Browsing by Subject "Racial disparity"

Now showing 1 - 6 of 6
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    Geographic Differences in Racial Disparities in Access to Kidney Transplantation
    (Elsevier, 2023-08-11) McPherson, Laura J.; Di, Mengyu; Adams, Ayrenne A.; Plantinga, Laura; Pastan, Stephen O.; Patzer, Rachel E.; Surgery, School of Medicine
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    Potential Health Disparities in the Early Detection and Prevention of Pancreatic Cancer
    (Springer Nature, 2024-05-13) Yip-Schneider, Michele T.; Muraru, Rodica; Rao, Nikita; Kim, Rachel C.; Rempala-Kurucz, Jennifer; Baril, Jackson A.; Roch, Alexandra M.; Schmidt, C. Max; Surgery, School of Medicine
    Introduction: Pancreatic cancer remains one of the deadliest cancers in the United States. Some types of pancreatic cysts, which are being detected more frequently and often incidentally on imaging, have the potential to develop into pancreatic cancer and thus provide a valuable window of opportunity for cancer interception. Although racial disparity in pancreatic cancer has been described, little is known regarding health disparities in pancreatic cancer prevention. In the present study, we investigate potential health disparities along the continuum of care for pancreatic cancer. Methods: The racial and ethnic composition of pancreatic patients at high-volume centers in Indiana were evaluated, representing patients undergoing surgery for pancreatic cancer (n=390), participating in biobanking (972 pancreatic cancer patients and 1984 patients with pancreatic disease), or being monitored for pancreatic cysts at an early detection center (n=1514). To assess racial disparities and potential differences in decision-making related to pancreatic cancer prevention and early detection, an exploratory online survey was administered through a volunteer registry (n=708). Results: We show that despite comprising close to 10% or 30% of the Indiana or Indianapolis population, respectively, African Americans make up only about 4-5% of our study cohorts consisting of patients undergoing pancreatic surgery or participating in biobanking and early detection. Analysis of online survey results revealed that given the hypothetical situation of being diagnosed with a pancreatic cyst or pancreatic cancer, the vast majority of respondents (>90%) would agree to undergo surveillance or surgery, respectively, regardless of race. Only a minority (3-12%) acknowledged any significant transportation, financial, or emotional barriers that would impact a decision to undergo surveillance or surgery. This suggests that the observed racial disparities may be due in part to the existence of other barriers that lie upstream of this decision point. Conclusion: Racial disparities exist not only for pancreatic cancer but also at earlier points along the continuum of care such as prevention and early detection. To our knowledge, this is the first study to document racial disparity in the management of patients with pancreatic cysts who are at risk of developing pancreatic cancer. Our results suggest that improving access to information and care for such at-risk individuals may lead to more equitable outcomes.
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    Racial Disparities in Liver Transplantation for Hepatocellular Carcinoma Are Not Explained by Differences in Comorbidities, Liver Disease Severity, or Tumor Burden
    (Wiley, 2018-12-03) Dakhoul, Lara; Gawrieh, Samer; Jones, Keaton R.; Ghabril, Marwan; McShane, Chelsey; Orman, Eric; Vilar‐Gomez, Eduardo; Chalasani, Naga; Nephew, Lauren; Medicine, School of Medicine
    Black patients have higher mortality and are less likely to receive liver transplantation for hepatocellular carcinoma (HCC) than white patients. Reasons for these disparities have not been fully elucidated. Comorbid disease, liver disease severity, cirrhosis etiologies, and tumor characteristics were compared between black and white patients with HCC seen at the Indiana University Academic Medical Center from January 2000 to June 2014. Logistic regression was used to investigate the primary outcome, which was liver transplantation. Log-rank testing was used to compare survival between the two groups. Subgroup analysis explored reasons for failure to undergo liver transplantation in patients within Milan criteria. The cohort included 1,032 (86%) white and 164 (14%) black patients. Black and white patients had similar Model for End-Stage Liver Disease (MELD) and Child-Pugh scores (CPSs). There was a trend toward larger tumor size (5.3 cm versus 4.7 cm; P = 0.05) in black patients; however, Barcelona Clinic Liver Cancer (BCLC) staging and Milan criteria were similar. Black patients were less likely to undergo liver transplantation than white patients; this was a disparity that was not attenuated (odds ratio [OR], 0.43; 95% confidence interval [CI], 0.21-0.90) on multivariable analysis. Substance abuse was more frequently cited as the reason black patients within Milan criteria failed to undergo transplantation compared to white patients. Survival was similar between the two groups. Conclusion: Racial differences in patient and tumor characteristics were small and did not explain the disparity in liver transplantation. Higher rates of substance abuse in black patients within Milan criteria who failed to undergo transplantation suggest social factors contribute to this disparity in this cohort.
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    Sexual identity development and sexual well-being: differences between racial/ethnic minority and non-racial/ethnic minority former foster youth
    (Taylor & Francis, 2023) Brandon-Friedman, Richard A.
    Little research has examined if there are differences in sexual well-being, negative sexual health outcomes, or levels of sexual identity development between racial/ethnic minority and non-racial/ethnic minority youth in the foster care system. Using a sample of youth formerly in the foster care system (n = 219), this study compared the sexual well-being, sexual identity development, and negative sexual health outcomes of racial/ethnic minority and non-racial/ethnic minority youth and found that racial/ethnic minority and non-racial/ethnic minority youth did not differ in overall levels of sexual well-being and had no significant differences in their levels of sexual identity development. There were differences in incidence of the youth or a partner having an STI/STD. These results indicate that there are few differences in sexual well-being, negative sexual health outcomes, or sexual identity development between racial/ethnic minority and non-racial/ethnic minority youth formerly in the foster care system. All four domains of sexual identity development predicted sexual well-being for non-racial/ethnic minority youth, but sexual orientation identity uncertainty did not predict sexual well-being for racial/ethnic minority youth, emphasizing the importance of sexual identity development. Attention to the sexual development and sexual health of youth in the foster care system continues to be lacking and should be expanded.
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    Trends and racial disparities in aggressive end of life care for a national sample of women with ovarian cancer
    (Wiley, 2021) Mullins, Megan A.; Ruterbusch, Julie J.; Clarke, Philippa; Uppal, Shitanshu; Wallner, Lauren P.; Cote, Michele L.; Epidemiology, Richard M. Fairbanks School of Public Health
    Background: The clinical landscape has moved toward less aggressive end-of-life care for women with ovarian cancer. However, whether there has been a decline in the use of aggressive end-of-life services is unknown. The authors evaluated current national trends and racial disparities in end-of-life care among women with ovarian cancer using the Surveillance, Epidemiology, and End Results-Medicare-linked data set. Methods: In total, 7756 Medicare beneficiaries aged >66 years with ovarian cancer who died between 2007 and 2016 were identified. The authors examined trends and racial disparities in late hospice or no hospice use, >1 emergency department (ED) visit, intensive care unit admission, >1 hospitalization, terminal hospitalization, chemotherapy, and invasive and/or life-extending procedures using multivariable logistic regression. Results: The median hospice length of stay did not change over time; however, women were increasingly admitted to the intensive care unit and had multiple ED visits in the last month of life (P < .001). Not enrolling in hospice at the end of life and terminal hospitalizations decreased over time (P < .001). Non-White women were more likely to receive aggressive end-of-life care, particularly for hospital-related utilization and life-extending procedures, whereas non-Hispanic Black women were more likely to have >1 ED visit (odds ratio, 2.04; 95% CI, 1.57-2.64) or life-extending procedures (odds ratio, 1.89; 95% CI, 1.45-2.48) compared with non-Hispanic White women. Conclusions: Despite clinical guidelines and increasing emphasis on reducing aggressive end-of-life care, the use of aggressive end-of-life care for women with ovarian cancer persists, and care is most aggressive for non-White women.
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    Vascular-brain Injury Progression after Stroke (VIPS) Study: concept for understanding racial and geographic determinants of cognitive decline after stroke
    (Elsevier, 2020) Sarfo, Fred Stephen; Akinyemi, Rufus; Howard, George; Howard, Virginia J.; Wahab, Kolawole; Cushman, Mary; Levine, Deborah A.; Ogunniyi, Adesola; Unverzagt, Fred; Owolabi, Mayowa; Ovbiagele, Bruce; Psychiatry, School of Medicine
    Cognitive impairment and dementia (CID) are major public health problems with substantial personal, social, and financial burdens. African Americans are at a heightened risk for Vascular Cognitive Impairment (VCI) compared to European Americans. Recent lines of evidence also suggest a high burden of Post-stroke VCI among indigenous Africans. A better understanding of the cause(s) of the racial disparity in CID, specifically VCI, is needed in order to develop strategies to reduce it. We propose and discuss the conceptual framework for a unique tri-population, trans-continental study titled The Vascular brain Injury Progression after Stroke (VIPS) study. The overarching objective of the VIPS Study will be to explore the interplay of multiple factors (racial, geographical, vascular, lifestyle, nutritional, psychosocial and inflammatory) influencing the level and trajectory of post-stroke cognitive outcomes and examine whether differences between indigenous Africans, African Americans and European Americans exist. We hypothesize that differences which might be due to racial factors will be observed in African Americans versus European Americans as well as Indigenous Africans versus European Americans but not in African Americans versus Indigenous Americans; differences due to geographical factors will be observed in Indigenous Americans versus African Americans and Indigenous Africans versus European Americans but not in African Americans versus European Americans. This overarching objective could be accomplished by building upon existing National Institutes of Health investments in the REasons for Geographical And Racial Differences in Stroke (REGARDS) study (based in the United States of America) and the Stroke Investigative Research and educational Network (SIREN) study (based in Sub-Saharan Africa).