1
|
Romeo GR, Caputo T, Stanescu IW, Alkhaddo JB. The Arduous Path Toward Equitable Access to Endocrinology Care. J Endocr Soc 2024; 8:bvae134. [PMID: 39071475 PMCID: PMC11273240 DOI: 10.1210/jendso/bvae134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Indexed: 07/30/2024] Open
Abstract
Multiple factors contribute to the widening gap between supply and demand of endocrinology services. In addition to the inadequate growth of the workforce, the inefficient utilization of endocrinologists' expertise coupled with the rising prevalence of endocrine conditions has generated a crisis in access to specialty care. This mismatch is magnified in underserved communities and among certain racial/ethnic groups that carry a disproportionate burden of chronic diseases, like diabetes and osteoporosis, thus perpetuating the cycle of health disparities in vulnerable populations. Reorienting the framework of endocrine care toward more effective and equitable access will require comprehensive changes in operational processes, system-based policies, and in the diversity of our workforce. Specifically, the progressive transition to outcome-driven, team-based models of care can extend endocrinology services beyond the traditional boundaries of in-office referrals and promote job satisfaction. Further, the implementation of policies that directly tackle structural determinants of health is a prerequisite to a more precise and equitable deployment of specialty care. In this view, the recruitment and professional growth of clinicians underrepresented in medicine along the career ladder, including leadership roles, is a key conduit to revitalize our field and to innovate the delivery of endocrine care across all communities.
Collapse
Affiliation(s)
- Giulio R Romeo
- Joslin Diabetes Center, Harvard Medical School, Boston, MA 02215, USA
- Beth Israel Deaconess Medical Center, Department of Medicine, Harvard Medical School, Boston, MA 02215, USA
| | - Tiziana Caputo
- Joslin Diabetes Center, Harvard Medical School, Boston, MA 02215, USA
| | - Izabela W Stanescu
- Ambulatory Operation Services, Mass General Brigham, Harvard Medical School, Boston, MA 02215, USA
| | - Jamil B Alkhaddo
- Division of Endocrinology, Department of Medicine, Allegheny Health Network, Pittsburgh, PA 15212, USA
| |
Collapse
|
2
|
Sivakumar A, Rana S, Rofaiel D, Ahmad T, Hari S, Yu CH. "The straw that broke the camel's back": An analysis of racialized women clinicians' experiences providing diabetes care. PLoS One 2024; 19:e0305473. [PMID: 38990933 PMCID: PMC11239002 DOI: 10.1371/journal.pone.0305473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/30/2024] [Indexed: 07/13/2024] Open
Abstract
INTRODUCTION Racialized women clinicians (RWCs) experience the brunt of unfair racial and gendered expectations, which is a direct result of their visible identity. Our study sought to understand how these experiences intersect to impact the personal and professional well-being of RWCs, and their approach to diabetes care. METHODS Data were collected from 24 RWCs working within Canadian diabetes care settings, who participated in semi-structured, one-on-one interviews conducted from April 2021 to September 2021. The data were qualitatively analyzed using thematic analysis to develop emergent themes, and interactions were explored using the socioecological model (SEM), adapted to our study context. RESULTS We identified three themes: (1) Discordance between self-identity and relational identity impacted how RWCs interacted with others, and how others interacted with them; (2) Tokenistic, "inclusive" organizational policies/practices and inherently racist and sexist social norms permitted acts of discrimination and led to the systematic othering and exclusion of RWCs within the workplace; and (3) Differential treatment of RWCs had both positive and negative impacts on participants' relational, workplace and self-identity. Using the SEM, we also found that differential treatment of RWCs stems from upstream policies, structures, and social norms, percolating through different levels of the SEM, including work environments and communities, which eventually impacts one's relational identity, as well as one's perception of oneself. CONCLUSION The differential treatment of RWCs arises predominantly from macro systems of the work environment. The burden to address these disparities must be shifted to the source (i.e., namely systems) by implementing interventions that equitably value diversity efforts, institute policies of accountability and correction of implicit biases, and prioritize an inclusive culture broadly across faculty and leadership.
Collapse
Affiliation(s)
- Arani Sivakumar
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
| | - Simrit Rana
- McMaster University, Hamilton, Ontario, Canada
| | | | - Tehmina Ahmad
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shriya Hari
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
| | - Catherine H. Yu
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
3
|
Kanis JA, Harvey NC, Lorentzon M, Liu E, Schini M, Abrahamsen B, Adachi JD, Alokail M, Borgstrom F, Bruyère O, Carey JJ, Clark P, Cooper C, Curtis EM, Dennison EM, Díaz-Curiel M, Dimai HP, Grigorie D, Hiligsmann M, Khashayar P, Lems W, Lewiecki EM, Lorenc RS, Papaioannou A, Reginster JY, Rizzoli R, Shiroma E, Silverman SL, Simonsick E, Sosa-Henríquez M, Szulc P, Ward KA, Yoshimura N, Johansson H, Vandenput L, McCloskey EV. Race-specific FRAX models are evidence-based and support equitable care: a response to the ASBMR Task Force report on Clinical Algorithms for Fracture Risk. Osteoporos Int 2024:10.1007/s00198-024-07162-w. [PMID: 38960982 DOI: 10.1007/s00198-024-07162-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 06/19/2024] [Indexed: 07/05/2024]
Abstract
Task Force on 'Clinical Algorithms for Fracture Risk' commissioned by the American Society for Bone and Mineral Research (ASBMR) Professional Practice Committee has recommended that FRAX® models in the US do not include adjustment for race and ethnicity. This position paper finds that an agnostic model would unfairly discriminate against the Black, Asian and Hispanic communities and recommends the retention of ethnic and race-specific FRAX models for the US, preferably with updated data on fracture and death hazards. In contrast, the use of intervention thresholds based on a fixed bone mineral density unfairly discriminates against the Black, Asian and Hispanic communities in the US. This position of the Working Group on Epidemiology and Quality of Life of the International Osteoporosis Foundation (IOF) is endorsed both by the IOF and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO).
Collapse
Affiliation(s)
- John A Kanis
- Mary McKillop Institute for Health Research, Catholic University, AustralianMelbourne, Australia.
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mattias Lorentzon
- Mary McKillop Institute for Health Research, Catholic University, AustralianMelbourne, Australia
- Sahlgrenska Osteoporosis Centre, Institute of Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Enwu Liu
- Mary McKillop Institute for Health Research, Catholic University, AustralianMelbourne, Australia
| | - Marian Schini
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Bo Abrahamsen
- Odense Patient Data Explorative Network, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Majed Alokail
- Biochemistry Department, College of Science, Riyadh, Kingdom of Saudi Arabia
| | | | - Olivier Bruyère
- Research Unit in Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - John J Carey
- School of Medicine, University of Galway, Galway, Ireland
| | - Patricia Clark
- Clinical Epidemiology Research Unit, Hospital Infantil de Mexico "Federico Gomez", Mexico City, Mexico
- Faculty of Medicine of National Autonomous University of Mexico (Universidad, Nacional Autónoma de México), Mexico City, Mexico
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Elizabeth M Curtis
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Elaine M Dennison
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- Victoria University of Wellington, Wellington, New Zealand
| | - Manuel Díaz-Curiel
- Metabolic Bone Diseases Unit, Department of Internal Medicine, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma Madrid, Madrid, Spain
| | - Hans P Dimai
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Styria, Austria
| | - Daniel Grigorie
- Carol Davila University of Medicine, Bucharest, Romania
- Department of Endocrinology & Bone Metabolism, National Institute of Endocrinology, Bucharest, Romania
| | - Mickael Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Patricia Khashayar
- International Institute for Biosensing, University of Minnesota, Minneapolis, USA
| | - Willem Lems
- Department of Rheumatology, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - E Michael Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA
| | - Roman S Lorenc
- Multidisciplinary Osteoporosis Forum, Warsaw, Poland, Poland
| | | | - Jean-Yves Reginster
- Protein Research Chair, Biochemistry Dept, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - René Rizzoli
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Eric Shiroma
- Laboratory of Epidemiology and Population Sciences, National Institute On Aging, Baltimore, MD, USA
| | - Stuart L Silverman
- Department of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Eleanor Simonsick
- Translational Gerontology Branch, National Institute On Aging Intramural Research Program, Baltimore, MD, USA
| | | | - Pawel Szulc
- INSERM UMR 1033, University of Lyon, Hospital Edouard Herriot, Lyon, France
| | - Kate A Ward
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- MRC Unit The Gambia, London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Noriko Yoshimura
- Department of Preventive Medicine for Locomotive Organ Disorders, The University of Tokyo Hospital, Tokyo, Japan
| | - Helena Johansson
- Mary McKillop Institute for Health Research, Catholic University, AustralianMelbourne, Australia
- Sahlgrenska Osteoporosis Centre, Institute of Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Liesbeth Vandenput
- Mary McKillop Institute for Health Research, Catholic University, AustralianMelbourne, Australia
| | - Eugene V McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
- Mellanby Centre for Musculoskeletal Research, MRC Versus Arthritis Centre for Integrated Research in Musculoskeletal Ageing, University of Sheffield, Sheffield, UK
| |
Collapse
|
4
|
Chesser H, Srinivasan S, Puckett C, Gitelman SE, Wong JC. Real-Time Continuous Glucose Monitoring in Adolescents and Young Adults With Type 2 Diabetes Can Improve Quality of Life. J Diabetes Sci Technol 2024; 18:911-919. [PMID: 36416098 DOI: 10.1177/19322968221139873] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Real-time continuous glucose monitoring (CGM) is effective for diabetes management in cases of type 1 diabetes and adults with type 2 diabetes (T2D) but has not been assessed in adolescents and young adults (AYAs) with T2D. The objective of this pilot interventional study was to assess the feasibility and acceptability of real-time CGM use in AYAs with T2D. METHODS Adolescents and young adults (13-21 years old) with T2D for six months or more and hemoglobin A1c (A1c) greater than 7%, on any Food and Drug Administration-approved treatment regimen, were included. After a blinded run-in period, participants were given access to a real-time CGM system for 12 weeks. The use and acceptability of the real-time CGM were evaluated by sensor usage, surveys, and focus group qualitative data. RESULTS Participants' (n = 9) median age was 19.1 (interquartile range [IQR] 16.8-20.5) years, 78% were female, 100% were people of color, and 67% were publicly insured. Baseline A1c was 11.9% (standard deviation ±2.8%), with median diabetes duration of 2.5 (IQR 1.4-6) years, and 67% were using insulin. Seven participants completed the study and demonstrated statistically significant improvement in diabetes-related quality of life, with the mean Pediatric Quality of Life inventory (PedsQL) diabetes score increasing from 70 to 75 after using CGM (P = .026). Focus group results supported survey results that CGM use among AYAs with T2D is feasible, can improve quality of life, and has the potential to modify behavior. CONCLUSION Real-time CGM is feasible and acceptable for AYAs with T2D and may improve the quality of life of patients with diabetes. Larger randomized controlled trials are needed to assess the effects on glycemic control and healthy lifestyle changes.
Collapse
Affiliation(s)
- Hannah Chesser
- Division of Endocrinology, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Shylaja Srinivasan
- Division of Endocrinology, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | | | - Stephen E Gitelman
- Division of Endocrinology, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Jenise C Wong
- Division of Endocrinology, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| |
Collapse
|
5
|
Burnett-Bowie SAM, Wright NC, Yu EW, Langsetmo L, Yearwood GMH, Crandall CJ, Leslie WD, Cauley JA. The American Society for Bone and Mineral Research Task Force on clinical algorithms for fracture risk report. J Bone Miner Res 2024; 39:517-530. [PMID: 38590141 DOI: 10.1093/jbmr/zjae048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/23/2024] [Accepted: 03/13/2024] [Indexed: 04/10/2024]
Abstract
Using race and ethnicity in clinical algorithms potentially contributes to health inequities. The American Society for Bone and Mineral Research (ASBMR) Professional Practice Committee convened the ASBMR Task Force on Clinical Algorithms for Fracture Risk to determine the impact of race and ethnicity adjustment in the US Fracture Risk Assessment Tool (US-FRAX). The Task Force engaged the University of Minnesota Evidence-based Practice Core to conduct a systematic review investigating the performance of US-FRAX for predicting incident fractures over 10 years in Asian, Black, Hispanic, and White individuals. Six studies from the Women's Health Initiative (WHI) and Study of Osteoporotic Fractures (SOF) were eligible; cohorts only included women and were predominantly White (WHI > 80% and SOF > 99%), data were not consistently stratified by race and ethnicity, and when stratified there were far fewer fractures in Black and Hispanic women vs White women rendering area under the curve (AUC) estimates less stable. In the younger WHI cohort (n = 64 739), US-FRAX without bone mineral density (BMD) had limited discrimination for major osteoporotic fracture (MOF) (AUC 0.53 (Black), 0.57 (Hispanic), and 0.57 (White)); somewhat better discrimination for hip fracture in White women only (AUC 0.54 (Black), 0.53 (Hispanic), and 0.66 (White)). In a subset of the older WHI cohort (n = 23 918), US-FRAX without BMD overestimated MOF. The Task Force concluded that there is little justification for estimating fracture risk while incorporating race and ethnicity adjustments and recommends that fracture prediction models not include race or ethnicity adjustment but instead be population-based and reflective of US demographics, and inclusive of key clinical, behavioral, and social determinants (where applicable). Research cohorts should be representative vis-à-vis race, ethnicity, gender, and age. There should be standardized collection of race and ethnicity; collection of social determinants of health to investigate impact on fracture risk; and measurement of fracture rates and BMD in cohorts inclusive of those historically underrepresented in osteoporosis research.
Collapse
Affiliation(s)
- Sherri-Ann M Burnett-Bowie
- Endocrine Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States
| | - Nicole C Wright
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35233, United States
| | - Elaine W Yu
- Endocrine Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States
| | - Lisa Langsetmo
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care Center, Minneapolis, MN 55417, United States
- Department of Medicine, University of Minnesota, Minneapolis, MN 55455, United States
| | - Gabby M H Yearwood
- Department of Anthropology and Center for Civil Rights and Racial Justice, University of Pittsburgh, Pittsburgh, PA 15260, United States
| | - Carolyn J Crandall
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA 90095, United States
| | - William D Leslie
- Departments of Internal Medicine and Radiology, Max Rady College of Medicine, University of Manitoba, Winnipeg R3E 0T6, Canada
| | - Jane A Cauley
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, United States
| |
Collapse
|
6
|
Hornbuckle K, Williams A, Joseph JJ, Nolan TS, Gray DM, Gregory J, Ewing AP. Cardiovascular Health and Colorectal Cancer Screening in Black Men: A Cross-Sectional Analysis. Am J Mens Health 2024; 18:15579883241249642. [PMID: 38721788 PMCID: PMC11084979 DOI: 10.1177/15579883241249642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 04/02/2024] [Accepted: 04/08/2024] [Indexed: 05/12/2024] Open
Abstract
African American/Black (henceforth Black) men face disproportionate risks of morbidity and mortality from both cardiovascular disease (CVD) and colorectal cancer (CRC). The American Heart Association's Life's Simple 7 (LS7) tool was designed to examine predictors of CVD with included behaviors also linked to CRC risk (i.e., smoking status, weight, diet, and physical activity). However, no studies have combined LS7 assessment alongside CRC screening history, which serves as a proxy for assessing CRC risk, in Black men. In this study, Black men aged 45-75 participating in annual community wellness events were screened for 6 of 7 LS7 measures (excluding diet, LS6) and self-reported CRC screening. Analyses conducted using R 4.0.5. revealed that Black men (N = 680), with an average age of 57.3 years (SD = 7.5), reported poor (39.7%), intermediate (34.6%), or ideal (25.7%) LS6 scores with higher scores corresponding to lower risk for CVD. However, for every 1-point increase in LS6 scores (0-6), there was a 26% lower odds of reported CRC screening (p = .001). In the fully adjusted model, men with 4+ ideal LS6 behaviors had a 60% lower odds of self-reported CRC screening compared to those with two ideal LS6 behaviors (p < .001). These findings underscore the need for culturally relevant interventions for Black men across all levels of cardiovascular health (CVH) to increase CRC screening uptake.
Collapse
Affiliation(s)
- Kasey Hornbuckle
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Amaris Williams
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Joshua J. Joseph
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Timiya S. Nolan
- The University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - John Gregory
- National African American Male Wellness Agency, National Center for Urban Solutions, Columbus, OH, USA
| | - Aldenise P. Ewing
- The Ohio State University College of Public Health, Division of Epidemiology, Columbus, OH, USA
| |
Collapse
|
7
|
Muth ND, Bolling C, Hannon T, Sharifi M. The Role of the Pediatrician in the Promotion of Healthy, Active Living. Pediatrics 2024; 153:e2023065480. [PMID: 38404207 PMCID: PMC11042797 DOI: 10.1542/peds.2023-065480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 02/27/2024] Open
Abstract
Few children and adolescents meet federal nutrition or physical activity recommendations, and many experience poor or inadequate sleep and negative health effects from screen use and social media. These lifestyle factors exacerbate physical and mental health risks for children and adolescents. This clinical report provides guidance to help pediatricians address the nutritional, physical activity, sleep, media and screen use, and social-emotional factors that affect child and adolescent health and wellness. The recommendations in this clinical report aim to promote health and wellness practices for infants, children, and adolescents across several domains of influence, including the individual, interpersonal, institutional, community, and public policy levels.
Collapse
Affiliation(s)
- Natalie D. Muth
- Children’s Primary Care Medical Group, Carlsbad, Californiaand Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, California
| | - Christopher Bolling
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Tamara Hannon
- Division of Pediatric Endocrinology and Diabetology, Department of Pediatrics, Indiana University School of Medicine, Bloomington, Indiana
| | - Mona Sharifi
- Departments of Pediatrics and Biostatistics, Yale School of Medicine, New Haven, Connecticut
| | | | | |
Collapse
|
8
|
Chen DW, Ospina NS, Haymart MR. Social Determinants of Health and Disparities in Thyroid Care. J Clin Endocrinol Metab 2024; 109:e1309-e1313. [PMID: 38057150 PMCID: PMC10876391 DOI: 10.1210/clinem/dgad716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 12/04/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND There have been documented racial and ethnic disparities in the care and clinical outcomes of patients with thyroid disease. CONTEXT Key to improving disparities in thyroid care is understanding the context for racial and ethnic disparities, which includes acknowledging and addressing social determinants of health. Thyroid disease diagnosis, treatment, and survivorship care are impacted by patient- and system-level factors, including socioeconomic status and economic stability, language, education, health literacy, and health care systems and health policy. The relationship between these factors and downstream clinical outcomes is intricate and complex, underscoring the need for a multifaceted approach to mitigate these disparities. CONCLUSION Understanding the factors that contribute to disparities in thyroid disease is critically important. There is a need for future targeted and multilevel interventions to address these disparities, while considering societal, health care, clinician, and patient perspectives.
Collapse
Affiliation(s)
- Debbie W Chen
- Division of Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, MI 48109, USA
| | - Naykky Singh Ospina
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Megan R Haymart
- Division of Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, MI 48109, USA
| |
Collapse
|
9
|
Brewer LC, Joseph JJ. Not a spectator sport: improving participation of Black patients in cardiovascular clinical trials. Nat Rev Cardiol 2024; 21:67-68. [PMID: 38062193 DOI: 10.1038/s41569-023-00978-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Affiliation(s)
- LaPrincess C Brewer
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Joshua J Joseph
- Division of Endocrinology, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| |
Collapse
|
10
|
Joseph JJ, Nolan TS, Brock G, Williams A, Zhao S, McKoy A, Kluwe B, Metlock F, Campanelli K, Odei JB, Khumalo MT, Lavender D, Gregory J, Gray DM. Improving mental health in black men through a 24-week community-based lifestyle change intervention: the black impact program. BMC Psychiatry 2024; 24:34. [PMID: 38195473 PMCID: PMC10775551 DOI: 10.1186/s12888-023-05064-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 07/29/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Poor mental health is a leading cause of morbidity and mortality among Black men in the United States. Efforts to improve mental health among Black men have been hampered by a lack of access and utilization of mental health services. Physical activity and social networks have been shown to improve mental health. Thus, we examined the effect of a community team-based physical activity, health education and social needs intervention among Black men on mental health over 24 weeks. METHODS Black adult males (n = 74) from a large Midwestern city participated in Black Impact, a 24-week community-based lifestyle change program adapted from the Diabetes Prevention Program and American Heart Association's (AHA) Check, Change, Control Blood Pressure Self-Management Program, which incorporates AHA's Life's Simple 7 (LS7) framework. Measures of mental health including the Center for Epidemiological Studies Depression Scale (CES-D), Patient Health Questionnaire 2-question depression screener (PHQ-2), and Perceived Stress Scale-10 (PSS-10) were completed at baseline, 12 and 24 weeks. The change in mental health scores from baseline to 12 and 24 weeks were evaluated using linear mixed-effects models adjusting for age, education, and income. The change in cardiovascular health scores, defined as objective metrics of LS7 (LS5 [blood pressure, total cholesterol, fasting glucose, body mass index and smoking]), by baseline mental health were evaluated using linear mixed-effects models with an interaction term (time*baseline mental health variable) and a random intercept for each participant. RESULTS Among 71 Black men (mean age 51, 85% employed) at 24 weeks, CES-D scores decreased from 10.54 to 7.90 (-2.64, 95%CI:-4.74, -0.55), PHQ-2 decreased from 1.04 to 0.63 (-0.41, 95%CI: -0.75, -0.07), and PSS-10 decreased from 14.62 to 12.91 (-1.71, 95%CI: -3.53, 0.12). A 1-unit higher CES-D at baseline was associated with less improvement in LS5 scores by -0.04 (95%CI: -0.076, -0.005) and - 0.032 (95%CI:-0.067, 0.003) units at week 12 and 24, respectively, with similar findings for PSS. CONCLUSIONS The Black Impact community-based lifestyle program has the potential to reduce depressive symptoms and stress in Black men. There is a dire need for larger, randomized studies to test the impact of Black Impact on mental health in Black men to advance health equity. TRIAL REGISTRATION Retrospectively Registered, ClinicalTrials.gov Identifier: NCT04787978.
Collapse
Affiliation(s)
- Joshua J Joseph
- The Ohio State University College of Medicine, Suite 5000, 700 Ackerman Road, Columbus, OH, 43202, USA.
| | - Timiya S Nolan
- The Ohio State University College of Nursing, Columbus, OH, USA
- The Ohio State University James Center for Cancer Health Equity, Columbus, OH, USA
| | - Guy Brock
- The Ohio State University College of Medicine, Suite 5000, 700 Ackerman Road, Columbus, OH, 43202, USA
| | - Amaris Williams
- The Ohio State University College of Medicine, Suite 5000, 700 Ackerman Road, Columbus, OH, 43202, USA
| | - Songzhu Zhao
- The Ohio State University College of Medicine, Suite 5000, 700 Ackerman Road, Columbus, OH, 43202, USA
| | - Alicia McKoy
- The Ohio State University College of Medicine, Suite 5000, 700 Ackerman Road, Columbus, OH, 43202, USA
- The Ohio State University James Center for Cancer Health Equity, Columbus, OH, USA
| | - Bjorn Kluwe
- The Ohio State University College of Medicine, Suite 5000, 700 Ackerman Road, Columbus, OH, 43202, USA
| | - Faith Metlock
- The Ohio State University College of Nursing, Columbus, OH, USA
| | | | - James B Odei
- The Ohio State University College of Public Health, Columbus, OH, USA
| | | | - Dana Lavender
- The African American Male Wellness Agency, Columbus, OH, USA
| | - John Gregory
- The African American Male Wellness Agency, Columbus, OH, USA
- National Center for Urban Solutions, Columbus, OH, USA
| | - Darrell M Gray
- The Ohio State University College of Medicine, Suite 5000, 700 Ackerman Road, Columbus, OH, 43202, USA
- The Ohio State University James Center for Cancer Health Equity, Columbus, OH, USA
| |
Collapse
|
11
|
Joseph JJ, Williams A, Azap RA, Zhao S, Brock G, Kline D, Odei JB, Foraker R, Sims M, Brewer LC, Gray DM, Nolan TS. Role of Sex in the Association of Socioeconomic Status With Cardiovascular Health in Black Americans: The Jackson Heart Study. J Am Heart Assoc 2023; 12:e030695. [PMID: 38038179 PMCID: PMC10727326 DOI: 10.1161/jaha.123.030695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/25/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Socioeconomic status (SES) is associated with cardiovascular health (CVH). Potential differences by sex in this association remain incompletely understood in Black Americans, where SES disparities are posited to be partially responsible for cardiovascular inequities. The association of SES measures (income, education, occupation, and insurance) with CVH scores was examined in the Jackson Heart Study. METHODS AND RESULTS American Heart Association CVH components (non-high-density-lipoprotein cholesterol, blood pressure, diet, tobacco use, physical activity, sleep, glycemia, and body mass index) were scored cross-sectionally at baseline (scale: 0-100). Differences in CVH and 95% CIs (Estimate, 95% CI) were calculated using linear regression, adjusting for age, sex, and discrimination. Heterogeneity by sex was assessed. Participants had a mean age of 54.8 years (SD 12.6 years), and 65% were women. Lower income, education, occupation (non-management/professional versus management/professional occupations), and insurance status (uninsured, Medicaid, Veterans Affairs, or Medicare versus private insurance) were associated with lower CVH scores (all P<0.01). There was heterogeneity by sex, with greater magnitude of associations of SES measures with CVH in women versus men. The lowest education level (high school) was associated with 8.8-point lower (95% CI: -10.2 to -7.3) and 5.4-point lower (95% CI: -7.2 to -3.6) CVH scores in women and men, respectively (interaction P=0.003). The lowest (<25 000) versus highest level of income (≥$75 000) was associated with a greater reduction in CVH scores in women than men (interaction P=0.1142). CONCLUSIONS Among Black Americans, measures of SES were associated with CVH, with a greater magnitude in women compared with men for education and income. Interventions aimed to address CVH through SES should consider the role of sex.
Collapse
Affiliation(s)
| | | | | | - Songzhu Zhao
- The Ohio State University College of MedicineColumbusOHUSA
| | - Guy Brock
- The Ohio State University College of MedicineColumbusOHUSA
| | - David Kline
- Department of Biostatistics and Data Science, Division of Public Health SciencesWake Forest School of MedicineWinston‐SalemNCUSA
| | - James B. Odei
- The Ohio State University College of Public HealthColumbusOHUSA
| | - Randi Foraker
- Department of Internal Medicine and Institute for InformaticsWashington University in St. Louis School of MedicineSt. LouisMOUSA
| | | | - LaPrincess C. Brewer
- Department of Cardiovascular MedicineCenter for Health Equity and Community Engagement Research, Mayo ClinicRochesterMNUSA
| | - Darrell M. Gray
- Elevance Health (formerly of The Ohio State University Wexner Medical Center)IndianapolisINUSA
| | | |
Collapse
|
12
|
Joseph JJ. Advancing Equity in Diabetes Prevention, Treatment, and Outcomes: Delivering on Our Values. Endocrinol Metab Clin North Am 2023; 52:559-572. [PMID: 37865473 DOI: 10.1016/j.ecl.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Diabetes inequities exist from diabetes prevention to outcomes and are rooted in the social drivers (determinants) of health. Historical policies such as "redlining" have adversely affected diabetes prevalence, control, and outcomes for decades. Advancing diabetes equity requires multimodal approaches, addressing both individual-level diabetes education, self-management, and treatment along with addressing social needs, and working to improve upstream drivers of health. All individuals affected by diabetes must advocate for policies to advance diabetes equity at the organizational, local, state, and federal levels. Centering diabetes efforts and interventions on equity will improve diabetes treatment and care for all.
Collapse
Affiliation(s)
- Joshua J Joseph
- Division of Endocrinology, Diabetes and Metabolism, The Ohio State University College of Medicine, Suite 5000E, 700 Ackerman Road, Columbus, OH 43202, USA.
| |
Collapse
|
13
|
Diaz-Thomas AM, Golden SH, Dabelea DM, Grimberg A, Magge SN, Safer JD, Shumer DE, Stanford FC. Endocrine Health and Health Care Disparities in the Pediatric and Sexual and Gender Minority Populations: An Endocrine Society Scientific Statement. J Clin Endocrinol Metab 2023; 108:1533-1584. [PMID: 37191578 PMCID: PMC10653187 DOI: 10.1210/clinem/dgad124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Indexed: 05/17/2023]
Abstract
Endocrine care of pediatric and adult patients continues to be plagued by health and health care disparities that are perpetuated by the basic structures of our health systems and research modalities, as well as policies that impact access to care and social determinants of health. This scientific statement expands the Society's 2012 statement by focusing on endocrine disease disparities in the pediatric population and sexual and gender minority populations. These include pediatric and adult lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA) persons. The writing group focused on highly prevalent conditions-growth disorders, puberty, metabolic bone disease, type 1 (T1D) and type 2 (T2D) diabetes mellitus, prediabetes, and obesity. Several important findings emerged. Compared with females and non-White children, non-Hispanic White males are more likely to come to medical attention for short stature. Racially and ethnically diverse populations and males are underrepresented in studies of pubertal development and attainment of peak bone mass, with current norms based on European populations. Like adults, racial and ethnic minority youth suffer a higher burden of disease from obesity, T1D and T2D, and have less access to diabetes treatment technologies and bariatric surgery. LGBTQIA youth and adults also face discrimination and multiple barriers to endocrine care due to pathologizing sexual orientation and gender identity, lack of culturally competent care providers, and policies. Multilevel interventions to address these disparities are required. Inclusion of racial, ethnic, and LGBTQIA populations in longitudinal life course studies is needed to assess growth, puberty, and attainment of peak bone mass. Growth and development charts may need to be adapted to non-European populations. In addition, extension of these studies will be required to understand the clinical and physiologic consequences of interventions to address abnormal development in these populations. Health policies should be recrafted to remove barriers in care for children with obesity and/or diabetes and for LGBTQIA children and adults to facilitate comprehensive access to care, therapeutics, and technological advances. Public health interventions encompassing collection of accurate demographic and social needs data, including the intersection of social determinants of health with health outcomes, and enactment of population health level interventions will be essential tools.
Collapse
Affiliation(s)
- Alicia M Diaz-Thomas
- Department of Pediatrics, Division of Endocrinology, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Sherita Hill Golden
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Dana M Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Adda Grimberg
- Department of Pediatrics, Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Sheela N Magge
- Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Joshua D Safer
- Department of Medicine, Division of Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY 10001, USA
| | - Daniel E Shumer
- Department of Pediatric Endocrinology, C.S. Mott Children's Hospital, University of Michigan School of Medicine, Ann Arbor, MI 48109, USA
| | - Fatima Cody Stanford
- Massachusetts General Hospital, Department of Medicine-Division of Endocrinology-Neuroendocrine, Department of Pediatrics-Division of Endocrinology, Nutrition Obesity Research Center at Harvard (NORCH), Boston, MA 02114, USA
| |
Collapse
|
14
|
Loomba L, Bonanno S, Arellano D, Crossen S, Glaser N. Disparities in Insulin Pump Use Among Spanish-Speaking Children With Type 1 Diabetes Compared to Their Non-Hispanic White Peers: Mixed Methods Study. JMIR Diabetes 2023; 8:e45890. [PMID: 37294607 DOI: 10.2196/45890] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/28/2023] [Accepted: 05/15/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Disparities in Insulin Pump Use Among Spanish-Speaking Children With Type 1 Diabetes Compared to Their Non-Hispanic White Peers: Mixed Methods Study. OBJECTIVE We aimed to investigate the use of insulin pumps and continuous glucose monitoring (CGM) devices among Spanish-language-preferring children in our clinic population and to identify specific barriers to technology use. METHODS First, we assessed rates and patterns of diabetes technology use (eg, insulin pumps and CGM devices) in a sample of 76 children (38 Spanish-language preferring and 38 non-Hispanic White). We compared rates of technology use, average length of time between diabetes diagnosis and initiation of insulin pump or CGM device, and rates of discontinuation of these devices between the Spanish-language-preferring and non-Hispanic White children. Second, to understand specific barriers to technology use, we compared responses to a questionnaire assessing decision-making about insulin pumps. RESULTS Spanish-language-preferring patients had lower rates of insulin pump use, even after controlling for age, gender, age at diagnosis, and type of health insurance. Spanish-language-preferring participants were more likely to report concerns over learning to use an insulin pump and were more likely to discontinue using an insulin pump after starting one. CONCLUSIONS These data confirm demographic disparities in insulin pump use among children with T1D and provide new insights about insulin pump discontinuation among Spanish-language-preferring children. Our findings suggest a need for improved patient education about insulin pump technology in general and improved support for Spanish-language-preferring families with T1D after initiation of pump therapy.
Collapse
Affiliation(s)
- Lindsey Loomba
- Department of Pediatrics, University of California, Davis, Sacramento, CA, United States
| | - Shaila Bonanno
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Diana Arellano
- UCSF Benioff Children's Hospital, San Francisco, CA, United States
| | - Stephanie Crossen
- Department of Pediatrics, University of California, Davis, Sacramento, CA, United States
| | - Nicole Glaser
- Department of Pediatrics, University of California, Davis, Sacramento, CA, United States
| |
Collapse
|
15
|
Courtney MG, Roberts J, Quintero Y, Godde K. Childhood Family Environment and Osteoporosis in a Population-Based Cohort Study of Middle-to Older-Age Americans. JBMR Plus 2023; 7:e10735. [PMID: 37197319 PMCID: PMC10184016 DOI: 10.1002/jbm4.10735] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 01/19/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
Demographic and early-life socioeconomic and parental investment factors may influence later-life health and development of chronic and progressive diseases, including osteoporosis, a costly condition common among women. The "long arm of childhood" literature links negative early-life exposures to lower socioeconomic attainment and worse adult health. We build on a small literature linking childhood socioeconomic status (SES) and bone health, providing evidence of whether associations exist between lower childhood SES and maternal investment and higher risk of osteoporosis diagnosis. We further examine whether persons identifying with non-White racial/ethnic groups experience underdiagnosis. Data from the nationally representative, population-based cohort Health and Retirement Study (N = 5,490-11,819) were analyzed for participants ages 50-90 to assess these relationships. Using a machine learning algorithm, we estimated seven survey-weighted logit models. Greater maternal investment was linked to lower odds of osteoporosis diagnosis (odds ratio [OR] = 0.80, 95% confidence interval [CI] = 0.69, 0.92), but childhood SES was not (OR = 1.03, 95% CI = 0.94, 1.13). Identifying as Black/African American (OR = 0.56, 95% CI = 0.40, 0.80) was associated with lower odds, and identifying as female (OR = 7.22, 95% CI = 5.54, 9.40) produced higher odds of diagnosis. There were differences in diagnosis across intersectional racial/ethnic and sex identities, after accounting for having a bone density scan, and a model predicting bone density scan receipt demonstrated unequal screening across groups. Greater maternal investment was linked to lower odds of osteoporosis diagnosis, likely reflecting links to life-course accumulation of human capital and childhood nutrition. There is some evidence of underdiagnosis related to bone density scan access. Yet results demonstrated a limited role for the long arm of childhood in later-life osteoporosis diagnosis. Findings suggest that (1) clinicians should consider life-course context when assessing osteoporosis risk and (2) diversity, equity, and inclusivity training for clinicians could improve health equity. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
Collapse
Affiliation(s)
| | - Josephine Roberts
- Department of Sociology/AnthropologyUniversity of La VerneLa VerneCaliforniaUSA
| | - Yadira Quintero
- Department of Sociology/AnthropologyUniversity of La VerneLa VerneCaliforniaUSA
| | - K. Godde
- Department of Sociology/AnthropologyUniversity of La VerneLa VerneCaliforniaUSA
| |
Collapse
|
16
|
Vimalananda VG, Brito JP, Eiland LA, Lal RA, Maraka S, McDonnell ME, Narla RR, Roth MY, Crossen SS. Appropriate Use of Telehealth Visits in Endocrinology: Policy Perspective of the Endocrine Society. J Clin Endocrinol Metab 2022; 107:2953-2962. [PMID: 36194041 DOI: 10.1210/clinem/dgac494] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This work aims to guide clinicians practicing endocrinology in the use of telehealth (synchronous patient-clinician visits conducted over video or telephone) for outpatient care. PARTICIPANTS The Endocrine Society convened a 9-member panel of US endocrinologists with expertise in telehealth clinical care, telehealth operations, patient-centered care, health care delivery research, and/or evidence-based medicine. EVIDENCE The panel conducted a literature search to identify studies published since 2000 about telehealth in endocrinology. One member extracted a list of factors affecting the quality of endocrine care via telehealth from the extant literature. The panel grouped these factors into 5 domains: clinical, patient, patient-clinician relationship, clinician, and health care setting and technology. CONSENSUS PROCESS For each domain, 2 or 3 members drew on existing literature and their expert opinions to draft a section examining the effect of the domain's component factors on the appropriateness of telehealth use within endocrine practice. Appropriateness was evaluated in the context of the 6 Institute of Medicine aims for health care quality: patient-centeredness, equity, safety, effectiveness, timeliness, and efficiency. The panel held monthly virtual meetings to discuss and revise each domain. Two members wrote the remaining sections and integrated them with the domains to create the full policy perspective, which was reviewed and revised by all members. CONCLUSIONS Telehealth has become a common care modality within endocrinology. This policy perspective summarizes the factors determining telehealth appropriateness in various patient care scenarios. Strategies to increase the quality of telehealth care are offered. More research is needed to develop a robust evidence base for future guideline development.
Collapse
Affiliation(s)
- Varsha G Vimalananda
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts 01730, USA
- Section of Endocrinology, Diabetes, Nutrition & Weight Management, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Juan P Brito
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, Minnesota, USA
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Leslie A Eiland
- Division of Diabetes, Endocrinology & Metabolism, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Rayhan A Lal
- Division of Endocrinology, Department of Medicine, Stanford University, Stanford, California, USA
- Division of Endocrinology, Department of Pediatrics, Stanford University, Stanford, California, USA
- Stanford Diabetes Research Center, Stanford University, Stanford, California, USA
| | - Spyridoula Maraka
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, Minnesota, USA
- Division of Endocrinology and Metabolism, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Section of Endocrinology, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, USA
| | - Marie E McDonnell
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Radhika R Narla
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Seattle, Washington, USA
- VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Mara Y Roth
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Stephanie S Crossen
- Division of Endocrinology, Department of Pediatrics, University of California Davis School of Medicine, Sacramento, California, USA
- Center for Health and Technology, University of California Davis Health, Sacramento, California, USA
| |
Collapse
|
17
|
Joseph JJ, Rajwani A, Roper D, Zhao S, Kline D, Odei J, Brock G, Echouffo-Tcheugui JB, Kalyani RR, Bertoni AG, Effoe VS, Sims M, Wu WC, Wand GS, Golden SH. Associations of Cardiometabolic Multimorbidity With All-Cause and Coronary Heart Disease Mortality Among Black Adults in the Jackson Heart Study. JAMA Netw Open 2022; 5:e2238361. [PMID: 36282500 PMCID: PMC9597394 DOI: 10.1001/jamanetworkopen.2022.38361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IMPORTANCE A combination of diabetes, coronary heart disease (CHD), and stroke has multiplicative all-cause mortality risk compared with any individual morbidity in White populations, but there is a lack of studies in Black populations in the US. OBJECTIVE To examine the association of cardiometabolic multimorbidity (diabetes, stroke, and CHD) individually and collectively with all-cause and CHD mortality. DESIGN, SETTING, AND PARTICIPANTS This cohort study included Black adults in the Jackson Heart Study followed over a median of 15 years. Baseline examinations were performed between 2000 and 2004, with follow-up on all-cause and CHD mortality through May 31, 2018. Participants were categorized into mutually exclusive groups at baseline: (1) free of cardiometabolic morbidity, (2) diabetes, (3) CHD, (4) stroke, (5) diabetes and stroke, (6) CHD and stroke, (7) diabetes and CHD, and (8) diabetes, stroke, and CHD. Data were analyzed from 2019 to 2021. EXPOSURE Cardiometabolic disease alone or in combination. MAIN OUTCOMES AND MEASURES The main outcomes were all-cause mortality and CHD mortality. Cox models estimated hazard ratios (HRs) with 95% CIs adjusted for sociodemographic and cardiovascular risk factors. RESULTS Among 5064 participants (mean [SD] age, 55.4 [12.8] years; 3200 [63%] women) in the Jackson Heart Study, 897 (18%) had diabetes, 192 (4%) had CHD, and 104 (2%) had a history of stroke. Among participants with cardiometabolic morbidities, the crude all-cause mortality rates were lowest for diabetes alone (24.4 deaths per 1000 person-years) and highest for diabetes, CHD, and stroke combined (84.1 deaths per 1000 person-years). For people with only 1 cardiometabolic morbidity, risk for all-cause mortality was highest for people with stroke (HR, 1.74; 95% CI, 1.24-2.42), followed by CHD (HR, 1.59 (95% CI, 1.22-2.08) and diabetes (HR, 1.50; 95% CI, 1.22-1.85), compared with no cardiometabolic morbidities. There were also increased risks of mortality with combinations of diabetes and stroke (HR, 1.71; 95% CI, 1.09-2.68), CHD and stroke (HR, 2.23; 95% CI, 1.35-3.69), and diabetes and CHD (HR, 2.28; 95% CI, 1.65-3.15). The combination of diabetes, stroke, and CHD was associated with the highest all-cause mortality (HR, 3.68; 95% CI, 1.96-6.93). Findings were similar for CHD mortality, but with a larger magnitude of association (eg, diabetes, stroke, and CHD: HR, 13.52; 95% CI, 3.38-54.12). CONCLUSIONS AND RELEVANCE In this cohort study, an increasing number of cardiometabolic multimorbidities was associated with a multiplicative increase in risk of all-cause mortality among Black adults, with a greater magnitude of association for CHD mortality.
Collapse
Affiliation(s)
- Joshua J. Joseph
- Department of Medicine, The Ohio State University Wexner Medical Center, Columbus
| | - Aakash Rajwani
- Department of Medicine, The Ohio State University Wexner Medical Center, Columbus
| | - Daniel Roper
- Department of Medicine, The Ohio State University Wexner Medical Center, Columbus
| | - Songzhu Zhao
- Department of Medicine, The Ohio State University Wexner Medical Center, Columbus
| | - David Kline
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - James Odei
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus
| | - Guy Brock
- Department of Medicine, The Ohio State University Wexner Medical Center, Columbus
| | - Justin B. Echouffo-Tcheugui
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Massachusetts
| | - Rita R. Kalyani
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Massachusetts
| | - Alain G. Bertoni
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Valery S. Effoe
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Wen-Chi Wu
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Gary S. Wand
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Massachusetts
| | - Sherita H. Golden
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Massachusetts
| |
Collapse
|
18
|
Cuda S, Censani M, Kharofa R, Williams DR, O'Hara V, Karjoo S, Paisley J, Browne NT. Social consequences and genetics for the child with overweight and obesity: An obesity medicine association (OMA) clinical practice statement 2022. OBESITY PILLARS (ONLINE) 2022; 3:100032. [PMID: 37990726 PMCID: PMC10662046 DOI: 10.1016/j.obpill.2022.100032] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 11/23/2023]
Abstract
Background This Obesity Medicine Association (OMA) clinical practice statement (CPS) covers two topics: 1) genetics and 2) social consequences for the child with overweight and obesity. This CPS is intended to provide clinicians with an overview of clinical practices applicable to children and adolescents with body mass indices greater than or equal to the 85th percentile for their ages, particularly those with adverse consequences resulting from increased body mass. The information in this CPS is based on scientific evidence, supported by the medical literature, and derived from the clinical experiences of members of the OMA. Methods The scientific information and clinical guidance in this CPS is based upon referenced evidence and derived from the clinical perspectives of the authors. Results This OMA clinical practice statement details two topics: 1) genetics and 2) social consequences for the child with overweight and obesity. Conclusions This OMA clinical practice statement on genetics and social consequences for the child with overweight and obesity is an overview of current literature. The literature provides a roadmap to the improvement of the health of children and adolescents with obesity, especially those with metabolic, physiological, and psychological complications.
Collapse
Affiliation(s)
- Suzanne Cuda
- Alamo City Healthy Kids and Families, 1919 Oakwell Farms Parkway, Ste 145 San Antonio, TX, 78218, USA
| | - Marisa Censani
- Associate Professor of Clinical Pediatrics, Division of Pediatric Endocrinology, Department of Pediatrics, New York Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, Box 103, New York, NY, 10021, USA
| | - Roohi Kharofa
- Center for Better Health & Nutrition, The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Dominique R. Williams
- The Ohio State University College of MedicineCenter for Healthy Weight and Nutrition, Nationwide Children's Hospital 700 Children's Drive LA, Suite 5F Columbus, OH, 43215, USA
| | - Valerie O'Hara
- Medical Director, WOW 4 Wellness Clinic/ PCHC, 6 Telcom Drive, Bangor, ME, 04401, USA
| | - Sara Karjoo
- Johns Hopkins All Children's Hospital Pediatric Gastroenterology, 501 6th Ave S, St. Petersburg, FL, 33701, USA
| | - Jennifer Paisley
- St Elizabeth Physician's Group Primary Care 98 Elm Street Lawrenceburg, IN, 47025-2048, USA
| | | |
Collapse
|
19
|
Malek R, Shibli-Rahhal A, Correa R, Szmuilowicz ED, Morgan F, Luthra P, Sirisena I, Gianoukakis A, Praw SS, Lieb DC, Haw JS, Mayson SE. An Assessment of Diversity, Inclusion, and Health Equity Training in Endocrinology Fellowship Programs in the United States. Endocr Pract 2022; 28:1159-1165. [PMID: 35985561 DOI: 10.1016/j.eprac.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/01/2022] [Accepted: 08/10/2022] [Indexed: 11/26/2022]
Abstract
CONTEXT The ACGME has instituted common program requirements related to diversity, equity, and inclusion (DEI) for post-graduate trainees in the United States; however, the extent to which DEI training is being incorporated across endocrinology fellowship programs is unknown. OBJECTIVES Describe the socio-demographic representation, and DEI training experiences within endocrinology fellowship programs. DESIGN, SETTING AND PARTICIPANTS National cross-sectional survey study of fellows and fellowship program leaders in the United States whose fellowships were members of the Association of Program Directors in Endocrinology and Metabolism (APDEM). MAIN OUTCOME MEASURES 1) Demographics of fellows and program leaders. 2) Programs' experience, confidence, and interest in formal DEI training. RESULTS A total of 108 and 106 fellow and faculty respectively responded to the survey, respectively. The majority of fellows and faculty are female. Less than 3% of fellows and 3.7% of faculty identify as Black. More than 90% of fellows/faculty are heterosexual and no respondents identified as transgender/non-binary; however, 5% and 2% of all respondents preferred not to disclose their sexual orientation and gender identity, respectively. While 85% of faculty received institutional diversity and inclusion training, 67.6% of fellows did. Fellows are more likely to have received training in health equity than program leaders. Both fellows and program leaders express a high interest in health equity curriculum. CONCLUSIONS Within the diversity of endocrinology training programs, Black physicians are under-represented in medicine, which persists in endocrinology fellowships. Fellowship programs express enthusiasm for national diversity and health equity curricula with the majority of programs reporting institutional DEI training.
Collapse
Affiliation(s)
- Rana Malek
- Division of Endocrinology, Diabetes, and Nutrition. University of Maryland School of Medicine, Baltimore, MD.
| | - Amal Shibli-Rahhal
- Division of Endocrinology, Diabetes and Metabolism, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Ricardo Correa
- Division of Endocrinology, Metabolism and Diabetes, University of Arizona College of Medicine, Phoenix, AZ
| | - Emily D Szmuilowicz
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Farah Morgan
- Division of Endocrinology, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ
| | - Pooja Luthra
- Division of Endocrinology, Diabetes and Metabolism, UConn Health, Farmington, CT
| | - Imali Sirisena
- Division of Endocrinology, Diabetes and Metabolism, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Andrew Gianoukakis
- The Lundquist Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA; David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, CA
| | - Stephanie Smooke Praw
- Division of Endocrinology, Diabetes & Metabolism, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - David C Lieb
- Division of Endocrine and Metabolic Conditions, Department of Internal Medicine, Eastern Virginia Medical School Norfolk, VA
| | - J Sonya Haw
- Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, Atlanta, GA
| | - Sarah E Mayson
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Aurora, CO
| |
Collapse
|
20
|
Tsai K, Long C, Liang TZ, Napolitano J, Khawaja R, Leung AM. Driving Factors to Pursue Endocrinology Training Fellowship: Empirical Survey Data and Future Strategies. J Clin Endocrinol Metab 2022; 107:e2459-e2463. [PMID: 35165741 DOI: 10.1210/clinem/dgac087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE There is a current and anticipated labor shortage of endocrinologists in the United States. Over the past decade, the number of applications to endocrinology fellowship programs has plateaued despite increased available positions, and interest in endocrinology has declined relative to other internal medicine subspecialty fields. The examination of driving factors for pursuit of endocrinology as a subspecialty career is needed. METHODS A 12-question online survey was developed to identify the primary reasons for current endocrinology fellows/trainees to pursue the field. This survey was sent to 152 U.S. endocrinology fellowship program directors for completion by their fellows between July and August 2021. RESULTS A total of 176 of 629 fellows (28.0%) completed the survey. The majority (57.4%) had decided to pursue endocrinology as a career during residency, while 27.3% had decided during medical school. The endocrinology rotation during residency was ranked by 79 fellows (44.9%) as the most influential factor, followed by having positive experiences with a clinical mentor (27.3%). Endocrinology exposure during medical school was sparse, with only 2.8% noting the availability of an endocrinology student interest group, while 59.7% reported inadequate endocrinology exposure during their medical school curriculum. CONCLUSION The majority of current endocrinology fellows/trainees report that exposure to the field during medical school was limited, and that their endocrinology elective and mentorship experiences during residency were the most influential factors for pursuing endocrinology as a subspecialty. Improved integration of endocrinology experiences between medical school and residency may enhance career interest in endocrinology.
Collapse
Affiliation(s)
- Karen Tsai
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
| | - Clarine Long
- The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Tom Z Liang
- Department of Pathology, Keck Medical Center of USC, Los Angeles, CA 90033, USA
| | - Jason Napolitano
- Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA
| | - Raheela Khawaja
- Division of Endocrinology, Diabetes, and Metabolism; The Ohio State University and Arthur G. James Cancer Center, Columbus, OH 43210, USA
| | - Angela M Leung
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
| |
Collapse
|