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Jahangiri S, Naeim M, Majidnia M, Mostafavi M, Imannezhad S, Mohammadi Y. Unveiling the neuro-cognitive paradigm: a new approach to the treatment of anxiety: a comprehensive review. Ann Med Surg (Lond) 2024; 86:3508-3513. [PMID: 38846870 PMCID: PMC11152884 DOI: 10.1097/ms9.0000000000002046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 03/30/2024] [Indexed: 06/09/2024] Open
Abstract
This study aimed to explore the neuro-cognitive paradigm in anxiety diseases by integrating neurobiological and cognitive perspectives. The ideal was to enhance our understanding of the complex interplay between neural and cognitive processes in anxiety and its counteraccusations for treatment. A comprehensive review of the literature was conducted, examining studies that delved into the neurobiological supplements and cognitive impulses in anxiety. The findings revealed the involvement of brain regions similar to the amygdala, prefrontal cortex, and hippocampus in anxiety diseases, along with dysregulation in neurotransmitter systems. Cognitive impulses, including attentional bias towards trouble, interpretation bias, and memory impulses, were constantly observed in individuals with anxiety. The results stressed the bidirectional relationship between neurobiology and cognition, demonstrating that neurobiological factors impact cognitive processes, and cognitive factors modulate neural exertion. Integrated interventions targeting both neurobiological and cognitive factors showed a pledge in treating anxiety diseases. The study linked gaps in the literature and emphasized the significance of considering artistic factors and developing individualized treatment approaches. Overall, this study contributes to a comprehensive understanding of anxiety diseases and informs unborn exploration and clinical practice.
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Affiliation(s)
- Shima Jahangiri
- Department of Research, Psychology and Counseling Organization, Tehran
| | - Mahdi Naeim
- Department of Research, Psychology and Counseling Organization, Tehran
| | | | - Maryam Mostafavi
- Department of Research, Psychology and Counseling Organization, Tehran
| | - Shima Imannezhad
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad
| | - Yasaman Mohammadi
- School of Dentistry, Shiraz Branch, Islamic Azad University, Shiraz, Iran
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Mesa RA, Damas OM, Schneiderman N, Palacio AM, Gallo LC, Talavera GA, Sotres-Alvarez D, Daviglus ML, Pirzada A, Llabre MM, Elfassy T. Association Between High-Sensitivity C-Reactive Protein and Metabolic Syndrome Among Hispanic/Latino Participants of the Hispanic Community Health Study/Study of Latinos. Metab Syndr Relat Disord 2024; 22:327-336. [PMID: 38563777 DOI: 10.1089/met.2023.0298] [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] [Indexed: 04/04/2024] Open
Abstract
Purpose: To determine whether high-sensitivity C-reactive protein (hsCRP) is associated with incident Metabolic Syndrome (MetS) among U.S. Hispanic/Latino adults. Patients and Methods: The Hispanic Community Health Study/Study of Latinos is a longitudinal observational cohort assessing cardiovascular health among diverse U.S. Hispanic/Latino adults. hsCRP was measured at visit 1 (2008-2011) and classified as low, moderate, or high, based on the Centers for Disease Control and Prevention and American Heart Association (CDC/AHA) guidelines. All MetS components [abdominal obesity, triglycerides, high-density lipoprotein (HDL) cholesterol, blood pressure, and fasting glucose] were measured at visit 1 and visit 2 (2014-2017). MetS was defined as the presence of three or more components based on the 2005 definition from the modified Third Report of the National Cholesterol Education Program Adult Treatment Panel (modified NCEP ATP III). Participants free of MetS at visit 1 and with complete data on hsCRP and all MetS components were included (n = 6121 participants). We used Poisson regression analysis to determine whether hsCRP was associated with incident MetS after adjusting for demographic, behavioral, and clinical factors. All analyses accounted for the complex survey design of the study. Results: In fully adjusted models, moderate versus low hsCRP was associated with a 33% increased risk of MetS [incidence rate ratio (IRR): 1.33, 95% confidence interval (CI): 1.10-1.61], while high versus low hsCRP was associated with a 89% increased risk of MetS (IRR: 1.89, 95% CI: 1.58-2.25). Conclusions: Greater levels of hsCRP were associated with new onset of MetS in a diverse sample of U.S. Hispanic/Latino adults. Results suggest that hsCRP may be an independent risk factor for MetS.
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Affiliation(s)
- Robert A Mesa
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Oriana M Damas
- Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | - Ana M Palacio
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Gregory A Talavera
- Department of Psychology, Graduate School of Public Health, San Diego State University, San Diego, California, USA
| | - Daniela Sotres-Alvarez
- Collaborative Studies Coordinating Center, Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois Chicago, Chicago, Illinois, USA
| | - Amber Pirzada
- Institute for Minority Health Research, University of Illinois Chicago, Chicago, Illinois, USA
| | - Maria M Llabre
- Department of Psychology, University of Miami, Miami, Florida, USA
| | - Tali Elfassy
- Katz Family Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
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Palacios N, Gordon S, Wang T, Burk R, Qi Q, Huttenhower C, Gonzalez HM, Knight R, De Carli C, Daviglus M, Lamar M, Telavera G, Tarraf W, Kosciolek T, Cai J, Kaplan RC. Gut Microbiome Multi-Omics and Cognitive Function in the Hispanic Community Health Study/Study of Latinos- Investigation of Neurocognitive Aging. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.17.24307533. [PMID: 38798527 PMCID: PMC11118626 DOI: 10.1101/2024.05.17.24307533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
INTRODUCTION We conducted a study within the Hispanic Community Health Study/Study of Latinos- Investigation of Neurocognitive Aging (HCHS/SOL-INCA) cohort to examine the association between gut microbiome and cognitive function. METHODS We analyzed the fecal metagenomes of 2,471 HCHS/SOL-INCA participants to, cross-sectionally, identify microbial taxonomic and functional features associated with global cognitive function. Omnibus (PERMANOVA) and feature-wise analyses (MaAsLin2) were conducted to identify microbiome-cognition associations, and specific microbial species and pathways (Kyoto Encyclopedia of Genes and Genomes (KEGG modules) associated with cognition. RESULTS Eubacterium species( E. siraeum and E. eligens ), were associated with better cognition. Several KEGG modules, most strongly Ornithine, Serine biosynthesis and Urea Cycle, were associated with worse cognition. DISCUSSION In a large Hispanic/Latino cohort, we identified several microbial taxa and KEGG pathways associated with cognition.
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Graves LV, Tarraf W, Gonzalez K, Bondi MW, Gallo LC, Isasi CR, Daviglus M, Lamar M, Zeng D, Cai J, González HM. Characterizing cognitive profiles in diverse middle-aged and older Hispanics/Latinos: Study of Latinos-Investigation of Neurocognitive Aging (HCHS/SOL). ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2024; 16:e12592. [PMID: 38655549 PMCID: PMC11035970 DOI: 10.1002/dad2.12592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/26/2024]
Abstract
Introduction We investigated cognitive profiles among diverse, middle-aged and older Hispanic/Latino adults in the Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA) cohort using a cross-sectional observational study design. Methods Based on weighted descriptive statistics, the average baseline age of the target population was 56.4 years, slightly more than half were women (54.6%), and 38.4% reported less than a high school education. We used latent profile analysis of demographically adjusted z scores on SOL-INCA neurocognitive tests spanning domains of verbal memory, language, processing speed, and executive function. Results Statistical fit assessment indices combined with clinical interpretation suggested five profiles: (1) a Higher Global group performing in the average-to-high-average range across all cognitive and instrumental activity of daily living (IADL) tests (13.8%); (2) a Higher Memory group with relatively high performance on memory tests but average performance across all other cognitive/IADL tests (24.6%); (3) a Lower Memory group with relatively low performance on memory tests but average performance across all other cognitive/IADL tests (32.8%); (4) a Lower Executive Function group with relatively low performance on executive function and processing speed tests but average-to-low-average performance across all other cognitive/IADL tests (16.6%); and (5) a Lower Global group performing low-average-to-mildly impaired across all cognitive/IADL tests (12.1%). Discussion Our results provide evidence of heterogeneity in the cognitive profiles of a representative, community-dwelling sample of diverse Hispanic/Latino adults. Our analyses yielded cognitive profiles that may assist efforts to better understand the early cognitive changes that may portend Alzheimer's disease and related dementias among diverse Hispanics/Latinos. Highlights The present study characterized cognitive profiles among diverse middle-aged and older Hispanic/Latino adults.Latent profile analysis of neurocognitive test scores was the primary analysis conducted.The target population consists of middle-aged and older Hispanic/Latino adults enrolled in the Hispanic Community Health Study/Study of Latinos and ancillary Study of Latinos - Investigation of Neurocognitive Aging.
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Affiliation(s)
- Lisa V. Graves
- Department of PsychologyCalifornia State University San MarcosSan MarcosCaliforniaUSA
| | - Wassim Tarraf
- Institute of Gerontology & Department of Healthcare SciencesWayne State UniversityDetroitMichiganUSA
| | - Kevin Gonzalez
- Department of NeurosciencesUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Mark W. Bondi
- Department of PsychiatryUniversity of California San DiegoSchool of MedicineLa JollaCaliforniaUSA
- Veterans Affairs San Diego Healthcare SystemSan DiegoCaliforniaUSA
| | - Linda C. Gallo
- Department of PsychologySan Diego State UniversitySan DiegoCaliforniaUSA
| | - Carmen R. Isasi
- Department of Epidemiology & Population HealthAlbert Einstein College of MedicineJack and Pearl Resnick CampusBronxNew YorkUSA
| | - Martha Daviglus
- Institute for Minority Health ResearchUniversity of Illinois at ChicagoCollege of MedicineChicagoIllinoisUSA
| | - Melissa Lamar
- Institute for Minority Health ResearchUniversity of Illinois at ChicagoCollege of MedicineChicagoIllinoisUSA
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
| | - Donglin Zeng
- Department of BiostatisticsUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Jianwen Cai
- Department of BiostatisticsUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Hector M. González
- Department of NeurosciencesUniversity of California San DiegoLa JollaCaliforniaUSA
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Graves LV, Beacham D, Sawitzky N, Lozano J, Weberg M, Reyes K, Vergonia L, Santana A, Hernandez E, Sarsar D, Conaway Z. Informant sex/gender moderates associations between reported functioning and memory performance in Mexican American adults. Clin Neuropsychol 2024; 38:715-737. [PMID: 37571992 DOI: 10.1080/13854046.2023.2246669] [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: 03/29/2023] [Accepted: 08/05/2023] [Indexed: 08/14/2023]
Abstract
Objective: In neuropsychological evaluations, assessing cognitive functioning is often achieved using objective neuropsychological measures, whereas subjective informant reports are typically obtained to determine manifest daily functioning. Informant reports of participant functioning and their associations with objective participant performance on neuropsychological testing have been shown to vary based on informant characteristics. However, associations among informant characteristics, reported functioning, and neuropsychological performance have not been adequately examined with Mexican American or other Hispanic/Latino samples, despite these populations' disproportionately higher rates of dementia due to Alzheimer's disease and related disorders. Method: We examined associations of informant characteristics with informant reports of participant functioning (assessed via the Functional Activities Questionnaire [FAQ]), and potential moderating effects of these characteristics on associations between reported functioning and participant performance on neuropsychological testing, for Mexican American adult participants in the National Alzheimer's Coordinating Center cohort (n = 294). Results: Female informants reported significantly worse participant functioning compared to male informants (p = .035, r = .126). Moreover, significant associations between reported functioning and memory performance were observed for participants with female informants, but not for those with male informants (p = .024, r = .138). Higher levels of informant education were associated with significantly worse participant functioning (p = .011, r = .151). However, informant education did not moderate associations between reported functioning and neuropsychological performance (ps > .05). Conclusions: Compared to male informants, female informants may provide subjective reports of Mexican American participant functioning that more closely corroborate objective participant performance in memory.
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Affiliation(s)
- Lisa V Graves
- Psychology Department, California State University San Marcos, San Marcos, CA, USA
| | - Dora Beacham
- Psychology Department, California State University San Marcos, San Marcos, CA, USA
| | - Nicole Sawitzky
- Psychology Department, California State University San Marcos, San Marcos, CA, USA
| | - Jennifer Lozano
- Psychology Department, California State University San Marcos, San Marcos, CA, USA
| | - Mathilde Weberg
- Psychology Department, California State University San Marcos, San Marcos, CA, USA
| | - Karissa Reyes
- Psychology Department, California State University San Marcos, San Marcos, CA, USA
| | - Lorraine Vergonia
- Psychology Department, California State University San Marcos, San Marcos, CA, USA
| | - Ashley Santana
- Psychology Department, California State University San Marcos, San Marcos, CA, USA
| | - Ezekiel Hernandez
- Psychology Department, California State University San Marcos, San Marcos, CA, USA
| | - Darya Sarsar
- Psychology Department, California State University San Marcos, San Marcos, CA, USA
| | - Zachary Conaway
- Psychology Department, California State University San Marcos, San Marcos, CA, USA
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6
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Estrella ML, Tarraf W, Kuwayama S, Gallo LC, Salazar CR, Stickel AM, Mattei J, Vásquez PM, Eldeirawi KM, Perreira KM, Penedo FJ, Isasi CR, Cai J, Zeng D, González HM, Daviglus ML, Lamar M. Associations of Allostatic Load with Level of and Change in Cognitive Function Among Middle-Aged and Older Hispanic/Latino Adults: The Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA). J Alzheimers Dis 2024; 99:1047-1064. [PMID: 38758999 DOI: 10.3233/jad-230796] [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: 05/19/2024]
Abstract
Background Higher allostatic load (AL), a multi-system measure of physiological dysregulation considered a proxy for chronic stress exposure, is associated with poorer global cognition (GC) in older non-Hispanic white adults. However, evidence of these associations in middle-aged and older US-based Hispanic/Latino adults is limited. Objective To examine associations of AL with level of cognition, performance in cognition 7 years later, and change in cognition over 7 years among middle-aged and older US-based Hispanic/Latino adults. Methods We used data (n = 5,799, 45-74 years at baseline) from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) and SOL-Investigation of Neurocognitive Aging (SOL-INCA). The AL score comprised 16 biomarkers representing cardiometabolic, glucose, cardiopulmonary, parasympathetic, and inflammatory systems (higher scores = greater dysregulation). Cognitive outcomes included GC and individual tests of verbal learning and memory, world fluency (WF), Digit Symbol Substitution (DSS), and Trail Making (Parts A & B). Survey-linear regressions assessed associations of AL with performance in cognition at baseline, 7 years later, and via 7-year cognitive change scores adjusting for sociodemographic characteristics, lifestyle factors, and depressive symptoms. Results Higher AL was associated with lower baseline performance in GC and WF; and lower 7-year follow-up performance in these same measures plus DSS and Trail Making Parts A & B. Higher AL was associated with more pronounced 7-year change (reduction) in GC and on WF and DSS tests. Conclusions Findings extend previous evidence in predominantly older non-Hispanic white cohorts to show that AL is related to level of and change in GC (as well as WF and DSS) among middle-aged and older US-based Hispanic/Latino adults.
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Affiliation(s)
- Mayra L Estrella
- Rush Alzheimer's Disease Center and the Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL, USA
| | - Wassim Tarraf
- Institute of Gerontology and Department of Healthcare Sciences, Wayne State University, Detroit, MI, USA
| | - Sayaka Kuwayama
- Department of Neurosciences and Shiley-Marcos Alzheimer's Disease Research Center, University of California, San Diego, San Diego, CA, USA
| | - Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Christian R Salazar
- University of California Irvine Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, USA
| | - Ariana M Stickel
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Josiemer Mattei
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Priscilla M Vásquez
- Department of Urban Public Health, Charles R. Drew University of Science and Medicine, Los Angeles, CA, USA
| | - Kamal M Eldeirawi
- Department of Population Health Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Krista M Perreira
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Frank J Penedo
- Department of Psychology and Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Carmen R Isasi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jianwen Cai
- Department of Biostatistics, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Donglin Zeng
- Department of Biostatistics, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Hector M González
- Department of Neurosciences and Shiley-Marcos Alzheimer's Disease Research Center, University of California, San Diego, CA, USA
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL, USA
| | - Melissa Lamar
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL, USA
- Rush Alzheimer's Disease Center and the Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
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Guarña LA, Kamalyan L, Watson CWM, Karcher K, Umlauf A, Morgan E, Moore D, Ellis R, Grant I, Cherner M, Moore RC, Zlatar ZZ, Heaton RK, Marquine MJ. Emotional health and its association with neurocognition in Hispanic and non-Hispanic White people with HIV. J Int Neuropsychol Soc 2024; 30:56-66. [PMID: 37078464 PMCID: PMC10766342 DOI: 10.1017/s1355617723000188] [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] [Indexed: 04/21/2023]
Abstract
OBJECTIVE Emotional functioning is linked to HIV-associated neurocognitive impairment, yet research on this association among diverse people with HIV (PWH) is scant. We examined emotional health and its association with neurocognition in Hispanic and White PWH. METHODS Participants included 107 Hispanic (41% primarily Spanish-speakers; 80% Mexican heritage/origin) and 216 White PWH (Overall age: M = 53.62, SD = 12.19; 86% male; 63% AIDS; 92% on antiretroviral therapy). Emotional health was assessed via the National Institute of Health Toolbox (NIHTB)-Emotion Battery, which yields T-scores for three factor-based summary scores (negative affect, social satisfaction, and psychological well-being) and 13 individual component scales. Neurocognition was measured via demographically adjusted fluid cognition T-scores from the NIHTB-cognition battery. RESULTS 27%-39% of the sample had problematic socioemotional summary scores. Hispanic PWH showed less loneliness, better social satisfaction, higher meaning and purpose, and better psychological well-being than Whites (ps <.05). Within Hispanics, Spanish-speakers showed better meaning and purpose, higher psychological well-being summary score, less anger hostility, but greater fear affect than English speakers. Only in Whites, worse negative affect (fear affect, perceived stress, and sadness) was associated with worse neurocognition (p <.05); and in both groups, worse social satisfaction (emotional support, friendship, and perceived rejection) was linked with worse neurocognition (p <.05). CONCLUSION Adverse emotional health is common among PWH, with subgroups of Hispanics showing relative strengths in some domains. Aspects of emotional health differentially relate to neurocogntition among PWH and cross-culturally. Understanding these varying associations is an important step towards the development of culturally relevant interventions that promote neurocognitive health among Hispanic PWH.
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Affiliation(s)
- Lesley A. Guarña
- Division of Geriatrics, Gerontology and Palliative Care, Department of Medicine, University of California San Diego, La Jolla, CA 92093-0662, USA
- HIV Neurobehavioral Research Program, University of California San Diego, 220 Dickinson Street, Suite B, San Diego, CA 92103-8231, USA
| | - Lily Kamalyan
- HIV Neurobehavioral Research Program, University of California San Diego, 220 Dickinson Street, Suite B, San Diego, CA 92103-8231, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. La Jolla, CA 92093, USA
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, USA
| | - Caitlin Wei-Ming Watson
- HIV Neurobehavioral Research Program, University of California San Diego, 220 Dickinson Street, Suite B, San Diego, CA 92103-8231, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. La Jolla, CA 92093, USA
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, USA
| | - Kayle Karcher
- Mentorship for Advancing Diversity in Undergraduate Research on Aging Program, University of California San Diego, 9500 Gilman Dr. La Jolla, CA, 920936, USA
| | - Anya Umlauf
- HIV Neurobehavioral Research Program, University of California San Diego, 220 Dickinson Street, Suite B, San Diego, CA 92103-8231, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. La Jolla, CA 92093, USA
| | - Erin Morgan
- HIV Neurobehavioral Research Program, University of California San Diego, 220 Dickinson Street, Suite B, San Diego, CA 92103-8231, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. La Jolla, CA 92093, USA
| | - David Moore
- HIV Neurobehavioral Research Program, University of California San Diego, 220 Dickinson Street, Suite B, San Diego, CA 92103-8231, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. La Jolla, CA 92093, USA
| | - Ronald Ellis
- HIV Neurobehavioral Research Program, University of California San Diego, 220 Dickinson Street, Suite B, San Diego, CA 92103-8231, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. La Jolla, CA 92093, USA
- Department of Neurosciences, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0662, USA
| | - Igor Grant
- HIV Neurobehavioral Research Program, University of California San Diego, 220 Dickinson Street, Suite B, San Diego, CA 92103-8231, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. La Jolla, CA 92093, USA
| | - Mariana Cherner
- HIV Neurobehavioral Research Program, University of California San Diego, 220 Dickinson Street, Suite B, San Diego, CA 92103-8231, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. La Jolla, CA 92093, USA
| | - Raeanne C. Moore
- HIV Neurobehavioral Research Program, University of California San Diego, 220 Dickinson Street, Suite B, San Diego, CA 92103-8231, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. La Jolla, CA 92093, USA
| | - Zvinka Z. Zlatar
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. La Jolla, CA 92093, USA
| | - Robert K. Heaton
- HIV Neurobehavioral Research Program, University of California San Diego, 220 Dickinson Street, Suite B, San Diego, CA 92103-8231, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. La Jolla, CA 92093, USA
| | - María J. Marquine
- Division of Geriatrics, Gerontology and Palliative Care, Department of Medicine, University of California San Diego, La Jolla, CA 92093-0662, USA
- HIV Neurobehavioral Research Program, University of California San Diego, 220 Dickinson Street, Suite B, San Diego, CA 92103-8231, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. La Jolla, CA 92093, USA
- Departments of Medicine (Geriatrics Division) and Psychiatry, Duke University, Durham, NC, USA
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Morris EP, Turney IC, Palms JD, Zaheed AB, Sol K, Amarante E, Beato J, Chesebro AG, Morales CD, Manly JJ, Brickman AM, Zahodne LB. Racial and ethnic differences in the relationship between financial worry and white matter hyperintensities in Latinx, non-Latinx Black, and non-Latinx White older adults. Neurobiol Aging 2023; 129:149-156. [PMID: 37331245 PMCID: PMC10878173 DOI: 10.1016/j.neurobiolaging.2023.05.008] [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: 05/23/2022] [Revised: 04/28/2023] [Accepted: 05/10/2023] [Indexed: 06/20/2023]
Abstract
Socioeconomic status (SES) is associated with white matter hyperintensities (WMHs) and contributes to racial and ethnic health disparities. However, traditional measures of SES may not accurately represent individual financial circumstances among non-Latinx Black and Latinx older adults due to longstanding structural inequities. This study examined associations between multiple SES indicators (education, income, subjective financial worry) and WMHs across non-Latinx Black, Latinx, and non-Latinx White older adults in the Washington Heights-Inwood Columbia Aging Project (N = 662). Latinx participants reported the lowest SES and greatest financial worry, while Black participants evidenced the most WMHs. Greater financial worry was associated with higher WMHs volume above and beyond education and income, which were not associated with WMHs. However, this association was only evident among Latinx older adults. These results provide evidence for the minority poverty hypothesis and highlight the need for systemic socioeconomic interventions to alleviate brain health disparities in older adulthood.
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Affiliation(s)
- Emily P Morris
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA.
| | - Indira C Turney
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Jordan D Palms
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Afsara B Zaheed
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Ketlyne Sol
- Social Environment and Health Program, Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Erica Amarante
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Juliet Beato
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Anthony G Chesebro
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Clarissa D Morales
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Jennifer J Manly
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Adam M Brickman
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Laura B Zahodne
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
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9
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Vásquez PM, Tarraf W, Chai A, Doza A, Sotres-Alvarez D, Diaz KM, Zlatar ZZ, Durazo-Arvizu RA, Gallo LC, Estrella ML, Vásquez E, Evenson KR, Khambaty T, Thyagarajan B, Singer RH, Schneiderman N, Daviglus ML, González HM. Accelerometer-Measured Latent Physical Activity Profiles and Neurocognition Among Middle-Aged and Older Hispanic/Latino Adults in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). J Gerontol B Psychol Sci Soc Sci 2022; 77:e263-e278. [PMID: 36219450 PMCID: PMC9799203 DOI: 10.1093/geronb/gbac161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Derive latent profiles of accelerometry-measured moderate-vigorous physical activity (MVPA) for Hispanic/Latino adults, examine associations between latent MVPA profiles and neurocognition, and describe profiles via self-reported MVPA. METHODS Complex survey design methods were applied to cross-sectional data from 7,672 adults ages 45-74 years in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL; 2008-2011). MVPA was measured via hip-worn accelerometers. Latent profile analysis was applied to derive latent MVPA profiles (minutes/day of week). Neurocognition was assessed with the Brief-Spanish English Verbal Learning Test (B-SEVLT) Sum, B-SEVLT Recall, Controlled Oral Word Association Test (word fluency), and Digit Symbol Substitution (DSS) test. All tests were z-scored, and a global neurocognition score was generated by averaging across scores. Survey linear regression models were used to examine associations between latent MVPA profiles and neurocognitive measures. Self-reported MVPA domains were estimated (occupational, transportation, and recreational) for each latent profile. RESULTS Four latent MVPA profiles from the overall adult target population (18-74 years) were derived and putatively labeled: No MVPA, low, moderate, and high. Only the high MVPA profile (compared to moderate) was associated with lower global neurocognition. Sensitivity analyses using latent MVPA profiles with only participants aged 45-74 years showed similar profiles, but no associations between latent MVPA profiles and neurocognition. The occupational MVPA domain led in all latent MVPA profiles. DISCUSSION We found no consistent evidence to link accelerometry-measured MVPA profiles to neurocognitive function. Research to better characterize the role of high occupational MVPA in relation to neurocognition among Hispanic/Latino adults are needed.
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Affiliation(s)
- Priscilla M Vásquez
- Department of Urban Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, California, USA
| | - Wassim Tarraf
- Institute of Gerontology and Department of Healthcare Services, Wayne State University, Detroit, Michigan, USA
| | - Albert Chai
- Department of Neuroscience, University of California San Diego, La Jolla, California, USA
| | - Adit Doza
- Institute of Gerontology and Department of Healthcare Services, Wayne State University, Detroit, Michigan, USA
| | - Daniela Sotres-Alvarez
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Keith M Diaz
- Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Zvinka Z Zlatar
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Ramon A Durazo-Arvizu
- Department of Pediatrics, University of Southern California, Los Angeles, California, USA
| | - Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Mayra L Estrella
- Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Elizabeth Vásquez
- School of Public Health, University at Albany, State University of New York, Rensselaer, New York, USA
| | - Kelly R Evenson
- Department of Epidemiology, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Tasneem Khambaty
- Department of Psychology, University of Maryland Baltimore County, Baltimore, Maryland, USA
| | - Bharat Thyagarajan
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Richard H Singer
- Department of Oral Science and Translational Research, College of Dental Medicine, Nova Southeastern University, Ft. Lauderdale, Florida, USA
| | - Neil Schneiderman
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Martha L Daviglus
- Institute for Minority Health Research, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Hector M González
- Department of Neuroscience, University of California San Diego, La Jolla, California, USA
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10
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Stites SD, Midgett S, Mechanic-Hamilton D, Zuelsdorff M, Glover CM, Marquez DX, Balls-Berry JE, Streitz ML, Babulal G, Trani JF, Henderson JN, Barnes LL, Karlawish J, Wolk DA. Establishing a Framework for Gathering Structural and Social Determinants of Health in Alzheimer's Disease Research Centers. THE GERONTOLOGIST 2022; 62:694-703. [PMID: 34919705 PMCID: PMC9154263 DOI: 10.1093/geront/gnab182] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Indexed: 11/13/2022] Open
Abstract
Structural and social determinants of health (SSDoH) are environmental conditions in which individuals are born, live, learn, work, play, worship, and age that affect health, functioning, and quality-of-life outcomes across the life course. Growing evidence suggests that SSDoH can help to explain heterogeneity in outcomes in Alzheimer's disease and Alzheimer's disease and related dementias (AD/ADRD) research and clinical practice. The National Institute on Aging has prioritized collecting SSDoH data to elucidate disease mechanisms and aid discovery of disease-modifying treatments. However, a major nexus of AD/ADRD research, the national network of Alzheimer's Disease Research Centers (ADRCs), collects few SSDoH data. We describe a framework for feasibly gathering and modeling SSDoH data across ADRCs. We lay out key constructs, their measures, and empirical evidence for their importance in elucidating disease and prevention mechanisms. Toward a goal of translation, the framework proposes a modular structure with a core set of measures and options for adjunctive modules. We describe considerations for measuring SSDoH in existing geographically and culturally diverse research cohorts. We also outline a rationale for universal implementation of a set of SSDoH measures and juxtapose the approach with alternatives aimed at collecting SSDoH data.
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Affiliation(s)
- Shana D Stites
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sharnita Midgett
- Department of Geriatric Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Megan Zuelsdorff
- Department of Nursing, Wisconsin University, Madison, Wisconsin, USA
| | - Crystal M Glover
- Department of Psychiatry, Rush University Medical Center, Chicago, Illinois, USA
| | - David X Marquez
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Joyce E Balls-Berry
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Marissa L Streitz
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Ganesh Babulal
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Psychology, University of Johannesburg, Johannesburg, South Africa
| | - Jean-Francois Trani
- Department of Public Health, Washington University in St. Louis, St. Louis, Missouri, USA
| | - J Neil Henderson
- Department of Family Medicine and Behavioral Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Lisa L Barnes
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Jason Karlawish
- Department of Geriatric Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Dave A Wolk
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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11
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Marquine MJ, Gallo LC, Tarraf W, Wu B, Moore AA, Vásquez PM, Talavera G, Allison M, Muñoz E, Isasi CR, Perreira KM, Bigornia SJ, Daviglus M, Estrella ML, Zeng D, González HM. The Association of Stress, Metabolic Syndrome, and Systemic Inflammation With Neurocognitive Function in the Hispanic Community Health Study/Study of Latinos and Its Sociocultural Ancillary Study. J Gerontol B Psychol Sci Soc Sci 2022; 77:860-871. [PMID: 34378777 PMCID: PMC9071500 DOI: 10.1093/geronb/gbab150] [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: 02/25/2021] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES Identifying sociocultural correlates of neurocognitive dysfunction among Hispanics/Latinos, and their underlying biological pathways, is crucial for understanding disparities in Alzheimer's disease and related dementias. We examined cross-sectional associations between stress and neurocognition, and the role that metabolic syndrome (MetS) and systemic inflammation might play in these associations. METHOD Participants included 3,045 adults aged 45-75 (56% female, education 0-20+ years, 86% Spanish-speaking, 23% U.S.-born), enrolled in the Hispanic Community Health Study/Study of Latinos and its Sociocultural Ancillary Study. Global neurocognition was the primary outcome and operationalized as the average of the z scores of measures of learning and memory, word fluency, and processing speed. Stress measures included self-report assessments of stress appraisal (perceived and acculturative stress) and exposure to chronic and traumatic stressors. MetS was defined via established criteria including waist circumference, high blood pressure, elevated triglycerides, fasting plasma glucose, and high levels of high-density lipoprotein cholesterol. Systemic inflammation was represented by high-sensitivity C-reactive protein (hs-CRP). RESULTS Separate survey multivariable linear regression models adjusting for covariates showed that higher perceived (b = -0.004, SE = 0.002, p < .05) and acculturative stress (b = -0.004, SE = 0.001, p < .0001) were significantly associated with worse global neurocognition, while lifetime exposure to traumatic stressors was associated with better global neurocognition (b = 0.034, SE = 0.009, p < .001). Neither MetS nor hs-CRP were notable pathways in the association between stress and neurocognition; rather, they were both independently associated with worse neurocognition in models including stress measures (ps < .05). DISCUSSION These cross-sectional analyses suggest that stress appraisal, MetS, and systemic inflammation may be targets to reduce neurocognitive dysfunction among Hispanics/Latinos.
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Affiliation(s)
- María J Marquine
- Department of Medicine, University of California San Diego, La Jolla, California, USA
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Wassim Tarraf
- Department of Healthcare Sciences, Institute of Gerontology, Wayne State University, Detroit, Michigan, USA
| | - Benson Wu
- Department of Neurosciences, University of California San Diego, La Jolla, California, USA
| | - Alison A Moore
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Priscilla M Vásquez
- Department of Urban Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, California, USA
| | - Gregory Talavera
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Matthew Allison
- Department of Family Medicine, University of California San Diego, La Jolla, California, USA
| | - Elizabeth Muñoz
- Department of Human Development and Family Sciences, University of Texas at Austin, Austin, Texas, USA
| | - Carmen R Isasi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Krista M Perreira
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sherman J Bigornia
- Department of Agriculture, Nutrition, and Food Systems, University of New Hampshire, Durham, New Hampshire, USA
| | - Martha Daviglus
- Institute of Minority Health Research, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Mayra L Estrella
- Institute of Minority Health Research, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Donglin Zeng
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Hector M González
- Department of Neurosciences, University of California San Diego, La Jolla, California, USA
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12
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Miller De Rutté AM, Rubenstein BP. Acculturative Stress and the Effects on Health and Health Behaviors in Hispanic Immigrants: A Systematic Review. HISPANIC JOURNAL OF BEHAVIORAL SCIENCES 2021. [DOI: 10.1177/07399863211044897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this systematic review was to investigate previously published literature that examined the impact of acculturative stress on health in Spanish-speaking populations. The database search yielded a final count of 32 eligible articles for inclusion in this review. Age, acculturative stress measure, and study results were analyzed. Overall, 81.2% of studies investigated the impacts of acculturative stress on mental health with the majority concluding that increased acculturative stress had a significant relationship with greater mental health issues, such as depression, anxiety, and psychological stress. Other studies in this review examined impacts on physical health and health behaviors, but yielded inconclusive results indicating that these are areas for future research.
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13
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Kronenfeld JP, Graves KD, Penedo FJ, Yanez B. Overcoming Disparities in Cancer: A Need for Meaningful Reform for Hispanic and Latino Cancer Survivors. Oncologist 2021; 26:443-452. [PMID: 33594785 DOI: 10.1002/onco.13729] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/29/2020] [Indexed: 12/12/2022] Open
Abstract
Hispanic and Latino (HL) cancer survivors are at a critical disadvantage compared with non-Hispanic White (NHW) patients regarding sociodemographic adversities and access to equitable treatment options. By 2030, there will be about four million HL cancer survivors in the U.S., representing nearly 20% of survivors in this country. Hispanics and Latinos are subjected to significant challenges in accessing and receiving equitable care relative to NHWs. Hispanics and Latinos also experience lower rates of health insurance and financial resources, limiting health care options. These disparities often originate from disparate social determinants of health, including lower funding for education and school programs, greater neighborhood stressors and violence, lower access to healthy and affordable food, and greater barriers to community health and exercise opportunities. Even among HL cancer survivors with proper access to health care, they experience disparate treatment options, including low inclusion in clinical trials and/or access to experimental therapies. A solution to these barriers necessitates complex and systemic changes that involve, for example, investing in public health programs, increasing the diversity and cultural awareness of the medical workforce, and promoting research opportunities such as clinical trials that are inclusive of HLs. Only through meaningful reform will equitable cancer care be available for all in the U.S. regardless of racial and/or ethnic background. This article reviews some of the critical social determinants of health and biases relevant to HL cancer survivors and provides recommendations for achieving cancer health equity. IMPLICATIONS FOR PRACTICE: Hispanics and Latinos experience a significant and often disproportionate cancer-related burden compared with non-Hispanic and Latino White individuals and other racial and ethnic groups. Meaningful reform to achieve health equity in oncology should focus on approaches to gaining trust among diverse patients, cultural and community sensitivity and engagement in oncology care and research, diversifying the workforce, and improving inclusion in clinical trial participation. Taken together, these recommendations can lead to exemplary and equitable care for all patients.
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Affiliation(s)
- Joshua P Kronenfeld
- University of Miami Miller School of Medicine & Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Kristi D Graves
- Georgetown University Lombardi Comprehensive Cancer Center, Washington, District of Columbia, USA
| | - Frank J Penedo
- University of Miami Miller School of Medicine & Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Betina Yanez
- Northwestern University Feinberg School of Medicine and Lurie Comprehensive Cancer Center, Chicago, Illinois, USA
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14
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Kronenfeld JP, Graves KD, Penedo FJ, Yanez B. Overcoming Disparities in Cancer: A Need for Meaningful Reform for Hispanic and Latino Cancer Survivors. Oncologist 2021. [PMID: 33594785 DOI: 10.1002/onco.13729.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Hispanic and Latino (HL) cancer survivors are at a critical disadvantage compared with non-Hispanic White (NHW) patients regarding sociodemographic adversities and access to equitable treatment options. By 2030, there will be about four million HL cancer survivors in the U.S., representing nearly 20% of survivors in this country. Hispanics and Latinos are subjected to significant challenges in accessing and receiving equitable care relative to NHWs. Hispanics and Latinos also experience lower rates of health insurance and financial resources, limiting health care options. These disparities often originate from disparate social determinants of health, including lower funding for education and school programs, greater neighborhood stressors and violence, lower access to healthy and affordable food, and greater barriers to community health and exercise opportunities. Even among HL cancer survivors with proper access to health care, they experience disparate treatment options, including low inclusion in clinical trials and/or access to experimental therapies. A solution to these barriers necessitates complex and systemic changes that involve, for example, investing in public health programs, increasing the diversity and cultural awareness of the medical workforce, and promoting research opportunities such as clinical trials that are inclusive of HLs. Only through meaningful reform will equitable cancer care be available for all in the U.S. regardless of racial and/or ethnic background. This article reviews some of the critical social determinants of health and biases relevant to HL cancer survivors and provides recommendations for achieving cancer health equity. IMPLICATIONS FOR PRACTICE: Hispanics and Latinos experience a significant and often disproportionate cancer-related burden compared with non-Hispanic and Latino White individuals and other racial and ethnic groups. Meaningful reform to achieve health equity in oncology should focus on approaches to gaining trust among diverse patients, cultural and community sensitivity and engagement in oncology care and research, diversifying the workforce, and improving inclusion in clinical trial participation. Taken together, these recommendations can lead to exemplary and equitable care for all patients.
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Affiliation(s)
- Joshua P Kronenfeld
- University of Miami Miller School of Medicine & Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Kristi D Graves
- Georgetown University Lombardi Comprehensive Cancer Center, Washington, District of Columbia, USA
| | - Frank J Penedo
- University of Miami Miller School of Medicine & Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Betina Yanez
- Northwestern University Feinberg School of Medicine and Lurie Comprehensive Cancer Center, Chicago, Illinois, USA
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