Elimination Of Disparities Research Articles

Abstract C032: Take Charge during Treatment: A randomized exercise trial for breast cancer patients

Abstract Introduction. Breast cancer (BC) is the most frequently diagnosed cancer with over 4 million survivors living in the United States. Recent treatment (Tx) advances such as in targeted (e.g. anti-HER2), systemic (e.g. anthracyclines), or combined therapies have supported the increased survival rates but continue to present adverse effects. Cardiotoxicity, which may be induced during or after Tx, is the second highest cause of mortality in BC survivors and also negatively impacts quality of life (QoL). Black/African American (B/AA) patients have higher rates of this effect along with a higher incidence of aggressive BC types. Limited research has targeted vascular function as an area of focus in the cardio-oncology field. Methods. The Discovery and Elimination of Cardio-Oncology Disparities Toward Equity in the Heartland Center is examining how anti-cancer treatments impact vascular function, the potential mitigating effects of exercise and how socioenvironmental factors moderate these effects. The Take Charge during Treatment randomized trial within this Center is testing the feasibility and acceptability of an exercise during treatment program for B/AA and non-Hispanic White (NHW) women newly diagnosed with BC. The study also examines and compares the effects of exercise on VO2 peak and QoL in participants. The 16-week intervention promotes adherence to the American College of Sports Medicine exercise guidelines for cancer survivors and is guided by a certified exercise trainer. To evaluate the intervention, patient's complete surveys including the FACT-B for QoL, a VO2 peak assessment, physical assessments, and anthropometry measurements at baseline (before BC Tx), after the 16-week program, and at a 12-month timepoint. Socioenvironmental factors are examined using participant addresses. Results. To date, 1330 patients were assessed for eligibility, 60 consented, and 49 enrolled and randomized. Herein, we present data on 45 of the 49 (35 NHW, 10 B/AA). The mean age of participants is 52 years (SD=12), most were diagnosed with Stage I or II BC, and they have varied education and income levels. Baseline (pre-treatment) differences are noted by racial group for QoL (Total score – 88 (SD=9) for NHW vs 74 (SD=29) for B/AA; Physical function – 25 (SD=3) for NHW vs 22 (SD=5) for B/AA; Functional – 21 (SD=4) for NHW vs 18 (SD=8) for B/AA), VO2 peak (22 (SD=5) for NHW vs 17 (SD=6) for B/AA), and obesity (NHW – 30%, B/AA – 70%). Cognitive function, pain interference, social isolation and perceived stress were similar across groups. B/AA women were more likely to report living in a highly redlined area (50%) compared to NHW women (3%), with lower percent tree canopy (13% vs 24%) and lower perceived social cohesion (15 vs 19). Reports of discrimination and resilience were similar across groups. Conclusions. Preliminary baseline results suggest that B/AA women enter BC Tx more vulnerable to developing QoL challenges and cardiotoxicity. Neighborhood environmental factors will be further examined to understand the association with adverse outcomes. Citation Format: Estefania Alonso, Melinda Stolley, Kirsten Beyer, Alison Kriegel, Shane Phillips, Matt Durand, Michael E. Widlansky, Amanda L. Kong, Kent Hoskins, Andreas Beyer. Take Charge during Treatment: A randomized exercise trial for breast cancer patients [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C032.

Abstract C098: CYR61 expression in prostate cancer patients at City of Hope

Abstract In the US, African-American (AA) and Hispanic/Latino (H/L) men have higher rates of advanced prostate cancer (PCa), increased PCa-specific mortality, and are more likely to undergo metastasis than non-Hispanic White (NHW) men attributed to a lack of access to early screening, and a higher prevalence of risk factors such as obesity, diet, and genetic differences. Consequently, effective treatment of advanced PCa and elimination of racial and ethnic disparities for this malignancy require the identification of mechanisms of disease progression. In PCa, the cysteine-rich angiogenic inducer 61 (CYR61) contributes to malignant cell growth through interactions with extracellular ligands, such as integrins avb3 and a6b4. In previous studies, we have found that CYR61 is upregulated in metastatic PCa cell lines and knockdown of this protein significantly reduced metastatic cell proliferation, viability, prostasphere formation, and activation of the PI3/AKT pathway, indicating a potential utilization of CYR61 inhibition in the therapy of metastatic PCa. Interestingly, we have observed that in metastatic PCa cell models, IGF1 induction increased CYR61 protein expression. However, the correlation between PCa aggressiveness and levels of CYR61 in tumor-derived tissues from patients is poorly studied. Our goal with this study is to identify possible correlations in CYR61 expression that may reflect health disparities in PCa outcomes. We used in silico analyses from whole exome paired tumor/normal DNA sequencing and tumor RNA sequencing data available on 542 PCa cases in the City of Hope POSEIDON database to determine whether gene expression of CYR61 and IGF1 was correlated with genetic ancestry, Gleason score, and tumor purity. In univariate analyses, we found that H/L PCa cases had significantly higher levels of expression of CYR61 than NHW PCa cases (p = 0.043) and that both H/L and AA PCa cases had higher IGF1 expression levels, although only significant in AA (p=0.031). We also found that PCa patients with Gleason scores of 8 and higher had significantly lower expression of IGF1 than those with Gleason scores of 7 or less (p=0.006). Both CYR61 and IGF1 expression levels were significantly lower in those with luminal B (p=0.00000000053, p=0.000009, respectively) and with basal subtypes (p=0.00035, p=0.000069, respectively compared to luminal A subtype. Tumor purity was estimated by RNA-seq based on 141 genes specific to stroma and 141 genes specific to immune cells. CYR61 expression was significantly correlated with stromal and immune infiltration. These results suggest that reduced CYR61 expression is associated with more aggressive PCa. Additional analyses are ongoing to understand the interplay of variables of race and ethnicity, age, Gleason score, and tumor purity and to investigate outcomes of biochemical recurrence and death from PCa. Citation Format: Greisha L. Ortiz-Hernandez, Yuan Chun Ding, Susan L. Neuhausen. CYR61 expression in prostate cancer patients at City of Hope [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C098.

Regional Differences in American Indian/Alaska Native Chronic Respiratory Disease Disparity: Evidence from National Survey Results.

American Indian/Alaska Native (AI/AN) persons in the US experience a disparity in chronic respiratory diseases compared to white persons. Using Behavioral Risk Factor Surveillance System (BRFSS) data, we previously showed that the AI/AN race/ethnicity variable was not associated with asthma and/or chronic obstructive pulmonary disease (COPD) in a BRFSS-defined subset of 11 states historically recognized as having a relatively high proportion of AI/AN residents. Here, we investigate the contributions of the AI/AN variable and other sociodemographic determinants to disease disparity in the remaining 39 US states and territories. Using BRFSS surveys from 2011 to 2019, we demonstrate that irrespective of race, the yearly adjusted prevalence for asthma and/or COPD was higher in the 39-state region than in the 11-state region. Logistic regression analysis revealed that the AI/AN race/ethnicity variable was positively associated with disease in the 39-state region after adjusting for sociodemographic covariates, unlike in the 11-state region. This shows that the distribution of disease prevalence and disparity for asthma and/or COPD is non-uniform in the US. Although AI/AN populations experience this disease disparity throughout the US, the AI/AN variable was only observed to contribute to this disparity in the 39-state region. It may be important to consider the geographical distribution of respiratory health determinants and factors uniquely impactful for AI/AN disease disparity when formulating disparity elimination policies.

Breast cancer clinical trial participation among diverse patients at a comprehensive cancer center

This study was designed to determine the enrollment patterns in breast cancer clinical trials (CCTs) of patients with diverse backgrounds in an equal access setting and to evaluate the factors contributing to low rates of clinical trial accrual in patients of low socioeconomic status (SES). We performed a retrospective review of a prospectively maintained database of new patients seen at the Dan L. Duncan Comprehensive Cancer Center dating from 5/2015 to 9/2021, which included 3043 patients screened for breast CCTs. We compared the rate of CCT availability, eligibility, and enrollment between two patient populations: Smith Clinic, where most patients are of low SES and uninsured, and Baylor St. Luke’s Medical Center (BSLMC) with mostly predominantly insured, higher income patients. We performed logistic regression to evaluate whether differences in age, clinic, race, trial type, and primary language may be underlying the differences in CCT enrollment. More patients were eligible for CCTs at Smith Clinic (53.7% vs 44.7%, p < 0.001). However, Smith Clinic patients were more likely to decline CCT enrollment compared to BSLMC (61.3% declined vs 39.4%, p < 0.001). On multivariate analysis, Black patients had a significantly higher rate of CCT refusal overall (OR = 0.26, 95% CI 0.12–0.56, p < 0.001) and BSLMC only (OR = 0.20, 95% CI 0.060–0.60, p = 0.006). Our data shows that it is likely an oversimplification to assume that equal access will lead to the elimination of CCT disparities. Efforts to diversify CCTs must include consideration of structural and institutional inequities as well as social needs.

Impact of racial disparities in follow-up and quality of colonoscopy on colorectal cancer outcomes.

The benefits of colorectal cancer (CRC) screening programs rely on completing follow-up colonoscopy when a noncolonoscopy test is abnormal and on quality of colonoscopy screening as measured by the endoscopists' adenoma detection rate. Existing data demonstrate substantially lower follow-up colonoscopy rates and adenoma detection rate for Black Americans than White Americans. However, the contributions of racial differences in follow-up colonoscopy and adenoma detection rate on CRC outcomes have not been rigorously evaluated. We used established and validated CRC-Adenoma Incidence and Mortality (CRC-AIM) model as our analysis platform, with inputs from published literature that report lower follow-up colonoscopy rates and adenoma detection rate in Black adults compared with White adults (15% and 10% lower, respectively). We simulated screening with annual fecal immunochemical test, triennial multitarget stool DNA, and colonoscopy every 10 years between ages 45 and 75 years using real-world utilization of the screening modalities vs no screening. We reported lifetime outcomes per 1000 Black adults. Elimination of Black-White disparities in follow-up colonoscopy rates would reduce CRC incidence and mortality by 5.2% and 9.3%, respectively, and improve life-years gained with screening by 3.4%. Elimination of Black-White disparities in endoscopists' adenoma detection rate would reduce CRC incidence and mortality by 9.4% and improve life-years gained by 3.7%. Elimination of both disparities would reduce CRC incidence and mortality by 14.6% and 18.7%, respectively, and improve life-years gained by 7.1%. This modeling study predicts eliminating racial differences in follow-up colonoscopy rates, and quality of screening colonoscopy would substantially reduce Black-White disparities in CRC incidence and mortality.

Ensuring safe and equitable discharge: a quality improvement initiative for individuals with hypertensive disorders of pregnancy

ObjectiveTo improve timely and equitable access to postpartum blood pressure (BP) monitoring in individuals with hypertensive disorders of pregnancy (HDP).MethodsA quality improvement initiative was implemented at a large academic medical...

The Day Disparities Died.

For many, many years, the public health community has grappled with health disparities. Reducing and/or eliminating health disparities are well-established goals, and have become a fixture in the public health space. The focus on health disparity elimination has permeated policy, resources, institutions of higher learning, and research agendas, to name a few. As a Black female public health professional, I believe that we play a central role in moving the country from a place of disparity to equity. Not only are our professional experiences critical for advancing public health, but our lived experiences can also contribute to the transformation that we all seek. This piece, titled "The Day Disparities Died," reflects this belief. To view the original version of this poem, see the supplemental material section of this article online.

Spatial justice in healthcare: Advancing equitable geographic access to primary healthcare in Migori County, Kenya

This study aims to demonstrate the utility of location-allocation models in promoting spatial justice and enhancing access to primary healthcare services. Given the limitations of healthcare resources, it is essential to develop sustainable and equitable frameworks for primary healthcare. To accomplish this, the study utilizes the Maximum Covering Location Problem (MCLP) to assess the existing level of access in Migori County and to propose a viable approach for improving access. The proposed approach achieved a spatial coverage rate of 96%, a notable improvement compared to the existing rate of 84%. Therefore, the planning intervention serves as a viable spatial framework to complement the implementation of the Kenya Primary Health Care Strategic Framework (2019–2024) within the county. The study concludes by emphasizing the importance of policymakers and healthcare providers prioritizing the elimination of geographical disparities in primary healthcare access to foster spatial justice and an efficient referral system.

ASO Visual Abstract: Pancreatic Cancer Multidisciplinary Clinic is Associated with Improved Treatment and Elimination of Socioeconomic Disparities.

ASO Visual Abstract: Pancreatic Cancer Multidisciplinary Clinic is Associated with Improved Treatment and Elimination of Socioeconomic Disparities.

Disparities in Diagnosis, Treatment, andOutcomes of Peripheral ArteryDisease: JACC Scientific Statement.

Disparities by sex, race, socioeconomic status, and geography exist in diagnosis, treatment, and outcomes for people with lower extremity peripheral artery disease (PAD). PAD prevalence is similar in men and women, but women have more atypical symptoms and undergo lower extremity revascularization at older ages compared to men. People who are Black have an approximately 2-fold higher prevalence of PAD, compared to people who are White and have more atypical symptoms, greater mobility loss, less optimal medical care, and higher amputation rates. Although fewer data are available for other races, people with PAD who are Hispanic have higher amputation rates than White people. Rates of amputation also vary by geography in the United States, with the highest rates of amputation in the southeastern United States. To improve PAD outcomes, intentional actions to eliminate disparities are necessary, including clinician education, patient education with culturally appropriate messaging, improved access to high-quality health care, science focused on disparity elimination, and health policy changes.

Community Engagement in Implementation Science: the Impact of Community Engagement Activities in the DECIPHeR Alliance.

The translation of evidence-based interventions into practice settings remains challenging. Implementation science aims to bridge the evidence-to-practice gap by understanding multilevel contexts and tailoring evidence-based interventions accordingly. Engaging community partners who possess timely, local knowledge is crucial for this process to be successful. The Disparities Elimination through Coordinated Interventions to Prevent and Control Heart and Lung Disease Risk (DECIPHeR) Alliance aims to address cardiopulmonary health disparities by engaging diverse community partners to improve the implementation of evidence-based interventions. The goal of the Community Engagement Subcommittee is to strengthen community engagement practice across DECIPHeR. This paper presents the subcommittee's "Why We Engage Communities" statement that outlines why community engagement is critical for implementation science. The paper also provides case examples of DECIPHeR community engagement activities. To develop the "Why We Engage Communities" statement, we conducted a literature review, surveyed subcommittee members to assess the importance of community engagement in their work, and integrated community partner feedback. We synthesize the findings into three key themes and present examples of community engagement activities and their impact across DECIPHeR projects. The statement presents three themes that illustrate why community engagement increases the impact of implementation and health equity research. Community engagement (1) engages local knowledge and expertise, (2) promotes authentic relationships, and (3) builds community and researcher capacity. The statement provides a guiding framework for strengthening DECIPHeR research and enhancing community partnerships. Community engagement can improve the implementation of evidence-based interventions across diverse settings, improving intervention effectiveness in underserved communities and furthering health equity.

Charting the Future of Health Equity Research: Lessons Learned and Future Aspirations for NHLBI's DECIPHeR Alliance.

The Disparities Elimination through Coordinated Interventions to Prevent and Control Heart and Lung Disease Risk (DECIPHeR) research program, supported by the National Heart, Lung, and Blood Institute (NHLBI), focuses on developing and testing sustainable interventions to reduce heart and lung disease disparities. This perspective piece reflects on lessons learned during the planning phase (UG3) and outlines the accomplishments of the DECIPHeR Alliance. The article emphasizes the importance of a biphasic (UG3/UH3) funding mechanism, technical assistance, and collaborative subcommittees in achieving success. As DECIPHeR enters phase 2 (UH3), the article anticipates rigorously planned studies addressing social determinants of health and emphasizes the need for effective implementation strategies and equitable research frameworks. The Alliance's contributions, such as the IM4Equity framework, offer novel approaches to community-engaged health equity and implementation science research. The article explores future opportunities, including dissemination strategies, community engagement, and collaboration with diverse partners, to maximize DECIPHeR's impact on health disparities beyond cardiovascular and pulmonary health.

Abstract B022: Understanding and addressing disparities in cancer therapy induced inflammation and associated endothelial dysfunction

Abstract Nearly 4 million breast cancer survivors live in the United States (U.S.). Continued improvements of cancer therapies (CTx), including targeted treatment options such as anti-HER2 therapy combined with traditional systemic CTx like anthracyclines (ANTs) have made adverse cardiovascular events the leading cause of non-cancer related mortality among BC survivors. Toxicities can be acute and/or reversible (e.g., anti-her2) or may persist for years (ANTs)). Most efforts focus on managing and defining the mechanism of cardiac damage in response to CTx. Yet, systemic vascular function, including microvascular endothelial function, is not only a predictor but also a contributor to a significant number of cardiovascular complications that is mostly overlooked in response to CTx. Little to no mechanistic evidence exists how CTx impacts the human circulation and endothelial function. Systemic inflammation (e.g., Interleukin levels or TLR signaling) is elevated in cancer and CV disease alike, yet the connection of CTx induced endothelial dysfunction has not been explored in breast cancer patients. Black/African American women are at higher risk for cardio-toxicity. Existing literature suggest significant racial differences in immune signaling and microvascular function perhaps explaining varying risk for CV toxicity post-CTx. However, contributing biological, social and environmental factors remain ill defined. The Discovery and Elimination of Cardio-Oncology Disparities for Equity (DECODE) in the Heartland center addresses critical gaps in the literature by testing if an exercise intervention can lower systemic inflammatory load to improve endothelial function and CV risk itself. We propose to: 1) quantify physiological and molecular differences in inflammation and endothelial function before and following CTx among 120 Black/African American and non-Hispanic White women with invasive, non-metastatic BC; 2) test the feasibility and efficacy of an exercise intervention during CTx designed to mitigate the adverse effects of treatment on exercise capacity and QoL; and 3) examine the influence of multi-level socio-ecological factors (individual, interpersonal, institutional, environmental) on inflammation, microvascular endothelial function, QoL and response to the exercise intervention among participants. This presentation presents DECODE’s novel translational study design and methodologies. Citation Format: Melinda Stolley, Andreas Beyer, Kirsten Beyer, Alison Kriegel, David Gutterman, Shane Phillips, Sherry Ann Brown, Kent Hoskins, Rodney Sparapani, Michael Widlansky, Amanda Kong. Understanding and addressing disparities in cancer therapy induced inflammation and associated endothelial dysfunction [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 B022.

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.

Implementation Research at NHLBI: Methodological and Design Challenges and Lessons Learned from the DECIPHeR Initiative.

NHLBI funded seven projects as part of the Disparities Elimination through Coordinated Interventions to Prevent and Control Heart and Lung Disease Risk (DECIPHeR) Initiative. They were expected to collaborate with community partners to (1) employ validated theoretical or conceptual implementation research frameworks, (2) include implementation research study designs, (3) include implementation measures as primary outcomes, and (4) inform our understanding of mediators and mechanisms of action of the implementation strategy. Several projects focused on late-stage implementation strategies that optimally and sustainably delivered two or more evidence-based multilevel interventions to reduce or eliminate cardiovascular and/or pulmonary health disparities and to improve population health in high-burden communities. Projects that were successful in the three-year planning phase transitioned to a 4-year execution phase. NHLBI formed a Technical Assistance Workgroup during the planning phase to help awardees refine study aims, strengthen research designs, detail analytic plans, and to use valid sample size methods. This paper highlights methodological and study design challenges encountered during this process. Important lessons learned included (1) the need for greater emphasis on implementation outcomes, (2) the need to clearly distinguish between intervention and implementation strategies in the protocol, (3) the need to address clustering due to randomization of groups or clusters, (4) the need to address the cross-classification that results when intervention agents work across multiple units of randomization in the same arm, (5) the need to accommodate time-varying intervention effects in stepped-wedge designs, and (6) the need for data-based estimates of the parameters required for sample size estimation.

Process of Engaging Community and Scientific Partners in the Development of the CIRCL-Chicago Study Protocol.

Hypertension affects 1 in 3 adults in the United States and disproportionately affects African Americans. Kaiser Permanente demonstrated that a "bundle" of evidence-based interventions significantly increased blood pressure control rates. This paper describes a multiyear process of developing the protocol for a trial of the Kaiser bundle for implementation in under-resourced urban communities experiencing cardiovascular health disparities during the planning phase of this biphasic award (UG3/UH3). The protocol was developed by a collaboration of faith-based community members, representatives from community health center practice-based research networks, and academic scientists with expertise in health disparities, implementation science, community-engaged research, social care interventions, and health informatics. Scientists from the National Institutes of Health and the other grantees of the Disparities Elimination through Coordinated Interventions to Prevent and Control Heart and Lung Disease Risk (DECIPHeR) Alliance also contributed to developing our protocol. The protocol is a hybrid type 3 effectiveness-implementation study using a parallel cluster randomized trial to test the impact of practice facilitation on implementation of the Kaiser bundle in community health centers compared with implementation without facilitation. A central strategy to the Kaiser bundle is to coordinate implementation via faith-based and other community organizations for recruitment and navigation of resources for health-related social risks. The proposed research has the potential to improve identification, diagnosis, and control of blood pressure among under-resourced communities by connecting community entities and healthcare organizations in new ways. Faith-based organizations are a trusted voice in African American communities that could be instrumental for eliminating disparities.

Physical activity reduces the socioeconomic disparity in dementia risk: A UK Biobank cohort study

AbstractBackgroundGreater socioeconomic deprivation (SED) has been shown to be associated with a higher risk of dementia. There is an urgent need to investigate whether modifiable lifestyle factors, such as physical activity (PA), can help address the SED disparity in dementia. The current study aims to examine whether PA moderates the association between SED and dementia risk.MethodData were obtained from UK Biobank, a nationwide cohort study with over half a million participants recruited during 2006‐2010. We excluded those diagnosed with dementia at baseline. SED was represented by the Townsend deprivation index (TDI) at recruitment, with a higher TDI score indicating a higher degree of deprivation. PA was assessed by an International Physical Activity Questionnaire, and participants were classified into low, moderate, and high PA groups according to their total amount of PA measured by metabolic equivalents. Dementia was defined from self‐reported verbal interviews, hospital episode records, and death register data. Cox proportional hazard models were used to examine the association of TDI and PA with dementia risk, adjusting for baseline age, sex, ethnicity, self‐reported overall health, and assessment centers.ResultThis study included 399,270 participants (209,358 [52.44%] females, and 363,116 [90.94%] Whites) aged 38‐73 years (mean = 56.32, standard deviation [SD] = 8.12), with a mean follow‐up period of 12.95 years (SD = 1.85). When categorized by TDI tertile, those in the high‐deprivation group (hazard ratio [HR] = 1.39, 95% confidence interval [CI] = 1.24‐1.56, p&lt;0.001) had an elevated risk of dementia, relative to the participants in the low‐deprivation group. Greater PA attenuated the association between TDI and dementia risk (HR[moderate‐PA*TDI] = 0.96, 95% CI = 0.93‐0.99, p = 0.021; HR[high‐PA*TDI] = 0.97, 95% CI = 0.93‐1.00, p = 0.080). In the low PA group, the high TDI group faced 1.46 times (95% CI = 1.13‐1.89, p = 0.004) higher risk of dementia than the low TDI group, while the associations were smaller in moderate (HR = 1.31, 95% CI = 1.10‐1.57, p = 0.003) and high (HR = 1.43, 95% CI = 1.17‐1.74, p&lt;0.001) PA groups.ConclusionGreater PA might, to some extent, help mitigate the detrimental effect of SED disparity in dementia risk, but further research is warranted to explore additional modifiable factors associated with health disparity elimination.

An epidemic behind the bars: AIDS in American prisons

Recommendation:By analyzing current research, the article provides useful strategies to prevent, detect, and treat HIV infection among the incarcerated population in the United States, emphasizing the critical need for interventions to mitigate the impact of the HIV epidemic among prisoners.Objective:The aim of this text is to present the challenges associated with the spread of the virus in the population incarcerated in correctional facilities and to emphasize the difficulties that the prison system faces in this context.Materials and Methods: Review of available literature using PubMed and Google Scholar platforms. Results and Conclusions: The article presents complex relationships between HIV infection and the prison system, emphasizing specific challenges and risk factors for infection. The history and evolution of the virus, its impact on the lives and health of prisoners, and issues related to treatment within the prison environment are discussed. The epidemiology of HIV in prisons is analyzed, pointing out positive trends, but further action is necessary. Ongoing intervention, improvement of access to healthcare, and collaboration are essential to effectively manage the issue of HIV infection among incarcerated individuals.Implications: The article implies that effective management of the HIV problem in the prison system requires a comprehensive approach, encompassing preventive strategies, equal access to healthcare, integration of care before and after release, elimination of racial and social disparities, as well as interinstitutional cooperation.

Pancreatic Cancer Multidisciplinary Clinic is Associated with Improved Treatment and Elimination of Socioeconomic Disparities.

To identify the association between multidisciplinary clinic (MDC) management and disparities in treatment for patients with pancreatic cancer. Socioeconomic status (SES) predicts treatment and survival for pancreatic cancer. Multidisciplinary clinics (MDCs) may improve surgical management for these patients. This is a retrospective cohort study (2010-2018) of all pancreatic cancer patients within a large, regional hospital system with a high-volume pancreatic cancer MDC. The primary outcome was receipt of treatment (surgery, chemotherapy, radiation, clinical trial participation, and palliative care); the secondary outcomes were overall survival and MDC management. Multiple logistic regressions were used for binary outcomes. Survival was analyzed using Kaplan-Meier survival analysis, Cox proportional hazards, and inverse probability of treatment weighting (IPTW). Of the 4141 patients studied, 1420 (34.3%) were managed by the MDC. MDC management was more likely for patients who were younger age, married, and privately insured, while less likely for low SES patients (all p < 0.05). MDC patients were more likely to receive all treatments, including neoadjuvant chemotherapy (OR 3.33, 95% CI 2.82-3.93), surgery (OR 1.39, 95% CI 1.15-1.68), palliative care (OR 1.21, 95% CI 1.05-1.38), and clinical trial participation (OR 3.76, 95% CI 2.86-4.93). Low SES patients were less likely to undergo surgery outside of the MDC (OR 0.47, 95% CI 0.31-0.73) but there was no difference within the MDC (OR 1.10, 95% CI 0.68-1.77). Across multiple survival analyses, low SES predicted inferior survival outside of the MDC, but there was no association among MDC patients. Multidisciplinary team-based care increases rates of treatment and eliminates socioeconomic disparities for pancreatic cancer patients.

Rates of Preterm Birth and Low Birth Weight in an Adolescent Obstetric Clinic: Achieving Health Equity Through Trauma-Informed Care.

Adolescents who are pregnant and identify as Black are exposed to more societal harms that increase their and their offspring's risk for poor health outcomes. The Colorado Adolescent Maternity Program (CAMP) offers comprehensive, multidisciplinary (medical, behavioral health, nutrition, case management), trauma-informed obstetric care to pregnant adolescents to ensure the healthiest pregnancy and birth possible and pursue health equity. The present study aimed to examine ethnic and racial disparities in preterm birth and low birth weight before and after implementation of a trauma-informed model of care. Participants were 847 pregnant adolescents (ages 12-22 years; 41% self-identified as Hispanic, 32% as non-Hispanic Black, 21% as non-Hispanic white) who received prenatal treatment-as-usual (TAU) or trauma-informed treatment. Demographic information, mental health symptoms, and birth outcomes were abstracted from medical records. Overall, findings provided support that implementation of a trauma-informed model of prenatal care led to equitable birth outcomes across racial and ethnic groups. Specifically, Black adolescents in the TAU group were more than twice as likely to deliver preterm or low birth weight infants compared with white and Hispanic adolescents. In the trauma-informed group, however, there were no statistical differences in birth outcomes across racial/ethnic groups, indicating an elimination of disparities in both preterm birth and low birth weight in this population. These more equitable birth outcomes occurred even in the context of adolescents of color having reported more severe depression symptoms postimplementation. These findings provide evidence that a health system-level intervention, herein trauma-informed obstetric care for adolescents, can play a meaningful role in the reduction of racial disparities in birth outcomes.