White Americans Research Articles

Economies of Difference and Identity-based Content on a Digital Platform: The Case Study of “Emily in Korea” on TikTok

This study presents a conceptualization of identity-based content creation in the digital sphere, examining the cases of two TikTok content creators, Amy and Erin, who leverage their identities to establish distinctive brands. Amy, a white American English teacher in Korea, highlights the differences between her and Korean society in her content about Korea, while Erin, a Korean American, critiques Amy’s content by emphasizing the distinction between her experience as an immigrant and Amy’s experience as a white American. The study explores how the emphasis on self-branding can obscure power dynamics and historical inequalities within identity-based content creation, which inherently reflects geopolitics and racial hierarchy. The research further examines how this type of content creation can serve as a space for the negotiation of power dynamics between dominant and non-dominant identities while also functioning as a means to build a self-brand in the digital content creation field.

Racial disparities in stroke incidence in the Women's Health Initiative: Exploring biological, behavioral, psychosocial, and social risk factors

Background– Disparities in incident stroke risk among women by race and ethnicity persist. Few studies report the distribution and association of stroke risk factors by age group among a diverse sample of women. Methods– Data from the Women's Health Initiative (WHI) Observational Study collected between 1993 and 2010 were used to calculate cumulative stroke incidence and incidence rates among non-Hispanic African American (NHAA), non-Hispanic white (NHW), and Hispanic white or African American (HWAA) women by age group in participants aged ≥50 years at baseline (N = 77,247). Hazard ratios (HRs) and 95% CIs for biological, behavioral, psychosocial, and socioeconomic factors overall and by race or ethnicity were estimated using sequential Cox proportional hazard regression models. Results– Average follow-up time was 11.52 (SD, 3.48) years. The incident stroke rate was higher among NHAA (306 per 100,000 person-years) compared to NHW (279/100,000py) and HWAA women (147/100,000py) overall and in each age group. The disparity was largest at ages >75 years. The association between stroke risk factors (e.g., smoking, BMI, physical activity) and incident stroke varied across race and ethnicity groups. Higher social support was significantly associated with decreased stroke risk overall (HR:0.84, 95% CI, 0.76, 0.93); the degree of protection varied across race and ethnicity groups. Socioeconomic factors did not contribute additional stroke risk beyond risk conferred by traditional and psychosocial factors. Conclusions– The distribution and association of stroke risk factors differed between NHAA and NHW women. There is a clear need for stroke prevention strategies that address factors driving racial disparities in stroke risk.

Cognitive and Socio‐Demographic Factors Related to Subjective Cognitive Decline in Native Americans

AbstractBackgroundSubjective cognitive decline (SCD) is commonly reported in neuropsychological evaluation, but self‐reported SCD can be influenced by anosognosia and depressed mood. Cognitive decline reported by a close informant, such as a spouse, may be more predictive of objective cognitive decline than a patient’s self‐report (Bellaali et al., 2021). Recent research comparing how racial and ethnic groups report SCD found strong evidence that Native Americans and their close informants reported SCD more frequently than White and Black Americans (Dixon & Woodard, N.D.). This study investigates whether unique socio‐demographic or cognitive variables could account for this phenomenon.MethodParticipants were selected from the National Alzheimer’s Coordinating Center (NACC) database. Participants were cognitively healthy at baseline, at least 65 years of age, and had an informant who lived with or visited the participant weekly (N = 9355). Participant racial groups included White Americans (n = 7770), Black Americans (n = 1517), and Native Americans/Alaskans (n = 68). Pairwise comparisons compared objective cognitive performance on the Mini‐Mental State Examination (MMSE), clinician‐determined functional decline, level of independence, educational attainment, self‐reported anxiety, Geriatric Depression Scale (GDS), and history of tobacco and substance abuse between each racial group using Bayesian contingency tables and t‐tests to find reliable evidence supporting the null or alternative hypothesis.ResultGroup comparisons indicated no reliable differences between Native Americans and the other racial groups on clinician‐determined functional decline, level of independence, self‐reported anxiety, tobacco use, and substance abuse (BF10 < 3). White Americans had significantly higher educational attainment and performed better on the MMSE (BF10 > 100) than Black and Native Americans. Native Americans exhibited reliably higher GDS scores than White (BF10 = 5.5) and Black (BF10 = 10.4) Americans.ConclusionThe greater rate of SCD reported by Native Americans and their close informants compared with White and Black Americans may be related to significantly higher rates of depressive symptoms reported by Native Americans/Alaskans. Careful evaluation of mood symptoms may be particularly important for clinicians working with Native American/Alaskan patients to differentiate between SCD and objective cognitive impairment.

Identifying probable dementia in undiagnosed Black and White Americans using machine learning in Veterans Health Administration electronic health records

AbstractBackgroundThe application of machine learning (ML) tools in electronic health records (EHRs) can help reduce the underdiagnosis of dementia, but models that are not designed to reflect minority population may perpetuate that underdiagnosis.MethodTo address the underdiagnosis of dementia in both Black Americans (BAs) and white Americans (WAs), we sought to develop and validate ML models that assign race‐specific risk scores. These scores were used to identify undiagnosed dementia in BA and WA Veterans in EHRs. More specifically, risk scores were generated separately for BAs (n = 10K) and WAs (n = 10K) in training samples of cases and controls by performing ML, equivalence mapping, topic modeling, and a support vector‐machine (SVM) in structured and unstructured EHR data. Scores were validated via blinded manual chart reviews (n = 1.2K) of controls from a separate sample (n = 20K). AUCs and negative and positive predictive values (NPVs and PPVs) were calculated to evaluate the models.ResultAmong Veterans with undiagnosed dementia who underwent chart review, those diagnosed by expert clinician reviewers with possible/probable dementia had higher ADRD ML risk scores compared to those diagnosed with no dementia (0.45 [0.38] vs. ‐0.02 [0.51] for BAs, and 0.38 [0.41] vs. ‐0.02 [0.47] for WAs; (see figure 1).Of the 1,200 Veterans who underwent chart review, 15.3% (n = 92) of BAs and 9.5% (n = 57) of WAs were identified with possible/probable dementia. However, adjusting for oversampling of Veterans with higher scores, the adjusted estimated prevalence was 4.1% for BA Veterans and 3.6% for WA Veterans. There was a strong positive relationship between risk scores and the prevalence of undiagnosed dementia (Figure 2). As anticipated, for Veterans with scores below the 90th percentile, the percentages of undiagnosed dementia were low: 3.9% for BA and 2.9% for WA Veterans. Among Veterans with scores above the 90th percentile, we found that a higher percentage of BA Veterans had undiagnosed dementia than WA Veterans: 25.6% vs. 15.3%.ConclusionOur findings suggest that race‐specific ML models can assist in the identification of undiagnosed dementia, particularly in BAs. Future studies should investigate implementing EHR‐based risk scores in clinics that serve both BA and WA Veterans.

Abstract A138: Impact of racial disparities in follow-up colonoscopy for abnormal stool-screening test results on colorectal cancer incidence and mortality: A simulation modeling analysis

Abstract Introduction: The benefits of colorectal cancer (CRC) screening programs for average-risk adults rely on completion of follow-up colonoscopy (FU-Col) after a positive result from either the stool-based fecal immunochemical test (FIT) or multi-target stool DNA (mt-sDNA) test. Existing data demonstrate significantly lower rates of FU-Col for Black Americans than White Americans. However, the contribution of differential FU-Col rates on disparate CRC outcomes among Black and White Americans has not been rigorously evaluated. Methods: We used the CRC-Adenoma Incidence and Mortality (CRC-AIM) model as our analysis platform, with inputs from published literature that report Black adults are approximately 15% less likely to complete FU-Col compared to White adults. CRC-AIM was validated against United Kingdom Flexible Sigmoidoscopy Screening Trial and three National Cancer Institute’s Cancer Intervention and Surveillance Modeling Network (CISNET) CRC models. We simulated screening with annual FIT and triennial mt-sDNA between ages 45 and 75 versus no screening. We considered two scenarios that assumed perfect adherence to FIT/mt-sDNA screening: 1) FU-Col rates for Black adults are 15% lower than those for White adults; 2) Black adults have the same FU-Col rates as White adults. In a secondary analysis, we considered real-world adherence to FIT (43%) and mt-sDNA (66%) and reran these two scenarios. Lifetime outcomes per 1,000 individuals were reported. Results: Assuming perfect adherence to FIT/mt-sDNA screening and 15% lower FU-Col rates, estimated life-year gains (LYG) from annual FIT and triennial mt-sDNA screening strategies compared to no screening was 227 and 239 per 1,000 individuals, respectively. If Black adults had the same FU-Col rates as White adults, the LYG would increase to 243 and 256 for FIT and mt-sDNA screening, respectively, which corresponds to a 7% improvement in LYG. Furthermore, elimination of racial disparities in FU-Col rates would reduce CRC incidence by 8% and 9% for FIT and mt-sDNA screening, respectively and reduce CRC mortality by 10% for both FIT and mt-sDNA screening. Secondary analysis shows that eliminating disparities in FU-Col would lead to 9-11% improvement in LYGs, 5-9% improvement in CRC incidence, and 7-11% improvement in CRC mortality for Black adults considering the real-world adherence to FIT/mt-sDNA screening. Conclusions: Data from this novel simulation modeling study that accounts for differences in FU-Col rates between Black and White Americans suggest that focused efforts to eliminate this gap would improve the anticipated LYG, CRC incidence, and CRC mortality benefits associated with stool-based CRC screening by over 7%, 8%, and 10%, respectively. Further investigation of this under-appreciated contributor to established racial disparities in CRC control may lead to innovative solutions for improving health equity. Citation Format: Oguz Alagoz, A. Mark Fendrick, Vahab Vahdat, Chris Estes, A. Burak Ozbay, Travelle Ellis, Paul J. Limburg, Durado Brooks. Impact of racial disparities in follow-up colonoscopy for abnormal stool-screening test results on colorectal cancer incidence and mortality: A simulation modeling analysis [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A138.

Who Buys the “Big Lie”? White Racial Grievance and Confidence in the Fairness of American Elections

AbstractElection skepticism has become a persistent feature of American politics since the Obama era. Such beliefs are most prevalent among White Americans and especially Republicans, and they are resistant to change. Conspiracy theory studies have shown that such beliefs are linked to feelings of ingroup victimization, at times associated with election loss. We draw on theories of White ingroup processes to argue that White grievance—the belief that Whites are victims of discrimination—is a key correlate of election skepticism among White Americans. White grievance was employed in the Obama era, but it was weaponized by Trump in the 2020 election. Our results based on four national datasets (2012–2020 ANES, 2021 YouGov) show that controlling for negative outgroup attitudes and other factors, White grievance is a significant predictor of election skepticism in all four studies. In 2020, the effect is stronger among White Republicans and independents. We also show that White identity/consciousness has the opposite effect, generally boosting trust in elections. Furthermore, a lagged dependent variable model using the 2016–2020 ANES panel shows that White grievance remains significant even after an LDV is included in the model.

Abstract B024: Engaging rural male cancer survivors during COVID-19

Abstract Purpose: The coronavirus disease 2019 (COVID-19) pandemic has many downstream effects. Over 16.9 million people have survived cancer in the United States. Although the overall death rate has declined, disparities exists among underserved populations. Black men, unfortunately, bear the greatest burden of suboptimal cancer outcomes and face the shortest life-expectancy of any other group in the United States. Multiple studies suggest that Black survivors (particularly men) have poorer overall health, social support, and cancer care outcomes. Men who are diagnosed with cancer have unique needs (e.g., support after treatment); however, men who live in rural areas have unique barriers that may impact their quality of life and outcomes (e.g., recurrence, mortality). Factors that influence cancer disparities are multi-level and multifactorial. Understanding these factors in rural Black men will help us develop interventions that are effective and sustainability. In this study, we examined rural men knowledge, attitudes, perceptions, and beliefs about support groups, surgical treatment, and genetic testing for colorectal cancer and prostate cancer which are critical to survivorship. Methods: A mix-method study was conducted with rural male survivors. Descriptive and comparative analyses were used to examine the impact of Covid-19 and multi-level facilitators and barriers related to access to care for social support, navigation to genetic testing, and geographic barriers. Focus groups with rural male survivors were conducted to obtain participants’ demographics, knowledge, attitudes, perceptions and beliefs about support groups, surgical treatment options, and genetic testing to determine facilitators and barriers to quality of care outcomes for male cancer survivors from underserved areas. Results: Findings from this study suggest that survivors who actively seek information and resources have higher satisfaction with treatment selection and quality of life outcomes. Surprisingly, during Covid-19 rural men did not actively seek resources that could have a direct positive impact on their survivorship and quality of life outcomes. 23 rural male survivors (prostate cancer (61%); colorectal cancer (39%)) participated in this study. 48% identified as Black Americans and 52% as White Americans. 67% reported having knowledge of cancer-related support groups, but only 24% actively participated during Covid-19. We will present findings from our analysis that look at facilitators and barriers to survivorship and quality of life outcomes. Conclusions: We hypothesize that lower access to resources that increase survivorship will be an independent predictor to lower quality of life outcomes. Rural males are less engaged in activities such as support groups that are effective tools to improve survivorship and quality of life outcomes. Knowledge gained from this study will inform future precision public health interventions that seek to improve the quality of life outcomes for male survivors in rural and underserved areas. Citation Format: Jala Lockhart, Levi Ross, Vanessa B. Sheppard, Michael A. Preston. Engaging rural male cancer survivors during COVID-19 [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B024.

Abstract B138: Examining factors that contribute to racial and ethnic disparities in liver cancer within an EHR-based epidemiologic cohort linked to cancer registries

Abstract Background: Racial and ethnic disparities in HCC risk have been documented, but disparities across detailed racial and ethnic groups and the relative contribution of these factors to HCC risk across those groups has not been assessed. We assembled a pooled, EHR-based cohort linked to cancer registry data to study disparities in HCC risk among detailed racial and ethnic groups and to examine the relative contribution of known and putative HCC risk factors to disparities in risk. Methods: Adults with at least one in-person encounter in 2000-2017 within three healthcare systems, San Francisco Health Network, Sutter Health Northern California, and Kaiser Permanente Hawai’i, were linked to their respective population-based state cancer registries for data on incident HCC. We used EHR data to define 17 detailed racial and ethnic groups and other sociodemographic and clinical factors. We used Cox proportional hazards regression with age as the timescale to examine racial/ethnic disparities in HCC risk with sex-specific models adjusted for length of active follow-up and with underlying stratification by site, birth cohort, baseline year and number of encounters. We calculated sex-specific hazards and population attributable fractions (PAFs) of HCC risk factors among racial/ethnic groups (e.g., smoking, hepatitis infections, metabolic syndrome). Results: The pooled cohort contained data on 4,249,671 adults followed a median of 6.8 years; 55% were female, and 2,916 had incident HCC. Compared to non-Hispanic White males, Vietnamese American males had greater risk of HCC (HR: 7.42; 95% CI: 4.25, 12.96) as did American Indian/Alaska Native, Black, Chinese American, Hispanic, Native Hawaiian, and Pacific Islander males, and those of multiple races or ethnicities. Among females, every group except for American Indian/Alaska Native, Asian Indian American, and Pacific Islander females had greater risk of HCC compared to the non-Hispanic White group; HRs ranged from 1.68 (1.01, 2.78) among Filipino to 6.38 (2.79, 14.55) among Vietnamese American females. Risk of HCC according to clinical risk factors was similar for males and females; however, the PAF of HCC for alcohol disorders was much higher for females (43%) than males (2%). Analyses by racial/ethnic group are ongoing, but variation in factor-specific risk of HCC was observed in preliminary analyses; for example, only non-Hispanic White and Asian American males had greater risk of HCC with metabolic-associated fatty liver disease and ever-smoking. Conclusions: Analysis of a large EHR-based cohort linked with cancer registry data yields additional information on cancer disparities across detailed racial and ethnic groups and may benefit efforts to identify targets for intervention. Our results indicate disparities in HCC risk across detailed racial and ethnic groups traditionally aggregated into larger groups (e.g., Asian American/Pacific Islander). Variation in the PAF of HCC for known risk factors suggest that the most impactful prevention efforts may require tailoring to the target populations. Citation Format: Mindy C. DeRouen, Alison J. Canchola, Janet Chu, Aly Cortella, Pushkar Inamdar, Sixiang Nie, Mai Vu, Ma Somsouk, Michele Tana, Caroline A. Thompson, Scarlett L. Gomez, Hashem El-Serag, Mi-Ok Kim, Mark Segal, Chanda Ho, Yihe G. Daida, Su-Ying Liang, Salma Shariff-Marco. Examining factors that contribute to racial and ethnic disparities in liver cancer within an EHR-based epidemiologic cohort linked to cancer registries [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B138.

Racial and Ethnic Differences in the Risk of Dementia under Hypothetical Blood‐Pressure‐Lowering Interventions: The Multi‐Ethnic Study of Atherosclerosis

AbstractBackgroundBlack and Latino people have a higher risk of Alzheimer’s disease and related dementias (ADRD) as well as ADRD comorbidities, including hypertension. Since hypertension is perhaps the most important modifiable vascular risk factor for the development of ADRD, we aimed to study whether sustained hypothetical interventions to reduce systolic blood pressure (SBP) would differentially change ADRD risk across racial/ethnic groups.MethodWe used 19 years of follow‐up data from the Multi‐Ethnic Study of Atherosclerosis. The study population included 6806 individuals between 44 and 84 years old, free of clinically recognized CVD and dementia diagnosis at baseline. We defined two sustained interventions on SBP based on continually maintaining SBP below (1) 120 mmHg and (2) 140 mmHg. We considered incident dementia diagnoses as outcome. We applied the parametric g‐formula to adjust for baseline and time‐varying confounding. Baseline covariates included sex, age, education level, income, health insurance, and clinical variables (e.g. diabetes). Time‐varying covariates included SBP, total cholesterol, low‐density lipoprotein, body mass index, health behaviors (e.g. alcohol use), myocardial infarction, stroke, and coronary heart disease diagnosis.ResultMean age was 62.1 (SD = 10.2), 52.9% were female, 38.5% (2617) self‐identified as White, 27.8% (1890) as Black, 21.9% (1495) as Latino and 11.8% (804) as Chinese American. The observed 19‐year risk for dementia was 8.6%. Compared to no specified intervention, maintaining SBP below 120 mmHg was associated with an overall dementia risk reduction of about 5% in the full study population (risk ratio (RR): 0.95, 95%CI: 0.88, 1.02). The estimated RRs for this same comparison were: 0.95(95%CI: 0.87, 1.03) for White participants, 0.93 for Black participants (95%CI: 0.81,1.06), 0.92 for Latino participants (95%CI:0.81, 1.09), and 1.15 for Chinese American participants (95%CI: 0.74,1.63) (Table 1). Of note, the proportion of participants who would have had to have been intervened differed by race/ethnicity, where 92% Black participants, 82% of White and Chinese American, and 86% of Latino participants would have had to have been intervened to maintain SBP below 120 mmHg.ConclusionOur results highlight a heterogenous effect that should be considered for implementation of blood pressure control strategies.

Neighborhood problems and sleep difficulties predict subjective cognitive decline in Black American men living in urban areas

AbstractBackgroundThe impact of the residential neighborhood on health and aging is being increasingly recognized in medical and health sciences. Specifically, research suggests that the neighborhood where people live can be a risk or protective factor for various health outcomes, including brain health. Similar to the impact of neighborhood on health and aging, sleep has been linked to subjective cognitive decline (SCD) in older adults, which may signal a cognitive trajectory to Alzheimer’s disease and related dementia (ADRD). This study aims to evaluate whether neighborhood problems and sleep difficulties predict subjective cognitive decline in Black men living in urban areas and, thus, may be related to elevated risks for ADRD.MethodBlack American men (N = 117), age 40 – 70 years, were recruited through a targeted advert on Amazon Mechanical Turk (MTURK) over a 3‐week period. The participants responded to a survey assessing neighborhood problems, bodily symptoms, length of residence, sleep difficulties, self‐rated health, sociodemographic characteristics, and subjective cognitive decline.ResultWe performed hierarchical regression. In Model 1, only education was a significant predictor of SCD (F (3,113) = 8.52, p<.001), accounting for 18% of the variation in SCD. In Model 2, socioeconomic status, education, and bodily symptoms were significant predictors of SCD (F (5,111) = 13.99, p<.001) and explained 39% of the variation in SCD. In Model 3, neighborhood problems, length of residence added, socioeconomic status, education, and bodily symptoms were significant predictors and contributed 44% of the total variance in SCD (F (7,109) = 12.10, p<.001). In Model 4, sleep difficulties, length of residence, bodily symptoms, socioeconomic status, and education were significant predictors of SCD (F (9,107) = 13.59, p<.001), and accounted for 50% of the variation in SCD.ConclusionGiven that Black Americans have been found to have a higher prevalence of sleep disturbances compared to white Americans, our findings could add to inform future health interventions and policy recommendations that can address modifiable sources of poorer brain health in Black men.

Racial disparities in epigenetic and cognitive aging

AbstractBackgroundRacial disparities in cognitive health are persistent and pervasive among older Americans. Black Americans have higher rates of cognitive impairment and dementia than their White counterparts and a significantly higher gap between epigenetic age and chronological age. Epigenetic aging measured by DNA methylation (DNAm) has been linked to cognitive outcomes in previous research, but these studies lacked racial diversity or did not account for important confounders. Rigorous evaluation of DNAm‐age’s contribution to cognitive health disparities is needed. We hypothesize that DNAm‐age gap, measured by two epigenetic clocks GrimAge and Dunedin Pace of Aging methylation (DPoAm), is associated with cognitive performance and decline and mediates significant portions of the Black‐White disparities in these outcomes.MethodWe performed retrospective analyses among 3278 non‐Hispanic participants (80.3% White, 19.7% Black) in the Health and Retirement Study whose 2016 epigenetic age is linked to survey responses and cognitive data. DNAm‐age gap is defined as the residual after regressing epigenetic age on chronological age. Cognitive outcomes are Telephone Interview for Cognitive Status (TICS) score in 2016 and change in TICS score from 2016 to 2018. We include age, gender, and measures of socioeconomic status, health status, and health behaviors as confounders. We implement multiple linear regression models to evaluate associations between DNAm‐age gap and cognitive outcomes and mediation models to evaluate the extent to which DNAm‐age gap mediates the relationship between race and cognitive outcomes.ResultWe found that although both GrimAge and DPoAm age gaps are associated with baseline cognitive performance and longitudinal decline in minimally adjusted models, only GrimAge remained a significant predictor after adjusting for confounders. Similarly, both GrimAge and DPoAm mediate a small but significant portion (∼6‐10%) of the racial disparities in cognitive performance and decline before adjusting for confounding variables. Socioeconomic status (education, wealth, and income) has the greatest attenuating effect.ConclusionAccelerated epigenetic aging for Black compared to White Americans may play a role in racial cognitive aging disparities. Follow‐up work is ongoing to determine the role of chronic psychosocial stressors and other important determinants of cognitive health in DNAm aging and racial disparities.

Willingness for Lung Cancer Screening: Disparities Among Informed, Screening-Eligible Individuals

BackgroundLung cancer is the leading cause of cancer-related death. Although lung cancer screening has been shown to reduce mortality, only a small fraction of eligible people receive screening. This study briefly educated screening-eligible individuals about lung cancer risk, prevention, and screening recommendations. We then evaluated race and gender as predictors of willingness to be screened once participants were educated. MethodsAn online lung cancer screening learning module was created and distributed to convenience samples of screening-eligible White Americans (n = 173) and Black Americans (n = 52) between November 2022 and February 2023. Participants viewed short modules about lung cancer risks and screening. Thereafter, participants rated their willingness to consider future screening using theory of planned behavior measurement frameworks (attitudes, norms, perceived control, and intentions to screen), with higher scores indicating greater willingness. Participant demographics were recorded. ResultsBlack Americans reported higher perceived control over obtaining screening than White Americans (t223 = −3.10; P < .001; d = 1.28). We observed no other racial differences in willingness as Black Americans and White Americans reported similar attitudes, normative beliefs, and intentions. Women also showed more positive attitudes and greater intention to be screened than men did (t223 = −2.42; P = .02; d = 1.66). ConclusionsOnce informed about lung cancer risks, prevention, and screening recommendations, Black Americans may be as willing as White Americans to undergo screening, highlighting potential causal factors other than willingness for existing racial disparities in lung cancer screening uptake. Gender differences in willingness highlight a potential need for gender-targeted outreach and communication.

Examining the Persistence of American Housing Discrimination Through the Asian Lens: A Literature Review

This paper examines the historically controversial and essential issue of racial influences in housing practices through the Asian scope. While many ongoing debates garnered national attention about the roots of the homeownership gap between Black and White Americans, the story of Asians and their housing struggle in America is vastly underreported. Various discriminatory realtor agencies across the United States still demonstrate racially motivated housing malpractices towards Asians, alluding subconsciously to the persisting stereotypes of the race arising in the 19th century. The aim of this literature review is to thoroughly analyze the roots, status quo, and possible modern solutions to the unseen issue of housing discrimination against Asians in the United States.

Board Games of the 20th Century and their Cultural Impact on Reinforcing Racial Stereotypes

In the twenty-first century, video games grew incredibly more popular and transitioned to the mainstream. However, many of these games face criticism for gameplay features that propagate problematic racial caricatures and stereotypes. By looking at board games from the twentieth century, this paper shows that racially problematic gameplay is not an exclusively modern trend; instead, it is but one facet of an entire play industry that has been replicating and disseminating racial (and often racist) stereotypes for decades. While many board game developers intended for their games to be critical of social issues, market forces demanded that these games reframe their messaging to better comply with narratives and views, however flawed and damaging, that were familiar to the consumer population, namely parents seeking wholesome entertainment for their children. Structured board games throughout the last century, including Monopoly, Blacks &amp; Whites, and Mystery Date, have further entrenched the notion of the “white normal” by honoring characteristics associated with white Americans and condemning traditionally nonwhite characteristics and lifestyles. Furthermore, Dungeons and Dragons and other tabletop, RPG fantasy games caricaturized actual races within the fantastical settings of their games, turning white individuals into graceful elves and nonwhite individuals into brutish orcs. An investigation of board games throughout the twentieth century reveals the tendency of dominating social views and cultural messages to reinforce themselves across generations, as social messaging in games and other consumer products are necessarily defined by the whims of the market and the wishes of the consumer.

Veteran Healthcare System: A Unique Healthcare Setting Providing Equitable Access to all Patients with Metastatic Lung Cancer in the Era of Precision Diagnostics

Abstract Introduction/Objective The National Comprehensive Cancer Network (NCCN) Non-Small Cell Lung Cancer (NSCLC) Guidelines Panel strongly advises broad molecular tumor profiling to identify mutations that help guide precision- based patient tailored therapy and subsequent patient counseling. Liquid biopsy with next generation sequencing represents a powerful tool to obtain this information through phlebotomy but is costly and only recently available. Although ethnic minorities may not have the same access to health care resources, studies of ethnic access to liquid biopsies in the setting of Veteran patients at a Veteran Affairs Medical Center (VAMC) with metastatic lung cancer have not been well studied. Methods/Case Report A retrospective review was performed of all patients with a submitted liquid biopsy specimen at a VAMC and a history of metastatic lung cancer from November 26th, 2019, to March 3rd, 2023. Demographic data was collected for each patient specimen and compared with the ethnic proportions noted in the census of the city where the VAMC is located. Results (if a Case Study enter NA) There were a total of 35 patient specimens, with the first liquid biopsy collection occurring on November 26th, 2019. The mean age of the patients was 70. The ethnic composition of the population was as follows: 16 were African American (45.7%), 16 were Caucasian American (45.7%), 2 mixed ethnicity (5.7%), and 1 declined to answer or were of unknown ethnicity (2.9%). The census of the surrounding metropolitan area demonstrated a general population ethnic composition of 43.6% African American and 44.4% Caucasian American. Conclusion The proportion of Veteran patients of each ethnicity with metastatic lung cancer that received liquid biopsy testing was similar to the ethnic distribution of the general population of the surrounding metropolitan area. This demonstrates that there was equitable access to this testing modality at the VAMC with potential to deliver best cancer care to the veterans by detection, prognosis, and monitoring treatment outcomes.

Ethnic Incidence of Metastatic Prostate Carcinoma in a Veteran Affairs Medical Center’s (VAMC) And Early Surveillance Guided by Sites of Metastases

Abstract Introduction/Objective Ethnic difference in incidence, mortality, and prognosis for prostate adenocarcinoma is well known with disparities between African American (AA), Caucasian and Asian origin population reported by tumor heterogeneity and increased number of gene mutations in genomic profiling. Early metastasis of prostate cancer with younger age at the presentation in AA ethnicity has been noted. Earlier screening, biopsy and tumor molecular profiling may lead to a decrease in morbidity and mortality related to metastatic prostate cancer. While there are known differences in the incidence of prostate cancer between different ethnic groups and differences in ethnic access to care and diagnosis varies widely between distinct medical practices, the ethnic incidence of diagnoses of metastatic prostatic adenocarcinoma and distribution of sites particularly in a Veteran population has not been well studied. Methods/Case Report A retrospective search was performed from December 2019 to October 2022 for metastatic prostatic carcinoma specimens at regional Veteran Affairs Medical Center (VAMC). Both H &amp; E and immunohistochemical antibodies for prostate were reviewed and used in the diagnosis of metastatic carcinoma of prostate origin. Results (if a Case Study enter NA) A total of 21 cases with metastatic prostatic adenocarcinoma were found from which 9 were metastases to bone, 5 were metastases to lymph node and 7 were metastatic to other organ sites. Majority of the cases were of ethnic African American veterans (12/21, 57%), followed by Caucasian Americans (7/21, 33%), and 2 of unknown ethnicity (2/21, 10%). On examination, most frequent site of metastases by ethnic African Americans was lymph node in 4 out of the 5 (80%) total cases metastatic to lymph node, and 5 out of 6 total cases (83%) with metastases to different organ sites together. On the other hand, ethnic Caucasian Americans the most common metastatic site was bone with 6 out of 10 total cases (60%) metastatic to bone. Conclusion African American Veteran patients have a higher incidence of metastatic prostate carcinoma and a higher incidence of earlier metastases. A similar trend was seen in the study population with African Americans making up most of the study population and also suggestively having more cases of lymph node and other organ metastases. The increased proportion of African Americans in the study population with lymph node metastases suggests targeting lymph nodes for biopsy for early detection of the metastatic prostatic carcinoma.

Metabolite Signature of Life's Essential 8 and Risk of Coronary Heart Disease Among Low-Income Black and White Americans.

Life's essential 8 (LE8) is a comprehensive construct of cardiovascular health. Yet, little is known about the LE8 score, its metabolic correlates, and their predictive implications among Black Americans and low-income individuals. In a nested case-control study of coronary heart disease (CHD) among 299 pairs of Black and 298 pairs of White low-income Americans from the Southern Community Cohort Study, we estimated LE8 score and applied untargeted plasma metabolomics and elastic net with leave-one-out cross-validation to identify metabolite signature (MetaSig) of LE8. Associations of LE8 score and MetaSig with incident CHD were examined using conditional logistic regression. The mediation effect of MetaSig on the LE8-CHD association was also examined. The external validity of MetaSig was evaluated in another nested CHD case-control study among 299 pairs of Chinese adults. Higher LE8 score was associated with lower CHD risk (standardized odds ratio, 0.61 [95% CI, 0.53-0.69]). The MetaSig, consisting of 133 metabolites, showed significant correlation with LE8 score (r=0.61) and inverse association with CHD (odds ratio, 0.57 [0.49-0.65]), robust to adjustment for LE8 score and across participants with different sociodemographic and health status ([odds ratios, 0.42-0.69]; all P<0.05). MetaSig mediated a large portion of the LE8-CHD association: 53% (32%-80%). Significant associations of MetaSig with LE8 score and CHD risk were found in validation cohort (r=0.49; odds ratio, 0.57 [0.46-0.69]). Higher LE8 score and its MetaSig were associated with lower CHD risk among low-income Black and White Americans. Metabolomics may offer an objective measure of LE8 and its metabolic phenotype relevant to CHD prevention among diverse populations.

Therapy Related Multiple Myeloma: A Distinct Entity

Background The development of therapy-related multiple myeloma (t-MM) is a poorly described entity. Multiple myeloma (MM) is the second most common hematologic malignancy. Despite significant strides in MM treatment over recent decades, identifying modifiable risk factors, optimizing screening methodologies, and identifying potential treatment strategies or targets to address t-MM remains of utmost importance, as this disease continues to pose a significant therapeutic challenge and remains incurable. This retrospective review seeks to explore the incidence and characteristics of t-MM at a medium-sized, academic center. Methods We performed a single institution retrospective chart review of patients diagnosed with multiple myeloma between 2008-2023 and evaluated for prior diagnosis of solid malignancy, excluding all skin cancers, lymphomas or myeloproliferative neoplasm (MPN). We collected data for the following: prior treatment for solid malignancy, lymphoma or MPN, lapsed time between prior therapy and development of MM, cytogenetics, prominent subtype present, renal failure and hypercalcemia if present at time of diagnosis, management of t-MM including transplant data, disease progression including relapse status, and survival data. Results In our study, we identified a subgroup of 17 individuals who had a previous history of solid malignancy, 1 patient with unknown prior solid tumor, 1 patient with history of Hodgkin's lymphoma, and 1 additional patient with history of MPN who received chemotherapy and/or radiation therapy, with 3 patients having MGUS prior to development of MM. Notably, among this population, 70% were male. All patients developed MM following the treatment for a solid malignancy, lymphoma or MPN. The average amount of time from diagnosis of solid tumor, lymphoma or MPN to development of MM was 9.53 years (1-25 years). 50% of the individuals were White Americans, while the remaining 50% were African Americans. A significant majority (85%) of the population had a single primary solid tumor. Among the primary solid tumors, 45% were prostate cancer, 15% were breast cancer, and 10% were renal cell carcinoma (Figure 1). 5 patients received chemotherapy alone without documented prior radiation exposure while 13 had prior radiation exposure for prior solid malignancy. At time of diagnosis, 45% of patients had renal failure with 10% of patients having both renal failure and hypercalcemia. Within the t-MM subtypes, we discovered that 50% had IgA type, with 70% of these individuals exhibiting the IgA Kappa subtype. 45% of the individuals who developed t-MM had the IgG type, with 78% of them with IgG Kappa subtype. 15 (75%) of the patients received transplant and only 2 patients had confirmed relapse with 2 patients unknown and 2 additional patients who passed away prior to starting maintenance therapy following transplant. 4 patients are very early in their disease process and as of yet have not undergo transplant. 55% of our patients are presumed living. The OS for patients with t-MM was 1190 days compared to the average OS of 2326 days in our institutional MM database without t-MM. Conclusion Our analysis focused on patients diagnosed with MM who had a prior history of solid primary tumors, lymphoma or MPN treated with chemotherapy and/or radiotherapy in hopes of providing valuable insights into the characteristics and outcomes of individuals who developed MM following treatment for solid tumors, lymphoma or MPN. Our findings highlighted specific risk factors associated with t-MM in this population. Being male and having a history of prostate cancer was associated with higher incidence of development of t-MM. This is likely related to the radiation therapy associated with prostate cancer, as radiation exposure has been a known risk factor for the development of MM. We observed that the predominant subtype of MM among these individuals was IgA kappa, which diverges from the prevalent subtype, IgG kappa, observed in the general population. IgA is known to typically have more cytogenetic abnormalities and overall poorer prognosis, likely contributing to the difference in OS compared to patients with t-MM and MM not associated with prior malignancy. These insights shed light on the unique characteristics and potential influences of treatment-related MM in patients with prior malignancies or MPN.

Real World Outcomes of Black Americans with Mantle Cell Lymphoma

Introduction Mantle cell lymphoma (MCL) is a rare subtype of non-Hodgkin lymphoma (NHL), accounting for approximately 6-8% of all NHL cases. MCL generally affects older, White, male patients, having a significantly lower incidence in Black patients. Thus, clinical outcomes of Black Americans with MCL are poorly characterized, though multiple sources have reported relatively poor survival outcomes when compared to their White counterparts. We aimed to evaluate the overall survival outcomes and explore potential factors contributing to poor survival outcomes for Black patients with MCL in the United States. Methods The National Cancer Database was used to identify MCL patients diagnosed from 2004-2020. Demographic and treatment characteristics were compared between White and Black MCL patients, by self-identified race. Patients of other races were excluded. Kaplan Meier and adjusted Cox regression survival analysis were used to compare overall survival (OS) by race, and stratified for age ≤ 65 or age &amp;gt; 65 years old. Finally, a propensity matched analysis was performed to compare OS in Black and White Americans matched by age, comorbidity burden, insurance status, and zip code income. Results A total of 34,872 patients with MCL were identified, of which 93.1% (N=32,407) were White, 4.2% (N=1,465) were Black, and 1.7% (N=942) identified as another race and were excluded from the dataset. Black patients were more likely to be female (34% Black vs. 29% White), have a younger age at diagnosis (mean age 65 years [SD ± 13] vs. 68 years [SD ± 12], p&amp;lt;0.001), more likely to have ≥1 co-morbidity (30% vs. 23%), and more likely to be uninsured (4% vs. 2%) when compared to White patients. Both Black and White patients had equal rates of stage IV disease (68% vs. 68%) and receipt of systemic therapy at diagnosis (84% vs. 84%), however White patients were more likely to receive stem cell transplant compared to Black patients (13% vs.11%). With a median follow-up of 40 months, the median OS for all MCL patients was 70 months (95% CI 66-71). Compared to White patients of the same age, Black patients age ≤ 65 years had worse median OS (116 months [95% CI 92-139] vs. 140 [95% CI 134-146] months for White patients) along with decreased 1-year (87% vs. 90%), 5-year (62% vs. 70%) and 10-year OS (38% vs. 55%), (all p &amp;lt;0.001). For MCL patients age &amp;gt; 65 years old, Black MCL patients had shorter median OS compared to their White counterparts (36 months [95% CI 28-43] vs. 43 months [95% CI 41-44]), and decreased 1-year (70% vs. 75%) and 5-year OS (40% vs. 41%) (all p=0.030), though by ten years there was no survival disparity. On age-adjusted cox regression, Black race was associated with increased hazard for all-cause death for MCL patients (hazard ratio [HR] 1.17, CI 1.08-1.26; p&amp;lt;0.001). However, when Black and White patients were 1:1 propensity score matched by age, co-morbidity score, insurance status, and income quartile of zip code, there was no significant difference in risk of death by race alone (HR 0.99, CI 0.91-1.08; p=0.61). Conclusion This is the largest study to-date evaluating outcomes among Black patients with MCL. Patients who are Black with MCL are more likely to present at a younger age, have female predominance, and have worse overall survival outcomes than White patients of similar age. Notably, we found that this survival difference was lost when controlling for surrogate markers of healthcare access, such as insurance and income. This study highlights existing disparities for Black patients with MCL, which appear to be related to socioeconomic disparities that may impact access to treatment, supportive care, and other vital aspects of care for MCL. Future studies may seek to evaluate the role of known high risk features for MCL such as TP53 status or blastoid/pleomorphic morphology in these populations. Interventions aimed at improving healthcare access for underserved populations, including racial minorities, are essential.

Demographic Disparities in Clinical Trial Enrollment of US Patients with Newly-Diagnosed Multiple Myeloma

Background: Racial, ethnic and gender disparities impact the real-world reproducibility of clinical trials leading to drug approvals for hematologic malignancies. Interestingly, a prior abstract (Boisclair et al., 2022) has shown an equitable enrollment between US demographic groups in frontline trials for newly-diagnosed non-Hodgkin lymphoma. Although disparities in multiple myeloma (MM) trial participation have been oftentimes demonstrated, prior studies (Kanapuru et al., 2022; Alqazaqi et al., 2022) predominantly involved patients with relapsed/refractory MM (RRMM). To further assess this gap, we conducted a cross-sectional analysis of US demographic representation in phase II or III trials for newly-diagnosed MM (NDMM). Methods: Clinicaltrials.gov was searched for completed NDMM trials with a recruitment period between 01/01/2007-12/31/2020. Studies limited to phase I data (n=10), enrolling &amp;lt;30 patients (n=35), including RRMM or other malignancies (n=18), and/or recruiting outside the US (n=93) were excluded. We subdivided patients according to gender, race, and ethnicity. For each subgroup, total new cases of MM from 2007-2020 were identified via the Surveillance, Epidemiology and End Results (SEER) Cancer Statistics Explorer Network, with subsequent calculation of a trial enrollment fraction (TEF; number of trial enrollees divided by incident US cases). Pearson's chi-square test was used to compare TEF between subgroups, yielding odds ratio (OR) and 95% confidence interval (95%CI) values, with P&amp;lt;0.05 deemed significant. Results: Among the 194 trials found on initial review, 25 met the established criteria for inclusion (Figure 1). All studies (n=3,559) described the participants' gender, while only 18 (72%; n=3,129) reported race and 9 (36%; n=2,319) reported ethnicity. Overall, women showed a significantly lower TEF compared to men (OR, 0.88; 95%CI, 0.82-0.94; P&amp;lt;0.001). When compared to White Americans, TEF was significantly lower for African Americans (OR, 0.71; 95%CI, 0.64-0.78; P&amp;lt;0.001) and Asian Americans/Pacific Islanders (AAPIs; OR, 0.64; 95%CI, 0.22-0.41; P&amp;lt;0.001). In studies reporting ethnicity, TEF was significantly lower for Hispanics compared to non-Hispanics (OR, 0.18; 95%CI, 0.14-0.24; P&amp;lt;0.001). Conclusion: Our cross-sectional analysis reveals an underrepresentation of women, African Americans, AAPIs, and Hispanics in NDMM trials conducted around the US. These findings are complementary to the enrollment disparities previously shown in RRMM trials. Through the implementation of a comprehensive diversity plan, MM trials must include a more inclusive representation of the US population affected by this blood cancer. Such an approach will not only enhance the external validity of these trials but also mitigate the impact of ascertainment bias and promote healthcare equity.