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Arif W, Bhimani RK, Ali Shah M, Tausif Z, Nisar U, Kumar R, Bhimani PD, Shoaibullah S, Naveed MA, Raja A, Raja S, Deepak F, Shafique MA, Mustafa MS. Unraveling disparities: Probing gender, race, and geographic inequities in pulmonary heart disease mortality in the United States: An extensive longitudinal examination (1999-2020) leveraging CDC WONDER data. Curr Probl Cardiol 2024; 49:102527. [PMID: 38492618 DOI: 10.1016/j.cpcardiol.2024.102527] [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: 02/20/2024] [Revised: 03/13/2024] [Accepted: 03/13/2024] [Indexed: 03/18/2024]
Abstract
This comprehensive study delves into the epidemiological landscape of Pulmonary Heart Disease (PHD) mortality in the United States from 1999 to 2020, leveraging the extensive CDC WONDER database. PHD encompasses conditions affecting the right side of the heart due to lung disorders or elevated pressure in the pulmonary arteries, including pulmonary hypertension, pulmonary embolism, and chronic thromboembolic pulmonary hypertension (CTEPH). Analyzing data from death certificates, demographic characteristics, and geographical segmentation, significant trends emerge. The age-adjusted mortality rates (AAMRs) for PHD-related deaths show a fluctuating pattern, initially decreasing from 1999 to 2006, followed by a steady increase until 2020. Male patients consistently exhibit higher AAMRs than females, with notable disparities observed among racial/ethnic groups and geographic regions. Non-hispanic (NH) Black or African American individuals, residents of specific states like Colorado and the District of Columbia, and those in the Midwest region demonstrate elevated AAMRs. Furthermore, nonmetropolitan areas consistently manifest higher AAMRs than metropolitan areas. These findings underscore the urgent need for intensified prevention and treatment strategies to address the rising mortality associated with PHD, particularly among vulnerable populations. Insights from this study offer valuable guidance for public health initiatives aimed at reducing PHD-related mortality and improving outcomes nationwide.
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Affiliation(s)
- Waqar Arif
- Dow International Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Mohsin Ali Shah
- Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan
| | | | - Umer Nisar
- Dow International Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Rohet Kumar
- Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan
| | | | - Syed Shoaibullah
- Dow International Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Adarsh Raja
- Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan.
| | - Sandesh Raja
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Fnu Deepak
- Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan
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Lees J, Crowther J, Hanlon P, Butterly EW, Wild SH, Mair F, Guthrie B, Gillies K, Dias S, Welton NJ, Katikireddi SV, McAllister DA. Participant characteristics and exclusion from phase 3/4 industry funded trials of chronic medical conditions: meta-analysis of individual participant level data. BMJ MEDICINE 2024; 3:e000732. [PMID: 38737200 PMCID: PMC11085787 DOI: 10.1136/bmjmed-2023-000732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 04/05/2024] [Indexed: 05/14/2024]
Abstract
Objectives To assess whether age, sex, comorbidity count, and race and ethnic group are associated with the likelihood of trial participants not being enrolled in a trial for any reason (ie, screen failure). Design Bayesian meta-analysis of individual participant level data. Setting Industry funded phase 3/4 trials of chronic medical conditions. Participants Participants were identified using individual participant level data to be in either the enrolled group or screen failure group. Data were available for 52 trials involving 72 178 screened individuals of whom 24 733 (34%) were excluded from the trial at the screening stage. Main outcome measures For each trial, logistic regression models were constructed to assess likelihood of screen failure in people who had been invited to screening, and were regressed on age (per 10 year increment), sex (male v female), comorbidity count (per one additional comorbidity), and race or ethnic group. Trial level analyses were combined in Bayesian hierarchical models with pooling across condition. Results In age and sex adjusted models across all trials, neither age nor sex was associated with increased odds of screen failure, although weak associations were detected after additionally adjusting for comorbidity (odds ratio of age, per 10 year increment was 1.02 (95% credibility interval 1.01 to 1.04) and male sex (0.95 (0.91 to 1.00)). Comorbidity count was weakly associated with screen failure, but in an unexpected direction (0.97 per additional comorbidity (0.94 to 1.00), adjusted for age and sex). People who self-reported as black seemed to be slightly more likely to fail screening than people reporting as white (1.04 (0.99 to 1.09)); a weak effect that seemed to persist after adjustment for age, sex, and comorbidity count (1.05 (0.98 to 1.12)). The between-trial heterogeneity was generally low, evidence of heterogeneity by sex was noted across conditions (variation in odds ratios on log scale of 0.01-0.13). Conclusions Although the conclusions are limited by uncertainty about the completeness or accuracy of data collection among participants who were not randomised, we identified mostly weak associations with an increased likelihood of screen failure for age, sex, comorbidity count, and black race or ethnic group. Proportionate increases in screening these underserved populations may improve representation in trials. Trial registration number PROSPERO CRD42018048202.
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Affiliation(s)
- Jennifer Lees
- College of Medical and Veterinary Life Sciences, University of Glasgow, Glasgow, UK
| | - Jamie Crowther
- College of Medical and Veterinary Life Sciences, University of Glasgow, Glasgow, UK
| | - Peter Hanlon
- College of Medical and Veterinary Life Sciences, University of Glasgow, Glasgow, UK
| | - Elaine W Butterly
- College of Medical and Veterinary Life Sciences, University of Glasgow, Glasgow, UK
| | - Sarah H Wild
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Frances Mair
- College of Medical and Veterinary Life Sciences, University of Glasgow, Glasgow, UK
| | - Bruce Guthrie
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Katie Gillies
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Sofia Dias
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Nicky J Welton
- Population Health Sciences, University of Bristol, Bristol, UK
| | | | - David A McAllister
- College of Medical and Veterinary Life Sciences, University of Glasgow, Glasgow, UK
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Prichard R, Maneze D, Straiton N, Inglis SC, McDonagh J. Strategies for improving diversity, equity, and inclusion in cardiovascular research: a primer. Eur J Cardiovasc Nurs 2024; 23:313-322. [PMID: 38190724 DOI: 10.1093/eurjcn/zvae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 01/02/2024] [Indexed: 01/10/2024]
Abstract
This paper aims to empower cardiovascular (CV) researchers by promoting diversity, equity, and inclusion (DE&I) principles throughout the research cycle. It defines DE&I and introduces practical strategies for implementation in recruitment, retention, and team dynamics within CV research. Evidence-based approaches supporting underrepresented populations' participation are outlined for each research phase. Emphasizing the significance of inclusive research environments, the paper offers guidance and resources. We invite CV researchers to actively embrace DE&I principles, enhancing research relevance and addressing longstanding CV health disparities.
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Affiliation(s)
- Roslyn Prichard
- Faculty of Health, University of the Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, 4556 Queensland, Australia
| | - Della Maneze
- School of Nursing, Faculty of Science, Medicine, and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Nicola Straiton
- St Vincent's Health Network, Nursing Research Institute, Australian Catholic University, Sydney, New South Wales, Australia
| | - Sally C Inglis
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Julee McDonagh
- School of Nursing, Faculty of Science, Medicine, and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Centre for Chronic and Complex Care Research, Blacktown Hospital, Blacktown, New South Wales, Australia
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Rice B, Mbatidde L, Oluleye O, Onwuanyi A, Adedinsewo D. Managing hypertension in African Americans with heart failure: A guide for the primary care clinician. J Natl Med Assoc 2023:S0027-9684(23)00144-X. [PMID: 38135590 DOI: 10.1016/j.jnma.2023.11.004] [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: 10/11/2023] [Accepted: 11/20/2023] [Indexed: 12/24/2023]
Abstract
Hypertension is the predominant risk factor for cardiovascular disease related morbidity and mortality among Black adults in the United States. It contributes significantly to the development of heart failure and increases the risk of death following heart failure diagnosis. It is also a leading predisposing factor for hypertensive disorders of pregnancy and peripartum cardiomyopathy in Black women. As such, all stakeholders including health care providers, particularly primary care clinicians (including physicians and advanced practice providers), patients, and communities must be aware of the consequences of uncontrolled hypertension among Black adults. Appropriate treatment strategies should be identified and implemented to ensure timely and effective blood pressure management among Black individuals, particularly those with, and at risk for heart failure.
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Affiliation(s)
- Bria Rice
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Lydia Mbatidde
- Department of Family Medicine, Mayo Clinic, Jacksonville, FL, United States
| | | | - Anekwe Onwuanyi
- Department of Cardiovascular Medicine, Morehouse School of Medicine, Atlanta, GA
| | - Demilade Adedinsewo
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States.
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Zafar MDB, Jamil Y, Bilal M, Rathi S, Anwer A. Impact of racial, ethnic and gender disparities in Cardiology. Curr Probl Cardiol 2023; 48:101725. [PMID: 36990187 DOI: 10.1016/j.cpcardiol.2023.101725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023]
Abstract
Literature shows evidence of racial and gender biases in many sub-specialties of medicine including cardiology. Racial, ethnic, and gender disparities exist along the path to cardiology residency, beginning as early as medical school admissions. Approximately 65.62% White, 4.71% Black, 18.06% Asian, and 8.86% Hispanic are cardiologists, while there are a total of 60.1% White, 12.2% Black, 5.6% Asian, and 18.5% Hispanic people in the US in 2019, showing evident underrepresentation. Gender disparities have an inevitable role in the lack of a diverse cardiovascular workforce. According to a recent study, only 13% of practicing cardiologists in the US are women, even though the female population in the US is 50.52% as compared to 49.48%- of men. These disparities led to underrepresented physicians earning less than their similarly qualified counterparts, decreased equity, increased workplace harassment, and also results in patients facing unconscious bias from their physicians leading to deteriorated clinical outcomes. Implications in the field of research include the underrepresentation of minorities and the female population despite the increased burden of cardiovascular disease they face. However, efforts are underway to eradicate the disparities that exist in cardiology. This paper aims to increase awareness regarding the issue and inform future policies with the goal of encouraging underrepresented communities to join the cardiology workforce.
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Affiliation(s)
| | - Yumna Jamil
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
| | - Maham Bilal
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Sushma Rathi
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Anusha Anwer
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
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Race-Based Analyses in Heart Failure Clinical Trials: What Makes Them Informative? JACC. HEART FAILURE 2023; 11:580-582. [PMID: 36868918 DOI: 10.1016/j.jchf.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 01/17/2023] [Indexed: 03/05/2023]
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Thomas KL, Garg J, Velagapudi P, Gopinathannair R, Chung MK, Kusumoto F, Ajijola O, Jackson LR, Turagam MK, Joglar JA, Sogade FO, Fontaine JM, Krahn AD, Russo AM, Albert C, Lakkireddy DR. Racial and ethnic disparities in arrhythmia care: A call for action. Heart Rhythm 2022; 19:1577-1593. [PMID: 35842408 PMCID: PMC10124949 DOI: 10.1016/j.hrthm.2022.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/01/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Kevin L Thomas
- Division of Cardiac Electrophysiology, Duke University School of Medicine, Durham, North Carolina
| | - Jalaj Garg
- Cardiac Arrhythmia Service, Loma Linda University Hospital, Loma Linda, California
| | - Poonam Velagapudi
- Division of Cardiology, University of Nebraska Medical Center, Omaha, Nebraska
| | | | - Mina K Chung
- Cardiac Pacing and Electrophysiology, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Fred Kusumoto
- Heart Rhythm Services, Mayo Clinic, Jacksonville, Florida
| | - Olujimi Ajijola
- Ronald Reagan University of California Los Angeles Cardiac Arrhythmia Center, Los Angeles, California
| | - Larry R Jackson
- Division of Cardiac Electrophysiology, Duke University School of Medicine, Durham, North Carolina
| | - Mohit K Turagam
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jose A Joglar
- Division of Cardiology, Clinical Cardiac Electrophysiology, UT Southwestern Medical Center, Dallas, Texas
| | - Felix O Sogade
- Clinical Cardiac Electrophysiology, Georgia Arrhythmia Consultants, Macon, Georgia
| | - John M Fontaine
- Clinical Cardiac Electrophysiology Service, University of Pittsburgh Medical Center Williamsport, Williamsport, Pennsylvania
| | - Andrew D Krahn
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrea M Russo
- Cooper Medical School of Rowan University, Division of Cardiovascular Disease, Cooper University Hospital, Camden, New Jersey
| | - Christine Albert
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
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Shea L, Pesa J, Geonnotti G, Powell V, Kahn C, Peters W. Improving diversity in study participation: Patient perspectives on barriers, racial differences and the role of communities. Health Expect 2022; 25:1979-1987. [PMID: 35765232 PMCID: PMC9327876 DOI: 10.1111/hex.13554] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 05/30/2022] [Accepted: 06/07/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The lack of racial/ethnic diversity in research potentially limits the generalizability of findings to a broader population, highlighting the need for greater diversity and inclusion in clinical research. Qualitative research (i.e., focus groups) was conducted to identify (i) the potential motivators and barriers to study participation across different races and ethnicities; (ii) preferred delivery of education and information to support healthcare decision-making and the role of the community. METHODS Patient focus groups were conducted with 26 participants from the sponsor's Patient Engagement Research Councils selected through subjective sampling. Recruitment prioritized adequate representation across different race/ethnic groups. Participation was voluntary and participants underwent a confidential interview process before selection. Narrative analysis was used to identify themes and draw insights from interactions. Experienced research specialists identified emerging concepts, and these were tested against new observations. The frequency of each concept was examined to understand its importance. RESULTS Based on self-selected race/ethnicity, participants were divided into five focus groups (Groups: African American/Black: 2; Hispanic/Latino, Asian American, and white: 1 each) and were asked to share their experiences/opinions regarding the stated objectives. Barriers to study participation included: limited awareness of opportunities to participate in research, fears about changes in standard therapy, breaking cultural norms/stigma, religion-related concerns and mistrust of clinical research. Participants identified the importance of transparency by pharmaceutical companies and other entities to build trust and partnership and cited key roles that communities can play. The perceptions of the African American group regarding diversity/inclusion in research studies appeared to be different from other groups; a lack of trust in healthcare providers, concerns about historical instances of research abuse and the importance of prayer were cited. CONCLUSION This study provided insights into barriers to study participation, and also highlighted the need for pharmaceutical companies and other entities to authentically engage in strategies that build trust within communities to enhance recruitment among diverse populations. PATIENT OR PUBLIC CONTRIBUTION The data collected in the present study was provided by the participants in the focus groups.
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Affiliation(s)
- Lisa Shea
- Janssen Scientific Affairs, LLC, Titusville, New Jersey, USA
| | - Jacqueline Pesa
- Janssen Scientific Affairs, LLC, Titusville, New Jersey, USA
| | | | | | - Caryl Kahn
- CorEvitas, LLC, Waltham, Massachusetts, USA
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9
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Beavers DP, Hsieh KL, Kitzman DW, Kritchevsky SB, Messier SP, Neiberg RH, Nicklas BJ, Rejeski WJ, Beavers KM. Estimating heterogeneity of physical function treatment response to caloric restriction among older adults with obesity. PLoS One 2022; 17:e0267779. [PMID: 35511858 PMCID: PMC9070937 DOI: 10.1371/journal.pone.0267779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 04/14/2022] [Indexed: 11/18/2022] Open
Abstract
Clinical trials conventionally test aggregate mean differences and assume homogeneous variances across treatment groups. However, significant response heterogeneity may exist. The purpose of this study was to model treatment response variability using gait speed change among older adults participating in caloric restriction (CR) trials. Eight randomized controlled trials (RCTs) with five- or six-month assessments were pooled, including 749 participants randomized to CR and 594 participants randomized to non-CR (NoCR). Statistical models compared means and variances by CR assignment and exercise assignment or select subgroups, testing for treatment differences and interactions for mean changes and standard deviations. Continuous equivalents of dichotomized variables were also fit. Models used a Bayesian framework, and posterior estimates were presented as means and 95% Bayesian credible intervals (BCI). At baseline, participants were 67.7 (SD = 5.4) years, 69.8% female, and 79.2% white, with a BMI of 33.9 (4.4) kg/m2. CR participants reduced body mass [CR: -7.7 (5.8) kg vs. NoCR: -0.9 (3.5) kg] and increased gait speed [CR: +0.10 (0.16) m/s vs. NoCR: +0.07 (0.15) m/s] more than NoCR participants. There were no treatment differences in gait speed change standard deviations [CR–NoCR: -0.002 m/s (95% BCI: -0.013, 0.009)]. Significant mean interactions between CR and exercise assignment [0.037 m/s (95% BCI: 0.004, 0.070)], BMI [0.034 m/s (95% BCI: 0.003, 0.066)], and IL-6 [0.041 m/s (95% BCI: 0.009, 0.073)] were observed, while variance interactions were observed between CR and exercise assignment [-0.458 m/s (95% BCI: -0.783, -0.138)], age [-0.557 m/s (95% BCI: -0.900, -0.221)], and gait speed [-0.530 m/s (95% BCI: -1.018, -0.062)] subgroups. Caloric restriction plus exercise yielded the greatest gait speed benefit among older adults with obesity. High BMI and IL-6 subgroups also improved gait speed in response to CR. Results provide a novel statistical framework for identifying treatment heterogeneity in RCTs.
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Affiliation(s)
- Daniel P. Beavers
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
- * E-mail:
| | - Katherine L. Hsieh
- Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - Dalane W. Kitzman
- Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - Stephen B. Kritchevsky
- Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - Stephen P. Messier
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States of America
| | - Rebecca H. Neiberg
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - Barbara J. Nicklas
- Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - W. Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States of America
| | - Kristen M. Beavers
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States of America
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Green AK, Trivedi N, Hsu JJ, Yu NL, Bach PB, Chimonas S. Despite The FDA's Five-Year Plan, Black Patients Remain Inadequately Represented In Clinical Trials For Drugs. Health Aff (Millwood) 2022; 41:368-374. [PMID: 35254926 DOI: 10.1377/hlthaff.2021.01432] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
For decades Black patients have been underrepresented in clinical trials of new treatments. In response, in 2015 the Food and Drug Administration (FDA) launched a five-year action plan aimed at improving diversity in and transparency of pivotal clinical trials for newly approved drugs. The plan contained many action steps that were aimed at improving the racial representativeness of clinical trials and enhancing the reporting of new drug side effects and benefits across diverse populations. Yet, relying on the FDA's Drug Trials Snapshots website, we failed to find evidence that the action plan improved representation of Black trial participants. Black patients remained inadequately represented in clinical trials for drugs, with a median of one-third the enrollment that would be required, whether the trials were started before, during, or after the action plan. Fewer than 20 percent of drugs had data regarding treatment benefits or side effects reported for Black patients; neither measure improved during the action plan period.
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Affiliation(s)
- Angela K Green
- Angela K. Green , Memorial Sloan Kettering Cancer Center, New York, New York
| | - Niti Trivedi
- Niti Trivedi, Memorial Sloan Kettering Cancer Center
| | - Jennifer J Hsu
- Jennifer J. Hsu, Memorial Sloan Kettering Cancer Center and Johns Hopkins University, New York, New York
| | - Nancy L Yu
- Nancy L. Yu, Memorial Sloan Kettering Cancer Center
| | - Peter B Bach
- Peter B. Bach, Memorial Sloan Kettering Cancer Center
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Sundaram V, Mackall JA. Cardiac Resynchronization Therapy: The Long and Short of It. JACC Clin Electrophysiol 2022; 8:222-224. [PMID: 35210079 DOI: 10.1016/j.jacep.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Varun Sundaram
- Louis Stokes VA Medical Center, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Judith A Mackall
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA.
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12
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Wattanakamolkul K, Nakayama Y. Incidence, economic burden, and treatment of acute respiratory tract infection in hematopoietic stem cell transplantation recipients using real world data in Japan: a retrospective claims data analysis. J Med Econ 2022; 25:870-879. [PMID: 35703058 DOI: 10.1080/13696998.2022.2088184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIMS Acute respiratory tract infections (ARTIs) are common in hematopoietic stem cell transplantation (HSCT) recipients, however, data is limited regarding epidemiology and economic burden of ARTI in HSCT recipients in Japan. We evaluated the incidence of ARTI in HSCT recipients, associated economic burden, and ARTI-related treatments post-HSCT. MATERIALS AND METHODS Patients receiving HSCT between July 2017 and December 2018, and those enrolled in the JMDC Claims Database for ≥6 months before index month (month when latest medical procedure code of HSCT recorded) were included. The outcomes included demographics, ARTI incidence, healthcare resource utilization (HCRU), direct costs, and ARTI-related treatments. RESULTS In 330 analyzed patients, the ARTI incidence rate was 85.5% during total follow-up, consisting of post-HSCT hospitalization of mean 2.1 months and post-discharge periods of mean 17.6 months (post-HSCT hospitalization: 44.8%; post-discharge: 77.6%). For ARTI vs non-ARTI patients during post-HSCT hospitalization, length of hospitalization was significantly longer (mean [SD] months; 2.40 [1.73] vs 1.84 [1.09]; p = 0.0004), and median cost was significantly higher (JPY; 6,250,120.00 vs 4,774,570.00; p = 0.0096). The cost of outpatient visits during post-discharge periods, drug-related and non-drug-related costs of outpatient visits were generally higher for ARTI vs non-ARTI patients. In ARTI vs non-ARTI patients, utilization of any symptom relievers (decongestants, antitussives, and antipyretics), bronchodilators, immunoglobulin G, antibiotics, antivirals, and oxygen supply were numerically higher during post-HSCT hospitalization and post-discharge periods. The proportion of patients and mean prescription days for immunosuppressants during post-HSCT hospitalization were higher in ARTI vs non-ARTI patients. LIMITATIONS This administrative claims study lacks clinical data and contains only direct medical costs. Patients were retained if they had at least 1 month of enrollment post-HSCT. CONCLUSIONS In HSCT recipients, ARTI leads to substantial incremental HCRU and direct costs for management in real-world settings in Japan.
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Sayer M, Duche A, Nguyen TJT, Le M, Patel K, Vu J, Pham D, Vernick B, Beuttler R, Roosan D, Roosan MR. Clinical Implications of Combinatorial Pharmacogenomic Tests Based on Cytochrome P450 Variant Selection. Front Genet 2021; 12:719671. [PMID: 34650593 PMCID: PMC8506148 DOI: 10.3389/fgene.2021.719671] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/12/2021] [Indexed: 11/13/2022] Open
Abstract
Despite the potential to improve patient outcomes, the application of pharmacogenomics (PGx) is yet to be routine. A growing number of PGx implementers are leaning toward using combinatorial PGx (CPGx) tests (i.e., multigene tests) that are reusable over patients’ lifetimes. However, selecting a single best available CPGx test is challenging owing to many patient- and population-specific factors, including variant frequency differences across ethnic groups. The primary objective of this study was to evaluate the detection rate of currently available CPGx tests based on the cytochrome P450 (CYP) gene variants they target. The detection rate was defined as the percentage of a given population with an “altered metabolizer” genotype predicted phenotype, where a CPGx test targeted both gene variants a prospective diplotypes. A potential genotype predicted phenotype was considered an altered metabolizer when it resulted in medication therapy modification based on Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines. Targeted variant CPGx tests found in the Genetic Testing Registry (GTR), gene selection information, and diplotype frequency data from the Pharmacogenomics Knowledge Base (PharmGKB) were used to determine the detection rate of each CPGx test. Our results indicated that the detection rate of CPGx tests covering CYP2C19, CYP2C9, CYP2D6, and CYP2B6 show significant variation across ethnic groups. Specifically, the Sub-Saharan Africans have 63.9% and 77.9% average detection rates for CYP2B6 and CYP2C19 assays analyzed, respectively. In addition, East Asians (EAs) have an average detection rate of 55.1% for CYP2C9 assays. Therefore, the patient’s ethnic background should be carefully considered in selecting CPGx tests.
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Affiliation(s)
- Michael Sayer
- Department of Pharmacy Practice, Chapman University School of Pharmacy, Irvine, CA, United States
| | - Ashley Duche
- Department of Pharmacy Practice, Chapman University School of Pharmacy, Irvine, CA, United States
| | - Trang Jenny Tran Nguyen
- Department of Pharmacy Practice, Chapman University School of Pharmacy, Irvine, CA, United States
| | - Michelle Le
- Department of Pharmacy Practice, Chapman University School of Pharmacy, Irvine, CA, United States
| | - Kunj Patel
- Department of Pharmacy Practice, Chapman University School of Pharmacy, Irvine, CA, United States
| | - Jacqueline Vu
- Department of Pharmacy Practice, Chapman University School of Pharmacy, Irvine, CA, United States
| | - Danny Pham
- Department of Pharmacy Practice, Chapman University School of Pharmacy, Irvine, CA, United States
| | - Brianne Vernick
- Department of Pharmacy Practice, Chapman University School of Pharmacy, Irvine, CA, United States
| | - Richard Beuttler
- Department of Pharmacy Practice, Chapman University School of Pharmacy, Irvine, CA, United States
| | - Don Roosan
- College of Pharmacy, Western University of Health Sciences, Pomona, CA, United States
| | - Moom R Roosan
- Department of Pharmacy Practice, Chapman University School of Pharmacy, Irvine, CA, United States
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Aljawadi MH, Aldhahri RA, AlMetwazi MS, Arafah A, Khoja AT. The Characteristics of Clinical Studies Submitted to the Saudi Food and Drug Authority from 2009 until 2020. Saudi Pharm J 2021; 29:1155-1165. [PMID: 34703369 PMCID: PMC8523333 DOI: 10.1016/j.jsps.2021.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 08/01/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Clinical trials are crucial in contemporary evidence-based medicine for discovering new treatments for diseases. Their registration in a registry increases the transparency in the dissemination of knowledge about clinical research. It is essential to understand the activity of clinical trials in a country, thus identifying research gaps. OBJECTIVE This study, therefore, aims to describe the clinical trial activity since the inception of clinical trials' administration and national clinical trials' registry within the Kingdom of Saudi Arabia (KSA). METHOD A descriptive study was conducted by reviewing all clinical studies that have been registered during 2009 and June 2020. The inclusion criterion was all phases of the clinical trials registered in the national registry during that period. Data analysis was done using descriptive statistics. RESULTS Since 2009, 352 studies have been registered. However, a total of 333 studies with complete data was included in the analysis. A total of 80 sponsors funded the clinical studies in the KSA. The majority of the clinical studies are funded by multinational pharmaceutical companies. Oncology (13.81%) and diabetes (11.71%) were the most common therapeutic areas and constituted the largest proportion of the overall studies. 44% were phase 4 and 40% were phase 3 studies. CONCLUSION With a population approaching 34 million, the number of clinical trials in the KSA is not sufficient. Since the inception of the clinical trial's administration and SCTR, the emphasis has been on phase 3 and phase 4 clinical studies. The most studied therapeutic areas were oncology and diabetes. Many clinical studies in the KSA were sponsored by multinational pharmaceutical companies.
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Affiliation(s)
- Mohammad H. Aljawadi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Renad A. Aldhahri
- Department of Pharmaceutical Care, King Abdullah bin Abdulaziz University Hospital, Princess Nourah Bint Abdul Rahman University, Riyadh, Kingdom of Saudi Arabia
| | - Mansour S. AlMetwazi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Azher Arafah
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Abdullah T. Khoja
- Public Health and Family Medicine Departments, College of Medicine, Al-Imam Muhammad ibn Saud Islamic University (IMSIU), Riyadh, Kingdom of Saudi Arabia
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Affiliation(s)
- John P A Ioannidis
- Department of Medicine, Stanford University School of Medicine, Stanford, California
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California
| | - Neil R Powe
- Zuckerberg San Francisco General Hospital and University of California-San Francisco
| | - Clyde Yancy
- Division of Cardiology, Department of Internal Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
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Williams MS, Yanek L, Ziegelstein RC, McCann U, Faraday N. Racial differences in platelet serotonin polymorphisms in acute coronary syndrome. Thromb Res 2021; 200:115-120. [PMID: 33582601 DOI: 10.1016/j.thromres.2021.01.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 01/05/2021] [Accepted: 01/28/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Genetic differences between races have been hypothesized to contribute to differences in outcome from acute coronary syndromes (ACS). Our objective was to assess racial differences in genetic variations in the platelet serotonin transporter (5HTT) and receptor in patients with ACS. MATERIALS AND METHODS 127 consecutive patients, African Americans (AA) = 27; Caucasian (C) =100, admitted with ACS were evaluated for platelet function by serotonin (5HT) induced platelet activation. All patients were genotyped for two polymorphisms in the serotonin-transporter-linked polymorphic region (5-HTTLPR) S/L and LG/LA and one polymorphism of the serotonin 2A receptor (5-HT2A, T102C) gene. All patients were followed for major and minor adverse cardiac events at 12 months. RESULTS AA when compared to C had a lower prevalence of the HTTLPR S allele (21% vs 45%, p = 0.0003) and a higher prevalence of the LG allele (24% vs 4.5%, p = 0.0001). Allelic frequency of the 5-HT2A T102C allele was not significantly different between the races. Platelet activation was lower in AA compared to C, median EC50 5HT was 12.08 μg vs 2.14 μg (p = 0.001). The 5-HTTLPR and the 5-HT2A polymorphisms were not associated with platelet functional responses to serotonin. There were no significant differences in major or minor adverse cardiac events in patients with serotonin transporter or receptor polymorphisms. CONCLUSION We found a lower prevalence of the S allele and a higher prevalence of the G allele in AA with ACS. We also found decreased platelet activation in AA which did not correlate with serotonin-related platelet polymorphisms. It is unclear if other contributing factors may explain these platelet functional differences.
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Affiliation(s)
- Marlene S Williams
- Division of Cardiology, Johns Hopkins University School of Medicine, 4940 Eastern Avenue, Baltimore, MD 21224, United States of America.
| | - Lisa Yanek
- Division of Cardiology, Johns Hopkins University School of Medicine, 4940 Eastern Avenue, Baltimore, MD 21224, United States of America
| | - Roy C Ziegelstein
- Division of Cardiology, Johns Hopkins University School of Medicine, 4940 Eastern Avenue, Baltimore, MD 21224, United States of America
| | - Una McCann
- Department of Psychiatry, Johns Hopkins University School of Medicine, 4940 Eastern Avenue, Baltimore, MD 21224, United States of America
| | - Nauder Faraday
- Department of Anesthesia, Johns Hopkins University School of Medicine, 4940 Eastern Avenue, Baltimore, MD 21224, United States of America
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Mehta A, Fillmore N, Dahiya S, D'Souza A, Sweetenham J, Kansagra A. Reporting of race and ethnicity at an international haematology conference. Br J Haematol 2020; 191:e107-e109. [DOI: 10.1111/bjh.17065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/03/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Ansh Mehta
- Department of Internal Medicine University of South Alabama Mobile AL USA
| | - Nathanael Fillmore
- VA Boston Healthcare System Boston MA USA
- Department of Medicine Brigham and Women's Hospital and Harvard Medical School Boston MA USA
- Dana‐Farber Cancer Institute Boston MA USA
| | - Saurabh Dahiya
- Division of Hematology/Oncology University of Maryland Maryland MD USA
| | - Anita D'Souza
- Center for International Blood and Bone Marrow Transplant Research Milwaukee WI USA
- Department of Medicine Medical College of Wisconsin Milwaukee WI USA
| | - John Sweetenham
- Division of Hematology/Oncology UT Southwestern Medical Center Dallas TX USA
- Simmons Comprehensive Cancer CenterUT Southwestern Medical Center Dallas TX USA
| | - Ankit Kansagra
- Division of Hematology/Oncology UT Southwestern Medical Center Dallas TX USA
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Beavers KM, Neiberg RH, Kritchevsky SB, Nicklas BJ, Kitzman DW, Messier SP, Rejeski WJ, Ard JD, Beavers DP. Association of Sex or Race With the Effect of Weight Loss on Physical Function: A Secondary Analysis of 8 Randomized Clinical Trials. JAMA Netw Open 2020; 3:e2014631. [PMID: 32821924 PMCID: PMC7442923 DOI: 10.1001/jamanetworkopen.2020.14631] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
IMPORTANCE Consideration of differential treatment effects among subgroups in clinical trial research is a topic of increasing interest. This is an especially salient issue for weight loss trials. OBJECTIVE To determine whether stratification by sex and race is associated with meaningful differences in physical function response to weight loss among older adults. DESIGN, SETTING, AND PARTICIPANTS This pooled analysis used individual-level data from 8 completed randomized clinical trials of weight loss conducted at Wake Forest University or Wake Forest School of Medicine, Winston-Salem, North Carolina. Data were housed within the Wake Forest Older Americans Independence Center data repository and provided complete exposure, outcome, and covariate information. Data were collected from November 1996 to March 30, 2017, and analyzed from August 15, 2019, to June 10, 2020. EXPOSURES Treatment arms within each study were collapsed into caloric restriction (CR [n = 734]) and non-CR (n = 583) categories based on whether caloric restriction was specified in the original study protocol. MAIN OUTCOMES AND MEASURES Objectively measured 6-month change in weight, fast-paced gait speed (meters per second), and Short Physical Performance Battery (SPPB) score. RESULTS A total of 1317 adults (mean [SD] age, 67.7 [5.4] years; 920 [69.9%] female; 275 [20.9%] Black) with overweight or obesity (mean [SD] body mass index [calculated as weight in kilograms divided by height in meters squared], 33.9 [4.4]) were included at baseline. Six-month weight change achieved among those randomized to CR was -7.7% (95% CI, -8.3% to -7.2%), with no difference noted by sex; however, White individuals lost more weight than Black individuals assigned to CR (-9.0% [95% CI, -9.6% to -8.4%] vs -6.0% [95% CI, -6.9% to 5.2%]; P < .001), and all CR groups lost a significantly greater amount from baseline compared with non-CR groups (Black participants in CR vs non-CR groups, -5.3% [95% CI, -6.4% to -4.1%; P < .001]; White participants in CR vs non-CR groups, -7.2% [95% CI, -7.8% to -6.6%; P < .001]). Women experienced greater weight loss-associated improvement in SPPB score (CR group, 0.35 [95% CI, 0.18-0.52]; non-CR group, 0.08 [95% CI, -0.11 to 0.27]) compared with men (CR group, 0.23 [95% CI, 0.00-0.46]; non-CR group, 0.34 [95% CI, 0.09-0.58]; P = .03). Black participants experienced greater weight loss-associated improvement in gait speed (CR group, 0.08 [95% CI, 0.05-0.10] m/s; non-CR group, 0.02 [95% CI, -0.01 to 0.05] m/s) compared with White participants (CR group, 0.07 [95% CI, 0.06-0.09] m/s; non-CR group, 0.06 [95% CI, 0.04-0.08] m/s; P = .02). CONCLUSIONS AND RELEVANCE The association of weight loss on physical function in older adults appears to differ by sex and race. These findings affirm the need to consider biological variables in clinical trial design.
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Affiliation(s)
- Kristen M. Beavers
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Rebecca H. Neiberg
- Department of Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Stephen B. Kritchevsky
- Sections of Gerontology and Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Barbara J. Nicklas
- Sections of Gerontology and Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Dalane W. Kitzman
- Sections of Gerontology and Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Stephen P. Messier
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - W. Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Jamy D. Ard
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Daniel P. Beavers
- Department of Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Lorch U, Pierscionek T, Freier A, Spencer CS, Täubel J. Safety, Tolerability, and Dose Proportionality of a Novel Transdermal Fentanyl Matrix Patch and Bioequivalence With a Matrix Fentanyl Patch: Two Phase 1 Single-Center Open-Label, Randomized Crossover Studies in Healthy Japanese Volunteers. Clin Pharmacol Drug Dev 2020; 10:260-271. [PMID: 32748570 PMCID: PMC7984375 DOI: 10.1002/cpdd.846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 06/07/2020] [Indexed: 11/29/2022]
Abstract
Two open‐label, single‐dose, randomized crossover studies were conducted in healthy Japanesemen to (1) assess dose proportionality of 5 doses (1.38, 2.75, 5.5, 8.25, and 11.0 mg) of Lafenta, a novel matrix‐type transdermal fentanyl patch with a rate‐controlling membrane; and (2) compare patch bioequivalence (11.0 mg) with a commercially available reference patch (Durotep MT Patch [16.8 mg]). Pharmacokinetics, adhesion performance, residual fentanyl, and safety parameters were assessed. Increases in mean AUC0‐t and Cmax after application of the test patch were dose proportional. The test patch (11.0 mg) was bioequivalent to the 16.8‐mg reference patch in terms of mean AUC0‐inf, AUC0‐t, and Cmax. Residual fentanyl levels 72 hours postapplication were lower in the test than in the reference patch. Differences in adhesion performance between the test and the reference patch did not affect delivery efficacy and reliability of the novel matrix patch. Safety findings were in line with previous experiences with fentanyl. Both studies showed low variation in fentanyl exposure and delivery via the test patch. The test patch provided equivalent fentanyl exposure at a lower dose than the reference patch formulation with lower variability and the potential to lower medicinal waste.
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Affiliation(s)
- Ulrike Lorch
- Richmond Pharmacology Ltd., St George's University London, London, UK
| | | | | | | | - Jörg Täubel
- Richmond Pharmacology Ltd., St George's University London, London, UK.,St George's University London, London, UK
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Grayson S, Doerr M, Yu JH. Developing pathways for community-led research with big data: a content analysis of stakeholder interviews. Health Res Policy Syst 2020; 18:76. [PMID: 32641140 PMCID: PMC7346420 DOI: 10.1186/s12961-020-00589-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 06/14/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Big data (BD) informs nearly every aspect of our lives and, in health research, is the foundation for basic discovery and its tailored translation into healthcare. Yet, as new data resources and citizen/patient-led science movements offer sites of innovation, segments of the population with the lowest health status are least likely to engage in BD research either as intentional data contributors or as 'citizen/community scientists'. Progress is being made to include a more diverse spectrum of research participants in datasets and to encourage inclusive and collaborative engagement in research through community-based participatory research approaches, citizen/patient-led research pilots and incremental research policy changes. However, additional evidence-based policies are needed at the organisational, community and national levels to strengthen capacity-building and widespread adoption of these approaches to ensure that the translation of research is effectively used to improve health and health equity. The aims of this study are to capture uses of BD ('use cases') from the perspectives of community leaders and to identify needs and barriers for enabling community-led BD science. METHODS We conducted a qualitative content analysis of semi-structured key informant interviews with 16 community leaders. RESULTS Based on our analysis findings, we developed a BD Engagement Model illustrating the pathways and various forces for and against community engagement in BD research. CONCLUSIONS The goal of our Model is to promote concrete, transparent dialogue between communities and researchers about barriers and facilitators of authentic community-engaged BD research. Findings from this study will inform the subsequent phases of a multi-phased project with the ultimate aims of organising fundable frameworks and identifying policy options to support BD projects within community settings.
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Affiliation(s)
- Shira Grayson
- Sage Bionetworks, 2901 Third Avenue, Seattle, WA, 98121, United States of America
- Institute for Public Health Genetics, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, United States of America
| | - Megan Doerr
- Sage Bionetworks, 2901 Third Avenue, Seattle, WA, 98121, United States of America.
| | - Joon-Ho Yu
- Institute for Public Health Genetics, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, United States of America
- Department of Pediatrics, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, United States of America
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, 1900 9th Ave, Seattle, WA, 98101, United States of America
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Bean DM, Kraljevic Z, Searle T, Bendayan R, Kevin O, Pickles A, Folarin A, Roguski L, Noor K, Shek A, Zakeri R, Shah AM, Teo JT, Dobson RJ. Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers are not associated with severe COVID-19 infection in a multi-site UK acute hospital trust. Eur J Heart Fail 2020; 22:967-974. [PMID: 32485082 PMCID: PMC7301045 DOI: 10.1002/ejhf.1924] [Citation(s) in RCA: 138] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 05/22/2020] [Accepted: 05/27/2020] [Indexed: 01/08/2023] Open
Abstract
AIMS The SARS-CoV-2 virus binds to the angiotensin-converting enzyme 2 (ACE2) receptor for cell entry. It has been suggested that angiotensin-converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARB), which are commonly used in patients with hypertension or diabetes and may raise tissue ACE2 levels, could increase the risk of severe COVID-19 infection. METHODS AND RESULTS We evaluated this hypothesis in a consecutive cohort of 1200 acute inpatients with COVID-19 at two hospitals with a multi-ethnic catchment population in London (UK). The mean age was 68 ± 17 years (57% male) and 74% of patients had at least one comorbidity. Overall, 415 patients (34.6%) reached the primary endpoint of death or transfer to a critical care unit for organ support within 21 days of symptom onset. A total of 399 patients (33.3%) were taking ACEi or ARB. Patients on ACEi/ARB were significantly older and had more comorbidities. The odds ratio for the primary endpoint in patients on ACEi and ARB, after adjustment for age, sex and co-morbidities, was 0.63 (95% confidence interval 0.47-0.84, P < 0.01). CONCLUSIONS There was no evidence for increased severity of COVID-19 in hospitalised patients on chronic treatment with ACEi or ARB. A trend towards a beneficial effect of ACEi/ARB requires further evaluation in larger meta-analyses and randomised clinical trials.
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Affiliation(s)
- Daniel M. Bean
- Department of Biostatistics and Health InformaticsInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
- Health Data Research UK LondonUniversity College LondonLondonUK
| | - Zeljko Kraljevic
- Department of Biostatistics and Health InformaticsInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Thomas Searle
- Department of Biostatistics and Health InformaticsInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Rebecca Bendayan
- Department of Biostatistics and Health InformaticsInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College LondonLondonUK
| | - O'Gallagher Kevin
- King's College Hospital NHS Foundation TrustLondonUK
- School of Cardiovascular Medicine & SciencesKing's College London British Heart Foundation Centre of ExcellenceLondonUK
| | - Andrew Pickles
- Department of Biostatistics and Health InformaticsInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Amos Folarin
- Department of Biostatistics and Health InformaticsInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
- Health Data Research UK LondonUniversity College LondonLondonUK
- Institute of Health InformaticsUniversity College LondonLondonUK
- NIHR Biomedical Research CentreUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Lukasz Roguski
- Health Data Research UK LondonUniversity College LondonLondonUK
- Institute of Health InformaticsUniversity College LondonLondonUK
- NIHR Biomedical Research CentreUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Kawsar Noor
- Health Data Research UK LondonUniversity College LondonLondonUK
- Institute of Health InformaticsUniversity College LondonLondonUK
- NIHR Biomedical Research CentreUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Anthony Shek
- Department of Clinical NeuroscienceInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Rosita Zakeri
- King's College Hospital NHS Foundation TrustLondonUK
- School of Cardiovascular Medicine & SciencesKing's College London British Heart Foundation Centre of ExcellenceLondonUK
| | - Ajay M. Shah
- King's College Hospital NHS Foundation TrustLondonUK
- School of Cardiovascular Medicine & SciencesKing's College London British Heart Foundation Centre of ExcellenceLondonUK
| | - James T.H. Teo
- King's College Hospital NHS Foundation TrustLondonUK
- Department of Clinical NeuroscienceInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Richard J.B. Dobson
- Department of Biostatistics and Health InformaticsInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
- Health Data Research UK LondonUniversity College LondonLondonUK
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College LondonLondonUK
- Institute of Health InformaticsUniversity College LondonLondonUK
- NIHR Biomedical Research CentreUniversity College London Hospitals NHS Foundation TrustLondonUK
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Liu P, Ross JS, Ioannidis JP, Dhruva SS, Vasiliou V, Wallach JD. Prevalence and significance of race and ethnicity subgroup analyses in Cochrane intervention reviews. Clin Trials 2019; 17:231-234. [PMID: 31709809 DOI: 10.1177/1740774519887148] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Joseph S Ross
- Section of General Internal Medicine and National Clinician Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - John Pa Ioannidis
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
| | - Sanket S Dhruva
- Department of Medicine, San Francisco School of Medicine and San Francisco VA Medical Center, University of California San Francisco, San Francisco, CA, USA
| | - Vasilis Vasiliou
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Joshua D Wallach
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA
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Loree JM, Anand S, Dasari A, Unger JM, Gothwal A, Ellis LM, Varadhachary G, Kopetz S, Overman MJ, Raghav K. Disparity of Race Reporting and Representation in Clinical Trials Leading to Cancer Drug Approvals From 2008 to 2018. JAMA Oncol 2019; 5:e191870. [PMID: 31415071 DOI: 10.1001/jamaoncol.2019.1870] [Citation(s) in RCA: 353] [Impact Index Per Article: 70.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Representative racial/ethnic participation in research, especially in clinical trials that establish standards of care, is necessary to minimize disparities in outcomes and to uphold societal equity in health care. Objective To evaluate the frequency of race reporting and proportional race representation in trials supporting US Food and Drug Administration (FDA) oncology drug approvals. Design, Setting, and Participants Database study of all reported trials supporting FDA oncology drug approvals granted between July 2008 and June 2018. Primary reports of trials were obtained from PubMed and ClinicalTrials.gov. Food and Drug Administration approvals were identified using the FDA archives. The US population-based cancer estimates by race were calculated using National Cancer Institute-Surveillance, Epidemiology, and End Results and US Census databases. Main Outcomes and Measures Primary outcomes were the proportion of trials reporting race and the proportion of patients by race participating in trials. Secondary outcomes included race subgroup analyses reporting and gaps between race proportion in trials and the US population. Descriptive statistics, Fisher exact, and χ2 tests were used to analyze the data. Proportions and odds ratios (OR) with 95% CIs were reported. Results Among 230 trials with a total of 112 293 participants, 145 (63.0%) reported on at least 1 race, 18 (7.8%) documented the 4 major races in the United States (white, Asian, black, and Hispanic), and 58 (25.2%) reported race subgroup analyses. Reporting on white, Asian, black, and Hispanic races was included in 144 (62.6%), 110 (47.8%), 88 (38.2%), and 23 (10.0%) trials, respectively. Between July 2008 and June 2013 vs July 2013 and June 2018, the number of trials reporting race (45 [56.6%] vs 100 [67.1%]; OR, 1.63; 95% CI, 0.93-2.87; P = .09) and race subgroup analysis (13 [16.1%] vs 45 [30.2%]; OR, 2.26, 95% CI, 1.16-4.67; P = .03) changed minimally and varied across races. Whites, Asians, blacks, and Hispanics represented 76.3%, 18.3%, 3.1% and 6.1% of trial participants, respectively, and the proportion for each race enrolled over time changed nominally (blacks, 3.6% vs 2.9% and Hispanics, 5.3% vs 6.7%) from July 2008 to June 2013 vs July 2013 to June 2018. Compared with their proportion of US cancer incidence, blacks (22% of expected) and Hispanics (44% of expected) were underrepresented compared with whites (98% of expected) and Asians (438% of expected). Conclusions and Relevance Race and race subgroup analysis reporting occurs infrequently, and black and Hispanic races are consistently underrepresented compared with their burden of cancer incidence in landmark trials that led to FDA oncology drug approvals. Enhanced minority engagement is needed in trials to ensure the validity of results and reliable benefits to all.
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Affiliation(s)
| | - Seerat Anand
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Arvind Dasari
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | | | | | | | - Gauri Varadhachary
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Scott Kopetz
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Michael J Overman
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Kanwal Raghav
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
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25
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Wasserman J, Palmer RC, Gomez MM, Berzon R, Ibrahim SA, Ayanian JZ. Advancing Health Services Research to Eliminate Health Care Disparities. Am J Public Health 2019; 109:S64-S69. [PMID: 30699021 PMCID: PMC6356134 DOI: 10.2105/ajph.2018.304922] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2018] [Indexed: 11/04/2022]
Abstract
Findings from health services research highlight continuing health care disparities in the United States, especially in the areas of access to health care and quality of care. Although attention to health care disparities has increased, considerable knowledge gaps still exist. A better understanding of how cultural, behavioral, and health system factors converge and contribute to unequal access and differential care is needed. Research-informed approaches for reducing health care disparities that are feasible and capable of sustained implementation are needed to inform policymakers. More important, for health equity to be achieved, it is essential to create a health care system that provides access, removes barriers to care, and provides equally effective treatment to all persons living in the United States.
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Affiliation(s)
- Joan Wasserman
- Joan Wasserman and Richard C. Palmer are with the Office of Extramural Research Administration, National Institute on Minority Health and Health Disparities, Bethesda, MD. Marcia M. Gomez is with the Office of Strategic Planning, Legislation, and Scientific Policy, National Institute on Minority Health and Health Disparities. Rick Berzon is with the Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities. Said A. Ibrahim was with the Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA. John Z. Ayanian is with the Institute for Healthcare Policy and Innovation; Division of General Medicine, Medical School; Department of Health Management and Policy, School of Public Health; and Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor. Richard C. Palmer is also a Guest Editor for this supplement issue
| | - Richard C Palmer
- Joan Wasserman and Richard C. Palmer are with the Office of Extramural Research Administration, National Institute on Minority Health and Health Disparities, Bethesda, MD. Marcia M. Gomez is with the Office of Strategic Planning, Legislation, and Scientific Policy, National Institute on Minority Health and Health Disparities. Rick Berzon is with the Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities. Said A. Ibrahim was with the Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA. John Z. Ayanian is with the Institute for Healthcare Policy and Innovation; Division of General Medicine, Medical School; Department of Health Management and Policy, School of Public Health; and Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor. Richard C. Palmer is also a Guest Editor for this supplement issue
| | - Marcia M Gomez
- Joan Wasserman and Richard C. Palmer are with the Office of Extramural Research Administration, National Institute on Minority Health and Health Disparities, Bethesda, MD. Marcia M. Gomez is with the Office of Strategic Planning, Legislation, and Scientific Policy, National Institute on Minority Health and Health Disparities. Rick Berzon is with the Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities. Said A. Ibrahim was with the Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA. John Z. Ayanian is with the Institute for Healthcare Policy and Innovation; Division of General Medicine, Medical School; Department of Health Management and Policy, School of Public Health; and Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor. Richard C. Palmer is also a Guest Editor for this supplement issue
| | - Rick Berzon
- Joan Wasserman and Richard C. Palmer are with the Office of Extramural Research Administration, National Institute on Minority Health and Health Disparities, Bethesda, MD. Marcia M. Gomez is with the Office of Strategic Planning, Legislation, and Scientific Policy, National Institute on Minority Health and Health Disparities. Rick Berzon is with the Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities. Said A. Ibrahim was with the Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA. John Z. Ayanian is with the Institute for Healthcare Policy and Innovation; Division of General Medicine, Medical School; Department of Health Management and Policy, School of Public Health; and Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor. Richard C. Palmer is also a Guest Editor for this supplement issue
| | - Said A Ibrahim
- Joan Wasserman and Richard C. Palmer are with the Office of Extramural Research Administration, National Institute on Minority Health and Health Disparities, Bethesda, MD. Marcia M. Gomez is with the Office of Strategic Planning, Legislation, and Scientific Policy, National Institute on Minority Health and Health Disparities. Rick Berzon is with the Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities. Said A. Ibrahim was with the Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA. John Z. Ayanian is with the Institute for Healthcare Policy and Innovation; Division of General Medicine, Medical School; Department of Health Management and Policy, School of Public Health; and Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor. Richard C. Palmer is also a Guest Editor for this supplement issue
| | - John Z Ayanian
- Joan Wasserman and Richard C. Palmer are with the Office of Extramural Research Administration, National Institute on Minority Health and Health Disparities, Bethesda, MD. Marcia M. Gomez is with the Office of Strategic Planning, Legislation, and Scientific Policy, National Institute on Minority Health and Health Disparities. Rick Berzon is with the Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities. Said A. Ibrahim was with the Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA. John Z. Ayanian is with the Institute for Healthcare Policy and Innovation; Division of General Medicine, Medical School; Department of Health Management and Policy, School of Public Health; and Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor. Richard C. Palmer is also a Guest Editor for this supplement issue
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Recruitment of racial and ethnic minorities to clinical trials conducted within specialty clinics: an intervention mapping approach. Trials 2018; 19:115. [PMID: 29454389 PMCID: PMC5816509 DOI: 10.1186/s13063-018-2507-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 01/26/2018] [Indexed: 11/21/2022] Open
Abstract
Background Despite efforts to increase diversity in clinical trials, racial/ethnic minority groups generally remain underrepresented, limiting researchers’ ability to test the efficacy and safety of new interventions across diverse populations. We describe the use of a systematic framework, intervention mapping (IM), to develop an intervention to modify recruitment behaviors of coordinators and specialist investigators with the goal of increasing diversity in trials conducted within specialty clinics. To our knowledge IM has not been used in this setting. Methods The IM framework was used to ensure that the intervention components were guided by health behavior theories and the evidence. The IM steps consisted of (1) conducting a needs assessment, (2) identification of determinants and objectives, (3) selection of theory-informed methods and practical applications, (4) development and creation of program components, (5) development of an adoption and implementation plan, and (6) creation of an evaluation plan. Results The intervention included five educational modules, one in-person and four web-based, plus technical assistance calls to coordinators. Modules addressed the intervention rationale, development of clinic-specific plans to obtain minority-serving physician referrals, physician-centered and patient-centered communication, and patient navigation. The evaluation, a randomized trial, was recently completed in 50 specialty clinics and is under analysis. Conclusions Using IM we developed a recruitment intervention that focused on building relationships with minority-serving physicians to encourage minority patient referrals. IM enhanced our understanding of factors that may influence minority recruitment and helped us integrate strategies from multiple disciplines that were relevant for our audience.
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Affiliation(s)
- Sabine Oertelt-Prigione
- Violence Prevention Clinic, Institute of Legal Medicine, Charité – Universitätsmedizin Berlin, Germany
| | - Angela HEM Maas
- Women’s Cardiac Health Program, Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
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Mitchell TR, Ryan M. An enhanced appreciation of cultural competency: Get off your island! J Am Pharm Assoc (2003) 2017; 57:294-295. [DOI: 10.1016/j.japh.2017.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hershkop E, Segal L, Fainaru O, Kol S. ‘Model’ versus ‘everyday’ patients: can randomized controlled trial data really be applied to the clinic? Reprod Biomed Online 2017; 34:274-279. [DOI: 10.1016/j.rbmo.2016.11.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 11/25/2016] [Accepted: 11/25/2016] [Indexed: 11/15/2022]
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Bondmass MD. Improving Outcomes for African Americans with Chronic Heart Failure: A Comparison of Two Home Care Management Delivery Methods. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2016. [DOI: 10.1177/1084822307304954] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Available data indicate disparity in heart failure (HF) morbidity and mortality among African Americans. African Americans are diagnosed with HF at a younger age, have a more rapid clinical progression, and have higher hospitalization rates related to HF than Whites. Lack of inclusion of African Americans in research studies has been suggested as a possible contributing factor to this disparity. This study presents a secondary analysis from a randomized trial comparing biopsychosocial outcomes for only the African Americans whose HF home management was provided by one of two home care delivery methods—nurse telemanagement (NTM) or nurse home visits. Results indicate significantly higher self-efficacy, home care satisfaction, and quality of life, with significantly lower symptom distress, HF rehospitalization, and intervention charges for African Americans whose HF home management was delivered by the NTM method. These data suggest, independent of race, that NTM may be more efficient and effective as a delivery method for HF home management.
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Affiliation(s)
- Mary D. Bondmass
- University of Nevada Las Vegas, 4505 Maryland Parkway, Box 453018, Las Vegas, NV 89154-3018,
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Ogedegbe G, Shah NR, Phillips C, Goldfeld K, Roy J, Guo Y, Gyamfi J, Torgersen C, Capponi L, Bangalore S. Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitor-Based Treatment on Cardiovascular Outcomes in Hypertensive Blacks Versus Whites. J Am Coll Cardiol 2015; 66:1224-1233. [PMID: 26361152 DOI: 10.1016/j.jacc.2015.07.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 07/04/2015] [Accepted: 07/06/2015] [Indexed: 01/13/2023]
Abstract
BACKGROUND Clinical trial evidence suggests poorer outcomes in blacks compared with whites when treated with an angiotensin-converting enzyme (ACE) inhibitor-based regimen, but this has not been evaluated in clinical practice. OBJECTIVES This study evaluated the comparative effectiveness of an ACE inhibitor-based regimen on a composite outcome of all-cause mortality, stroke, and acute myocardial infarction (AMI) in hypertensive blacks compared with whites. METHODS We conducted a retrospective cohort study of 434,646 patients in a municipal health care system. Four exposure groups (Black-ACE, Black-NoACE, White-ACE, White-NoACE) were created based on race and treatment exposure (ACE or NoACE). Risk of the composite outcome and its components was compared across treatment groups and race using weighted Cox proportional hazard models. RESULTS Our analysis included 59,316 new users of ACE inhibitors, 47% of whom were black. Baseline characteristics were comparable for all groups after inverse probability weighting adjustment. For the composite outcome, the race treatment interaction was significant (p = 0.04); ACE use in blacks was associated with poorer cardiovascular outcomes (ACE vs. NoACE: 8.69% vs. 7.74%; p = 0.05) but not in whites (6.40% vs. 6.74%; p = 0.37). Similarly, the Black-ACE group had higher rates of AMI (0.46% vs. 0.26%; p = 0.04), stroke (2.43% vs. 1.93%; p = 0.05), and congestive heart failure (3.75% vs. 2.25%; p < 0.0001) than the Black-NoACE group. However, the Black-ACE group was no more likely to develop adverse effects than the White-ACE group. CONCLUSIONS ACE inhibitor-based therapy was associated with poorer cardiovascular outcomes in hypertensive blacks but not in whites. These findings confirm clinical trial evidence that hypertensive blacks have poorer outcomes than whites when treated with an ACE inhibitor-based regimen.
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Affiliation(s)
- Gbenga Ogedegbe
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, New York.
| | - Nirav R Shah
- Kaiser Permanente Southern California, Pasadena, California
| | | | - Keith Goldfeld
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, New York
| | - Jason Roy
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yu Guo
- The Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York
| | - Joyce Gyamfi
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, New York
| | - Christopher Torgersen
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, New York
| | - Louis Capponi
- New York City Health and Hospitals Corporation, New York, New York; Division of General Internal Medicine, New York University School of Medicine, New York, New York
| | - Sripal Bangalore
- The Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York
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Outcomes with Angiotensin-converting Enzyme Inhibitors vs Other Antihypertensive Agents in Hypertensive Blacks. Am J Med 2015; 128:1195-203. [PMID: 26071821 DOI: 10.1016/j.amjmed.2015.04.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 04/21/2015] [Accepted: 04/21/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND Angiotensin-converting enzyme inhibitors are used widely in the treatment of patients with hypertension. However, their efficacy in hypertensive blacks when compared with other antihypertensive agents is not well established. METHODS We performed a cohort study of patients using data from a clinical data warehouse of 434,646 patients from New York City's Health and Hospitals Corporation from January 2004 to December 2009. Patients were divided into the following comparison groups: angiotensin-converting enzyme inhibitors vs calcium channel blockers, angiotensin-converting enzyme inhibitors vs thiazide diuretics, and angiotensin-converting enzyme inhibitors vs β-blockers. The primary outcome was a composite of death, myocardial infarction, and stroke. Secondary outcomes included the individual components and heart failure. RESULTS In the propensity score-matched angiotensin-converting enzyme inhibitors vs calcium channel blocker comparison cohort (4506 blacks in each group), angiotensin-converting enzyme inhibitors were associated with a higher risk of primary outcome (hazard ratio [HR], 1.45; 95% confidence interval [CI], 1.19-1.77; P = .0003), myocardial infarction (HR, 3.40; 95% CI, 1.25-9.22; P = .02), stroke (HR, 1.82; 95% CI, 1.29-2.57; P = .001), and heart failure (HR, 1.77; 95% CI, 1.30-2.42; P = .0003) when compared with calcium channel blockers. For the angiotensin-converting enzyme inhibitors vs thiazide diuretics comparison (5337 blacks in each group), angiotensin-converting enzyme inhibitors were associated with a higher risk of primary outcome (HR, 1.65; 95% CI, 1.33-2.05; P < .0001), death (HR, 1.35; 95% CI, 1.03-1.76; P = .03), myocardial infarction (HR, 4.00; 95% CI, 1.34-11.96; P = .01), stroke (HR, 1.97; 95% CI, 1.34-2.92; P = .001), and heart failure (HR, 3.00; 95% CI, 1.99-4.54; P < .0001). For the angiotensin-converting enzyme inhibitors vs β-blocker comparison, the outcomes between the groups were not significantly different. CONCLUSIONS In a real-world cohort of hypertensive blacks, angiotensin-converting enzyme inhibitors were associated with a higher risk of cardiovascular events when compared with calcium channel blockers or thiazide diuretics.
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Comparison in the incidence of anorectal malformations between a first- and third-world referral center. Pediatr Surg Int 2015; 31:759-64. [PMID: 26129979 DOI: 10.1007/s00383-015-3740-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2015] [Indexed: 12/22/2022]
Abstract
PURPOSE Aim of study was to evaluate the differences in incidence and presentation of anorectal malformations (ARMs) between selected Pediatric Surgery Divisions in the Republic of South Africa (ZAR) and Italy. METHODS A retrospective cohort study involved analysis of clinical records of patients with ARM born between 2005 and 2012. Type of ARM, maternal age, birth weight, gestational age, presence of associated anomalies and delayed diagnosis were analyzed. RESULTS 335 patients were included in this study. Of note, statistically significant differences between the African and European patient groups were observed in a male predominance in the ZAR patient population. In addition, female recto-perineal fistulas were diagnosed in significantly more Italian patients than in ZAR. Furthermore, a more advanced maternal age and a lower gestational age was noted in the European cohort with a minimal delay in initial diagnosis as opposed to the African counterpart. Both centers reported recto-perineal fistula as the most common malformation in male patients. CONCLUSION With the exception of perineal fistulas in females, the incidence of specific subtypes of ARMs was similar in the two groups. This may be of importance when extrapolating European study conclusion to the South African setting.
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The complex relationship of race to outcomes in heart failure with preserved ejection fraction. Am J Med 2015; 128:591-600. [PMID: 25554372 PMCID: PMC4442751 DOI: 10.1016/j.amjmed.2014.11.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 11/22/2014] [Accepted: 11/24/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND An improved understanding of racial differences in the natural history, clinical characteristics, and outcomes of heart failure will have important clinical and public health implications. We assessed how clinical characteristics and outcomes vary across racial groups (whites, blacks, and Asians) in adults with heart failure with preserved ejection fraction. METHODS We identified all adults with heart failure with preserved ejection fraction between 2005 and 2008 from 4 health systems in the Cardiovascular Research Network using hospital principal discharge and ambulatory visit diagnoses. RESULTS Among 13,437 adults with confirmed heart failure with preserved ejection fraction, 85.9% were white, 7.6% were black, and 6.5% were Asian. After adjustment for potential confounders and use of cardiovascular therapies, compared with whites, blacks (adjusted hazard ratio [HR], 0.72; 95% confidence interval [CI], 0.62-0.85) and Asians (HR, 0.75; 95% CI, 0.64-0.87) had a lower risk of death from any cause. Compared with whites, blacks had a higher risk of hospitalization for heart failure (HR, 1.48; 95% CI, 1.29-1.68); no difference was observed for Asians compared with whites (HR, 1.01; 95% CI, 0.86-1.18). Compared with whites, no significant differences were detected in risk of hospitalization for any cause for blacks (HR, 1.03; 95% CI, 0.95-1.12) and Asians (HR, 0.93; 95% CI, 0.85-1.02). CONCLUSIONS In a diverse population with heart failure with preserved ejection fraction, we observed complex relationships between race and important clinical outcomes. More detailed studies of large populations are needed to fully characterize the epidemiologic picture and to elucidate potential pathophysiologic and treatment-response differences that may relate to race.
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Toledo L, McLellan-Lemal E, Arreola S, Campbell C, Sutton M. African-American and Hispanic Perceptions of HIV Vaccine Clinical Research: A Qualitative Study. Am J Health Promot 2014; 29:e82-90. [DOI: 10.4278/ajhp.130125-qual-48] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. To examine perceptions of phase-I human immunodeficiency virus (HIV) vaccine trial participation among African-Americans and Hispanics in San Francisco, California. Design. Qualitative, semistructured interviews. Setting. San Francisco Department of Health. Participants. Thirty-six African-American and Hispanic men and women, 18 to 50 years of age, residing in the San Francisco Bay Area. Method. Purposive sampling using advertisements, community-based organization rosters, and snowball referrals. Thematic analysis of transcripts identified salient themes and patterns. Results. Participants viewed participation in HIV research as important; however, they held that HIV was not a health priority given limited awareness about HIV research or beliefs that only infected or high-risk persons were eligible for participation. Altruism and personal gain, trustworthy trial staff, convenient schedules and facilities, and involvement of trusted community groups in recruitment were perceived to motivate participants. Concerns about the social consequences of participating in HIV research and product-related side effects were seen as discouraging participation. Limitations include the possibility that participants in interview research have more favorable views of biomedical research than those who refuse to participate. Conclusion. Historically, African-Americans and Hispanics in the United States have had limited participation in HIV trials. Understanding their perceptions of HIV biomedical research, identifying facilitators and barriers to participation, addressing misinformation about HIV, distorted risk perceptions, HIV stigma, and providing accessible opportunities to participate are imperative to ensure health equity and generalizability of findings.
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Abstract
Hispanics are the largest and fastest-growing minority population in the United States, currently comprising about 16.3% (52 million) of the total population. With an increased prevalence of metabolic risk factors in this population, the rate of uncontrolled hypertension (HTN) in Hispanics significantly exceeds the rates observed among non-Hispanic blacks and whites. Unfortunately, data on HTN in Hispanics remains limited due to the under-representation of Hispanics in clinical trials; with most of the data primarily restricted to observational and retrospective subgroup analyses. This article aims to review the available data on prevalence, awareness and control of HTN, risk factors and some of the challenges unique to the Hispanics population. We also discuss treatment strategies derived from large HTN trials that included Hispanics.
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Cunningham BA, Bonham VL, Sellers SL, Yeh HC, Cooper LA. Physicians' anxiety due to uncertainty and use of race in medical decision making. Med Care 2014; 52:728-33. [PMID: 25025871 PMCID: PMC4214364 DOI: 10.1097/mlr.0000000000000157] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND The explicit use of race in medical decision making is contested. Researchers have hypothesized that physicians use race in care when they are uncertain. OBJECTIVES The aim of this study was to investigate whether physician anxiety due to uncertainty (ADU) is associated with a higher propensity to use race in medical decision making. RESEARCH DESIGN This study included a national cross-sectional survey of general internists. SUBJECTS A national sample of 1738 clinically active general internists drawn from the SK&A physician database were included in the study. MEASURES ADU is a 5-item measure of emotional reactions to clinical uncertainty. Bonham and Sellers Racial Attributes in Clinical Evaluation (RACE) scale includes 7 items that measure self-reported use of race in medical decision making. We used bivariate regression to test for associations between physician characteristics, ADU, and RACE. Multivariate linear regression was performed to test for associations between ADU and RACE while adjusting for potential confounders. RESULTS The mean score on ADU was 19.9 (SD=5.6). Mean score on RACE was 13.5 (SD=5.6). After adjusting for physician demographics, physicians with higher levels of ADU scored higher on RACE (+β=0.08 in RACE, P=0.04, for each 1-point increase in ADU), as did physicians who understood "race" to mean biological or genetic ancestral, rather than sociocultural, group. Physicians who graduated from a US medical school, completed fellowship, and had more white patients scored lower on RACE. CONCLUSIONS This study demonstrates positive associations between physicians' ADU, meanings attributed to race, and self-reported use of race in medical decision making. Future research should examine the potential impact of these associations on patient outcomes and health care disparities.
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Affiliation(s)
| | - Vence L. Bonham
- Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD, United States
| | - Sherrill L. Sellers
- Department of Family Studies & Social Work, Miami University, Oxford, OH, United States
| | - Hsin-Chieh Yeh
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Lisa A. Cooper
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
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Schneider BC, Gross AL, Bangen KJ, Skinner JC, Benitez A, Glymour MM, Sachs BC, Shih RA, Sisco S, Manly JJ, Luchsinger JA. Association of vascular risk factors with cognition in a multiethnic sample. J Gerontol B Psychol Sci Soc Sci 2014; 70:532-44. [PMID: 24821298 DOI: 10.1093/geronb/gbu040] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 03/24/2014] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To examine the relationship between cardiovascular risk factors (CVRFs) and cognitive performance in a multiethnic sample of older adults. METHOD We used longitudinal data from the Washington Heights-Inwood Columbia Aging Project. A composite score including smoking, stroke, heart disease, diabetes, hypertension, and central obesity represented CVRFs. Multiple group parallel process multivariate random effects regression models were used to model cognitive functioning and examine the contribution of CVRFs to baseline performance and change in general cognitive processing, memory, and executive functioning. RESULTS Presence of each CVRF was associated with a 0.1 SD lower score in general cognitive processing, memory, and executive functioning in black and Hispanic participants relative to whites. Baseline CVRFs were associated with poorer baseline cognitive performances among black women and Hispanic men. CVRF increase was related to baseline cognitive performance only among Hispanics. CVRFs were not related to cognitive decline. After adjustment for medications, CVRFs were not associated with cognition in Hispanic participants. DISCUSSION CVRFs are associated with poorer cognitive functioning, but not cognitive decline, among minority older adults. These relationships vary by gender and medication use. Consideration of unique racial, ethnic, and cultural factors is needed when examining relationships between CVRFs and cognition.
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Affiliation(s)
- Brooke C Schneider
- Psychology Service, VA Greater Los Angeles Healthcare System, California
| | - Alden L Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland
| | | | - Jeannine C Skinner
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - Andreana Benitez
- Department of Radiology and Radiological Sciences, Center for Biomedical Imaging, Medical University of South Carolina, Charleston
| | - M Maria Glymour
- Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, Massachusetts. Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Bonnie C Sachs
- Department of Neurology, Virginia Commonwealth University School of Medicine, Richmond
| | | | - Shannon Sisco
- North Florida/South Georgia Veterans Health System, Department of Veterans Affairs, Gainesville
| | - Jennifer J Manly
- Cognitive Neuroscience Division, Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - José A Luchsinger
- Department of Epidemiology, Joseph P. Mailman School of Public Health, and Department of Medicine, Columbia University Medical Center, New York.
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Studnicki J, Ekezue BF, Tsulukidze M, Honoré P, Moonesinghe R, Fisher J. Disparity in race-specific comorbidities associated with central venous catheter-related bloodstream infection (AHRQ-PSI7). Am J Med Qual 2013; 28:525-32. [PMID: 23526359 DOI: 10.1177/1062860613480826] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Studies of racial disparities in hospital-level patient safety outcomes typically apply a race-common approach to risk adjustment. Risk factors specific to a minority population may not be identified in a race-common analysis if they represent only a small percentage of total cases. This study identified patient comorbidities and characteristics associated with the likelihood of a venous catheter-related bloodstream infection (Agency for Healthcare Research and Quality Patient Safety Indicator 7 [PSI7]) separately for blacks and whites using race-specific logistic regression models. Hospitals were ranked by the racial disparity in PSI7 and segmented into 4 groups. The analysis identified both black- and white-specific risk factors associated with PSI7. Age showed race-specific reverse association, with younger blacks and older whites more likely to have a PSI7 event. These findings suggest the need for race-specific covariate adjustments in patient outcomes and provide a new context for examining racial disparities.
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Krim SR, Vivo RP, Krim NR, Cox M, Hernandez AF, Peterson ED, Fonarow GC, Piña IL, Schwamm LH, Bhatt DL. Regional differences in clinical profile, quality of care, and outcomes among Hispanic patients hospitalized with acute myocardial infarction in the Get with Guidelines-Coronary Artery Disease (GWTG-CAD) registry. Am Heart J 2011; 162:988-995.e4. [PMID: 22137071 DOI: 10.1016/j.ahj.2011.09.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 09/08/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although Hispanics constitute the largest minority in the United States, it is unknown whether regional differences in quality of care and outcomes exist among Hispanic patients hospitalized with acute myocardial infarction (MI). METHODS Using the GWTG-CAD Registry, clinical characteristics, conformity with quality measures, and in-hospital outcomes were assessed among Hispanic patients from different geographic regions admitted for acute MI in participating hospitals. RESULTS A total of 11,299 Hispanic patients treated for acute MI at 277 hospitals from 4 regions were included in the study. Midwestern Hispanics were more likely to be younger, with male predominance in all regions. Northeastern Hispanics were more often insured with Medicaid. All subgroups showed high rates of hypertension, dyslipidemia, diabetes, and smoking, with the highest rates observed in the northeast region. Northeastern Hispanics were more likely to be discharged on angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, β-blockers, and statin or other lipid-lowering therapy. No significant regional differences were observed in aspirin, clopidogrel, and guideline-recommended door-to-balloon and door-to-thrombolysis times. Although Hispanics in the south and northeast were more likely to have a longer hospital stay compared with the west, there were no regional differences in in-hospital mortality. CONCLUSIONS Among Hispanics with acute MI enrolled in the GWTG-CAD program, there were modest regional differences in clinical profile; high rates of use and, with few exceptions, no regional differences in guideline-recommended therapies; and no regional variation in in-hospital mortality.
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Eiser AR. Does over-expression of transforming growth factor-beta account for the increased morbidity in African-Americans?: possible clinical study and therapeutic implications. Med Hypotheses 2010; 75:418-21. [PMID: 20457494 DOI: 10.1016/j.mehy.2010.04.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Revised: 03/23/2010] [Accepted: 04/01/2010] [Indexed: 11/17/2022]
Abstract
African-Americans experience an excessive prevalence of a number of apparently disparate disorders that all appear to be, at least in part, mediated by the over-expression or activation of transforming growth factor-beta (TGF-beta) signaling pathways, and that certain genotypes including the codon 10 polymorphism occur more commonly among African-Americans and appears to predispose to these disorders. These disorders, fibrosing in nature, include hypertension, focal glomerulosclerosis, diabetic nephropathy, end stage renal disease, sarcoidosis, uterine leiomyoma, keloids, myocardial fibrosis, and glaucoma. The specific polymorphism for TGF-beta, codon 10, has been implicated in glomerulosclerosis and diabetic nephropathy as well as cardiac transplant rejection. Although TGF-beta over-expression is not the sole factor in these disorders, it is suggested that by designing future clinical studies that consider genomic differences in TGF-beta expression, a more complete understanding of these clinical disorders will be possible. A more thorough understanding of the genetic basis of disease will like promote improved therapeutic regimens and may help reduce the disparate health outcomes for African-Americans as well as improve treatment of individuals of various and diverse ethnic backgrounds.
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Affiliation(s)
- Arnold R Eiser
- Mercy Health System of SE PA, Drexel University College of Medicine, Jefferson School of Population Health, 1500 Lansdowne Avenue, Darby, PA 19023, USA.
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Taylor AJ, Villines TC, Stanek EJ, Devine PJ, Griffen L, Miller M, Weissman NJ, Turco M. Extended-release niacin or ezetimibe and carotid intima-media thickness. N Engl J Med 2009; 361:2113-22. [PMID: 19915217 DOI: 10.1056/nejmoa0907569] [Citation(s) in RCA: 469] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Treatment added to statin monotherapy to further modify the lipid profile may include combination therapy to either raise the high-density lipoprotein (HDL) cholesterol level or further lower the low-density lipoprotein (LDL) cholesterol level. METHODS We enrolled patients who had coronary heart disease or a coronary heart disease risk equivalent, who were receiving long-term statin therapy, and in whom an LDL cholesterol level under 100 mg per deciliter (2.6 mmol per liter) and an HDL cholesterol level under 50 mg per deciliter for men or 55 mg per deciliter for women (1.3 or 1.4 mmol per liter, respectively) had been achieved. The patients were randomly assigned to receive extended-release niacin (target dose, 2000 mg per day) or ezetimibe (10 mg per day). The primary end point was the between-group difference in the change from baseline in the mean common carotid intima-media thickness after 14 months. The trial was terminated early, on the basis of efficacy, according to a prespecified analysis conducted after 208 patients had completed the trial. RESULTS The mean HDL cholesterol level in the niacin group increased by 18.4% over the 14-month study period, to 50 mg per deciliter (P < 0.001), and the mean LDL cholesterol level in the ezetimibe group decreased by 19.2%, to 66 mg per deciliter (1.7 mmol per liter) (P < 0.001). Niacin therapy significantly reduced LDL cholesterol and triglyceride levels; ezetimibe reduced the HDL cholesterol and triglyceride levels. As compared with ezetimibe, niacin had greater efficacy regarding the change in mean carotid intima-media thickness over 14 months (P = 0.003), leading to significant reduction of both mean (P = 0.001) and maximal carotid intima-media thickness (P < or = 0.001 for all comparisons). Paradoxically, greater reductions in the LDL cholesterol level in association with ezetimibe were significantly associated with an increase in the carotid intima-media thickness (R = -0.31, P < 0.001). The incidence of major cardiovascular events was lower in the niacin group than in the ezetimibe group (1% vs. 5%, P = 0.04 by the chi-square test). CONCLUSIONS This comparative-effectiveness trial shows that the use of extended-release niacin causes a significant regression of carotid intima-media thickness when combined with a statin and that niacin is superior to ezetimibe. (ClinicalTrials.gov number, NCT00397657.)
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Affiliation(s)
- Allen J Taylor
- Cardiology Service, Walter Reed Army Medical Center, Washington, DC, USA.
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Frampton GK, Shepherd J, Dorne JLCM. Demographic data in asthma clinical trials: a systematic review with implications for generalizing trial findings and tackling health disparities. Soc Sci Med 2009; 69:1147-54. [PMID: 19592148 DOI: 10.1016/j.socscimed.2009.06.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Indexed: 01/18/2023]
Abstract
The prevalence of asthma, and the morbidity, adverse events, mortality and healthcare utilisation of asthmatic patients vary widely among racial/ethnic and other socio-demographic groups. Debates over the meanings of race and ethnicity and the strategic need to resolve health inequalities have prompted extensive recommendations for reporting and analyzing racial/ethnic and demographic information in clinical trials. We conducted a systematic review to determine the extent to which race/ethnicity, socio-economic status and other demographic variables are analyzed and reported in publications from randomized controlled trials of asthma interventions. Randomized controlled trials of inhaled corticosteroids and long-acting beta-agonists in asthmatic patients were identified by systematically searching 12 electronic bibliographic databases. We identified peer-reviewed papers reporting 87 relevant trials published during 1985-2006, from which we extracted data on patients' race/ethnicity, ancestry, gender, socio-economic variables and geographical attributes. The proportion of the papers reporting the race/ethnicity of their participants was lower than would be expected by chance and has recently declined. None of the papers included race/ethnicity or gender in statistical analyses or reported socio-economic variables, ancestry, or genetic data for their participants, and few discussed the generalizability of their findings. The frequency of reporting race/ethnicity was statistically significantly lower in trials conducted in the UK than in the US, but 23 of the 87 papers did not identify countries. Despite extensive recommendations in the literature, guidance from health agencies on analyzing and reporting demographic data in clinical trials still appears inconsistent and vague. There remains a need to improve guidance on the representation and analysis of minority populations in asthma clinical trials, in order to encourage transparent reporting of population selection, analysis approaches, and trial generalizability. To assist this process, asthma clinical trials should be based on clear hypotheses that link both to existing demographic evidence and to demographic healthcare goals.
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Affiliation(s)
- Geoff K Frampton
- School of Medicine, University of Southampton, Southampton, Hampshire SO16 7NS, UK.
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Heart Failure in Hispanics. J Am Coll Cardiol 2009; 53:1167-75. [DOI: 10.1016/j.jacc.2008.12.037] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Revised: 10/31/2008] [Accepted: 12/01/2008] [Indexed: 11/21/2022]
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Warshauer-Baker E, Bonham VL, Jenkins J, Stevens N, Page Z, Odunlami A, McBride CM. Family physicians' beliefs about genetic contributions to racial/ethnic and gender differences in health and clinical decision-making. COMMUNITY GENETICS 2008; 11:352-8. [PMID: 18690003 PMCID: PMC3399248 DOI: 10.1159/000133307] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Greater attention towards genetics as a contributor to group health differences may lead to inappropriate use of race/ethnicity and gender as genetic heuristics and exacerbate health disparities. As part of a web-based survey, 1,035 family physicians (FPs) rated the contribution of genetics and environment to racial/ethnic and gender differences in health outcomes, and the importance of race/ethnicity and gender in their clinical decision-making. FPs attributed racial/ethnic and gender differences in health outcomes equally to environment and genetics. These beliefs were not associated with rated importance of race/ethnicity or gender in clinical decision-making. FPs appreciate the complexity of genetic and environmental influences on health differences by race/ethnicity and gender.
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Affiliation(s)
- Esther Warshauer-Baker
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892-0249, USA
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Séguin B, Hardy B, Singer PA, Daar AS. Bidil: recontextualizing the race debate. THE PHARMACOGENOMICS JOURNAL 2008; 8:169-73. [DOI: 10.1038/sj.tpj.6500489] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Park IU, Taylor AL. Race and ethnicity in trials of antihypertensive therapy to prevent cardiovascular outcomes: a systematic review. Ann Fam Med 2007; 5:444-52. [PMID: 17893387 PMCID: PMC2000316 DOI: 10.1370/afm.708] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2006] [Revised: 01/31/2007] [Accepted: 03/17/2007] [Indexed: 12/12/2022] Open
Abstract
PURPOSE We wanted to systematically review (1) the participation of racial and ethnic minorities in clinical trials of antihypertensive drug therapy and (2) racial differences in the efficacy of these therapies for the prevention of cardiovascular outcomes. METHODS MEDLINE, EMBASE, LILACS, African Index Medicus, and the Cochrane Library were searched from their inception to December 2005 for randomized controlled trials testing the efficacy of antihypertensive drug therapy in preventing myocardial infarction, stroke, revascularization, or cardiovascular death. MEDLINE was also searched from 2005 through 2006. The 2 authors independently assessed studies for inclusion and quality. RESULTS Twenty-eight studies met inclusion criteria. Eight trials reported results by racial subgroup. Trials with black and Hispanic participants (ALLHAT, INVEST, VALUE) found similar primary outcomes, but ALLHAT found a greater magnitude of benefit for blacks on diuretic therapy compared with nonblacks. One trial (PROGRESS) compared Asians with non-Asians, reporting that angiotensin-converting enzyme inhibitors (vs placebo) were equally effective for preventing stroke in both groups. In the LIFE trial, post hoc analyses showed different outcomes for blacks and nonblacks, raising questions about the usefulness of angiotensin-receptor blockers as first-line antihypertensive agents in blacks. In 3 studies conducted exclusively in Asians (JMIC-B, FEVER, NICS-EH), calcium channel blockers were effective in preventing cardiovascular outcomes. No trials described cardiovascular outcomes in Native Americans. CONCLUSIONS Five trials made interethnic group comparisons; 4 had similar primary outcomes for ethnic minorities and whites. Increased minority participation in future studies is needed to determine optimal prevention therapies, especially in outcome-driven trials comparing multidrug antihypertensive treatment regimens.
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Affiliation(s)
- Ina U Park
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minn, USA.
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Wright JT, Brundage WF, Mackowiak PA. A 59-Year-Old Man With "Racial Characteristics". J Clin Hypertens (Greenwich) 2007; 9:128-33. [PMID: 17268217 PMCID: PMC8109962 DOI: 10.1111/j.1524-6175.2007.06388.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Jackson T. Wright
- From the General Clinical Research Center and Division of Nephrology and Hypertension, Case Western Reserve University, Cleveland, OH;the Department of History, University of North Carolina, Chapel Hill, NC;andthe Medical Care Clinical Center, VA Maryland Health Care System and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - W. Fitzhugh Brundage
- From the General Clinical Research Center and Division of Nephrology and Hypertension, Case Western Reserve University, Cleveland, OH;the Department of History, University of North Carolina, Chapel Hill, NC;andthe Medical Care Clinical Center, VA Maryland Health Care System and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Philip A. Mackowiak
- From the General Clinical Research Center and Division of Nephrology and Hypertension, Case Western Reserve University, Cleveland, OH;the Department of History, University of North Carolina, Chapel Hill, NC;andthe Medical Care Clinical Center, VA Maryland Health Care System and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
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Abstract
Studies have shown that appropriate treatment of hypertension will reduce cardiovascular, renal, and cerebrovascular morbidity and mortality for all patients. Because hypertension has a multifaceted nature the disorder presents with unique features in prevalence, morbidity, and mortality among ethnic groups. Blacks, Hispanics, and Native Americans have been identified as special populations at risk for unique experiences with hypertension. Among these special populations, black Americans present unique issues in etiology, pathophysiology, severity, and response to treatment. This article reviews the varied aspects of hypertension detection, treatment, and control as they relate to the special population of black Americans.
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Affiliation(s)
- David Stewart
- Section of Hypertension, Division of Cardiology, University of Maryland School of Medicine, 419 West Redwood Street, Baltimore, MD 21201, USA
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Taylor AL, Lindenfeld J, Ziesche S, Walsh MN, Mitchell JE, Adams K, Tam SW, Ofili E, Sabolinski ML, Worcel M, Cohn JN. Outcomes by Gender in the African-American Heart Failure Trial. J Am Coll Cardiol 2006; 48:2263-7. [PMID: 17161257 DOI: 10.1016/j.jacc.2006.06.020] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2006] [Revised: 07/31/2006] [Accepted: 08/01/2006] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Previous trials testing isosorbide dinitrate/hydralazine (I/H) were performed in all-male study cohorts, and thus the efficacy of I/H in women was unknown; 40% of the A-HeFT (African-American Heart Failure Trial) cohort were women. We therefore compared outcomes by gender and treatment. BACKGROUND Fixed-dose combined I/H significantly reduced mortality and heart failure hospitalizations and improved quality of life in 1,050 black patients with heart failure treated with background neurohormonal blockade. Previous trials testing I/H were done in all-male study cohorts, and thus the efficacy of I/H in women was unknown. METHODS Baseline characteristics and medications were compared between men and women by I/H and placebo treatment. Survival, time to first heart failure hospitalization, change in quality of life, and event-free survival were compared by gender and treatment. RESULTS At baseline, women had lower hemoglobin and creatinine levels; less renal insufficiency; and higher body mass indexes, diabetes prevalence, and systolic blood pressures; but worse quality of life scores. All-cause mortality was lower in women than in men treated with I/H but without significant treatment interaction by gender. The primary composite score, which weighted mortality, first heart failure hospitalization, and change in quality of life at 6 months, was similarly improved by I/H in men and women. First heart failure hospitalization and event-free survival (time to death or first heart failure hospitalization) were similarly improved in both genders. CONCLUSIONS Fixed-dose I/H improved heart failure outcomes in both men and women in A-HeFT. The I/H significantly improved the primary composite score and event-free survival as well as reduced the risk of first heart failure hospitalizations similarly in both genders. The I/H had a slightly greater mortality benefit in women, but without a significant treatment interaction by gender.
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Affiliation(s)
- Anne L Taylor
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota 55455, USA.
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