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Praça MSL, de Sousa FTR, Cândido EB, Lamaita RM, Wender MCO, Silva AL. Beyond the diagnosis: gender disparities in the social and emotional impact of cancer. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e2024S115. [PMID: 38865535 PMCID: PMC11164259 DOI: 10.1590/1806-9282.2024s115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 12/19/2023] [Indexed: 06/14/2024]
Affiliation(s)
- Mariana Seabra Leite Praça
- Universidade Federal de Minas Gerais, Department of Obstetrics and Gynecology – Belo Horizonte (MG), Brazil
| | | | - Eduardo Batista Cândido
- Universidade Federal de Minas Gerais, Department of Obstetrics and Gynecology – Belo Horizonte (MG), Brazil
| | - Rívia Mara Lamaita
- Universidade Federal de Minas Gerais, Department of Obstetrics and Gynecology – Belo Horizonte (MG), Brazil
| | - Maria Celeste Osório Wender
- Universidade Federal do Rio Grande do Sul, Department of Gynecology and Obstetrics – Porto Alegre (RS), Brazil
| | - Agnaldo Lopes Silva
- Universidade Federal de Minas Gerais, Department of Obstetrics and Gynecology – Belo Horizonte (MG), Brazil
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Mersky JP, Lee CP, Hami D. Adverse Childhood Experiences and Sexual Orientation: An Intersectional Analysis of Nationally Representative Data. Am J Prev Med 2024; 66:483-491. [PMID: 37884176 DOI: 10.1016/j.amepre.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 10/28/2023]
Abstract
INTRODUCTION This study compared the prevalence of adverse childhood experiences across intersections of sexual orientation, gender, race/ethnicity, and economic status. METHODS Data collected between 1994 and 2018 from 12,519 participants in the National Longitudinal Study of Adolescent to Adult Health were analyzed in 2023 to generate adverse childhood experience prevalence estimates. Unadjusted 1-way ANOVAs and multivariate regressions were performed to compare differences in independent and cumulative adversity measures by sexual orientation, gender, race/ethnicity, and poverty status. A multilevel analysis of individual heterogeneity and discriminatory accuracy was conducted to estimate adversity scores across 24 groups that were stratified by sexual orientation, gender, race/ethnicity, and poverty status. RESULTS Adolescents with same-sex attractions and adults who identified with a sexual minority group reported more adverse childhood experiences overall than straight participants, although associations varied by type of adversity. Strikingly, adversity scores were higher among White youth with same-sex attractions than among Black youth with same-sex attractions, among more economically advantaged bisexual adults than among poorer ones, and among poor White participants than among poor Black and Hispanic participants, suggesting that the combination of disadvantaged and marginalized statuses does not necessarily correspond with greater childhood adversity. A multilevel analysis of individual heterogeneity and discriminatory accuracy interaction model showed that sexual orientation and poverty status contributed significant variance to cumulative adversity scores, whereas gender and race/ethnicity did not. CONCLUSIONS The results show that disparities in adverse experiences can be more fully and accurately represented when sexual orientation and other social identities are modeled as intersectional configurations. Given that adverse childhood experiences are linked to morbidity and mortality, the findings have salient implications for understanding health disparities that affect population subgroups.
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Affiliation(s)
- Joshua P Mersky
- Institute for Child and Family Well-being, Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin.
| | - ChienTi Plummer Lee
- Institute for Child and Family Well-being, Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin
| | - Davin Hami
- School of Medicine and Public Health, University of Wisconsin-Madison, Milwaukee, Wisconsin
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Dugan CL, Othieno AA, Goldman ME. Genitourinary Syndrome of Menopause in Cancer Survivors. Clin Obstet Gynecol 2024; 67:89-100. [PMID: 38108399 DOI: 10.1097/grf.0000000000000848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Genitourinary syndrome of menopause (GSM) encompasses the symptoms of estrogen deprivation in the vaginal, vulva, and bladder areas. Because many cancer treatments induce a hypoestrogenic state, GSM is common in cancer survivors. The number of cancer survivors is increasing, and the unique aspects of GSM management for cancer survivors, such as the safety of hormonal therapies, is important to understand. In this review, we cover important considerations in the assessment of GSM; nonpharmacologic, behavioral, integrative, pharmacologic, and medical device treatments for GSM: the unique considerations in GSM by cancer treatment modality; bladder manifestations of GSM; and GSM in specific populations.
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Affiliation(s)
- Catherine L Dugan
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
| | - Alisha A Othieno
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
| | - Mindy E Goldman
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
- Midi Health, Menlo Park, California
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Shires DA, Kattari L, Hosea F, Hirsch J, Mulvaney M, Matthews AK, Thompson HS. Healthcare experiences among Black and White sexual and gender minority cancer survivors: a qualitative study. J Cancer Surviv 2023:10.1007/s11764-023-01504-z. [PMID: 38051422 DOI: 10.1007/s11764-023-01504-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/21/2023] [Indexed: 12/07/2023]
Abstract
PURPOSE The purpose of this study was to explore healthcare experiences of Black and White sexual and gender minority (SGM) cancer survivors across the cancer care continuum. METHODS This was a qualitative analysis of two focus groups and eight individual interviews completed as part of a larger initiative using a community-engaged research approach to reduce cancer disparities in marginalized communities. There was a total of 16 participants in the study (9 were White, 7 were Black) and data were collected between 2019 and 2020. RESULTS Three main themes emerged from the thematic analysis: strategically coming out, provider preferences, and health system challenges. Participants noted that they often came out through their support system, decided to come out based on the relevance of their SGM identity that they perceived, and expressed a desire for privacy. Lack of an accessible and competent PCP was tied to delayed cancer diagnosis and many participants voiced a preference for consistency when they found a provider they liked. CONCLUSIONS Providers across specialties can address barriers for SGM patients by not making assumptions about patient sexual orientation or gender identity. Institutions should systematically collect sexual orientation and gender identity information. Primary care providers should be aware that due to resistance to switching from trusted providers, they may need to take greater initiative to facilitate cancer screenings for their patients when appropriate or take special care when making referrals to ensure they are using SGM-affirming providers. IMPLICATIONS FOR CANCER SURVIVORS SGM cancer survivors often benefit from a cultivating relationship with a trusted PCP or other provider.
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Affiliation(s)
- Deirdre A Shires
- School of Social Work, Michigan State University, 655 Auditorium Road, 122 Baker Hall, East Lansing, MI, 48824, USA.
| | - Leonardo Kattari
- Department of Health and Human Services, University of Michigan - Dearborn, Dearborn, MI, USA
| | - Forrest Hosea
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Jen Hirsch
- School of Social Work, Michigan State University, 655 Auditorium Road, 122 Baker Hall, East Lansing, MI, 48824, USA
| | - Megan Mulvaney
- Indiana University School of Public Health, Bloomington, IN, USA
| | | | - Hayley S Thompson
- Office of Cancer Health Equity and Community Engagement, Karmanos Cancer Institute, Detroit, MI, USA
- Department of Oncology, School of Medicine, Wayne State University, Detroit, MI, USA
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Andersen BL, Lacchetti C, Ashing K, Berek JS, Berman BS, Bolte S, Dizon DS, Given B, Nekhlyudov L, Pirl W, Stanton AL, Rowland JH. Management of Anxiety and Depression in Adult Survivors of Cancer: ASCO Guideline Update. J Clin Oncol 2023:JCO2300293. [PMID: 37075262 DOI: 10.1200/jco.23.00293] [Citation(s) in RCA: 31] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
PURPOSE To update the American Society of Clinical Oncology guideline on the management of anxiety and depression in adult cancer survivors. METHODS A multidisciplinary expert panel convened to update the guideline. A systematic review of evidence published from 2013-2021 was conducted. RESULTS The evidence base consisted of 17 systematic reviews ± meta analyses (nine for psychosocial interventions, four for physical exercise, three for mindfulness-based stress reduction [MBSR], and one for pharmacologic interventions), and an additional 44 randomized controlled trials. Psychological, educational, and psychosocial interventions led to improvements in depression and anxiety. Evidence for pharmacologic management of depression and anxiety in cancer survivors was inconsistent. The lack of inclusion of survivors from minoritized groups was noted and identified as an important consideration to provide high-quality care for ethnic minority populations. RECOMMENDATIONS It is recommended to use a stepped-care model, that is, provide the most effective and least resource-intensive intervention based on symptom severity. All oncology patients should be offered education regarding depression and anxiety. For patients with moderate symptoms of depression, clinicians should offer cognitive behavior therapy (CBT), behavioral activation (BA), MBSR, structured physical activity, or empirically supported psychosocial interventions. For patients with moderate symptoms of anxiety, clinicians should offer CBT, BA, structured physical activity, acceptance and commitment therapy, or psychosocial interventions. For patients with severe symptoms of depression or anxiety, clinicians should offer cognitive therapy, BA, CBT, MBSR, or interpersonal therapy. Treating clinicians may offer a pharmacologic regimen for depression or anxiety for patients who do not have access to first-line treatment, prefer pharmacotherapy, have previously responded well to pharmacotherapy, or have not improved following first-line psychological or behavioral management.Additional information is available at www.asco.org/survivorship-guidelines.
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Affiliation(s)
| | | | | | | | | | - Sage Bolte
- Inova Health Foundation, Falls Church, VA
| | - Don S Dizon
- Legorreta Cancer Center at Brown University and Lifespan Cancer Institute, Providence, RI
| | | | - Larissa Nekhlyudov
- Brigham and Women's Hospital, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA
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Schulz-Quach C, Kennedy M, Lyver B. Sexual and gender diversity in cancer care and survivorship. Curr Opin Support Palliat Care 2023; 17:55-69. [PMID: 36656606 DOI: 10.1097/spc.0000000000000628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE OF THE REVIEW Sexual and gender diverse (SGD) cancer patients possess unique identities and needs that must be considered during their cancer care. This narrative review explores the current literature on sexual and gender diversity in cancer care and survivorship, in addition to providing recommendations encouraged by the current literature. RECENT FINDINGS We performed a literature search for articles published in English between January 2021 and June 2022 in Medline ALL and Embase. Fifty-two studies were included in this review. The many identities encapsulated in 2SLGBTQIA+ (2 Spirited, Lesbian, Gay, Bisexual, Transgender, Queer, Intersexual, Asexual, Agender, Aromantic and all gender identities and sexual orientations that are not listed) communities each have their own unique backgrounds, needs and disparities in cancer care and survivorship. However, we also identified specific protective factors in the cancer experience of SGD patients such as reports of higher resiliency and stronger support networks. Much of the recent research features recommendations on improving cancer care by creating inclusive patient questionnaires, improving in-person and online resources, and educating healthcare providers and patient-facing staff on inclusive care. SUMMARY SGD patients have their own specific challenges during and following their cancer care. As the research continues to grow, we gain a better understanding of the needs of these patients and future steps to take to improve SGD patients' cancer experience.
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Affiliation(s)
- Christian Schulz-Quach
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network
- Centre of Mental Health, University Health Network, Toronto, Ontario, Canada
| | - Margo Kennedy
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network
| | - Brendan Lyver
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network
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Chen JC, Pawlik T, Kelly EP, Obeng-Gyasi S. Intersectionality in patients with cancer: who should care and why? Future Oncol 2022; 18:4137-4140. [PMID: 36802840 PMCID: PMC10072129 DOI: 10.2217/fon-2022-0992] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 11/21/2022] [Indexed: 02/22/2023] Open
Affiliation(s)
- JC Chen
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center & James Cancer Hospital, Columbus, OH 43210, USA
| | - Timothy Pawlik
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center & James Cancer Hospital, Columbus, OH 43210, USA
| | - Elizabeth Palmer Kelly
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center & James Cancer Hospital, Columbus, OH 43210, USA
| | - Samilia Obeng-Gyasi
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center & James Cancer Hospital, Columbus, OH 43210, USA
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Boehmer U, Clark MA, Winter M, Berklein F, Ozonoff A. Sexual minority-specific experiences of colorectal cancer survivors. Health Psychol 2022; 41:884-892. [PMID: 36074595 PMCID: PMC10367941 DOI: 10.1037/hea0001229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine how sexual minority-specific factors relate to colorectal cancer survivors' health-related quality of life, psychological adjustment, and quality of care. METHOD One hundred twenty-seven sexual minority survivors diagnosed with stage I, II, or III colorectal cancer were recruited from four cancer registries. An average of 3 years after diagnosis, eligible survivors participated in a telephone survey, which measured survivors' outcomes, consisting of physical and mental quality of life, anxiety, depression, self-rated fair or poor health, and quality of care. We considered sexual minority-specific factors (e.g., outness, discrimination) as correlates for each survivorship outcome using forward selection with generalized linear or logistic regression models. RESULTS After adjusting for confounders, accumulation of lifetime discrimination experiences had negative associations with survivors' physical and mental quality of life, anxiety, and depression. Sexual minority-specific discrimination experiences were negatively associated with perceived quality of care after adjusting for confounders. Sexual minority survivors' self-rated fair or poor health and their rating of care as excellent were independent of sexual minority-specific factors. CONCLUSION Addressing and counteracting sexual minority-specific and other lifetime discrimination experiences may be a pathway to improving sexual minority cancer survivors' quality of care, quality of life, and psychological adjustment. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Ulrike Boehmer
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA
| | - Melissa A Clark
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Michael Winter
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA
| | - Flora Berklein
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA
| | - Al Ozonoff
- Harvard Medical School, Boston, MA
- Boston Children’s Hospital, Boston, MA
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Ussher JM, Allison K, Perz J, Power R. LGBTQI cancer patients' quality of life and distress: A comparison by gender, sexuality, age, cancer type and geographical remoteness. Front Oncol 2022; 12:873642. [PMID: 36203463 PMCID: PMC9530284 DOI: 10.3389/fonc.2022.873642] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 08/12/2022] [Indexed: 11/16/2022] Open
Abstract
Background There is growing acknowledgement of the psycho-social vulnerability of lesbian, gay, bisexual, transgender, queer and/or intersex (LGBTQI) people with cancer. The majority of research to date has focused on cisgender adults with breast or prostate cancer. Study Aim This study examined psycho-social factors associated with distress and quality of life for LGBTQI cancer patients and survivors, across a range of sexualities and gender identities, intersex status, tumor types, ages and urban/rural/remote location using an intersectional theoretical framework. Method 430 LGBTQI people with cancer completed an online survey, measuring distress, quality of life (QOL), and a range of psycho-social variables. Participants included 216 (50.2%) cisgender women, 145 (33.7%) cisgender men, and 63 (14.7%) transgender and gender diverse (TGD) people. Thirty-one (7.2%) participants reported intersex variation and 90 (20%) were adolescents or young adults (AYA), aged 15-39. The majority lived in urban areas (54.4%) and identified as lesbian, gay or bisexual (73.7%), with 10.9% identifying as bisexual, and 10.5% as queer, including reproductive (32.4%) and non-reproductive (67.6%) cancers. Results Forty-one percent of participants reported high or very high distress levels, 3-6 times higher than previous non-LGBTQI cancer studies. Higher rates of distress and lower QOL were identified in TGD compared to cisgender people, AYAs compared to older people, those who identify as bisexual or queer, compared to those who identify as lesbian, gay or homosexual, and those who live in rural or regional areas, compared to urban areas. Elevated distress and lower QOL was associated with greater minority stress (discrimination in life and in cancer care, discomfort being LGBTQI, lower outness) and lower social support, in these subgroups. There were no differences between reproductive and non-reproductive cancers. For the whole sample, distress and poor QOL were associated with physical and sexual concerns, the impact of cancer on gender and LGBTQI identities, minority stress, and lack of social support. Conclusion LGBTQI people with cancer are at high risk of distress and impaired QOL. Research and oncology healthcare practice needs to recognize the diversity of LGBTQI communities, and the ways in which minority stress and lack of social support may affect wellbeing.
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Ángela María JU, Mario CF, Mauricio HC, Ana Gisset GP, Jorge Alirio HR, Guillermo PP, Alejandro BC. A cross-sectional study of the socio-demographic and epidemiological factors associated with childhood cancer in Cali, Colombia. Heliyon 2022; 8:e09410. [PMID: 35620634 PMCID: PMC9126933 DOI: 10.1016/j.heliyon.2022.e09410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 01/09/2022] [Accepted: 05/06/2022] [Indexed: 11/27/2022] Open
Abstract
This study investigates the occurrence of childhood cancer between the years 2015 and 2016 in the city of Cali, Colombia, with respect to: a) sociodemographic characteristics, b) type of cancer, c) epidemiological weeks of cancer and d) comparative survival according to health system affiliation by consolidating the records notified to the municipal health secretariat. Statistically significant differences were found between the groups analysed in relation to the variables related to the type of cancer (p = 0.006). With respect to the proportion of cancer mortality between the years 2015–2016 there was no significant change, even though survival increased in the year 2016. The implications for collective health and public policies in Latin America are discussed.
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Santiago-Rodríguez EJ, Rivadeneira NA, DeVost MA, Sarkar U, Hiatt RA. Cancer Risk Behaviors, Cancer Beliefs, and Health Information Seeking Among Under-Represented Populations in San Francisco: Differences by Sexual Orientation and Gender Identity. Health Equity 2022; 6:669-680. [PMID: 36225663 PMCID: PMC9536334 DOI: 10.1089/heq.2022.0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose Sexual and gender minority (SGM) individuals in the United States are at increased risk of cancer compared to the non-SGM population. Understanding how SGM persons perceive cancer risk and their practices and preferences for accessing health information is key for improving the preventive and health care services they receive. Methods In this cross-sectional study, we analyzed data from the San Francisco Health Information National Trends Survey. SGM individuals were identified by self-report. Differences in cancer risk factors, cancer beliefs, and health information seeking were evaluated by SGM status using multivariable logistic regression models. Results Out of 1027 participants, 130 (13%) reported being SGM individuals. Current smoking (odds ratio [OR]=1.93, 95% confidence interval [CI]=1.24-3.01) and alcohol use (OR=1.69, 95% CI=1.10-2.59) were more common among SGM persons than among non-SGM persons. No differences by SGM status were observed in health information seeking behaviors, preferences, and cancer beliefs, but SGM participants reported significantly higher odds of feeling frustrated (OR=1.78, 95% CI=1.20-2.64) and having concerns about the quality of the information (OR=1.54, 95% CI=1.03-2.31) during their most recent health information search. Conclusions Intervention efforts aimed at SGM individuals with current use of tobacco and/or alcohol should be expanded. SGM communities also need improved access to consistent, reliable, and accurate sources of health information. Their increased frustration when seeking health information and concerns about the quality of the information they find have important implications for SGM health and care, and the drivers of these differences merit further evaluation.
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Affiliation(s)
- Eduardo J Santiago-Rodríguez
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Natalie A Rivadeneira
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.,Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Michelle A DeVost
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Urmimala Sarkar
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA.,Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Robert A Hiatt
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
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