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Loehrer AP, Weiss JE, Chatoorgoon KK, Bello OT, Diaz A, Carter B, Akré ER, Hasson RM, Carlos HA. Residential Redlining, Neighborhood Trajectory, and Equity of Breast and Colorectal Cancer Care. Ann Surg 2024; 279:1054-1061. [PMID: 37982529 DOI: 10.1097/sla.0000000000006156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
OBJECTIVE To determine the influence of structural racism, vis-à-vis neighborhood socioeconomic trajectory, on colorectal and breast cancer diagnosis and treatment. BACKGROUND Inequities in cancer care are well-documented in the United States but less is understood about how historical policies like residential redlining and evolving neighborhood characteristics influence current gaps in care. METHODS This retrospective cohort study included adult patients diagnosed with colorectal or breast cancer between 2010 and 2015 in 7 Indiana cities with available historic redlining data. Current neighborhood socioeconomic status was determined by the Area Deprivation Index. Based on historic redlining maps and the current Area Deprivation Index, we created 4 "neighborhood trajectory" categories: advantage stable, advantage reduced, disadvantage stable, and disadvantage reduced. Modified Poisson regression models estimated the relative risks (RRs) of neighborhood trajectory on cancer stage at diagnosis and receipt of cancer-directed surgery (CDS). RESULTS A final cohort derivation identified 4862 cancer patients with colorectal or breast cancer. Compared with "advantage stable" neighborhoods, "disadvantage stable" neighborhood was associated with a late-stage diagnosis for both colorectal and breast cancer [RR = 1.30 (95% CI: 1.05-1.59); RR = 1.41 (1.09-1.83), respectively]. Black patients had a lower likelihood of receiving CDS in "disadvantage reduced" neighborhoods [RR = 0.92 (0.86-0.99)] than White patients. CONCLUSIONS Disadvantage stable neighborhoods were associated with late-stage diagnoses of breast and colorectal cancer. "Disadvantage reduced" (gentrified) neighborhoods were associated with racial inequity in CDS. Improved neighborhood socioeconomic conditions may improve timely diagnosis but could contribute to racial inequities in surgical treatment.
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Affiliation(s)
- Andrew P Loehrer
- Geisel School of Medicine at Dartmouth, Hanover, NH
- Dartmouth Cancer Center, Lebanon, NH
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
| | | | | | | | - Adrian Diaz
- Department of Surgery, The Ohio State University, Columbus, OH
| | - Benjamin Carter
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
| | - Ellesse-Roselee Akré
- Geisel School of Medicine at Dartmouth, Hanover, NH
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
| | - Rian M Hasson
- Geisel School of Medicine at Dartmouth, Hanover, NH
- Dartmouth Cancer Center, Lebanon, NH
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
| | - Heather A Carlos
- Geisel School of Medicine at Dartmouth, Hanover, NH
- Dartmouth Cancer Center, Lebanon, NH
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McKay T, Akré ER, Henne J, Kari N, Conway A, Gothelf I. LGBTQ+ Affirming Care May Increase Awareness and Understanding of Undetectable = Untransmittable among Midlife and Older Gay and Bisexual Men in the US South. Int J Environ Res Public Health 2022; 19:10534. [PMID: 36078248 PMCID: PMC9518313 DOI: 10.3390/ijerph191710534] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/15/2022] [Accepted: 08/18/2022] [Indexed: 06/15/2023]
Abstract
One of the most significant innovations in HIV prevention is the use of HIV treatment to prevent HIV transmission. This information has been disseminated as the "Undetectable = Untransmittable" (U = U) message. Despite evidence of effectiveness, U = U awareness, belief, and understanding remains limited in some communities. In this study, we examine whether having an LGBTQ affirming healthcare provider increases U = U awareness, belief, and understanding among midlife and older gay and bisexual men in the US south, an understudied and underserved population and region where new HIV infections are increasing. We used data from the Vanderbilt University Social Networks Aging and Policy Study (VUSNAPS) on sexual minority men aged 50 to 76 from four southern US states collected in 2020-2021. We found that only one in four men reported prior awareness of U = U, but awareness was higher among men who have an LGBTQ affirming provider. Among HIV negative men, those with an affirming provider were more likely to believe and understand U = U, have more accurate risk perception, and have ever tested for HIV. Improving access to LGBTQ affirming healthcare may improve U = U awareness, belief, and understanding, which could help to curb HIV transmission in the US south.
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Affiliation(s)
- Tara McKay
- Department of Medicine, Health and Society, Vanderbilt University, Nashville, TN 37235, USA
| | | | | | - Nitya Kari
- Department of Medicine, Health and Society, Vanderbilt University, Nashville, TN 37235, USA
| | - Adam Conway
- Department of Medicine, Health and Society, Vanderbilt University, Nashville, TN 37235, USA
| | - Isabel Gothelf
- Department of Medicine, Health and Society, Vanderbilt University, Nashville, TN 37235, USA
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Abstract
Purpose: Very little research has examined mental health among transgender people of color using population-based data. The objective of this study was to use large-scale data to examine mental health disparities at the intersections of gender identity, race, and ethnicity. Methods: Data for this study came from transgender (n = 4024) and cisgender (n = 935,793) adults aged 18 years and older in the 2014-2018 Behavioral Risk Factor Surveillance System. We estimated and compared frequent mental distress and lifetime depression diagnoses using multivariable logistic regression models. Regression results are presented as adjusted odds ratios (AORs) with 95% confidence intervals (CIs). Results: After controlling for sociodemographic characteristics and compared with cisgender White adults, transgender White adults (AOR = 1.81; 95% CI = 1.49-2.21), transgender American Indian or Alaska Native (AIAN) adults (AOR = 8.06; 95% CI = 2.03-32.00), and transgender adults of other/multiple races and ethnicities (AOR = 3.15; 95% CI = 1.78-5.59) had higher odds of exhibiting frequent mental distress. Transgender White adults (AOR = 2.07; 95% CI = 1.75-2.46), transgender AIAN adults (AOR = 3.61; 95% CI = 1.06-12.32), and transgender adults of other/multiple races and ethnicities (AOR = 2.37; 95% CI = 1.41-4.01) had higher odds of reporting a lifetime depression diagnosis compared with White cisgender adults. Conclusion: This study serves as a reminder that LGBT health should be analyzed through an intersectional lens as some individuals with multiple marginalized identities may have worse health as a result of double discrimination. Public health practitioners and health care providers should be mindful of the diversity within the transgender population in their work.
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Affiliation(s)
- Lee Robertson
- Department of Psychology and Health, and Society, Vanderbilt University, Nashville, Tennessee, USA
| | - Ellesse-Roselee Akré
- Department of Medicine, Health, and Society, Vanderbilt University, Nashville, Tennessee, USA
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Gilbert Gonzales
- Department of Medicine, Health, and Society, Vanderbilt University, Nashville, Tennessee, USA
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Akré ER, Anderson A, Stojanovski K, Chung KW, VanKim NA, Chae DH. Depression, Anxiety, and Alcohol Use Among LGBTQ+ People During the COVID-19 Pandemic. Am J Public Health 2021; 111:1610-1619. [PMID: 34410817 PMCID: PMC8589058 DOI: 10.2105/ajph.2021.306394] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To describe disparities in depression, anxiety, and problem drinking by sexual orientation, sexual behavior, and gender identity during the COVID-19 pandemic. Methods. Data were collected May 21 to July 15, 2020, from 3245 adults living in 5 major US metropolitan areas (Atlanta, Georgia; Chicago, Illinois; New Orleans, Louisiana; New York, New York; and Los Angeles, California). Participants were characterized as cisgender straight or LGBTQ+ (i.e., lesbian, gay, bisexual, and transgender people, and men who have sex with men, and women who have sex with women not identifying as lesbian, gay, bisexual, or transgender). Results. Cisgender straight participants had the lowest levels of depression, anxiety, and problem drinking compared with all other sexual orientation, sexual behavior, and gender identity groups, and, in general, LGBTQ+ participants were more likely to report that these health problems were "more than usual" during the COVID-19 pandemic. Conclusions. LGBTQ+ communities experienced worse mental health and problem drinking than their cisgender straight counterparts during the COVID-19 pandemic. Future research should assess the impact of the pandemic on health inequities. Policymakers should consider resources to support LGBTQ+ mental health and substance use prevention in COVID-19 recovery efforts.
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Affiliation(s)
- Ellesse-Roselee Akré
- At the time of the study, E. R. Akré was a postdoctoral researcher at Vanderbilt University, Nashville, TN, and she completed the work while with Geisel School of Medicine at Dartmouth, the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH. Andrew Anderson is with Tulane University, School of Public Health and Tropical Medicine, Department of Health Policy and Management, New Orleans, LA. Kristefer Stojanovski is with University of Michigan, School of Public Health, Department of Health Behavior and Health Education, Ann Arbor. Kara W. Chung and David H. Chae are with Tulane University, School of Public Health and Tropical Medicine, Department of Global Community Health and Behavioral Sciences. Nicole A. VanKim is with University of Massachusetts: Amherst, School of Public Health and Health Sciences, Department of Epidemiology
| | - Andrew Anderson
- At the time of the study, E. R. Akré was a postdoctoral researcher at Vanderbilt University, Nashville, TN, and she completed the work while with Geisel School of Medicine at Dartmouth, the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH. Andrew Anderson is with Tulane University, School of Public Health and Tropical Medicine, Department of Health Policy and Management, New Orleans, LA. Kristefer Stojanovski is with University of Michigan, School of Public Health, Department of Health Behavior and Health Education, Ann Arbor. Kara W. Chung and David H. Chae are with Tulane University, School of Public Health and Tropical Medicine, Department of Global Community Health and Behavioral Sciences. Nicole A. VanKim is with University of Massachusetts: Amherst, School of Public Health and Health Sciences, Department of Epidemiology
| | - Kristefer Stojanovski
- At the time of the study, E. R. Akré was a postdoctoral researcher at Vanderbilt University, Nashville, TN, and she completed the work while with Geisel School of Medicine at Dartmouth, the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH. Andrew Anderson is with Tulane University, School of Public Health and Tropical Medicine, Department of Health Policy and Management, New Orleans, LA. Kristefer Stojanovski is with University of Michigan, School of Public Health, Department of Health Behavior and Health Education, Ann Arbor. Kara W. Chung and David H. Chae are with Tulane University, School of Public Health and Tropical Medicine, Department of Global Community Health and Behavioral Sciences. Nicole A. VanKim is with University of Massachusetts: Amherst, School of Public Health and Health Sciences, Department of Epidemiology
| | - Kara W Chung
- At the time of the study, E. R. Akré was a postdoctoral researcher at Vanderbilt University, Nashville, TN, and she completed the work while with Geisel School of Medicine at Dartmouth, the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH. Andrew Anderson is with Tulane University, School of Public Health and Tropical Medicine, Department of Health Policy and Management, New Orleans, LA. Kristefer Stojanovski is with University of Michigan, School of Public Health, Department of Health Behavior and Health Education, Ann Arbor. Kara W. Chung and David H. Chae are with Tulane University, School of Public Health and Tropical Medicine, Department of Global Community Health and Behavioral Sciences. Nicole A. VanKim is with University of Massachusetts: Amherst, School of Public Health and Health Sciences, Department of Epidemiology
| | - Nicole A VanKim
- At the time of the study, E. R. Akré was a postdoctoral researcher at Vanderbilt University, Nashville, TN, and she completed the work while with Geisel School of Medicine at Dartmouth, the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH. Andrew Anderson is with Tulane University, School of Public Health and Tropical Medicine, Department of Health Policy and Management, New Orleans, LA. Kristefer Stojanovski is with University of Michigan, School of Public Health, Department of Health Behavior and Health Education, Ann Arbor. Kara W. Chung and David H. Chae are with Tulane University, School of Public Health and Tropical Medicine, Department of Global Community Health and Behavioral Sciences. Nicole A. VanKim is with University of Massachusetts: Amherst, School of Public Health and Health Sciences, Department of Epidemiology
| | - David H Chae
- At the time of the study, E. R. Akré was a postdoctoral researcher at Vanderbilt University, Nashville, TN, and she completed the work while with Geisel School of Medicine at Dartmouth, the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH. Andrew Anderson is with Tulane University, School of Public Health and Tropical Medicine, Department of Health Policy and Management, New Orleans, LA. Kristefer Stojanovski is with University of Michigan, School of Public Health, Department of Health Behavior and Health Education, Ann Arbor. Kara W. Chung and David H. Chae are with Tulane University, School of Public Health and Tropical Medicine, Department of Global Community Health and Behavioral Sciences. Nicole A. VanKim is with University of Massachusetts: Amherst, School of Public Health and Health Sciences, Department of Epidemiology
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