Browsing by Subject "Health disparities"
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Item A cortactin CTTN coding SNP contributes to lung vascular permeability and inflammatory disease severity in African descent subject(Elsevier, 2022) Belvitch, Patrick; Casanova, Nancy; Sun, Xiaoguang; Camp, Sara M.; Sammani, Saad; Brown, Mary E.; Mascarhenas, Joseph; Lynn, Heather; Adyshev, Djanybek; Siegler, Jessica; Desai, Ankit; Seyed-Saadat, Laleh; Rizzo, Alicia; Bime, Christian; Shekhawat, Gajendra S.; Dravid, Vinayak P.; Reilly, John P.; Jones, Tiffanie K.; Feng, Rui; Letsiou, Eleftheria; Meyer, Nuala J.; Ellis, Nathan; Garcia, Joe G. N.; Dudek, Steven M.; Medicine, School of MedicineThe cortactin gene (CTTN), encoding an actin-binding protein critically involved in cytoskeletal dynamics and endothelial cell (EC) barrier integrity, contains single nucleotide polymorphisms (SNPs) associated with severe asthma in Black patients. As loss of lung EC integrity is a major driver of mortality in the Acute Respiratory Distress Syndrome (ARDS), sepsis, and the acute chest syndrome (ACS), we speculated CTTN SNPs that alter EC barrier function will associate with clinical outcomes from these types of conditions in Black patients. In case-control studies, evaluation of a nonsynonymous CTTN coding SNP Ser484Asn (rs56162978, G/A) in a severe sepsis cohort (725 Black subjects) revealed significant association with increased risk of sepsis mortality. In a separate cohort of sickle cell disease (SCD) subjects with and without ACS (177 SCD Black subjects), significantly increased risk of ACS and increased ACS severity (need for mechanical ventilation) was observed in carriers of the A allele. Human lung EC expressing the cortactin S484N transgene exhibited: (i) delayed EC barrier recovery following thrombin-induced permeability; (ii) reduced levels of critical Tyr486 cortactin phosphorylation; (iii) inhibited binding to the cytoskeletal regulator, nmMLCK; and (iv) attenuated EC barrier-promoting lamellipodia dynamics and biophysical responses. ARDS-challenged Cttn+/- heterozygous mice exhibited increased lung vascular permeability (compared to wild-type mice) which was significantly attenuated by IV delivery of liposomes encargoed with CTTN WT transgene but not by CTTN S484N transgene. In summary, these studies suggest that the CTTN S484N coding SNP contributes to severity of inflammatory injury in Black patients, potentially via delayed vascular barrier restoration.Item Addressing Disparities through TCOM Strategies(2016-11) Walton, Betty A.; Harrold, WendyWhile America is rapidly become more diverse, the human service workforce is changing more slowly. Behavioral health disparities in accessing appropriate services and in outcomes are well documented. Can TCOM strategies be leveraged to address these issues? Combining existing information (insurance claim and workforce data) with TCOM information clarifies local challenges and provides a framework to monitor progress. Moving beyond considerations of gender and age, possible access issues and lower or disrupted service use may be reflected in differences in service utilization by language, race, and ethnicity. Exploring available information can identify access and/or engagement and systematic reporting issues. Implementing recommended TCOM reports provides tools to help identify disparities in behavioral health outcomes for programs and services by geography and demographics. In reviewing outcome management reports for teenagers and transition age youth, questions arise about the significance of observed differences. In response, a predictive analysis using ANSA data asks if age, gender, race, ethnicity, current personal recovery factors (strengths and recreation), or the identification of cultural or linguistic challenges predict resolving actionable needs over time. Routinely monitoring differences in access and outcomes is recommended as a TCOM quality improvement process.Item An Organizing Opportunity to Change the World(Elsevier, 2023) Lewsey, Sabra C.; Bisonó, Janina Quintero; Breathett, Khadijah; Medicine, School of MedicineItem Analysis of COVID-19 Case Demographics and Disease Outcomes in Gary, Indiana(MDPI, 2023-09-07) Sabir, Maryam; Al-Tarshan, Yazan; Snapp, Cameron; Brown, Martin; Walker, Roland; Han, Amy; Kostrominova, Tatiana; Psychiatry, School of MedicineBackground: The COVID-19 pandemic further exposed the prevalence of existing health disparities in Black communities in the U.S. The current study evaluates COVID-19 data collected in Gary, Indiana, from June 2020 to June 2021. We hypothesized that the number of COVID-19 cases, hospitalizations, and deaths were influenced by race and income. Methods: In collaboration with the Gary Health Department (GHD), we analyzed demographic data on COVID-19-positive cases. Results: Compared to Gary's non-Black population, age- and population-adjusted rates of hospitalizations and deaths in the Black population were 3-fold (p < 0.0001) and 2-fold (p < 0.05) higher, respectively. This is despite a higher infection rate (p < 0.0001) in the non-Black population. The median household income of a zip code was negatively correlated with COVID-19 hospitalizations (R2 = 0.6345, p = 0.03), but did not correlate with infections and deaths. Conclusions: The current study demonstrates clear health disparities of income and race in the context of COVID-19-related infections and outcomes in the city of Gary. Indiana University School of Medicine Northwest and GHD officials can collaborate to utilize these data for the reallocation of resources and health education efforts in Gary's highly populated, low-income, and predominantly Black neighborhoods. It should also prompt further investigation into national health resource allocation.Item Analyzing Chlamydia and Gonorrhea Health Disparities from Health Information Systems: A Closer Examination Using Spatial Statistics and Geographical Information Systems(2022-05) Lai, Patrick T. S.; Jones, Josette; Dixon, Brian E.; Wilson, Jeffrey; Wu, Huanmei; Shih, PatrickThe emergence and development of electronic health records have contributed to an abundance of patient data that can greatly be used and analyzed to promote health outcomes and even eliminate health disparities. However, challenges exist in the data received with factors such as data inconsistencies, accuracy issues, and unstructured formatting being evident. Furthermore, the current electronic health records and clinical information systems that are present do not contain the social determinants of health that may enhance our understanding of the characteristics and mechanisms of disease risk and transmission as well as health disparities research. Linkage to external population health databases to incorporate these social determinants of health is often necessary. This study provides an opportunity to identify and analyze health disparities using geographical information systems on two important sexually transmitted diseases in chlamydia and gonorrhea using Marion County, Indiana as the geographical location of interest. Population health data from the Social Assets and Vulnerabilities Indicators community information system and electronic health record data from the Indiana Network for Patient Care will be merged to measure the distribution and variability of greatest chlamydia and gonorrhea risk and to determine where the greatest areas of health disparities exist. A series of both statistical and spatial statistical methods such as a longitudinal measurement of health disparity through the Gini index, a hot-spot and cluster analysis, and a geographically weighted regression will be conducted in this study. The outcome and broader impact of this research will contribute to enhanced surveillance and increased effective strategies in identifying the level of health disparities for sexually transmitted diseases in vulnerable localities and high-risk communities. Additionally, the findings from this study will lead to improved standardization and accuracy in data collection to facilitate subsequent studies involving multiple disparate data sources. Finally, this study will likely introduce ideas for potential social determinants of health to be incorporated into electronic health records and clinical information systems.Item The Association between Incarceration and Transactional Sex among HIV-infected Young Men Who Have Sex with Men in the United States(Springer Nature, 2018-08) Philbin, Morgan M.; Kinnard, Elizabeth N.; Tanner, Amanda E.; Ware, Samuella; Chambers, Brittany D.; Ma, Alice; Fortenberry, J. Dennis; Pediatrics, School of MedicineCriminal justice practices in the USA disproportionately affect sexual and racial/ethnic minority men, who are at higher risk of incarceration. Previous research demonstrates associations between incarceration and sexual risk behaviors for men who have sex with men (MSM). However, little of this work focuses on young MSM (YMSM), particularly HIV-infected YMSM, despite nearly one-third reporting engagement in sexual risk behaviors, such as transactional sex. We therefore explored the association between incarceration and transactional sex among HIV-infected YMSM. We recruited 97 HIV-infected YMSM across 14 clinical sites in urban centers from August 2015 to February 2016. We used multivariate logistic regression to examine the relationship between incarceration and transactional sex among YMSM. The majority was 24 years old (78%) and racial/ethnic minority (95%); over half were not in school and reported an annual income of < $12,000. In the multivariate model, having ever been incarcerated (aOR = 3.20; 95% CI 1.07–9.63) was independently associated with a history of transactional sex. Being 24 years vs. younger (aOR = 9.68; 95% CI 1.42–65.78) and having ever been homeless (aOR = 3.71, 95% CI 1.18–11.65) also remained independently associated with a history of transactional sex. This analysis fills a gap in the literature by examining the relationship between incarceration and transactional sex among HIV-infected YMSM. Facilitating youths’ engagement with social services available in their HIV clinic may serve as a key strategy in promoting health. Public health efforts need to address social-structural factors driving disproportionate rates of arrest and incarceration and related harms among this population.Item Association Between the Affordable Care Act Medicaid Expansion and Receipt of Cardiac Resynchronization Therapy by Race and Ethnicity(American Heart Association, 2022) Mwansa, Hunter; Barry, Ibrahim; Knapp, Shannon M.; Mazimba, Sula; Calhoun, Elizabeth; Sweitzer, Nancy K.; Breathett, Khadijah; Medicine, School of MedicineBackground: Black and Hispanic patients are less likely to receive cardiac resynchronization therapy (CRT) than White patients. Medicaid expansion has been associated with increased access to cardiovascular care among racial and ethnic groups with higher prevalence of underinsurance. It is unknown whether the Medicaid expansion was associated with increased receipt of CRT by race and ethnicity. Methods and Results: Using Healthcare Cost and Utilization Project Data State Inpatient Databases from 19 states and Washington, DC, we analyzed 1061 patients from early‐adopter states (Medicaid expansion by January 2014) and 745 patients from nonadopter states (no implementation 2013–2014). Estimates of change in census‐adjusted rates of CRT with or without defibrillator by race and ethnicity and Medicaid adopter status 1 year before and after January 2014 were conducted using a quasi‐Poisson regression model. Following the Medicaid expansion, the rate of CRT did not significantly change among Black individuals from early‐adopter states (1.07 [95% CI, 0.78–1.48]) or nonadopter states (0.79 [95% CI, 0.57–1.09]). There were no significant changes in rates of CRT among Hispanic individuals from early‐adopter states (0.99 [95% CI, 0.70–1.38]) or nonadopter states (1.01 [95% CI, 0.65–1.57]). There was a 34% increase in CRT rates among White individuals from early‐adopter states (1.34 [95% CI, 1.05–1.70]), and no significant change among White individuals from nonadopter states (0.77 [95% CI, 0.59–1.02]). The change in CRT rates among White individuals was associated with the timing of the Medicaid implementation (P=0.003). Conclusions: Among states participating in Healthcare Cost and Utilization Project Data State Inpatient Databases, implementation of Medicaid expansion was associated with increase in CRT rates among White individuals residing in states that adopted the Medicaid expansion policy. Further work is needed to address disparities in CRT among Black and Hispanic patients.Item Barriers and facilitators to participating in Alzheimer’s disease biomarker research in Black and White older adults(Wiley, 2023-06-05) Eliacin, Johanne; Polsinelli, Angelina J.; Epperson, Francine; Gao, Sujuan; Van Heiden, Sarah; Westmoreland, Glenda; Richards, Ralph; Richards, Mollie; Campbell, Christopher; Hendrie, Hugh; Risacher, Shannon L.; Saykin, Andrew J.; Wang, Sophia; Medicine, School of MedicineIntroduction: The study examined Black and White prospective participants' views of barriers to and facilitators of participation in Alzheimer's disease (AD) biomarker research. Methods: In a mixed-methods study, 399 community-dwelling Black and White older adults (age ≥55) who had never participated in AD research completed a survey about their perceptions of AD biomarker research. Individuals from lower socioeconomic and education backgrounds and Black men were over-sampled to address perspectives of traditionally under-represented groups. A subset of participants (n = 29) completed qualitative interviews. Results: Most participants expressed interest in biomarker research (overall 69%). However, Black participants were comparatively more hesitant than White participants (28.9% vs 15.1%), were more concerned about study risks (28.9% vs 15.1%), and perceived multiple barriers to participating in brain scans. These results persisted even after adjusting for trust and perceived knowledge of AD. Information was a primary barrier (when absent) and incentive (when provided) for AD biomarker research participation. Black older adults desired more information about AD (eg, risk, prevention), general research processes, and specific biomarker procedures. They also desired return of results to make informed decisions about their health, research-sponsored community awareness events, and for researchers to mitigate the burden placed on participants in research (eg, transportation, basic needs). Conclusion: Our findings increase representativeness in the literature by focusing on individuals with no history of AD research experience and those from traditionally underrepresented groups in research. Results suggest that the research community needs to improve information sharing and raising awareness, increase their presence in the communities of underrepresented groups, reduce incidental costs, and provide valuable personal health information to participants to increase interest. Specific recommendations for improving recruitment are addressed. Future studies will assess the implementation of evidence-based, socioculturally sensitive recruitment strategies to increase enrollment of Black older adults into AD biomarker studies. HIGHLIGHTS: Individuals from under-represented groups are interested in Alzheimer's disease (AD) biomarker research. After adjusting for trust and AD knowledge, Black participants were still more hesitant .Information is a barrier (when absent) to and incentive (when given) for biomarker studies. Reducing burden (e.g., transportation) is essential for recruiting Black older adults.Item Bias in pain care: What patient variables do providers report as influencing their treatment decisions?(2024-10) Rose-McCandlish, Margaret; Hirsh, Adam; Mosher, Catherine; Stewart, JesseRacialized and low socioeconomic status (SES) patients are often under-treated for chronic pain, despite reporting more pain on average. This disparity is likely due to multiple systemic factors, including healthcare provider bias. Providers often treat patients differently for chronic pain depending on the patient’s race and SES, but little is known about providers’ awareness of the extent to which patient demographic variables influence their pain treatment decisions. The present study examined the variables that providers report as influencing their pain treatment decisions, whether these variables group together to form distinct factors, and whether providers who demonstrate racial or socioeconomic bias in their treatment decisions report different patient variables or factors as influencing their treatment decisions compared to providers who did not demonstrate biases. Four hundred thirty-two United States-based physician residents and fellows (“providers”) made treatment decisions for 12 computer-simulated patients with chronic pain who varied by race (Black/White) and SES (high/low). Providers then rated the level to which 15 different variables influenced their treatment decision-making. Robust repeated measures ANOVAs indicated that providers rated patient sex/gender, age, and race as the least influential variables in their pain treatment decisions for the simulated patients. For the factor analysis, I sequentially omitted variables to achieve proper model fit and reliability and arrived at a three-factor solution; I labelled these factors Demographic, Biomedical, and Psychosocial, according to the variables’ conceptual overlap. Robust repeated measures ANOVAs found that reported use of variables did not differ between the providers who demonstrated bias and those who did not demonstrate bias, nor did factor scores for the three factors. The present study suggests that providers have low awareness of the extent to which patient race and SES may influence their clinical decision-making in pain care. Results can help inform future research to improve interventions to reduce the impact of racial and socioeconomic bias on providers’ treatment decisions for patients with chronic pain.Item Black vs African American: Why are communication and clinical researchers not paying attention to what descendants of the African Diaspora want to be called, and why is that a problem?(Indiana Medical Student Program for Research and Scholarship (IMPRS), 2020) Owusu, Raiven; Ridley-Merriweather, Katherine; Hoffmann-Longtin, KristaProblem: Descendants of African Diaspora (DADs) in the U.S. experience greater health disparities than other racial or ethnic minority groups. Many factors play a role, including their lack of participation in clinical trials. By refusing to participate, DADs cannot benefit from medical research. The barriers to recruiting DADs is well discussed in literature, but we found no research suggesting that mislabeling participants could be creating another barrier. This essay delves into the history of labeling DADs to illuminate the existing tensions between the use of “Black” and “African American” and the impact they may have on recruitment. Processes: Communication Theory of Identity and Critical Race Theory shaped our analysis of this mislabeling issue and its possible implications. Both theories offer insight into how an individual shapes and is simultaneously shaped by communication. We reviewed, summarized, and coded literature in the academic and popular press to answer the research question: How can mislabeling DADs possibly deter them from participating in clinical trials? Findings: Within DADs, there are several subgroups with different cultural heritages that contribute to how people identify. Therefore, no “catch-all” label can be used to accurately describe DADs. Academic and popular press literature indicate that preferences exist amongst this group for how they wish to be identified. Researchers should realize that “Black” and “African American” are not perceived the same by many DADs and should refrain from using them interchangeably. Conclusion: Given the current Black Lives Matter movement, it is imperative that health communication scholars and health researchers consider how language shapes participation and research outcomes for DADs. More research is needed to determine if the use of “Black” and “African American” interchangeably creates another barrier to the recruitment of DADs. However, if possible, researchers should take time to note the preferences of their target populations prior to recruitment.