bims-cahedi 2023-04-02 papers

New Genet Soc. 2022 ;41(3): 216-226

The Challenge of Recruiting Diverse Populations into Health Research: An embedded social science perspective.

Simon M Outram, Sara L Ackerman, Matthew Norstad, Barbara Koenig.

Addressing health disparities has become a central remit for conducting health research. In the following paper, we explore the conceptual and methodological challenges posed by the call to recruit medically underserved populations. This exploration of challenges is undertaken from the perspective of social science researchers embedded in a large within a clinical genomics research study. We suggest that these challenges are found in respect to the development of recruiting strategies, analysis of the data in respect to understanding and interpreting the experiences of being medically underserved, and in comparing the experiences of being medically underserved compared to not being underserved. By way of conclusion, it is argued that there is important role for social scientists with large health research studies which, if achieved successfully, can benefit study teams and society as a whole.

DOI: https://doi.org/10.1080/14636778.2022.2115349

Am J Respir Crit Care Med. 2023 Mar 27.

Race and Ethnicity in Pulmonary Function Test Interpretation: An Official American Thoracic Society Statement.

Current American Thoracic Society (ATS) standards promote the use of racial/ethnic-specific reference equations for pulmonary function test (PFT) interpretation. There is rising concern that the use of race/ethnicity in PFT interpretation contributes to a false view of fixed differences between races and may mask the effects of differential exposures. This use of race/ethnicity may contribute to health disparities by norming differences in pulmonary function. In the United States, race serves as a social construct that is based on appearance and reflects social values, structures, and practices. Classification of people into racial/ethnic groups differs geographically and temporally. These considerations challenge the notion that racial/ethnic categories have biological meaning and question the use of race in PFT interpretation. The ATS convened a diverse group of clinicians and investigators for a workshop to evaluate the use of race/ethnicity in PFT interpretation. Review of evidence published since then that challenges current practice and continued discussion concluded with a recommendation to replace race/ethnicity-specific equations with race-neutral average reference equations, which must be accompanied with broader re-evaluation of how PFTs are used to make clinical/employment/insurance decisions. There was also a call to engage key stakeholders not represented in this workshop and a statement of caution regarding the uncertain effects and potential harms of this change. Other recommendations include continued research and education to understand the impact of the change, to improve the evidence for the use of PFTs in general, and to identify modifiable risk factors for reduced pulmonary function.

Keywords: pulmonary function test; race; ethnicity; interpretation; PFT

DOI: https://doi.org/10.1164/rccm.202302-0310ST

Sleep Med. 2023 Mar 13. pii: S1389-9457(23)00096-5. [Epub ahead of print]105 85

Racial disparities in cardiovascular outcomes are windows into structural racism, not genetics.

Francois G Rollin, Kara J Mould, Daniel Colon Hidalgo.

DOI: https://doi.org/10.1016/j.sleep.2023.03.010

J Natl Med Assoc. 2023 Mar 29. pii: S0027-9684(23)00030-5. [Epub ahead of print]

Addressing disparities in cancer care and incorporating precision medicine for minority populations.

Robert Winn, Karen Winkfield, Edith Mitchell.

Cancer incidence and outcomes vary considerably between racial and ethnic groups. Non-Hispanic (NH) Blacks are disproportionately burdened with the most common cancer types, having the highest death rate of any group. Racial health disparities are complex and have been identified at each step of the cancer care continuum, encompassing patient and provider factors and health care system processes. The higher cancer mortality among NH Blacks may reflect underuse of prevention strategies such as vaccination and screening, resulting in later stage of disease at diagnosis and underuse of cancer-directed therapy. Inequalities in the quality of care, including access to health care and receipt of recommended diagnostic and therapeutic interventions as well as supportive care also contribute to the excess burden of cancer-related deaths among NH Blacks. Non-clinical factors such as structural racism and lower socioeconomic status are associated with unequal access to resources such as housing, healthy foods, employment, and education, which have been demonstrated to drive racial disparities in cancer. Concerted efforts to understand and target the causes of the observed differences in access, screening, and treatment utilization will be critical for achieving more equitable treatment delivery and outcomes for all patients with cancer. Moreover, ongoing efforts to enhance diversity in clinical trials enrollment and access to novel precision medicine initiatives are processes warranted to reduce healthcare inequalities.

Keywords: Access to treatment; Disparities; Early detection; Prevention; Social determinants of health; Structural racism

DOI: https://doi.org/10.1016/j.jnma.2023.02.001

Cancer Rep (Hoboken). 2023 Mar 27. e1807

Racial disparities in cancer care, an eyeopener for developing better global cancer management strategies.

Bharmjeet, Asmita Das.

BACKGROUND: In the last few decades, advancements in cancer research, both in the field of cancer diagnostics as well as treatment of the disease have been extensive and multidimensional. Increased availability of health care resources and growing awareness has resulted in the reduction of consumption of carcinogens such as tobacco; adopting various prophylactic measures; cancer testing on regular basis and improved targeted therapies have greatly reduced cancer mortality among populations, globally. However, this notable reduction in cancer mortality is discriminate and reflective of disparities between various ethnic populations and economic classes. Several factors contribute to this systemic inequity, at the level of diagnosis, cancer prognosis, therapeutics, and even point-of-care facilities.
RECENT FINDINGS: In this review, we have highlighted cancer health disparities among different populations around the globe. It encompasses social determinants such as status in society, poverty, education, diagnostic approaches including biomarkers and molecular testing, treatment as well as palliative care. Cancer treatment is an active area of constant progress and newer targeted treatments like immunotherapy, personalized treatment, and combinatorial therapies are emerging but these also show biases in their implementation in various sections of society. The involvement of populations in clinical trials and trial management is also a hotbed for racial discrimination. The immense progress in cancer management and its worldwide application needs a careful evaluation by identifying the biases in racial discrimination in healthcare facilities.
CONCLUSION: Our review gives a comprehensive evaluation of this global racial discrimination in cancer care and would be helpful in designing better strategies for cancer management and decreasing mortality.

Keywords: cancer care; cancer health disparities; cancer management; cancer therapy; racial disparities

DOI: https://doi.org/10.1002/cnr2.1807

Prostate Cancer Prostatic Dis. 2023 Mar 25.

Race-dependent association of clinical trial participation with improved outcomes for high-risk prostate cancer patients treated in the modern era.

Ting Martin Ma, Felix Y Feng, Seth A Rosenthal, Matthew B Rettig, Ann C Raldow, Daniel E Spratt, Michael Xiang, Amar U Kishan.

It is unclear whether cancer patients enrolled in clinical trials have improved outcomes compared with non-study patients. We compared prostate cancer-specific mortality (PCSM) in patients in a real-world setting (SEER-Medicare database) versus on a trial (NRG/RTOG 0521). The 7-year freedom from PCSM was superior in trial patients (92.4% vs. 88.1%, sHR = 1.77 [95% CI 1.05-2.97], P = 0.03). Black trial patients had significantly superior freedom from PCSM than Black real-world patients (sHR 6.52, 95% CI 1.43-29.72, P = 0.02), which was not seen among non-Black patients. Trial patients may have improved outcomes, and racial disparities are accentuated in the real world.

DOI: https://doi.org/10.1038/s41391-023-00663-5