: Our sample included 17,566 respondents, nationally representing 25 million. In the 2010 sample, continuous PDC and binary adherence distributions, based on actual and derived days’ supply, were very similar: Lin’s concordance coeff. 0.83 and C-statistic 0.93, respectively. Part D was associated with a reduction in Hispanic-white disparity in overall CV medication adherence by 15.38 percentage points (95%CI: 2.41, 28.36; P=0.02), and a non-significant increase in the black-white disparity by 5.32% points (95%CI: -17.19, 6.56; P=0.38). In sensitivity analyses, these effects were robust to various adjustments, and to including 2006 data in the post period. The largest reduction in Hispanic-white disparities was observed in adherence to beta blockers (28.9% points; 95% CI: 5.11, 52.69; P=0.02), whereas black-white disparities in statin adherence increased the most (14.7% points; 95%CI: -31.92, 2.52; P=0.09). Conclusion: With Part D, Hispanic-white adherence disparities appear to have been mitigated. Significant black-white disparities still persist post Part D, meriting further attention.

Investigation of an ethnic predisposition to developing brain metastases (BM) in Asian patients with colorectal cancer (CRC).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15023-e15023
Author(s):  
Kerri McGovern ◽  
Teresa Rodriguez ◽  
Melissa H Smith ◽  
Antonia Maloney ◽  
Wasif M. Saif
Keyword(s):  
Overall Survival ◽  
Molecular Markers ◽  
Ethnic Disparities ◽  
The United States ◽  
Treatment Modalities ◽  
Increased Risk ◽  
Incidence And Mortality ◽  
Race Ethnicity ◽  
The Impact ◽  
Hispanic White

e15023 Background: CRC, the third most common cancer in the United States, carries racial/ethnic disparities in both incidence and mortality. With availability of effective systemic therapies, the life of CRC patients can be prolonged which thereby increases the risk of metastases at uncommon sites, such as the brain. We report our investigation into the impact of race/ethnicity on the incidence of BM in CRC patients using retrospective data (2010 – 2018) at a single institution. Methods: We retrospectively reviewed patients diagnosed with CRC and collected data on age, race/ethnicity, stage, treatment modalities, metastatic sites, and survival. Race and ethnicity were defined in accordance with federal standards set by the U.S. Census. Following this, race/ethnicity was self-declared and/or based on the primary language declared and categorized as non-Hispanic White, Hispanic White, non–Hispanic Black, Asian, or Unknown/Other. CRC location was classified as right-sided, left-sided or rectal. Results: We identified 264 CRC patients (median age: 61; range: 38 - 99). Among them 123 identified as non-Hispanic white, 28 non-Hispanic black, 26 Hispanic white, and 9 declared Other. There were 76 (29%) who identified as Asian. Of those 76 patients, 5 (7%) developed BM. All 5 patients were male and stage IV at initial diagnosis. BM was a late stage phenomenon with rectal primary and lung metastases seemly associated with an increased risk in the specific cohort. Molecular markers such as KRAS were available in 3 patients without clear association. Median time to development of BM was 29 months (range: 26 - 33). Median overall survival after BM diagnosis was 5.5 months (range: 4 - 11). Overall survival was longest for the patient who had both radiation and surgery. Conclusions: Our study showed an incidence of BM of 7% in the Asian sub-population compared to the historical control of 0.6 – 3.2% in the overall population. These results at the least warrant further investigation in a larger patient population of BM in CRC patients with emphasis on molecular markers. Recognition of BM in CRC patients is clinically relevant secondary to multiple lines of therapy as mentioned earlier and its grave impact on outcome.

scholarly journals The Benefits of Rental Assistance for Children's Health and School Attendance in the United States

Demography ◽  
2021 ◽  
Author(s):  
Andrew Fenelon ◽  
Michel Boudreaux ◽  
Natalie Slopen ◽  
Sandra J. Newman
Keyword(s):  
School Attendance ◽  
Average Length ◽  
Ethnic Disparities ◽  
Black Children ◽  
The United States ◽  
Future Research ◽  
Latino Children ◽  
The Impact ◽  
Racial Ethnic ◽  
Hispanic White

Abstract Programs that provide affordable and stable housing may contribute to better child health and thus to fewer missed days of school. Drawing on a unique linkage of survey and administrative data, we use a quasi-experimental approach to examine the impact of rental assistance programs on missed days of school due to illness. We compare missed school days due to illness among children receiving rental assistance with those who will enter assistance within two years of their interview, the average length of waitlists for federal rental assistance. Overall, we find that children who receive rental assistance miss fewer days of school due to illness relative to those in the pseudo-waitlist group. We demonstrate that rental assistance leads to a reduction in the number of health problems among children and thus to fewer days of school missed due to illness. We find that the effect of rental assistance on missed school days is stronger for adolescents than for younger children. Additionally, race-stratified analyses reveal that rental assistance leads to fewer missed days due to illness among non-Hispanic White and Hispanic/Latino children; this effect, however, is not evident for non-Hispanic Black children, the largest racial/ethnic group receiving assistance. These findings suggest that underinvestment in affordable housing may impede socioeconomic mobility among disadvantaged non-Hispanic White and Hispanic/Latino children. In contrast, increases in rental assistance may widen racial/ethnic disparities in health among disadvantaged children, and future research should examine why this benefit is not evident for Black children.

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