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Williams O, Ting T, Matthews L, Block G, Block T, Teresi J, Eimicke J, Kong J, Silver S, Ravenell J, Mallaiah J, Jammalamadaka S, Nelson LM, Karmally W, Hankerson S. Community Health workers United to Reduce Colorectal cancer and cardiovascular disease among people at Higher risk (CHURCH): study protocol for a randomized controlled trial. Trials 2024; 25:283. [PMID: 38671470 PMCID: PMC11046862 DOI: 10.1186/s13063-024-08110-z] [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: 01/30/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is the second most lethal cancer in the United States (U.S.) with the highest incidence and mortality rates among African Americans (AAs) compared to other racial groups. Despite these disparities, AAs are the least likely to undergo CRC screening, have precancerous colorectal polyps removed, and have CRC detected at stages early enough for curative excision. In addition, compelling evidence links inflammatory dietary patterns to increased CRC and cardiovascular disease risk. Studies show that AA churches can successfully engage in health promotion activities including those related to cancer control. The current study seeks to leverage church-placed Community Health Workers (CHWs) to increase CRC screening and reduce CRC risk. DESIGN AND METHODS We aim to (1) increase guideline concordant CRC screening uptake using church-placed CHWs trained in screening with a validated instrument, Brief Intervention using Motivational Interviewing, and Referral to Treatment (SBIRT); and (2) reduce dietary risk factors (inflammatory dietary patterns) linked to CRC. The latter will be addressed by culturally adapting an existing, web-based lifestyle program called Alive!. Using a Hybrid Type 1 Implementation-Effectiveness cluster randomized design, we will randomize 22 AA churches into either the dual intervention arm (CHW-led SBIRT intervention plus Alive!) or a usual care arm comprised of CRC prevention educational pamphlets and a list of CRC screening sites. We will recruit 440 subjects and evaluate the effects of both arms on screening uptake (colonoscopy, fecal DNA) (primary outcome) and dietary inflammation score (secondary outcome) at 6-month follow-up, and Life Simple7 (LS7)-a cardiovascular disease (CVD) risk score-at 6 months and 1 year (secondary outcome). Finally, guided by a racism-conscious adaptation of the Consolidated Framework for Implementation Research (CFIR), we will conduct a mixed-methods process evaluation with key stakeholders to understand multi-level influences on CRC screening and CVD risk behaviors. DISCUSSION Church-placed CHWs are trusted influential connectors between communities and health systems. Studies have shown that these CHWs can successfully implement health prevention protocols in churches, including those related to cancer control, making them potentially important community mediators of CRC screening uptake and CRC/CVD risk reduction. TRIAL REGISTRATION NCT05174286; clinicaltrials.gov; August 31st, 2023.
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Affiliation(s)
- Olajide Williams
- Columbia University Irving Medical Center, 710 West 168th Street, New York, NY, 10032, USA
| | - Tina Ting
- Columbia University Irving Medical Center, 710 West 168th Street, New York, NY, 10032, USA.
| | - Lisa Matthews
- Columbia University Irving Medical Center, 710 West 168th Street, New York, NY, 10032, USA
| | - Gladys Block
- NutritionQuest and Turnaround Health, Berkeley, CA, USA
| | - Torin Block
- NutritionQuest and Turnaround Health, Berkeley, CA, USA
| | - Jeanne Teresi
- Division of Medicine, Data Coordinating Center Unit, Columbia University Irving Medical Center, Stroud Center at New York State Psychiatric Institute, 622 West 168th Street, New York, NY, 10032, USA
| | - Joseph Eimicke
- Division of Medicine, Data Coordinating Center Unit, Columbia University Irving Medical Center, Stroud Center at New York State Psychiatric Institute, 622 West 168th Street, New York, NY, 10032, USA
| | - Jian Kong
- Division of Medicine, Data Coordinating Center Unit, Columbia University Irving Medical Center, Stroud Center at New York State Psychiatric Institute, 622 West 168th Street, New York, NY, 10032, USA
| | - Stephanie Silver
- Division of Medicine, Data Coordinating Center Unit, Columbia University Irving Medical Center, Stroud Center at New York State Psychiatric Institute, 622 West 168th Street, New York, NY, 10032, USA
| | - Joseph Ravenell
- New York University Grossman School of Medicine, Manhattan, NY, USA
| | - Janhavi Mallaiah
- Columbia University Irving Medical Center, 710 West 168th Street, New York, NY, 10032, USA
| | - Soujanya Jammalamadaka
- Columbia University Irving Medical Center, 710 West 168th Street, New York, NY, 10032, USA
| | - Laura Maudene Nelson
- Columbia University Irving Medical Center, 710 West 168th Street, New York, NY, 10032, USA
| | - Wahida Karmally
- Columbia University Irving Medical Center, 710 West 168th Street, New York, NY, 10032, USA
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Williams O, Ting T, Matthews L, Block G, Block T, Teresi J, Eimicke J, Kong J, Silver S, Ravenell J, Mallaiah J, Jammalamadaka S, Nelson LM, Karmally W, Hankerson S. Community Health workers United to Reduce Colorectal cancer and cardiovascular disease among people at Higher risk (CHURCH): study protocol for a randomized controlled trial. RESEARCH SQUARE 2024:rs.3.rs-3797889. [PMID: 38659874 PMCID: PMC11042434 DOI: 10.21203/rs.3.rs-3797889/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Background: Colorectal cancer (CRC) is the second most lethal cancer in the United States (U.S.) with the highest incidence and mortality rates among African Americans (AAs) compared to other racial groups. Despite these disparities, AAs are the least likely to undergo CRC screening, have precancerous colorectal polys removed, and have CRC detected at stages early enough for curative excision. In addition, compelling evidence links inflammatory dietary patterns to increased CRC and cardiovascular disease risk. Studies show that AA churches can successfully engage in health promotion activities including those related to cancer control. The current study seeks to leverage church-placed Community Health Workers (CHWs) to increase CRC screening and reduce CRC risk. Design and Methods: We aim to (1) increase guideline concordant CRC screening uptake using church-placed CHWs trained in screening with a validated instrument, Brief Intervention using Motivational Interviewing, and Referral to Treatment (SBIRT); and (2) reduce dietary risk factors (inflammatory dietary patterns) linked to CRC. The latter will be addressed by culturally adapting an existing, web-based lifestyle program called Alive!. Using a Hybrid Type 1 Implementation-Effectiveness cluster randomized design, we will randomize 22 AA churches into either the dual intervention arm (CHW-led SBIRT intervention plus Alive!) or a usual care arm comprised of CRC prevention educational pamphlets and a list of CRC screening sites. We will recruit 440 subjects and evaluate the effects of both arms on screening uptake (colonoscopy, fecal DNA) (primary outcome) and dietary inflammation score (secondary outcome) at 6-months follow up, and Life Simple7 (LS7) - a cardiovascular disease (CVD) risk score - at 6 months and 1-year (secondary outcome). Finally, guided by a racism-conscious adaptation of the Consolidated Framework for Implementation Research (CFIR), we will conduct a mixed- methods process evaluation with key stakeholders to understand multi-level influences on CRC screening and CVD risk behaviors. Discussion: Church-placed CHWs are trusted influential connectors between communities and health systems. Studies have shown that these CHWs can successfully implement health prevention protocols in churches, including those related to cancer control, making them potentially important community mediators of CRC screening uptake and CRC/CVD risk reduction. Trial registration: NCT05174286.
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Rahman SN, Long JB, Westvold SJ, Leapman MS, Spees LP, Hurwitz ME, McManus HD, Gross CP, Wheeler SB, Dinan MA. Area Vulnerability and Disparities in Therapy for Patients With Metastatic Renal Cell Carcinoma. JAMA Netw Open 2024; 7:e248747. [PMID: 38687479 PMCID: PMC11061765 DOI: 10.1001/jamanetworkopen.2024.8747] [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: 12/06/2023] [Accepted: 02/28/2024] [Indexed: 05/02/2024] Open
Abstract
Importance Area-level measures of sociodemographic disadvantage may be associated with racial and ethnic disparities with respect to receipt of treatment for metastatic renal cell carcinoma (mRCC) but have not been investigated previously, to our knowledge. Objective To assess the association between area-level measures of social vulnerability and racial and ethnic disparities in the treatment of US Medicare beneficiaries with mRCC from 2015 through 2019. Design, Setting, and Participants This retrospective cohort study included Medicare beneficiaries older than 65 years who were diagnosed with mRCC from January 2015 through December 2019 and were enrolled in fee-for-service Medicare Parts A, B, and D from 1 year before through 1 year after presumed diagnosis or until death. Data were analyzed from November 22, 2022, through January 26, 2024. Exposures Five different county-level measures of disadvantage and 4 zip code-level measures of vulnerability or deprivation and segregation were used to dichotomize whether an individual resided in the most vulnerable quartile according to each metric. Patient-level factors included age, race and ethnicity, sex, diagnosis year, comorbidities, frailty, Medicare and Medicaid dual enrollment eligibility, and Medicare Part D low-income subsidy (LIS). Main Outcomes and Measures The main outcomes were receipt and type of systemic therapy (oral anticancer agent or immunotherapy from 2 months before to 1 year after diagnosis of mRCC) as a function of patient and area-level characteristics. Multivariable regression analyses were used to adjust for patient factors, and odds ratios (ORs) from logistic regression and relative risk ratios (RRRs) from multinomial logistic regression are reported. Results The sample included 15 407 patients (mean [SD] age, 75.6 [6.8] years), of whom 9360 (60.8%) were men; 6931 (45.0%), older than 75 years; 93 (0.6%), American Indian or Alaska Native; 257 (1.7%), Asian or Pacific Islander; 757 (4.9%), Hispanic; 1017 (6.6%), non-Hispanic Black; 12 966 (84.2%), non-Hispanic White; 121 (0.8%), other; and 196 (1.3%), unknown. Overall, 8317 patients (54.0%) received some type of systemic therapy. After adjusting for individual factors, no county or zip code-level measures of social vulnerability, deprivation, or segregation were associated with disparities in treatment. In contrast, patient-level factors, including female sex (OR, 0.78; 95% CI, 0.73-0.84) and LIS (OR, 0.48; 95% CI, 0.36-0.65), were associated with lack of treatment, with particularly limited access to immunotherapy for patients with LIS (RRR, 0.25; 95% CI, 0.14-0.43). Associations between individual-level factors and treatment in multivariable analysis were not mediated by the addition of area-level metrics. Disparities by race and ethnicity were consistently and only observed within the most vulnerable areas, as indicated by the top quartile of each vulnerability deprivation index. Conclusions and Relevance In this cohort study of older Medicare patients diagnosed with mRCC, individual-level demographics, including race and ethnicity, sex, and income, were associated with receipt of systemic therapy, whereas area-level measures were not. However, individual-level racial and ethnic disparities were largely limited to socially vulnerable areas, suggesting that efforts to improve racial and ethnic disparities may be most effective when targeted to socially vulnerable areas.
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Affiliation(s)
- Syed N. Rahman
- Department of Urology, Yale School of Medicine, New Haven, Connecticut
| | - Jessica B. Long
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale University, New Haven, Connecticut
| | - Sarah J. Westvold
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale University, New Haven, Connecticut
| | - Michael S. Leapman
- Department of Urology, Yale School of Medicine, New Haven, Connecticut
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale University, New Haven, Connecticut
| | - Lisa P. Spees
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill
| | - Michael E. Hurwitz
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Hannah D. McManus
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Cary P. Gross
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale University, New Haven, Connecticut
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Stephanie B. Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill
| | - Michaela A. Dinan
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale University, New Haven, Connecticut
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
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Islami F, Baeker Bispo J, Lee H, Wiese D, Yabroff KR, Bandi P, Sloan K, Patel AV, Daniels EC, Kamal AH, Guerra CE, Dahut WL, Jemal A. American Cancer Society's report on the status of cancer disparities in the United States, 2023. CA Cancer J Clin 2024; 74:136-166. [PMID: 37962495 DOI: 10.3322/caac.21812] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 09/07/2023] [Indexed: 11/15/2023] Open
Abstract
In 2021, the American Cancer Society published its first biennial report on the status of cancer disparities in the United States. In this second report, the authors provide updated data on racial, ethnic, socioeconomic (educational attainment as a marker), and geographic (metropolitan status) disparities in cancer occurrence and outcomes and contributing factors to these disparities in the country. The authors also review programs that have reduced cancer disparities and provide policy recommendations to further mitigate these inequalities. There are substantial variations in risk factors, stage at diagnosis, receipt of care, survival, and mortality for many cancers by race/ethnicity, educational attainment, and metropolitan status. During 2016 through 2020, Black and American Indian/Alaska Native people continued to bear a disproportionately higher burden of cancer deaths, both overall and from major cancers. By educational attainment, overall cancer mortality rates were about 1.6-2.8 times higher in individuals with ≤12 years of education than in those with ≥16 years of education among Black and White men and women. These disparities by educational attainment within each race were considerably larger than the Black-White disparities in overall cancer mortality within each educational attainment, ranging from 1.03 to 1.5 times higher among Black people, suggesting a major role for socioeconomic status disparities in racial disparities in cancer mortality given the disproportionally larger representation of Black people in lower socioeconomic status groups. Of note, the largest Black-White disparities in overall cancer mortality were among those who had ≥16 years of education. By area of residence, mortality from all cancer and from leading causes of cancer death were substantially higher in nonmetropolitan areas than in large metropolitan areas. For colorectal cancer, for example, mortality rates in nonmetropolitan areas versus large metropolitan areas were 23% higher among males and 21% higher among females. By age group, the racial and geographic disparities in cancer mortality were greater among individuals younger than 65 years than among those aged 65 years and older. Many of the observed racial, socioeconomic, and geographic disparities in cancer mortality align with disparities in exposure to risk factors and access to cancer prevention, early detection, and treatment, which are largely rooted in fundamental inequities in social determinants of health. Equitable policies at all levels of government, broad interdisciplinary engagement to address these inequities, and equitable implementation of evidence-based interventions, such as increasing health insurance coverage, are needed to reduce cancer disparities.
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Affiliation(s)
| | | | | | | | | | - Priti Bandi
- American Cancer Society, Atlanta, Georgia, USA
| | | | | | | | | | - Carmen E Guerra
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Woodard N, Butler J, Ghosh D, Green KM, Knott CL. The Association between State-Level Structural Racism and Alcohol and Tobacco Use Behaviors among a National Probability Sample of Black Americans. Cancer Epidemiol Biomarkers Prev 2024; 33:261-269. [PMID: 38032218 PMCID: PMC10872984 DOI: 10.1158/1055-9965.epi-23-0873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/24/2023] [Accepted: 11/28/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Structural racism is how society maintains and promotes racial hierarchy and discrimination through established and interconnected systems. Structural racism is theorized to promote alcohol and tobacco use, which are risk factors for adverse health and cancer-health outcomes. The current study assesses the association between measures of state-level structural racism and alcohol and tobacco use among a national sample of 1,946 Black Americans. METHODS An existing composite index of state-level structural racism including five dimensions (subscales; i.e., residential segregation and employment, economic, incarceration, and educational inequities) was merged with individual-level data from a national sample dataset. Hierarchical linear and logistic regression models, accounting for participant clustering at the state level, assessed associations between structural racism and frequency of alcohol use, frequency of binge drinking, smoking status, and smoking frequency. Two models were estimated for each behavioral outcome, one using the composite structural racism index and one modeling dimensions of structural racism in lieu of the composite measure, each controlling for individual-level covariates. RESULTS Results indicated positive associations between the incarceration dimension of the structural racism index and binge drinking frequency, smoking status, and smoking frequency. An inverse association was detected between the education dimension and smoking status. CONCLUSIONS Results suggest that state-level structural racism expressed in incarceration disparities, is positively associated with alcohol and tobacco use among Black Americans. IMPACT Addressing structural racism, particularly in incarceration practices, through multilevel policy and intervention may help to reduce population-wide alcohol and tobacco use behaviors and improve the health outcomes of Black populations.
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Affiliation(s)
- Nathaniel Woodard
- Cancer Care Quality Training Program, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - James Butler
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, College Park, MD, USA
| | - Debarchana Ghosh
- Department of Geography, University of Connecticut, University of Connecticut, Storrs, CT, USA
| | - Kerry M. Green
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, College Park, MD, USA
| | - Cheryl L. Knott
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, College Park, MD, USA
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Moazzam Z, Woldesenbet S, Munir MM, Lima HA, Alaimo L, Endo Y, Cloyd J, Dillhoff M, Ejaz A, Pawlik TM. Mediators of racial disparities in postoperative outcomes among patients undergoing complex surgery. Am J Surg 2024; 228:165-172. [PMID: 37743217 DOI: 10.1016/j.amjsurg.2023.09.014] [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: 06/17/2023] [Revised: 08/07/2023] [Accepted: 09/11/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND This study sought to quantify the direct and indirect effects of race on postoperative outcomes after complex surgery. METHODS Medicare patients who underwent abdominal aortic aneurysm (AAA) repair, coronary artery bypass grafting (CABG), lung resection or colectomy were identified (2014-2018). Generalized structural equation modelling was utilized to quantify the direct and indirect effects of race on Textbook outcome (TO). RESULTS Among 930,033 patients, 46.8% of patients achieved a TO, with Black patients less likely to achieve a TO (referent: White; Black: OR 0.72, 95% CI 0.70-0.73). Notably, 32.3% of the disparities in TO were attributable to race itself, while 67.7% was explained by other factors. Specifically, residential segregation accounted for 39.4% of the lower TO rates among Black patients, while 21.0% was attributable to a high comorbidity burden. CONCLUSIONS These data highlight the need to target structural racism as a policy priority to promote a more equitable healthcare system.
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Affiliation(s)
- Zorays Moazzam
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Selamawit Woldesenbet
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Muhammad Musaab Munir
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Henrique A Lima
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Laura Alaimo
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Yutaka Endo
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Jordan Cloyd
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Mary Dillhoff
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Aslam Ejaz
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
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Jayasekera J, El Kefi S, Fernandez JR, Wojcik KM, Woo JMP, Ezeani A, Ish JL, Bhattacharya M, Ogunsina K, Chang CJ, Cohen CM, Ponce S, Kamil D, Zhang J, Le R, Ramanathan AL, Butera G, Chapman C, Grant SJ, Lewis-Thames MW, Dash C, Bethea TN, Forde AT. Opportunities, challenges, and future directions for simulation modeling the effects of structural racism on cancer mortality in the United States: a scoping review. J Natl Cancer Inst Monogr 2023; 2023:231-245. [PMID: 37947336 PMCID: PMC10637025 DOI: 10.1093/jncimonographs/lgad020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/23/2023] [Accepted: 07/03/2023] [Indexed: 11/12/2023] Open
Abstract
PURPOSE Structural racism could contribute to racial and ethnic disparities in cancer mortality via its broad effects on housing, economic opportunities, and health care. However, there has been limited focus on incorporating structural racism into simulation models designed to identify practice and policy strategies to support health equity. We reviewed studies evaluating structural racism and cancer mortality disparities to highlight opportunities, challenges, and future directions to capture this broad concept in simulation modeling research. METHODS We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Review Extension guidelines. Articles published between 2018 and 2023 were searched including terms related to race, ethnicity, cancer-specific and all-cause mortality, and structural racism. We included studies evaluating the effects of structural racism on racial and ethnic disparities in cancer mortality in the United States. RESULTS A total of 8345 articles were identified, and 183 articles were included. Studies used different measures, data sources, and methods. For example, in 20 studies, racial residential segregation, one component of structural racism, was measured by indices of dissimilarity, concentration at the extremes, redlining, or isolation. Data sources included cancer registries, claims, or institutional data linked to area-level metrics from the US census or historical mortgage data. Segregation was associated with worse survival. Nine studies were location specific, and the segregation measures were developed for Black, Hispanic, and White residents. CONCLUSIONS A range of measures and data sources are available to capture the effects of structural racism. We provide a set of recommendations for best practices for modelers to consider when incorporating the effects of structural racism into simulation models.
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Affiliation(s)
- Jinani Jayasekera
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Safa El Kefi
- NYU Langone Health, New York University, New York, NY, USA
| | - Jessica R Fernandez
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Kaitlyn M Wojcik
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Jennifer M P Woo
- Epidemiology Branch at the National Institute of Environmental Health Sciences at the National Institutes of Health, Bethesda, MD, USA
| | - Adaora Ezeani
- Health Behaviors Research Branch of the Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Jennifer L Ish
- Epidemiology Branch at the National Institute of Environmental Health Sciences at the National Institutes of Health, Bethesda, MD, USA
| | - Manami Bhattacharya
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, and the Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Kemi Ogunsina
- Epidemiology Branch at the National Institute of Environmental Health Sciences at the National Institutes of Health, Bethesda, MD, USA
| | - Che-Jung Chang
- Epidemiology Branch at the National Institute of Environmental Health Sciences at the National Institutes of Health, Bethesda, MD, USA
| | - Camryn M Cohen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Stephanie Ponce
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Dalya Kamil
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Julia Zhang
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
- Sophomore at Williams College, Williamstown, MA, USA
| | - Randy Le
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Amrita L Ramanathan
- Diabetes, Endocrinology, & Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Gisela Butera
- Office of Research Services, National Institutes of Health Library, Bethesda, MD, USA
| | - Christina Chapman
- Department of Radiation Oncology, Baylor College of Medicine, and the Center for Innovations in Quality, Effectiveness, and Safety in the Department of Medicine, Baylor College of Medicine and the Houston Veterans Affairs, Houston, TX, USA
| | - Shakira J Grant
- Department of Medicine, Division of Hematology, University of North Carolina, Chapel Hill, NC, USA
| | - Marquita W Lewis-Thames
- Department of Medical Social Science, Center for Community Health at Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Chiranjeev Dash
- Office of Minority Health and Health Disparities Research at the Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Traci N Bethea
- Office of Minority Health and Health Disparities Research at the Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Allana T Forde
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
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Sacks OA, Davids JS. Disparities in Rectal Cancer Care-What Are We Missing? JAMA Surg 2023; 158:1203. [PMID: 37728902 DOI: 10.1001/jamasurg.2023.4228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Affiliation(s)
- Olivia A Sacks
- Department of Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Jennifer S Davids
- Department of Surgery, Boston University School of Medicine, Boston, Massachusetts
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Liu JJ, DeCuir N, Kia L, Peterson J, Miller C, Issaka RB. Tools to Measure the Impact of Structural Racism and Discrimination on Gastrointestinal and Hepatology Disease Outcomes: A Scoping Review. Clin Gastroenterol Hepatol 2023; 21:2759-2788.e6. [PMID: 36549469 PMCID: PMC10279803 DOI: 10.1016/j.cgh.2022.12.002] [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: 08/08/2022] [Revised: 11/23/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND & AIMS Structural racism and discrimination (SRD) are important upstream determinants of health perpetuated by discriminatory laws and policies. Therefore, measuring SRD and its impact on health is critical to developing interventions that address resultant health disparities. We aimed to identify gastrointestinal (GI) or liver studies that report measures of SRD or interventions to achieve health equity in these domains by addressing upstream determinants of health. METHODS We conducted a scoping review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses scoping reviews guidelines. Studies that used an SRD measure or examined an upstream intervention in GI or liver disease were included. Studies that described health disparities in GI or liver conditions without mentioning SRD were excluded. Study characteristics, findings, and limitations were extracted. RESULTS Forty-six articles (19 studies using SRD measures and 27 studies of upstream interventions) were identified. Measures of residential racial segregation were reported most frequently. SRD was associated with poorer health outcomes for racial and ethnic minority populations. Although upstream intervention studies focused primarily on policies related to colon cancer screening and organ graft allocation, racial and ethnic disparities often persisted post-intervention. CONCLUSIONS To achieve health equity in GI and liver conditions, there is an urgent need for research that goes beyond describing health disparities to incorporating measures of SRD and implementing interventions that address this understudied determinant of health.
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Affiliation(s)
- Joy J Liu
- Division of Gastroenterology, Department of Medicine, Feinberg School of Medicine at Northwestern University, Chicago, Illinois
| | - Nicole DeCuir
- Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Leila Kia
- Division of Gastroenterology, Department of Medicine, Feinberg School of Medicine at Northwestern University, Chicago, Illinois
| | - Jonna Peterson
- Galter Health Sciences Library & Learning Center, Feinberg School of Medicine at Northwestern University, Chicago, Illinois
| | - Corinne Miller
- Galter Health Sciences Library & Learning Center, Feinberg School of Medicine at Northwestern University, Chicago, Illinois
| | - Rachel B Issaka
- Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington; Clinical Research and Public Health Sciences Divisions, Fred Hutchinson Cancer Center, Seattle, Washington; Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, Washington.
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Taylor KK, Neiman PU, Bonner S, Ranganathan K, Tipirneni R, Scott JW. Unmet Social Health Needs as a Driver of Inequitable Outcomes After Surgery: A Cross-sectional Analysis of the National Health Interview Survey. Ann Surg 2023; 278:193-200. [PMID: 36017938 PMCID: PMC10122453 DOI: 10.1097/sla.0000000000005689] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aims to identify opportunities to improve surgical equity by evaluating unmet social health needs by race, ethnicity, and insurance type. BACKGROUND Although inequities in surgical care and outcomes based on race, ethnicity, and insurance have been well documented for decades, underlying drivers remain poorly understood. METHODS We used the 2008-2018 National Health Interview Survey to identify adults age 18 years and older who reported surgery in the past year. Outcomes included poor health status (self-reported), socioeconomic status (income, education, employment), and unmet social health needs (food, housing, transportation). We used logistic regression models to progressively adjust for the impact of patient demographics, socioeconomic status, and unmet social health needs on health status. RESULTS Among a weighted sample of 14,471,501 surgical patients, 30% reported at least 1 unmet social health need. Compared with non-Hispanic White patients, non-Hispanic Black, and Hispanic patients reported higher rates of unmet social health needs. Compared with private insurance, those with Medicaid or no insurance reported higher rates of unmet social health needs. In fully adjusted models, poor health status was independently associated with unmet social health needs: food insecurity [adjusted odds ratio (aOR)=2.14; 95% confidence interval (CI): 1.89-2.41], housing instability (aOR=1.69; 95% CI: 1.51-1.89), delayed care due to lack of transportation (aOR=2.58; 95% CI: 2.02-3.31). CONCLUSIONS Unmet social health needs vary significantly by race, ethnicity, and insurance, and are independently associated with poor health among surgical populations. As providers and policymakers prioritize improving surgical equity, unmet social health needs are potential modifiable targets.
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Affiliation(s)
- Kathryn K Taylor
- National Clinician Scholars Program, University of Michigan, Ann Arbor, MI
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
- Department of Surgery, Stanford University, Stanford, CA
| | - Pooja U Neiman
- National Clinician Scholars Program, University of Michigan, Ann Arbor, MI
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
- Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Sidra Bonner
- National Clinician Scholars Program, University of Michigan, Ann Arbor, MI
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Kavitha Ranganathan
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, MA
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA
| | - Renuka Tipirneni
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - John W Scott
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
- Department of Surgery, University of Michigan, Ann Arbor, MI
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11
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Needham BL, Ali T, Allgood KL, Ro A, Hirschtick JL, Fleischer NL. Institutional Racism and Health: a Framework for Conceptualization, Measurement, and Analysis. J Racial Ethn Health Disparities 2023; 10:1997-2019. [PMID: 35994173 PMCID: PMC9395863 DOI: 10.1007/s40615-022-01381-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 11/28/2022]
Abstract
Despite growing interest in the health-related consequences of racially discriminatory institutional policies and practices, public health scholars have yet to reach a consensus on how to measure and analyze exposure to institutional racism. The purpose of this paper is to provide an overview of the conceptualization, measurement, and analysis of institutional racism in the context of quantitative research on minority health and health disparities in the United States. We begin by providing definitions of key concepts (e.g., racialization, racism, racial inequity) and describing linkages between these ideas. Next, we discuss the hypothesized mechanisms that link exposure to institutional racism with health. We then provide a framework to advance empirical research on institutional racism and health, informed by a literature review that summarizes measures and analytic approaches used in previous studies. The framework addresses six considerations: (1) policy identification, (2) population of interest, (3) exposure measurement, (4) outcome measurement, (5) study design, and (6) analytic approach. Research utilizing the proposed framework will help inform structural interventions to promote minority health and reduce racial and ethnic health disparities.
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Affiliation(s)
- Belinda L. Needham
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI USA
| | - Talha Ali
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT USA
| | - Kristi L. Allgood
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI USA
| | - Annie Ro
- Department of Health, Society, and Behavior, University of California-Irvine Program in Public Health, Irvine, CA USA
| | - Jana L. Hirschtick
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI USA
| | - Nancy L. Fleischer
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI USA
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12
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Munir MM, Woldesenbet S, Endo Y, Lima HA, Alaimo L, Moazzam Z, Shaikh C, Cloyd J, Ejaz A, Azap R, Azap L, Pawlik TM. Racial Segregation Among Patients with Cholangiocarcinoma-Impact on Diagnosis, Treatment, and Outcomes. Ann Surg Oncol 2023; 30:4238-4246. [PMID: 36695990 DOI: 10.1245/s10434-023-13122-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/02/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND Racial segregation, an effect of historical marginalization, may impact cancer care and outcomes. We sought to examine the impact of racial segregation on the diagnosis, treatment, and outcomes of patients with cholangiocarcinoma (CCA). PATIENTS AND METHODS Data on Black and White patients with CCA were obtained from the linked SEER-Medicare database (2004-2015) and 2010 Census data. The index of dissimilarity (IoD), a validated measure of segregation, was used to assess Black-White disparities in stage disease presentation, surgery for localized disease, and cancer-specific mortality. Multivariable Poisson regression was performed, and competing risk regression analysis was used to determine cancer-specific survival. RESULTS Among 7480 patients with CCA, 90.2% (n = 6748) were White and 9.8% (n = 732) were Black. Overall, Black patients were more likely to reside in segregated areas compared with White patients (IoD, 0.42 vs. 0.38; p < 0.05). On multivariable Poisson regression, Black patients were more likely to present with advanced-stage disease [relative risk (RR) 1.17, 95% confidence interval (CI) 1.08-1.27; p < 0.001] and were less likely to undergo surgery for localized disease (RR 0.62, 95% CI 0.51-0.76; p < 0.001). Black patients also had worse cancer-specific survival (CSS) compared with White patients (median CSS: 4 vs. 8 months; p < 0.01). Black patients living in the highest areas of segregation had 40% increased hazard of mortality versus White patients residing in the lowest IoD areas (hazard ratio 1.40, 95% CI 1.10-1.80; p < 0.01). CONCLUSION Racial segregation, as a proxy for structural racism, had a marked effect on Black-White disparities among patients with CCA.
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Affiliation(s)
- Muhammad Musaab Munir
- Department of Surgery, The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH, USA
| | - Selamawit Woldesenbet
- Department of Surgery, The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH, USA
| | - Yutaka Endo
- Department of Surgery, The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH, USA
| | - Henrique A Lima
- Department of Surgery, The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH, USA
| | - Laura Alaimo
- Department of Surgery, The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH, USA
| | - Zorays Moazzam
- Department of Surgery, The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH, USA
| | - Chanza Shaikh
- Department of Surgery, The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH, USA
| | - Jordan Cloyd
- Department of Surgery, The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH, USA
| | - Aslam Ejaz
- Department of Surgery, The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH, USA
| | - Rosevine Azap
- Department of Surgery, The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH, USA
| | - Lovette Azap
- Department of Surgery, The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH, USA.
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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13
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Papageorge MV, Woods AP, de Geus SWL, Ng SC, McAneny D, Tseng JF, Kenzik KM, Sachs TE. The Persistence of Poverty and its Impact on Cancer Diagnosis, Treatment and Survival. Ann Surg 2023; 277:995-1001. [PMID: 35796386 DOI: 10.1097/sla.0000000000005455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the effect of persistent poverty on the diagnosis, surgical resection and survival of patients with non-small cell lung (NSCLC), breast, and colorectal cancer. BACKGROUND Disparities in cancer outcomes exist in counties with high levels of poverty, defined as ≥20% of residents below the federal poverty level. Despite this well-established association, little is known about how the duration of poverty impacts cancer care and outcomes. One measure of poverty duration is that of "persistent poverty," defined as counties in high poverty since 1980. METHODS In this retrospective cohort study, patients with NSCLC, breast and colorectal cancer were identified from SEER (2012-2016). County-level poverty was obtained from the American Community Survey (1980-2015). Outcomes included advanced stage at diagnosis (stage III-IV), resection of localized disease (stage I-II) and cancer-specific survival. Hierarchical generalized linear models and accelerated failure time models with Weibull distribution were used, adjusted for patient-level covariates and region. RESULTS Overall, 522,514 patients were identified, of which 5.1% were in persistent poverty. Patients in persistent poverty were more likely to present with advanced disease [NSCLC odds ratio (OR): 1.12, 95% confidence interval (CI): 1.06-1.18; breast OR: 1.09, 95% CI: 1.02-1.17; colorectal OR: 1.00, 95% CI: 0.94-1.06], less likely to undergo surgery (NSCLC OR: 0.81, 95% CI: 0.73-0.90; breast OR: 0.82, 95% CI: 0.72-0.94; colorectal OR: 0.84, 95% CI: 0.70-1.00) and had increased cancer-specific mortality (NSCLC HR: 1.09, 95% CI: 1.06-1.13; breast HR: 1.18, 95% CI: 1.05-1.32; colorectal HR: 1.09, 95% CI: 1.03-1.17) as compared with those without poverty. These differences were observed to a lesser magnitude in counties with current, but not persistent, poverty and disappeared in counties no longer in poverty. CONCLUSIONS The duration of poverty has a direct impact on cancer-specific outcomes, with the greatest effect seen in persistent poverty and resolution of disparities when a county is no longer in poverty. Policy focused on directing resources to communities in persistent poverty may represent a possible strategy to reduce disparities in cancer care and outcomes.
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Affiliation(s)
- Marianna V Papageorge
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Alison P Woods
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Susanna W L de Geus
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Sing Chau Ng
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - David McAneny
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Jennifer F Tseng
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Kelly M Kenzik
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Teviah E Sachs
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA
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Trounstine J, Goldman-Mellor S. County-Level Segregation and Racial Disparities in COVID-19 Outcomes. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2023; 48:187-214. [PMID: 36174248 DOI: 10.1215/03616878-10234170] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
CONTEXT Segregation has been linked to unequal life chances. Individuals from marginalized communities experience more crime, higher levels of poverty, poorer health, and less civic engagement. In addition, segregated metropolitan regions have been found to display inequality in access to basic services. This article builds on these findings by linking segregation to infection and deaths from COVID-19. METHODS Using census data matched to COVID infection and death statistics at the county level, this article offers a theoretical basis for the researchers' choice of segregation measures and predictions for different racial groups. It analyzes the relationship between two dimensions of segregation-racial isolation and racial unevenness-and COVID outcomes for different racial and ethnic groups. FINDINGS In counties where Black and Latino residents lived in more racially isolated neighborhoods, they were much more likely to contract COVID-19. This pattern was exacerbated in counties with a high proportion of frontline workers. In addition, racial segregation increased COVID-19 death rates for Black, Latino, and white residents. CONCLUSIONS These findings suggest that devastating outcomes of the coronavirus pandemic were linked to a long history of racial marginalization and entrenched discrimination produced by structural inequalities embedded in our geographies. This knowledge should be used to inform public health planning.
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15
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Joshi A, Wilson LE, Pinheiro LC, Akinyemiju T. Association of racial residential segregation with all-cause and cancer-specific mortality in the reasons for geographic and racial differences in stroke (REGARDS) cohort study. SSM Popul Health 2023; 22:101374. [PMID: 37132018 PMCID: PMC10149269 DOI: 10.1016/j.ssmph.2023.101374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/12/2022] [Accepted: 02/27/2023] [Indexed: 04/03/2023] Open
Abstract
•Increased racial residential segregation increased the risk of all-cause mortality among White participants.•Higher interaction lowered the risk of all-cause mortality among White participants.•Higher isolation lowered the risk of cancer mortality among Black participants.
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16
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Molina G, Ruan M, Lipsitz SR, Iyer HS, Hassett MJ, Brindle ME, Trinh QD. Association of Variation in US County-Level Rates of Liver Surgical Resection for Colorectal Liver Metastasis With Poverty Rates in 2010. JAMA Netw Open 2023; 6:e230797. [PMID: 36848088 PMCID: PMC9972196 DOI: 10.1001/jamanetworkopen.2023.0797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
IMPORTANCE Among patients with colorectal liver metastasis (CRLM) who are eligible for curative-intent liver surgical resection, only half undergo liver metastasectomy. It is currently unclear how rates of liver metastasectomy vary geographically in the US. Geographic differences in county-level socioeconomic characteristics may, in part, explain variability in the receipt of liver metastasectomy for CRLM. OBJECTIVE To describe county-level variation in the receipt of liver metastasectomy for CRLM in the US and its association with poverty rates. DESIGN, SETTING, AND PARTICIPANTS This ecological, cross-sectional, and county-level analysis was conducted using data from the Surveillance, Epidemiology, and End Results Research Plus database. The study included the county-level proportion of patients who had colorectal adenocarcinoma diagnosed between January 1, 2010, and December 31, 2018, underwent primary surgical resection, and had liver metastasis without extrahepatic metastasis. The county-level proportion of patients with stage I colorectal cancer (CRC) was used as a comparator. Data analysis was performed on March 2, 2022. EXPOSURES County-level poverty in 2010 obtained from the US Census (proportion of county population below the federal poverty level). MAIN OUTCOMES AND MEASURES The primary outcome was county-level odds of liver metastasectomy for CRLM. The comparator outcome was county-level odds of surgical resection for stage I CRC. Multivariable binomial logistic regression accounting for clustering of outcomes within a county via an overdispersion parameter was used to estimate the county-level odds of receiving a liver metastasectomy for CRLM associated with a 10% increase in poverty rate. RESULTS In the 194 US counties included in this study, there were 11 348 patients. At the county level, the majority of the population was male (mean [SD], 56.9% [10.2%]), White (71.9% [20.0%]), and aged between 50 and 64 (38.1% [11.0%]) or 65 and 79 (33.6% [11.4%]) years. The adjusted odds of undergoing a liver metastasectomy was lower in counties with higher poverty in 2010 (per 10% increase; odds ratio, 0.82 [95% CI, 0.69-0.96]; P = .02). County-level poverty was not associated with receipt of surgery for stage I CRC. Despite the difference in rates of surgery (mean county-level rates were 0.24 for liver metastasectomy for CRLM and 0.75 for surgery for stage I CRC), the variance at the county-level for these 2 surgical procedures was similar (F370, 193 = 0.81; P = .08). CONCLUSIONS AND RELEVANCE The findings of this study suggest that higher poverty was associated with lower receipt of liver metastasectomy among US patients with CRLM. Surgery for a more common and less complex cancer comparator (ie, stage I CRC) was not observed to be associated with county-level poverty rates. However, county-level variation in surgical rates was similar for CRLM and stage I CRC. These findings further suggest that access to surgical care for complex gastrointestinal cancers such as CRLM may be partially influenced by where patients live.
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Affiliation(s)
- George Molina
- Division of Surgical Oncology, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Dana-Farber/Brigham and Women’s Cancer Center, Boston, Massachusetts
- Ariadne Labs, Brigham and Women’s Hospital, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Mengyuan Ruan
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Stuart R. Lipsitz
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Hari S. Iyer
- Section of Epidemiology and Health Outcomes, Rutgers-Cancer Institute of New Jersey, New Brunswick
| | - Michael J. Hassett
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Mary E. Brindle
- Ariadne Labs, Brigham and Women’s Hospital, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Quoc-Dien Trinh
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Dana-Farber/Brigham and Women’s Cancer Center, Boston, Massachusetts
- Division of Urological Surgery, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
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Leslie TF, Frankenfeld CL, Menon N. Disparities in colorectal cancer time-to-treatment and survival time associated with racial and economic residential segregation surrounding the diagnostic hospital, Georgia 2010-2015. Cancer Epidemiol 2022; 81:102267. [PMID: 36166941 DOI: 10.1016/j.canep.2022.102267] [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: 05/31/2022] [Revised: 08/26/2022] [Accepted: 09/20/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate patient-level colorectal cancer outcomes in relation to residential income and racial segregation and composition of the neighborhood surrounding the diagnosing hospitals, and characterize presence of cancer-relevant diagnosis and treatment modalities that might contribute to these associations. METHODS We utilized Georgia state cancer registry data (2010-2015), matching diagnosis information to hospital technology provided by the American Hospital Association and spatial information to the US Census. We modeled time-to-treatment and survival time, using Cox proportional hazards models, stratified by segregation. Segregation was examined as residential economic and racial evenness (Atkinson index) and isolation (isolation index) and mean income at the Census tract level. To assess possible contributing factors, analysis of hospital diagnosis and treatment technologies in relation to segregation was conducted. RESULTS Average income of the Census tract and racial residential segregation of the diagnosing hospital's neighborhood was generally unassociated with time-to-treatment or survival time. Higher income evenness around the diagnosing hospital was associated with shorter time-to-treatment, with no association with time-to-death. Higher income isolation for the diagnosing hospital, conversely, was associated with longer times to treatment, but also longer survival times. Hospitals in regions with higher level of residential income segregation were less likely to have a particular diagnosing or treatment technologies, such as virtual colonoscopy and chemotherapy. CONCLUSION Hospital resources may be a function of their immediate economic environment, and this may have influence on cancer outcomes. Future work should evaluate patient outcomes in light of technologies or therapies utilized within particular economic environments.
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Affiliation(s)
- Timothy F Leslie
- Department of Geography and Geoinformation Science, George Mason University, Fairfax, VA, USA.
| | | | - Nirup Menon
- School of Business, George Mason University, Fairfax, VA, USA
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18
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Petrick JL, Barber LE, Rosenberg L. What Are the Factors Underlying Colorectal Cancer Health Disparities? Cancer Prev Res (Phila) 2022; 15:561-563. [PMID: 36047055 DOI: 10.1158/1940-6207.capr-22-0292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 06/28/2022] [Accepted: 06/28/2022] [Indexed: 11/16/2022]
Abstract
Black Americans have the highest colorectal cancer incidence and mortality rates of any U.S. racial/ethnic group. Warren Andersen and colleagues report that sociocultural, lifestyle, and healthcare factors did not explain the racial disparity in colorectal cancer incidence, but colorectal cancer screening lessened the disparity. While screening is a cornerstone of colorectal cancer prevention, an improved understanding of etiologic factors may inform additional strategies for primary prevention or risk stratification. As important "established" colorectal cancer risk factors have not been corroborated for Black Americans, this begs the question of what other etiologic factors are important for colorectal cancer development in Black American populations. See related article, p. 595.
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Affiliation(s)
- Jessica L Petrick
- Slone Epidemiology Center at Boston University, Boston, Massachusetts
| | - Lauren E Barber
- Department of Epidemiology, Emory University, Atlanta, Georgia
| | - Lynn Rosenberg
- Slone Epidemiology Center at Boston University, Boston, Massachusetts
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19
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Booth A, Ford W, Brennan E, Magwood G, Forster E, Curran T. Towards Equitable Surgical Management of Inflammatory Bowel Disease: A Systematic Review of Disparities in Surgery for Inflammatory Bowel Disease. Inflamm Bowel Dis 2022; 28:1405-1419. [PMID: 34553754 DOI: 10.1093/ibd/izab237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Existing evidence for disparities in inflammatory bowel disease is fragmented and heterogenous. Underlying mechanisms for differences in outcomes based on race and socioeconomic status remain undefined. We performed a systematic review of the literature to examine disparities in surgery for inflammatory bowel disease in the United States. METHODS Electronic databases were searched from 2000 through June 11, 2021, to identify studies addressing disparities in surgical treatment for adults with inflammatory bowel disease. Eligible English-language publications comparing the use or outcomes of surgery by racial/ethnic, socioeconomic, geographic, and/or institutional factors were included. Studies were grouped according to whether outcomes of surgery were reported or surgery itself was the relevant end point (utilization). Quality was assessed using the Newcastle-Ottawa Scale for observational studies. RESULTS Forty-five studies were included. Twenty-four reported surgical outcomes and 21addressed utilization. Race/ethnicity was considered in 96% of studies, socioeconomic status in 44%, geographic factors in 27%, and hospital/surgeon factors in 22%. Although study populations and end points were heterogeneous, Black and Hispanic patients were less likely to undergo abdominal surgery when hospitalized; they were more likely to have a complication when they did have surgery. Differences based on race were correlated with socioeconomic factors but frequently remained significant after adjustments for insurance and baseline health. CONCLUSIONS Surgical disparities based on sociologic and structural factors reflect unidentified differences in multidisciplinary disease management. A broad, multidimensional approach to disparities research with more granular and diverse data sources is needed to improve health care quality and equity for inflammatory bowel disease.
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Affiliation(s)
- Alexander Booth
- Division of Colon and Rectal Surgery, Medical University of South Carolina, Charleston, SC, USA.,Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, SC, USA
| | - Wilson Ford
- College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Emily Brennan
- Colbert Education Center and Library, Medical University of South Carolina, Charleston, SC, USA
| | - Gayenell Magwood
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Erin Forster
- Division of Gastroenterology, Hepatology and Nutrition, Medical University of South Carolina, Charleston, SC, USA
| | - Thomas Curran
- Division of Colon and Rectal Surgery, Medical University of South Carolina, Charleston, SC, USA
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Pinheiro LC, Groner L, Soroka O, Prosper AE, Jack K, Tamimi RM, Safford M, Phillips E. Analysis of Eligibility for Lung Cancer Screening by Race After 2021 Changes to US Preventive Services Task Force Screening Guidelines. JAMA Netw Open 2022; 5:e2229741. [PMID: 36053535 PMCID: PMC9440399 DOI: 10.1001/jamanetworkopen.2022.29741] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
IMPORTANCE Lung cancer incidence and mortality have disproportionate consequences for racial and ethnic minority populations. The extent to which the 2021 changes to the US Preventive Services Task Force (USPSTF) screening guidelines have reduced the racial disparity gap in lung cancer screening eligibility is not known. OBJECTIVE To assess the consequences of the changes in USPSTF low-dose computed tomography eligibility criteria for lung cancer screening between 2013 and 2021 among Black and White community-dwelling adults. DESIGN, SETTING, AND PARTICIPANTS This cohort study analyzed data from the Reasons for Geographic and Racial Differences in Stroke study, a prospective longitudinal cohort study of community-dwelling Black and White adults 45 years and older who were initially recruited across the US between January 2003 and October 2007, with ongoing follow-up. All participants who would have been potentially eligible for lung cancer screening based on the 2021 USPSTF guidelines (N = 14 285) were included. Follow-up data for the current cohort study were collected and analyzed between January 2013 and December 2017, with final analysis performed in 2021. EXPOSURES Self-reported Black vs White race. PRIMARY OUTCOMES AND MEASURES Differences in the proportion of Black vs White participants eligible for lung cancer screening according to 2013 and 2021 guidelines were assessed using modified Poisson models with robust SEs. Associations between important covariates (demographic characteristics and social factors associated with health), including interaction and dissimilarity indices (2 measures of residential segregation), and differences in screening eligibility were also examined. RESULTS Among 14 285 participants (mean [SD] age, 64.7 [7.5] years; 7675 men [53.7%]), 5787 (40.5%) self-identified as Black and 8498 (59.5%) as White. Based on the 2013 USPSTF guidelines, 1109 of 5787 Black participants (19.2%) and 2313 of 8498 White participants (27.2%) were eligible for lung cancer screening (difference, -8.06 percentage points; 95% CI, -9.44 to -6.67 percentage points). Based on the 2021 guidelines, 1667 of 5787 Black participants (28.8%) and 2940 of 8498 White participants (34.6%) were eligible for screening (difference, -5.73 percentage points; 95% CI, -7.28 to -4.19 percentage points). After adjustment for differences in individual characteristics and residential segregation, the 2013 difference in screening eligibility among Black vs White participants was -12.66 percentage points (95% CI, -14.71 to -10.61 percentage points), and the 2021 difference was -12.15 percentage points (95% CI, -14.37 to -9.93 percentage points). CONCLUSIONS AND RELEVANCE In this study, 2021 changes to the USPSTF lung cancer screening guidelines were associated with reductions in but not elimination of existing eligibility disparities in lung cancer screening among Black and White adults. These findings suggest that accounting for factors beyond age and pack-years of smoking is needed when tailoring guidelines to improve screening eligibility among groups at high risk of lung cancer.
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Affiliation(s)
- Laura C. Pinheiro
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York–Presbyterian Hospital, New York
- Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York–Presbyterian Hospital, New York
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Lauren Groner
- Department of Radiology, Weill Cornell Medicine, New York–Presbyterian Hospital, New York
| | - Orysya Soroka
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York–Presbyterian Hospital, New York
| | - Ashley E. Prosper
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles
| | - Kellie Jack
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York–Presbyterian Hospital, New York
- Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York–Presbyterian Hospital, New York
| | - Rulla M. Tamimi
- Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York–Presbyterian Hospital, New York
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Monika Safford
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York–Presbyterian Hospital, New York
| | - Erica Phillips
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York–Presbyterian Hospital, New York
- Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York–Presbyterian Hospital, New York
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21
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Zhong P, Yang B, Pan F, Hu F. Temporal trends in Black-White disparities in cancer surgery and cancer-specific survival in the United States between 2007 and 2015. Cancer Med 2022; 12:3509-3519. [PMID: 35968573 PMCID: PMC9939184 DOI: 10.1002/cam4.5141] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 07/16/2022] [Accepted: 08/02/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The American Society of Clinical Oncology (ASCO) has strived to address racial/ethnic disparities in cancer care since 2009. Surgery plays a pivotal role in cancer care; however, it is unclear whether and how racial/ethnic disparities in cancer surgery have changed over time. METHODS This cohort study included 1,113,256 White and Black cancer patients across 9 years (2007-2015) using patient data extracted from the Surveillance, Epidemiology, and End Results (SEER)-18 registries. Patient data were included from 2007 to adjust insurance status and by 2015 to obtain at least a 3-year survival follow-up (until 2018). The primary outcome was a surgical intervention. The secondary outcomes were the use of (neo)adjuvant chemotherapy and cancer-specific survival (CSS). Adjusted associations of the race (Black/White) with the outcomes were measured in each cancer type and year. RESULTS The gap between surgery rates for Black and White patients narrowed overall, from an adjusted odds ratio (aOR) of 0.621 (0.592-0.652) in 2007 to 0.734 (0.702-0.768) in 2015. However, the racial gap persisted in the surgery rates for lung, breast, prostate, esophageal, and ovarian cancers. In surgically treated patients with lymph node metastasis, Black patients with colorectal cancer (CRC) were less likely to receive (neo)adjuvant chemotherapy than White patients. Black patients undergoing surgery were more likely to have a worse CSS rate than White patients undergoing surgery. In breast cancer patients, the overall trend was narrow, but continuously present, with an adjusted hazard ratio (aHR) of 1.224 (1.278-1.173) in 2007 and 1.042 (1.132-0.96) in 2015. CONCLUSIONS Overall, progress has been made toward narrowing the Black-White gap in cancer surgical opportunity and survival. Future efforts should be directed toward those specific cancers for which the Black-White gap continues. Additionally, it is worth addressing the Black-White gap regarding the use of (neo)adjuvant chemotherapy for CRC treatment.
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Affiliation(s)
- Peijie Zhong
- Clinical Medical CollegeSouthwest Medical UniversityLuzhouChina
- Department of Gastroenterology and HepatologyHuaihe Hospital of Henan UniversityKaifengChina
| | - Bo Yang
- Department of Interventional MedicineThe Affiliated hospital of Southwest Medical UniversityLuzhouChina
| | - Feng Pan
- Department of Interventional MedicineThe Affiliated hospital of Southwest Medical UniversityLuzhouChina
| | - Fang Hu
- Department of Interventional MedicineThe Affiliated hospital of Southwest Medical UniversityLuzhouChina
- College of nursingSouthwest Medical UniversityLuzhouChina
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22
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Rekulapelli A, Desai RP, Narayan A, Martin LW, Hall R, Larner JM, Balkrishnan R. Racial and Treatment Center Differences on Time to Treatment Initiation for Nonsmall Cell Lung Cancer Patients Receiving Radiation Therapy As an Initial Treatment. Health Equity 2022; 6:603-609. [PMID: 36081886 PMCID: PMC9448516 DOI: 10.1089/heq.2022.0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: Because time to treatment has been shown to be associated with increase in the risk of death for Non Small Cell Lung Cancer (NSCLC) patients, we examined the prevalence and magnitude of racial disparities in mean time to radiation therapy (TTRT) for Stage I-III non-small cell lung cancer patients across a variety of treatment facilities. Methods: Utilizing the United States National Cancer Database (NCDB), we determined differences in TTRT between different races and different treatment facilities. Results: Concordant with past research, we found that non-White patients and patients treated at academic facilities, regardless of race, have longer mean TTRT, and that racial disparities in TTRT extend across all treatment facilities (all p<0.05). Conclusions: These findings shed light on the potential presence of and impact of structural racism on patients seeking cancer treatment, and the need for further investigation behind the reasonings behind longer TTI for non-White patients. To elucidate the real-world applicability of these results, further investigation into the societal determinants that perpetuate disparity in time to radiation therapy, and potential interventions in the clinical setting to improve cultural and racial sensitivity among healthcare professionals is recommended.
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Affiliation(s)
- Akhil Rekulapelli
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Raj P. Desai
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Aditya Narayan
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Linda W. Martin
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Richard Hall
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - James M. Larner
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Rajesh Balkrishnan
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
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23
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Ponce SEB, Thomas CR, Diaz DA. Social determinants of health, workforce diversity, and financial toxicity: A review of disparities in cancer care. Curr Probl Cancer 2022; 46:100893. [DOI: 10.1016/j.currproblcancer.2022.100893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 11/26/2022]
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24
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Dagne GA. Geographic variation and association of risk factors with incidence of colorectal cancer at small-area level. Cancer Causes Control 2022; 33:1155-1160. [DOI: 10.1007/s10552-022-01607-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 06/27/2022] [Indexed: 11/30/2022]
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25
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Hansen M, Hamieh NM, Markt SC, Vaselkiv JB, Pernar CH, Gonzalez-Feliciano AG, Peisch S, Chowdhury-Paulino IM, Rencsok EM, Rebbeck TR, Platz EA, Giovannucci EL, Wilson KM, Mucci LA. Racial Disparities in Prostate Cancer: Evaluation of Diet, Lifestyle, Family History, and Screening Patterns. Cancer Epidemiol Biomarkers Prev 2022; 31:982-990. [PMID: 35247879 PMCID: PMC9083301 DOI: 10.1158/1055-9965.epi-21-1064] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/09/2021] [Accepted: 02/22/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Racial disparities in prostate cancer incidence and mortality rates are considerable. We previously found in the Health Professionals Follow-up Study (HPFS) that African-American men had an 80% higher prostate cancer risk than White men. With 21 additional years of follow-up and four-fold increase in cases, we undertook a contemporary analysis of racial differences in prostate cancer incidence and mortality in HPFS. METHODS For 47,679 men, we estimated HRs and 95% confidence intervals (CI) for the association between race and risk of prostate cancer through 2016 using Cox proportional hazards regression. Multivariable models (mHR) were adjusted for lifestyle, diet, family history, and PSA screening collected on biennial questionnaires. RESULTS 6,909 prostate cancer cases were diagnosed in White, 89 in African-American, and 90 in Asian-American men. African-Americans had higher prostate cancer incidence (mHR = 1.31; 95% CI, 1.06-1.62) and mortality (mHR = 1.67; 95% CI, 1.00-2.78), and lower PSA screening prevalence than White men. The excess risk was greater in the pre-PSA screening era (HR = 1.68; 95% CI, 1.14-2.48) than the PSA screening era (HR = 1.20; 95% CI, 0.93-1.56). Asian-Americans had lower prostate cancer risk (mHR = 0.74; 95% CI, 0.60-0.92), but similar risk of fatal disease compared with white men. CONCLUSIONS Racial differences in prostate cancer incidence and mortality in HPFS are not fully explained by differences in lifestyle, diet, family history, or PSA screening. IMPACT Additional research is necessary to address the disproportionately higher rates of prostate cancer in African-American men.
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Affiliation(s)
- Megan Hansen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- University of Massachusetts Medical School, Worcester, MA
| | - Nadine M. Hamieh
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Sarah C. Markt
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH
| | - Jane B. Vaselkiv
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Claire H. Pernar
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | | | - Samuel Peisch
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | | | - Emily M. Rencsok
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Harvard-MIT Division of Health Sciences and Technology, Harvard Medical School, Boston, MA
| | - Timothy R. Rebbeck
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Elizabeth A. Platz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Edward L. Giovannucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital/Harvard Medical School, Boston, MA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Kathryn M. Wilson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital/Harvard Medical School, Boston, MA
| | - Lorelei A. Mucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital/Harvard Medical School, Boston, MA
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26
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Leopold SS. Editor's Spotlight/Take 5: Is Our Science Representative? A Systematic Review of Racial and Ethnic Diversity in Orthopaedic Clinical Trials from 2000 to 2020. Clin Orthop Relat Res 2022; 480:843-847. [PMID: 35323147 PMCID: PMC9007184 DOI: 10.1097/corr.0000000000002193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/08/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Seth S Leopold
- Editor-in-Chief, Clinical Orthopaedics and Related Research® , Philadelphia, PA, USA
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27
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Llanos AAM, Li J, Tsui J, Gibbons J, Pawlish K, Nwodili F, Lynch S, Ragin C, Stroup AM. Variation in Cancer Incidence Rates Among Non-Hispanic Black Individuals Disaggregated by Nativity and Birthplace, 2005-2017: A Population-Based Cancer Registry Analysis. Front Oncol 2022; 12:857548. [PMID: 35463326 PMCID: PMC9024350 DOI: 10.3389/fonc.2022.857548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/16/2022] [Indexed: 01/25/2023] Open
Abstract
Objectives Compared to other racial and ethnic groups, little to no disaggregated cancer incidence data exist for subgroups of non-Hispanic Blacks (NHBs), despite heterogeneity in sociodemographic characteristics and cancer risk factors within this group. Our objective was to examine age-adjusted cancer incidence by nativity and birthplace among NHB cancer cases diagnosed in New Jersey. Methods Race, ethnicity, and birthplace data from the New Jersey State Cancer Registry were used to classify NHB cancer cases diagnosed between 2005-2017. Thirteen waves of population estimates (by county, nativity, gender, age-group) were derived from the American Community Survey using Integrated Public-Use Microdata to approximate yearly demographics. Age-adjusted cancer incidence rates (overall and by site) by birthplace were generated using SEER*Stat 8.3.8. Bivariate associations were assessed using chi-square and Fisher's exact tests. Trend analyses were performed using Joinpoint 4.7. Results Birthplace was available for 62.3% of the 71,019 NHB cancer cases. Immigrants represented 12.3%, with African-born, Haitian-born, Jamaican-born, 'other-Caribbean-born', and 'other-non-American-born' accounting for 18.5%, 17.7%, 16.5%, 10.6%, and 36.8%, respectively. Overall, age-adjusted cancer incidence rates were lower for NHB immigrants for all sites combined and for several of the top five cancers, relative to American-born NHBs. Age-adjusted cancer incidence was lower among immigrant than American-born males (271.6 vs. 406.8 per 100,000) and females (191.9 vs. 299.2 per 100,000). Age-adjusted cancer incidence was lower for Jamaican-born (114.6 per 100,000) and other-Caribbean-born females (128.8 per 100,000) than African-born (139.4 per 100,000) and Haitian-born females (149.9 per 100,000). No significant differences in age-adjusted cancer incidence were observed by birthplace among NHB males. Age-adjusted cancer incidence decreased for all sites combined from 2005-2017 among American-born males, immigrant males, and American-born females, while NHB immigrant female rates remained relatively stable. Conclusions There is variation in age-adjusted cancer incidence rates across NHB subgroups, highlighting the need for more complete birthplace information in population-based registries to facilitate generating disaggregated cancer surveillance statistics by birthplace. This study fills a knowledge gap of critical importance for understanding and ultimately addressing cancer inequities.
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Affiliation(s)
- Adana A. M. Llanos
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, United States
- Cancer Population Science, Herbert Irving Comprehensive Cancer Center, New York, NY, United States
| | - Jie Li
- New Jersey State Cancer Registry, New Jersey Department of Health, Trenton, NJ, United States
| | - Jennifer Tsui
- Department of Population and Public Health, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Joseph Gibbons
- Department of Sociology, San Diego State University, San Diego, CA, United States
| | - Karen Pawlish
- New Jersey State Cancer Registry, New Jersey Department of Health, Trenton, NJ, United States
| | - Fechi Nwodili
- Rutgers University School of Arts and Sciences, Douglass Residential College, New Brunswick, NJ, United States
| | - Shannon Lynch
- Cancer Prevention and Control Program, Fox Chase Cancer Center-Temple Health, Philadelphia, PA, United States
| | - Camille Ragin
- Cancer Prevention and Control Program, Fox Chase Cancer Center-Temple Health, Philadelphia, PA, United States
| | - Antoinette M. Stroup
- New Jersey State Cancer Registry, New Jersey Department of Health, Trenton, NJ, United States
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, United States
- Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
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28
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Janeway M, Wilson S, Sanchez SE, Arora TK, Dechert T. Citizenship and Social Responsibility in Surgery: A Review. JAMA Surg 2022; 157:532-539. [PMID: 35385071 DOI: 10.1001/jamasurg.2022.0621] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance Social determinants of health have been shown to be key drivers of disparities in access to surgical care and surgical outcomes. Though the concept of social responsibility has received growing attention in the medical field, little has been published contextualizing social responsibility in surgery. In this narrative review, we define social responsibility as it relates to surgery, explore the duty of surgeons to society, and provide examples of social factors associated with adverse surgical outcomes and how they can be mitigated. Observations The concept of social responsibility in surgery has deep roots in medical codes of ethics and evolved alongside changing views on human rights and the role of social factors in disease. The ethical duty of surgeons to society is based on the ethical principles of benevolence and justice and is grounded within the framework of the social contract. Surgeons have a responsibility to understand how factors such as patient demographics, the social environment, clinician awareness, and the health care system are associated with inequitable patient outcomes. Through education, we can empower surgeons to advocate for their patients, address the causes and consequences of surgical disparities, and incorporate social responsibility into their daily practice. Conclusions and Relevance One of the greatest challenges in the field of surgery is ensuring that surgical care is provided in an equitable and sustainable way. Surgeons have a duty to understand the factors that lead to health care disparities and use their knowledge, skills, and privileged position to address these issues at the individual and societal level.
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Affiliation(s)
- Megan Janeway
- Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Spencer Wilson
- Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Sabrina E Sanchez
- Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Tania K Arora
- Augusta University at the Medical College of Georgia, Augusta
| | - Tracey Dechert
- Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
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Islami F, Guerra CE, Minihan A, Yabroff KR, Fedewa SA, Sloan K, Wiedt TL, Thomson B, Siegel RL, Nargis N, Winn RA, Lacasse L, Makaroff L, Daniels EC, Patel AV, Cance WG, Jemal A. American Cancer Society's report on the status of cancer disparities in the United States, 2021. CA Cancer J Clin 2022; 72:112-143. [PMID: 34878180 DOI: 10.3322/caac.21703] [Citation(s) in RCA: 108] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 02/06/2023] Open
Abstract
In this report, the authors provide comprehensive and up-to-date US data on disparities in cancer occurrence, major risk factors, and access to and utilization of preventive measures and screening by sociodemographic characteristics. They also review programs and resources that have reduced cancer disparities and provide policy recommendations to further mitigate these inequalities. The overall cancer death rate is 19% higher among Black males than among White males. Black females also have a 12% higher overall cancer death rate than their White counterparts despite having an 8% lower incidence rate. There are also substantial variations in death rates for specific cancer types and in stage at diagnosis, survival, exposure to risk factors, and receipt of preventive measures and screening by race/ethnicity, socioeconomic status, and geographic location. For example, kidney cancer death rates by sex among American Indian/Alaska Native people are ≥64% higher than the corresponding rates in each of the other racial/ethnic groups, and the 5-year relative survival for all cancers combined is 14% lower among residents of poorer counties than among residents of more affluent counties. Broad and equitable implementation of evidence-based interventions, such as increasing health insurance coverage through Medicaid expansion or other initiatives, could substantially reduce cancer disparities. However, progress will require not only equitable local, state, and federal policies but also broad interdisciplinary engagement to elevate and address fundamental social inequities and longstanding systemic racism.
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Affiliation(s)
- Farhad Islami
- Cancer Disparity Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Carmen E Guerra
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Adair Minihan
- Screening and Risk Factors Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - K Robin Yabroff
- Health Services Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Stacey A Fedewa
- Screening and Risk Factors Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Kirsten Sloan
- Public Policy, American Cancer Society Cancer Action Network, Washington, District of Columbia
| | - Tracy L Wiedt
- Health Equity, Prevention and Early Detection, American Cancer Society, Atlanta, Georgia
| | - Blake Thomson
- Cancer Disparity Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Rebecca L Siegel
- Surveillance Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Nigar Nargis
- Tobacco Control Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Robert A Winn
- Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia
| | - Lisa Lacasse
- American Cancer Society Cancer Action Network, Washington, District of Columbia
| | - Laura Makaroff
- Prevention and Early Detection, American Cancer Society, Atlanta, Georgia
| | - Elvan C Daniels
- Extramural Discovery Science, American Cancer Society, Atlanta, Georgia
| | - Alpa V Patel
- Department of Population Science, American Cancer Society, Atlanta, Georgia
| | - William G Cance
- Office of the Chief Medical and Scientific Officer, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
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Poulson MR, Geary A, Annesi C, Dechert T, Kenzik K, Hall J. The Impact of Income and Social Mobility on Colorectal Cancer Outcomes and Treatment: A Cross-sectional Study. Ann Surg 2022; 275:546-550. [PMID: 34954755 DOI: 10.1097/sla.0000000000005347] [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: 11/26/2022]
Abstract
OBJECTIVE To determine the impact of income mobility on racial disparities in colorectal cancer. BACKGROUND There are well-documented disparities in colorectal cancer treatment and outcomes between Black and White patients. Socioeconomic status, insurance, and other patient-level factors have been shown important, but little has been done to show the discriminatory factors that lead to these outcomes. METHODS Data were obtained from the Surveillance Epidemiology and End-Results database for Black and White patients with colorectal cancer between 2005 and 2015. County level measures of Black (BIM) and White income mobility (WIM) were obtained from the Opportunity Atlas as a measure of intergenerational poverty and social mobility. Regression models were created to assess the relative risk of advanced stage at diagnosis (Stage IV), surgery for localized disease (Stage I/II), and cancer-specific mortality. RESULTS There was no significant association of BIM or WIM on advanced stage at diagnosis in Black or White patients. An increase of $10,000 of BIM was associated with a 9% decrease in hazards of death for both Black (hazard ratio 0.91, 95% confidence interval 0.86,0.95) and White (0.91, 95%CI 0.90,0.93) patients, while the same increase in WIM was associated with no significant difference in hazards among Black patients (hazard ratio 0.99, 95% confidence interval 0.97,1.02). There were no predicted racial differences in hazards of death at high levels of BIM. CONCLUSIONS Increased Black income mobility significantly improves survival for both Black and White patients. Interventions aimed at increasing economic and social mobility could significantly decrease mortality in both Black and White patients while alleviating disparities in outcomes.
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Affiliation(s)
- Michael R Poulson
- Department of Surgery, Boston Medical Center, Boston, MA
- Boston University School of Medicine, Boston, MA
| | - Alaina Geary
- Department of Surgery, Boston Medical Center, Boston, MA
- Boston University School of Medicine, Boston, MA
| | | | - Tracey Dechert
- Department of Surgery, Boston Medical Center, Boston, MA
- Boston University School of Medicine, Boston, MA
| | - Kelly Kenzik
- Department of Surgery, Boston Medical Center, Boston, MA
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Jason Hall
- Department of Surgery, Boston Medical Center, Boston, MA
- Boston University School of Medicine, Boston, MA
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Abstract
Health care disparities are defined as health differences between groups that are avoidable, unnecessary, and unjust. Racial disparities in colorectal cancer mortality, particularly for Black patients, are well-described. Disparities in preventative measures, early detection, effective treatment, and posttreatment services contribute to these differences. Underlying these issues are patient, provider, health care system, and policy-level factors that lead to these disparities. Multilevel interventions designed to address each level of care can provide an effective means to mitigate these disparities.
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Hu X, Ye H, Yan W, Sun Y. Factors Associated With Patient's Refusal of Recommended Cancer Surgery: Based on Surveillance, Epidemiology, and End Results. Front Public Health 2022; 9:785602. [PMID: 35111717 PMCID: PMC8801711 DOI: 10.3389/fpubh.2021.785602] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/22/2021] [Indexed: 02/01/2023] Open
Abstract
Objectives Most non-metastatic cancer patients can harvest a preferable survival after surgical treatment, however, patients sometimes refuse the recommended cancer-directed surgery. It is necessary to uncover the factors associated with patent's decision in taking cancer surgery and explore racial/ethnic disparities in surgery refusal. Methods Based on the Surveillance, Epidemiology and End Results (SEER)-18 program, we extracted data of non-metastatic cancer patients who didn't undergo surgery. Ten common solid cancers were selected. Four racial/ethnic categories were included: White, black, Hispanic, and Asian/Pacific Islander (API). Primary outcome was patient's refusal of surgery. Multivariable logistic regression models were used, with reported odds ratio (OR) and 95% confidence interval (CI). Results Among 318,318 patients, the incidence of surgery refusal was 3.5%. Advanced age, female patients, earlier cancer stage, uninsured/Medicaid and unmarried patients were significantly associated with higher odds of surgery refusal. Black and API patients were more likely to refuse recommended surgery than white patients in overall cancer (black-white: adjusted OR, 1.18; 95% CI, 1.11–1.26; API-white: adjusted OR, 1.56; 95% CI, 1.41–1.72); those racial/ethnic disparities narrowed down after additionally adjusting for insurance type and marital status. In subgroup analysis, API-white disparities in surgery refusal widely existed in prostate, lung/bronchus, liver, and stomach cancers. Conclusions Patient's socioeconomic conditions reflected by insurance type and marital status may play a key role in racial/ethnic disparities in surgery refusal. Oncological surgeons should fully consider the barriers behind patient's refusal of recommended surgery, thus promoting patient-doctor shared decision-making and guiding patients to the most appropriate therapy.
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Affiliation(s)
- Xianglin Hu
- Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- *Correspondence: Xianglin Hu
| | - Hui Ye
- Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Wangjun Yan
- Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Wangjun Yan
| | - Yangbai Sun
- Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Yangbai Sun
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Poulson MR, Kenzik KM, Singh S, Pavesi F, Steiling K, Litle VR, Suzuki K. Redlining, structural racism, and lung cancer screening disparities. J Thorac Cardiovasc Surg 2021; 163:1920-1930.e2. [PMID: 34774325 DOI: 10.1016/j.jtcvs.2021.08.086] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/19/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The objective of this study was to understand the effect of historical redlining (preclusion from home loans and wealth-building for Black Americans) and its downstream factors on the completion of lung cancer screening in Boston. METHODS Patients within our institution were identified as eligible for lung cancer screening on the basis of the United State Preventive Service Task Force criteria and patient charts were reviewed to determine if patients completed low-dose computed tomography screening. Individual addresses were geocoded and overlayed with original 1930 Home Owner Loan Corporation redlining vector files. Structural equation models were used to estimate the odds of screening for Black and White patients, interacted with sex, in redlined and nonredlined areas. RESULTS Black patients had a 44% lower odds of screening compared with White (odds ratio [OR], 0.66; 95% CI, 0.52-0.85). With race as a mediator, Black patients in redlined areas were 61% less likely to undergo screening than White patients (OR, 0.39; 95% CI, 0.24-0.64). Similarly, in redlined areas Black women had 61% (OR, 0.39; 95% CI, 0.21-0.73) and Black men 47% (OR, 0.53; 95% CI, 0.29-0.98) lower odds of screening compared with White men in redlined areas. CONCLUSIONS Despite higher rates of lung cancer screening in redlined areas, Black race mediated worse screening rates in these areas, suggesting racist structural factors contributing to the disparities in lung cancer screening completion among Black and White patients. Furthermore, these disparities were more apparent in Black women, suggesting that racial and gender intersectional discrimination are important in lung cancer screening completion.
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Affiliation(s)
- Michael R Poulson
- Department of Surgery, Boston University School of Medicine, Boston, Mass; Department of Surgery, Boston University Medical Center, Boston, Mass
| | - Kelly M Kenzik
- Department of Surgery, Boston University Medical Center, Boston, Mass; University of Alabama at Birmingham, Birmingham, Ala
| | - Sarah Singh
- Department of Surgery, Boston University School of Medicine, Boston, Mass
| | - Flaminio Pavesi
- Department of Surgery, Boston University School of Medicine, Boston, Mass
| | - Katrina Steiling
- Department of Pulmonology, Boston University Medical Center, Boston, Mass
| | - Virginia R Litle
- Department of Surgery, Boston University School of Medicine, Boston, Mass; Department of Thoracic Surgery, Boston University Medical Center, Boston, Mass
| | - Kei Suzuki
- Department of Surgery, Boston University School of Medicine, Boston, Mass; Department of Thoracic Surgery, Boston University Medical Center, Boston, Mass.
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Nolan TS, Alston A, Choto R, Moss KO. Cultural Humility: Retraining and Retooling Nurses to Provide Equitable Cancer Care. Clin J Oncol Nurs 2021; 25:3-9. [PMID: 34533531 PMCID: PMC8532165 DOI: 10.1188/21.cjon.s1.3-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cancer outcome disparities exist among Black, Indigenous, and people of color despite advancements in screening, detection, and treatment. In addition to racial and ethnic diversity, the U.S. population is experiencing shifts in sociodemographics, including a growing aging population, sex and gender identities, spiritual and religious belief systems, and divides between high- and low-income households. OBJECTIVES This article provides a foundation for cultural humility as a clinical competency in nursing to improve the quality of cancer care. METHODS CINAHL®, PubMed®, Google Scholar, and grey literature were searched using keywords, including cultural humility, cultural competence, nursing, nursing pipeline, nursing workforce, and health. FINDINGS Retraining and retooling the nursing workforce promotes multiculturalism in oncology care and increases opportunities to provide more appropriate, patient-centered care to those living with cancer. Increasing the diversity of nursing faculty and staff, enhancing nursing curricula and education, and creating equitable relationships to support patient-centered care are initiatives to ensure high-quality care.
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Affiliation(s)
- Timiya S Nolan
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
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Johnston FM, Yeo HL, Clark C, Stewart JH. Bias Issues in Colorectal Cancer Management: A Review. Ann Surg Oncol 2021; 29:2166-2173. [PMID: 34142287 DOI: 10.1245/s10434-021-10232-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/02/2021] [Indexed: 12/11/2022]
Abstract
Based on census data, over one-third of the US population identifies as a racial or ethnic minority. This group of racial and ethnic minorities is more likely to develop cancer and die from it when compared with the general population of the USA. These disparities are most pronounced in the African American community. Despite overall CRC rates decreasing nationally and within certain racial and ethnic minorities in the USA, there continue to be disparities in incidence and mortality when compared with non-Hispanic Whites. The disparities in CRC incidence and mortality are related to systematic racism and bias inherent in healthcare systems and society. Disparities in CRC management will continue to exist until specific interventions are implemented in the context of each racial and ethnic group. This review's primary aim is to highlight the disparities in CRC among African Americans in the USA. For surgeons, understanding these disparities is formative to creating change and improving the quality of care, centering equity for all patients.
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Affiliation(s)
- Fabian M Johnston
- Division of Surgical Oncology, Department of Surgery, Johns Hopkins University, Baltimore, MD, USA.
| | - Heather L Yeo
- Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - Callisia Clark
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - John H Stewart
- Department of Surgery, The University of Illinois at Chicago, Chicago, IL, USA.,University of Illinois Cancer Center, Chicago, IL, USA
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Singh S, Sridhar P. A narrative review of sociodemographic risk and disparities in screening, diagnosis, treatment, and outcomes of the most common extrathoracic malignancies in the United States. J Thorac Dis 2021; 13:3827-3843. [PMID: 34277073 PMCID: PMC8264686 DOI: 10.21037/jtd-21-87] [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: 01/13/2021] [Accepted: 05/20/2021] [Indexed: 11/06/2022]
Abstract
There is a well-established association between multiple sociodemographic risk factors and disparities in cancer care. These risk factors include minority race and ethnicity, low socioeconomic status (SES) including low income and education level, non-English primary language, immigrant status, and residential segregation, and distance to facilities that deliver cancer care. As cancer care advances, existing disparities in screening, treatment, and outcomes have become more evident. Lung cancer remains the most common and fatal malignancy in the United States, with breast, colorectal, and prostate cancer being the three most common and deadly extrathoracic malignancies. Achieving the best outcomes for patients with these malignancies relies on strong physician-patient relationships leading to robust screening, early diagnosis, and early referral to facilities that can deliver multidisciplinary care and multimodal therapy. It is likely that challenges experienced in developing patient trust and understanding, providing access to screening, and building referral pipelines for definitive therapy in lung cancer care to vulnerable populations are paralleled by those in extrathoracic malignancies. Likewise, progress made in delivering optimal care to all patients across sociodemographic and geographic barriers can serve as a roadmap. Therefore, we provide a narrative review of current disparities in screening, treatment, and outcomes for patients with breast, prostate, and colorectal malignancies.
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Affiliation(s)
- Sarah Singh
- Division of Thoracic Surgery, Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Praveen Sridhar
- Division of Thoracic Surgery, Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
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Suzuki K, Litle VR. Healthcare disparities in thoracic malignancies. J Thorac Dis 2021; 13:3741-3744. [PMID: 34277065 PMCID: PMC8264713 DOI: 10.21037/jtd-2021-15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 03/19/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Kei Suzuki
- Division of Thoracic Surgery, Department of Surgery, Boston University School of Medicine, Boston, MA, USA
| | - Virginia R Litle
- Division of Thoracic Surgery, Department of Surgery, Boston University School of Medicine, Boston, MA, USA
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Annesi CA, Poulson M, Mak KS, Tapan U, Dechert TA, Litle VR, Suzuki K. The Impact of Residential Racial Segregation on Non-Small Cell Lung Cancer Treatment and Outcomes. Ann Thorac Surg 2021; 113:1291-1298. [PMID: 34033745 DOI: 10.1016/j.athoracsur.2021.04.096] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/28/2021] [Accepted: 04/30/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite decreases in lung cancer incidence, racial disparities in diagnosis and treatment persist. Residential segregation and structural racism have effects on socioeconomic status for black people, affecting healthcare access. This study aims to determine the impact of residential segregation on racial disparities in non-small cell lung cancer (NSCLC) treatment and mortality. METHODS Patient data were obtained from Surveillance, Epidemiology, and End Results Program (SEER) database for black and white patients diagnosed with NSCLC from 2004-2016 in the 100 most populous counties. Regression models were built to assess outcomes of interest - stage at diagnosis and surgical resection of disease. Predicted margins assessed impact of index of dissimilarity (IoD) on these disparities. Competing risk regressions for black and white patients in highest and lowest quartiles of IoD were used to assess cancer-specific mortality. RESULTS Our cohort had 193,369 white and 35,649 black patients. Black patients were more likely to be diagnosed at advanced stage than white patients with increasing IoD. With increasing IoD, black patients were less likely to undergo surgical resection than white. Disparities were eliminated at low IoD. Black patients at high IoD had lower cancer-specific survival. CONCLUSIONS Black patients were more likely to present at advanced disease, were less likely to receive surgery for early stage, and had higher cancer-specific mortality at higher IoD. Our findings highlight the impact of structural racism and residential segregation on NSCLC outcomes. Solutions to these disparities must come from policy reforms to reverse residential segregation and deleterious socioeconomic effects of discriminatory policies.
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Affiliation(s)
| | - Michael Poulson
- Boston University School of Medicine; Boston University Medical Center, Department of Surgery
| | - Kimberley S Mak
- Boston University School of Medicine; Boston University Medical Center, Department of Radiation Oncology
| | - Umit Tapan
- Boston University School of Medicine; Boston University Medical Center, Department of Internal Medicine - Hematology & Oncology
| | - Tracey A Dechert
- Boston University School of Medicine; Boston University Medical Center, Division of Acute Care & Trauma Surgery/Surgical Critical Care, Department of Surgery
| | - Virginia R Litle
- Boston University School of Medicine; Boston University Medical Center, Division of Thoracic Surgery, Department of Surgery
| | - Kei Suzuki
- Boston University School of Medicine; Boston University Medical Center, Division of Thoracic Surgery, Department of Surgery.
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