Racial Disparities Research Research Articles

The Concerning Disaggregation of Gender and Racial/Ethnicity Disparity Investigation at Recent ASCO Annual Meetings.

There has been a recent emphasis in the peer-reviewed oncology literature on examining disparities by gender. Such emphasis provides an excellent opportunity to simultaneously examine race/ethnicity disparities in the same cohort. The degree to which gender disparities research has been performed concomitantly with racial disparities research at prominent oncologic societies has yet to be investigated. ABSTRACTs presented at the American Society of Clinical Oncology (ASCO) annual meeting were reviewed. Abstracts selected for the oral abstract or clinical science symposium sessions at the 2020, 2021, and 2022 annual meetings were evaluated to determine the amount of gender disparities research presented. Such research was further assessed to determine whether racial/ethnicity disparities were examined simultaneously. From 2020 to 2022, 1219 abstracts were presented at the ASCO annual meetings, oral abstract or clinical science symposium sessions. Of these, 7 involved gender disparities examination, of which only 2 (29%) concomitantly examined race/ethnicity. No study since 2020 concomitantly examined gender and racial disparities. More than 70% of gender disparities work presented at ASCO has been disaggregated from concomitant racial disparities examination, with complete disaggregation since 2021. Gender disparities work remains a miniscule aspect of the overall research landscape. Future work in examining gender disparities may be best aggregated with racial/ethnicity disparities to optimize timely solutions in both areas; such work could potentially be incentivized from the inclusion criteria of future funding mechanisms.

Facilitating Harmonization of Variables in Framingham, MESA, ARIC, and REGARDS Studies Through a Metadata Repository.

High-quality research in cardiovascular prevention, as in other fields, requires inclusion of a broad range of data sets from different sources. Integrating and harmonizing different data sources are essential to increase generalizability, sample size, and representation of understudied populations-strengthening the evidence for the scientific questions being addressed. Here, we describe an effort to build an open-access repository and interactive online portal for researchers to access the metadata and code harmonizing data from 4 well-known cohort studies-the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study, FHS (Framingham Heart Study), MESA (Multi-Ethnic Study of Atherosclerosis), and ARIC (Atherosclerosis Risk in Communities) study. We introduce a methodology and a framework used for preprocessing and harmonizing variables from multiple studies. We provide a real-case study and step-by-step guidance to demonstrate the practical utility of our repository and interactive web page. In addition to our successful development of such an open-access repository and interactive web page, this exercise in harmonizing data from multiple cohort studies has revealed several key themes. These themes include the importance of careful preprocessing and harmonization of variables, the value of creating an open-access repository to facilitate collaboration and reproducibility, and the potential for using harmonized data to address important scientific questions and disparities in cardiovascular disease research. By integrating and harmonizing these large-scale cohort studies, such a repository may improve the statistical power and representation of understudied cohorts, enabling development and validation of risk prediction models, identification and investigation of risk factors, and creating a platform for racial disparities research. URL: https://precision.heart.org/duke-ninds.

Race, Healthcare, and Health Disparities: A Critical Review and Recommendations for Advancing Health Equity.

An overwhelming body of evidence points to an inextricable link between race and health disparities in the United States. Although race is best understood as a social construct, its role in health outcomes has historically been attributed to increasingly debunked theories of underlying biological and genetic differences across races. Recently, growing calls for health equity and social justice have raised awareness of the impact of implicit bias and structural racism on social determinants of health, healthcare quality, and ultimately, health outcomes. This more nuanced recognition of the role of race in health disparities has, in turn, facilitated introspective racial disparities research, root cause analyses, and changes in practice within the medical community. Examining the complex interplay between race, social determinants of health, and health outcomes allows systems of health to create mechanisms for checks and balances that mitigate unfair and avoidable health inequalities. As one of the specialties most intertwined with social medicine, emergency medicine (EM) is ideally positioned to address racism in medicine, develop health equity metrics, monitor disparities in clinical performance data, identify research gaps, implement processes and policies to eliminate racial health inequities, and promote anti-racist ideals as advocates for structural change. In this critical review our aim was to (a)provide a synopsis of racial disparities across a broad scope of clinical pathology interests addressed in emergency departments-communicable diseases, non-communicable conditions, and injuries-and (b)through a race-conscious analysis, develop EM practice recommendations for advancing a culture of equity with the potential for measurable impact on healthcare quality and health outcomes.

Cross-sectional Comparison of Disparities by Race Using White vs Hispanic as Reference Among Children and Youths With Developmental Disabilities Referred for Speech Therapy

Health care research on racial disparities among children and youths has historically used the White race as a reference category with which other racial and ethnic groups are compared, which may inadvertently set up Whiteness as a standard for health. To compare 2 interpretations of an analysis of racial disparities in speech therapy receipt among children and youths with developmental disabilities: a traditional, White-referenced analysis and a Hispanic majority-referenced analysis. This cross-sectional study used multiple logistic regression to analyze speech therapy referrals for children, adolescents, and transition age youths in an integrated health care system in Southern California from 2017 to 2020. Eligible participants were children and youths up to age 26 years with 1 or more diagnosed intellectual or developmental disability (eg, autism spectrum disorder, speech or language delay, developmental delay, Down syndrome, and others). Child or youth race and ethnicity as reported by parents or caregivers (Asian, Black and African American, Hispanic and Latinx, American Indian or Alaskan Native, Native Hawaiian or Pacific Islander, White, multiple, and other). Receipt of speech therapy within 1 year of referral. A total 66 402 referrals were included; 65 833 referrals (99.1%) were for children under age 17 years, 47 323 (71.3%) were for boys, and 39 959 (60.2%) were commercially insured. A majority of participants were identified as Hispanic (36 705 [55.3%]); 6167 (9.3%) were identified as Asian, 4810 (7.2%) as Black, and 14 951 (22.5%) as White. In the traditional racial disparities model where the reference category was White, referrals of children and youths who identified as Hispanic, Black, Pacific Islander, and other had lower odds of actual receipt of speech therapy compared with referrals for White children and youths (Hispanic: OR, 0.79; 95% CI, 0.75-0.83; Black: OR, 0.72; 95% CI, 0.66-0.78; Pacific Islander: OR, 0.74; 95% CI, 0.57-0.98). When using the majority race group (Hispanic) as the reference category, referrals for children and youths who identified as White (OR, 1.26; 95% CI, 1.20-1.30), Asian (OR, 1.21; 95% CI, 1.12-1.30), and multiracial (OR, 1.35; 95% CI, 1.08-1.71) had higher odds of resulting in actual service receipt in comparison with referrals for Hispanic children and youths. The cross-sectional study demonstrates the value of decentering Whiteness in interpreting racial disparities research and considering racial differences against multiple referents. Racial disparities researchers should consider investigating multiple between-group differences instead of exclusively using White as the default reference category.

The concerning disaggregation of gender disparity and racial disparity investigation at recent ASCO annual meetings.

164 Background: There has been a recent emphasis in the peer-reviewed oncology literature on examining disparities by gender. Such emphasis provides an excellent opportunity to provide parallel disparities analysis. The degree to which gender disparities research has been performed concomitantly with racial disparities research at prominent oncologic societies has yet to be investigated. Methods: Abstracts presented at the American Society of Clinical Oncology (ASCO) annual meeting, the largest worldwide clinical oncology conference, were reviewed. Highly-valued abstracts selected for the elite oral abstract or clinical science symposium sessions at the 2020, 2021, and 2022 annual meetings were stratified to determine the amount of gender disparities research presented. Such research was then further assessed to determine whether racial disparities were examined simultaneously. Results: From 2020-2022, a total of 1,217 abstracts were presented at the ASCO annual meetings oral abstract or clinical science symposium sessions. Of these, seven involved gender disparities examination, of which only two (29%) concomitantly examined race. No study since 2020 concomitantly examined gender and racial disparities. Conclusions: More than 70% of elite gender disparities work presented at ASCO has been disaggregated from concomitant racial disparities examination, with complete disaggregation since 2021. Gender disparities work remains a miniscule aspect of the overall elite research landscape. Future work in examining gender disparities may be best aggregated with racial disparities in order to optimize timely solutions in both areas; such work could potentially be incentivized by stipulations of future funding mechanisms.

Interdisciplinary Notes on the Dual Nature of Disability: Disrupting Ideology–Ontology Circuits in Racial Disparities Research

Research on racial and linguistic disparities in disability identification must be grounded on the dual nature of disability as an object of protection and a tool of stratification. This dual nature requires a situated research approach to understand the stratifying power of disability—Who is targeted? Where? How? By whom and to what consequences? I contrast this perspective with the traditional research approach that privileges a deficit and colorblind framing of racial disparities. The application of a colorblind ideology enables researchers to envision students of color as innately damaged and in need of remediation; thus, forming ideology–ontology circuits. I offer three strategies to disrupt these circuits in future learning disabilities research, namely the elimination of colorblind research strategies, the adoption of a historical imagination, and the discontinuation of Black and Brown abstractions.

Are Neighborhood Characteristics Associated With Outcomes After THA and TKA? Findings From a Large Healthcare System Database.

Are Neighborhood Characteristics Associated With Outcomes After THA and TKA? Findings From a Large Healthcare System Database.

Abstract B057: Racial disparity research in ovarian cancer: Evaluating race definition in differential gene expression

Abstract Objective: Several studies have reported worse prognosis for Black ovarian cancer patients in comparison to non-Hispanic White patients, even after adjusting for clinical parameters, treatment and environmental factors. Self-reported race has been widely recognized as one of the biggest limitations to racial disparities research. Here we evaluated the effect of race definition in the survival outcome and differential gene expression profiling of 72 high-grade serous ovarian carcinoma patients. Methods: We isolated total RNA and genomic DNA from tumor tissue cores of 72 self-reported (SR) Black and non-Hispanic White patients with high-grade serous ovarian carcinoma. Racial genetic admixture (RGA) was performed using a custom panel of previously validated SNPs for estimation of ancestry from African, European, and Amerindian ancestry. Full-genome RNAseq library was constructed and sequenced on Illumina HiSeq instrument. Differentially expressed genes were inferred using DESeq2 software. Candidate gene sets of significantly regulated genes were used for functional and pathway enrichment analyses. Results: 72 patients were included with SR 58% (n=42) Non-Hispanic White and 42% (n=30) Black. SR black patients had mean RGA of African descent of 89.6% (range 48.3-100%), while SR white patients had mean European descent of 88.6% (range 27.5-99.7%). Survivals were similar between SR groups. However, survival differences were seen when compared by proportion of African racial genetic admixture (RGA). Regardless of SR, patients with the highest tertile of African ancestry (AA) had lower median progression-free survival than patients in the lowest AA tertile (8 vs. 23mos; p=0.003). An OS difference of 27 vs. 54mos was seen for the highest and lowest AA tertiles, respectively (p=0.02). Genetic analyses were grouped based on (a) SR vs. (b) Tertiles for African RGA vs. (c) Continuous African RGA. A total of 1,954 genes demonstrated significant up/down expression across all racial cohorts. The “Top 40” genes with the greatest 20 upregulated and 20 downregulated log-fold expression for each genetic cohort demonstrated low concordance among the 3 genetic cohorts, with sentinel genes specific to each racial cohort. Subsequent pathway analyses based on gene expression demonstrated low concordance rates among racial cohorts as well. Conclusions: Racial genetic admixture for African ancestry was more predictive of disparate progression-free survival in high-grade serous ovarian carcinoma than self-designated race. Additionally, how race was defined had significant differences in global gene expression levels and subsequent molecular pathway analyses. Collectively, these data support the incorporation of racial genetic admixture when evaluating biologic etiologies of racial disparities in cancer. Citation Format: Luciana Madeira da Silva, Dmytro Starenki, Megan Missanelli, Jennifer Young-Pierce, Jerlinda Ross, Jaroslav Slamecka, Nathaniel Jones, Jennifer Scalici, Rodney P. Rocconi. Racial disparity research in ovarian cancer: Evaluating race definition in differential gene expression [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B057.

Recruiting and Retaining Young Urban Black Men in a Study of Violence: Procedures Used and Lessons Learned

We conducted a study about three common recruitment and retention obstacles facing scholars interested in racial disparities research: potential mistrust from the black community, a stigmatized research topic, and high participation burden. Nonetheless, we successfully recruited and retained 28 young black men in a three-month study of violence. In this article, we describe and explore the recruitment, engagement, and retention strategies employed during the study. Using a concurrent triangulation mixed-method design, we analyzed data from our web-based administrative system, participant enrollment and exit surveys, and team members’ field notes. A large percentage (79%) of participants completed the study. We received 81% of 556 expected surveys, and 100% of the remaining participants wanted to continue participating at study’s end. We conclude that internal incentives, the combination of informal and formal community recruiters, the visibility of the principal investigator, and face-to-face meetings may have contributed to the success of the project.

Survival-related Selection Bias in Studies of Racial Health Disparities: The Importance of the Target Population and Study Design.

The impact of survival-related selection bias has not always been discussed in relevant studies of racial health disparities. Moreover, the analytic approaches most frequently employed in the epidemiologic literature to minimize selection bias are difficult to implement appropriately in racial disparities research. This difficulty stems from the fact that frequently employed analytic techniques require that common causes of survival and the outcome are accurately measured. Unfortunately, such common causes are often unmeasured or poorly measured in racial health disparities studies. In the absence of accurate measures of the aforementioned common causes, redefining the target population or changing the study design represents a useful approach for reducing the extent of survival-related selection bias. To help researchers recognize and minimize survival-related selection bias in racial health disparities studies, we illustrate the aforementioned selection bias and how redefining the target population or changing the study design can be useful.

The HCUP SID Imputation Project: Improving Statistical Inferences for Health Disparities Research by Imputing Missing Race Data.

To identify the most appropriate imputation method for missing data in the HCUP State Inpatient Databases (SID) and assess the impact of different missing data methods on racial disparities research. HCUP SID. A novel simulation study compared four imputation methods (random draw, hot deck, joint multiple imputation [MI], conditional MI) for missing values for multiple variables, including race, gender, admission source, median household income, and total charges. The simulation was built on real data from the SID to retain their hierarchical data structures and missing data patterns. Additional predictive information from the U.S. Census and American Hospital Association (AHA) database was incorporated into the imputation. Conditional MI prediction was equivalent or superior to the best performing alternatives for all missing data structures and substantially outperformed each of the alternatives in various scenarios. Conditional MI substantially improved statistical inferences for racial health disparities research with the SID.

Racial Differences in Misclassification of Healthy Eating Based on Food Frequency Questionnaire and 24-Hour Dietary Recalls.

To examine the agreement in nutrient intake and alternate healthy eating indices (AHEI) between a self-administered Food Frequency Questionnaire (FFQ) and 24-hour recall (24HR) measurements of diet by race, among urban older women. Cross-sectional observational study. Urban neighborhoods in Washington, DC, USA. Community-dwelling White and Black women aged 65 and older. In 2014 and 2015, 49 White and 44 Black older women were queried on diet using both FFQ and 24-hour recalls. The correlation coefficients of 55 nutrient intake measures and agreements on healthy eating classification between the two instruments were compared overall and by race. The mean correlation coefficient (rho) was 0.46 for Whites and 0.23 for Blacks. For 47 measures, rho was lower for Blacks. Whites had a strong correlation of ≥0.5 for 28 items, while Blacks had strong correlations for only 3 items. Based on FFQ, the mean (SD) of AHEI were 54.0 (10.3) for Whites and 45.9 (8.8) for Blacks (p<0.001). Based on 24HR, the mean (SD) were 43.9 (10.8) for Whites and 33.2 (9.6) for Blacks (p<0.001). Using 32 as the cutoff (40% of maximum AHEI score), 50% of Blacks and 14% of Whites were classified as eating unhealthy based on the 24HR, versus 2.6% and 0% based on the FFQ. The FFQ has limited ability to accurately assess nutrient intake among older Black women, and tends to underestimate racial differences in healthy eating. The FFQ should be further improved for use in racial disparities research of healthy eating in older age, using a larger sample of older women with racial and geographic diversities.

Concordance of Demographic Characteristics, Sexual Behaviors, and Relationship Attributes Among Sex Dyads of Black and White Men Who Have Sex with Men.

Differences in individual behaviors have failed to explain racial disparities between Black and White men who have sex with men (MSM). However, reporting of behaviors and partner characteristics are assumed to be non-differentially reported by race. From 314 participants, this study used the two-sided data-where sexual partners provide information on each other and their relationship-of 127 dyads of Black and White MSM from Atlanta, GA, to assess the reliability of partner-reported demographic characteristics and the concordance of sexual behaviors and partnership attributes by race. We compared proportions of concordance by race using a modified kappa (K m) to assess chance-corrected agreement. The median difference in age between self- and partner-reports was 0 (0-1) years. Compared to self-reports, 97% of the partners of Black participants and 96% of the partners of White participants correctly classified their race. We observed poor agreement on pre-sexual discussion (K m=0.18) and being in an ongoing relationship (K m=0.13), with no differences by race (p=0.11). Although not statistically significant, Black MSM dyads had lower levels of concordance for unprotected anal intercourse in the previous 12months (68%) compared to White dyads (90%), with fair agreement among Black dyads (K m=0.26). Measures of partner-reported age and race are likely accurate; however, certain self-reported sexual behaviors and partnership attributes may be unreliable and differentially reported by race. Our findings highlight the need to assess the validity of measures used to estimate HIV transmission and inform racial disparities research.

Perceived discrimination, coping, and quality of life for African-American and Caucasian persons with cancer.

In racial disparities research, perceived discrimination is a proposed risk factor for unfavorable health outcomes. In a proposed "threshold-constraint" theory, discrimination intensity may exceed a threshold and require coping strategies, but social constraint limits coping options for African Americans, who may react to perceived racial discrimination with disengagement, because active strategies are not viable under this social constraint. Caucasian Americans may experience less discrimination and lower social constraint, and may use more active coping strategies. There were 213 African Americans and 121 Caucasian Americans with cancer who participated by completing measures of mistreatment, coping, and quality of life. African Americans reported more mistreatment than Caucasian Americans (p < 001) and attributed mistreatment more to race or ethnicity (p < .001). In the mistreatment-quality of life relationship, disengagement was a significant mediator for Caucasians (B = -.39; CI .13-.83) and African Americans (B = -.20; CI .07-.43). Agentic coping was a significant mediator only for Caucasians (B = -.48; CI .18-.81). Discrimination may exceed threshold more often for African Americans than for Caucasians and social constraint may exert greater limits for African Americans. Results suggest that perceived discrimination affects quality of life for African Americans with cancer because their coping options to counter mistreatment, which is racially based, are limited. This process may also affect treatment, recovery, and survivorship.

How cancer crossed the color line

3366 The Journal of Clinical Investigation http://www.jci.org Volume 121 Number 9 September 2011 early part of the 20th century, women’s reproductive cancers occupied nearly all of the social awareness about the disease, leading to hypotheses about the relationship between cancer incidence and women’s reproductive roles. An explanatory model that linked cancer incidence to the changing social roles of women was reinforced by the observation that African-American women experienced lower rates of cancer, and it was speculated that this was related to the fact that women remained closer to their “natural” roles in those communities. Toward the middle of the century, differences in cancer incidence between racial and ethnic groups became of increasing interest, as some of the first epidemiologic studies of cancer rates provided surprising and vivid accounts of the population variation. These differences spawned new hypotheses about the causes of cancer, including the role of diet and environmental exposure. These studies also brought more attention to the debate about the role of inadequate access to care and poor reporting infrastructure in masking the true burden of cancer among minorities. By the last half of the century, cancer awareness had grown substantially as had the challenges in finding effective prevention and treatment. Public desperation for effective cancer treatment and skepticism about the intellectual establishment led to the increasing politicization of cancer at the same time that race became even more politicized in the US. Following the report by Howard University researchers in 1972, demonstrating the dramatic increase in the cancer burden among African Americans, the social and political activity around race and cancer coalesced in a growing focus on racial disparities in cancer incidence. The story of race and cancer in the US is important, and there is a sense of achievement in the publication of this book. It offers an overdue perspective both on the history of cancer in our society and on how we come to define and understand differences across racial groups in any disease. However, Wailoo writes as a historian for a social science audience, and the book’s impact in those fields is likely to be far greater than that in the biomedical world. Several topics receive too little attention to be satisfying for most cancer researchers, particularly those interested in disparities. The debate about the role of biology/genetics is glossed over with little insight into the revolutions in molecular genetics that continue to inform and influence the discourse surrounding race and cancer. Similarly, the role of health care quality, encompassing prevention, early detection, and treatment, receives remarkably little attention given its prominence in the lay and medical press about cancer disparities. Wailoo identifies one of the fundamental paradoxes of racial disparities research (i.e., that racial identity must be simplified and categorized if disparities are to be measured and monitored) but has very little to offer as a way forward in this area. Science grows from attempts to explain observations. The history of race and cancer in the US shows how the interpretations of some observations can be been influenced by the sociopolitical environment of any period and can, in turn, influence the sociopolitical environment in the future. In the end, the main reason to read How Cancer Crossed the Color Line has less to do with gaining a comprehensive understanding of race and cancer in the US and more to do with catching yet another glimpse of the fundamental truth that science and society are inextricably linked. How cancer crossed the color line

How cancer crossed the color line

How cancer crossed the color line