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Browsing by Subject "Racial disparity"
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Item 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 MedicineItem 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 MedicineBlack 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.Item 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.Item 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 MedicineCognitive 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).