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Oladele CR, Khandpur N, Galusha D, Hassan S, Colón-Ramos U, Miller M, Adams OP, Maharaj RG, Nazario CM, Nunez M, Pérez-Escamilla R, Hassell T, Nunez-Smith M. Consumption of sugar-sweetened beverages and T2D diabetes in the Eastern Caribbean. Public Health Nutr 2023; 26:1403-1413. [PMID: 36856024 PMCID: PMC10346089 DOI: 10.1017/s1368980023000381] [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] [Received: 12/17/2021] [Revised: 01/20/2023] [Accepted: 02/06/2023] [Indexed: 03/02/2023]
Abstract
OBJECTIVE Sugar-sweetened beverages (SSB) are implicated in the increasing risk of diabetes in the Caribbean. Few studies have examined associations between SSB consumption and diabetes in the Caribbean. DESIGN SSB was measured as teaspoon/d using questions from the National Cancer Institute Dietary Screener Questionnaire about intake of soda, juice and coffee/tea during the past month. Diabetes was measured using self-report, HbA1C and use of medication. Logistic regression was used to examine associations. SETTING Baseline data from the Eastern Caribbean Health Outcomes Research Network Cohort Study (ECS), collected in Barbados, Puerto Rico, Trinidad and Tobago and US Virgin Islands, were used for analysis. PARTICIPANTS Participants (n 1701) enrolled in the ECS. RESULTS Thirty-six percentage of participants were unaware of their diabetes, 33% aware and 31% normoglycaemic. Total mean intake of added sugar from SSB was higher among persons 40-49 (9·4 tsp/d), men (9·2 tsp/d) and persons with low education (7·0 tsp/d). Participants who were unaware (7·4 tsp/d) or did not have diabetes (7·6 tsp/d) had higher mean SSB intake compared to those with known diabetes (5·6 tsp/d). In multivariate analysis, total added sugar from beverages was not significantly associated with diabetes status. Results by beverage type showed consumption of added sugar from soda was associated with greater odds of known (OR = 1·37, 95 % CI (1·03, 1·82)) and unknown diabetes (OR = 1·54, 95 % CI (1·12, 2·13)). CONCLUSIONS Findings indicate the need for continued implementation and evaluation of policies and interventions to reduce SSB consumption in the Caribbean.
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Affiliation(s)
- Carol R Oladele
- Equity Research and Innovation Center, Yale School of Medicine, 100 Church Street South, Suite A200, New Haven, CT06510, USA
| | - Neha Khandpur
- Department of Nutrition, School of Public Health, University of São Paulo, Av. Dr. Arnaldo, São Paulo, Brazil
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Deron Galusha
- Equity Research and Innovation Center, Yale School of Medicine, 100 Church Street South, Suite A200, New Haven, CT06510, USA
| | - Saria Hassan
- Equity Research and Innovation Center, Yale School of Medicine, 100 Church Street South, Suite A200, New Haven, CT06510, USA
| | - Uriyoán Colón-Ramos
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Mary Miller
- Equity Research and Innovation Center, Yale School of Medicine, 100 Church Street South, Suite A200, New Haven, CT06510, USA
| | - Oswald P Adams
- The University of the West Indies, Cave Hill Campus, Barbados
| | - Rohan G Maharaj
- The University of the West Indies, St. Augustine Campus, Trinidad and Tobago
| | - Cruz M Nazario
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Maxine Nunez
- University of the Virgin Islands, School of Nursing, St. Thomas, VI, USA
| | | | | | - Marcella Nunez-Smith
- Equity Research and Innovation Center, Yale School of Medicine, 100 Church Street South, Suite A200, New Haven, CT06510, USA
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Lao C, Gurney J, Stanley J, Krebs J, Meredith I, Campbell I, Teng A, Sika-Paotonu D, Koea J, Lawrenson R. Association of diabetes and breast cancer characteristics at diagnosis. Cancer Causes Control 2023; 34:103-111. [PMID: 36409455 DOI: 10.1007/s10552-022-01654-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/09/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE This study aims to examine the association of diabetes and breast cancer characteristics at diagnosis in Aotearoa/New Zealand. METHODS Patients diagnosed with invasive breast cancer between 2005 and 2020 were identified from the National Breast Cancer Register. Logistic regression modeling was used to estimate the adjusted odds ratio (OR) of having stage III-IV cancer and the OR of having stage IV cancer for women with diabetes compared to those without diabetes. The adjusted OR of having screen-detected breast cancers for patients aged 45-69 years with diabetes compared to patients without diabetes was estimated. RESULTS 26,968 women were diagnosed with breast cancer, with 3,137 (11.6%) patients having diabetes at the time of cancer diagnosis. The probability of co-occurrence of diabetes and breast cancer increased with time. Māori, Pacific and Asian women were more likely to have diabetes than European/Others. The probability of having diabetes also increased with age. For patients with diabetes, the probability of being diagnosed with stage III-IV cancer and stage IV cancer was higher than for patients without diabetes (OR 1.14, 95% CI 1.03-1.27; and 1.17, 95% CI 1.00-1.38). Women aged 45-69 years with diabetes were more likely to have screen-detected cancer than those without diabetes (OR 1.13, 95% CI 1.02-1.26). CONCLUSIONS The co-occurrence of diabetes and breast cancer is becoming more common. Overall there is a small but significant adverse impact of having advanced disease for women with diabetes that is found at the time of breast cancer diagnosis, and this may contribute to other inequities that occur in the treatment pathway that may impact on patient outcomes.
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Affiliation(s)
- Chunhuan Lao
- Medical Research Centre, The University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand.
| | - Jason Gurney
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - James Stanley
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Jeremy Krebs
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Ineke Meredith
- General Surgery, Wakefield Hospital, Wellington, New Zealand
| | - Ian Campbell
- General Surgery, Wakefield Hospital, Wellington, New Zealand
- School of Medicine, The University of Auckland, Auckland, New Zealand
| | - Andrea Teng
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Dianne Sika-Paotonu
- Department of Pathology & Molecular Medicine, University of Otago, Wellington, New Zealand
| | - Jonathan Koea
- General Surgery, Wakefield Hospital, Wellington, New Zealand
- Medical Surgery, The University of Auckland, Auckland, New Zealand
| | - Ross Lawrenson
- Medical Research Centre, The University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand
- Strategy and Funding, Waikato Hospital, Hamilton, New Zealand
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Hassan S, Magny-Normilus C, Galusha D, Adams OP, Maharaj RG, Nazario CM, Nunez M, Nunez-Smith M. Glycemic control and management of cardiovascular risk factors among adults with diabetes in the Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study. Prim Care Diabetes 2022; 16:107-115. [PMID: 34253484 PMCID: PMC8743302 DOI: 10.1016/j.pcd.2021.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 06/15/2021] [Accepted: 06/21/2021] [Indexed: 02/03/2023]
Abstract
AIMS To determine the level of glycemic control and cardiovascular (CVD) risk among adults with diabetes in the Eastern Caribbean. METHODS Baseline data from the Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study (ECS) were used for the analysis. ECS participants were 40 years of age and older, residing in the US Virgin Islands, Puerto Rico, Trinidad, or Barbados. Participants completed a survey, physical exam, and laboratory studies. CVD risk was calculated using the Atherosclerotic CVD risk equation. Bivariate analysis followed by multinomial logistic regression was used to assess social and biological factors (education, lifestyle, access to care, medical history) associated with level of glycemic control. RESULTS Twenty-three percent of participants with diabetes had an HbA1c ≥ 9% (>75 mmol/mol). Participants with diabetes had poorly controlled CVD risk factors: 70.2% had SBP ≥ 130 mmHg, 52.2% had LDL ≥ 100 mg/dl (2.59 mmol/L), and 73.2% had a 10-year CVD risk of more than 10%. Age and education level were significant, independent predictors of glycemic control. CONCLUSION There is a high prevalence of uncontrolled diabetes among adults in ECS. The high burden of elevated CVD risk explains the premature mortality we see in the region. Strategies are needed to improve glycemic control and CVD risk factor management among individuals with diabetes in the Caribbean.
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Affiliation(s)
- Saria Hassan
- Yale School of Medicine, Department of Medicine, 100 Church Street South, New Haven, CT 06510, United States; Emory University School of Medicine, Atlanta, GA 30322.
| | - Cherlie Magny-Normilus
- Yale School of Medicine, Department of Medicine, 100 Church Street South, New Haven, CT 06510, United States
| | - Deron Galusha
- Yale School of Medicine, Department of Medicine, 100 Church Street South, New Haven, CT 06510, United States
| | - Oswald P Adams
- University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - Rohan G Maharaj
- University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad, Trinidad and Tobago
| | - Cruz M Nazario
- University of Puert Rico, Medical Sciences Campus, Graduate School of Public Health, San Juan, Puerto Rico 00921
| | - Maxine Nunez
- University of the Virgin Islands, School of Nursing, St. Thomas, US Virgin Islands
| | - Marcella Nunez-Smith
- Yale School of Medicine, Department of Medicine, 100 Church Street South, New Haven, CT 06510, United States
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Kim SE, Bachorik AE, Bertrand KA, Gunn CM. Differences in Breast Cancer Screening Practices by Diabetes Status and Race/Ethnicity in the United States. J Womens Health (Larchmt) 2021; 31:848-855. [PMID: 34935471 DOI: 10.1089/jwh.2021.0396] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Socioeconomic and health-related factors, including comorbid illness, may affect mammography screening rates and subsequently contribute to breast cancer outcomes. We explored the association between diabetes and mammography screening, and whether this association varied between racial, ethnic, and geographic groups. Methods: Cross-sectional data from the 2012, 2014, 2016, and 2018 Behavioral Risk Factor Surveillance System were used to fit logistic regression models assessing the association between diabetes and up-to-date mammography screening in 497,600 women, aged 50-74 years. Participants were considered exposed if they responded "yes" to "(Ever told) you have diabetes?" and up to date on screening if they responded "yes" to having a mammogram within the past 2 years. Models were adjusted for age, health status, socioeconomic, and access variables. Results: The majority of participants were White (79.6%), non-Hispanic (88.9%), and up to date on screening (78.8%). Overall, 16.8% reported having diabetes. In fully adjusted models, White women with diabetes were 12% more likely to be up to date on screening (odds ratio [OR]: 1.12, 95% confidence interval [CI]: 1.06-1.19) than those without diabetes. Black/African American women and those of Hispanic ethnicity with diabetes were more likely to report being up to date with mammography (ORBlack: 1.28, 95% CI: 1.12-1.45; ORHispanic: 1.19, 95% CI: 1.13-1.24) than those without. Patterns were similar across geographic regions. Conclusions: Women of ages 50-74 years with diabetes were more likely to be up to date on screening than women without diabetes. Chronic disease management may represent an opportunity to address cancer screening.
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Affiliation(s)
- Sydney E Kim
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Alexandra E Bachorik
- Section of General Internal Medicine, Women's Health Unit, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | | | - Christine M Gunn
- Section of General Internal Medicine, Women's Health Unit, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.,Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
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Samaroo K, Hosein A, Olivier LK, Ali J. Breast Cancer in the Caribbean. Cureus 2021; 13:e17042. [PMID: 34522520 PMCID: PMC8428164 DOI: 10.7759/cureus.17042] [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: 08/07/2021] [Indexed: 11/22/2022] Open
Abstract
Breast cancer (BC) is one of the leading causes of death among women globally. In the Caribbean, there is a higher mortality rate compared with North American and European countries which have higher incidence rates. We conducted a literature review to examine the BC dynamic in the Caribbean and determine the areas where further investigations are needed. The PubMed database was used for identifying relevant studies using a combination of specific keyword searches. All studies focusing on BC within the defined Caribbean population were selected for this review. A total of 117 papers were included. The data were organized and presented under the following headings and reported according to the country where available: BC incidence and mortality, patient demographics, clinicopathology, genetics, behavioral risks, diagnosis and treatment, and BC control. Our review uncovered major variability in the incidence, management, etiology, and mortality of BC among Caribbean countries. Low-resource countries are burdened by more advanced disease with expected poorer BC outcomes (i.e., shorter periods of disease-free survival). Countries with established national cancer registries seem to have a better approach to the management of BC. The introduction of cancer treatment programs in association with international nonprofit groups has shown tremendous improvement in quality, accessible cancer care for patients, particularly in low- and middle-income settings. BC research is relatively limited in the Caribbean, lacking in both scope and consistency. The unique Caribbean BC population of diverse ethnicities, environmental influence, immigrants, socioeconomic status, and sociocultural practices allows an optimal opportunity for epidemiological investigations that can provide deeper insights into the status of BC.
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Affiliation(s)
- Kristy Samaroo
- Biomedical Engineering, The University of Trinidad & Tobago, Port of Spain, TTO
| | - Amalia Hosein
- Biomedical Engineering, The University of Trinidad & Tobago, Port of Spain, TTO
| | - Lyronne K Olivier
- General Surgeon/Breast Surgical Oncologist, Sangre Grande General Hospital, Port of Spain, TTO
| | - Jameel Ali
- Surgery, University of Toronto, Toronto, CAN
- Breast Unit, St. James Medical Complex, Port of Spain, TTO
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Hassan S, Oladele C, Galusha D, Adams OP, Maharaj RG, Nazario CM, Nunez M, Nunez-Smith M. Anthropometric measures of obesity and associated cardiovascular disease risk in the Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study. BMC Public Health 2021; 21:399. [PMID: 33632164 PMCID: PMC7905572 DOI: 10.1186/s12889-021-10399-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 02/05/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Accurately defining obesity using anthropometric measures that best capture obesity-related risk is important for identifying high risk groups for intervention. The purpose of this study is to compare the association of different anthropometric measures of obesity with 10-year cardiovascular disease (CVD) risk in adults in the Eastern Caribbean. METHODS Data from the Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study (ECS) were analyzed. The ECS is comprised of adults aged 40 and older residing in the US Virgin Islands, Puerto Rico, Barbados, and Trinidad. 10-year CVD risk was calculated using the American Heart Association (ACC/AHA) ASCVD Risk Algorithm and categorized in the following high-risk groups: > 7.5, > 10, and > 20%. Logistic regression was used to examine associations between four anthropometric measures of obesity (BMI, waist circumference, waist-to-hip ratio, waist-to height ratio) and 10-year CVD risk. RESULTS Mean age (SD) of participants (n = 1617) was 56.6 years (±10.2), 64% were women, 74% were overweight/obese, and 24% had an ASCVD risk score above 10%. Elevated body mass index (BMI, > 30 kg/m2) and waist circumference were not associated with CVD risk. Elevated waist-to-hip ratio (WHR, > 0.9 men, > 0.85 women) and elevated waist-to-height ratio (> 0.5) were associated with all three categories of CVD risk. Area under the receiver curve was highest for WHR for each category of CVD risk. Elevated WHR demonstrated odds of 2.39, 2.58, and 3.32 (p < 0.0001) for CVD risk of > 7.5, > 10 and > 20% respectively. CONCLUSION Findings suggest that WHR is a better indicator than BMI of obesity-related CVD risk and should be used to target adults in the Caribbean, and of Caribbean-descent, for interventions.
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Affiliation(s)
- Saria Hassan
- Department of Medicine, Yale School of Medicine, 100 Church Street South, Suite A200, New Haven, CT, 06510, USA.
- Emory University School of Medicine, Emory Rollins School of Public Health, Atlanta, GA, 30319, USA.
| | - Carol Oladele
- Department of Medicine, Yale School of Medicine, 100 Church Street South, Suite A200, New Haven, CT, 06510, USA
| | - Deron Galusha
- Department of Medicine, Yale School of Medicine, 100 Church Street South, Suite A200, New Haven, CT, 06510, USA
| | | | - Rohan G Maharaj
- University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad
| | - Cruz M Nazario
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Maxine Nunez
- University of the Virgin Islands, School of Nursing, St. Thomas, US Virgin Islands
| | - Marcella Nunez-Smith
- Department of Medicine, Yale School of Medicine, 100 Church Street South, Suite A200, New Haven, CT, 06510, USA
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Wang K, Grossetta Nardini H, Post L, Edwards T, Nunez-Smith M, Brandt C. Information Loss in Harmonizing Granular Race and Ethnicity Data: Descriptive Study of Standards. J Med Internet Res 2020; 22:e14591. [PMID: 32706693 PMCID: PMC7399950 DOI: 10.2196/14591] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 02/24/2020] [Accepted: 03/12/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Data standards for race and ethnicity have significant implications for health equity research. OBJECTIVE We aim to describe a challenge encountered when working with a multiple-race and ethnicity assessment in the Eastern Caribbean Health Outcomes Research Network (ECHORN), a research collaborative of Barbados, Puerto Rico, Trinidad and Tobago, and the US Virgin Islands. METHODS We examined the data standards guiding harmonization of race and ethnicity data for multiracial and multiethnic populations, using the Office of Management and Budget (OMB) Statistical Policy Directive No. 15. RESULTS Of 1211 participants in the ECHORN cohort study, 901 (74.40%) selected 1 racial category. Of those that selected 1 category, 13.0% (117/901) selected Caribbean; 6.4% (58/901), Puerto Rican or Boricua; and 13.5% (122/901), the mixed or multiracial category. A total of 17.84% (216/1211) of participants selected 2 or more categories, with 15.19% (184/1211) selecting 2 categories and 2.64% (32/1211) selecting 3 or more categories. With aggregation of ECHORN data into OMB categories, 27.91% (338/1211) of the participants can be placed in the "more than one race" category. CONCLUSIONS This analysis exposes the fundamental informatics challenges that current race and ethnicity data standards present to meaningful collection, organization, and dissemination of granular data about subgroup populations in diverse and marginalized communities. Current standards should reflect the science of measuring race and ethnicity and the need for multidisciplinary teams to improve evolving standards throughout the data life cycle.
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Affiliation(s)
- Karen Wang
- Equity Research and Innovation Center, General Internal Medicine, Yale School of Medicine, New Haven, CT, United States
- Center for Medical Informatics, Yale School of Medicine, New Haven, CT, United States
| | - Holly Grossetta Nardini
- Harvey Cushing/John Hay Whitney Medical Library, Yale School of Medicine, New Haven, CT, United States
| | - Lori Post
- Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Chicago, IL, United States
| | - Todd Edwards
- Division of Epidemiology, Department of Medicine, Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Marcella Nunez-Smith
- Equity Research and Innovation Center, General Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Cynthia Brandt
- Center for Medical Informatics, Yale School of Medicine, New Haven, CT, United States
- Veteran Affairs Connecticut Healthcare System, US Department of Veteran Affairs, West Haven, CT, United States
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Wang K, Hambleton I, Linnander E, Marenco L, Hassan S, Kumara M, Fredericks LE, Harrigan S, Hasse TA, Brandt C, Nunez-Smith M. Toward Reducing Health Information Inequities in the Caribbean: Our Experience Building a Participatory Health Informatics Project. Ethn Dis 2020; 30:193-202. [PMID: 32269461 PMCID: PMC7138447 DOI: 10.18865/ed.30.s1.193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Precision medicine seeks to leverage technology to improve the health for all individuals. Successful health information systems rely fundamentally on the integration and sharing of data from a range of disparate sources. In many settings, basic infrastructure inequities exist that limit the usefulness of health information systems. We discuss the work of the Yale Transdisciplinary Collaborative Center for Health Disparities focused on Precision Medicine, which aims to improve the health of people in the Caribbean and Caribbean diaspora by leveraging precision medicine approaches. We describe a participatory informatics approach to sharing data as a potential mechanism to reducing inequities in the existing data infrastructure.
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Affiliation(s)
- Karen Wang
- Equity Research and Innovation Center, General Internal Medicine, Yale School of Medicine, New Haven, CT
- Center for Medical Informatics, Yale School of Medicine, New Haven, CT
| | - Ian Hambleton
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Cave Hill campus, Barbados
| | - Erika Linnander
- Global Health Leadership Initiative, Yale School of Public Health, New Haven, CT
| | - Luis Marenco
- Center for Medical Informatics, Yale School of Medicine, New Haven, CT
| | - Saria Hassan
- Equity Research and Innovation Center, General Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Mahima Kumara
- Equity Research and Innovation Center, General Internal Medicine, Yale School of Medicine, New Haven, CT
| | | | | | | | - Cynthia Brandt
- Center for Medical Informatics, Yale School of Medicine, New Haven, CT
| | - Marcella Nunez-Smith
- Equity Research and Innovation Center, General Internal Medicine, Yale School of Medicine, New Haven, CT
| | - the ECHORN Writing Group
- Equity Research and Innovation Center, General Internal Medicine, Yale School of Medicine, New Haven, CT
- Center for Medical Informatics, Yale School of Medicine, New Haven, CT
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Cave Hill campus, Barbados
- Global Health Leadership Initiative, Yale School of Public Health, New Haven, CT
- US Virgin Islands Department of Health, St. Thomas, USVI
- Community, New York, NY, USA
- Healthy Caribbean Coalition, Bridgetown, Barbados
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Miles RC, Narayan AK, Lopez DB, Lehman CD, Harvey HB, Mishra V, Glover M, Flores EJ. Chronic Medical Illness as a Risk Factor for Poor Mammography Screening Adherence. J Womens Health (Larchmt) 2019; 28:1378-1383. [DOI: 10.1089/jwh.2018.7315] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
- Randy C. Miles
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Anand K. Narayan
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Diego B. Lopez
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Constance D. Lehman
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - H. Benjamin Harvey
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Vishala Mishra
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - McKinley Glover
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Efren J. Flores
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
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