Racial Disparities in Neutrophil Counts Among Patients with Metastatic Breast Cancer during Treatment with CDK4/6 Inhibitors

Purpose: The three CDK4/6 inhibitors (CDK4/6i) approved for use in HR-positive/HER2-negative metastatic breast cancer (MBC), palbociclib, ribociclib, and abemaciclib, are generally well tolerated but their most common toxicity is neutropenia. Within the general population, neutropenia has been shown to be more common in individuals of African descent. The landmark CDK4/6i trials in MBC lacked racial diversity in their patient populations. We aimed to assess the toxicity profiles of CDK4/6i in a racially diverse population.Methods: We conducted a retrospective study at Montefiore Medical Center in patients with HR-positive/HER2-negative MBC prescribed CDK4/6i as first or subsequent lines of therapy between January 2015 and April 2020. Baseline characteristics and laboratory data at various treatment timepoints were collected. Results: A total of 182 patients were included in the final analysis. Baseline absolute neutrophil count (ANC) was lower in the Black vs. Non-Black cohort (p=0.001) but the change in ANC from baseline (Delta-ANC) was smaller in the Black vs. Non-Black cohort and the ANC at different treatment timepoints was similar between groups. There was no difference in the rate of infection or number of dose delays or reductions between Black and Non-Black cohorts. Conclusion: We analyzed toxicity profiles of 182 patients with HR-positive/HER2-negative MBC treated with CDK4/6i. Our population included 46% Black patients, who were found to have a lower baseline ANC but no increase in complications. Despite the lower baseline ANC seen in our Black cohort prior to starting CDK4/6i, treatment toxicities were similar between racial groups.

Links Between Early-Life Contextual Factors and Later-Life Cognition and the Role of Educational Attainment

Educational attainment is a well-documented predictor of later-life cognition, but less is known about upstream contextual factors. This study aimed to identify which early-life contextual factors uniquely predict later-life global cognition and whether educational attainment mediates these relationships. Participants were drawn from the Michigan Cognitive Aging Project (N=461; Mage=63.51; SDage=3.13; 50% non-Hispanic Black). School-level contextual factors included U.S. region during elementary school (Midwest, South, Northeast), racial diversity of school (mostly White, mostly Black, diverse), self-reported education quality, and school type (public versus private). Household-level contextual factors included mother’s and/or father’s education, number of adults (1, 2, 3+), and number of children. Later-life global cognition was operationalized with a composite score derived from a comprehensive neuropsychological battery. A mediation model controlling for sociodemographics estimated total, direct, and indirect effects of contextual factors through educational attainment (years). Lower education quality, attending a mostly Black or diverse school, attending a public school, and reporting three or more adults in the household were each associated with lower cognition. After accounting for educational attainment, associations remained for education quality, school type, and reporting three or more adults in the household. Indirect effects through educational attainment were observed for elementary school region, education quality, racial diversity of school, and mother’s education. School context appears to more consistently predict later-life cognition than household context, highlighting the potential long-term benefits of school-level interventions for cognitive aging. Future research should consider causal relationships among household-level and school-level contextual factors, as well as additional mediators beyond educational attainment.

Equality and Closure: The Paradox of Local Citizenship

In Bourgeois Utopias, a cultural history of suburbia in America, Robert Fishman states the fundamental paradox about the suburbs: “[H]ow can a form based on the principle of exclusion include every-one?” The promise of the American suburb was that every middle-class family would be able to own a home with a yard, but this egalitarian ideal was illusory because what made the suburbs appealing was precisely what it excluded, namely everything having to do with the city—its congestion, political corruption, and most importantly, its racial diversity. And so, as suburbia was mass-produced and made avail-able with cheap low-interest loans to white middle-class families, racial minorities were rigidly excluded. Although several waves of demographic change have reshaped the suburbs over the generations, this paradox remains evident today. Suburbs are becoming more dense and more diverse as many minorities have migrated from “inner cities” toward first-ring suburbs, and immigrants have found welcoming enclaves in the suburbs. But while suburbs have grown more diverse, they have also grown more segregated. High opportunity suburbs with plentiful jobs and good schools mandate low-density sprawl through zoning regulations, like mini-mum lot size and floor area requirements, parking mandates, and set-backs, that have the cumulative effect of making housing scarce and expensive. Only the very affluent or those lucky enough to have purchased a home years ago are welcome in these places. Racial minorities who, thanks to the earlier generation of suburban exclusion, have not had the opportunity to build the inter-generational wealth that is often a prerequisite to purchasing a home in the suburbs still find themselves locked out of the most desirable communities. The infra-structure of suburban communities, such as roads, sewers, and schools, are designed, perhaps deliberately, to completely collapse if the number of users increases by even a small amount, so these communities fiercely oppose any efforts to densify and permit more housing. Even modest attempts at densification are treated as calls to destroy suburban neighborhoods. But because our society has made a decision, undoubtedly questionable in retrospect, to treat suburban homeownership as the central tool for wealth building in this country, we cannot hope to meet our national aspirations for equality without opening up our suburbs to more housing. And so the question re-mains—how can a form based on the principle of exclusion include everyone?

Spatial approach to analyzing dynamics of racial diversity in large U.S. cities: 1990–2000–2010

Over the last several decades large U.S. cities became increasingly racially diverse. Understanding spatio-temporal dynamics of this significant social change and identifying its broad trends is important for numerous stakeholders. High resolution population grids, which recently become available for the entire conterminous U.S. and for three-time points from 1990 to 2010, are an ideal dataset for analyzing dynamics of racial diversity. Their value to diversity analysis has been already demonstrated at the level of the entire U.S. as well as at the level of an individual city.In this paper, we demonstrate their value for performing a survey aimed at synthesizing diversity dynamics from different cities in order to identify prevalent nationwide trends. Our survey consists of 41 large cities. 1990-2000-2010 snapshots of racial conditions at each city are provided by respective grids in which each cell is assigned one of nine possible diversity/dominant race categories. All cells with the same diversity label constitute a zone which we refer to as community and measure using a percentage of landscape (PLAND) and an aggregation index (AI) metrics. The inclusion of the AI metric makes it possible to determine not only whether a given community grows or shrinks but also whether it’s merging or fragmenting. We analyze spatio-temporal evolution of communities by tracking changes in the pairs of the values of these metrics. To simplify we categorize these changes into eight categories resulting in 64 possible change trajectories for each community. Trajectories are histogrammed to reveal the variety of scarcity of possible modes of change. Frequent trajectories are identified with broad trends. Eight such trends are identified, they represent the most prevalent racial dynamics in the U.S. during the decades of 1990-2010. Two trends correspond to the decay of whites-only and blacks-only communities. The remaining six trends correspond to the expansion of Hispanics, Asian, and racially diverse communities. Trends do not show regional dependence, they truly reflect profound social change occurring across the entire U.S.

Political ideology moderates White Americans’ reactions to racial demographic change

An emerging body of research finds that exposure to the shifting racial demographics of a nation can engender concerns about racial group status among members of the dominant racial group. The present work revisits this finding, probing a broader set of group status concerns than has been examined in most past research. Three experiments exposed four samples of White Americans to racial demographic information or race-neutral control information, then assessed their perception that the relative status of racial groups in the nation would change and the extent to which they were alarmed by such a status shift—that is, status threat. Consistent with past work, what we now term perceived status change increased in response to salient racial demographics information, relative to race-neutral control information, irrespective of participants’ political ideology. Departing from past work, however, the perceived threat associated with changing racial demographics was moderated by political ideology. Specifically, politically conservative White participants demonstrated high levels of group status threat in the neutral control condition that either increased (Study 1a, Study 2) or stayed equally high (Study 1b, Study 3) after exposure to information about a racial shift. In contrast, in all studies, politically liberal White participants demonstrated a modest level of group status threat in the control condition that was attenuated upon exposure to a racial shift. Taken together, these results suggest a polarization of responses to the increasing racial diversity of the nation, one that was not observed even just a few years ago.

Why Are All the White Kids Sitting Together in the Cafeteria?: Toward Challenging Constructions of a Persecuted White Collective

In the context of ongoing antagonism on college campuses, attacks on Critical Race Theory, and widespread backlash against racial justice initiatives, this paper underscores the growing need to recognize co-optation and other counterinsurgent strategies used against racial justice to make room for transformative scholarship. By presenting qualitative interviews from 15 white HBCU students, we illustrate how diversity research, advocacy, and organizing previously used to advocate for racial justice has instead constructed distorted understandings of race and racism and has been used to expand ideologies of whiteness. The findings show what CRT scholars have cautioned about for decades—when left uninterrupted, ahistorical approaches to racial diversity programming and research may lend to the co-optation of justice-focused diversity language and the appropriation of BIPOC strategies of resistance. This not only inhibits and detracts from racial justice work, but can function to expand white supremacy. We relate these narratives to an emerging racial backlash whereby white people attempt to distort understandings of structural racism to claim a “persecuted” status—a delusion that we argue warrants a new ideological frame. We posit this work lays the foundation for advancing equity in one of the most counterinsurgent eras in higher education (Matias & Newlove, 2017).

Community Diversity and Donor Control: An Empirical Analysis of Contributions to Donor-Advised Funds at Community Foundations

This study examines the relationship between community ethnic-racial diversity and contributions to donor-advised funds (DAFs) held by community foundations. Unlike general contributions, DAFs allow donors to retain advisory control over their fund distribution based on individual preferences. In contrast to prior research that generally finds that diversity dampens private provision of public goods, we show that greater ethnic-racial diversity is significantly associated with higher levels of contributions to DAFs at community foundations but not with general contributions. The findings contribute to the literature on diversity and public goods provision and have practical implications for the policy role of private philanthropy.

Top-tier liberal arts colleges in the United States and the struggle for racial diversity: re-stating the problem and re-crafting its solution

This study concludes that, despite a rising din of criticism, and despite the existence of alternate assessment frameworks, top-tier liberal arts colleges in the United States measure themselves along axes of wealth and exclusivity, and prioritize their operations accordingly. Paradoxically, though, they articulate diversity, particularly racial diversity, as a key goal. To reconcile their exclusivity with racial diversity, such institutions recruit students that, regardless of race, arrive on campus pre-acculturated to the dominant White culture—a self-defeating recruitment pattern that tends to exclude students not so acculturated. This study reviews various ways such institutions can go about discussing and resolving this inherent conflict at the institutional level and in so doing support minority students from more typical schools and neighborhoods, who become fully immersed in the dominant culture for the first time only upon initiating their post-secondary education.