Health Disparities Study Research Articles

A Cross‐sectional HABS‐HD study of Plasma Biomarkers of Cognitive Decline across Diagnoses in a Diverse Community Cohort

AbstractBackgroundDue to their low cost, less invasive nature and ready availability, plasma biomarkers of Alzheimer’s disease have been proposed as one time screening tools for clinical trials and research. The impact of ethnoracial factors on these biomarkers has received little attention. The current study investigated the levels of Aβ40, Aβ42, total tau and NfL across diagnoses for each of the three major ethnoracial groups in the US in a community based cohort of older adults.Method1862 participants (852 Mexican Americans (MA); 775 Non‐Hispanic Whites (NHW) and 235 African Americans (AA)) drawn from The Health & Aging Brain Study – Health Disparities (HABS‐HD) study were included. Diagnoses were assigned using an algorithm (decision tree) verified by consensus review. Plasma samples were assayed using Simoa technology. Data were analyzed using ANOVA comparing the level of each biomarker across the cognitive diagnoses (Normal Cognition (NC), MCI & Dementia) within each ethnoracial group co‐varying age and sex.ResultFor NHW there were no significant differences between NC, MCI and Dementia groups in levels of Aβ40 or Aβ42. For t tau, MCI t tau was significantly higher than NC. The t tau level did not differ between the two cognitively impaired groups. There was a significant effect for diagnosis for NfL with the MCI NfL and the Dementia NfL level being significantly higher than the NC NfL level. The impaired groups did not differ in NfL between the impaired groups. For the MA significant differences across diagnoses were found only for NfL. The Dementia NfL level was significantly higher than the NC and significantly higher than the MCI. The only biomarker showing significant differences across diagnoses for AA was NfL. The Dementia NfL level was significantly higher than the NC and MCI levels.ConclusionAlthough cross‐sectional, the results suggest different patterns of plasma biomarkers across diagnoses for NHW as compared to MA and AA. NfL levels were highest in the Dementia group for all. Ongoing longitudinal research will show how biomarkers change as cognition declines.

Material Culture and Structural Violence: Reframing Evidence of the Social Gradient in Industrial Contexts.

Coal mining is an industry that historically has exposed laborers to a variety of environmental and occupational health hazards that have resulted in injury, illness, and/or physical disability. These health hazards, however, did not impact all laborers involved in coal mining equally. As a coal-mining company town organized with four distinct housing areas that correlate historically with the socioeconomic statuses of the jobs held at the colliery, Eckley Miners' Village provides a case study to explore how these health disparities were lived with and treated by residents of the industrial company town. Through an analysis of health-related material culture from house lots in two different sections of Eckley Miners' Village, evidence of the social gradient can be seen in the quality and quantity of medical ephemera present in the archaeological record. By utilizing archaeology, scholars can develop a longitudinal study of health disparities in the coal-mining towns of northeastern Pennsylvania. Examining contemporary health disparities requires tracing the historical foundations of these inequities, providing a critical space for archaeologists to contribute meaningful insights into the implications of social, political, and economic factors on exposure to health hazards and access to treatment materials.

Youth Assets, Neighborhood Factors, Parental Income, and Tobacco Use: A Longitudinal Study of Health Disparities.

This study aimed to assess how the relationship between youth assets and future no-tobacco use among youth might differ according to race/ethnicity, neighborhood factors and socio-economic status. Five waves of annual data were collected from 1111 youth/parent pairs living in Oklahoma, USA who were randomly selected to participate in the Youth Asset Study (YAS). A marginal logistic regression model using all five waves of no-tobacco use, demographics, and their interaction was used to compare the change in tobacco use over time. Among 1111 youth, (Mean age = 14.3; 53% female; 39% White, 28% Hispanic, 24% Black, and 9% other), the percentage of youth tobacco use increased significantly from baseline to wave 5 (4 years after baseline) for all racial/ethnic groups and all parental income groups. Assets were prospectively associated with no tobacco use in the past 30 days for Black, White and Hispanic youth and for youth in all income categories (adjusted odds ratio range = 1.9–2.7). There was one statistically significant association between the neighborhood environment and future no tobacco use. To conclude, the protective effects of youth assets in terms of prevention of tobacco use among youth do not differ by youth race/ethnicity or parental income in the presence of neighborhood environmental factors.

Characterizing Plasma Biomarkers of Alzheimer's in a Diverse Community-Based Cohort: A Cross-Sectional Study of the HAB-HD Cohort.

Due to their low cost, less invasive nature, and ready availability, plasma biomarkers of Alzheimer's disease have been proposed as one-time screening tools for clinical trials and research. The impact of ethnoracial factors on these biomarkers has received little attention. The current cross-sectional study investigated the levels of Aβ40, Aβ42, total tau (t tau), and neurofilament light (NfL) across diagnoses for each of the three major ethnoracial groups in the United States in a community-based cohort of older adults. A total of 1,862 participants (852 Mexican Americans (MAs); 775 non-Hispanic Whites (NHWs), and 235 African Americans (AAs)) drawn from The Health & Aging Brain Study-Health Disparities (HABS-HD) study were included. Diagnoses were assigned using an algorithm (decision tree) verified by consensus review. Plasma samples were assayed using Simoa technology. Levels of each biomarker were compared for the three ethnoracial groups across cognitive diagnoses using ANOVA covarying sex and age. Significant differences were found across the groups at each level of cognitive impairment. Cognitively unimpaired (CU) AA had significantly lower levels of each of the biomarkers than cognitively unimpaired MA or NHW and NHW had higher levels of Aβ40, and NfL than the other two groups. MA had higher t tau than AA or NHW. Mild cognitive impairment (MCI) group NHW had the highest levels on all the biomarkers and AA had the lowest. NHW and MA have higher levels of Aβ40, Aβ42, and t tau there was no difference between the groups for Aβ42. NHW had significantly higher levels of Aβ40, t tau, and NfL than AA. AA had a higher Aβ42/Aβ40 ratio than either NHW or MA for CU MCI. The use of plasma biomarkers of cognitive decline is promising given their advantages over other biomarkers such as CSF and imaging but as the current research shows, ethnoracial differences must be considered to enhance accuracy and utility. Developing ethnoracial-specific cut points and establishing normative ranges by assay platform for each of the biomarkers are needed. Longitudinal research to assess changes in biomarkers during a cognitive decline is ongoing.

Recommendations for Using Causal Diagrams to Study Racial Health Disparities.

There have been calls for race to be denounced as a biological variable and for a greater focus on racism, instead of solely race, when studying racial health disparities in the United States. These calls are grounded in extensive scholarship and the rationale that race is not a biological variable, but instead socially constructed, and that structural/institutional racism is a root cause of race-related health disparities. However, there remains a lack of clear guidance for how best to incorporate these assertions about race and racism into tools, such as causal diagrams, that are commonly used by epidemiologists to study population health. We provide clear recommendations for using causal diagrams to study racial health disparities that were informed by these calls. These recommendations consider a health disparity to be a difference in a health outcome that is related to social, environmental, or economic disadvantage. We present simplified causal diagrams to illustrate how to implement our recommendations. These diagrams can be modified based on the health outcome and hypotheses, or for other group-based differences in health also rooted in disadvantage (e.g., gender). Implementing our recommendations may lead to the publication of more rigorous and informative studies of racial health disparities.

Overall survival is the lowest among young women with postpartum breast cancer

BackgroundWomen diagnosed with breast cancer prior to age 45 years (<45y) and within the first 5 years postpartum (postpartum breast cancer, PPBC) have the greatest risk for distal metastatic recurrence. MethodsPooling data from the Colorado Young Women Breast Cancer cohort and the Breast Cancer Health Disparities Study (N = 2519 cases), we examined the association of parity, age, and clinical factors with overall survival (OS) of breast cancer over 15 years of follow-up. ResultsWomen with PPBC diagnosed at <45y had the lowest OS (p < 0.0001), while OS of nulliparous cases diagnosed at <45y did not differ from OS of cases diagnosed at 45-65y regardless of parity status. After adjustment for study site, race/ethnicity, clinical stage, year of diagnosis and stratification for oestrogen receptor status, PPBC remained an independent factor associated with poor OS. Among cases diagnosed at <45y, nulliparous cases had 1.6 times better OS (hazard ratio (HR) = 0.61, 95%CI 0.42–0.87) compared to those with PPBC, with a more pronounced survival difference among stage I breast cancers (HR = 0.30, 95%CI 0.11–0.79). Among very young women diagnosed at age ≤35y, nulliparous cases had 2.3 times better OS (HR = 0.44, 95%CI 0.23–0.84) compared to PPBC. ConclusionOur results suggest that postpartum status is the main driver of poor prognosis in young women with breast cancer, with the strongest association in patients diagnosed at age ≤35y and in those with stage I disease.

Disparities in Underlying Health Conditions and COVID-19 Infection and Mortality in Louisiana, USA.

BackgroundLouisiana is ranked among the top 10 states with the highest COVID-19 death rate in the USA, and African Americans (AA) that account 32.2% (1.5 million) of the state’s population have been impacted differentially with higher rates of chronic health conditions such as hypertension, obesity, and diabetes. These conditions can compromise immune systems and increase susceptibility to COVID-19. Prior health disparity and COVID-19 studies in Louisiana are limited to comprehensively evaluate the risk of underlying health conditions on COVID-19 incidence and death in minority communities and thus the study aims to address this research gap.MethodsNegative binomial regression analyses were used to correlate risk factors with COVID-19 incidence and death rates using SAS software. Spatial distribution and burden of COVID-19 incidence and mortality rates were mapped using ArcGIS Pro.ResultsWe found that AA COVID-19 death was three times higher than other races, and mortality rate was ten times higher in counties with more than 40% AA. Highest AA case and death counts were found in Orleans County; mortality rate in Bienville; and incidence rate in East Feliciana. Hypertension, diabetes, and obesity were significantly correlated with both COVID-19 incidence and mortality rates in AA. Greater odds of incidence and death rates also found in counties with higher AA population density with higher burden of underlying health conditions. Furthermore, living in poverty, being 65 years and older significantly influenced COVID-19 cases and deaths in the state.ConclusionsThe study highlights the need to reduce the burden of health disparities in underserved communities, and help to inform the public, scientific communities, and policy makers to plan effective responses to reduce the risks of COVID-19 infection, death, and other potential infectious diseases at the state.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40615-022-01268-9.

Exploring the relevance of intersectionality in Australian dietetics: Issues of diversity and representation

Through an exploration of the origins of dietetics in the West, and specifically in Australia, we problematise the lack of diversity within the profession through the lens of intersectionality. Dietetics in Australia continues to be dominated by Australian‐born women, and ideologies about dietitians perpetuate narratives of white, young, slim, women. Intersectional approaches to critiquing diversity in dietetics provides a useful framework to extend critical studies of health disparities into disparities in the dietetics professional workforce, which is advanced through structural, political and representational intersectionality guided critique. Through the analysis, a dialog is prompted in order to chart paths forward to find ‘how differences will find expression’ within the professional group. To do this, dietetics as a profession must reckon with its historical roots and step forward, out of a perceived position of objective neutrality regarding people and diversity, and into a position that can recognise that professional institutions have the power to exclude and marginalise, along with the power to include and transform.

Population-Level Patterns of Prostate Cancer Occurrence: Disparities in Virginia.

Prostate cancer is the most common cancer and the second leading cause of cancer-related deaths among men in the United States. In Virginia, which is a representative, ethnically diverse state of more than 8 million people that was established nearly 400 years ago, prostate cancer has the highest rate of new detection for any type of cancer. All men are at risk of developing prostate cancer regardless of demographics, but some men have an increased mortality risk due to cancer metastasis. Notably, one in five African American men will be diagnosed with prostate cancer in their lifetime and they have the highest prostate cancer mortality rate of any ethnic group in the United States, including Virginia. A person's genetic profile and family history are important biological determinants of prostate cancer risk, but modifiable environmental factors (e.g., pollution) appear to be correlated with patterns of disease prevalence and risk. In this review, we examine current perspectives on population-level spatial patterns of prostate cancer in Virginia. For context, recent, publicly available data from the Centers for Disease Control and Prevention are highlighted and presented in spatial format. In addition, we explore possible co-morbidities of prostate cancer that may have demographic underpinnings highlighted in recent health disparity studies.

A Systematic Review of Head and Neck Cancer Health Disparities: A Call for Innovative Research.

(1) Describe the existing head and neck cancer health disparities literature. (2) Contextualize these studies by using the NIMHD research framework (National Institute on Minority Health and Health Disparities). (3) Explore innovative ideas for further study and intervention. Ovid MEDLINE, Embase, Web of Science, and Google Scholar. Databases were systematically searched from inception to April 20, 2020. The PRISMA checklist was followed (Preferred Reporting Items for Systematic Reviews and Meta-analyses). Two authors reviewed all articles for inclusion. Extracted data included health disparity population and outcomes, study details, and main findings and recommendations. Articles were also classified per the NIMHD research framework. There were 148 articles included for final review. The majority (n = 104) focused on health disparities related to at least race/ethnicity. Greater than two-thirds of studies (n = 105) identified health disparities specific to health behaviors or clinical outcomes. Interaction between the individual domain of influence and the health system level of influence was most discussed (n = 99, 66.9%). Less than half of studies (n = 61) offered specific recommendations or interventions. There has been extensive study of health disparities for head and neck cancer, largely focusing on individual patient factors or health care access and quality. This review identifies gaps in this research, with large numbers of retrospective database studies and little discussion of potential contributors and explanations for these disparities. We recommend shifting research on disparities upstream toward a focus on community and societal factors, rather than individual, and an evaluation of interventions to promote health equity.

The knowns and unknowns of disparities, biology, and clinical outcomes in Hispanic and Latinx multiple myeloma patients in the U.S.

Multiple myeloma (MM) is a plasma cell malignancy that accounts for approximately a tenth of all blood cancers. The last two decades, have witnessed considerable improvement in survival rates driven by a better understanding of the biology of MM and the development of novel therapies to treat MM. Despite these advancements, MM remains an incurable disease. Marked disparities exist by race and ethnicity for MM, particularly a higher incidence and an earlier age of onset of MM among Non-Hispanic Black and Hispanic and Latinx individuals compared to Non-Hispanic Whites. Inequities in receipt and time to utilization of novel therapies and stem cell transplantation as well as participation in clinical trials have also been observed for Non-Hispanic Black and Hispanic and Latinx patients with a diagnosis of MM compared to Non-Hispanic White patients, yet Non-Hispanic Black patients have slightly better survival rates compared to Non-Hispanic White and Hispanic patients with MM. Most of the ongoing work to characterize and elucidate causes of these racial and ethnic disparities in MM etiology, outcomes, and treatment response compares Black and Non-Hispanic White individuals, with the Hispanic and Latinx population vastly understudied. Here, we provide an overview of the current state of knowledge on racial and ethnic differences in the epidemiology, biology, and clinical outcomes of patients with MM, with a special emphasis on Hispanic and Latinx individuals. We additionally discuss potential opportunities to consider for disparities research that includes Hispanic and Latinx patients with MM. Despite the encouraging progress in the study of health disparities in MM thus far, our review highlights the critical gaps that still remain to better understand MM in diverse populations and to develop more effective tools and approaches to provide all patients diagnosed with MM meaningful and transformative care.

Structural Racism and Quantitative Causal Inference: A Life Course Mediation Framework for Decomposing Racial Health Disparities.

Quantitative studies of racial health disparities often use static measures of self-reported race and conventional regression estimators, which critics argue is inconsistent with social-constructivist theories of race, racialization, and racism. We demonstrate an alternative counterfactual approach to explain how multiple racialized systems dynamically shape health over time, examining racial inequities in cardiometabolic risk in the National Longitudinal Study of Adolescent to Adult Health. This framework accounts for the dynamics of time-varying confounding and mediation that is required in operationalizing a "race" variable as part of a social process (racism) rather than a separable, individual characteristic. We decompose the observed disparity into three types of effects: a controlled direct effect ("unobserved racism"), proportions attributable to interaction ("racial discrimination"), and pure indirect effects ("emergent discrimination"). We discuss the limitations of counterfactual approaches while highlighting how they can be combined with critical theories to quantify how interlocking systems produce racial health inequities.

Abstract IA-17: Why study cancer health disparities globally: US and global perspectives

Abstract Despite many advances in cancer research, cancer health disparities have persisted globally. Cancer incidence and mortality rates are declining in most high income countries while low and middle income (LMIC) countries continue to experience an increase in the burden of cancer incidence and death rates. Furthermore, cancer research in many LMIC populations has been underrepresented and understudied in general which further exacerbates cancer health disparities in populations within those countries. Global cancer research contributes valuable data towards understanding and addressing cancer prevention and control in the United States, in particular cancer disparities faced by diverse populations including immigrant populations. The study of cancer health disparities globally also provides numerous opportunities to address disparities observed in different geographic regions around the world. This presentation highlights the significance of global cancer health disparities research US and global perspectives. Citation Format: Camille C.R. Ragin. Why study cancer health disparities globally: US and global perspectives [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr IA-17.

Critical Thoughts About Health Disparities With the NIA Division of Neuroscience

Population-based health disparities studies requires improved research design and appropriate research questions for investigation that will inform evidenced-based interventions and prevention strategies. The NIA Division of Neuroscience is committed to supporting new studies that 1) invests in health priorities as reflected by needs of minoritized populations (e.g. Race/Ethnic minorities; Rural or Sexual Gender Minorities); 2) examines Alzheimer’s Disease and cognitive changes across the individual lifespan; and 3) understands intersectionality of cohorts and minimize potential biases in participant selection. This brief session will outline updated steps to permit critical thought about the use of the NIA’s Health Disparities Framework to examine relevant biological, sociocultural, behavioral and environmental across multiple levels of influence.

Utility of combined plasma amyloid beta 40, amyloid beta 42, total tau, and NfL along with a measure of cognitive functioning in detecting cognitive impairment among Hispanic, Mexican Americans compared to non‐Hispanic whites

AbstractBackgroundThe AT(N) diagnostic framework for Alzheimer’s Disease (AD) highlights the importance of specific plasma biomarkers associated with neurodegeneration (Amyloid Beta, Tau) and neuronal injury (Neurofilament light chain [Nf‐L]). Despite a wealth of research on such plasma biomarkers of AD pathology, limited work has specifically been conducted among minority populations. Our study sought to examine a combination of AD biomarkers both alone and in combination with a select measure of cognition among Hispanic, Mexican Americans (MA) and Non‐Hispanics Whites (NHW) in detecting cognitive impairment.MethodPlasma samples were assayed on n=1703 participants (n= 890 MA [n=676 Normal Cognition [NC]; n=214 Cognitively Impaired [CI]]; n= 813 NHW [n=673 NC; n=140 CI]) enrolled in a study of health disparities. Plasma Amyloid Beta 40, Amyloid Beta 42, Total Tau, and Nf‐L were assayed using Simoa. A measure of verbal fluency (FAS) was utilized. The samples were randomly split (70/30) to allow for a training and test set. Random Forest (RF) models were conducted with performance on the test set reported.ResultAmong MA, AD biomarkers alone produced an area under the curve (AUC) of 0.50 with a sensitivity (SN) of 0.77 and specificity (SP) of 0.17. When the AD biomarkers were included along with a measure of verbal fluency (FAS)(biomarker‐cognitive profile), AUC increased to 0.63 with an SN of 0.82 and SP of 0.17. Inclusion of demographics (age, gender, education) to the biomarker‐cognitive profile increased only SP, which reached 0.50. Among NHW, AD biomarkers alone produced an AUC of 0.35 with SN of 0.88 and SP of 0.74. The combined biomarker‐cognitive profile increased AUC to 0.66 with an SN of 0.42 and SP of 0.81. The addition of demographics further increased AUC to 0.72 (SN=0.53; SP=0.88).ConclusionDetection accuracy differed by ethnicity with a broader range shown among NHW (AUCs 0.35‐0.72) compared to MA (AUCs 0.50‐0.63). Utility of AD plasma biomarkers improved with the addition of a select cognitive measure. This is consistent with prior work showing the application of a combined model (biomarker‐cognitive profile) to distinguish those with cognitive impairment. The addition of demographic factors improved the detection only for NHW.

The roles atherosclerotic cardiovascular disease risk and depression on cognitive outcomes in Mexican Americans and non‐Hispanic whites

AbstractBackgroundMexican Americans (MA) experience cognitive decline at younger ages and have higher rates of cardiovascular disease (CVD) than Non‐Hispanic whites (NHW). Persons who are depressed are more likely to have one or more risk factors for cardiovascular disease. The purpose of this study was to examine the impact of depression and Atherosclerotic Cardiovascular Disease (ASCVD) on cognitive function in MA and NHW.MethodData was collected from the Health and Aging Brain Study: Health Disparities (HABS‐HD) study. A total of 1094 participants who were classified as normal controls were stratified into 4 groups: no depression and low risk ASCVD (N= 684), no depression and high risk ASCVD (N= 222), depression and low risk ASCVD (N=140), and depression and high risk ASCVD (N=48). Depressive symptoms were assessed via Geriatric Depression Scale (GDS). ASCVD risk was calculated using a risk calculator. One‐way ANOVAs were conducted to examine differences in cognitive performance based on ASCVD risk and depression.ResultThe results showed that depressed NHW and MA males with a low ASCVD risk had significantly lower mean scores on Trail Making Test A than the non‐depressed with low ASCVD risk group (p &lt; 0.006), (p &lt; 0.017). Depressed MA males with high ASCVD risk had significantly lower mean scores on the MMSE than the non‐depressed low ASCVD risk group (p &lt; 0.00). Depressed NHW females with low ASCVD risk had significantly lower mean scores on delayed memory than the non‐depressed low ASCVD risk group (p &lt; 0.008). Depressed MA females with a high ASCVD risk demonstrated significantly lower mean scores on the COWA and SEVLT Trials 1‐5 and the non‐depressed low ASCVD risk group (p &lt; 0.002), (p &lt; 0.046).ConclusionThe results of this study indicated that depression and risk of ASCVD can impact cognitive functioning in different ways. In men depression impacted scores on Trails A. In MA women comorbid depression and high risk for ASCVD affect scores on the COWA and SEVLT. These findings support that medical comorbidities influence cognitive function. Future research directions include exploring the relationships between other CVD risk factors and depression.

Factors influencing intent to receive COVID-19 vaccination among Black and White adults in the southeastern United States, October – December 2020

ABSTRACT Vaccination intent is foundational for effective COVID-19 vaccine campaigns. To understand factors and attitudes influencing COVID-19 vaccination intent in Black and White adults in the US south, we conducted a mixed-methods cross-sectional survey of 4512 adults enrolled in the Southern Community Cohort Study (SCCS), an ongoing study of racial and economic health disparities. Vaccination intent was measured as “If a vaccine to prevent COVID-19 became available to you, how likely are you to choose to get the COVID-19 vaccination?” with options of “very unlikely,” “somewhat unlikely,” “neither unlikely nor likely,” “somewhat likely,” and “very likely.” Reasons for intent, socio-demographic factors, preventive behaviors, and other factors were collected. 46% of participants had uncertain or low intent. Lower intent was associated with female gender, younger age, Black race, more spiritual/religious, lower perceived COVID-19 susceptibility, living in a greater deprivation area, lower reading ability, and lack of confidence in childhood vaccine safety or COVID-19 vaccine effectiveness or safety (p < .05 for all). Most factors were present in all racial/gender groups. Contextual influences, vaccine/vaccination specific issues, and personal/group influences were identified as reasons for low intent. Reasons for higher intent included preventing serious illness, life returning to normal, and recommendation of trusted messengers. Hesitancy was complex, suggesting tailored interventions may be required to address low intent.

Assessing Racial and Ethnic Discrimination in Children: A Scoping Review of Available Measures for Child Health Disparities Research.

Objectives: To characterize the availability, content, and psychometric properties of self-reported measures that assess race/ethnicity-related discrimination or psychosocial stress and have potential relevance to studies of health disparities in children and adolescents.Design: Using PRISMA extension guidelines for scoping reviews, we searched Ovid Medline, CINAHL, PsychInfo, and Scopus databases from 1946 to April 20, 2020, using the search terms “stress,” “child,” “adolescents,” “discrimination,” and “psychometrics.” We limited the search to articles in English, with children and adolescents, in the United States. For each measure, we extracted information about the content, reliability, and construct validity.Results: The 12 measures that met inclusion criteria assessed discrimination or stress from racial discrimination in African American children and adolescents (n=8), acculturative stress in Hispanic/Latino children (n=1), or bicultural stress in Mexican American adolescents (n=2), and one measure assessed both discrimination-related and acculturative stress in Hispanic/Latino children. The majority (n=7) articles were published between 2001 and 2010. All discrimination measures evaluated individual experiences of discrimination and one also evaluated stressfulness of discrimination and coping. The acculturative stress measures assessed general stress and immigration-related discrimination, and the bicultural stress measures evaluated many different aspects of biculturalism.Conclusions: Despite the recent increased interest in the racial discrimination and stress as a contributor to racial or ethnic health disparities affecting U.S. children and adolescents, the small number of eligible measures identified and incomplete coverage of various types of racial and ethnic discrimination within and across population groups indicates a currently inadequate capacity to conduct child health disparity studies on this issue.

Selection, experience, and disadvantage: Examining sources of health inequalities among naturalized US citizens

ObjectivesWe integrated major theories in immigrant health and assimilation into a single analytical framework to quantify the degrees to which demographic composition, pathways to citizenship, and socioeconomic assimilation account for physical and mental health disparities between naturalized immigrants by region of origin. MethodsUsing the restricted data from the 2015–2016 California Health Interview Survey, we decomposed differences in physical and mental health into demographic factors, path to citizenship, and socioeconomic characteristics by region of origin using the Karlson, Holm, and Breen (KHB) method. ResultsDifferences in socioeconomic status mediated most of the disparity in physical health between naturalized immigrants from different regions. Factors associated with major immigrant health theories—demographic composition, pathways to citizenship, and socioeconomic assimilation—did not mediate disparities in mental health. ConclusionThis article argues that the study of health disparities among immigrants must simultaneously account for differences in demographic composition, immigration experience, and socioeconomic disadvantage. The findings also underscore the need for theory development that can better explain mental health disparities among immigrants.

Comparison of Radiomic Features in a Diverse Cohort of Patients With Pancreatic Ductal Adenocarcinomas.

BackgroundSignificant racial disparities in pancreatic cancer incidence and mortality rates exist, with the highest rates in African Americans compared to Non-Hispanic Whites and Hispanic/Latinx populations. Computer-derived quantitative imaging or “radiomic” features may serve as non-invasive surrogates for underlying biological factors and heterogeneity that characterize pancreatic tumors from African Americans, yet studies are lacking in this area. The objective of this pilot study was to determine if the radiomic tumor profile extracted from pretreatment computed tomography (CT) images differs between African Americans, Non-Hispanic Whites, and Hispanic/Latinx with pancreatic cancer.MethodsWe evaluated a retrospective cohort of 71 pancreatic cancer cases (23 African American, 33 Non-Hispanic White, and 15 Hispanic/Latinx) who underwent pretreatment CT imaging at Moffitt Cancer Center and Research Institute. Whole lesion semi-automated segmentation was performed on each slice of the lesion on all pretreatment venous phase CT exams using Healthmyne Software (Healthmyne, Madison, WI, USA) to generate a volume of interest. To reduce feature dimensionality, 135 highly relevant non-texture and texture features were extracted from each segmented lesion and analyzed for each volume of interest.ResultsThirty features were identified and significantly associated with race/ethnicity based on Kruskal-Wallis test. Ten of the radiomic features were highly associated with race/ethnicity independent of tumor grade, including sphericity, volumetric mean Hounsfield units (HU), minimum HU, coefficient of variation HU, four gray level texture features, and two wavelet texture features. A radiomic signature summarized by the first principal component partially differentiated African American from non-African American tumors (area underneath the curve = 0.80). Poorer survival among African Americans compared to Non-African Americans was observed for tumors with lower volumetric mean CT [HR: 3.90 (95% CI:1.19–12.78), p=0.024], lower GLCM Avg Column Mean [HR:4.75 (95% CI: 1.44,15.37), p=0.010], and higher GLCM Cluster Tendency [HR:3.36 (95% CI: 1.06–10.68), p=0.040], and associations persisted in volumetric mean CT and GLCM Avg Column after adjustment for key clinicopathologic factors.ConclusionsThis pilot study identified several textural radiomics features associated with poor overall survival among African Americans with PDAC, independent of other prognostic factors such as grade. Our findings suggest that CT radiomic features may serve as surrogates for underlying biological factors and add value in predicting clinical outcomes when integrated with other parameters in ongoing and future studies of cancer health disparities.