Developing Partnerships to Reduce Disparities in Cancer Screening

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Breslau, Erica S.; Rochester, Phyllis W.; Saslow, Debbie; Crocoll, Caroline E.; Johnson, Lenora E.; Vinson, Cynthia A.

2010-01-01

Background Interventions in scientific settings to improve the well-being of women who are not regularly screened for cancer have failed. Consequently, community-based prevention and control efforts are needed. Community Context From 2003 through 2007, three federal agencies and 1 nongovernmental agency collaborated with county-level public health counterparts from 6 states to address screening disparities in cervical and breast cancer in counties with the highest prevalence. This case study ...

Racial and ethnic disparities in human papillomavirus-associated cancer burden with first-generation and second-generation human papillomavirus vaccines.

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Burger, Emily A; Lee, Kyueun; Saraiya, Mona; Thompson, Trevor D; Chesson, Harrell W; Markowitz, Lauri E; Kim, Jane J

2016-07-01

In the United States, the burden of human papillomavirus (HPV)-associated cancers varies by racial/ethnic group. HPV vaccination may provide opportunities for primary prevention of these cancers. Herein, the authors projected changes in HPV-associated cancer burden among racial/ethnic groups under various coverage assumptions with the available first-generation and second-generation HPV vaccines to evaluate changes in racial/ethnic disparities. Cancer-specific mathematical models simulated the burden of 6 HPV-associated cancers. Model parameters, informed using national registries and epidemiological studies, reflected sex-specific, age-specific, and racial/ethnic-specific heterogeneities in HPV type distribution, cancer incidence, stage of disease at detection, and mortality. Model outcomes included the cumulative lifetime risks of developing and dying of 6 HPV-associated cancers. The level of racial/ethnic disparities was evaluated under each alternative HPV vaccine scenario using several metrics of social group disparity. HPV vaccination is expected to reduce the risks of developing and dying of HPV-associated cancers in all racial/ethnic groups as well as reduce the absolute degree of disparities. However, alternative metrics suggested that relative disparities would persist and in some scenarios worsen. For example, when assuming high uptake with the second-generation HPV vaccine, the lifetime risk of dying of an HPV-associated cancer for males decreased by approximately 60%, yet the relative disparity increased from 3.0 to 3.9. HPV vaccines are expected to reduce the overall burden of HPV-associated cancers for all racial/ethnic groups and to reduce the absolute disparity gap. However, even with the second-generation vaccine, relative disparities will likely still exist and may widen if the underlying causes of these disparities remain unaddressed. Cancer 2016;122:2057-66. © 2016 American Cancer Society. © 2016 American Cancer Society.

Racial and Socioeconomic Disparities Are More Pronounced in Inflammatory Breast Cancer Than Other Breast Cancers

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Ryan A. Denu

2017-01-01

Full Text Available Inflammatory breast cancer (IBC is a rare yet aggressive form of breast cancer. We examined differences in patient demographics and outcomes in IBC compared to locally advanced breast cancer (LABC and all other breast cancer patients from the Breast and Prostate Cancer Data Quality and Patterns of Care Study (POC-BP, containing information from cancer registries in seven states. Out of 7,624 cases of invasive carcinoma, IBC and LABC accounted for 2.2% (N=170 and 4.9% (N=375, respectively. IBC patients were more likely to have a higher number (P=0.03 and severity (P=0.01 of comorbidities than other breast cancer patients. Among IBC patients, a higher percentage of patients with metastatic disease versus nonmetastatic disease were black, on Medicaid, and from areas of higher poverty and more urban areas. Black and Hispanic IBC patients had worse overall and breast cancer-specific survival than white patients; moreover, IBC patients with Medicaid, patients from urban areas, and patients from areas of higher poverty and lower education had worse outcomes. These data highlight the effects of disparities in race and socioeconomic status on the incidence of IBC as well as IBC outcomes. Further work is needed to reveal the causes behind these disparities and methods to improve IBC outcomes.

Contribution of screening and survival differences to racial disparities in colorectal cancer rates

NARCIS (Netherlands)

I. Lansdorp-Vogelaar (Iris); K.M. Kuntz (Karen); A.B. Knudsen (Amy); M. van Ballegooijen (Marjolein); A. Zauber (Ann); A. Jemal (Ahmedin)

2012-01-01

textabstractBackground: Considerable disparities exist in colorectal cancer (CRC) incidence and mortality rates between blacks and whites in the United States. We estimated how much of these disparities could be explained by differences in CRC screening and stage-specific relative CRC survival.

Sex disparities in cancer incidence in Jiashan County, China, 1995-2014.

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Jiang, Xiyi; Cai, Shaofang; Hu, Yunqing; Ye, Ding; Li, Qilong; Chen, Kun; Jin, Mingjuan

2017-10-01

To describe the sex-specific incidence rates and the male-to-female incidence-rate ratios (IRRs) of different cancer types, and to explore the corresponding sex disparities in an area of Eastern China. We used data from the Cancer Registry in Jiashan County, and calculated the sex-specific age-standardized (2010 China standard population) incidence rates and the male-to-female IRRs for different cancer types during the period 1995-2014. The age-standardized incidence rates of all cancers for the whole period 1995-2014 were 151.48 per 100,000 person-years for males and 83.75 per 100,000 person-years for females, and the corresponding male-to-female IRR was 1.81 (95% confidence interval: 1.77-1.85). Specifically, males presented higher incidences in most types of cancer with the exceptions of cancers of connective and other soft tissues, gallbladder (including extrahepatic bile ducts), and thyroid gland. In addition, the age-specific incidences of the ten most common cancers in males were higher than those in females in most age groups. Our results reveal a male predominance in incidence for a majority of cancers in Jiashan County, Eastern China. Possible explanations for these sex disparities in cancer incidence may include lifestyle factors, particularly smoking. Copyright © 2017. Published by Elsevier Ltd.

Socioeconomic disparity in survival after breast cancer in ireland: observational study.

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Paul M Walsh

Full Text Available We evaluated the relationship between breast cancer survival and deprivation using data from the Irish National Cancer Registry. Cause-specific survival was compared between five area-based socioeconomic deprivation strata using Cox regression. Patient and tumour characteristics and treatment were compared using modified Poisson regression with robust variance estimation. Based on 21356 patients diagnosed 1999-2008, age-standardized five-year survival averaged 80% in the least deprived and 75% in the most deprived stratum. Age-adjusted mortality risk was 33% higher in the most deprived group (hazard ratio 1.33, 95% CI 1.21-1.45, P<0.001. The most deprived groups were more likely to present with advanced stage, high grade or hormone receptor-negative cancer, symptomatically, or with significant comorbidity, and to be smokers or unmarried, and less likely to have breast-conserving surgery. Cox modelling suggested that the available data on patient, tumour and treatment factors could account for only about half of the survival disparity (adjusted hazard ratio 1.18, 95% CI 0.97-1.43, P = 0.093. Survival disparity did not diminish over time, compared with the period 1994-1998. Persistent survival disparities among Irish breast cancer patients suggest unequal use of or access to services and highlight the need for further research to understand and remove the behavioural or other barriers involved.

Cancer Genomics: Diversity and Disparity Across Ethnicity and Geography.

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Tan, Daniel S W; Mok, Tony S K; Rebbeck, Timothy R

2016-01-01

Ethnic and geographic differences in cancer incidence, prognosis, and treatment outcomes can be attributed to diversity in the inherited (germline) and somatic genome. Although international large-scale sequencing efforts are beginning to unravel the genomic underpinnings of cancer traits, much remains to be known about the underlying mechanisms and determinants of genomic diversity. Carcinogenesis is a dynamic, complex phenomenon representing the interplay between genetic and environmental factors that results in divergent phenotypes across ethnicities and geography. For example, compared with whites, there is a higher incidence of prostate cancer among Africans and African Americans, and the disease is generally more aggressive and fatal. Genome-wide association studies have identified germline susceptibility loci that may account for differences between the African and non-African patients, but the lack of availability of appropriate cohorts for replication studies and the incomplete understanding of genomic architecture across populations pose major limitations. We further discuss the transformative potential of routine diagnostic evaluation for actionable somatic alterations, using lung cancer as an example, highlighting implications of population disparities, current hurdles in implementation, and the far-reaching potential of clinical genomics in enhancing cancer prevention, diagnosis, and treatment. As we enter the era of precision cancer medicine, a concerted multinational effort is key to addressing population and genomic diversity as well as overcoming barriers and geographical disparities in research and health care delivery. © 2015 by American Society of Clinical Oncology.

Addressing cancer disparities via community network mobilization and intersectoral partnerships: a social network analysis.

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Shoba Ramanadhan

Full Text Available Community mobilization and collaboration among diverse partners are vital components of the effort to reduce and eliminate cancer disparities in the United States. We studied the development and impact of intersectoral connections among the members of the Massachusetts Community Network for Cancer Education, Research, and Training (MassCONECT. As one of the Community Network Program sites funded by the National Cancer Institute, this infrastructure-building initiative utilized principles of Community-based Participatory Research (CBPR to unite community coalitions, researchers, policymakers, and other important stakeholders to address cancer disparities in three Massachusetts communities: Boston, Lawrence, and Worcester. We conducted a cross-sectional, sociometric network analysis four years after the network was formed. A total of 38 of 55 members participated in the study (69% response rate. Over four years of collaboration, the number of intersectoral connections reported by members (intersectoral out-degree increased, as did the extent to which such connections were reported reciprocally (intersectoral reciprocity. We assessed relationships between these markers of intersectoral collaboration and three intermediate outcomes in the effort to reduce and eliminate cancer disparities: delivery of community activities, policy engagement, and grants/publications. We found a positive and statistically significant relationship between intersectoral out-degree and community activities and policy engagement (the relationship was borderline significant for grants/publications. We found a positive and statistically significant relationship between intersectoral reciprocity and community activities and grants/publications (the relationship was borderline significant for policy engagement. The study suggests that intersectoral connections may be important drivers of diverse intermediate outcomes in the effort to reduce and eliminate cancer disparities

KRAS biomarker testing disparities in colorectal cancer patients in New Mexico

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Alissa Greenbaum

2017-11-01

Full Text Available Introduction: American Society of Clinical Oncology (ASCO guidelines recommend that all patients with metastatic colorectal cancer (mCRC receive KRAS testing to guide anti-EGFR monoclonal antibody treatment. The aim of this study was to assess for disparities in KRAS testing and mutational status. Methods: The New Mexico Tumor Registry (NMTR, a population-based cancer registry participating in the National Cancer Institute’s Surveillance, Epidemiology and End Results program, was queried to identify all incident cases of CRC diagnosed among New Mexico residents from 2010 to 2013. Results: Six hundred thirty-seven patients were diagnosed with mCRC from 2010–2013. As expected, KRAS testing in Stage 4 patients presented the highest frequency (38.4%, though testing in stage 3 (8.5%, stage 2 (3.4% and stage 1 (1.2% was also observed. In those with metastatic disease, younger patients (≤ 64 years were more likely to have had testing than patients 65 years and older (p < 0.0001. Patients residing in urban areas received KRAS testing more often than patients living in rural areas (p = 0.019. No significant racial/ethnic disparities were observed (p = 0.66. No significant differences were seen by year of testing. Conclusion: Age and geographic disparities exist in the rates of KRAS testing, while sex, race/ethnicity and the year tested were not significantly associated with testing. Further study is required to assess the reasons for these disparities and continued suboptimal adherence to current ASCO KRAS testing guidelines. Keywords: Oncology, Health sciences, Clinical genetics

Identification of racial disparities in breast cancer mortality: does scale matter?

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Zhan F Benjamin

2010-07-01

Full Text Available Abstract Background This paper investigates the impact of geographic scale (census tract, zip code, and county on the detection of disparities in breast cancer mortality among three ethnic groups in Texas (period 1995-2005. Racial disparities were quantified using both relative (RR and absolute (RD statistics that account for the population size and correct for unreliable rates typically observed for minority groups and smaller geographic units. Results were then correlated with socio-economic status measured by the percentage of habitants living below the poverty level. Results African-American and Hispanic women generally experience higher mortality than White non-Hispanics, and these differences are especially significant in the southeast metropolitan areas and southwest border of Texas. The proportion and location of significant racial disparities however changed depending on the type of statistic (RR versus RD and the geographic level. The largest proportion of significant results was observed for the RD statistic and census tract data. Geographic regions with significant racial disparities for African-Americans and Hispanics frequently had a poverty rate above 10.00%. Conclusions This study investigates both relative and absolute racial disparities in breast cancer mortality between White non-Hispanic and African-American/Hispanic women at the census tract, zip code and county levels. Analysis at the census tract level generally led to a larger proportion of geographical units experiencing significantly higher mortality rates for minority groups, although results varied depending on the use of the relative versus absolute statistics. Additional research is needed before general conclusions can be formulated regarding the choice of optimal geographic regions for the detection of racial disparities.

Cancer mortality disparities among New York City's Upper Manhattan neighborhoods.

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Hashim, Dana; Manczuk, Marta; Holcombe, Randall; Lucchini, Roberto; Boffetta, Paolo

2017-11-01

The East Harlem (EH), Central Harlem (CH), and Upper East Side (UES) neighborhoods of New York City are geographically contiguous to tertiary medical care, but are characterized by cancer mortality rate disparities. This ecological study aims to disentangle the effects of race and neighborhood on cancer deaths. Mortality-to-incidence ratios were determined using neighborhood-specific data from the New York State Cancer Registry and Vital Records Office (2007-2011). Ecological data on modifiable cancer risk factors from the New York City Community Health Survey (2002-2006) were stratified by sex, age group, race/ethnicity, and neighborhood and modeled against stratified mortality rates to disentangle race/ethnicity and neighborhood using logistic regression. Significant gaps in mortality rates were observed between the UES and both CH and EH across all cancers, favoring UES. Mortality-to-incidence ratios of both CH and EH were similarly elevated in the range of 0.41-0.44 compared with UES (0.26-0.30). After covariate and multivariable adjustment, black race (odds ratio=1.68; 95% confidence interval: 1.46-1.93) and EH residence (odds ratio=1.20; 95% confidence interval: 1.07-1.35) remained significant risk factors in all cancers' combined mortality. Mortality disparities remain among EH, CH, and UES neighborhoods. Both neighborhood and race are significantly associated with cancer mortality, independent of each other. Multivariable adjusted models that include Community Health Survey risk factors show that this mortality gap may be avoidable through community-based public health interventions.

Commentary: Utilizing Community-Engaged Approaches to Investigate and Address Hmong Women’s Cancer Disparities

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Shannon M.A. Sparks

2014-12-01

Full Text Available Cancer is a growing concern for women in the Hmong community. Hmong women experience poor health outcomes for both cervical and breast cancer, largely due to low rates of screening and resultant late-stage at diagnosis. Both breast and cervical cancer screening are complicated by a multitude of social, cultural and environmental factors which influence health care decision-making and can otherwise serve to restrict access. We argue that community-engaged research, an orientation which prioritizes collaborative, equitable partnerships and community voice in identifying both problems and solutions, can be a valuable approach to helping address cancer health disparities for Hmong women. Using the Milwaukee-based “Healthy Hmong Women” project as a case example, we detail how the community-engaged approach implemented by the project partners was critical in identifying factors contributing to Hmong cancer disparities and appropriate interventions, as well as the overall acceptance and success of the project. Specifically, we discuss how this approach: (1 promoted community investment and ownership in the project; (2 facilitated the integration of local perspectives and experiences; (3 built capacity to address cancer screening disparities; (4 facilitated the creation of interventions targeting multiple ecological levels; and (5 framed the community as the foundation and driver of positive change.

Socioeconomic disparities in breast cancer survival: relation to stage at diagnosis, treatment and race

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Yu Xue

2009-10-01

Full Text Available Abstract Background Previous studies have documented lower breast cancer survival among women with lower socioeconomic status (SES in the United States. In this study, I examined the extent to which socioeconomic disparity in breast cancer survival was explained by stage at diagnosis, treatment, race and rural/urban residence using the Surveillance, Epidemiology, and End Results (SEER data. Methods Women diagnosed with breast cancer during 1998-2002 in the 13 SEER cancer registry areas were followed-up to the end of 2005. The association between an area-based measure of SES and cause-specific five-year survival was estimated using Cox regression models. Six models were used to assess the extent to which SES differences in survival were explained by clinical and demographical factors. The base model estimated the hazard ratio (HR by SES only and then additional adjustments were made sequentially for: 1 age and year of diagnosis; 2 stage at diagnosis; 3 first course treatment; 4 race; and 5 rural/urban residence. Results An inverse association was found between SES and risk of dying from breast cancer (p Conclusion Stage at diagnosis, first course treatment and race explained most of the socioeconomic disparity in breast cancer survival. Targeted interventions to increase breast cancer screening and treatment coverage in patients with lower SES could reduce much of socioeconomic disparity.

Disparities in Gynecological Malignancies

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Sudeshna eChatterjee

2016-02-01

Full Text Available Objectives: Health disparities and inequalities in access to care among different socioeconomic, ethnic, and racial groups have been well documented in the U.S. healthcare system. In this review, we aimed to provide an overview of barriers to care contributing to health disparities in gynecological oncology management and to describe site-specific disparities in gynecologic care for endometrial, ovarian, and cervical cancer. Methods: We performed a literature review of peer-reviewed academic and governmental publications focusing on disparities in gynecological care in the United States by searching PubMed and Google Scholar electronic databases. Results: There are multiple important underlying issues that may contribute to the disparities in gynecological oncology management in the United States, namely geographic access and hospital based-discrepancies, research-based discrepancies, influence of socioeconomic and health insurance status, and finally the influence of race and biological factors. Despite the reduction in overall cancer-related deaths since the 1990s, the 5-year survival for Black women is significantly lower than for White women for each gynecologic cancer type and each stage of diagnosis. For ovarian and endometrial cancer, black patients are less likely to receive treatment consistent with evidence-based guidelines and have worse survival outcomes even after accounting for stage and comorbidities. For cervical and endometrial cancer, the mortality rate for black women remains twice that of White women. Conclusions: Health care disparities in the incidence and outcome of gynecologic cancers are complex and involve biologic factors as well as racial, socioeconomic and geographic barriers that influence treatment and survival. These barriers must be addressed to provide optimal care to women in the U.S. with gynecologic cancer.

The Impact of a Population-Based Screening Program on Income- and Immigration-Related Disparities in Colorectal Cancer Screening.

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Kiran, Tara; Glazier, Richard H; Moineddin, Rahim; Gu, Sumei; Wilton, Andrew S; Paszat, Lawrence

2017-09-01

Background: A population-based program promoting the Fecal Occult Blood Test (FOBT) for colorectal cancer screening was introduced in 2008 in Ontario, Canada, where opportunistic screening with colonoscopy had been increasing in frequency. We evaluated the impact of the program on income and immigration-related disparities in screening. Methods: We used linked administrative data to calculate colorectal cancer screening rates for eligible Ontarians in each year between 2001/02 ( n = 2,852,619) and 2013/14 ( n = 4,139,304). We quantified disparities using an "inequality ratio" of screening rates in the most disadvantaged group relative to the most advantaged group. We performed segmented logistic regression analyses stratified by screening modality and adjusted for age, sex, rurality, comorbidity, and morbidity. Results: Between 2001/02 and 2013/14, the income and immigration inequality ratios narrowed from 0.74 to 0.80 and 0.55 to 0.69, respectively. Before the screening program, the income inequality ratio was widening by 1% per year (95% CI 1% to 1%); in the year it was introduced, it narrowed by 4% (95% CI 2% to 7%) and in the years following, it remained stable [0% decrease (95% CI 1% decrease to 0% decrease) per year]. Results were similar for immigration-related disparities. After program introduction, disparities in receiving FOBT were narrowing at a faster rate while disparities in receiving colonoscopy were widening at a slower rate. Conclusions: Introduction of a population-based screening program promoting FOBT for colorectal cancer was associated with only modest improvements in immigration and income-related disparities. Impact: Reducing immigration and income-related disparities should be a focus for future research and policy work. Disparities in Ontario seem to be driven by a higher uptake of colonoscopy among more advantaged groups. Cancer Epidemiol Biomarkers Prev; 26(9); 1401-10. ©2017 AACR . ©2017 American Association for Cancer Research.

Individual Breast Cancer risk assessment in Underserved Populations: Integrating empirical Bioethics and Health Disparities Research

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Anderson, Emily E.; Hoskins, Kent

2013-01-01

Research suggests that individual breast cancer risk assessment may improve adherence to recommended screening and prevention guidelines, thereby decreasing morbidity and mortality. Further research on the use of risk assessment models in underserved minority populations is critical to informing national public health efforts to eliminate breast cancer disparities. However, implementing individual breast cancer risk assessment in underserved patient populations raises particular ethical issues that require further examination. After reviewing these issues, we will discuss how empirical bioethics research can be integrated with health disparities research to inform the translation of research findings. Our in-progress National Cancer Institute (NCI) funded study, How Do Underserved Minority Women Think About Breast Cancer?, conducted in the context of a larger study on individual breast cancer risk assessment, is presented as a model. PMID:23124498

Reducing Cancer Health Disparities through Community Engagement: Working with Faith-Based Organizations (Project CHURCH)

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Lorna H. McNeill, PhD, MPH, is Chair and Associate Professor in the Department of Health Disparities at the University of Texas MD Anderson Cancer Center. Dr. McNeill's research is on the elimination of cancer-related health disparities in minority populations. Her research has particular emphasis on understanding the influence of social contextual determinants of cancer in minorities, with a special focus of the role of physical activity as a key preventive behavior and obesity as a major cancer determinant. Her research takes place in minority and underserved communities such as public housing developments, black churches, community-based clinics and low-income neighborhoods-communities with excess cancer death rates. She has been continuously funded, receiving grants from various funding agencies (i.e., National Institutes of Health, Robert Wood Johnson Foundation, etc.), to better understand and design innovative solutions to address obesity in racial/ethnic minority communities. Dr. McNeill is PI of several community-based studies, primarily working with African American churches. One is a called Project CHURCH, an academic-faith-based partnership established to: 1) identify underlying reasons for health disparities in cancer and cancer risk factors (e.g., screening, diet) among AAs using a cohort study (N=2400), 2) engage AAs as partners in the research process, and 3) to ultimately eliminate disparities among AAs. In 2014 Dr. McNeill furthered her partnership through the Faith, Health, and Family (FHF) Collaborative. The goals of FHF are to enhance the Project CHURCH partnership to address family obesity in African Americans, strengthen the partnership by developing a larger coalition of organizations and stakeholders to address the problem, assess church and community interest in family obesity and develop an agenda to address obesity in faith settings. To date we have 50 churches as members. Dr. McNeill is also director of the Center for Community

Take Action to Decrease Your Cancer Risk - Obesity and Its Role in Cancer Health Disparities

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In support of this year’s National Minority Health Month theme “Prevention is Power: Taking Action for Health Equity!”, CRCHD is highlighting the role of obesity in cancer health disparities among diverse population groups in the U.S.

Unintended effects of emphasizing disparities in cancer communication to African-Americans.

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Nicholson, Robert A; Kreuter, Matthew W; Lapka, Christina; Wellborn, Rachel; Clark, Eddie M; Sanders-Thompson, Vetta; Jacobsen, Heather M; Casey, Chris

2008-11-01

Little is known about how minority groups react to public information that highlights racial disparities in cancer. This double-blind randomized study compared emotional and behavioral reactions to four versions of the same colon cancer (CRC) information presented in mock news articles to a community sample of African-American adults (n = 300). Participants read one of four articles that varied in their framing and interpretation of race-specific CRC mortality data, emphasizing impact (CRC is an important problem for African-Americans), two dimensions of disparity (Blacks are doing worse than Whites and Blacks are improving, but less than Whites), or progress (Blacks are improving over time). Participants exposed to disparity articles reported more negative emotional reactions to the information and were less likely to want to be screened for CRC than those in other groups (both P emotional reactions and participants were more likely to want to be screened. Moreover, negative emotional reaction seemed to mediate the influence of message type on individuals wanting to be screened for CRC. Overall, these results suggest that the way in which disparity research is reported in the medium can influence public attitudes and intentions, with reports about progress yielding a more positive effect on intention. This seems especially important among those with high levels of medical mistrust who are least likely to use the health care system and are thus the primary target of health promotion advertising.

Assessing needs and assets for building a regional network infrastructure to reduce cancer related health disparities.

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Wells, Kristen J; Lima, Diana S; Meade, Cathy D; Muñoz-Antonia, Teresita; Scarinci, Isabel; McGuire, Allison; Gwede, Clement K; Pledger, W Jack; Partridge, Edward; Lipscomb, Joseph; Matthews, Roland; Matta, Jaime; Flores, Idhaliz; Weiner, Roy; Turner, Timothy; Miele, Lucio; Wiese, Thomas E; Fouad, Mona; Moreno, Carlos S; Lacey, Michelle; Christie, Debra W; Price-Haywood, Eboni G; Quinn, Gwendolyn P; Coppola, Domenico; Sodeke, Stephen O; Green, B Lee; Lichtveld, Maureen Y

2014-06-01

Significant cancer health disparities exist in the United States and Puerto Rico. While numerous initiatives have been implemented to reduce cancer disparities, regional coordination of these efforts between institutions is often limited. To address cancer health disparities nation-wide, a series of regional transdisciplinary networks through the Geographic Management Program (GMaP) and the Minority Biospecimen/Biobanking Geographic Management Program (BMaP) were established in six regions across the country. This paper describes the development of the Region 3 GMaP/BMaP network composed of over 100 investigators from nine institutions in five Southeastern states and Puerto Rico to develop a state-of-the-art network for cancer health disparities research and training. We describe a series of partnership activities that led to the formation of the infrastructure for this network, recount the participatory processes utilized to develop and implement a needs and assets assessment and implementation plan, and describe our approach to data collection. Completion, by all nine institutions, of the needs and assets assessment resulted in several beneficial outcomes for Region 3 GMaP/BMaP. This network entails ongoing commitment from the institutions and institutional leaders, continuous participatory and engagement activities, and effective coordination and communication centered on team science goals. Copyright © 2014 Elsevier Ltd. All rights reserved.

Assessing Needs and Assets for Building a Regional Network Infrastructure to Reduce Cancer Related Health Disparities

Science.gov (United States)

Wells, Kristen J.; Lima, Diana S.; Meade, Cathy D.; Muñoz-Antonia, Teresita; Scarinci, Isabel; McGuire, Allison; Gwede, Clement K.; Pledger, W. Jack; Partridge, Edward; Lipscomb, Joseph; Matthews, Roland; Matta, Jaime; Flores, Idhaliz; Weiner, Roy; Turner, Timothy; Miele, Lucio; Wiese, Thomas E.; Fouad, Mona; Moreno, Carlos S.; Lacey, Michelle; Christie, Debra W.; Price-Haywood, Eboni G.; Quinn, Gwendolyn P.; Coppola, Domenico; Sodeke, Stephen O.; Green, B. Lee; Lichtveld, Maureen Y.

2015-01-01

Significant cancer health disparities exist in the United States and Puerto Rico. While numerous initiatives have been implemented to reduce cancer disparities, regional coordination of these efforts between institutions is often limited. To address cancer health disparities nationwide, a series of regional transdisciplinary networks through the Geographic Management Program (GMaP) and the Minority Biospecimen/Biobanking Geographic Management Program (BMaP) were established in six regions across the country. This paper describes the development of the Region 3 GMaP/BMaP network composed of over 100 investigators from nine institutions in five Southeastern states and Puerto Rico to develop a state-of-the-art network for cancer health disparities research and training. We describe a series of partnership activities that led to the formation of the infrastructure for this network, recount the participatory processes utilized to develop and implement a needs and assets assessment and implementation plan, and describe our approach to data collection. Completion, by all nine institutions, of the needs and assets assessment resulted in several beneficial outcomes for Region 3 GMaP/BMaP. This network entails ongoing commitment from the institutions and institutional leaders, continuous participatory and engagement activities, and effective coordination and communication centered on team science goals. PMID:24486917

Racial disparities in cancer care in the Veterans Affairs health care system and the role of site of care.

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Samuel, Cleo A; Landrum, Mary Beth; McNeil, Barbara J; Bozeman, Samuel R; Williams, Christina D; Keating, Nancy L

2014-09-01

We assessed cancer care disparities within the Veterans Affairs (VA) health care system and whether between-hospital differences explained disparities. We linked VA cancer registry data with VA and Medicare administrative data and examined 20 cancer-related quality measures among Black and White veterans diagnosed with colorectal (n = 12,897), lung (n = 25,608), or prostate (n = 38,202) cancer from 2001 to 2004. We used logistic regression to assess racial disparities for each measure and hospital fixed-effects models to determine whether disparities were attributable to between- or within-hospital differences. Compared with Whites, Blacks had lower rates of early-stage colon cancer diagnosis (adjusted odds ratio [AOR] = 0.80; 95% confidence interval [CI] = 0.72, 0.90), curative surgery for stage I, II, or III rectal cancer (AOR = 0.57; 95% CI = 0.41, 0.78), 3-year survival for colon cancer (AOR = 0.75; 95% CI = 0.62, 0.89) and rectal cancer (AOR = 0.61; 95% CI = 0.42, 0.87), curative surgery for early-stage lung cancer (AOR = 0.50; 95% CI = 0.41, 0.60), 3-dimensional conformal or intensity-modulated radiation (3-D CRT/IMRT; AOR = 0.53; 95% CI = 0.47, 0.59), and potent antiemetics for highly emetogenic chemotherapy (AOR = 0.87; 95% CI = 0.78, 0.98). Adjustment for hospital fixed-effects minimally influenced racial gaps except for 3-D CRT/IMRT (AOR = 0.75; 95% CI = 0.65, 0.87) and potent antiemetics (AOR = 0.95; 95% CI = 0.82, 1.10). Disparities in VA cancer care were observed for 7 of 20 measures and were primarily attributable to within-hospital differences.

Sociodemographic disparities in survival for adolescents and young adults with cancer differ by health insurance status.

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DeRouen, Mindy C; Parsons, Helen M; Kent, Erin E; Pollock, Brad H; Keegan, Theresa H M

2017-08-01

To investigate associations of sociodemographic factors-race/ethnicity, neighborhood socioeconomic status (SES), and health insurance-with survival for adolescents and young adults (AYAs) with invasive cancer. Data on 80,855 AYAs with invasive cancer diagnosed in California 2001-2011 were obtained from the California Cancer Registry. We used multivariable Cox proportional hazards regression to estimate overall survival. Associations of public or no insurance with greater risk of death were observed for 11 of 12 AYA cancers examined. Compared to Whites, Blacks experienced greater risk of death, regardless of age or insurance, while greater risk of death among Hispanics and Asians was more apparent for younger AYAs and for those with private/military insurance. More pronounced neighborhood SES disparities in survival were observed among AYAs with private/military insurance, especially among younger AYAs. Lacking or having public insurance was consistently associated with shorter survival, while disparities according to race/ethnicity and neighborhood SES were greater among AYAs with private/military insurance. While health insurance coverage associates with survival, remaining racial/ethnic and socioeconomic disparities among AYAs with cancer suggest additional social factors also need consideration in intervention and policy development.

Unintended Effects of Emphasizing Disparities in Cancer Communication to African-Americans

OpenAIRE

Nicholson, Robert A.; Kreuter, Matthew W.; Lapka, Christina; Wellborn, Rachel; Clark, Eddie M.; Sanders-Thompson, Vetta; Jacobsen, Heather M.; Casey, Chris

2008-01-01

Little is known about how minority groups react to public information that highlights racial disparities in cancer. This double-blind randomized study compared emotional and behavioral reactions to four versions of the same colon cancer (CRC) information presented in mock news articles to a community sample of African-American adults (n = 300). Participants read one of four articles that varied in their framing and interpretation of race-specific CRC mortality data, emphasizing impact (CRC is...

Differential splicing of oncogenes and tumor suppressor genes in African and Caucasian American populations: contributing factor in prostate cancer disparities

Science.gov (United States)

2017-12-01

populations: contributing factor in prostate cancer disparities? PRINCIPAL INVESTIGATOR: Norman H Lee, PhD CONTRACTING ORGANIZATION: George Washington...splicing of oncogenes and tumor suppressor genes in African and Caucasian American populations: contributing factor in prostate cancer disparities? 5b...American (AA) versus Caucasian American (CA) prostate cancer (PCa). We focused our efforts on two oncogenes, phosphatidylinositol-4,5-bisphosphate 3

Designing a community-based lay health advisor training curriculum to address cancer health disparities.

Science.gov (United States)

Gwede, Clement K; Ashley, Atalie A; McGinnis, Kara; Montiel-Ishino, F Alejandro; Standifer, Maisha; Baldwin, Julie; Williams, Coni; Sneed, Kevin B; Wathington, Deanna; Dash-Pitts, Lolita; Green, B Lee

2013-05-01

Racial and ethnic minorities have disproportionately higher cancer incidence and mortality than their White counterparts. In response to this inequity in cancer prevention and care, community-based lay health advisors (LHAs) may be suited to deliver effective, culturally relevant, quality cancer education, prevention/screening, and early detection services for underserved populations. APPROACH AND STRATEGIES: Consistent with key tenets of community-based participatory research (CBPR), this project engaged community partners to develop and implement a unique LHA training curriculum to address cancer health disparities among medically underserved communities in a tricounty area. Seven phases of curriculum development went into designing a final seven-module LHA curriculum. In keeping with principles of CBPR and community engagement, academic-community partners and LHAs themselves were involved at all phases to ensure the needs of academic and community partners were mutually addressed in development and implementation of the LHA program. Community-based LHA programs for outreach, education, and promotion of cancer screening and early detection, are ideal for addressing cancer health disparities in access and quality care. When community-based LHAs are appropriately recruited, trained, and located in communities, they provide unique opportunities to link, bridge, and facilitate quality cancer education, services, and research.

Community strategies to address cancer disparities in Appalachian Kentucky.

Science.gov (United States)

Schoenberg, Nancy E; Howell, Britteny M; Fields, Nell

2012-01-01

Central Appalachian residents suffer disproportionate health disparities, including an all-cancer mortality rate 17% higher than the general population. During 10 focus groups and 19 key informant interviews, 91 Appalachian residents identified cancer screening challenges and strategies. Challenges included (1) inadequate awareness of screening need, (2) insufficient access to screening, and (3) lack of privacy. Strategies included (1) witnessing/storytelling, (2) capitalizing on family history, (3) improving publicity about screening resources, (4) relying on lay health advisors, and (5) bundling preventive services. These insights shaped our community-based participatory research intervention and offered strategies to others working in Appalachia, rural locales, and other traditionally underserved communities.

Disparities in the survivorship experience among Latina survivors of breast cancer.

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Olagunju, Tinuke O; Liu, Yihang; Liang, Li-Jung; Stomber, James M; Griggs, Jennifer J; Ganz, Patricia A; Thind, Amardeep; Maly, Rose C

2018-04-06

The authors investigated disparities in the survivorship experience among Latinas with breast cancer (BC) in comparison with non-Latinas. A cross-sectional bilingual telephone survey was conducted among 212 Latina and non-Latina women within 10 to 24 months after a diagnosis of BC (AJCC TNM staging system stage 0-III) at 2 Los Angeles County public hospitals. Data were collected using the Preparing for Life as a (New) Survivor (PLANS) scale, Perceived Efficacy in Patient-Physician Interactions Questionnaire (PEPPI), Breast Cancer Prevention Trial (BCPT) Symptom Checklist, Satisfaction with Care and Information Scale, Consumer Assessment of Healthcare Providers and Systems (CAHPS) tool, Charlson Comorbidity Index adapted for patient self-report, and the 12-item Short Form Health Survey. Controlling variables included age, stage as determined by the American Joint Committee on Cancer (AJCC) TNM staging system, educational level, and study site in multivariate analyses. The mean ages of Latinas and non-Latinas were 51.5 years and 56.6 years, respectively. Compared with non-Latinas, Latinas reported less BC survivorship knowledge (27.3 vs 30.7; Psatisfaction with BC survivorship care (9.6 vs 8.8; P = .298), or their discussion with physicians (9.6 vs 8.1; P = .07). These ethnic group differences persisted in multivariate analyses, with the exception of PEPPI. Latina survivors of BC experienced disparities in BC knowledge and satisfaction with information received, but believed themselves to be prepared for survivorship and were as satisfied with providers, care received, and discussions with physicians as non-Latinas. Cancer 2018. © 2018 American Cancer Society. © 2018 American Cancer Society.

Cancer statistics for African Americans, 2016: Progress and opportunities in reducing racial disparities.

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DeSantis, Carol E; Siegel, Rebecca L; Sauer, Ann Goding; Miller, Kimberly D; Fedewa, Stacey A; Alcaraz, Kassandra I; Jemal, Ahmedin

2016-07-01

In this article, the American Cancer Society provides the estimated number of new cancer cases and deaths for blacks in the United States and the most recent data on cancer incidence, mortality, survival, screening, and risk factors for cancer. Incidence data are from the National Cancer Institute, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries, and mortality data are from the National Center for Health Statistics. Approximately 189,910 new cases of cancer and 69,410 cancer deaths will occur among blacks in 2016. Although blacks continue to have higher cancer death rates than whites, the disparity has narrowed for all cancers combined in men and women and for lung and prostate cancers in men. In contrast, the racial gap in death rates has widened for breast cancer in women and remained level for colorectal cancer in men. The reduction in overall cancer death rates since the early 1990s translates to the avoidance of more than 300,000 deaths among blacks. In men, incidence rates from 2003 to 2012 decreased for all cancers combined (by 2.0% per year) as well as for the top 3 cancer sites (prostate, lung, and colorectal). In women, overall rates during the corresponding time period remained unchanged, reflecting increasing trends in breast cancer combined with decreasing trends in lung and colorectal cancer rates. Five-year relative survival is lower for blacks than whites for most cancers at each stage of diagnosis. The extent to which these disparities reflect unequal access to health care versus other factors remains an active area of research. Progress in reducing cancer death rates could be accelerated by ensuring equitable access to prevention, early detection, and high-quality treatment. CA Cancer J Clin 2016;66:290-308. © 2016 American Cancer Society. © 2016 American Cancer Society, Inc.

Model-based analyses to compare health and economic outcomes of cancer control: inclusion of disparities.

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Goldie, Sue J; Daniels, Norman

2011-09-21

Disease simulation models of the health and economic consequences of different prevention and treatment strategies can guide policy decisions about cancer control. However, models that also consider health disparities can identify strategies that improve both population health and its equitable distribution. We devised a typology of cancer disparities that considers types of inequalities among black, white, and Hispanic populations across different cancers and characteristics important for near-term policy discussions. We illustrated the typology in the specific example of cervical cancer using an existing disease simulation model calibrated to clinical, epidemiological, and cost data for the United States. We calculated average reduction in cancer incidence overall and for black, white, and Hispanic women under five different prevention strategies (Strategies A1, A2, A3, B, and C) and estimated average costs and life expectancy per woman, and the cost-effectiveness ratio for each strategy. Strategies that may provide greater aggregate health benefit than existing options may also exacerbate disparities. Combining human papillomavirus vaccination (Strategy A2) with current cervical cancer screening patterns (Strategy A1) resulted in an average reduction of 69% in cancer incidence overall but a 71.6% reduction for white women, 68.3% for black women, and 63.9% for Hispanic women. Other strategies targeting risk-based screening to racial and ethnic minorities reduced disparities among racial subgroups and resulted in more equitable distribution of benefits among subgroups (reduction in cervical cancer incidence, white vs. Hispanic women, 69.7% vs. 70.1%). Strategies that employ targeted risk-based screening and new screening algorithms, with or without vaccination (Strategies B and C), provide excellent value. The most effective strategy (Strategy C) had a cost-effectiveness ratio of $28,200 per year of life saved when compared with the same strategy without

Rural Women's Perceptions About Cancer Disparities and Contributing Factors: a Call to Communication.

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Molina, Yamile; Zimmermann, Kristine; Carnahan, Leslie R; Paulsey, Ellen; Bigman, Cabral A; Khare, Manorama M; Zahnd, Whitney; Jenkins, Wiley D

2017-02-27

Rural cancer disparities are increasingly documented in the USA. Research has identified and begun to address rural residents' cancer knowledge and behaviors, especially among women. Little, however, is known about rural female residents' awareness of cancer inequities and perceived contributing factors affecting them and their families. The purpose of this study was to address these gaps in the literature via a secondary analysis of qualitative needs assessment in Illinois' rural southernmost seven counties, a geographic region with relatively high rates of cancer incidence, morbidity, and mortality. A convenience sample of 202 rural adult female residents was recruited and participated in 26 focus groups, with 3-13 women per group. Inductive content analysis, guided by the principle of constant comparison, was used to analyze the qualitative data. Most respondents indicated their awareness of disproportionate cancer burden in their communities. Individual-level behaviors and environmental toxins were identified as contributing factors. Interestingly, however, environmental toxins were more often discussed as factors contributing to geographic differences, whereas individual-level behaviors were noted as important for overall cancer prevention and control. This study provides important insight into female rural residents' perspectives and offers novel venues for educational programs and research in the context of communication to eliminate disparities.

Localization and upregulation of survivin in cancer health disparities: a clinical perspective

Directory of Open Access Journals (Sweden)

Khan S

2015-07-01

Full Text Available Salma Khan,1,2 Heather Ferguson Bennit,1,2 Malyn May Asuncion Valenzuela,1,2 David Turay,1,3 Carlos J Diaz Osterman,1,2 Ron B Moyron,1,2 Grace E Esebanmen,1,2 Arjun Ashok,1,2 Nathan R Wall1,2 1Department of Biochemistry, 2Center for Health Disparities and Molecular Medicine, 3Department of Anatomy, Loma Linda University School of Medicine, Loma Linda, CA, USA Abstract: Survivin is one of the most important members of the inhibitors of apoptosis protein family, as it is expressed in most human cancers but is absent in normal, differentiated tissues. Lending to its importance, survivin has proven associations with apoptosis and cell cycle control, and has more recently been shown to modulate the tumor microenvironment and immune evasion as a result of its extracellular localization. Upregulation of survivin has been found in many cancers including breast, prostate, pancreatic, and hematological malignancies, and it may prove to be associated with the advanced presentation, poorer prognosis, and lower survival rates observed in ethnically diverse populations. Keywords: survivin, cancer, exosomes, health disparity

Analysis of PSPHL as a Candidate Gene Influencing the Racial Disparity in Endometrial Cancer

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Allard, Jay E. [Walter Reed Army Medical Center, Washington, DC (United States); Chandramouli, Gadisetti V. R. [Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University College of Human Medicine, Grand Rapids, MI (United States); Stagliano, Katherine [Curtis and Elizabeth Anderson Cancer Institute at Memorial Health University Medical Center, Savannah, GA (United States); Hood, Brian L. [Women’s Health Integrated Research Center at Inova Health System, Annandale, VA (United States); Litzi, Tracy [Walter Reed Army Medical Center, Washington, DC (United States); Women’s Health Integrated Research Center at Inova Health System, Annandale, VA (United States); Shoji, Yutaka [Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University College of Human Medicine, Grand Rapids, MI (United States); Curtis and Elizabeth Anderson Cancer Institute at Memorial Health University Medical Center, Savannah, GA (United States); Boyd, Jeff [Curtis and Elizabeth Anderson Cancer Institute at Memorial Health University Medical Center, Savannah, GA (United States); Fox Chase Cancer Center, Philadelphia, PA (United States); Berchuck, Andrew [Division of Gynecologic Oncology, Duke University, Durham, NC (United States); Conrads, Thomas P. [Curtis and Elizabeth Anderson Cancer Institute at Memorial Health University Medical Center, Savannah, GA (United States); Maxwell, G. Larry [Walter Reed Army Medical Center, Washington, DC (United States); Women’s Health Integrated Research Center at Inova Health System, Annandale, VA (United States); Risinger, John I., E-mail: john.risinger@hc.msu.edu [Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University College of Human Medicine, Grand Rapids, MI (United States); Curtis and Elizabeth Anderson Cancer Institute at Memorial Health University Medical Center, Savannah, GA (United States)

2012-07-04

Endometrial cancer is the most commonly diagnosed gynecologic malignancy in the United States. A well recognized disparity by race in both incidence and survival outcome exists for this cancer. Specifically Caucasians are about two times more likely to develop endometrial cancer than are African-Americans. However, African-American women are more likely to die from this disease than are Caucasians. The basis for this disparity remains unknown. Previous studies have identified differences in the types and frequencies of gene mutations among endometrial cancers from Caucasians and African-Americans suggesting that the tumors from these two groups might have differing underlying genetic defects. We performed a gene expression microarray study in an effort to identify differentially expressed transcripts between African-American and Caucasian women’s endometrial cancers. Our gene expression screen identified a list of potential biomarkers that are differentially expressed between these two groups of cancers. Of these we identified a poorly characterized transcript with a region of homology to phospho serine phosphatase (PSPH) and designated phospho serine phosphatase like (PSPHL) as the most differentially over-expressed gene in cancers from African-Americans. We further clarified the nature of expressed transcripts. Northern blot analysis confirmed the message was limited to a transcript of under 1 kB. Sequence analysis of transcripts confirmed two alternate open reading frame (ORF) isoforms due to alternative splicing events. Splice specific primer sets confirmed both isoforms were differentially expressed in tissues from Caucasians and African-Americans. We further examined the expression in other tissues from women to include normal endometrium, normal and malignant ovary. In all cases PSPHL expression was more often present in tissues from African-Americans than Caucasians. Our data confirm the African-American based expression of the PSPHL transcript in

Analysis of PSPHL as a Candidate Gene Influencing the Racial Disparity in Endometrial Cancer

International Nuclear Information System (INIS)

Allard, Jay E.; Chandramouli, Gadisetti V. R.; Stagliano, Katherine; Hood, Brian L.; Litzi, Tracy; Shoji, Yutaka; Boyd, Jeff; Berchuck, Andrew; Conrads, Thomas P.; Maxwell, G. Larry; Risinger, John I.

2012-01-01

Endometrial cancer is the most commonly diagnosed gynecologic malignancy in the United States. A well recognized disparity by race in both incidence and survival outcome exists for this cancer. Specifically Caucasians are about two times more likely to develop endometrial cancer than are African-Americans. However, African-American women are more likely to die from this disease than are Caucasians. The basis for this disparity remains unknown. Previous studies have identified differences in the types and frequencies of gene mutations among endometrial cancers from Caucasians and African-Americans suggesting that the tumors from these two groups might have differing underlying genetic defects. We performed a gene expression microarray study in an effort to identify differentially expressed transcripts between African-American and Caucasian women’s endometrial cancers. Our gene expression screen identified a list of potential biomarkers that are differentially expressed between these two groups of cancers. Of these we identified a poorly characterized transcript with a region of homology to phospho serine phosphatase (PSPH) and designated phospho serine phosphatase like (PSPHL) as the most differentially over-expressed gene in cancers from African-Americans. We further clarified the nature of expressed transcripts. Northern blot analysis confirmed the message was limited to a transcript of under 1 kB. Sequence analysis of transcripts confirmed two alternate open reading frame (ORF) isoforms due to alternative splicing events. Splice specific primer sets confirmed both isoforms were differentially expressed in tissues from Caucasians and African-Americans. We further examined the expression in other tissues from women to include normal endometrium, normal and malignant ovary. In all cases PSPHL expression was more often present in tissues from African-Americans than Caucasians. Our data confirm the African-American based expression of the PSPHL transcript in

Special Issue on Global Health Disparities Focus on Cancer.

Science.gov (United States)

Lee, Haeok

2016-01-01

Haeok Lee, PhD, RN, FAAN who is a Korean-American nurse scientist, received her doctor al degree from the Nursing Physiology Department, College of Nursing, University of California, San Francisco (UCSF), in 1993, and her post doctor al training from College of Medicine, UCSF. Dr. Lee worked at Case Western Reserve University and University of Colorado Health Sciences Center. She has worked at the UMass Boston since 2008. Dr. Lee has established a long-term commitment to minority health, especially Asian American Pacific Islanders, as a community leader, community health educator, and community researcher, and all these services have become a foundation for her community-based participatory research. Dr. Lee's research addresses current health problems framed in the context of social, political, and economic settings, and her studies have improved racial and ethnic data and developed national health policies to address health disparities in hepatitis B virus (HBV) infections and liver cancer among minorities. Dr. Lee's research, which is noteworthy for its theoretical base, is clearly filling the gap. Especially, Dr. Lee's research is beginning to have a favorable impact on national and international health policies and continuing education programs directed toward the global elimination of cervical and liver cancer-related health disparities in underserved and understudied populations.

PSPHL as a candidate gene influencing racial disparities in endometrial cancer incidence and survival

Directory of Open Access Journals (Sweden)

Jay eAllard

2012-07-01

Full Text Available Endometrial cancer is the most commonly diagnosed gynecologic malignancy in the United States and is characterized by a well recognized racial disparity in both incidence and survival. Specifically Caucasians are about two times more likely to develop endometrial cancer than are African Americans. However, African American women are more likely to die from this disease than are Caucasians. The basis for this disparity remains unknown. Previous studies have identified differences in the types and frequencies of gene mutations among endometrial cancers from Caucasians and African Americans suggesting. We performed a gene expression microarray study in an effort to further examine differences between African American and Caucasian women’s endometrial cancers. This expression screen identified a list of potential biomarkers differentially expressed between these two groups of cancers. Of these we identified a poorly characterized transcript with a region of homology to phospho serine phospatase (PSPH and designated phospho serine phospatase like (PSPHL as the most differentially over-expressed gene in cancers from African Americans. We clarified the nature of expressed transcripts. Northern blot analysis confirmed PSPHL messages under 1 KB. Sequence analysis of transcripts confirmed two alternate open reading frame (ORF isoforms due to alternative splicing events. Splice specific primer sets confirmed both isoforms were differentially expressed in tissues from Caucasians and African Americans. We further examined the expression in other tissues from women to include normal endometrium, normal and malignant ovary. In all cases PSPHL expression was more often present in tissues from African-Americans than Caucasians. Our data confirm the African-American based expression of the PSPHL transcript several tissue types. PSPHL represents a candidate gene that might influence the observed racial disparity in endometrial and other cancers.

Socioeconomic and clinical factors are key to uncovering disparity in accrual onto therapeutic trials for breast cancer.

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Behrendt, Carolyn E; Hurria, Arti; Tumyan, Lusine; Niland, Joyce C; Mortimer, Joanne E

2014-11-01

To monitor and address disparity in accrual, patient participation in cancer clinical trials is routinely summarized by race/ethnicity. To investigate whether confounding obscures racial/ethnic disparity in participation, all women with breast cancer treated by medical oncologists at City of Hope Comprehensive Cancer Center from 2004 through 2009 were classified by birthplace and self-reported race/ethnicity, and followed for accrual onto therapeutic trials through 2010. Undetectable on univariate analysis, significantly reduced participation by subjects of African, Asian, Eastern European, Latin American, and Middle Eastern ancestries was revealed after accounting for age, socioeconomic factors, tumor and oncologist characteristics, and intrapractice clustering of patients. Copyright © 2014 by the National Comprehensive Cancer Network.

Contribution of screening and survival differences to racial disparities in colorectal cancer rates

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Lansdorp-Vogelaar, Iris; Kuntz, Karen M.; Knudsen, Amy B.; van Ballegooijen, Marjolein; Zauber, Ann G.; Jemal, Ahmedin

2012-01-01

Background Considerable disparities exist in colorectal cancer (CRC) incidence and mortality rates between blacks and whites in the US. We estimated how much of these disparities could be explained by differences in CRC screening and stage-specific relative CRC survival. Methods We used the MISCAN-Colon microsimulation model to estimate CRC incidence and mortality rates in blacks aged 50 years and older from 1975 to 2007 assuming they had: 1) the same trends in screening rates as whites instead of observed screening rates (incidence and mortality); and 2) the same trends in stage-specific relative CRC survival rates as whites instead of observed (mortality only); and 3) a combination of both. The racial disparities in CRC incidence and mortality rates attributable to differences in screening and/or stage-specific relative CRC survival were then calculated by comparing rates from these scenarios to the observed black rates. Results Differences in screening account for 42% of disparity in CRC incidence and 19% of disparity in CRC mortality between blacks and whites. 36% of the disparity in CRC mortality could be attributed to differences in stage-specific relative CRC survival. Together screening and survival explained a little over 50% of the disparity in CRC mortality between blacks and whites. Conclusion Differences in screening and relative CRC survival are responsible for a considerable proportion of the observed disparities in CRC incidence and mortality rates between blacks and whites. Impact Enabling blacks to achieve equal access to care as whites could substantially reduce the racial disparities in CRC burden. PMID:22514249

Cancer Health Disparities Research: Where have we been and where should we go?

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Scarlett Lin Gomez, PhD, MPH, is Professor in the Department of Epidemiology and Biostatistics and a member of the Helen Diller Family Comprehensive Cancer Center at the University of California, San Francisco. She is also Director of the Greater Bay Area Cancer Registry, a part of the California Cancer Registry and the NCI Surveillance Epidemiology End Results (SEER) Program. Her research focuses primarily on cancer health disparities and aims to understand the multilevel drivers of those disparities. She has contributed surveillance data regarding cancer incidence and outcome patterns and trends for distinct Asian American, Native Hawaiian, and Pacific Islander and Hispanic ethnic groups, as well as cancer patterns by nativity status and neighborhood characteristics. She developed the California Neighborhoods Data System, a compilation of small-area level data on social and built environment characteristics, and has used these data in more than a dozen funded studies to evaluate the impact of social and built neighborhood environment factors on disease outcomes. Since 1996, Dr. Lin Gomez has received many honors and awards, including being named Author of the Year in 2010 by the American Journal of Public Health, the Above and Beyond Excellence Award in 2012 and the Mentoring Award in 2014, both by the Cancer Prevention Institute of California. She completed her education in epidemiology with an MPH at the University of Michigan, Ann Arbor, and her PhD at Stanford.

Black-White Disparities in Breast Cancer Subtype: The Intersection of Socially Patterned Stress and Genetic Expression

Directory of Open Access Journals (Sweden)

Erin Linnenbringer

2017-11-01

Full Text Available Hormone receptor negative (HR- breast cancer subtypes are etiologically distinct from the more common, less aggressive, and more treatable form of estrogen receptor positive (ER+ breast cancer. Numerous population-based studies have found that, in the United States, Black women are 2 to 3 times more likely to develop HR- breast cancer than White women. Much of the existing research on racial disparities in breast cancer subtype has focused on identifying predisposing genetic factors associated with African ancestry. This approach fails to acknowledge that racial stratification shapes a wide range of environmental and social exposures over the life course. Human stress genomics considers the role of individual stress perceptions on gene expression. Yet, the role of structurally rooted biopsychosocial processes that may be activated by the social patterning of stressors in an historically unequal society, whether perceived by individual black women or not, could also impact cellular physiology and gene expression patterns relevant to HR- breast cancer etiology. Using the weathering hypothesis as our conceptual framework, we develop a structural perspective for examining racial disparities in breast cancer subtypes, integrating important findings from the stress biology, breast cancer epidemiology, and health disparities literatures. After integrating key findings from these largely independent literatures, we develop a theoretically and empirically guided framework for assessing potential multilevel factors relevant to the development of HR- breast cancer disproportionately among Black women in the US. We hypothesize that a dynamic interplay among socially patterned psychosocial stressors, physiological & behavioral responses, and genomic pathways contribute to the increased risk of HR- breast cancer among Black women. This work provides a basis for exploring potential alternative pathways linking the lived experience of race to the risk of HR

Black-White Disparities in Breast Cancer Subtype: The Intersection of Socially Patterned Stress and Genetic Expression.

Science.gov (United States)

Linnenbringer, Erin; Gehlert, Sarah; Geronimus, Arline T

2017-01-01

Hormone receptor negative (HR-) breast cancer subtypes are etiologically distinct from the more common, less aggressive, and more treatable form of estrogen receptor positive (ER+) breast cancer. Numerous population-based studies have found that, in the United States, Black women are 2 to 3 times more likely to develop HR- breast cancer than White women. Much of the existing research on racial disparities in breast cancer subtype has focused on identifying predisposing genetic factors associated with African ancestry. This approach fails to acknowledge that racial stratification shapes a wide range of environmental and social exposures over the life course. Human stress genomics considers the role of individual stress perceptions on gene expression. Yet, the role of structurally rooted biopsychosocial processes that may be activated by the social patterning of stressors in an historically unequal society, whether perceived by individual black women or not, could also impact cellular physiology and gene expression patterns relevant to HR- breast cancer etiology. Using the weathering hypothesis as our conceptual framework, we develop a structural perspective for examining racial disparities in breast cancer subtypes, integrating important findings from the stress biology, breast cancer epidemiology, and health disparities literatures. After integrating key findings from these largely independent literatures, we develop a theoretically and empirically guided framework for assessing potential multilevel factors relevant to the development of HR- breast cancer disproportionately among Black women in the US. We hypothesize that a dynamic interplay among socially patterned psychosocial stressors, physiological & behavioral responses, and genomic pathways contribute to the increased risk of HR- breast cancer among Black women. This work provides a basis for exploring potential alternative pathways linking the lived experience of race to the risk of HR- breast cancer, and

Individual and Neighborhood Socioeconomic Status and Healthcare Resources in Relation to Black-White Breast Cancer Survival Disparities

Directory of Open Access Journals (Sweden)

Tomi F. Akinyemiju

2013-01-01

Full Text Available Background. Breast cancer survival has improved significantly in the US in the past 10–15 years. However, disparities exist in breast cancer survival between black and white women. Purpose. To investigate the effect of county healthcare resources and SES as well as individual SES status on breast cancer survival disparities between black and white women. Methods. Data from 1,796 breast cancer cases were obtained from the Surveillance Epidemiology and End Results and the National Longitudinal Mortality Study dataset. Cox Proportional Hazards models were constructed accounting for clustering within counties. Three sequential Cox models were fit for each outcome including demographic variables; demographic and clinical variables; and finally demographic, clinical, and county-level variables. Results. In unadjusted analysis, black women had a 53% higher likelihood of dying of breast cancer and 32% higher likelihood of dying of any cause (P<0.05 compared with white women. Adjusting for demographic variables explained away the effect of race on breast cancer survival (HR, 1.40; 95% CI, 0.99–1.97, but not on all-cause mortality. The racial difference in all-cause survival disappeared only after adjusting for county-level variables (HR, 1.27; CI, 0.95–1.71. Conclusions. Improving equitable access to healthcare for all women in the US may help eliminate survival disparities between racial and socioeconomic groups.

Racial, socioeconomic, and demographic disparities in access to fertility preservation in young women diagnosed with cancer.

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Letourneau, Joseph M; Smith, James F; Ebbel, Erin E; Craig, Amaranta; Katz, Patricia P; Cedars, Marcelle I; Rosen, Mitchell P

2012-09-15

This study seeks to examine the relation between sociodemographic characteristics and the utilization of fertility preservation services in reproductive age women diagnosed with cancer. A total of 1041 women diagnosed with cancer between the ages of 18 and 40 years responded to a retrospective survey on demographic information and reproductive health history. Five cancer types were included: leukemia, Hodgkin disease, non-Hodgkin lymphoma, breast cancer, and gastrointestinal cancer. Nine hundred eighteen women reported treatment with potential to affect fertility (chemotherapy, pelvic radiation, pelvic surgery, or bone marrow transplant). Student t test, linear regression, and multivariate logistic regression were used where appropriate to determine the relation between sociodemographic characteristics and the odds of using fertility preservation services. Sixty-one percent of women were counseled on the risk of cancer treatment to fertility by the oncology team. Overall, 4% of women pursued fertility preservation. In multivariate analysis, women who had not attained a bachelor's degree (odds ratio [OR], 0.7; 95% confidence interval [CI], 0.5-0.9) were less likely to be counseled. Trends also suggested possible disparities in access to fertility preservation with age older than 35 years (OR, 0.1; 95% CI, 0.0-1.4) or previous children (OR, 0.3; 95% CI, 0.1-1.1) at diagnosis. Disparities in access to fertility preservation based on ethnicity and sexual orientation were also observed. Sociodemographic health disparities likely affect access to fertility preservation services. Although awareness of fertility preservation has improved in the past decade, an unmet need remains for reproductive health counseling and fertility preservation in reproductive age women diagnosed with cancer. Copyright © 2012 American Cancer Society.

Racial disparities in the development of breast cancer metastases among older women: a multilevel study.

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Schootman, Mario; Jeffe, Donna B; Gillanders, William E; Aft, Rebecca

2009-02-15

Distant metastases are the most common and lethal type of breast cancer relapse. The authors examined whether older African American breast cancer survivors were more likely to develop metastases compared with older white women. They also examined the extent to which 6 pathways explained racial disparities in the development of metastases. The authors used 1992-1999 Surveillance, Epidemiology, and End Results (SEER) data with 1991-1999 Medicare data. They used Medicare's International Classification of Diseases, Ninth Revision, Clinical Modification codes to identify metastases of respiratory and digestive systems, brain, bone, or other unspecified sites. The 6 pathways consisted of patient characteristics, tumor characteristics, type of treatment received, access to medical care, surveillance mammography use, and area-level characteristics (poverty rate and percentage African American) and were obtained from the SEER or Medicare data. Of the 35,937 women, 10.5% developed metastases. In univariate analysis, African American women were 1.61 times (95% confidence interval [CI], 1.54-1.83) more likely to develop metastasis than white women. In multivariate analysis, tumor grade, stage at diagnosis, and census-tract percentage African American explained why African American women were more likely to develop metastases than white women (hazard ratio, 0.84; 95% CI, 0.68-1.03). Interventions to reduce late-stage breast cancer among African Americans also may reduce racial disparities in subsequent increased risk of developing metastasis. African Americans diagnosed with high-grade breast cancer could be targeted to reduce their risk of metastasis. Future studies should identify specific reasons why the racial distribution in census tracts was associated with racial disparities in the risk of breast cancer metastases. (c) 2009 American Cancer Society.

Identifying DNA Methylation Features that Underlie Prostate Cancer Disparities

Science.gov (United States)

2017-10-01

15.3%) NA 6 (6%) 6 (5.4%) Prostate - specific Antigen (PSA) ng/mL 76.7 (42.9) 78.2 (40.7) pTNM Stage T2 68 (67.3%) 48 (43.2%) T3 29 (28.7%) 58...Profiles Primary Aim #1: Determine if methylation profiles differ by race/ancestry Primary Aim #2: Identify ethnicity- specific markers of prostate ...by ethnicity and to identify ethnicity- specific methylation features of prostate cancer that could contribute the racial disparities that exist in

Gender Identity Disparities in Cancer Screening Behaviors.

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Tabaac, Ariella R; Sutter, Megan E; Wall, Catherine S J; Baker, Kellan E

2018-03-01

Transgender (trans) and gender-nonconforming adults have reported reduced access to health care because of discrimination and lack of knowledgeable care. This study aimed to contribute to the nascent cancer prevention literature among trans and gender-nonconforming individuals by ascertaining rates of breast, cervical, prostate, and colorectal cancer screening behaviors by gender identity. Publicly available de-identified data from the 2014-2016 Behavioral Risk Factor Surveillance System surveys were utilized to evaluate rates of cancer screenings by gender identity, while controlling for healthcare access, sociodemographics, and survey year. Analyses were conducted in 2017. Weighted chi-square tests identified significant differences in the proportion of cancer screening behaviors by gender identity among lifetime colorectal cancer screenings, Pap tests, prostate-specific antigen tests, discussing prostate-specific antigen test advantages/disadvantages with their healthcare provider, and up-to-date colorectal cancer screenings and Pap tests (pgender identity were fully explained by covariates, trans women had reduced odds of having up-to-date colorectal cancer screenings compared to cisgender (cis) men (AOR=0.20) and cis women (AOR=0.24), whereas trans men were more likely to ever receive a sigmoidoscopy/colonoscopy as compared to cis men (AOR=2.76) and cis women (AOR=2.65). Trans women were more likely than cis men to have up-to-date prostate-specific antigen tests (AOR=3.19). Finally, trans men and gender-nonconforming individuals had reduced odds of lifetime Pap tests versus cis women (AOR=0.14 and 0.08, respectively), and gender-nonconforming individuals had lower odds of discussing prostate-specific antigen tests than cis men (AOR=0.09; all pgender identity disparities in cancer screenings persist beyond known sociodemographic and healthcare factors. It is critical that gender identity questions are included in cancer and other health-related surveillance

Meta-analysis of racial disparities in survival in association with socioeconomic status among men and women with colon cancer.

Science.gov (United States)

Du, Xianglin L; Meyer, Tamra E; Franzini, Luisa

2007-06-01

Few studies have addressed racial disparities in survival for colon cancer by adequately incorporating both treatment and socioeconomic factors, and the findings from those studies have been inconsistent. The objectives of the current study were to systematically review the existing literature and provide a more stable estimate of the measures of association between socioeconomic status and racial disparities in survival for colon cancer by undertaking a meta-analysis. For this meta-analysis, the authors searched the MEDLINE database to identify articles published in English from 1966 to August 2006 that met the following inclusion criteria: original research articles that addressed the association between race/ethnicity and survival in patients with colon or colorectal cancer after adjusting for socioeconomic status. In total, 66 full articles were reviewed, and 56 of those articles were excluded, which left 10 studies for the final analysis. The pooled hazard ratio (HR) for African Americans compared with Caucasians was 1.14 (95% confidence interval [95% CI], 1.00-1.29) for all-cause mortality and 1.13 (95% CI, 1.01-1.28) for colon cancer-specific mortality. The test for homogeneity of the HR was statistically significant across the studies for all-cause mortality (Q=31.69; Pcolon cancer-specific mortality (Q=7.45; P=.114). Racial disparities in survival for colon cancer between African Americans and Caucasians were only marginally significant after adjusting for socioeconomic factors and treatment. Attempts to modify treatment and socioeconomic factors with the objective of reducing racial disparities in health outcomes may have important clinical and public health implications. (c) 2007 American Cancer Society.

Individual and Neighborhood Socioeconomic Status and Health care Resources in Relation to Black-White Breast Cancer Survival Disparities

International Nuclear Information System (INIS)

Akinyemiju, T. F.

2013-01-01

Breast cancer survival has improved significantly in the US in the past 10-15 years. However, disparities exist in breast cancer survival between black and white women. Purpose. To investigate the effect of county health care resources and SES as well as individual SES status on breast cancer survival disparities between black and white women. Methods. Data from 1,796 breast cancer cases were obtained from the Surveillance Epidemiology and End Results and the National Longitudinal Mortality Study dataset. Cox Proportional Hazards models were constructed accounting for clustering within counties. Three sequential Cox models were fit for each outcome including demographic variables; demographic and clinical variables; and finally demographic, clinical, and county-level variables. Results. In unadjusted analysis, black women had a 53% higher likelihood of dying of breast cancer and 32% higher likelihood of dying of any cause ( P < 0.05) compared with white women. Adjusting for demographic variables explained away the effect of race on breast cancer survival (HR, 1.40; 95% CI, 0.99-1.97), but not on all-cause mortality. The racial difference in all-cause survival disappeared only after adjusting for county-level variables (HR, 1.27; CI, 0.95-1.71). Conclusions. Improving equitable access to health care for all women in the US may help eliminate survival disparities between racial and socioeconomic groups.

Effect of Diabetes and Obesity on Disparities in Prostate Cancer Outcomes

Science.gov (United States)

2016-10-01

AWARD NUMBER: W81XWH-14-1-0503 TITLE: Effect of Diabetes and Obesity on Disparities in Prostate Cancer Outcomes PRINCIPAL INVESTIGATOR: Bettina F...FOR: U.S. Army Medical Research and Materiel Command Fort Detrick, Maryland 21702-5012 DISTRIBUTION STATEMENT : Approved for Public Release...Department of the Army position , policy or decision unless so designated by other documentation. REPORT DOCUMENTATION PAGE Form Approved OMB No

Assessing the Racial and Ethnic Disparities in Breast Cancer Mortality in the United States.

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Yedjou, Clement G; Tchounwou, Paul B; Payton, Marinelle; Miele, Lucio; Fonseca, Duber D; Lowe, Leroy; Alo, Richard A

2017-05-05

Breast cancer is the second leading cause of cancer related deaths among women aged 40-55 in the United States and currently affects more than one in ten women worldwide. It is also one of the most diagnosed cancers in women both in wealthy and poor countries. Fortunately, the mortality rate from breast cancer has decreased in recent years due to increased emphasis on early detection and more effective treatments in White population. Although the mortality rates have declined in some ethnic populations, the overall cancer incidence among African American and Hispanic populations has continued to grow. The goal of the present review article was to highlight similarities and differences in breast cancer morbidity and mortality rates primarily among African American women compared to White women in the United States. To reach our goal, we conducted a search of articles in journals with a primary focus on minority health, and authors who had published articles on racial/ethnic disparity related to breast cancer patients. A systematic search of original research was conducted using MEDLINE, PUBMED and Google Scholar databases. We found that racial/ethnic disparities in breast cancer may be attributed to a large number of clinical and non-clinical risk factors including lack of medical coverage, barriers to early detection and screening, more advanced stage of disease at diagnosis among minorities, and unequal access to improvements in cancer treatment. Many African American women have frequent unknown or unstaged breast cancers than White women. These risk factors may explain the differences in breast cancer treatment and survival rate between African American women and White women. New strategies and approaches are needed to promote breast cancer prevention, improve survival rate, reduce breast cancer mortality, and ultimately improve the health outcomes of racial/ethnic minorities.

Disparities in quality of cancer care: The role of health insurance and population demographics.

Science.gov (United States)

Parikh-Patel, Arti; Morris, Cyllene R; Kizer, Kenneth W

2017-12-01

Escalating costs and concerns about quality of cancer care have increased calls for quality measurement and performance accountability for providers and health plans. The purpose of the present cross-sectional study was to assess variability in the quality of cancer care by health insurance type in California.Persons with breast, ovary, endometrium, cervix, colon, lung, or gastric cancer during the period 2004 to 2014 were identified in the California Cancer Registry. Individuals were stratified into 5 health insurance categories: private insurance, Medicare, Medicaid, dual Medicare and Medicaid eligible, and uninsured. Quality of care was evaluated using Commission on Cancer quality measures. Logistic regression models were generated to assess the independent effect of health insurance type on stage at diagnosis, quality of care and survival after adjusting for age, sex, race/ethnicity, and socioeconomic status (SES).A total of 763,884 cancer cases were evaluated. Individuals with Medicaid or Medicare-Medicaid dual-eligible coverage and the uninsured had significantly lower odds of receiving recommended radiation and/or chemotherapy after diagnosis or surgery for breast, endometrial, and colon cancer, relative to those with private insurance. Dual eligible patients with gastric cancer had 21% lower odds of having the recommended number of lymph nodes removed and examined compared to privately insured patients.After adjusting for known demographic confounders, substantial and consistent disparities in quality of cancer care exist according to type of health insurance in California. Further study is needed to identify particular factors and mechanisms underlying the identified treatment disparities across sources of health insurance. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

Advancing Social Workers' Responsiveness to Health Disparities: The Case of Breast Cancer Screening

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Altpeter, Mary; Mitchell, James F.; Pennell, Joan

2005-01-01

This study provides the basis for customizing culturally responsive social work health promotion programs aimed at eliminating breast cancer screening and mortality disparities between white and African American women. Survey data collected from a random sample of 853 women in rural North Carolina were used to explore the impact of psychosocial…

Addressing Breast Cancer Health Disparities in the Mississippi Delta Through an Innovative Partnership for Education, Detection, and Screening.

Science.gov (United States)

Mayfield-Johnson, Susan; Fastring, Danielle; Fortune, Melody; White-Johnson, Freddie

2016-06-01

Projects to reduce disparities in cancer treatment and research include collaborative partnerships and multiple strategies to promote community awareness, education, and engagement. This is especially needed in underserved areas such as the Mississippi Delta where more women are diagnosed at regional and distant stages of breast cancer. The purpose for this project was to increase the relatively low screening rate for African American women in the Mississippi Delta through a partnership between the Mississippi Network for Cancer Control and Prevention at The University of Southern Mississippi, The Fannie Lou Hamer Cancer Foundation and the Mississippi State Department of Health to decrease health disparities in breast cancer through increased awareness on self-early detection methods, leveraging resources to provide mammography screenings, and adequate follow-up with services and treatment for abnormal findings. Through this collaborative effort, over 500 women in three rural Mississippi Delta counties were identified, provided community education on early self-detection, and given appointments for mammography screenings within one fiscal year.

Economic, racial and ethnic disparities in breast cancer in the US: towards a more comprehensive model.

Science.gov (United States)

Campbell, Richard T; Li, Xue; Dolecek, Therese A; Barrett, Richard E; Weaver, Kathryn E; Warnecke, Richard B

2009-09-01

Using cancer registry data, we focus on racial and ethnic disparities in stage of breast cancer diagnosis in Cook County, IL. The county health system is the "last resort" health-care provider for low-income persons. Socioeconomic status is measured using empirical Bayes estimates of tract-level poverty, specific to non-Hispanic whites, non-Hispanic blacks or Hispanics in one of three age groups. We use ordinal logistic regression with non-proportional odds to model stage. Blacks and Hispanics are at greater risk for regional and distant stage diagnosis, but the disparity declines with age. Women in high-poverty areas are at substantially greater risk for late-stage diagnosis. The effects of poverty do not differ by age or across racial and ethnic groups.

Illuminating cancer health disparities using ethnogenetic layering (EL) and phenotype segregation network analysis (PSNA).

Science.gov (United States)

Jackson, Fatimah L C

2006-01-01

Resolving cancer health disparities continues to befuddle simplistic racial models. The racial groups alluded to in biomedicine, public health, and epidemiology are often profoundly substructured. EL and PSNA are computational assisted techniques that focus on microethnic group (MEG) substructure. Geographical variations in cancer may be due to differences in MEG ancestry or similar environmental exposures to a recognized carcinogen. Examples include breast and prostate cancers in the Chesapeake Bay region and Bight of Biafra biological ancestry, hypertension and stroke in the Carolina Coast region and Central African biological ancestry, and pancreatic cancer in the Mississippi Delta region and dietary/medicinal exposure to safrol from Sassafras albidum.

Age Disparity in Palliative Radiation Therapy Among Patients With Advanced Cancer

Energy Technology Data Exchange (ETDEWEB)

Wong, Jonathan [University of Hawaii, John A. Burns School of Medicine, Honolulu, Hawaii (United States); Xu, Beibei [Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California (United States); Moores Cancer Center, University of California San Diego, La Jolla, California (United States); Yeung, Heidi N.; Roeland, Eric J. [Moores Cancer Center, University of California San Diego, La Jolla, California (United States); Division of Palliative Medicine, Department of Internal Medicine, University of California San Diego, La Jolla, California (United States); Martinez, Maria Elena [Moores Cancer Center, University of California San Diego, La Jolla, California (United States); Department of Family and Preventive Medicine, University of California San Diego, La Jolla, California (United States); Le, Quynh-Thu [Department of Radiation Oncology, Stanford University, Stanford, California (United States); Mell, Loren K. [Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California (United States); Moores Cancer Center, University of California San Diego, La Jolla, California (United States); Murphy, James D., E-mail: j2murphy@ucsd.edu [Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California (United States); Moores Cancer Center, University of California San Diego, La Jolla, California (United States)

2014-09-01

Purpose/Objective: Palliative radiation therapy represents an important treatment option among patients with advanced cancer, although research shows decreased use among older patients. This study evaluated age-related patterns of palliative radiation use among an elderly Medicare population. Methods and Materials: We identified 63,221 patients with metastatic lung, breast, prostate, or colorectal cancer diagnosed between 2000 and 2007 from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. Receipt of palliative radiation therapy was extracted from Medicare claims. Multivariate Poisson regression analysis determined residual age-related disparity in the receipt of palliative radiation therapy after controlling for confounding covariates including age-related differences in patient and demographic covariates, length of life, and patient preferences for aggressive cancer therapy. Results: The use of radiation decreased steadily with increasing patient age. Forty-two percent of patients aged 66 to 69 received palliative radiation therapy. Rates of palliative radiation decreased to 38%, 32%, 24%, and 14% among patients aged 70 to 74, 75 to 79, 80 to 84, and over 85, respectively. Multivariate analysis found that confounding covariates attenuated these findings, although the decreased relative rate of palliative radiation therapy among the elderly remained clinically and statistically significant. On multivariate analysis, compared to patients 66 to 69 years old, those aged 70 to 74, 75 to 79, 80 to 84, and over 85 had a 7%, 15%, 25%, and 44% decreased rate of receiving palliative radiation, respectively (all P<.0001). Conclusions: Age disparity with palliative radiation therapy exists among older cancer patients. Further research should strive to identify barriers to palliative radiation among the elderly, and extra effort should be made to give older patients the opportunity to receive this quality of life-enhancing treatment at the end

Sociodemographic disparities in the utilization of proton therapy for prostate cancer at an urban academic center

Directory of Open Access Journals (Sweden)

Kristina D. Woodhouse, MD

2017-04-01

Conclusion: Sociodemographic disparities exist in PT use for prostate cancer at an urban academic institution. Further investigation of potential barriers to access is warranted to ensure equitable distribution across all demographic groups.

Disparities in Geographic Accessibility of National Cancer Institute Cancer Centers in the United States.

Science.gov (United States)

Xu, Yanqing; Fu, Cong; Onega, Tracy; Shi, Xun; Wang, Fahui

2017-11-11

The National Cancer Institute (NCI) Cancer Centers form the backbone of the cancer care system in the United States since their inception in the early 1970s. Most studies on their geographic accessibility used primitive measures, and did not examine the disparities across urbanicity or demographic groups. This research uses an advanced accessibility method, termed "2-step floating catchment area (2SFCA)" and implemented in Geographic Information Systems (GIS), to capture the degree of geographic access to NCI Cancer Centers by accounting for competition intensity for the services and travel time between residents and the facilities. The results indicate that urban advantage is pronounced as the average accessibility is highest in large central metro areas, declines to large fringe metro, medium metro, small metro, micropolitan and noncore rural areas. Population under the poverty line are disproportionally concentrated in lower accessibility areas. However, on average Non-Hispanic White have the lowest geographic accessibility, followed by Hispanic, Non-Hispanic Black and Asian, and the differences are statistically significant. The "reversed racial disadvantage" in NCI Cancer Center accessibility seems counterintuitive but is consistent with an influential prior study; and it is in contrast to the common observation of co-location of concentration of minority groups and people under the poverty line.

Network-Based Integration of Disparate Omic Data To Identify "Silent Players" in Cancer.

Directory of Open Access Journals (Sweden)

Matthew Ruffalo

2015-12-01

Full Text Available Development of high-throughput monitoring technologies enables interrogation of cancer samples at various levels of cellular activity. Capitalizing on these developments, various public efforts such as The Cancer Genome Atlas (TCGA generate disparate omic data for large patient cohorts. As demonstrated by recent studies, these heterogeneous data sources provide the opportunity to gain insights into the molecular changes that drive cancer pathogenesis and progression. However, these insights are limited by the vast search space and as a result low statistical power to make new discoveries. In this paper, we propose methods for integrating disparate omic data using molecular interaction networks, with a view to gaining mechanistic insights into the relationship between molecular changes at different levels of cellular activity. Namely, we hypothesize that genes that play a role in cancer development and progression may be implicated by neither frequent mutation nor differential expression, and that network-based integration of mutation and differential expression data can reveal these "silent players". For this purpose, we utilize network-propagation algorithms to simulate the information flow in the cell at a sample-specific resolution. We then use the propagated mutation and expression signals to identify genes that are not necessarily mutated or differentially expressed genes, but have an essential role in tumor development and patient outcome. We test the proposed method on breast cancer and glioblastoma multiforme data obtained from TCGA. Our results show that the proposed method can identify important proteins that are not readily revealed by molecular data, providing insights beyond what can be gleaned by analyzing different types of molecular data in isolation.

Disparities in Intratumoral Steroidogenesis

Science.gov (United States)

2017-12-01

cancer. The reasons for this racial disparity in prostate cancer incidence and mortality are unknown but may stem from economic , social, psychological...them are elevated in the prostate tumors of African American men. We further hypothesize that elevated cholesterol, which is an essential component of...cancer promotional effects of high cholesterol. Essentially , we anticipate the level of cholesterol reduction needed to protect the prostate will be

Geographical, temporal and racial disparities in late-stage prostate cancer incidence across Florida: A multiscale joinpoint regression analysis

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Goovaerts Pierre

2011-12-01

Full Text Available Abstract Background Although prostate cancer-related incidence and mortality have declined recently, striking racial/ethnic differences persist in the United States. Visualizing and modelling temporal trends of prostate cancer late-stage incidence, and how they vary according to geographic locations and race, should help explaining such disparities. Joinpoint regression is increasingly used to identify the timing and extent of changes in time series of health outcomes. Yet, most analyses of temporal trends are aspatial and conducted at the national level or for a single cancer registry. Methods Time series (1981-2007 of annual proportions of prostate cancer late-stage cases were analyzed for non-Hispanic Whites and non-Hispanic Blacks in each county of Florida. Noise in the data was first filtered by binomial kriging and results were modelled using joinpoint regression. A similar analysis was also conducted at the state level and for groups of metropolitan and non-metropolitan counties. Significant racial differences were detected using tests of parallelism and coincidence of time trends. A new disparity statistic was introduced to measure spatial and temporal changes in the frequency of racial disparities. Results State-level percentage of late-stage diagnosis decreased 50% since 1981; a decline that accelerated in the 90's when Prostate Specific Antigen (PSA screening was introduced. Analysis at the metropolitan and non-metropolitan levels revealed that the frequency of late-stage diagnosis increased recently in urban areas, and this trend was significant for white males. The annual rate of decrease in late-stage diagnosis and the onset years for significant declines varied greatly among counties and racial groups. Most counties with non-significant average annual percent change (AAPC were located in the Florida Panhandle for white males, whereas they clustered in South-eastern Florida for black males. The new disparity statistic indicated

Geographical, temporal and racial disparities in late-stage prostate cancer incidence across Florida: a multiscale joinpoint regression analysis.

Science.gov (United States)

Goovaerts, Pierre; Xiao, Hong

2011-12-05

Although prostate cancer-related incidence and mortality have declined recently, striking racial/ethnic differences persist in the United States. Visualizing and modelling temporal trends of prostate cancer late-stage incidence, and how they vary according to geographic locations and race, should help explaining such disparities. Joinpoint regression is increasingly used to identify the timing and extent of changes in time series of health outcomes. Yet, most analyses of temporal trends are aspatial and conducted at the national level or for a single cancer registry. Time series (1981-2007) of annual proportions of prostate cancer late-stage cases were analyzed for non-Hispanic Whites and non-Hispanic Blacks in each county of Florida. Noise in the data was first filtered by binomial kriging and results were modelled using joinpoint regression. A similar analysis was also conducted at the state level and for groups of metropolitan and non-metropolitan counties. Significant racial differences were detected using tests of parallelism and coincidence of time trends. A new disparity statistic was introduced to measure spatial and temporal changes in the frequency of racial disparities. State-level percentage of late-stage diagnosis decreased 50% since 1981; a decline that accelerated in the 90's when Prostate Specific Antigen (PSA) screening was introduced. Analysis at the metropolitan and non-metropolitan levels revealed that the frequency of late-stage diagnosis increased recently in urban areas, and this trend was significant for white males. The annual rate of decrease in late-stage diagnosis and the onset years for significant declines varied greatly among counties and racial groups. Most counties with non-significant average annual percent change (AAPC) were located in the Florida Panhandle for white males, whereas they clustered in South-eastern Florida for black males. The new disparity statistic indicated that the spatial extent of racial disparities reached a

Evaluating Disparities in Inpatient Surgical Cancer Care Among American Indian/Alaska Native Patients

Science.gov (United States)

Simianu, Vlad V.; Morris, Arden M.; Varghese, Thomas K.; Porter, Michael P.; Henderson, Jeffrey A.; Buchwald, Dedra S.; Flum, David R.; Javid, Sara H.

2016-01-01

Background American Indian/Alaska Native (AI/AN) patients with cancer have the lowest survival rates of all racial and ethnic groups, possibly because they are less likely to receive “best practice” surgical care than patients of other races. Methods Prospective cohort study comparing adherence to generic and cancer-specific guidelines on processes of surgical care between AI/AN and non-Hispanic white (NHW) patients in Washington State (2010–2014). Results 156 AI/AN and 6,030 NHW patients underwent operations for 10 different cancers, and had similar mean adherence to generic surgical guidelines (91.5% vs 91.9%, p=0.57). AI/AN patients with breast cancer less frequently received preoperative diagnostic core-needle biopsy (81% versus 94%, p=0.004). AI/AN patients also less frequently received care adherent to prostate cancer-specific guidelines (74% versus 92%,p=0.001). Conclusions While AI/ANs undergoing cancer operations in Washington receive similar overall best practice surgical cancer care to NHW patients, there remain important, modifiable disparities that may contribute to their lower survival. PMID:26846176

Neighborhood disadvantage and racial disparities in colorectal cancer incidence: a population-based study in Louisiana.

Science.gov (United States)

Danos, Denise M; Ferguson, Tekeda F; Simonsen, Neal R; Leonardi, Claudia; Yu, Qingzhao; Wu, Xiao-Cheng; Scribner, Richard A

2018-05-01

Colorectal cancer (CRC) continues to demonstrate racial disparities in incidence and survival in the United States. This study investigates the role of neighborhood concentrated disadvantage in racial disparities in CRC incidence in Louisiana. Louisiana Tumor Registry and U.S. Census data were used to assess the incidence of CRC diagnosed in individuals 35 years and older between 2008 and 2012. Neighborhood concentrated disadvantage index (CDI) was calculated based on the PhenX Toolkit protocol. The incidence of CRC was modeled using multilevel binomial regression with individuals nested within neighborhoods. Our study included 10,198 cases of CRC. Adjusting for age and sex, CRC risk was 28% higher for blacks than whites (risk ratio [RR] = 1.28; 95% confidence interval [CI] = 1.22-1.33). One SD increase in CDI was associated with 14% increase in risk for whites (RR = 1.14; 95% CI = 1.10-1.18) and 5% increase for blacks (RR = 1.05; 95% CI = 1.02-1.09). After controlling for differential effects of CDI by race, racial disparities were not observed in disadvantaged areas. CRC incidence increased with neighborhood disadvantage and racial disparities diminished with mounting disadvantage. Our results suggest additional dimensions to racial disparities in CRC outside of neighborhood disadvantage that warrants further research. Copyright © 2018 Elsevier Inc. All rights reserved.

[Disparities of breast cancer burden between China and western countries and its implication].

Science.gov (United States)

Zheng, Ying; Zhang, Minlu

2015-12-01

The disease burden of breast cancer in China is growing, and its proportion contributed to the global burden is increasing accordingly. The western countries have achieved reduction of mortality and slow growth of incidence, while the breast cancer incidence and mortality rates have been increasing constantly with lower survival rates in China. The remarkable characteristics of breast cancer burden in China is the disparities of the current status and time trends of incidence, mortality and survival between urban and rural area. The breast cancer disease distributions and time trends in China and the differential from the developed countries are described, which may be benefit to draw the international experience on prevention, early detection, medical care and survival management. Assessment of the existing evidence, elaboration of the prevention, control strategies in consideration of Chinese social-economic and culture situation would be beneficial to rise to the future challenge.

Advanced glycation end-products: a biological consequence of lifestyle contributing to cancer disparity.

Science.gov (United States)

Turner, David P

2015-05-15

Low income, poor diet, obesity, and a lack of exercise are interrelated lifestyle factors that can profoundly alter our biologic make up to increase cancer risk, growth, and development. We recently reported a potential mechanistic link between carbohydrate-derived metabolites and cancer, which may provide a biologic consequence of lifestyle that can directly affect tumor biology. Advanced glycation end-products (AGE) are reactive metabolites produced as a by-product of sugar metabolism. Failure to remove these highly reactive metabolites can lead to protein damage, aberrant cell signaling, increased stress responses, and decreased genetic fidelity. Critically, AGE accumulation is also directly affected by our lifestyle choices and shows a race-specific, tumor-dependent pattern of accumulation in cancer patients. This review will discuss the contribution of AGEs to the cancer phenotype, with a particular emphasis on their biologic links with the socioeconomic and environmental risk factors that drive cancer disparity. Given the potential benefits of lifestyle changes and the potential biologic role of AGEs in promoting cancer, opportunities exist for collaborations affecting basic, translational, epidemiologic, and cancer prevention initiatives. ©2015 American Association for Cancer Research.

Mediation by peer violence victimization of sexual orientation disparities in cancer-related tobacco, alcohol, and sexual risk behaviors: pooled youth risk behavior surveys.

Science.gov (United States)

Rosario, Margaret; Corliss, Heather L; Everett, Bethany G; Russell, Stephen T; Buchting, Francisco O; Birkett, Michelle A

2014-06-01

We examined the role of adolescent peer violence victimization (PVV) in sexual orientation disparities in cancer-related tobacco, alcohol, and sexual risk behaviors. We pooled data from the 2005 and 2007 Youth Risk Behavior Surveys. We classified youths with any same-sex sexual attraction, partners, or identity as sexual minority and the remainder as heterosexual. We had 4 indicators of tobacco and alcohol use and 4 of sexual risk and 2 PVV factors: victimization at school and carrying weapons. We stratified associations by gender and race/ethnicity. PVV was related to disparities in cancer-related risk behaviors of substance use and sexual risk, with odds ratios (ORs) of 1.3 (95% confidence interval [CI] = 1.03, 1.6) to 11.3 (95% CI = 6.2, 20.8), and to being a sexual minority, with ORs of 1.4 (95% CI = 1.1, 1.9) to 5.6 (95% CI = 3.5, 8.9). PVV mediated sexual orientation disparities in substance use and sexual risk behaviors. Findings were pronounced for adolescent girls and Asian/Pacific Islanders. Interventions are needed to reduce PVV in schools as a way to reduce sexual orientation disparities in cancer risk across the life span.

Social disparities in access to breast and cervical cancer screening by women living in Spain.

Science.gov (United States)

Ricardo-Rodrigues, I; Jiménez-García, R; Hernández-Barrera, V; Carrasco-Garrido, P; Jiménez-Trujillo, I; López de Andrés, A

2015-07-01

To describe uptake of breast and cervical cancer screening by women living in Spain, analyse the possible associated social and health factors, and compare uptake rates with those obtained in previous surveys. Cross-sectional study using data from the 2011 Spanish national health survey. Uptake of breast cancer screening was analysed by asking women aged 40-69 years whether they had undergone mammography in the previous two years. Uptake of cervical cancer screening was analysed by asking women aged 25-65 years whether they had undergone cervical cytology in the previous three years. Independent variables included sociodemographic characteristics, and variables related to health status and lifestyle. Seventy-two percent of women had undergone mammography in the previous two years. Having private health insurance increased the probability of breast screening uptake four-fold [odds ratio (OR) 3.96, 95% confidence interval (CI) 2.71-5.79], and being an immigrant was a negative predictor for breast screening uptake. Seventy percent of women had undergone cervical cytology in the previous three years. Higher-educated women were more likely to have undergone cervical cancer screening (OR 2.59, 95% CI 1.97-3.40), and obese women and women living in rural areas were less likely to have undergone cervical cancer screening. There have been no relevant improvements in uptake rates of either breast or cervical cancer screening since 2006. Uptake of breast and cervical cancer screening could be improved in Spain, and uptake rates have stagnated over recent years. Social disparities have been detected with regard to access to these screening tests, indicating that it is necessary to continue researching and optimizing prevention programmes in order to improve uptake and reduce these disparities. Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Addressing Cancer Disparities Among American Indians through Innovative Technologies and Patient Navigation: The Walking Forward Experience

Energy Technology Data Exchange (ETDEWEB)

Petereit, Daniel G. [Department of Oncology, John T. Vucurevich Cancer Care Institute, Rapid City, SD (United States); Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI (United States); Guadagnolo, B. Ashleigh [Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Wong, Rosemary; Coleman, C. Norman, E-mail: dpetereit@regionalhealth.com [Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, MD (United States)

2011-06-22

Purpose/Objective(s): American Indians (AIs) present with more advanced stages of cancer and, therefore, suffer from higher cancer mortality rates compared to non-AIs. Under the National Cancer Institute (NCI) Cancer Disparities Research Partnership (CDRP) Program, we have been researching methods of improving cancer treatment and outcomes since 2002, for AIs in Western South Dakota, through the Walking Forward (WF) Program. Materials/Methods: This program consists of (a) a culturally tailored patient navigation program that facilitated access to innovative clinical trials in conjunction with a comprehensive educational program encouraging screening and early detection, (b), surveys to evaluate barriers to access, (c) clinical trials focusing on reducing treatment length to facilitate enhanced participation using brachytherapy and intensity modulated radiotherapy (IMRT) for breast and prostate cancer, as AIs live a median of 140 miles from the cancer center, and (d) a molecular study (ataxia telangiectasia mutated) to address whether there is a specific profile that increases toxicity risks. Results: We describe the design and implementation of this program, summary of previously published results, and ongoing research to influence stage at presentation. Some of the critical outcomes include the successful implementation of a community-based research program, development of trust within tribal communities, identification of barriers, analysis of nearly 400 navigated cancer patients, clinical trial accrual rate of 10%, and total enrollment of nearly 2,500 AIs on WF research studies. Conclusion: This NCI funded pilot program has achieved some initial measures of success. A research infrastructure has been created in a community setting to address new research questions and interventions. Efforts underway to promote cancer education and screening are presented, as well as applications of the lessons learned to other health disparity populations – both nationally and

Addressing Cancer Disparities Among American Indians through Innovative Technologies and Patient Navigation: The Walking Forward Experience

International Nuclear Information System (INIS)

Petereit, Daniel G.; Guadagnolo, B. Ashleigh; Wong, Rosemary; Coleman, C. Norman

2011-01-01

Purpose/Objective(s): American Indians (AIs) present with more advanced stages of cancer and, therefore, suffer from higher cancer mortality rates compared to non-AIs. Under the National Cancer Institute (NCI) Cancer Disparities Research Partnership (CDRP) Program, we have been researching methods of improving cancer treatment and outcomes since 2002, for AIs in Western South Dakota, through the Walking Forward (WF) Program. Materials/Methods: This program consists of (a) a culturally tailored patient navigation program that facilitated access to innovative clinical trials in conjunction with a comprehensive educational program encouraging screening and early detection, (b), surveys to evaluate barriers to access, (c) clinical trials focusing on reducing treatment length to facilitate enhanced participation using brachytherapy and intensity modulated radiotherapy (IMRT) for breast and prostate cancer, as AIs live a median of 140 miles from the cancer center, and (d) a molecular study (ataxia telangiectasia mutated) to address whether there is a specific profile that increases toxicity risks. Results: We describe the design and implementation of this program, summary of previously published results, and ongoing research to influence stage at presentation. Some of the critical outcomes include the successful implementation of a community-based research program, development of trust within tribal communities, identification of barriers, analysis of nearly 400 navigated cancer patients, clinical trial accrual rate of 10%, and total enrollment of nearly 2,500 AIs on WF research studies. Conclusion: This NCI funded pilot program has achieved some initial measures of success. A research infrastructure has been created in a community setting to address new research questions and interventions. Efforts underway to promote cancer education and screening are presented, as well as applications of the lessons learned to other health disparity populations – both nationally and

Rural Disparities in Treatment-Related Financial Hardship and Adherence to Surveillance Colonoscopy in Diverse Colorectal Cancer Survivors.

Science.gov (United States)

McDougall, Jean A; Banegas, Matthew P; Wiggins, Charles L; Chiu, Vi K; Rajput, Ashwani; Kinney, Anita Y

2018-03-28

Cancer survivors increasingly report financial hardship as a consequence of the high cost of cancer care, yet the financial experience of rural cancer survivors remains largely unstudied. The purpose of this study was to investigate potential rural disparities in the likelihood of financial hardship and nonadherence to surveillance colonoscopy. Individuals diagnosed with localized or regional colorectal cancer (CRC) between 2004-2012 were ascertained by the population-based New Mexico Tumor Registry. Participants completed a mailed questionnaire or telephone survey about their CRC survivorship experience, including treatment-related financial hardship and receipt of surveillance colonoscopy. Multivariable logistic regression was used to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI). Compared to urban CRC survivors (n=168), rural CRC survivors (n=109) were slightly older, more likely to be married (65% v. 59%) and have an annual income financial hardship (OR 1.86, 95% CI 1.06-3.28) and nonadherence to surveillance colonoscopy guidelines (OR 2.28, 95% CI 1.07-4.85). In addition, financial hardship was independently associated with nonadherence to surveillance colonoscopy (OR 2.17, 95% CI 1.01-4.85). Substantial rural disparities in the likelihood of financial hardship and nonadherence to surveillance colonoscopy exist. Treatment-related financial hardship among rural CRC survivors may negatively impact adherence to guideline recommended follow-up care. Copyright ©2018, American Association for Cancer Research.

Integrating Multiple Social Statuses in Health Disparities Research: The Case of Lung Cancer

Science.gov (United States)

Williams, David R; Kontos, Emily Z; Viswanath, K; Haas, Jennifer S; Lathan, Christopher S; MacConaill, Laura E; Chen, Jarvis; Ayanian, John Z

2012-01-01

Objective To illustrate the complex patterns that emerge when race/ethnicity, socioeconomic status (SES), and gender are considered simultaneously in health care disparities research and to outline the needed research to understand them by using disparities in lung cancer risks, treatment, and outcomes as an example. Principal Findings SES, gender, and race/ethnicity are social categories that are robust predictors of variations in health and health services utilization. These are usually considered separately, but intersectionality theory indicates that the impact of each depends on the others. Each reflects historically and culturally contingent variations in social, economic, and political status. Distinct patterns of risk and resilience emerge at the intersections of multiple social categories and shape the experience of health, health care access, utilization, quality, and outcomes where these categories intersect. Intersectional approaches call for greater attention to understand social processes at multiple levels of society and require the collection of relevant data and utilization of appropriate analytic approaches to understand how multiple risk factors and resources combine to affect the distribution of disease and its management. Conclusions Understanding how race/ethnicity, gender, and SES are interactive, interdependent, and social identities can provide new knowledge to enhance our efforts to effectively address health disparities. PMID:22568674

What makes African American health disparities newsworthy? An experiment among journalists about story framing

Science.gov (United States)

Hinnant, Amanda; Oh, Hyun Jee; Caburnay, Charlene A.; Kreuter, Matthew W.

2011-01-01

News stories reporting race-specific health information commonly emphasize disparities between racial groups. But recent research suggests this focus on disparities has unintended effects on African American audiences, generating negative emotions and less interest in preventive behaviors (Nicholson RA, Kreuter MW, Lapka C et al. Unintended effects of emphasizing disparities in cancer communication to African-Americans. Cancer Epidemiol Biomarkers Prev 2008; 17: 2946–52). They found that black adults are more interested in cancer screening after reading about the progress African Americans have made in fighting cancer than after reading stories emphasizing disparities between blacks and whites. This study builds on past findings by (i) examining how health journalists judge the newsworthiness of stories that report race-specific health information by emphasizing disparities versus progress and (ii) determining whether these judgments can be changed by informing journalists of audience reactions to disparity versus progress framing. In a double-blind-randomized experiment, 175 health journalists read either a disparity- or progress-framed story on colon cancer, preceded by either an inoculation about audience effects of such framing or an unrelated (i.e. control) information stimuli. Journalists rated the disparity-frame story more favorably than the progress-frame story in every category of news values. However, the inoculation significantly increased positive reactions to the progress-frame story. Informing journalists of audience reactions to race-specific health information could influence how health news stories are framed. PMID:21911844

Cancer Data and Aboriginal Disparities (CanDAD)—developing an Advanced Cancer Data System for Aboriginal people in South Australia: a mixed methods research protocol

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Yerrell, Paul Henry; Roder, David; Cargo, Margaret; Reilly, Rachel; Banham, David; Micklem, Jasmine May; Morey, Kim; Stewart, Harold Bundamurra; Stajic, Janet; Norris, Michael; Brown, Alex

2016-01-01

Introduction In Australia, Aboriginal and Torres Strait Islander People carry a greater burden of cancer-related mortality than non-Aboriginal Australians. The Cancer Data and Aboriginal Disparities Project aims to develop and test an integrated, comprehensive cancer monitoring and surveillance system capable of incorporating epidemiological and narrative data to address disparities and advocate for clinical system change. Methods and analysis The Advanced Cancer Data System will integrate routinely collected unit record data from the South Australian Population Cancer Registry and a range of other data sources for a retrospective cohort of indigenous people with cancers diagnosed from 1990 to 2010. A randomly drawn non-Aboriginal cohort will be matched by primary cancer site, sex, age and year at diagnosis. Cross-tabulations and regression analyses will examine the extent to which demographic attributes, cancer stage and survival vary between the cohorts. Narratives from Aboriginal people with cancer, their families, carers and service providers will be collected and analysed using patient pathway mapping and thematic analysis. Statements from the narratives will structure both a concept mapping process of rating, sorting and prioritising issues, focusing on issues of importance and feasibility, and the development of a real-time Aboriginal Cancer Measure of Experience for ongoing linkage with epidemiological data in the Advanced Cancer Data System. Aboriginal Community engagement underpins this Project. Ethics and dissemination The research has been approved by relevant local and national ethics committees. Findings will be disseminated in local and international peer-reviewed journals and conference presentations. In addition, the research will provide data for knowledge translation activities across the partner organisations and feed directly into the Statewide Cancer Control Plan. It will provide a mechanism for monitoring and evaluating the implementation of

Aboriginal experiences of cancer and care coordination: Lessons from the Cancer Data and Aboriginal Disparities (CanDAD) narratives.

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Reilly, Rachel; Micklem, Jasmine; Yerrell, Paul; Banham, David; Morey, Kim; Stajic, Janet; Eckert, Marion; Lawrence, Monica; Stewart, Harold B; Brown, Alex

2018-04-24

Aboriginal people with cancer experience worse outcomes than other Australians for a range of complex and interrelated reasons. A younger age at diagnosis, higher likelihood of more advanced cancer or cancer type with poorer prognosis, geographic isolation and cultural and language diversity mean that patient pathways are potentially more complex for Aboriginal people with cancer. In addition, variation in the quality and acceptability of care may influence cancer outcomes. This study sought to understand how care coordination influences Aboriginal people's experiences of cancer treatment. Interviews with 29 Aboriginal patients or cancer survivors, 11 carers and 22 service providers were carried out. Interviews were semi-structured and sought to elicit experiences of cancer and the health-care system. The manifest content of the cancer narratives was entered onto a cancer pathway mapping tool and underlying themes were identified inductively. The practice of cancer care coordination was found to address the needs of Aboriginal patients and their families/carers in 4 main areas: "navigating the health system"; "information and communication"; "things to manage at home"; and "cultural safety". The CanDAD findings indicate that, when the need for cancer care coordination is met, it facilitated continuity of care in a range of ways that may potentially improve cancer outcomes. However, the need remains unmet for many. Findings support the importance of dedicated care coordination to enable Aboriginal people to receive adequate and appropriate patient-centred care, so that the unacceptable disparity in cancer outcomes between Aboriginal and non-Aboriginal people can be addressed. © 2018 The Authors. Health Expectations published by John Wiley & Sons Ltd.

Reduced disparities and improved surgical outcomes for Asian Americans with colorectal cancer.

Science.gov (United States)

Mulhern, Kayln C; Wahl, Tyler S; Goss, Lauren E; Feng, Katey; Richman, Joshua S; Morris, Melanie S; Chen, Herbert; Chu, Daniel I

2017-10-01

Studies suggest Asian Americans may have improved oncologic outcomes compared with other ethnicities. We hypothesized that Asian Americans with colorectal cancer would have improved surgical outcomes in mortality, postoperative complications (POCs), length of stay (LOS), and readmissions compared with other racial/ethnic groups. We queried the 2011-2014 American College of Surgeons National Surgical Quality Improvement Program for patients who underwent surgery for colorectal cancer and stratified patients by race. Primary outcome was 30-d mortality with secondary outcomes including POCs, LOS, and 30-d readmission. Stepwise backward logistic regression analyses and incident rate ratio calculations were performed to identify risk factors for disparate outcomes. Of the 28,283 patients undergoing colorectal surgery for malignancy, racial/ethnic groups were divided into Caucasian American (84%), African American (12%), or Asian American (4%). On unadjusted analyses, compared with other racial/ethnic groups, Asian Americans were more likely to have normal weight, not smoke, and had lower American Society of Anesthesiologists score of 1 or 2 (P Asian Americans had the shortest LOS and the lowest rates of complications due to ileus, respiratory, and renal complications (P Asian American race was independently associated with less postoperative ileus (odds ratio 0.8, 95% confidence interval 0.66-0.98, P American and Caucasian American patients, respectively (P Asian Americans undergoing surgery for colorectal cancer have shorter LOS and fewer POCs when compared with other racial/ethnic groups without differences in 30-d mortality or readmissions. The mechanism(s) underlying these disparities will require further study, but may be a result of patient, provider, and healthcare system differences. Copyright © 2017 Elsevier Inc. All rights reserved.

The Influence of Socioeconomic Status on Racial/Ethnic Disparities among the ER/PR/HER2 Breast Cancer Subtypes

International Nuclear Information System (INIS)

Parise, C. A.; Caggiano, V.Caggiano

2015-01-01

Background. The eight ER/PR/HER2 breast cancer subtypes vary widely in demographic and clinico pathologic characteristics and survival. This study assesses the contribution of SES to the risk of mortality for blacks, Hispanics, Asian/Pacific Islanders, and American Indians when compared with white women for each ER/PR/HER2 subtype. Methods. We identified 143,184 cases of first primary female invasive breast cancer from the California Cancer Registry between 2000 and 2012. The risk of mortality was computed for each race/ethnicity within each ER/PR/HER2 subtype. Models were adjusted for tumor grade, year of diagnosis, and age. SES was added to a second set of models. Analyses were conducted separately for each stage. Results. Race/ethnicity did not contribute to the risk of mortality for any subtype in stage 1 when adjusted for SES. In stages 2, 3, and 4, race/ethnicity was associated with risk of mortality and adjustment for SES changed the risk only in some subtypes. SES reduced the risk of mortality by over 45% for American Indians with stage 2 ER+/PR+/HER2-cancer, but it decreased the risk of mortality for blacks with stage 2 triple negative cancer by less than 4%. Conclusions. Racial/ethnic disparities do not exist in all ER/PR/HER2 subtypes and, in general, SES modestly alters these disparities.

Disparities in breast cancer surgery delay: the lingering effect of race.

Science.gov (United States)

Sheppard, Vanessa B; Oppong, Bridget A; Hampton, Regina; Snead, Felicia; Horton, Sara; Hirpa, Fikru; Brathwaite, Echo J; Makambi, Kepher; Onyewu, S; Boisvert, Marc; Willey, Shawna

2015-09-01

Delays to surgical breast cancer treatment of 90 days or more may be associated with greater stage migration. We investigated racial disparities in time to receiving first surgical treatment in breast cancer patients. Insured black (56 %) and white (44 %) women with primary breast cancer completed telephone interviews regarding psychosocial (e.g., self-efficacy) and health care factors (e.g., communication). Clinical data were extracted from medical charts. Time to surgery was measured as the days between diagnosis and definitive surgical treatment. We also examined delays of more than 90 days. Unadjusted hazard ratios (HRs) examined univariate relationships between delay outcomes and covariates. Cox proportional hazard models were used for multivariate analyses. Mean time to surgery was higher in blacks (mean 47 days) than whites (mean 33 days; p = .001). Black women were less likely to receive therapy before 90 days compared to white women after adjustment for covariates (HR .58; 95 % confidence interval .44, .78). Health care process factors were nonsignificant in multivariate models. Women with shorter delay reported Internet use (vs. not) and underwent breast-conserving surgery (vs. mastectomy) (p interventions to address delay are needed.

Racial disparities in cancer-related survival in patients with squamous cell carcinoma of the esophagus in the US between 1973 and 2013.

Directory of Open Access Journals (Sweden)

Alice Kim

Full Text Available Esophageal cancer makes up approximately 1% of all diagnosed cancers in the US. There is a persistent disparity in incidence and cancer-related mortality rates among different races for esophageal squamous cell carcinoma (SCC. Most previous studies investigated racial disparities between black and white patients, occasionally examining disparities for Hispanic patients. Studies including Asians/Pacific Islanders (API as a subgroup are rare. Our objective was to determine whether there is an association between race and cancer-related survival in patients with esophageal SCC.This was a retrospective cohort study using the National Cancer Institute's Surveillance, Epidemiology, and End Result (SEER database. The SEER registry is a national database that collects information on all incident cancer cases in 13 states of the United States and covers nearly 26% of the US population Patients aged 18 and over of White, Black, or Asian/Pacific Islander (API race with diagnosed esophageal SCC from 1973 to 2013 were included (n = 13,857. To examine overall survival, Kaplan-Meier curves were estimated for each race and the log-rank test was used to compare survival distributions. Cox proportional hazards models were used to estimate unadjusted and adjusted hazard ratios with 95% confidence intervals. The final adjusted model controlled for sex, marital status, age at diagnosis, decade of diagnosis, ethnicity, stage at diagnosis, and form of treatment. Additional analyses stratified by decade of diagnosis were conducted to explore possible changes in survival disparities over time. After adjustment for potential confounders, black patients had a statistically significantly higher hazard ratio compared to white patients (HR 1.08; 95% confidence interval (CI 1.03-1.13. However, API patients did not show a statistically significant difference in survival compared with white patients (HR 1.00; 95% CI 0.93-1.07. Patients diagnosed between 1973 and 1979 had twice

Racial and Ethnic Disparity in Symptomatic Breast Cancer Awareness despite a Recent Screen: The Role of Tumor Biology and Mammography Facility Characteristics.

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Mortel, Mylove; Rauscher, Garth H; Murphy, Anne Marie; Hoskins, Kent; Warnecke, Richard B

2015-10-01

In a racially and ethnically diverse sample of recently diagnosed urban patients with breast cancer, we examined associations of patient, tumor biology, and mammography facility characteristics on the probability of symptomatic discovery of their breast cancer despite a recent prior screening mammogram. In the Breast Cancer Care in Chicago study, self-reports at interview were used to define patients as having a screen-detected breast cancer or having symptomatic awareness despite a recent screening mammogram (SADRS), in the past 1 or 2 years. Patients with symptomatic breast cancer who did not report a recent prior screen were excluded from these analyses. Characteristics associated with more aggressive disease [estrogen receptor (ER)- and progesterone receptor (PR)-negative status and higher tumor grade] were abstracted from medical records. Mammogram facility characteristics that might indicate aspects of screening quality were defined and controlled for in some analyses. SADRS was more common among non-Hispanic black and Hispanic than among non-Hispanic white patients (36% and 42% vs. 25%, respectively, P = 0.0004). SADRS was associated with ER/PR-negative and higher-grade disease. Patients screened at sites that relied on dedicated radiologists and sites that were breast imaging centers of excellence were less likely to report SADRS. Tumor and facility factors together accounted for two thirds of the disparity in SADRS (proportion mediated = 70%, P = 0.02). Facility resources and tumor aggressiveness explain much of the racial/ethnic disparity in symptomatic breast cancer among recently screened patients. A more equitable distribution of high-quality screening would ameliorate but not eliminate this disparity. ©2015 American Association for Cancer Research.

Understanding Cancer Prognosis

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Full Text Available ... Understanding Cancer What Is Cancer? Cancer Statistics Cancer Disparities Understanding Cancer What Is Cancer Cancer Statistics Cancer Disparities Causes & Prevention Risk Factors Genetics Cancer Prevention Overview ...

Communication strategies to reduce cancer disparities: Insights from African-American mother-daughter dyads.

Science.gov (United States)

Mosavel, Maghboeba; Wilson Genderson, Maureen; Ports, Katie A; Carlyle, Kellie E

2015-12-01

Mothers and daughters share a powerful and unique bond, which has potential for the dissemination of information on a variety of women's health issues, including the primary and secondary prevention of breast and cervical cancer. This study presents formative research from a long-term project examining the potential of mother-daughter communication in promoting cancer screening among African American women. Thirty-two mother-daughter pairs (N = 64) completed orally administered surveys regarding their cancer knowledge, beliefs and attitudes, and barriers to care. This study compares the attitudes and beliefs of low-income, urban, African American mothers and their adolescent daughters regarding cervical and breast cancer screening. Both mothers and daughters had fairly high levels of knowledge about breast and cervical cancer. In addition, there was a high concordance rate between mothers' and daughters' responses, suggesting a potential sharing of health knowledge between mother and daughter. These results have implications for selecting communication strategies to reduce health disparities, and support that the mother-daughter dyad could be a viable unit to disseminate targeted screening information. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

Geographic variation and sociodemographic disparity in the use of oxaliplatin-containing chemotherapy in patients with stage III colon cancer.

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Panchal, Janki M; Lairson, David R; Chan, Wenyaw; Du, Xianglin L

2013-06-01

This study examined the geographic variation and sociodemographic disparities in the use of oxaliplatin chemotherapy, which has not been widely studied in the past. Our results suggest that chemotherapy use varies across geographic regions. Patterns of use that relate specifically to oxaliplatin-containing chemotherapy can inform providers and researchers how newer regimens are being used as standard chemotherapy in a real-world setting. According to the National Cancer Comprehensive Network (NCCN), oxaliplatin with 5-fluorouracil and leucovorin (5-FU/LV) is the recommended adjuvant chemotherapy for patients with resected stage III colon cancer. Age and race are considered strong predictors of chemotherapy receipt, whereas geographic disparity has received minimal attention. The purpose of this study was to examine geographic variation and sociodemographic disparity in the use of chemotherapy in patients with stage III colon cancer, focusing specifically on oxaliplatin. A retrospective cohort of 4106 Medicare patients was identified from the Surveillance, Epidemiology and End Results (SEER)/Medicare linked database. Descriptive statistics show how oxaliplatin-containing chemotherapy was used in various geographic regions among different age and racial groups. Multiple logistic regression analysis was performed to examine the relationship between receipt of oxaliplatin-containing chemotherapy and geographic region while adjusting for other sociodemographic and tumor characteristics. Only 49% of the patients with stage III disease received adjuvant chemotherapy within 3 to 6 months of colon cancer-specific surgery. Patients aged 66 to 70 years were 78% more likely to receive chemotherapy than were those aged 80 years and older (Pcancer care to all patients according to their preferences and needs. Copyright © 2013 Elsevier Inc. All rights reserved.

Cancer Data and Aboriginal Disparities (CanDAD)-developing an Advanced Cancer Data System for Aboriginal people in South Australia: a mixed methods research protocol.

Science.gov (United States)

Yerrell, Paul Henry; Roder, David; Cargo, Margaret; Reilly, Rachel; Banham, David; Micklem, Jasmine May; Morey, Kim; Stewart, Harold Bundamurra; Stajic, Janet; Norris, Michael; Brown, Alex

2016-12-23

In Australia, Aboriginal and Torres Strait Islander People carry a greater burden of cancer-related mortality than non-Aboriginal Australians. The Cancer Data and Aboriginal Disparities Project aims to develop and test an integrated, comprehensive cancer monitoring and surveillance system capable of incorporating epidemiological and narrative data to address disparities and advocate for clinical system change. The Advanced Cancer Data System will integrate routinely collected unit record data from the South Australian Population Cancer Registry and a range of other data sources for a retrospective cohort of indigenous people with cancers diagnosed from 1990 to 2010. A randomly drawn non-Aboriginal cohort will be matched by primary cancer site, sex, age and year at diagnosis. Cross-tabulations and regression analyses will examine the extent to which demographic attributes, cancer stage and survival vary between the cohorts. Narratives from Aboriginal people with cancer, their families, carers and service providers will be collected and analysed using patient pathway mapping and thematic analysis. Statements from the narratives will structure both a concept mapping process of rating, sorting and prioritising issues, focusing on issues of importance and feasibility, and the development of a real-time Aboriginal Cancer Measure of Experience for ongoing linkage with epidemiological data in the Advanced Cancer Data System. Aboriginal Community engagement underpins this Project. The research has been approved by relevant local and national ethics committees. Findings will be disseminated in local and international peer-reviewed journals and conference presentations. In addition, the research will provide data for knowledge translation activities across the partner organisations and feed directly into the Statewide Cancer Control Plan. It will provide a mechanism for monitoring and evaluating the implementation of the recommendations in these documents. Published by the

Cigarette Smoking and Breast Cancer Risk in Hispanic and Non-Hispanic White Women: The Breast Cancer Health Disparities Study.

Science.gov (United States)

Connor, Avonne E; Baumgartner, Kathy B; Baumgartner, Richard N; Pinkston, Christina M; Boone, Stephanie D; John, Esther M; Torres-Mejía, Gabriela; Hines, Lisa M; Giuliano, Anna R; Wolff, Roger K; Slattery, Martha L

2016-03-01

Few epidemiological studies have included Hispanics with the evaluation of the effects of cigarette smoking and breast cancer. We examined the relationship between cigarette smoking, ethnicity, and breast cancer risk using data from the Breast Cancer Health Disparities Study (BCHDS). The BCHDS is a consortium of three population-based case-control studies, including U.S. non-Hispanic whites (NHWs) (1,525 cases; 1,593 controls), U.S. Hispanics/Native Americans (1,265 cases; 1,495 controls), and Mexican women (990 cases; 1,049 controls). Multivariable logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Breast cancer risk was elevated among Mexican former smokers (OR 1.43, 95% CI 1.04-1.96) and among those who smoked ≥ 31 years (OR 1.95, 95% CI 1.13-3.35), compared to never smokers. In addition, Mexican former smokers with a history of alcohol consumption had increased breast cancer risk (OR 2.30, 95% CI 1.01-5.21). Among NHW premenopausal women, breast cancer risk was increased for smoking ≥ 20 cigarettes per day (OR 1.61, 95% CI 1.07-2.41). Our findings suggest the possibility of ethnic differences with the associations between cigarette smoking and breast cancer risk.

Does exclusion of cancers registered only from death-certificate information diminish socio-demographic disparities in recorded survival?

Science.gov (United States)

Tervonen, Hanna E; Roder, David; Morrell, Stephen; You, Hui; Currow, David C

2017-06-01

Death Certificate Only (DCO) cancer cases are commonly excluded from survival analyses due to unknown survival time. This study examines whether socio-demographic factors are associated with DCO diagnosis, and the potential effects of excluding DCO cases on socio-demographic cancer survival disparities in NSW, Australia. NSW Cancer Registry data for cases diagnosed in 2000-2008 were used in this study. Logistic regression was used to estimate the odds of DCO registration by socio-demographic sub-group (socio-economic disadvantage, residential remoteness, country of birth, age at diagnosis). Cox proportional hazard regression was used to estimate the probability of death from cancer by socio-demographic subgroup when DCO cases were included and excluded from analyses. DCO cases consisted of 1.5% (n=4336) of all cases (n=299,651). DCO diagnosis was associated with living in socio-economically disadvantaged areas (most disadvantaged compared with least disadvantaged quintile: odds ratio OR 1.25, 95%CI 1.12-1.40), living in inner regional (OR 1.16, 95%CI 1.08-1.25) or remote areas (OR 1.48, 95%CI 1.01-2.19), having an unknown country of birth (OR 1.63, 95%CI 1.47-1.81) and older age. Including or excluding DCO cases had no significant impact on hazard ratios for cancer death by socio-economic disadvantage quintile or remoteness category, and only a minor impact on hazard ratios by age. Socio-demographic factors were associated with DCO diagnosis in NSW. However, socio-demographic cancer survival disparities remained unchanged or varied only slightly irrespective of including/excluding DCO cases. Further research could examine the upper limits of DCO proportions that significantly alter estimated cancer survival differentials if DCOs are excluded. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

Sexual orientation disparities in cancer-related risk behaviors of tobacco, alcohol, sexual behaviors, and diet and physical activity: pooled Youth Risk Behavior Surveys.

Science.gov (United States)

Rosario, Margaret; Corliss, Heather L; Everett, Bethany G; Reisner, Sari L; Austin, S Bryn; Buchting, Francisco O; Birkett, Michelle

2014-02-01

We examined sexual orientation disparities in cancer-related risk behaviors among adolescents. We pooled data from the 2005 and 2007 Youth Risk Behavior Surveys. We classified youths with any same-sex orientation as sexual minority and the remainder as heterosexual. We compared the groups on risk behaviors and stratified by gender, age ( 14 years), and race/ethnicity. Sexual minorities (7.6% of the sample) reported more risk behaviors than heterosexuals for all 12 behaviors (mean = 5.3 vs 3.8; P sexual orientation disparities in analyses by gender, followed by age, and then race/ethnicity; they persisted in analyses by gender, age, and race/ethnicity, although findings were nuanced. Data on cancer risk, morbidity, and mortality by sexual orientation are needed to track the potential but unknown burden of cancer among sexual minorities.

Strengthening cancer biology research, prevention, and control while reducing cancer disparities: student perceptions of a collaborative master's degree program in cancer biology, preventions, and control.

Science.gov (United States)

Jillson, I A; Cousin, C E; Blancato, J K

2013-09-01

This article provides the findings of a survey of previous and current students in the UDC/GU-LCCC master's degree program. This master's degree program, Cancer Biology, Prevention, and Control is administered and taught jointly by faculty of a Minority Serving Institution, the University of the District of Columbia, and the Lombardi Comprehensive Cancer Center to incorporate the strengths of a community-based school with a research intensive medical center. The program was initiated in 2008 through agreements with both University administrations and funding from the National Cancer Institute. The master's degree program is 36 credits with a focus on coursework in biostatistics, epidemiology, tumor biology, cancer prevention, medical ethics, and cancer outreach program design. For two semesters during the second year, students work full-time with a faculty person on a laboratory or outreach project that is a requirement for graduation. Students are supported and encouraged to transition to a doctoral degree after they obtain the master's and many of them are currently in doctorate programs. Since the inception of the program, 45 students have initiated the course of study, 28 have completed the program, and 13 are currently enrolled in the program. The survey was designed to track the students in their current activities, as well as determine which courses, program enhancements, and research experiences were the least and most useful, and to discern students' perceptions of knowledge acquired on various aspects of Cancer Biology Prevention, and Control Master's Program. Thirty of the 35 individuals to whom email requests were sent responded to the survey, for a response rate of 85.7%. The results of this study will inform the strengthening of the Cancer Biology program by the Education Advisory Committee. They can also be used in the development of comparable collaborative master's degree programs designed to address the significant disparities in prevalence of

Disparity in liver cancer incidence and chronic liver disease mortality by nativity in Hispanics: The Multiethnic Cohort.

Science.gov (United States)

Setiawan, Veronica Wendy; Wei, Pengxiao C; Hernandez, Brenda Y; Lu, Shelly C; Monroe, Kristine R; Le Marchand, Loic; Yuan, Jian Min

2016-05-01

Hepatocellular carcinoma (HCC) and chronic liver disease (CLD) are major causes of morbidity and mortality among Hispanics. Disparities in the incidence of HCC and in CLD deaths by nativity in Hispanics have been reported. Whether individual-level risk factors could explain these disparities was assessed in a prospective study of 36,864 Hispanics (18,485 US-born and 18,379 foreign-born) in the Multiethnic Cohort. Risk factors were assessed with a baseline questionnaire and Medicare claim files. During a 19.6-year follow-up, 189 incident cases of HCC and 298 CLD deaths were identified. The HCC incidence rate was almost twice as high for US-born Hispanic men versus foreign-born Hispanic men (44.7 vs 23.1), but the rates were comparable for women (14.5 vs 13.4). The CLD mortality rate was about twice as high for US-born Hispanics versus foreign-born Hispanics (66.3 vs 35.1 for men and 42.2 vs 19.7 for women). Heavy alcohol consumption was associated with HCC and CLD in foreign-born individuals, whereas the current smoking status, hepatitis B/C viral infection, and diabetes were associated with both HCC and CLD. After adjustments for these risk factors, the hazard rate ratios for HCC and CLD death were 1.58 (95% confidence interval, 1.00-2.51) and 1.85 (95% confidence interval, 1.25-2.73), respectively, for US-born Hispanics versus foreign-born Hispanics. US-born Hispanics, particularly males, are at greater risk for HCC and death from CLD than foreign-born Hispanics. Overall known differences in risk factors do not account for these disparities. Future studies are warranted to identify factors that contribute to the elevated risk of HCC development and CLD death in US-born Hispanics. Cancer 2016;122:1444-1452. © 2016 American Cancer Society. © 2016 American Cancer Society.

Disparities in staging prostate magnetic resonance imaging utilization for nonmetastatic prostate cancer patients undergoing definitive radiation therapy

Directory of Open Access Journals (Sweden)

Ayobami Ajayi, BA

2016-10-01

Conclusions: In this urban, academic center cohort, older patients across all risk groups and black or nonprivate insurance patients in the low risk group were less likely to undergo staging prostate MRI scans. Further research should investigate these differences to ensure equitable utilization across all demographic groups considering the burden of prostate cancer disparities.

Understanding Cancer Prognosis

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Full Text Available ... Research Screening & Early Detection Cancer Treatment Research Cancer & Public Health Cancer Health Disparities Childhood Cancers Clinical Trials ... Cancer Diagnosis Prevention Screening & Early Detection Treatment Cancer & Public Health Cancer Health Disparities Childhood Cancer Clinical Trials ...

The Biology of Cancer Health Disparities

Science.gov (United States)

These examples show how biology contributes to health disparities (differences in disease incidence and outcomes among distinct racial and ethnic groups, ), and how biological factors interact with other relevant factors, such as diet and the environment.

Differential Splicing of Oncogenes and Tumor Suppressor Genes in African- and Caucasian-American Populations: Contributing Factor in Prostate Cancer Disparities

Science.gov (United States)

2016-10-01

for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data...Olender (PhD graduate student) 5d. PROJECT NUMBER 5e. TASK NUMBER E-Mail: nhlee@gwu. edu 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION...inhibitory effects of idelalisib. 15. SUBJECT TERMS prostate cancer, cancer health disparities, alternative splicing, African American, European

Understanding Cancer Prognosis

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Interactions among genes, tumor biology and the environment in cancer health disparities: examining the evidence on a national and global scale.

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Wallace, Tiffany A; Martin, Damali N; Ambs, Stefan

2011-08-01

Cancer incidence and mortality rates show great variations across nations and between population groups. These variations are largely explained by differences in age distribution, diet and lifestyle, access to health care, cultural barriers and exposure to carcinogens and pathogens. Cancers caused by infections are significantly more common in developing than developed countries, and they overproportionally affect immigrant populations in the USA and other countries. The global pattern of cancer is not stagnant. Instead, it is dynamic because of fluctuations in the age distribution of populations, improvements in cancer prevention and early detection in affluent countries and rapid changes in diet and lifestyle in parts of the world. For example, increased smoking rates have caused tobacco-induced cancers to rise in various Asian countries, whereas reduced smoking rates have caused these cancers to plateau or even begin to decline in Western Europe and North America. Some population groups experience a disproportionally high cancer burden. In the USA and the Caribbean, cancer incidence and mortality rates are excessively high in populations of African ancestry when compared with other population groups. The causes of this disparity are multifaceted and may include tumor biological and genetic factors and their interaction with the environment. In this review, we will discuss the magnitude and causes of global cancer health disparities and will, with a focus on African-Americans and selected cancer sites, evaluate the evidence that genetic and tumor biological factors contribute to existing cancer incidence and outcome differences among population groups in the USA.

Bioavailable insulin-like growth factor-I as mediator of racial disparity in obesity-relevant breast and colorectal cancer risk among postmenopausal women.

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Jung, Su Yon; Barrington, Wendy E; Lane, Dorothy S; Chen, Chu; Chlebowski, Rowan; Corbie-Smith, Giselle; Hou, Lifang; Zhang, Zuo-Feng; Paek, Min-So; Crandall, Carolyn J

2017-03-01

Bioavailable insulin-like growth factor-I (IGF-I) interacts with obesity and exogenous estrogen (E) in a racial disparity in obesity-related cancer risk, yet their interconnected pathways are not fully characterized. We investigated whether circulating bioavailable IGF-I acted as a mediator of the racial disparity in obesity-related cancers such as breast and colorectal (CR) cancers and how obesity and E use regulate this relationship. A total of 2,425 white and 164 African American (AA) postmenopausal women from the Women's Health Initiative Observational Study were followed from October 1, 1993 through August 29, 2014. To assess bioactive IGF-I as a mediator of race-cancer relationship, we used the Baron-Kenny method and quantitative estimation of the mediation effect. Compared with white women, AA women had higher IGF-I levels; their higher risk of CR cancer, after accounting for IGF-I, was no longer significant. IGF-I was associated with breast and CR cancers even after controlling for race. Among viscerally obese (waist/hip ratio >0.85) and overall nonobese women (body mass index obesity-related breast and CR cancer risk between postmenopausal AA and white women. Body fat distribution and E use may be part of the interconnected hormonal pathways related to racial difference in IGF-I levels and obesity-related cancer risk.

Colorectal Cancer Incidence and Mortality Disparities in New Mexico

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Hoffman, R. M.; Gonzales, M.; Wiggins, C. L.; Hoffman, R. M.

2014-01-01

Previous analyses indicated that New Mexican Hispanics and American Indians (AI) did not experience the declining colorectal cancer (CRC) incidence and mortality rates observed among non-Hispanic whites (NHW). We evaluated more recent data to determine whether racial/ethnic differences persisted. Methods. We used New Mexico Surveillance Epidemiology and End Results data from 1995 to 2009 to calculate age-specific incidence rates and age-adjusted incidence rates overall and by tumor stage. We calculated mortality rates using National Center for Health Statistics’ data. We used join point regression to determine annual percentage change (APC) in age-adjusted incidence rates. Analyses were stratified by race/ethnicity and gender. Results. Incidence rates continued declining in NHW (APC −1.45% men, −1.06% women), while non significantly increasing for AI (1.67% men, 1.26% women) and Hispanic women (0.24%). The APC initially increased in Hispanic men through 2001 (3.33%, P = 0.06), before declining (−3.10%, P = 0,003). Incidence rates declined in NHW and Hispanics aged 75 and older. Incidence rates for distant-stage cancer remained stable for all groups. Mortality rates declined significantly in NHW and Hispanics. Conclusions. Racial/ethnic disparities in CRC persist in New Mexico. Incidence differences could be related to risk factors or access to screening; mortality differences could be due to patterns of care for screening or treatment.

Racial Disparities in the Molecular Landscape of Cancer.

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Heath, Elisabeth I; Lynce, Filipa; Xiu, Joanne; Ellerbrock, Angela; Reddy, Sandeep K; Obeid, Elias; Liu, Stephen V; Bollig-Fischer, Aliccia; Separovic, Duska; Vanderwalde, Ari

2018-04-01

African Americans (AA) have the highest incidence and mortality of any racial/ethnic group in the US for most cancer types. Heterogeneity in the molecular biology of cancer, as a contributing factor to this disparity, is poorly understood. To address this gap in knowledge, we explored the molecular landscape of colorectal cancer (CRC), non-small cell lung cancer (NSCLC) and high-grade glioma (HGG) from 271 AA and 636 Caucasian (CC) cases. DNA from formalin-fixed paraffin-embedded tumors was sequenced using next-generation sequencing. Additionally, we evaluated protein expression using immunohistochemistry. The Exome Aggregation Consortium Database was evaluated for known ethnicity associations. Considering only pathogenic or presumed pathogenic mutations, as determined by the American College of Medical Genetics and Genomics guidelines, and using Bonferroni and Benjamini-Hochberg corrections for multiple comparisons, we found that CRC tumors from AA patients harbored significantly more mutations of phosphatidylinositol-4,5-bisphosphate 3-kinase, catalytic subunit alpha (PIK3CA) than those from CC patients. CRC tumors in AA patients also appeared to harbor more mutations of mitogen-activated protein kinase kinase 1 (MAP2K1/MEK1), MPL proto-oncogene (MPL), thrombo-poietin receptor, and neurofibromin 1 (NF1) than those from CC patients. In contrast, CRCs from AA patients were likely to carry fewer mutations of ataxia-telangiectasia mutated (ATM), as well as of proto-oncogene B-Raf (BRAF), including the V600E variant, than those from CC patients. Rates of immunohistochemical positivity for epidermal growth factor receptor (EGFR) and DNA topoisomerase 2-alpha (TOP2A) tended to be higher in CRCs from AA patients than in CC patients. In NSCLC adenocarcinoma, BRAF variants appeared to be more frequent in the AA than in the CC cohort, whereas in squamous cell lung carcinoma, programmed death-ligand 1 (PD-L1) expression tended to be lower in the AA than in CC group. Moreover

Reducing Disparities in Cancer Screening and Prevention through Community-Based Participatory Research Partnerships with Local Libraries: A Comprehensive Dynamic Trial.

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Rapkin, Bruce D; Weiss, Elisa; Lounsbury, David; Michel, Tamara; Gordon, Alexis; Erb-Downward, Jennifer; Sabino-Laughlin, Eilleen; Carpenter, Alison; Schwartz, Carolyn E; Bulone, Linda; Kemeny, Margaret

2017-09-01

Reduction of cancer-related disparities requires strategies that link medically underserved communities to preventive care. In this community-based participatory research project, a public library system brought together stakeholders to plan and undertake programs to address cancer screening and risk behavior. This study was implemented over 48 months in 20 large urban neighborhoods, selected to reach diverse communities disconnected from care. In each neighborhood, Cancer Action Councils were organized to conduct a comprehensive dynamic trial, an iterative process of program planning, implementation and evaluation. This process was phased into neighborhoods in random, stepped-wedge sequence. Population-level outcomes included self-reported screening adherence and smoking cessation, based on street intercept interviews. Event-history regressions (n = 9374) demonstrated that adherence outcomes were associated with program implementation, as were mediators such as awareness of screening programs and cancer information seeking. Findings varied by ethnicity, and were strongest among respondents born outside the U.S. or least engaged in care. This intervention impacted health behavior in diverse, underserved and vulnerable neighborhoods. It has been sustained as a routine library system program for several years after conclusion of grant support. In sum, participatory research with the public library system offers a flexible, scalable approach to reduce cancer health disparities. © Society for Community Research and Action 2017.

Disparities in the Utilization of Laparoscopic Surgery for Colon Cancer in Rural Nebraska: A Call for Placement and Training of Rural General Surgeons.

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Gruber, Kelli; Soliman, Amr S; Schmid, Kendra; Rettig, Bryan; Ryan, June; Watanabe-Galloway, Shinobu

2015-01-01

Advances in medical technology are changing surgical standards for colon cancer treatment. The laparoscopic colectomy is equivalent to the standard open colectomy while providing additional benefits. It is currently unknown what factors influence utilization of laparoscopic surgery in rural areas and if treatment disparities exist. The objectives of this study were to examine demographic and clinical characteristics associated with receiving laparoscopic colectomy and to examine the differences between rural and urban patients who received either procedure. This study utilized a linked data set of Nebraska Cancer Registry and hospital discharge data on colon cancer patients diagnosed and treated in the entire state of Nebraska from 2008 to 2011 (N = 1,062). Multiple logistic regression analysis was performed to identify predictors of receiving the laparoscopic treatment. Rural colon cancer patients were 40% less likely to receive laparoscopic colectomy compared to urban patients. Independent predictors of receiving laparoscopic colectomy were younger age (colon cancer and important disparities exist for rural cancer patients in accessing the specialized treatment. As cancer treatment becomes more specialized, the importance of training and placement of general surgeons in rural communities must be a priority for health care planning and professional training institutions. © 2015 National Rural Health Association.

Breast Cancer Disparities

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... 2.65 MB] Read the MMWR Science Clips Breast Cancer Black Women Have Higher Death Rates from Breast ... of Page U.S. State Info Number of Additional Breast Cancer Deaths Among Black Women, By State SOURCE: National ...

We are Not Hard-to-Reach: Community Competent Research to Address Racial Tobacco-Related Disparities

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Dr. Webb Hooper is Associate Director for Cancer Disparities Research and Director of the Office of Cancer Disparities Research in the Case Comprehensive Cancer Center at Case Western Reserve University. She is also Professor of Oncology, Family Medicine & Community Health and Psychological Sciences. Dr. Webb Hooper is a licensed clinical health psychologist whose research interests are in chronic illness prevention and cancer risk behaviors, with an emphasis on minority health and racial/ethnic disparities. Much of her research focuses on tobacco use and weight management interventions, the development of culturally specific approaches, and understanding relationships between behavior change and race/ethnicity, cultural variables, modifiable risk factors, and the biological stress response. Dr. Webb Hooper has received international recognition for her contributions to nicotine and tobacco research, and is a leader in the field of cancer health disparities. Her research goal is to make a significant public health impact by reducing the prevalence of cancer and cancer health disparities in high-risk populations. Her long-term goal is to help eliminate disparities in chronic diseases. Dr. Webb Hooper’s research has been funded with over $9 million dollars by the National Cancer Institute (NCI), American Cancer Society (ACS), CVS Health Foundation, and the Florida Department of Health James and Esther King Biomedical Research Program.  In addition, Dr. Webb Hooper serves on committees for the NIH, several peer-reviewed journal editorial boards, is an Associate Editor of the Ethnicity & Disease Journal, and is Co-Chair of the Health Disparities Network of the Society for Research on Nicotine and Tobacco. WebEx When it's time, join the meeting. Meeting number (access code):  857 862 211 Meeting password:  Colloqu1@ Join by phone 1-650-479-3207 Call-in toll number (US/Canada) Can't join the meeting? IMPORTANT NOTICE:  Please note that this WebEx service allows

Disparities in psychosocial cancer care: a report from the International Federation of Psycho-oncology Societies.

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Grassi, Luigi; Fujisawa, Daisuke; Odyio, Philip; Asuzu, Chioma; Ashley, Laura; Bultz, Barry; Travado, Luzia; Fielding, Richard

2016-10-01

The aim of the study was to understand the characteristics of the International Federation of Psycho-oncology Societies (FPOS) and possible disparities in providing psychosocial care in countries where psycho-oncology societies exist. A survey was conducted among 29 leaders of 28 countries represented within the FPOS by using a questionnaire covering (i) characteristics of the society; (ii) characteristics of the national health care system; (iii) level of implementation of psycho-oncology; and (iv) main problems of psycho-oncology in the country. Twenty-six (90%) FPOS returned the questionnaires. One-third reported to have links with and support from their government, while almost all had links with other scientific societies. The FPOS varied in their composition of members' professions. Psychosocial care provision was covered by state-funded health services in a minority of countries. Disparities between countries arose from different causes and were problematic in some parts of the world (eg, Africa and SE Asia). Elsewhere (eg, Southern Europe and Eastern Europe), austerity policies were reportedly responsible for resource shortages with negative consequences on psychosocial cancer care. Half of FPOS rated themselves to be integrated into mainstream provision of care, although lack of funding was the most common complain. The development and implementation of psycho-oncology is fragmented and undeveloped, particularly in some parts of the world. More effort is needed at national level by strong coalitions with oncology societies, better national research initiatives, cancer plans, and patient advocacy, as well as by stronger partnership with international organizations (eg, World Health Organization and Union for International Cancer Control). Copyright © 2016 John Wiley & Sons, Ltd.

Impact of geographic area level on measuring socioeconomic disparities in cancer survival in New South Wales, Australia: A period analysis.

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Stanbury, Julia F; Baade, Peter D; Yu, Yan; Yu, Xue Qin

2016-08-01

Area-based socioeconomic measures are widely used in health research. In theory, the larger the area used the more individual misclassification is introduced, thus biasing the association between such area level measures and health outcomes. In this study, we examined the socioeconomic disparities in cancer survival using two geographic area-based measures to see if the size of the area matters. We used population-based cancer registry data for patients diagnosed with one of 10 major cancers in New South Wales (NSW), Australia during 2004-2008. Patients were assigned index measures of socioeconomic status (SES) based on two area-level units, census Collection District (CD) and Local Government Area (LGA) of their address at diagnosis. Five-year relative survival was estimated using the period approach for patients alive during 2004-2008, for each socioeconomic quintile at each area-level for each cancer. Poisson-regression modelling was used to adjust for socioeconomic quintile, sex, age-group at diagnosis and disease stage at diagnosis. The relative excess risk of death (RER) by socioeconomic quintile derived from this modelling was compared between area-units. We found extensive disagreement in SES classification between CD and LGA levels across all socioeconomic quintiles, particularly for more disadvantaged groups. In general, more disadvantaged patients had significantly lower survival than the least disadvantaged group for both CD and LGA classifications. The socioeconomic survival disparities detected by CD classification were larger than those detected by LGA. Adjusted RER estimates by SES were similar for most cancers when measured at both area levels. We found that classifying patient SES by the widely used Australian geographic unit LGA results in underestimation of survival disparities for several cancers compared to when SES is classified at the geographically smaller CD level. Despite this, our RER of death estimates derived from these survival

Disparities in the Use of Postmastectomy Radiation Therapy for Inflammatory Breast Cancer

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Loveland-Jones, Catherine [MD Anderson Cancer Center at Cooper, Camden, New Jersey (United States); Lin, Heather; Shen, Yu; Bedrosian, Isabelle; Shaitelman, Simona; Kuerer, Henry [University of Texas, MD Anderson Cancer Center, Houston, Texas (United States); Woodward, Wendy; Ueno, Naoto; Valero, Vicente [University of Texas, MD Anderson Cancer Center, Houston, Texas (United States); MD Anderson Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, Houston, Texas (United States); Babiera, Gildy, E-mail: gvbabiera@mdanderson.org [University of Texas, MD Anderson Cancer Center, Houston, Texas (United States); MD Anderson Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, Houston, Texas (United States)

2016-07-15

Purpose: Although radiation therapy improves locoregional control and survival for inflammatory breast cancer (IBC), it is underused in this population. The purpose of this study was to identify variables associated with the underuse of postmastectomy radiation therapy (PMRT) for IBC. Methods and Materials: Using the 1998 to 2011 National Cancer Data Base, we identified 8273 women who underwent mastectomy for nonmetastatic IBC. We used logistic regression modeling to determine the demographic, tumor, and treatment variables associated with the underuse of PMRT. Results: Although the use of PMRT increased over time, a total of 30.3% of our cohort did not receive PMRT. On multivariate analysis, variables associated with the underuse of PMRT for IBC included the following (all P<.05): Medicare insurance (odds ratio [OR] = 0.70), annual income <$34,999 (<$30,000: OR=0.79; $30,000-$34,999: OR=0.82), cN2 and cN0 disease (cN2: OR=0.71; cN0: OR=0.63), failure to receive chemotherapy and hormone therapy (chemotherapy: OR=0.15; hormone therapy: OR=0.35), treatment at lower-volume centers (OR=0.83), and treatment in the South and West (South: OR=0.73; West: OR=0.80). Greater distance between patient's residence and radiation facility was also associated with the underuse of PMRT (P=.0001). Conclusions: Although the use of PMRT for IBC has increased over time, it continues to be underused. Disparities related to a variety of variables impact which IBC patients receive PMRT. A concerted effort must be made to address these disparities in order to optimize the outcomes for IBC.

Urban?rural disparities in colorectal cancer screening: cross-sectional analysis of 1998?2005 data from the Centers for Disease Control's Behavioral Risk Factor Surveillance Study

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Cole, Allison M; Jackson, J Elizabeth; Doescher, Mark

2012-01-01

Despite the existence of effective screening, colorectal cancer remains the second leading cause of cancer death in the United States. Identification of disparities in colorectal cancer screening will allow for targeted interventions to achieve national goals for screening. The objective of this study was to contrast colorectal cancer screening rates in urban and rural populations in the United States. The study design comprised a cross-sectional study in the United States 1998?2005. Behavior...

Impact of individual and neighborhood factors on disparities in prostate cancer survival.

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DeRouen, Mindy C; Schupp, Clayton W; Koo, Jocelyn; Yang, Juan; Hertz, Andrew; Shariff-Marco, Salma; Cockburn, Myles; Nelson, David O; Ingles, Sue A; John, Esther M; Gomez, Scarlett L

2018-04-01

We addressed the hypothesis that individual-level factors act jointly with social and built environment factors to influence overall survival for men with prostate cancer and contribute to racial/ethnic and socioeconomic (SES) survival disparities. We analyzed multi-level data, combining (1) individual-level data from the California Collaborative Prostate Cancer Study, a population-based study of non-Hispanic White (NHW), Hispanic, and African American prostate cancer cases (N = 1800) diagnosed from 1997 to 2003, with (2) data on neighborhood SES (nSES) and social and built environment factors from the California Neighborhoods Data System, and (3) data on tumor characteristics, treatment and follow-up through 2009 from the California Cancer Registry. Multivariable, stage-stratified Cox proportional hazards regression models with cluster adjustments were used to assess education and nSES main and joint effects on overall survival, before and after adjustment for social and built environment factors. African American men had worse survival than NHW men, which was attenuated by nSES. Increased risk of death was associated with residence in lower SES neighborhoods (quintile 1 (lowest nSES) vs. 5: HR = 1.56, 95% CI: 1.11-2.19) and lower education (cancer. Additional research is needed to identify the mechanisms underlying these robust associations. Copyright © 2018 Elsevier Ltd. All rights reserved.

The 22Rv1 prostate cancer cell line carries mixed genetic ancestry: Implications for prostate cancer health disparities research using pre-clinical models.

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Woods-Burnham, Leanne; Basu, Anamika; Cajigas-Du Ross, Christina K; Love, Arthur; Yates, Clayton; De Leon, Marino; Roy, Sourav; Casiano, Carlos A

2017-12-01

Understanding how biological factors contribute to prostate cancer (PCa) health disparities requires mechanistic functional analysis of specific genes or pathways in pre-clinical cellular and animal models of this malignancy. The 22Rv1 human prostatic carcinoma cell line was originally derived from the parental CWR22R cell line. Although 22Rv1 has been well characterized and used in numerous mechanistic studies, no racial identifier has ever been disclosed for this cell line. In accordance with the need for racial diversity in cancer biospecimens and recent guidelines by the NIH on authentication of key biological resources, we sought to determine the ancestry of 22RV1 and authenticate previously reported racial identifications for four other PCa cell lines. We used 29 established Ancestry Informative Marker (AIM) single nucleotide polymorphisms (SNPs) to conduct DNA ancestry analysis and assign ancestral proportions to a panel of five PCa cell lines that included 22Rv1, PC3, DU145, MDA-PCa-2b, and RC-77T/E. We found that 22Rv1 carries mixed genetic ancestry. The main ancestry proportions for this cell line were 0.41 West African (AFR) and 0.42 European (EUR). In addition, we verified the previously reported racial identifications for PC3 (0.73 EUR), DU145 (0.63 EUR), MDA-PCa-2b (0.73 AFR), and RC-77T/E (0.74 AFR) cell lines. Considering the mortality disparities associated with PCa, which disproportionately affect African American men, there remains a burden on the scientific community to diversify the availability of biospecimens, including cell lines, for mechanistic studies on potential biological mediators of these disparities. This study is beneficial by identifying another PCa cell line that carries substantial AFR ancestry. This finding may also open the door to new perspectives on previously published studies using this cell line. © 2017 Wiley Periodicals, Inc.

Large Population-Based Study Reveals Disparities in Myeloma Precursor Disease | Center for Cancer Research

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Multiple myeloma (MM) is a cancer of plasma cells, which are antibody-producing white blood cells. Patients with MM have a characteristic excess of monoclonal antibodies, so called M proteins, in their serum, urine, or both and plasma cell infiltration into their bone marrow at multiple sites. African Americans are more than twice as likely as whites to develop MM, but the reason for this higher prevalence is not entirely clear. Since MM is nearly always preceded by the premalignant condition monoclonal gammopathy of undetermined significance (MGUS), Ola Landgren, M.D., Ph.D., a Senior Investigator in CCR’s Lymphoid Malignancies Branch, and colleagues from NCI’s Division of Cancer Epidemiology and Genetics, the Mayo Clinic, and the Centers for Disease Control and Prevention (CDC), wanted to determine whether there were also disparities in MGUS prevalence or in biomarkers associated with a high risk of MGUS progression to MM.

[Disparities of sex on cancer incidence and mortality in Jiashan county, Zhejiang province,1990-2014].

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Jiang, X Y; Hu, Y Q; Ye, D; Li, Q L; Chen, K; Jin, M J

2017-06-10

Objective: This study aimed to describe the sex disparities on cancer incidence and mortality in Jiashan population. Methods: All data concerning incident and death cases of cancers were gathered from the database of Cancer Registry in Jiashan county. Data from the 2010 China census was used as the standard population. Sex-specific age-standardized incidence rates (ASIRs), mortality rates (ASMRs) per 100 000 persons for all cancers and types of each cancer were calculated for the years of 1990 to 1999, 2000 to 2009, 2010 to 2014, and 1990 to 2014. In addition, the corresponding male-to-female incidence rate ratios ( IRRs ) and mortality rate ratios ( MRRs ) were also calculated. Results: The ASIR of all cancers was 226.13/10(5) for the whole period of 1990 to 2014, with 266.04/10(5) for males and 187.22/10(5) for females, respectively. The corresponding IRR was 1.42 (95 %CI : 1.39-1.46), with significant difference noticed in the incidence rates between males and females ( P ASMR of all cancers was 155.39/10(5), with 206.55/10(5) for males and 104.98/10(5) for females, respectively. The corresponding MRR was 1.97 (95 % CI : 1.91-2.03), with significant difference between males and females ( P <0.05). Among all the cancer types, only gallbladder cancer and thyroid cancer showed female predominance in both incidence and mortality, with male predominance in all the remaining cancers. Conclusion: Finding from our study suggested that a male predominance in both incidence and mortality for a majority of cancers in Jiashan population.

Do gender-based disparities in authorship also exist in cancer palliative care? A 15-year survey of the cancer palliative care literature.

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Singh, Preet Paul; Jatoi, Aminah

2008-01-01

Women physicians in the United States publish less than men and advance academically at a slower pace. Do such gender-based disparities also occur in cancer palliative care, a field in which women appear to hold a strong interest? We undertook a detailed survey of the cancer palliative care literature. We selected 5 cancer palliative care journals on the basis of their high impact factors, and we assessed authorship for the years 1990, 1995, 2000, and 2005. We determined gender and highest educational degree for all US first and last authors. A total of 794 authors are the focus of this report. In 2005, 50% of first authors were women, but only 14% were women physicians. Similarly, 39% of senior authors were women during this year, but only 8% were women physicians. Over this 15-year period, no statistically significant trends were detected to indicate an increase in the number of women authors. These findings are sobering. Future efforts might focus on strategies to improve rates of authorship and, ultimately, improve rates of academic promotion for women interested in cancer palliative care.

Hidden Breast Cancer Disparities in Asian Women: Disaggregating Incidence Rates by Ethnicity and Migrant Status

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Quach, Thu; Horn-Ross, Pamela L.; Pham, Jane T.; Cockburn, Myles; Chang, Ellen T.; Keegan, Theresa H. M.; Glaser, Sally L.; Clarke, Christina A.

2010-01-01

Objectives. We estimated trends in breast cancer incidence rates for specific Asian populations in California to determine if disparities exist by immigrant status and age. Methods. To calculate rates by ethnicity and immigrant status, we obtained data for 1998 through 2004 cancer diagnoses from the California Cancer Registry and imputed immigrant status from Social Security Numbers for the 26% of cases with missing birthplace information. Population estimates were obtained from the 1990 and 2000 US Censuses. Results. Breast cancer rates were higher among US- than among foreign-born Chinese (incidence rate ratio [IRR] = 1.84; 95% confidence interval [CI] = 1.72, 1.96) and Filipina women (IRR = 1.32; 95% CI = 1.20, 1.44), but similar between US- and foreign-born Japanese women. US-born Chinese and Filipina women who were younger than 55 years had higher rates than did White women of the same age. Rates increased over time in most groups, as high as 4% per year among foreign-born Korean and US-born Filipina women. From 2000–2004, the rate among US-born Filipina women exceeded that of White women. Conclusions. These findings challenge the notion that breast cancer rates are uniformly low across Asians and therefore suggest a need for increased awareness, targeted cancer control, and research to better understand underlying factors. PMID:20147696

Disseminating Health Disparities Education Through Tele-Learning

Directory of Open Access Journals (Sweden)

LaSonya Knowles

2008-08-01

Full Text Available Twenty years of research demonstrate that there are wide disparities in health throughout America. Health disparities are differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist when specific population subgroups are compared. Health Disparities in America: Working Toward Social Justice is a course instructed every fall by Dr. Lovell Jones, director of The Center for Research on Minority Health (CRMH at UT M.D. Anderson Cancer Center. The CRMH has created a course that examines the social and societal factors that are fundamental in creating disparities in health. Students from 10 different academic programs and institutions participate in this course. The course is unique in the aspect that various, diverse speakers whom are experts in their field of study instruct each class. This health disparities course is conducted at one of three different academic institutions in the Houston area and broadcast via satellite to various academic institutions by means of teleeducation. Tele-education is defined as a mode of instruction utilizing different forms of media such as video, audio technology tools and computers. Video and audio technologies involve the transmission of interface between learners and instructors, either interactive or non-interactive. Tele-education technologies have an important role to play in addressing the dissemination of health disparities education. The purpose of this program is to determine the feasibility of tele-education as a mode of instruction to introduce the multi-disciplinary components of health disparities. Our findings suggest that tele-education is a useful tool in imparting health disparities education.

Racial disparities and socioeconomic status in association with survival in a large population-based cohort of elderly patients with colon cancer.

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Du, Xianglin L; Fang, Shenying; Vernon, Sally W; El-Serag, Hashem; Shih, Y Tina; Davila, Jessica; Rasmus, Monica L

2007-08-01

To the authors' knowledge, few studies have addressed racial disparities in the survival of patients with colon cancer by adequately incorporating treatment and socioeconomic factors in addition to patient and tumor characteristics. The authors studied a nationwide and population-based, retrospective cohort of 18,492 men and women who were diagnosed with stage II or III colon cancer at age >or=65 years between 1992 and 1999. This cohort was identified from the Surveillance, Epidemiology, and End Results (SEER) cancer registries-Medicare linked databases and included up to 11 years of follow-up. A larger proportion (70%) of African-American patients with colon cancer fell into the poorest quartiles of socioeconomic status compared with Caucasians (21%). Patients who lived in communities with the lowest socioeconomic level had 19% higher all-cause mortality compared with patients who lived in communities with the highest socioeconomic status (hazards ratio [HR], 1.19; 95% confidence interval [95% CI], 1.13-1.26; P colon cancer, African-American patients were 21% more likely to die after controlling for age, sex, comorbidity scores, tumor stage, and grade (HR, 1.21; 95% CI, 1.12-1.30). After also adjusting for definitive therapy and socioeconomic status, the HR of mortality was only marginally significantly higher in African Americans compared with Caucasians for all-cause mortality (HR, 1.10; 95% CI, 1.02-1.19) and colon cancer-specific mortality (HR, 1.16; 95% CI, 1.01-1.33). Lower socioeconomic status and lack of definitive treatment were associated strongly with decreased survival in both men and women with colon cancer. Racial disparities in survival were explained substantially by differences in socioeconomic status. (c) 2007 American Cancer Society.

Disparities in Adolescent and Young Adult Survival After Testicular Cancer Vary by Histologic Subtype: A Population-Based Study in California 1988-2010.

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DeRouen, Mindy C; Mujahid, Mahasin; Srinivas, Sandy; Keegan, Theresa H M

2016-03-01

Testicular cancer is the most common cancer among adolescent and young adult (AYA) men 15-39 years of age. This study aims to determine whether race/ethnicity and/or neighborhood socioeconomic status (SES) contribute independently to survival of AYAs with testicular cancer. Data on 14,249 eligible AYAs with testicular cancer diagnosed in California between 1988 and 2010 were obtained from the population-based California Cancer Registry. Multivariable Cox proportional hazards regression was used to examine overall and testicular cancer-specific survival and survival for the seminoma and nonseminoma histologic subtypes according to race/ethnicity, census-tract level neighborhood SES, and other patient and clinical characteristics. Compared with White AYAs, Hispanic AYAs had worse overall and testicular cancer-specific survival (hazard ratio [HR], 1.21; 95% confidence interval [CI], 1.07-1.37) and Black AYAs had worse overall survival (HR, 1.41; 95% CI, 1.01-1.97), independent of neighborhood SES and other demographic and clinical factors. Racial/ethnic disparities in survival were more pronounced for nonseminoma than for seminoma. AYAs residing in middle and low SES neighborhoods experienced worse survival across both histologic subtypes independent of race/ethnicity and other factors, while improvements in survival over time were more pronounced for seminoma. Longer time to treatment was also associated with worse survival, particularly for AYAs with nonseminoma. Among AYAs, race/ethnicity, and neighborhood SES are independently associated with survival after testicular cancer. Variation in disparities by histologic type according to demographic factors, year of diagnosis, and time to treatment may reflect differences in prognosis and extent of treatment for the two histologies.

Socioeconomic and Racial/Ethnic Disparities in Cancer Mortality, Incidence, and Survival in the United States, 1950–2014: Over Six Decades of Changing Patterns and Widening Inequalities

Directory of Open Access Journals (Sweden)

Gopal K. Singh

2017-01-01

Full Text Available We analyzed socioeconomic and racial/ethnic disparities in US mortality, incidence, and survival rates from all-cancers combined and major cancers from 1950 to 2014. Census-based deprivation indices were linked to national mortality and cancer data for area-based socioeconomic patterns in mortality, incidence, and survival. The National Longitudinal Mortality Study was used to analyze individual-level socioeconomic and racial/ethnic patterns in mortality. Rates, risk-ratios, least squares, log-linear, and Cox regression were used to examine trends and differentials. Socioeconomic patterns in all-cancer, lung, and colorectal cancer mortality changed dramatically over time. Individuals in more deprived areas or lower education and income groups had higher mortality and incidence rates than their more affluent counterparts, with excess risk being particularly marked for lung, colorectal, cervical, stomach, and liver cancer. Education and income inequalities in mortality from all-cancers, lung, prostate, and cervical cancer increased during 1979–2011. Socioeconomic inequalities in cancer mortality widened as mortality in lower socioeconomic groups/areas declined more slowly. Mortality was higher among Blacks and lower among Asian/Pacific Islanders and Hispanics than Whites. Cancer patient survival was significantly lower in more deprived neighborhoods and among most ethnic-minority groups. Cancer mortality and incidence disparities may reflect inequalities in smoking, obesity, physical inactivity, diet, alcohol use, screening, and treatment.

Disparities in Adolescent and Young Adult Survival After Testicular Cancer Vary by Histologic Subtype: A Population-Based Study in California 1988–2010

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Mujahid, Mahasin; Srinivas, Sandy; Keegan, Theresa H.M.

2016-01-01

Purpose: Testicular cancer is the most common cancer among adolescent and young adult (AYA) men 15–39 years of age. This study aims to determine whether race/ethnicity and/or neighborhood socioeconomic status (SES) contribute independently to survival of AYAs with testicular cancer. Methods: Data on 14,249 eligible AYAs with testicular cancer diagnosed in California between 1988 and 2010 were obtained from the population-based California Cancer Registry. Multivariable Cox proportional hazards regression was used to examine overall and testicular cancer-specific survival and survival for the seminoma and nonseminoma histologic subtypes according to race/ethnicity, census-tract level neighborhood SES, and other patient and clinical characteristics. Results: Compared with White AYAs, Hispanic AYAs had worse overall and testicular cancer-specific survival (hazard ratio [HR], 1.21; 95% confidence interval [CI], 1.07–1.37) and Black AYAs had worse overall survival (HR, 1.41; 95% CI, 1.01–1.97), independent of neighborhood SES and other demographic and clinical factors. Racial/ethnic disparities in survival were more pronounced for nonseminoma than for seminoma. AYAs residing in middle and low SES neighborhoods experienced worse survival across both histologic subtypes independent of race/ethnicity and other factors, while improvements in survival over time were more pronounced for seminoma. Longer time to treatment was also associated with worse survival, particularly for AYAs with nonseminoma. Conclusion: Among AYAs, race/ethnicity, and neighborhood SES are independently associated with survival after testicular cancer. Variation in disparities by histologic type according to demographic factors, year of diagnosis, and time to treatment may reflect differences in prognosis and extent of treatment for the two histologies. PMID:26812451

Identifying health disparities across the tobacco continuum.

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Fagan, Pebbles; Moolchan, Eric T; Lawrence, Deirdre; Fernander, Anita; Ponder, Paris K

2007-10-01

Few frameworks have addressed work-force diversity, inequities and inequalities as part of a comprehensive approach to eliminating tobacco-related health disparities. This paper summarizes the literature and describes the known disparities that exist along the tobacco disease continuum for minority racial and ethnic groups, those living in poverty, those with low education and blue-collar and service workers. The paper also discusses how work-force diversity, inequities in research practice and knowledge allocation and inequalities in access to and quality of health care are fundamental to addressing disparities in health. We examined the available scientific literature and existing public health reports to identify disparities across the tobacco disease continuum by minority racial/ethnic group, poverty status, education level and occupation. Results indicate that differences in risk indicators along the tobacco disease continuum do not explain fully tobacco-related cancer consequences among some minority racial/ethnic groups, particularly among the aggregate groups, blacks/African Americans and American Indians/Alaska Natives. The lack of within-race/ethnic group data and its interactions with socio-economic factors across the life-span contribute to the inconsistency we observe in the disease causal paradigm. More comprehensive models are needed to understand the relationships among disparities, social context, diversity, inequalities and inequities. A systematic approach will also help researchers, practitioners, advocates and policy makers determine critical points for interventions, the types of studies and programs needed and integrative approaches needed to eliminate tobacco-related disparities.

Waiting time disparities in breast cancer diagnosis and treatment: a population-based study in France.

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Molinié, F; Leux, C; Delafosse, P; Ayrault-Piault, S; Arveux, P; Woronoff, A S; Guizard, A V; Velten, M; Ganry, O; Bara, S; Daubisse-Marliac, L; Tretarre, B

2013-10-01

Waiting times are key indicators of a health's system performance, but are not routinely available in France. We studied waiting times for diagnosis and treatment according to patients' characteristics, tumours' characteristics and medical management options in a sample of 1494 breast cancers recorded in population-based registries. The median waiting time from the first imaging detection to the treatment initiation was 34 days. Older age, co-morbidity, smaller size of tumour, detection by organised screening, biopsy, increasing number of specimens removed, multidisciplinary consulting meetings and surgery as initial treatment were related to increased waiting times in multivariate models. Many of these factors were related to good practices guidelines. However, the strong influence of organised screening programme and the disparity of waiting times according to geographical areas were of concern. Better scheduling of diagnostic tests and treatment propositions should improve waiting times in the management of breast cancer in France. Copyright © 2013 Elsevier Ltd. All rights reserved.

Household-level disparities in cancer risks from vehicular air pollution in Miami

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Collins, Timothy W; Grineski, Sara E; Chakraborty, Jayajit

2015-01-01

Environmental justice (EJ) research has relied on ecological analyses of socio-demographic data from areal units to determine if particular populations are disproportionately burdened by toxic risks. This article advances quantitative EJ research by (a) examining whether statistical associations found for geographic units translate to relationships at the household level; (b) testing alternative explanations for distributional injustices never before investigated; and (c) applying a novel statistical technique appropriate for geographically-clustered data. Our study makes these advances by using generalized estimating equations to examine distributive environmental inequities in the Miami (Florida) metropolitan area, based on primary household-level survey data and census block-level cancer risk estimates of hazardous air pollutant (HAP) exposure from on-road mobile emission sources. In addition to modeling determinants of on-road HAP cancer risk among all survey participants, two subgroup models are estimated to examine whether determinants of risk differ based on disadvantaged minority (Hispanic and non-Hispanic Black) versus non-Hispanic white racial/ethnic status. Results reveal multiple determinants of risk exposure disparities. In the model including all survey participants, renter-occupancy, Hispanic and non-Hispanic black race/ethnicity, the desire to live close to work/urban services or public transportation, and higher risk perception are associated with greater on-road HAP cancer risk; the desire to live in an amenity-rich environment is associated with less risk. Divergent subgroup model results shed light on the previously unexamined role of racial/ethnic status in shaping determinants of risk exposures. While lower socioeconomic status and higher risk perception predict significantly greater on-road HAP cancer risk among disadvantaged minorities, the desire to live near work/urban services or public transport predict significantly greater risk among

Development of a community-based participatory colorectal cancer screening intervention to address disparities, Arkansas, 2008-2009.

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Yeary, Karen; Flowers, Eric; Ford, Gemessia; Burroughs, Desiree; Burton, Jackie; Woods, Delores; Stewart, Chara; Mehta, Paulette; Greene, Paul; Henry-Tillman, Ronda

2011-03-01

The death rate from colorectal cancer is high and affects poor and medically underserved populations disproportionately. In the United States, health disparities are particularly acute in the Lower Mississippi River Delta region. Because many in the region have limited access to basic health care resources, they are not screened for cancer, even though screening is one of the most effective strategies to prevent colorectal cancer. Community-based participatory research is a promising approach to prevent colorectal cancer in this population. The Empowering Communities for Life program was implemented in 2 underserved counties in the Arkansas Lower Mississippi River Delta. The program arose from a 9-year partnership between the University of Arkansas for Medical Sciences and 9 cancer councils across Arkansas. Empowering Communities for Life is a community-based participatory intervention designed to increase colorectal cancer screening in rural, underserved communities through fecal occult blood testing. Community and academic partners collaborated to develop research infrastructure, intervention materials and methods, and the assessment instrument. Project outcomes were strengthened community-academic partnerships, certification of community partners in conducting human subjects research, development of a randomized controlled design to test the intervention's efficacy, an interactive PowerPoint presentation, an informational pamphlet, the certification of 6 lay health advisors and 22 role models to provide the intervention, and an assessment tool using an audience response system. Lessons learned in working collaboratively with diverse groups include the importance of meeting face to face and listening.

Socioeconomic disparities in breast cancer screening in Hawaii.

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Halliday, Timothy; Taira, Deborah A; Davis, James; Chan, Henry

2007-10-01

Despite evidence that breast cancer screening reduces morbidity and mortality, many women do not obtain mammograms. Our objective was to analyze the relationship between income and mammography screening for members enrolled in a large health plan in Hawaii. We analyzed claims data for women (N = 46,328) aged 50 to 70 years during 2003 and 2004. We used parametric and nonparametric regression techniques. We used probit estimation to conduct multivariate analysis. At the 5th percentile of the earnings distribution, the probability of mammography is 57.1%, and at the 95th percentile, it is 67.7%. Movement from the 5th percentile to the 35th percentile of the earnings distribution increases the probability of mammography by 0.0378 percentage points. A similar movement from the 65th percentile to the 95th percentile increases the probability by 0.0394 percentage points. Also, we observed an income gradient within narrowly defined geographic regions where physical access to medical care providers is not an issue. We observed a steep income gradient in mammography screening in Hawaii. Because of the prevalence of measurement error, this gradient is probably far greater than our estimate. We cannot plausibly attribute our findings to disparities in coverage because 100% of our sample had health insurance coverage. The gradient also does not appear to result from poorer people residing in areas that are geographically isolated from providers of medical care.

Disparities in Breast Cancer Survival Among Asian Women by Ethnicity and Immigrant Status: A Population-Based Study

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Clarke, Christina A.; Shema, Sarah J.; Chang, Ellen T.; Keegan, Theresa H. M.; Glaser, Sally L.

2010-01-01

Objectives. We investigated heterogeneity in ethnic composition and immigrant status among US Asians as an explanation for disparities in breast cancer survival. Methods. We enhanced data from the California Cancer Registry and the Surveillance, Epidemiology, and End Results program through linkage and imputation to examine the effect of immigrant status, neighborhood socioeconomic status, and ethnic enclave on mortality among Chinese, Japanese, Filipino, Korean, South Asian, and Vietnamese women diagnosed with breast cancer from 1988 to 2005 and followed through 2007. Results. US-born women had similar mortality rates in all Asian ethnic groups except the Vietnamese, who had lower mortality risk (hazard ratio [HR] = 0.3; 95% confidence interval [CI] = 0.1, 0.9). Except for Japanese women, all foreign-born women had higher mortality than did US-born Japanese, the reference group. HRs ranged from 1.4 (95% CI = 1.2, 1.7) among Koreans to 1.8 (95% CI = 1.5, 2.2) among South Asians and Vietnamese. Little of this variation was explained by differences in disease characteristics. Conclusions. Survival after breast cancer is poorer among foreign- than US-born Asians. Research on underlying factors is needed, along with increased awareness and targeted cancer control. PMID:20299648

Cancer Statistics

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... What Is Cancer? Cancer Statistics Cancer Disparities Cancer Statistics Cancer has a major impact on society in ... success of efforts to control and manage cancer. Statistics at a Glance: The Burden of Cancer in ...

Understanding environmental health inequalities through comparative intracategorical analysis: racial/ethnic disparities in cancer risks from air toxics in El Paso County, Texas.

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Collins, Timothy W; Grineski, Sara E; Chakraborty, Jayajit; McDonald, Yolanda J

2011-01-01

This paper contributes to the environmental justice literature by analyzing contextually relevant and racial/ethnic group-specific variables in relation to air toxics cancer risks in a US-Mexico border metropolis at the census block group-level. Results indicate that Hispanics' ethnic status interacts with class, gender and age status to amplify disproportionate risk. In contrast, results indicate that non-Hispanic whiteness attenuates cancer risk disparities associated with class, gender and age status. Findings suggest that a system of white-Anglo privilege shapes the way in which race/ethnicity articulates with other dimensions of inequality to create unequal cancer risks from air toxics. Copyright © 2010 Elsevier Ltd. All rights reserved.

Understanding Cancer Prognosis

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Racial disparities in survival outcomes by breast tumor subtype among African American women in Memphis, Tennessee.

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Vidal, Gregory; Bursac, Zoran; Miranda-Carboni, Gustavo; White-Means, Shelley; Starlard-Davenport, Athena

2017-07-01

Racial disparities in survival among African American (AA) women in the United States have been well documented. Breast cancer mortality rates among AA women is higher in Memphis, Tennessee as compared to 49 of the largest US cities. In this study, we investigated the extent to which racial/ethnic disparities in survival outcomes among Memphis women are attributed to differences in breast tumor subtype and treatment outcomes. A total of 3527 patients diagnosed with stage I-IV breast cancer between January 2002 and April 2015 at Methodist Health hospitals and West Cancer Center in Memphis, TN were included in the analysis. Kaplan-Meier survival curves were generated and Cox proportional hazards regression were used to compare survival outcomes among 1342 (38.0%) AA and 2185 (62.0%) non-Hispanic White breast cancer patients by race and breast tumor subtype. Over a mean follow-up time of 29.9 months, AA women displayed increased mortality risk [adjusted hazard ratio (HR), 1.65; 95% confidence interval (CI), 1.35-2.03] and were more likely to be diagnosed at advanced stages of disease. AA women with triple-negative breast cancer (TNBC) had the highest death rate at 26.7% compared to non-Hispanic White women at 16.5%. AA women with TNBC and luminal B/HER2- breast tumors had the highest risk of mortality. Regardless of race, patients who did not have surgery had over five times higher risk of dying compared to those who had surgery. These findings provide additional evidence of the breast cancer disparity gap between AA and non-Hispanic White women and highlight the need for targeted interventions and policies to eliminate breast cancer disparities in AA populations, particularly in Memphis, TN. © 2017 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

Disparities in the Use of Radiation Therapy in Patients With Local-Regionally Advanced Breast Cancer

International Nuclear Information System (INIS)

Martinez, Steve R.; Beal, Shannon H.; Chen, Steven L.; Canter, Robert J.; Khatri, Vijay P.; Chen, Allen; Bold, Richard J.

2010-01-01

Background: Radiation therapy (RT) is indicated for the treatment of local-regionally advanced breast cancer (BCa). Hypothesis: We hypothesized that black and Hispanic patients with local-regionally advanced BCa would receive lower rates of RT than their white counterparts. Methods: The Surveillance Epidemiology and End Results database was used to identify white, black, Hispanic, and Asian patients with invasive BCa and ≥10 metastatic lymph nodes diagnosed between 1988 and 2005. Univariate and multivariate logistic regression evaluated the relationship of race/ethnicity with use of RT. Multivariate models stratified for those undergoing mastectomy or lumpectomy. Results: Entry criteria were met by 12,653 patients. Approximately half of the patients did not receive RT. Most patients were white (72%); the remainder were Hispanic (10.4%), black (10.3%), and Asian (7.3%). On univariate analysis, Hispanics (odd ratio [OR] 0.89; 95% confidence interval [CI], 0.79-1.00) and blacks (OR 0.79; 95% CI, 0.70-0.89) were less likely to receive RT than whites. On multivariate analysis, blacks (OR 0.76; 95% CI, 0.67-0.86) and Hispanics (OR 0.80; 95% CI, 0.70-0.90) were less likely than whites to receive RT. Disparities persisted for blacks (OR 0.74; 95% CI, 0.64-0.85) and Hispanics (OR 0.77; 95% CI, 0.67-0.89) who received mastectomy, but not for those who received lumpectomy. Conclusions: Many patients with local-regionally advanced BCa do not receive RT. Blacks and Hispanics were less likely than whites to receive RT. This disparity was noted predominately in patients who received mastectomy. Future efforts at improving rates of RT are warranted. Efforts at eliminating racial/ethnic disparities should focus on black and Hispanic candidates for postmastectomy RT.

Non-Hispanic Black-White disparities in pain and pain management among newly admitted nursing home residents with cancer.

Science.gov (United States)

Mack, Deborah S; Hunnicutt, Jacob N; Jesdale, Bill M; Lapane, Kate L

2018-01-01

Racial disparities in pain management persist across health care settings and likely extend into nursing homes. No recent studies have evaluated racial disparities in pain management among residents with cancer in nursing homes at time of admission. Using a cross-sectional study design, we compared reported pain and pain management between non-Hispanic White and non-Hispanic Black newly admitted nursing home residents with cancer (n=342,920) using the de-identified Minimum Data Set version 3.0. Pain management strategies included the use of scheduled analgesics, pro re nata analgesics, and non-pharmacological methods. Presence of pain was based on self-report when residents were able, and staff report when unable. Robust Poisson models provided estimates of adjusted prevalence ratios (aPR) and 95% CIs for reported pain and pain management strategies. Among nursing home residents with cancer, ~60% reported pain with non-Hispanic Blacks less likely to have both self-reported pain (aPR [Black versus White]: 0.98, 95% CI: 0.97-0.99) and staff-reported pain (aPR: 0.89, 95% CI: 0.86-0.93) documentation compared with Non-Hispanic Whites. While most residents received some pharmacologic pain management, Blacks were less likely to receive any compared with Whites (Blacks: 66.6%, Whites: 71.1%; aPR: 0.98, 95% CI: 0.97-0.99), consistent with differences in receipt of non-pharmacologic treatments (Blacks: 25.8%, Whites: 34.0%; aPR: 0.98, 95 CI%: 0.96-0.99). Less pain was reported for Black compared with White nursing home residents and White residents subsequently received more frequent pain management at admission. The extent to which unequal reporting and management of pain persists in nursing homes should be further explored.

Racial and ethnic disparities in patient-provider communication, quality-of-care ratings, and patient activation among long-term cancer survivors.

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Palmer, Nynikka R A; Kent, Erin E; Forsythe, Laura P; Arora, Neeraj K; Rowland, Julia H; Aziz, Noreen M; Blanch-Hartigan, Danielle; Oakley-Girvan, Ingrid; Hamilton, Ann S; Weaver, Kathryn E

2014-12-20

We examined racial and ethnic disparities in patient-provider communication (PPC), perceived care quality, and patient activation among long-term cancer survivors. In 2005 to 2006, survivors of breast, prostate, colorectal, ovarian, and endometrial cancers completed a mailed survey on cancer follow-up care. African American, Asian/Pacific Islander (Asian), Hispanic, and non-Hispanic white (white) survivors who had seen a physician for follow-up care in the past 2 years (n = 1,196) composed the analytic sample. We conducted linear and logistic regression analyses to identify racial and ethnic differences in PPC (overall communication and medical test communication), perceived care quality, and patient activation in clinical care (self-efficacy in medical decisions and perceived control). We further examined the potential contribution of PPC to racial and ethnic differences in perceived care quality and patient activation. Compared with white survivors (mean score, 85.16), Hispanic (mean score, 79.95) and Asian (mean score, 76.55) survivors reported poorer overall communication (P = .04 and P Asian survivors (mean score, 79.97) reported poorer medical test communication (P = .001). Asian survivors were less likely to report high care quality (odds ratio, 0.47; 95% CI, 0.30 to 0.72) and reported lower self-efficacy in medical decisions (mean score, 74.71; P Asian disparities remained significant. Asian survivors report poorer follow-up care communication and care quality. More research is needed to identify contributing factors beyond PPC, such as cultural influences and medical system factors. © 2014 by American Society of Clinical Oncology.

Cancer and Women

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Cancer and Men

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... Materials Infographics Cancer and Alcohol Web Features Breast Cancer Awareness Breast Cancer in Young Women Cancer and Men ... in Childhood Cancer, the Flu, and You Cervical Cancer Awareness Colorectal Cancer Awareness Gynecologic Cancer Awareness Health Disparities ...

Understanding Cancer Prognosis

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Understanding Cancer Prognosis

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Understanding Cancer Prognosis

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Understanding Cancer Prognosis

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Geographic access to radiation therapy facilities and disparities of early-stage breast cancer treatment

Directory of Open Access Journals (Sweden)

Yan Lin

2018-05-01

geographic proximity to treatment facilities plays an important role on the treatment for early-stage breast cancer patients, this study has important implications for developing targeted intervention to reduce disparities in breast cancer treatment in South Dakota.

Liver Cancer Disparities in New York City: A Neighborhood View of Risk and Harm Reduction Factors

Directory of Open Access Journals (Sweden)

Geetanjali R. Kamath

2018-06-01

Full Text Available IntroductionLiver cancer is the fastest increasing cancer in the United States and is one of the leading causes of cancer-related death in New York City (NYC, with wide disparities among neighborhoods. The purpose of this cross-sectional study was to describe liver cancer incidence by neighborhood and examine its association with risk factors. This information can inform preventive and treatment interventions.Materials and methodsPublicly available data were collected on adult NYC residents (n = 6,407,022. Age-adjusted data on liver and intrahepatic bile duct cancer came from the New York State Cancer Registry (1 (2007–2011 average annual incidence; and the NYC Vital Statistics Bureau (2015, mortality. Data on liver cancer risk factors (2012–2015 were sourced from the New York City Department of Health and Mental Hygiene: (1 Community Health Survey, (2 A1C registry, and (3 NYC Health Department Hepatitis surveillance data. They included prevalence of obesity, diabetes, diabetic control, alcohol-related hospitalizations or emergency department visits, hepatitis B and C rates, hepatitis B vaccine coverage, and injecting drug use.ResultsLiver cancer incidence in NYC was strongly associated with neighborhood poverty after adjusting for race/ethnicity (β = 0.0217, p = 0.013; and with infection risk scores (β = 0.0389, 95% CI = 0.0088–0.069, p = 0.011, particularly in the poorest neighborhoods (β = 0.1207, 95% CI = 0.0147–0.2267, p = 0.026. Some neighborhoods with high hepatitis rates do not have a proportionate number of hepatitis prevention services.ConclusionHigh liver cancer incidence is strongly associated with infection risk factors in NYC. There are gaps in hepatitis prevention services like syringe exchange and vaccination that should be addressed. The role of alcohol and metabolic risk factors on liver cancer in NYC warrants further study.

Understanding Cancer Prognosis

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Health insurance coverage and racial disparities in breast reconstruction after mastectomy.

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Shippee, Tetyana P; Kozhimannil, Katy B; Rowan, Kathleen; Virnig, Beth A

2014-01-01

Breast reconstruction after mastectomy offers clinical, cosmetic, and psychological benefits compared with mastectomy alone. Although reconstruction rates have increased, racial/ethnic disparities in breast reconstruction persist. Insurance coverage facilitates access to care, but few studies have examined whether health insurance ameliorates disparities. We used the Nationwide Inpatient Sample for 2002 through 2006 to examine the relationships between health insurance coverage, race/ethnicity, and breast reconstruction rates among women who underwent mastectomy for breast cancer. We examined reconstruction rates as a function of the interaction of race and the primary payer (self-pay, private health insurance, government) while controlling for patient comorbidity, and we used generalized estimating equations to account for clustering and hospital characteristics. Minority women had lower breast reconstruction rates than White women (adjusted odds ratio [AOR], 0.57 for African American; AOR, 0.70 for Hispanic; AOR, 0.45 for Asian; p women (AOR, 0.33) and those with public coverage were less likely to undergo reconstruction (AOR, 0.35; p women. Racial/ethnic disparities were less prominent within insurance types. Minority women, whether privately or publicly insured, had lower odds of undergoing reconstruction than White women. Among those without insurance, reconstruction rates did not differ by race/ethnicity. Insurance facilitates access to care, but does not eliminate racial/ethnic disparities in reconstruction rates. Our findings-which reveal persistent health care disparities not explained by patient health status-should prompt efforts to promote both access to and use of beneficial covered services for women with breast cancer. Copyright © 2014 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Racial disparities: disruptive genes in prostate carcinogenesis.

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Singh, Savita; Plaga, Alexis; Shukla, Girish C

2017-06-01

Population specific studies in prostate cancer (PCa) reveal a unique heterogeneous etiology. Various factors, such as genetics, environment and dietary regimen seems to determine disease progression, therapeutic resistance and rate of mortality. Enormous disparity documented in disease incidences, aggressiveness and mortality in PCa among AAs (African Americans) and CAs (Caucasian Americans) is attributed to the variations in genetics, epigenetics and their association with metabolism. Scientific and clinical evidences have revealed the influence of variations in Androgen Receptor (AR), RNAse L, macrophage scavenger receptor 1 ( MRS1 ), androgen metabolism by cytochrome P450 3A4, differential regulation of microRNAs, epigenetic alterations and diet in racial disparity in PCa incidences and mortality. Concerted efforts are needed to identify race specific prognostic markers and treatment regimen for a better management of the disease.

CDC's Cervical Cancer Study

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American Society of Clinical Oncology Position Statement: Strategies for Reducing Cancer Health Disparities Among Sexual and Gender Minority Populations.

Science.gov (United States)

Griggs, Jennifer; Maingi, Shail; Blinder, Victoria; Denduluri, Neelima; Khorana, Alok A; Norton, Larry; Francisco, Michael; Wollins, Dana S; Rowland, Julia H

2017-07-01

ASCO is committed to addressing the needs of sexual and gender minority (SGM) populations as a diverse group at risk for receiving disparate care and having suboptimal experiences, including discrimination, throughout the cancer care continuum. This position statement outlines five areas of recommendations to address the needs of both SGM populations affected by cancer and members of the oncology workforce who identify as SGM: (1) patient education and support; (2) workforce development and diversity; (3) quality improvement strategies; (4) policy solutions; and (5) research strategies. In making these recommendations, the Society calls for increased outreach and educational support for SGM patients; increased SGM cultural competency training for providers; improvement of quality-of-care metrics that include sexual orientation and gender information variables; and increased data collection to inform future work addressing the needs of SGM communities.

Short sleep duration as a contributor to racial disparities in breast cancer tumor grade

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Kevin Allan

2017-07-01

Full Text Available Although African Americans (AAs are less likely to get breast cancer than European Americans (EAs, they get more aggressive forms. We previously showed that short sleep is associated with higher tumor grade. It is well documented that AAs get less sleep, on average, than EAs. We studied the contribution of short sleep to racial disparities in breast cancer aggressiveness among 809 invasive breast cancer patients who responded to a survey on their lifestyle. Multivariable regressions and mediation analyses were performed to assess the effect of sleep duration on the association of race with tumor grade. AAs reported shorter average sleep (mean [standard deviation] 6.57 [1.47] h than EAs (mean [standard deviation] 7.11 [1.16] h; P<0.0001 and were almost twice as likely to report less than 6 h of sleep per night (48.0% vs. 25.3%, P<0.0001. AA patients were more likely to have high-grade tumors (52.6% vs. 28.7% in EAs, P=0.0002. In multivariate analysis, race was associated with tumor grade (P<0.0001. On adjustment for sleep duration, the effect of race was reduced by 7.1%, but remained statistically significant (P=0.0006. However, the Sobel test did not indicate statistical significance (z=1.69, P=0.091. In other models accounting for these and additional confounders, we found similar results. Because of the conservative nature of the mediation analysis and smaller sample size, replication of our results in larger studies with more AA patients is warranted.

Stroma-induced Jagged1 expression drives PC3 prostate cancer cell migration; disparate effects of RIP-generated proteolytic fragments on cell behaviour and Notch signaling

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Delury, Craig, E-mail: c.delury@lancaster.ac.uk [Division of Biomedical and Life Sciences, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YQ (United Kingdom); Hart, Claire, E-mail: claire.hart@manchester.ac.uk [Genito Urinary Cancer Research Group, Institute of Cancer Sciences, Paterson Building, The University of Manchester, Manchester Academic Health Science Centre, Wilmslow Road, Manchester, M20 4BX (United Kingdom); Brown, Mick, E-mail: michael.brown@ics.manchester.ac.uk [Genito Urinary Cancer Research Group, Institute of Cancer Sciences, Paterson Building, The University of Manchester, Manchester Academic Health Science Centre, Wilmslow Road, Manchester, M20 4BX (United Kingdom); Clarke, Noel, E-mail: noel.clarke@christie.nhs.uk [Genito Urinary Cancer Research Group, Institute of Cancer Sciences, Paterson Building, The University of Manchester, Manchester Academic Health Science Centre, Wilmslow Road, Manchester, M20 4BX (United Kingdom); Parkin, Edward, E-mail: e.parkin@lancaster.ac.uk [Division of Biomedical and Life Sciences, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YQ (United Kingdom)

2016-03-25

The Notch ligand Jagged1 is subject to regulated intramembrane proteolysis (RIP) which yields a soluble ectodomain (sJag) and a soluble Jagged1 intracellular domain (JICD). The full-length Jagged1 protein enhances prostate cancer (PCa) cell proliferation and is highly expressed in metastatic cells. However, little is known regarding the mechanisms by which Jagged1 or its RIP-generated fragments might promote PCa bone metastasis. In the current study we show that bone marrow stroma (BMS) induces Jagged1 expression in bone metastatic prostate cancer PC3 cells and that this enhanced expression is mechanistically linked to the promotion of cell migration. We also show that RIP-generated Jagged1 fragments exert disparate effects on PC3 cell behaviour and Notch signaling. In conclusion, the expression of both the full-length ligand and its RIP-generated fragments must be considered in tandem when attempting to regulate Jagged1 as a possible PCa therapy. - Highlights: • Bone marrow stroma induces Jagged1 expression in prostate cancer (PCa) PC3 cells. • This enhanced expression of full-length Jagged1 is required for PC3 cell migration. • Proteolytic fragments of Jagged1 exert disparate effects on PC3 cell behaviour. • Effects of fragments on cell behaviour do not correlate with Notch signaling. • Effects of Jagged1 and its fragments on PCa metastasis likely to be complex.

Health Disparities

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... Health and Health Disparities conduct transdisciplinary research involving social, behavioral, biological, and genetic research to improve knowledge of the causes of health disparities and devise effective methods of preventing, diagnosing, and treating disease and promoting ...

A Seat at the Table: Culturally based cancer research

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NCI supports research to address cancer disparities among American Indian and Alaska Native populations. In this video, two researchers advocate for more culturally sensitive practices to help people who are most disproportionately affected by cancer disparities.

Nonlinear Predictive Models for Multiple Mediation Analysis: With an Application to Explore Ethnic Disparities in Anxiety and Depression Among Cancer Survivors.

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Yu, Qingzhao; Medeiros, Kaelen L; Wu, Xiaocheng; Jensen, Roxanne E

2018-04-02

Mediation analysis allows the examination of effects of a third variable (mediator/confounder) in the causal pathway between an exposure and an outcome. The general multiple mediation analysis method (MMA), proposed by Yu et al., improves traditional methods (e.g., estimation of natural and controlled direct effects) to enable consideration of multiple mediators/confounders simultaneously and the use of linear and nonlinear predictive models for estimating mediation/confounding effects. Previous studies find that compared with non-Hispanic cancer survivors, Hispanic survivors are more likely to endure anxiety and depression after cancer diagnoses. In this paper, we applied MMA on MY-Health study to identify mediators/confounders and quantify the indirect effect of each identified mediator/confounder in explaining ethnic disparities in anxiety and depression among cancer survivors who enrolled in the study. We considered a number of socio-demographic variables, tumor characteristics, and treatment factors as potential mediators/confounders and found that most of the ethnic differences in anxiety or depression between Hispanic and non-Hispanic white cancer survivors were explained by younger diagnosis age, lower education level, lower proportions of employment, less likely of being born in the USA, less insurance, and less social support among Hispanic patients.

Scalable Combinatorial Tools for Health Disparities Research

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Michael A. Langston

2014-10-01

Full Text Available Despite staggering investments made in unraveling the human genome, current estimates suggest that as much as 90% of the variance in cancer and chronic diseases can be attributed to factors outside an individual’s genetic endowment, particularly to environmental exposures experienced across his or her life course. New analytical approaches are clearly required as investigators turn to complicated systems theory and ecological, place-based and life-history perspectives in order to understand more clearly the relationships between social determinants, environmental exposures and health disparities. While traditional data analysis techniques remain foundational to health disparities research, they are easily overwhelmed by the ever-increasing size and heterogeneity of available data needed to illuminate latent gene x environment interactions. This has prompted the adaptation and application of scalable combinatorial methods, many from genome science research, to the study of population health. Most of these powerful tools are algorithmically sophisticated, highly automated and mathematically abstract. Their utility motivates the main theme of this paper, which is to describe real applications of innovative transdisciplinary models and analyses in an effort to help move the research community closer toward identifying the causal mechanisms and associated environmental contexts underlying health disparities. The public health exposome is used as a contemporary focus for addressing the complex nature of this subject.

Disparities in location of death of adolescents and young adults with cancer: A longitudinal, population study in California.

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Rajeshuni, Nitya; Johnston, Emily E; Saynina, Olga; Sanders, Lee M; Chamberlain, Lisa J

2017-11-01

Patients with a terminal illness should have access to their chosen location of death. Cancer is the leading cause of non-accidental death among adolescents and young adults (AYAs; those aged 15-39 years). Although surveys have suggested that a majority of these patients prefer a home death, to the authors' knowledge, little is known regarding their barriers to accessing their preferred location of death. As a first step, the authors sought to determine, across a large population, 20-year trends in the location of death among AYA patients with cancer. Using the Vital Statistics Death Certificate Database of the California Office of Statewide Health Planning and Development, the authors performed a retrospective, population-based analysis of California patients with cancer aged 15 to 39 years who died between 1989 and 2011. Sociodemographic and clinical factors associated with hospital death were examined using multivariable logistic regression. Of 30,573 AYA oncology decedents, 57% died in a hospital, 33% died at home, and 10% died in other locations (eg, hospice facility or nursing facility). Between 1989 and 1994, hospital death rates decreased from 68.3% to 53.6% and at-home death rates increased from 16.8% to 35.5%. Between 1995 and 2011, these rates were stable. Those individuals who were more likely to die in a hospital were those aged deaths occurred in a hospital, with a 5-year shift to more in-home deaths that abated after 1995. In-hospital deaths were more common among younger patients, patients of minority race/ethnicities, and those with a leukemia or lymphoma diagnosis. Further study is needed to determine whether these rates and disparities are consistent with patient preferences. Cancer 2017;123:4178-4184. © 2017 American Cancer Society. © 2017 American Cancer Society.

Prostate cancer disparities in Black men of African descent: a comparative literature review of prostate cancer burden among Black men in the United States, Caribbean, United Kingdom, and West Africa

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Reams R Renee

2009-02-01

Full Text Available Abstract Background African American men have the highest prostate cancer morbidity and mortality rates than any other racial or ethnic group in the US. Although the overall incidence of and mortality from prostate cancer has been declining in White men since 1991, the decline in African American men lags behind White men. Of particular concern is the growing literature on the disproportionate burden of prostate cancer among other Black men of West African ancestry in the Caribbean Islands, United Kingdom and West Africa. This higher incidence of prostate cancer observed in populations of African descent may be attributed to the fact that these populations share ancestral genetic factors. To better understand the burden of prostate cancer among men of West African Ancestry, we conducted a review of the literature on prostate cancer incidence, prevalence, and mortality in the countries connected by the Transatlantic Slave Trade. Results Several published studies indicate high prostate cancer burden in Nigeria and Ghana. There was no published literature for the countries Benin, Gambia and Senegal that met our review criteria. Prostate cancer morbidity and/or mortality data from the Caribbean Islands and the United Kingdom also provided comparable or worse prostate cancer burden to that of US Blacks. Conclusion The growing literature on the disproportionate burden of prostate cancer among other Black men of West African ancestry follows the path of the Transatlantic Slave Trade. To better understand and address the global prostate cancer disparities seen in Black men of West African ancestry, future studies should explore the genetic and environmental risk factors for prostate cancer among this group.

Engendering health disparities.

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Spitzer, Denise L

2005-01-01

How is gender implicated in our exploration of health disparities in Canada? Set against the backdrop of federal government policy, this review paper examines the ways in which gender intersects with other health determinants to produce disparate health outcomes. An overview of salient issues including the impact of gender roles, environmental exposures, gender violence, workplace hazards, economic disparities, the costs of poverty, social marginalization and racism, aging, health conditions, interactions with health services, and health behaviours are considered. This review suggests health is detrimentally affected by gender roles and statuses as they intersect with economic disparities, cultural, sexual, physical and historical marginalization as well as the strains of domestic and paid labour. These conditions result in an unfair health burden borne in particular by women whose access to health determinants is--in various degrees--limited. While progress has certainly been made on some fronts, the persistence of health disparities among diverse populations of women and men suggests a postponement of the vision of a just society with health for all that was articulated in the Federal Plan on Gender Equality. Commitment, creativity and collaboration from stakeholders ranging from various levels of government, communities, academics, non-governmental agencies and health professionals will be required to reduce and eliminate health disparities between and among all members of our society.

Closing the quality gap: revisiting the state of the science (vol. 3: quality improvement interventions to address health disparities).

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McPheeters, Melissa L; Kripalani, Sunil; Peterson, Neeraja B; Idowu, Rachel T; Jerome, Rebecca N; Potter, Shannon A; Andrews, Jeffrey C

2012-08-01

This review evaluates the effectiveness of quality improvement (QI) strategies in reducing disparities in health and health care. We identified papers published in English between 1983 and 2011 from the MEDLINE® database, the Cumulative Index of Nursing and Allied Health Literature (CINAHL), Web of Science Social Science Index, and PsycINFO. All abstracts and full-text articles were dually reviewed. Studies were eligible if they reported data on effectiveness of QI interventions on processes or health outcomes in the United States such that the impact on a health disparity could be measured. The review focused on the following clinical conditions: breast cancer, colorectal cancer, diabetes, heart failure, hypertension, coronary artery disease, asthma, major depressive disorder, cystic fibrosis, pneumonia, pregnancy, and end-stage renal disease. It assessed health disparities associated with race or ethnicity, socioeconomic status, insurance status, sexual orientation, health literacy/numeracy, and language barrier. We evaluated the risk of bias of individual studies and the overall strength of the body of evidence based on risk of bias, consistency, directness, and precision. Nineteen papers, representing 14 primary research studies, met criteria for inclusion. All but one of the studies incorporated multiple components into their QI approach. Patient education was part of most interventions (12 of 14), although the specific approach differed substantially across the studies. Ten of the studies incorporated self-management; this would include, for example, teaching individuals with diabetes to check their blood sugar regularly. Most (8 of 14) included some sort of provider education, which may have focused on the clinical issue or on raising awareness about disparities affecting the target population. Studies evaluated the effect of these strategies on disparities in the prevention or treatment of breast or colorectal cancer, cardiovascular disease, depression, or

Unraveling the etiology of ovarian cancer racial disparity in the deep south: Is it nature or nurture?

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Ross, Jerlinda; Braswell, Katelyn V; Madeira da Silva, Luciana; Mujica, Frances; Stutsman, Sam; Finan, Michael A; Nicolson, William; Harmon, Mary Danner; Missanelli, Megan; Cohen, Alex; Singh, Ajay; Scalici, Jennifer M; Rocconi, Rodney P

2017-05-01

Our objective was to evaluate racial treatment and survival disparities in black women with ovarian cancer in the Deep South and to determine how environmental factors / socioeconomic status (SES) influence survival. A retrospective study of ovarian cancer patients from 2007 to 2014 was performed. Socioeconomic status (SES) was obtained though U.S. Census block data and compared using Yost scores. Comparisons were performed using standard statistical approaches. A total of 393 patients were evaluated, 325 (83%) white and 68 (17%) black. Demographic information and surgical approach were similar in each racial group. However, compared to whites, black patients had lower rates of optimal debulking [89% vs. 71%, respectively (p=0.001)] and intraperitoneal chemotherapy (19% vs. 11%, p=0.01). Black women had lower SES parameters including education, income, and poverty. As a result, more black patients had the lowest SES (SES-1) when compared to white patients (17% vs. 41%, pvs. 27months, p=0.003) and overall survival (42 vs. 88months, p<0.001). Despite controlling for clinical and environmental factors, a survival disadvantage was still observed in black patients with ovarian cancer in the Deep South. Black women had lower optimal debulking rates and more platinum resistant disease. These data suggest other factors like tumor biology may play a role in racial survival differences, however, more research is needed to determine this causation. Copyright © 2017 Elsevier Inc. All rights reserved.

Ethnic and Racial Disparities in Education: Psychology's Role in Understanding and Reducing Disparities

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Quintana, Stephen M.; Mahgoub, Lana

2016-01-01

We review the scope and sources of ethnic and racial disparities in education with a focus on the the implications of psychological theory and research for understanding and redressing these disparities. We identify 3 sources of ethnic and racial disparities including (a) social class differences, (b) differential treatment based on ethnic and…

Social factors matter in cancer risk and survivorship.

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Dean, Lorraine T; Gehlert, Sarah; Neuhouser, Marian L; Oh, April; Zanetti, Krista; Goodman, Melody; Thompson, Beti; Visvanathan, Kala; Schmitz, Kathryn H

2018-07-01

Greater attention to social factors, such as race/ethnicity, socioeconomic position, and others, are needed across the cancer continuum, including breast cancer, given differences in tumor biology and genetic variants have not completely explained the persistent Black/White breast cancer mortality disparity. In this commentary, we use examples in breast cancer risk assessment and survivorship to demonstrate how the failure to appropriately incorporate social factors into the design, recruitment, and analysis of research studies has resulted in missed opportunities to reduce persistent cancer disparities. The conclusion offers recommendations for how to better document and use information on social factors in cancer research and care by (1) increasing education and awareness about the importance of inclusion of social factors in clinical research; (2) improving testing and documentation of social factors by incorporating them into journal guidelines and reporting stratified results; and (3) including social factors to refine extant tools that assess cancer risk and assign cancer care. Implementing the recommended changes would enable more effective design and implementation of interventions and work toward eliminating cancer disparities by accounting for the social and environmental contexts in which cancer patients live and are treated.

Cancer survival disparities worsening by socio-economic disadvantage over the last 3 decades in new South Wales, Australia

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Hanna E. Tervonen

2017-09-01

Full Text Available Abstract Background Public concerns are commonly expressed about widening health gaps. This cohort study examines variations and trends in cancer survival by socio-economic disadvantage, geographical remoteness and country of birth in an Australian population over a 30-year period. Methods Data for cases diagnosed in New South Wales (NSW in 1980–2008 (n = 651,245 were extracted from the population-based NSW Cancer Registry. Competing risk regression models, using the Fine & Gray method, were used for comparative analyses to estimate sub-hazard ratios (SHR with 95% confidence intervals (CI among people diagnosed with cancer. Results Increased risk of cancer death was associated with living in the most socio-economically disadvantaged areas compared with the least disadvantaged areas (SHR 1.15, 95% CI 1.13–1.17, and in outer regional/remote areas compared with major cities (SHR 1.05, 95% CI 1.03–1.06. People born outside Australia had a similar or lower risk of cancer death than Australian-born (SHR 0.99, 95% CI 0.98–1.01 and SHR 0.91, 95% CI 0.90–0.92 for people born in other English and non-English speaking countries, respectively. An increasing comparative risk of cancer death was observed over time when comparing the most with the least socio-economically disadvantaged areas (SHR 1.07, 95% CI 1.04–1.10 for 1980–1989; SHR 1.14, 95% CI 1.12–1.17 for 1990–1999; and SHR 1.24, 95% CI 1.21–1.27 for 2000–2008; p < 0.001 for interaction between disadvantage quintile and year of diagnosis. Conclusions There is a widening gap in comparative risk of cancer death by level of socio-economic disadvantage that warrants a policy response and further examination of reasons behind these disparities.

Outcome disparities in African American women with triple negative breast cancer: a comparison of epidemiological and molecular factors between African American and Caucasian women with triple negative breast cancer

International Nuclear Information System (INIS)

Sturtz, Lori A; Melley, Jen; Mamula, Kim; Shriver, Craig D; Ellsworth, Rachel E

2014-01-01

Although diagnosed less often, breast cancer in African American women (AAW) displays different characteristics compared to breast cancer in Caucasian women (CW), including earlier onset, less favorable clinical outcome, and an aggressive tumor phenotype. These disparities may be attributed to differences in socioeconomic factors such as access to health care, lifestyle, including increased frequency of obesity in AAW, and tumor biology, especially the higher frequency of triple negative breast cancer (TNBC) in young AAW. Improved understanding of the etiology and molecular characteristics of TNBC in AAW is critical to determining whether and how TNBC contributes to survival disparities in AAW. Demographic, pathological and survival data from AAW (n = 62) and CW (n = 98) with TNBC were analyzed using chi-square analysis, Student’s t-tests, and log-rank tests. Frozen tumor specimens were available from 57 of the TNBC patients (n = 23 AAW; n = 34 CW); RNA was isolated after laser microdissection of tumor cells and was hybridized to HG U133A 2.0 microarrays. Data were analyzed using ANOVA with FDR <0.05, >2-fold difference defining significance. The frequency of TNBC compared to all BC was significantly higher in AAW (28%) compared to CW (12%), however, significant survival and pathological differences were not detected between populations. Gene expression analysis revealed the tumors were more similar than different at the molecular level, with only CRYBB2P1, a pseudogene, differentially expressed between populations. Among demographic characteristics, AAW consumed significantly lower amounts of caffeine and alcohol, were less likely to breastfeed and more likely to be obese. These data suggest that TNBC in AAW is not a unique disease compared to TNBC in CW. Rather, higher frequency of TNBC in AAW may, in part, be attributable to the effects of lifestyle choices. Because these risk factors are modifiable, they provide new opportunities for the development of risk

Breast cancer screening disparities among immigrant women by world region of origin: a population-based study in Ontario, Canada.

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Vahabi, Mandana; Lofters, Aisha; Kumar, Matthew; Glazier, Richard H

2016-07-01

Rates of mammography screening for breast cancer are disproportionately low in certain subgroups including low-income and immigrant women. The purpose of the study was to examine differences in rates of appropriate breast cancer screening (i.e., screening mammography every 2 years) among Ontario immigrant women by world region of origin and explore the association between appropriate breast cancer screening among these women groups and individual and structural factors. A cohort of 183,332 screening-eligible immigrant women living in Ontario between 2010 and 2012 was created from linked databases and classified into eight world regions of origin. Appropriate screening rates were calculated for each region by age group and selected sociodemographic, immigration, and healthcare-related characteristics. The association between appropriate screening across the eight regions of origin and selected sociodemographic, immigration, and health-related characteristics was explored using multivariate Poisson regression. Screening varied by region of origin, with South Asian women (48.5%) having the lowest and Caribbean and Latin American women (63.7%) the highest cancer screening rates. Factors significantly associated with lower screening across the world regions of origin included living in the lowest income neighborhoods, having a refugee status, being a new immigrant, not having a regular physical examination, not being enrolled in a primary care patient enrollment model, having a male physician, and having an internationally trained physician. Multiple interventions entailing cross-sector collaboration, promotion of patient enrollment models, community engagement, comprehensive and intensive outreach to women, and knowledge translation and transfer to physicians should be considered to address screening disparities among immigrant population. Consideration should be given to design and delivery of culturally appropriate and easily accessible cancer screening programs

Mortality among active workers at EDF-GDF: social and occupational disparities and evolution

International Nuclear Information System (INIS)

Poncet, M.; Chevalier, A.; Bumsel, F.; Lahon, G.

2003-01-01

Background: Two studies, conducted in the eighties and the nineties, reported that mortality was lower- in the French national electric and gas company (EDF-GDF) the utility workers than in the general French Population. The purpose of our study was to compare the mortality of these 140.000 utility workers to that of the French population of the same age for the period from 1997 to 2001. Secondly we aimed to assess the disparities of mortality among the workforce according to demographic and socio-professional criteria. Finally, we analyzed the evolution of this mortality over the last twenty years. Methods: We undertook a cross-sectional study using the indirect standardization method. Results: Risk of death was lower in the utility workers than in the French Population (SMR=54% for men, and 58% for women). These differences had increased over the last twenty years for each main cause of death (cancers, cardio-vascular diseases and accidents). The reported excess of brain cancer death risk raises etiologic questions. Moreover; we noticed important social disparities in the workforce, increasing with tune. Conclusion: The well-known 'healthy worker effect' seems to be particularly important in the EDF-GDF company. The workers have a high level of living conditions and good working conditions, although internal social disparities persist. Further studies in other large corporations are greatly needed for comparisons. (author)

Vertical binocular disparity is encoded implicitly within a model neuronal population tuned to horizontal disparity and orientation.

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Jenny C A Read

2010-04-01

Full Text Available Primary visual cortex is often viewed as a "cyclopean retina", performing the initial encoding of binocular disparities between left and right images. Because the eyes are set apart horizontally in the head, binocular disparities are predominantly horizontal. Yet, especially in the visual periphery, a range of non-zero vertical disparities do occur and can influence perception. It has therefore been assumed that primary visual cortex must contain neurons tuned to a range of vertical disparities. Here, I show that this is not necessarily the case. Many disparity-selective neurons are most sensitive to changes in disparity orthogonal to their preferred orientation. That is, the disparity tuning surfaces, mapping their response to different two-dimensional (2D disparities, are elongated along the cell's preferred orientation. Because of this, even if a neuron's optimal 2D disparity has zero vertical component, the neuron will still respond best to a non-zero vertical disparity when probed with a sub-optimal horizontal disparity. This property can be used to decode 2D disparity, even allowing for realistic levels of neuronal noise. Even if all V1 neurons at a particular retinotopic location are tuned to the expected vertical disparity there (for example, zero at the fovea, the brain could still decode the magnitude and sign of departures from that expected value. This provides an intriguing counter-example to the common wisdom that, in order for a neuronal population to encode a quantity, its members must be tuned to a range of values of that quantity. It demonstrates that populations of disparity-selective neurons encode much richer information than previously appreciated. It suggests a possible strategy for the brain to extract rarely-occurring stimulus values, while concentrating neuronal resources on the most commonly-occurring situations.

Establishing the infrastructure to conduct comparative effectiveness research toward the elimination of disparities: a community-based participatory research framework.

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Wilson, Danyell S; Dapic, Virna; Sultan, Dawood H; August, Euna M; Green, B Lee; Roetzheim, Richard; Rivers, Brian

2013-11-01

In Tampa, Florida, researchers have partnered with community- and faith-based organizations to create the Comparative Effectiveness Research for Eliminating Disparities (CERED) infrastructure. Grounded in community-based participatory research, CERED acts on multiple levels of society to enhance informed decision making (IDM) of prostate cancer screening among Black men. CERED investigators combined both comparative effectiveness research and community-based participatory research to design a trial examining the effectiveness of community health workers and a digitally enhanced patient decision aid to support IDM in community settings as compared with "usual care" for prostate cancer screening. In addition, CERED researchers synthesized evidence through the development of systematic literature reviews analyzing the effectiveness of community health workers in changing knowledge, attitudes and behaviors of African American adults toward cancer prevention and education. An additional systematic review analyzed chemoprevention agents for prostate cancer as an emerging technique. Both of these reviews, and the comparative effectiveness trial supporting the IDM process, add to CERED's goal of providing evidence to eliminate cancer health disparities.

Conjunctions between motion and disparity are encoded with the same spatial resolution as disparity alone.

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Allenmark, Fredrik; Read, Jenny C A

2012-10-10

Neurons in cortical area MT respond well to transparent streaming motion in distinct depth planes, such as caused by observer self-motion, but do not contain subregions excited by opposite directions of motion. We therefore predicted that spatial resolution for transparent motion/disparity conjunctions would be limited by the size of MT receptive fields, just as spatial resolution for disparity is limited by the much smaller receptive fields found in primary visual cortex, V1. We measured this using a novel "joint motion/disparity grating," on which human observers detected motion/disparity conjunctions in transparent random-dot patterns containing dots streaming in opposite directions on two depth planes. Surprisingly, observers showed the same spatial resolution for these as for pure disparity gratings. We estimate the limiting receptive field diameter at 11 arcmin, similar to V1 and much smaller than MT. Higher internal noise for detecting joint motion/disparity produces a slightly lower high-frequency cutoff of 2.5 cycles per degree (cpd) versus 3.3 cpd for disparity. This suggests that information on motion/disparity conjunctions is available in the population activity of V1 and that this information can be decoded for perception even when it is invisible to neurons in MT.

Health journalism internships: a social marketing strategy to address health disparities.

Science.gov (United States)

Nguyen, Duy H; Shimasaki, Suzuho; Stafford, Helen Shi; Sadler, Georgia Robins

2010-09-01

The USA seeks to eliminate health disparities by stimulating the rapid uptake of health-promoting behaviors within disadvantaged communities. A health journalism internship incorporates social marketing strategies to increase communities' access to cancer information, while helping the interns who are recruited from underrepresented communities gain admission to top graduate schools. Interns are taught basic health journalism skills that enable them to create immediate streams of cancer-related press releases for submission to community newspapers. Interns are charged with the social responsibility of continuing this dissemination process throughout their careers. Intermediate outcomes are measured as mediators of distal behavioral change goals.

Healthcare disparities in critical illness.

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Soto, Graciela J; Martin, Greg S; Gong, Michelle Ng

2013-12-01

To summarize the current literature on racial and gender disparities in critical care and the mechanisms underlying these disparities in the course of acute critical illness. MEDLINE search on the published literature addressing racial, ethnic, or gender disparities in acute critical illness, such as sepsis, acute lung injury, pneumonia, venous thromboembolism, and cardiac arrest. Clinical studies that evaluated general critically ill patient populations in the United States as well as specific critical care conditions were reviewed with a focus on studies evaluating factors and contributors to health disparities. Study findings are presented according to their association with the prevalence, clinical presentation, management, and outcomes in acute critical illness. This review presents potential contributors for racial and gender disparities related to genetic susceptibility, comorbidities, preventive health services, socioeconomic factors, cultural differences, and access to care. The data are organized along the course of acute critical illness. The literature to date shows that disparities in critical care are most likely multifactorial involving individual, community, and hospital-level factors at several points in the continuum of acute critical illness. The data presented identify potential targets as interventions to reduce disparities in critical care and future avenues for research.

The moral problem of health disparities.

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Jones, Cynthia M

2010-04-01

Health disparities exist along lines of race/ethnicity and socioeconomic class in US society. I argue that we should work to eliminate these health disparities because their existence is a moral wrong that needs to be addressed. Health disparities are morally wrong because they exemplify historical injustices. Contractarian ethics, Kantian ethics, and utilitarian ethics all provide theoretical justification for viewing health disparities as a moral wrong, as do several ethical principles of primary importance in bioethics. The moral consequences of health disparities are also troubling and further support the claim that these disparities are a moral wrong. The Universal Declaration of Human Rights provides additional support that health disparities are a moral wrong, as does an analogy with the generally accepted duty to provide equal access to education. In this article, I also consider and respond to 3 objections to my thesis.

Mapping Medicare Disparities Tool

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U.S. Department of Health & Human Services — The CMS Office of Minority Health has designed an interactive map, the Mapping Medicare Disparities Tool, to identify areas of disparities between subgroups of...

The colorectal cancer mortality-to-incidence ratio as an indicator of global cancer screening and care.

Science.gov (United States)

Sunkara, Vasu; Hébert, James R

2015-05-15

Disparities in cancer screening, incidence, treatment, and survival are worsening globally. The mortality-to-incidence ratio (MIR) has been used previously to evaluate such disparities. The MIR for colorectal cancer is calculated for all Organisation for Economic Cooperation and Development (OECD) countries using the 2012 GLOBOCAN incidence and mortality statistics. Health system rankings were obtained from the World Health Organization. Two linear regression models were fit with the MIR as the dependent variable and health system ranking as the independent variable; one included all countries and one model had the "divergents" removed. The regression model for all countries explained 24% of the total variance in the MIR. Nine countries were found to have regression-calculated MIRs that differed from the actual MIR by >20%. Countries with lower-than-expected MIRs were found to have strong national health systems characterized by formal colorectal cancer screening programs. Conversely, countries with higher-than-expected MIRs lack screening programs. When these divergent points were removed from the data set, the recalculated regression model explained 60% of the total variance in the MIR. The MIR proved useful for identifying disparities in cancer screening and treatment internationally. It has potential as an indicator of the long-term success of cancer surveillance programs and may be extended to other cancer types for these purposes. © 2015 American Cancer Society.

Use of partnership strategies to build radiation oncology disparities research programs in five Western Pennsylvania communities: an organizational case study.

Science.gov (United States)

Morgenlander, Keith H; Heron, Dwight E; Schenken, Larry L

2009-01-01

Many cancer treatment and prevention trials as well as surveillance programs suffer from a disproportionately low rate of accrual and a high rate of noncompliance or dropouts of racial minorities and the poor. One suggested strategy to help remediate this trend is to directly involve those targeted populations within the development, implementation, and evaluation of these services. The Radiation Oncology Community Outreach Group (ROCOG) and Neighborhood Cancer Care Cooperative (NCCC) are designed based upon this type of highly collaborative organizational structure, consistent with the general principles of community-based participatory research. Funded by the National Cancer Institute Cancer Disparities Research Partnership program, ROCOG/NCCC provide oncology-focused, community hospital-based initiatives intended to help close the cancer disparities gap. This article presents a descriptive case study of the organizational and political process that preceded our grant proposal submission, the potential benefits and difficulties associated with our extensive collaborative model, and an example of how highly competitive health care organizations can become partners in narrowly focused initiatives aimed at a greater social good.

Prostate cancer incidence and tumor severity in Georgia: descriptive epidemiology, racial disparity, and geographic trends.

Science.gov (United States)

Wagner, Sara E; Bauer, Sarah E; Bayakly, A Rana; Vena, John E

2013-01-01

Limited research has been conducted to describe the geographical clustering and distribution of prostate cancer (PrCA) incidence in Georgia (GA). This study describes and compares the temporal and geographic trends of PrCA incidence in GA with a specific focus on racial disparities. GA Comprehensive Cancer Registry PrCA incidence data were obtained for 1998-2008. Directly standardized age-adjusted PrCA incidence rates per 100,000 were analyzed by race, stage, grade, and county. County-level hotspots of PrCA incidence were analyzed with the Getis-Ord Gi* statistic in a geographic information system; a census tract-level cluster analysis was performed with a Discrete Poisson model and implemented in SaTScan(®) software. Significant (p incidence were observed in nine southwestern counties and six centrally located counties among men of both races. Six significant (p incidence rates were detected for men of both races in north and northwest central Georgia. When stratified by race, clusters among white and black men were similar, although centroids were slightly shifted. Most notably, a large (122 km radius) cluster in northwest central Georgia was detected only in whites, and two smaller clusters (0-32 km radii) were detected in Southwest Georgia only in black men. Clusters of high-grade and late-stage tumors were identified primarily in the northern portion of the state among men of both races. This study revealed a pattern of higher incidence and more advanced disease in northern and northwest central Georgia, highlighting geographic patterns that need more research and investigation of possible environmental determinants.

Racial disparities in smoking knowledge among current smokers: data from the health information national trends surveys.

Science.gov (United States)

Reimer, Rachel Ann; Gerrard, Meg; Gibbons, Frederick X

2010-10-01

Although African-Americans (Blacks) smoke fewer cigarettes per day than European-Americans (Whites), there is ample evidence that Blacks are more susceptible to smoking-related health consequences. A variety of behavioural, social and biological factors have been linked to this increased risk. There has been little research, however, on racial differences in smoking-related knowledge and perceived risk of lung cancer. The primary goal of the current study was to evaluate beliefs and knowledge that contribute to race disparities in lung cancer risk among current smokers. Data from two separate nationally representative surveys (the Health Information National Trends surveys 2003 and 2005) were analysed. Logistic and hierarchical regressions were conducted; gender, age, education level, annual household income and amount of smoking were included as covariates. In both studies, Black smokers were significantly more likely to endorse inaccurate statements than were White smokers, and did not estimate their lung cancer risk to be significantly higher than Whites. Results highlight an important racial disparity in public health knowledge among current smokers.

Reduction of Racial Disparities in Prostate Cancer

Science.gov (United States)

2008-12-01

African Americans and whites revealed increased risks among men who reported a history of gonorrhea or syphilis or who had positive serology for...cancer, of 1.49 to 2.64 for syphilis, and 1.16 to 1.50 for gonorrhea .16 The meta-analysis also found an association be- tween prostate cancer and...tients with prostatitis include Chlamydia trachoma- tis, Ureaplasma, Mycoplasma, Neisseria gonorrhea , Pseudomonas, Escherichia coli, and

Cancer Support Needs for African American Breast Cancer Survivors and Caregivers.

Science.gov (United States)

Haynes-Maslow, Lindsey; Allicock, Marlyn; Johnson, La-Shell

2016-03-01

Improved cancer screening and treatment advances have led to higher cancer survival rates in the United States. However, racial disparities in breast cancer survival persist for African American women who experience lower survival rates than white women. These disparities suggest that unmet needs related to survivorship still exist. This study focuses on the challenges that both African American cancer survivors and caregivers face across the cancer continuum. Five African American focus groups examined cancer survivor and caregiver support needs. Focus groups were recorded, transcribed, and uploaded into Atlas.ti. Thematic content analysis was applied to the text during the coding process. Themes were identified and emphasized based on the research team's integrated and unified final codes. Forty-one African Americans participated in five focus groups: 22 cancer survivors and 19 caregivers. Participants discussed five themes: (1) a culture that discourages the discussion of cancer; (2) lack of support services for African American cancer survivors; (3) lack of support services for cancer caregivers; (4) need for culturally appropriate cancer resources, including resources targeted at African American women; and (5) aspects that were helpful to cancer survivors and caregivers, including connecting with other survivors and caregivers, and having strong social support networks. We gained new insight into the unmet support needs for survivors and caregivers, especially when coping with the cancer experience continuum. While some cancer and caregiver support services exist, our study reveals a great need for services that incorporate the cultural differences that exist across races.

Validation and Interrogation of Differentially Expressed and Alternately Spliced Genes in African American Prostate Cancer

Science.gov (United States)

2017-10-01

receptor (AR) and epidermal growth factor receptor (EGFR) pathways in AA versus white prostate cancer . Thus, there is an urgent need to develop a novel...androgen receptor signaling and aggressive prostate cancer . AACR Conference on The Science of Cancer Health Disparities in Racial/Ethnic Minorities and...Freedman and S. R. Patierno. Race-related differential splicing of the insulin receptor : A novel target underlying prostate cancer disparities. AACR

Comparing the Relative Efficacy of Narrative vs Nonnarrative Health Messages in Reducing Health Disparities Using a Randomized Trial.

Science.gov (United States)

Murphy, Sheila T; Frank, Lauren B; Chatterjee, Joyee S; Moran, Meghan B; Zhao, Nan; Amezola de Herrera, Paula; Baezconde-Garbanati, Lourdes A

2015-10-01

We compared the relative efficacy of a fictional narrative film to a more traditional nonnarrative film in conveying the same health information. We used a random digit dial procedure to survey the cervical cancer-related knowledge, attitudes, and behavior of non-Hispanic White, Mexican American, and African American women, aged 25 to 45 years, living in Los Angeles, California, from 2011 to 2012. Participants (n = 704) were randomly assigned to view either a narrative or nonnarrative film containing the same information about how cervical cancer could be prevented or detected, and they were re-contacted 2 weeks and 6 months later. At 2 weeks, both films produced a significant increase in cervical cancer-related knowledge and attitudes, but these effects were significantly higher for the narrative film. At 6 months, viewers of both films retained greater than baseline knowledge and more positive attitudes toward Papanicolaou (Pap) tests, but women who saw the narrative were significantly more likely to have had or scheduled a Pap test. The narrative was particularly effective for Mexican American women, eliminating cervical cancer screening disparities found at baseline. Narratives might prove to be a useful tool for reducing health disparities.

Economic hardship of minority and non-minority cancer survivors 1 year after diagnosis: another long-term effect of cancer?

Science.gov (United States)

Pisu, Maria; Kenzik, Kelly M; Oster, Robert A; Drentea, Patricia; Ashing, Kimlin T; Fouad, Mona; Martin, Michelle Y

2015-04-15

Current literature suggests that racial/ethnic minority survivors may be more likely than whites to experience economic hardship after a cancer diagnosis; however, little is known about such hardship. Patients with lung cancer (LC) and colorectal cancer (CRC) participating in the Cancer Care Outcomes Research and Surveillance (CanCORS) Consortium were surveyed approximately 4 months (baseline) and 12 months (follow-up) after diagnosis. Economic hardship at follow-up was present if participants 1) indicated difficulty living on household income; and/or 2) for the following 2 months, anticipated experiencing hardships (inadequate housing, food, or medical attention) or reducing living standards to the bare necessities of life. The authors tested whether African Americans (AAs) and Hispanics were more likely than whites to experience economic hardship controlling for sex, age, education, marital status, cancer stage, treatment, and economic status at baseline (income, prescription drug coverage). Of 3432 survivors (39.7% with LC, 60.3% with CRC), 14% were AA, 7% were Hispanic, and 79% were white. AAs and Hispanics had lower education and income than whites. Approximately 68% of AAs, 58% of Hispanics, and 44.5% of whites reported economic hardship. In LC survivors, the Hispanic-white disparity was not significant in unadjusted or adjusted analyses, and the AA-white disparity was explained by baseline economic status. In CRC survivors, the Hispanic-white disparity was explained by baseline economic status, and the AA-white disparity was not explained by the variables that were included in the model. Economic hardship was evident in almost 1 in 2 cancer survivors 1 year after diagnosis, especially AAs. Research should evaluate and address risk factors and their impact on survival and survivorship outcomes. © 2015 American Cancer Society.

Processing vertical size disparities in distinct depth planes.

Science.gov (United States)

Duke, Philip A; Howard, Ian P

2012-08-17

A textured surface appears slanted about a vertical axis when the image in one eye is horizontally enlarged relative to the image in the other eye. The surface appears slanted in the opposite direction when the same image is vertically enlarged. Two superimposed textured surfaces with different horizontal size disparities appear as two surfaces that differ in slant. Superimposed textured surfaces with equal and opposite vertical size disparities appear as a single frontal surface. The vertical disparities are averaged. We investigated whether vertical size disparities are averaged across two superimposed textured surfaces in different depth planes or whether they induce distinct slants in the two depth planes. In Experiment 1, two superimposed textured surfaces with different vertical size disparities were presented in two depth planes defined by horizontal disparity. The surfaces induced distinct slants when the horizontal disparity was more than ±5 arcmin. Thus, vertical size disparities are not averaged over surfaces with different horizontal disparities. In Experiment 2 we confirmed that vertical size disparities are processed in surfaces away from the horopter, so the results of Experiment 1 cannot be explained by the processing of vertical size disparities in a fixated surface only. Together, these results show that vertical size disparities are processed separately in distinct depth planes. The results also suggest that vertical size disparities are not used to register slant globally by their effect on the registration of binocular direction of gaze.

Minority Health and Health Disparities

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... ik People" People Awakening Resilience Project (PARP), Cuqyun "Measuring" Treatment and Health Services Research Alcohol Treatment and ... addressing Health Disparities . 1 2009-2013 Health Disparities Strategic Plan, p.4 2 Ibid, p.4 3 ...

Socioeconomic position and survival after cervical cancer

DEFF Research Database (Denmark)

Ibfelt, E H; Kjær, S K; Høgdall, C

2013-01-01

In an attempt to decrease social disparities in cancer survival, it is important to consider the mechanisms by which socioeconomic position influences cancer prognosis. We aimed to investigate whether any associations between socioeconomic factors and survival after cervical cancer could...... be explained by socioeconomic differences in cancer stage, comorbidity, lifestyle factors or treatment....

The Role of Socioeconomic Status and Health Care Access in Breast Cancer Screening Compliance Among Hispanics.

Science.gov (United States)

Jadav, Smruti; Rajan, Suja S; Abughosh, Susan; Sansgiry, Sujit S

2015-01-01

Considerable disparities in breast cancer screening exist between Hispanic and non-Hispanic white (NHW) women. Identifying and quantifying the factors contributing to these racial-ethnic disparities can help shape interventions and policies aimed at reducing these disparities. This study, for the first time, identified and quantified individual-level sociodemographic and health-related factors that contribute to racial-ethnic disparities in breast cancer screening using the nonlinear Blinder-Oaxaca decomposition method. Analysis of the retrospective pooled cross-sectional Medical Expenditure Panel Survey data from 2000 to 2010 was conducted. Women aged 40 years and older were included in the study. Logistic regressions were used to estimate racial-ethnic disparities in breast cancer screening. Nonlinear Blinder-Oaxaca decomposition method was used to identify and quantify the contribution of each individual-level factor toward racial-ethnic disparities. Based on the unadjusted analyses, Hispanic women had lower odds of receiving mammogram screening (MS) (odds ratio [OR]: 0.74; 95% confidence interval [CI]: 0.69-0.80) and breast cancer screening (OR: 0.75; 95% CI: 0.70-0.81) as compared with NHW women. However, the relationship reversed in adjusted analyses, such that Hispanic women had higher odds of receiving MS (OR: 1.27; 95% CI: 1.16-1.40) and breast cancer screening (OR: 1.28; 95% CI: 1.17-1.40) as compared with NHW women. The Blinder-Oaxaca decomposition estimated that improving insurance status, access to care, education, and income will considerably increase screening rates among Hispanic women. The study projects that improving health care access and health education will considerably increase breast cancer screening compliance among Hispanic women. Policies like the Affordable Care Act, and patient navigation and health education interventions, might considerably reduce screening disparities in the Hispanic population.

Disparities in Prostate Cancer Treatment Modality and Quality of Life

Science.gov (United States)

2010-11-01

producing hormones) 1 0 10 11 B8f. Watchful waiting (no treatment, wait and see if your prostate cancer grows) 1 0 10 11 B8g. Cryotherapy (process...your prostate cancer grows) 7 Cryotherapy (process to freeze and destroy prostate tissue) 8 Chemotherapy (use of anti- cancer drugs) 9 Any other...and attitudes concerning prostate cancer and preventative measures. Prostate Cancer Questionnaire IRB1012# – Version 3 08/01/08 33 Now, I

Effect of information seeking and avoidance behavior on self-rated health status among cancer survivors.

Science.gov (United States)

Jung, Minsoo; Ramanadhan, Shoba; Viswanath, Kasisomayajula

2013-07-01

Social determinants, such as socioeconomic status (SES) and race/ethnicity are linked to striking health disparities across the cancer continuum. One important mechanism linking social determinants and health disparities may be communication inequalities that are caused by differences in accessing, processing and utilizing cancer information. In this context, we examined health information-seeking/avoidance as a potential mediator between social determinants and self-rated health (SRH) status among cancer survivors. Data came from the 2008 well-informed, thriving and surviving (WITS) study of post-treatment cancer survivors (n=501). We examined the mediating effect of health communication-related behavior between SES and disparities in SRH. The likelihood of belonging to the Low SRH group was higher among patients who had avoided health information and whose family members had not sought health information on behalf of the survivor, those in the lowest household income bracket, and those who had high school or less education after adjusting for potential confounders. Differences in SRH among cancer survivors are associated with SES as well as communication inequalities. It is necessary to provide a supportive environment in which health information is made available if disparities in health-related quality of life among cancer survivors are to be reduced. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Employing the Church as a Marketer of Cancer Prevention

Science.gov (United States)

Lumpkins, Crystal Y.; Coffey, Candice R.; Daley, Christine M.; Greiner, K. Allen

2013-01-01

Health promotion programs designed to address colorectal cancer disparities among African Americans are increasing. Unfortunately, this group still shoulders a disproportionate mortality burden in the United States; these numbers are also reflective of colorectal cancer (CRC) disparities in the Midwest. The purpose of this study was to extrapolate results from in-depth interviews and brief surveys on the effectiveness of the church as a social marketer of CRC-prevention messages. Results show that pastors believe the congregation has limited knowledge about CRC risk and prevention; they also believe the church can improve cancer-prevention communication among members and those affiliated with the church. PMID:23718957

Sociodemographic inequalities in barriers to cancer pain management: a report from the American Cancer Society's Study of Cancer Survivors-II (SCS-II).

Science.gov (United States)

Stein, Kevin D; Alcaraz, Kassandra I; Kamson, Chelsey; Fallon, Elizabeth A; Smith, Tenbroeck G

2016-10-01

Research has increasingly documented sociodemographic inequalities in the assessment and management of cancer-related pain. Most studies have focused on racial/ethnic disparities, while less is known about the impact of other sociodemographic factors, including age and education. We analyzed data from a large, national, population-based study of cancer survivors to examine the influence of sociodemographic factors, and physical and mental health comorbidities on barriers to cancer pain management. The study included data from 4707 cancer survivors in the American Cancer Society's Study of Cancer Survivors-II, who reported experiencing pain from their cancer. A multilevel, socioecological, conceptual framework was used to generate a list of 15 barriers to pain management, representing patient, provider, and system levels. Separate multivariable logistic regressions for each barrier identified sociodemographic and health-related inequalities in cancer pain management, controlling for years since diagnosis, disease stage, and cancer treatment. Two-thirds of survivors reported at least 1 barrier to pain management. While patient-related barriers were most common, the greatest disparities were noted in provider- and system-level barriers. Specifically, inequalities by race/ethnicity, education, age, and physical and mental health comorbidities were observed. Findings indicate survivors who were nonwhite, less educated, older, and/or burdened by comorbidities were most adversely affected. Future efforts in research, clinical practice, and policy should identify and/or implement new strategies to address sociodemographic inequalities in cancer pain management. Copyright © 2016 John Wiley & Sons, Ltd.

Cancer control and the communication innovation in South Korea: implications for cancer disparities.

Science.gov (United States)

Jung, Minsoo

2013-01-01

Over the last 10 years, the number of cancer survivors in South Korea has reached nearly one million with a survival rate of 49.4%. However, integrated supportive care for cancer survivors is lagging. One area in which the current cancer control policy needs updating is in the utilization of information and communication technology (ICT). The remarkable progress in the field of ICT over the past 10 years presents exciting new opportunities for health promotion. Recent communication innovations are conducive to the exchange of meta-information, giving rise to a new service area and transforming patients into active medical consumers. Consequently, such innovations encourage active participation in the mutual utilization and sharing of high-quality information. However, these benefits from new ICTs will almost certainly not be equally available to all, leading to so-called communication inequalities where cancer survivors from lower socioeconomic classes will likely have more limited access to the best means of making use of the health information. Therefore, most essentially, emphasis must be placed on helping cancer survivors and their caregivers utilize such advances in ICT to create a more efficient flow of health information, thereby reducing communication inequalities and expanding social support. Once we enhance access to health information and better manage the quality of information, as a matter of fact, we can expect an alleviation of the health inequalities faced by cancer survivors.

Patient Choice of Nonsurgical Treatment Contributes to Disparities in Head and Neck Squamous Cell Carcinoma.

Science.gov (United States)

Parhar, Harman S; Anderson, Donald W; Janjua, Arif S; Durham, J Scott; Prisman, Eitan

2018-06-01

Objectives There are well-established outcome disparities among different demographic groups with head and neck squamous cell carcinoma (HNSCC). We aimed to investigate the potential contribution of patient choice of nonsurgical treatment to these disparities by estimating the rate of this phenomenon, identifying its predictors, and estimating the effect on cancer-specific survival. Study Design Retrospective nationwide analysis. Settings Surveillance, Epidemiology, and End Results Database (2004-2014). Subjects and Methods Patients with HNSCC, who were recommended for primary surgery, were included. Multivariable logistic regression was used to identify demographic and clinical factors associated with patient choice of nonsurgical treatment, and Kaplan Meier/Cox regression was used to analyze survival. Results Of 114,506 patients with HNSCC, 58,816 (51.4%) were recommended for primary surgery, and of those, 1550 (2.7%) chose nonsurgical treatment. Those who chose nonsurgical treatment were more likely to be older (67.1 ± 12.6 vs 63.6 ± 13.1, P unmarried (OR married, 0.50; 95% CI, 0.44-0.58), had an advanced tumor, and had a hypopharyngeal or laryngeal primary. Choice of nonsurgical treatment imparted a 2.16-fold (95% CI, 2.02-2.30) increased risk of cancer-specific death. Conclusion Of the patients, 2.7% chose nonsurgical treatment despite a provider recommendation that impairs survival. Choice of nonsurgical treatment is associated with older age, having Black or Asian ethnicity, being unmarried, having an advanced stage tumor, and having a primary site in the hypopharynx or larynx. Knowledge of these disparities may help providers counsel patients and help patients make informed decisions.

Cancer treatment disparities in HIV-infected individuals in the United States.

Science.gov (United States)

Suneja, Gita; Shiels, Meredith S; Angulo, Rory; Copeland, Glenn E; Gonsalves, Lou; Hakenewerth, Anne M; Macomber, Kathryn E; Melville, Sharon K; Engels, Eric A

2014-08-01

HIV-infected individuals with cancer have worse survival rates compared with their HIV-uninfected counterparts. One explanation may be differing cancer treatment; however, few studies have examined this. We used HIV and cancer registry data from Connecticut, Michigan, and Texas to study adults diagnosed with non-Hodgkin's lymphoma, Hodgkin's lymphoma, or cervical, lung, anal, prostate, colorectal, or breast cancers from 1996 to 2010. We used logistic regression to examine associations between HIV status and cancer treatment, adjusted for cancer stage and demographic covariates. For a subset of local-stage cancers, we used logistic regression to assess the relationship between HIV status and standard treatment modality. We identified predictors of cancer treatment among individuals with both HIV and cancer. We evaluated 3,045 HIV-infected patients with cancer and 1,087,648 patients with cancer without HIV infection. A significantly higher proportion of HIV-infected individuals did not receive cancer treatment for diffuse large B-cell lymphoma (DLBCL; adjusted odds ratio [aOR], 1.67; 95% CI, 1.41 to 1.99), lung cancer (aOR, 2.18; 95% CI, 1.80 to 2.64), Hodgkin's lymphoma (aOR, 1.77; 95% CI, 1.33 to 2.37), prostate cancer (aOR, 1.79; 95% CI, 1.31 to 2.46), and colorectal cancer (aOR, 2.27; 95% CI, 1.38 to 3.72). HIV infection was associated with a lack of standard treatment modality for local-stage DLBCL (aOR, 2.02; 95% CI, 1.50 to 2.72), non-small-cell lung cancer (aOR, 2.43; 95% CI, 1.46 to 4.03), and colon cancer (aOR, 4.77; 95% CI, 1.76 to 12.96). Among HIV-infected individuals, factors independently associated with lack of cancer treatment included low CD4 count, male sex with injection drug use as mode of HIV exposure, age 45 to 64 years, black race, and distant or unknown cancer stage. HIV-infected individuals are less likely to receive treatment for some cancers than uninfected people, which may affect survival rates. © 2014 by American Society of Clinical

Racial disparities in the survival of American children, adolescents, and young adults with acute lymphoblastic leukemia, acute myelogenous leukemia, and Hodgkin lymphoma.

Science.gov (United States)

Kahn, Justine M; Keegan, Theresa H M; Tao, Li; Abrahão, Renata; Bleyer, Archie; Viny, Aaron D

2016-09-01

Race-based survival in children and adolescents with hematologic malignancies has been a national challenge for decades. Large-scale investigations of age- and race-based survival trends over time in these patients have not previously been reported. The objective of this study was to investigate whether race- and age-related differences in pediatric and adolescent and young adult (AYA) leukemia and lymphoma survival persist and to what extent these differences have changed over time. Using the Surveillance, Epidemiology, and End Results program, this study investigated the outcomes of black and white (1975-2012; n = 27,369) and white and Hispanic (1992-2012; n = 20,574) children (0-14 years old) and AYAs (15-39 years old) with acute lymphoblastic leukemia (ALL), acute myelogenous leukemia (AML), and Hodgkin lymphoma (HL). Estimates of 5- and 10-year relative survival were compared over time. Trends showed a convergence of survival for white and black children with ALL but a divergence in survival for AYA patients. Hispanic children and AYAs both suffered inferior outcomes. Trends for AML revealed persistent survival differences between black and white children and suggested worsening disparities for AYAs. Survival trends in HL revealed sustained survival differences between black and white AYA patients, whereas no differences were found in Hispanic and white patient outcomes for AML or HL. Although survival for children and AYAs with ALL, AML, and HL has improved over the past 4 decades, differences persist between black, white, and Hispanic children and AYAs; survival disparities between black and white children with ALL have been nearly eliminated. Strategies aimed at identifying causality and reducing disparities are warranted. Cancer 2016. © 2016 American Cancer Society. Cancer 2016;122:2723-2730. © 2016 American Cancer Society. © 2016 American Cancer Society.

Employing the church as a marketer of cancer prevention: a look at a health promotion project aimed to reduce colorectal cancer among African Americans in the Midwest.

Science.gov (United States)

Lumpkins, Crystal Y; Coffey, Candice R; Daley, Christine M; Greiner, K Allen

2013-01-01

Health promotion programs designed to address colorectal cancer disparities among African Americans are increasing. Unfortunately, this group still shoulders a disproportionate mortality burden in the United States; these numbers are also reflective of colorectal cancer (CRC) disparities in the Midwest. The purpose of this study was to extrapolate results from in-depth interviews and brief surveys on the effectiveness of the church as a social marketer of CRC-prevention messages. Results show that pastors believe the congregation has limited knowledge about CRC risk and prevention; they also believe the church can improve cancer-prevention communication among members and those affiliated with the church.

Health disparities through a psychological lens.

Science.gov (United States)

Adler, Nancy E

2009-11-01

There is growing concern in the United States about avoidable, unjust differences in health associated with sociodemographic characteristics, such as socioeconomic status and race/ethnicity. This concern has sparked research to identify how disparities develop and how they can be reduced. Studies showing that disparities occur at all levels of socioeconomic status, not simply at the very bottom, suggest that psychosocial factors play an important role. The author discusses both content and process issues in psychological research on disparities. Copyright 2009 by the American Psychological Association

Do wealth disparities contribute to health disparities within racial/ethnic groups?

Science.gov (United States)

Pollack, Craig Evan; Cubbin, Catherine; Sania, Ayesha; Hayward, Mark; Vallone, Donna; Flaherty, Brian; Braveman, Paula A

2013-05-01

Though wide disparities in wealth have been documented across racial/ethnic groups, it is largely unknown whether differences in wealth are associated with health disparities within racial/ethnic groups. Data from the Survey of Consumer Finances (2004, ages 25-64) and the Health and Retirement Survey (2004, ages 50+), containing a wide range of assets and debts variables, were used to calculate net worth (a standard measure of wealth). Among non-Hispanic black, Hispanic and non-Hispanic white populations, we tested whether wealth was associated with self-reported poor/fair health status after accounting for income and education. Except among the younger Hispanic population, net worth was significantly associated with poor/fair health status within each racial/ethnic group in both data sets. Adding net worth attenuated the association between education and poor/fair health (in all racial/ethnic groups) and between income and poor/fair health (except among older Hispanics). The results add to the literature indicating the importance of including measures of wealth in health research for what they may reveal about disparities not only between but also within different racial/ethnic groups.

Prostate Cancer Disparities in an Incarcerated Community

Science.gov (United States)

2013-09-01

diseases, Liver diseases, Cerebrovascular accident , non-Illnesses, and finally AIDS. 30% of inmates incarcerated in the WDOC die from Cancer while it is...are higher among WDOC inmates than the general U.S. population; while Cerebrovascular Accidents (CVA) are lower among WDOC inmates than the general

Philanthropy and disparities: progress, challenges, and unfinished business.

Science.gov (United States)

Mitchell, Faith; Sessions, Kathryn

2011-10-01

Philanthropy has invested millions of dollars to reduce disparities in health care and improve minority health. Grants to strengthen providers' cultural competence, diversify health professions, and collect data have improved understanding of and spurred action on disparities. The persistence of disparities in spite of these advances has shifted philanthropic attention toward strategies to change social, economic, and environmental conditions. We argue that these evolving perspectives, along with earlier groundwork, present new opportunities for funders, especially in combination with progress toward universal health coverage. This article looks at how philanthropy has addressed health disparities over the past decade, with a focus on accomplishments, the work remaining to be done, and how funders can help advance the disparities agenda.

Environmental Health Disparities in Housing

Science.gov (United States)

2011-01-01

The physical infrastructure and housing make human interaction possible and provide shelter. How well that infrastructure performs and which groups it serves have important implications for social equity and health. Populations in inadequate housing are more likely to have environmental diseases and injuries. Substantial disparities in housing have remained largely unchanged. Approximately 2.6 million (7.5%) non-Hispanic Blacks and 5.9 million Whites (2.8%) live in substandard housing. Segregation, lack of housing mobility, and homelessness are all associated with adverse health outcomes. Yet the experience with childhood lead poisoning in the United States has shown that housing-related disparities can be reduced. Effective interventions should be implemented to reduce environmental health disparities related to housing. PMID:21551378

REGIONAL DISPARITIES – HISTORICAL CULTURAL INFLUENCES AND

Directory of Open Access Journals (Sweden)

MARIA OŢIL

2015-08-01

Full Text Available In recent decades, the issue of regional disparities has become a highly debated topic, knowledge regarding regional disparities being a matter of political priority as their persistence hinders the appropriate integration process. On the other hand, emphasis was put on integration through the process of EU enlargement, thus highlighting other issues related to the nature and size of disparities. Regional disparities regarding development and the living standards of the population have long been the concern of all Member States. In the case of Romania, recently admitted into the European structures, registering large backlogs to economically developed countries, the intense mobilization of internal and external factors of economic growth in order to reduce and eliminate disparities compared to other countries, represents a clear necessity. The "European Union" (EU project is of an unprecedented complexity and scale because it involves a plurality of states, which are culturally and economically heterogeneous. Moreover, these economic and cultural differences exist even within the states. Hence, there is also the central idea of the Union, regarding unity in diversity. In Romania the local, regional communities have a strong identity, but still evolving. Taking into account Romania's objective of successfully integrating into European structures, and the principles of democratic decision-making requires that regional development should aim at reducing economic and social disparities based on a notable involvement of the local, regional communities. Based on these facts, the paper aims to present the current regional (and intra-regional disparities in Romania with regard to a number of synthetic indicators of capital, of labor and of outcomes. The persistence in time of these economic disparities can be explained by considering the cultural legacies – represented by norms, values, institutions, that impact on how people interact, communicate

Rural Urban Disparity in and around Surabaya Region, Indonesia

Directory of Open Access Journals (Sweden)

Vely Kukinul Siswanto

2014-12-01

Full Text Available A shift in development towards the outskirts of urban areas changes the characteristics of the region and can ultimately lead to urban disparities in economic and social terms. The current study has tried to divide the study area covers the areas of surrounding Surabaya as urban, peri urban and rural areas with reference to three time periods (2008, 2009 and 2010 and shows that the typology in the study area changes each year. Furthermore, based on the theil index analysis, using a number of pre-prosperous household for social disparity and per capita GDP (Gross Domestic Product for economic disparity shows that urban and peri urban areas have medium and high level of social and economic disparity compare with rural area which have low levels of disparity. Through multivariate correlation analysis can be seen that the health center distance, electricity and water users effecting the social disparity. Moreover, the financial, industrial, electricity, trade, construction, transportation, agriculture, and mining sector's productivity have a significant relationship with the economic disparity. Health facilities, water and electricity improvement strategies to be followed for reducing the social disparity. Electricity improvement, water, services sector, transportation infrastructure, and industrial development to reduce the economic disparity.

Global stereo matching algorithm based on disparity range estimation

Science.gov (United States)

Li, Jing; Zhao, Hong; Gu, Feifei

2017-09-01

The global stereo matching algorithms are of high accuracy for the estimation of disparity map, but the time-consuming in the optimization process still faces a curse, especially for the image pairs with high resolution and large baseline setting. To improve the computational efficiency of the global algorithms, a disparity range estimation scheme for the global stereo matching is proposed to estimate the disparity map of rectified stereo images in this paper. The projective geometry in a parallel binocular stereo vision is investigated to reveal a relationship between two disparities at each pixel in the rectified stereo images with different baselines, which can be used to quickly obtain a predicted disparity map in a long baseline setting estimated by that in the small one. Then, the drastically reduced disparity ranges at each pixel under a long baseline setting can be determined by the predicted disparity map. Furthermore, the disparity range estimation scheme is introduced into the graph cuts with expansion moves to estimate the precise disparity map, which can greatly save the cost of computing without loss of accuracy in the stereo matching, especially for the dense global stereo matching, compared to the traditional algorithm. Experimental results with the Middlebury stereo datasets are presented to demonstrate the validity and efficiency of the proposed algorithm.

Trends in adherence to recommended cancer screening: The US population and working cancer survivors

Directory of Open Access Journals (Sweden)

Tainya C. Clarke

2012-12-01

Full Text Available Introduction: Over the past decade the United States has seen a decrease in advanced cancer diagnoses. There has also been an increase in the number of cancer survivors returning to work. Cancer screening behaviors among survivors may play an important role in their return-to-work process. Adherence to a post-treatment cancer screening protocol increases early detection of secondary tumors and reduces potentially limiting side-effects. We compared screening trends among all cancer survivors, working survivors, and the general population over the last decade.Methods: Trends in adherence to recommended screening were analyzed by site-specific cancer. We used the Healthy People goals as a measure of desired adherence. We selected participants 18+ years from 1997 to 2010 National Health Interview Survey (NHIS for years where detailed cancer screening information was available. Using the recommendations of the American Cancer Society as a guide, we assessed adherence to cancer screening across the decade. There were 174,393 participants. Analyses included 7,528 working cancer survivors representing 3.8 million US workers, and 119,374 adults representing more than 100 million working Americans with no cancer history.Results: The US population met the Healthy People 2010 goal for colorectal screening, but declined in all other recommended cancer screening. Cancer survivors met and maintained the HP2010 goal for all, except cervical cancer screening. Survivors had higher screening rates than the general population. Among survivors, white-collar and service occupations had higher screening rates than blue-collar survivors.Conclusions: Cancer survivors report higher screening rates than the general population. Nevertheless, national screening rates are lower than desired, and disparities exist by cancer history and occupation. Understanding existing disparities, and the impact of cancer screening on survivors is crucial as the number of working survivors

Impact of end-of-life discussions on the reduction of Latino/non-Latino disparities in do-not-resuscitate order completion.

Science.gov (United States)

Shen, Megan Johnson; Prigerson, Holly G; Paulk, Elizabeth; Trevino, Kelly M; Penedo, Frank J; Tergas, Ana I; Epstein, Andrew S; Neugut, Alfred I; Maciejewski, Paul K

2016-06-01

Compared with non-Latino, white patients with advanced cancer, Latino patients with advanced cancer are less likely to sign do-not-resuscitate (DNR) orders, which is a form of advance care planning associated with better quality of life at the end of life (EOL). Latinos' completion of DNR orders may be more sensitive to clinical discussions regarding EOL care. The current study examined differences between Latino and white terminally ill patients with cancer with regard to the association between EOL discussions and DNR order completion. A total of 117 participants with advanced cancer (61 of whom were Latino and 56 of whom were non-Latino white individuals) were recruited between 2002 and 2008 from Parkland Hospital (a public hospital in Dallas, Texas) as part of the Coping with Cancer study, which is a large, multiinstitutional, prospective cohort study of patients with advanced cancer that is designed to examine social and psychological influences on EOL care. In structured interviews, patients reported if they had EOL discussions with their physicians, and if they completed DNR orders. The association between EOL discussions and DNR order completion was significantly greater in Latino compared with white patients, adjusting for potential confounds (interaction adjusted odds ratio, 6.64; P = .041). Latino patients who had an EOL discussion were >10 times more likely (adjusted odds ratio, 10.91; P = .001) to complete a DNR order than those who had not, and were found to be equally as likely to complete a DNR order as white patients. Differences in the impact of EOL discussions on DNR order completion may explain Latino/non-Latino ethnic disparities in DNR order completion in EOL care, and point to a means to eliminate those disparities. Cancer 2016;122:1749-56. © 2016 American Cancer Society. © 2016 American Cancer Society.

Allometric disparity in rodent evolution

OpenAIRE

Wilson LAB

2013-01-01

In this study, allometric trajectories for 51 rodent species, comprising equal representatives from each of the major clades (Ctenohystrica, Muroidea, Sciuridae), are compared in a multivariate morphospace (=allometric space) to quantify magnitudes of disparity in cranial growth. Variability in allometric trajectory patterns was compared to measures of adult disparity in each clade, and dietary habit among the examined species, which together encapsulated an ecomorphological breadth. Results ...

Health Disparities Calculator (HD*Calc) - SEER Software

Science.gov (United States)

Statistical software that generates summary measures to evaluate and monitor health disparities. Users can import SEER data or other population-based health data to calculate 11 disparity measurements.

Rates and predictors of colorectal cancer screening by race among motivated men participating in a prostate cancer risk assessment program

Science.gov (United States)

Hall, Michael J.; Ruth, Karen; Giri, Veda N.

2011-01-01

Background Screening by fecal occult blood test and lower endoscopy have lowered colorectal cancer (CRC) mortality, but compliance gaps persist. Of concern are possible disparities in uptake of CRC screening between White and African American (AA) men. Our goal was to assess for disparities in uptake of CRC screening among men participating in a high-risk prostate cancer clinic. If present, such disparities could support hypotheses for further research examining racial differences in awareness and patient preferences in undergoing CRC screening. Methods Baseline data on a racially diverse cohort of men age 50–69 at increased risk of prostate cancer collected via the prostate cancer risk assessment program (PRAP) at Fox Chase Cancer Center were analyzed. Predictors of uptake of CRC screening were assessed using multivariable logistic regression. Results Compared to Whites, AA men had statistically significantly lower uptake of fecal occult blood testing (AA 49.0% vs White 60.7%, p=0.035), lower endoscopy (AA 44.1% vs White 58.5%, p=0.011), and any CRC screening (AA 66.2% vs White 76.3%, p=0.053). Predictors of uptake of lower endoscopy among AA men included older age (OR 3.61, 95% CI 1.87–6.97), family history of CRC (OR 3.47, 95% CI 1.30–9.25), and insurance status (OR 1.90, 95% CI 1.04–3.46). Conclusion Despite awareness of cancer risk and motivation to seek prostate cancer screening through a specialized prostate cancer risk assessment program, evidence supporting compliance gaps with CRC screening among men was found. Tailored messages to younger AA men with and without a family history of CRC are needed. PMID:21751189

Energy price disparity and public welfare

International Nuclear Information System (INIS)

Templet, P.H.

2001-01-01

The differences in the price of energy to economic sectors are linked to a number of system parameters and to public welfare. There are large disparities in energy prices within states when comparing residential and industrial prices although neoclassical economics predicts one price in markets. The large disparities between the two sectors across states negatively affects the efficiency of resource allocation, creates subsidies for those getting the cheap energy and results in unequal access to energy. These in turn lead to inefficient partitioning of energy between products and waste, higher pollution, leakage of wealth and poorer energy use efficiency, i.e. high energy intensity. States with large energy price disparities between sectors have statistically higher poverty, lower incomes, more pollution and use more energy but with less efficiency. Higher energy price disparities also result in higher throughput per unit of output thus reducing the chances for sustainability and lower public welfare. 31 refs

California Breast Cancer Prevention Initiatives: Setting a research agenda for prevention.

Science.gov (United States)

Sutton, P; Kavanaugh-Lynch, M H E; Plumb, M; Yen, I H; Sarantis, H; Thomsen, C L; Campleman, S; Galpern, E; Dickenson, C; Woodruff, T J

2015-07-01

The environment is an underutilized pathway to breast cancer prevention. Current research approaches and funding streams related to breast cancer and the environment are unequal to the task at hand. We undertook the California Breast Cancer Prevention Initiatives, a four-year comprehensive effort to set a research agenda related to breast cancer, the environment, disparities and prevention. We identified 20 topics for Concept Proposals reflecting a life-course approach and the complex etiology of breast cancer; considering the environment as chemical, physical and socially constructed exposures that are experienced concurrently: at home, in the community and at work; and addressing how we should be modifying the world around us to promote a less carcinogenic environment. Redirecting breast cancer research toward prevention-oriented discovery could significantly reduce the incidence and associated disparities of the disease among future generations. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

Luminance, Colour, Viewpoint and Border Enhanced Disparity Energy Model.

Directory of Open Access Journals (Sweden)

Jaime A Martins

Full Text Available The visual cortex is able to extract disparity information through the use of binocular cells. This process is reflected by the Disparity Energy Model, which describes the role and functioning of simple and complex binocular neuron populations, and how they are able to extract disparity. This model uses explicit cell parameters to mathematically determine preferred cell disparities, like spatial frequencies, orientations, binocular phases and receptive field positions. However, the brain cannot access such explicit cell parameters; it must rely on cell responses. In this article, we implemented a trained binocular neuronal population, which encodes disparity information implicitly. This allows the population to learn how to decode disparities, in a similar way to how our visual system could have developed this ability during evolution. At the same time, responses of monocular simple and complex cells can also encode line and edge information, which is useful for refining disparities at object borders. The brain should then be able, starting from a low-level disparity draft, to integrate all information, including colour and viewpoint perspective, in order to propagate better estimates to higher cortical areas.

Trends in colorectal cancer screening over time for persons with and without chronic disability.

Science.gov (United States)

Iezzoni, Lisa I; Kurtz, Stephen G; Rao, Sowmya R

2016-07-01

Persons with disabilities have often experienced disparities in routine cancer screening. However, with civil rights protections from the 1990 Americans with Disabilities Act, such disparities may diminish over time. To examine whether disability disparities exist for colorectal cancer screening and whether these screening patterns have changed over time. We analyzed National Health Interview Survey responses from civilian, non-institutionalized U.S. residents 50-75 years old from selected years between 1998 and 2010. We specified 7 chronic disability indicators using self-reported functional impairments, activity/participation limitations, and expected duration. Separately for women and men, we conducted bivariable and multivariable logistic regression analyses examining associations of self-reported colorectal cancer screening services with sociodemographic factors and disability type. Patterns of chronic disability differed somewhat between women and men; disability rates generally rose over time. For both women and men, colorectal cancer screening rates increased substantially from 1998 through 2010. Over time, relatively few statistically significant differences were reported in colorectal cancer screening rates between nondisabled persons and individuals with various disabilities. In 2010, reported screening rates were generally comparable between nondisabled and disabled persons. In the few statistically significant differences, persons with disabilities almost always reported higher colorectal cancer screening rates than nondisabled individuals. According to national survey data, reported use of colorectal cancer screening is similar between nondisabled persons and individuals with a variety of different disability types. Despite physical demands of some colorectal cancer screening tests, disparities do not appear between populations with and without disability. Copyright © 2016 Elsevier Inc. All rights reserved.

Environmental injustice and sexual minority health disparities: A national study of inequitable health risks from air pollution among same-sex partners.

Science.gov (United States)

Collins, Timothy W; Grineski, Sara E; Morales, Danielle X

2017-10-01

Air pollution is deleterious to human health, and numerous studies have documented racial and socioeconomic inequities in air pollution exposures. Despite the marginalized status of lesbian, gay, bisexual, and transgender (LGBT) populations, no national studies have examined if they experience inequitable exposures to air pollution. This cross-sectional study investigated inequities in the exposure of same-sex partner households to hazardous air pollutants (HAPs) in the US. We examined cancer and respiratory risks from HAPs across 71,207 census tracts using National Air Toxics Assessment and US Census data. We calculated population-weighted mean cancer and respiratory risks from HAPs for same-sex male, same-sex female and heterosexual partner households. We used generalized estimating equations (GEEs) to examine multivariate associations between sociodemographics and health risks from HAPs, while focusing on inequities based on the tract composition of same-sex, same-sex male and same-sex female partners. We found that mean cancer and respiratory risks from HAPs for same-sex partners are 12.3% and 23.8% greater, respectively, than for heterosexual partners. GEEs adjusting for racial/ethnic and socioeconomic status, population density, urban location, and geographic clustering show that living in census tracts with high (vs. low) proportions of same-sex partners is associated with significantly greater cancer and respiratory risks from HAPs, and that living in same-sex male partner enclaves is associated with greater risks than living in same-sex female partner enclaves. Results suggest that some health disparities experienced by LGBT populations (e.g. cancer, asthma) may be compounded by environmental exposures. Findings highlight the need to extend the conceptual framework for explaining LGBT health disparities beyond psycho-behavioral mechanisms translating social stress into illness to include environmental mechanisms. Because psycho-behavioral and environmental

Cancer screening delivery in persistent poverty rural counties.

Science.gov (United States)

Bennett, Kevin J; Pumkam, Chaiporn; Bellinger, Jessica D; Probst, Janice C

2011-10-01

Rural populations are diagnosed with cancer at different rate and stages than nonrural populations, and race/ethnicity as well as the area-level income exacerbates the differences. The purpose of this analysis was to explore cancer screening rates across persistent poverty rural counties, with emphasis on nonwhite populations. The 2008 Behavioral Risk Factor Surveillance System was used, combined with data from the Area Resource File (analytic n = 309 937 unweighted, 196 344 347 weighted). Unadjusted analysis estimated screening rates for breast, cervical, and colorectal cancer. Multivariate analysis estimated the odds of screening, controlling for individual and county-level effects. Rural residents, particularly those in persistent poverty counties, were less likely to be screened than urban residents. More African Americans in persistent poverty rural counties reported not having mammography screening (18.3%) compared to 15.9% of urban African Americans. Hispanics had low screening rates across all service types. Multivariate analysis continued to find disparities in screening rates, after controlling for individual and county-level factors. African Americans in persistent poverty rural counties were more likely to be screened for both breast cancer (odds ratio, 1.44; 95% confidence interval, 1.12-1.85) and cervical cancer (1.46; 1.07-1.99) when compared with urban whites. Disparities in cancer screening rates exist across not only race/ethnicity but also county type. These disparities cannot be fully explained by either individual or county-level effects. Programs have been successful in improving screening rates for African American women and should be expanded to target other vulnerable women as well as other services such as colorectal cancer screening.

Health Disparities in Veterans: A Map of the Evidence.

Science.gov (United States)

Kondo, Karli; Low, Allison; Everson, Teresa; Gordon, Christine D; Veazie, Stephanie; Lozier, Crystal C; Freeman, Michele; Motu'apuaka, Makalapua; Mendelson, Aaron; Friesen, Mark; Paynter, Robin; Friesen, Caroline; Anderson, Johanna; Boundy, Erin; Saha, Somnath; Quiñones, Ana; Kansagara, Devan

2017-09-01

Goals for improving the quality of care for all Veterans and eliminating health disparities are outlined in the Veterans Health Administration Blueprint for Excellence, but the degree to which disparities in utilization, health outcomes, and quality of care affect Veterans is not well understood. To characterize the research on health care disparities in the Veterans Health Administration by means of a map of the evidence. We conducted a systematic search for research studies published from 2006 to February 2016 in MEDLINE and other data sources. We included studies of Veteran populations that examined disparities in 3 outcome categories: utilization, quality of health care, and patient health. We abstracted data on study design, setting, population, clinical area, outcomes, mediators, and presence of disparity for each outcome category. We grouped the data by population characteristics including race, disability status, mental illness, demographics (age, era of service, rural location, and distance from care), sex identity, socioeconomic status, and homelessness, and created maps illustrating the evidence. We reviewed 4249 citations and abstracted data from 351 studies which met inclusion criteria. Studies examining disparities by race/ethnicity comprised by far the vast majority of the literature, followed by studies examining disparities by sex, and mental health condition. Very few studies examined disparities related to lesbian, gay, bisexual, or transgender identity or homelessness. Disparities findings vary widely by population and outcome. Our evidence maps provide a "lay of the land" and identify important gaps in knowledge about health disparities experienced by different Veteran populations.

A Narrative Review of the Confluence of Breast Cancer and Low-wage Employment and Its Impact on Receipt of Guideline-recommended Treatment

OpenAIRE

Vanderpool, Robin C.; Swanberg, Jennifer E.; Chambers, Mara D.

2013-01-01

Breast cancer is the leading cause of cancer among women in the United States, costing the healthcare system, employers, and society billions of dollars each year. Despite improvements in screening and treatment, significant breast cancer treatment and survivorship disparities exist among various groups of women. One variable that has not been explored extensively as a possible contributor to breast cancer treatment disparities is employment. This is concerning, given the changing economic an...

Disparity modifications and the emotional effects of stereoscopic images

Science.gov (United States)

Kawai, Takashi; Atsuta, Daiki; Tomiyama, Yuya; Kim, Sanghyun; Morikawa, Hiroyuki; Mitsuya, Reiko; Häkkinen, Jukka

2014-03-01

This paper describes a study that focuses on disparity changes in emotional scenes of stereoscopic (3D) images, in which an examination of the effects on pleasant and arousal was carried out by adding binocular disparity to 2D images that evoke specific emotions, and applying disparity modification based on the disparity analysis of famous 3D movies. From the results of the experiment, for pleasant, a significant difference was found only for the main effect of the emotions. On the other hand, for arousal, there was a trend of increasing the evaluation values in the order 2D condition, 3D condition and 3D condition applied the disparity modification for happiness, surprise, and fear. This suggests the possibility that binocular disparity and the modification affect arousal.

The intersection of disability and healthcare disparities: a conceptual framework.

Science.gov (United States)

Meade, Michelle A; Mahmoudi, Elham; Lee, Shoou-Yih

2015-01-01

This article provides a conceptual framework for understanding healthcare disparities experienced by individuals with disabilities. While health disparities are the result of factors deeply rooted in culture, life style, socioeconomic status, and accessibility of resources, healthcare disparities are a subset of health disparities that reflect differences in access to and quality of healthcare and can be viewed as the inability of the healthcare system to adequately address the needs of specific population groups. This article uses a narrative method to identify and critique the main conceptual frameworks that have been used in analyzing disparities in healthcare access and quality, and evaluating those frameworks in the context of healthcare for individuals with disabilities. Specific models that are examined include the Aday and Anderson Model, the Grossman Utility Model, the Institute of Medicine (IOM)'s models of Access to Healthcare Services and Healthcare Disparities, and the Cultural Competency model. While existing frameworks advance understandings of disparities in healthcare access and quality, they fall short when applied to individuals with disabilities. Specific deficits include a lack of attention to cultural and contextual factors (Aday and Andersen framework), unrealistic assumptions regarding equal access to resources (Grossman's utility model), lack of recognition or inclusion of concepts of structural accessibility (IOM model of Healthcare Disparities) and exclusive emphasis on supply side of the healthcare equation to improve healthcare disparities (Cultural Competency model). In response to identified gaps in the literature and short-comings of current conceptualizations, an integrated model of disability and healthcare disparities is put forth. We analyzed models of access to care and disparities in healthcare to be able to have an integrated and cohesive conceptual framework that could potentially address issues related to access to

Understanding PSA and its derivatives in prediction of tumor volume: Addressing health disparities in prostate cancer risk stratification.

Science.gov (United States)

Chinea, Felix M; Lyapichev, Kirill; Epstein, Jonathan I; Kwon, Deukwoo; Smith, Paul Taylor; Pollack, Alan; Cote, Richard J; Kryvenko, Oleksandr N

2017-03-28

To address health disparities in risk stratification of U.S. Hispanic/Latino men by characterizing influences of prostate weight, body mass index, and race/ethnicity on the correlation of PSA derivatives with Gleason score 6 (Grade Group 1) tumor volume in a diverse cohort. Using published PSA density and PSA mass density cutoff values, men with higher body mass indices and prostate weights were less likely to have a tumor volume PSA derivatives when predicting for tumor volume. In receiver operator characteristic analysis, area under the curve values for all PSA derivatives varied across race/ethnicity with lower optimal cutoff values for Hispanic/Latino (PSA=2.79, PSA density=0.06, PSA mass=0.37, PSA mass density=0.011) and Non-Hispanic Black (PSA=3.75, PSA density=0.07, PSA mass=0.46, PSA mass density=0.008) compared to Non-Hispanic White men (PSA=4.20, PSA density=0.11 PSA mass=0.53, PSA mass density=0.014). We retrospectively analyzed 589 patients with low-risk prostate cancer at radical prostatectomy. Pre-operative PSA, patient height, body weight, and prostate weight were used to calculate all PSA derivatives. Receiver operating characteristic curves were constructed for each PSA derivative per racial/ethnic group to establish optimal cutoff values predicting for tumor volume ≥0.5 cm3. Increasing prostate weight and body mass index negatively influence PSA derivatives for predicting tumor volume. PSA derivatives' ability to predict tumor volume varies significantly across race/ethnicity. Hispanic/Latino and Non-Hispanic Black men have lower optimal cutoff values for all PSA derivatives, which may impact risk assessment for prostate cancer.

Why the WTA - WTP disparity matters

Science.gov (United States)

Brown Thomas C.; Gregory R.

1999-01-01

The disparity between willingness to pay (WTP) and willingness to accept compensation (WTA) has been demonstrated repeatedly. Because using WTP estimates of value where a WTA estimate is appropriate tends to undervalue environmental assets, this issue is important to environmental managers. We summarize reasons for the disparity and then discuss some of the...

Early Onset Malignancies - Genomic Study of Cancer Disparities

Science.gov (United States)

The Early Onset Malignancies Initiative studies the genomic basis of six cancers that develop at an earlier age, occur in higher rates, and are typically more aggressive in certain minority populations.

34 CFR 222.162 - What disparity standard must a State meet in order to be certified and how are disparities in...

Science.gov (United States)

2010-07-01

... 34 Education 1 2010-07-01 2010-07-01 false What disparity standard must a State meet in order to be certified and how are disparities in current expenditures or revenues per pupil measured? 222.162... of the Act § 222.162 What disparity standard must a State meet in order to be certified and how are...

Gender and Bladder Cancer: A Collaborative Review of Etiology, Biology, and Outcomes.

Science.gov (United States)

Dobruch, Jakub; Daneshmand, Siamak; Fisch, Margit; Lotan, Yair; Noon, Aidan P; Resnick, Matthew J; Shariat, Shahrokh F; Zlotta, Alexandre R; Boorjian, Stephen A

2016-02-01

The incidence of bladder cancer is three to four times greater in men than in women. However, women are diagnosed with more advanced disease at presentation and have less favorable outcomes after treatment. To review the literature on potential biologic mechanisms underlying differential gender risk for bladder cancer, and evidence regarding gender disparities in bladder cancer presentation, management, and outcomes. A literature search of English-language publications that included an analysis of the association of gender with bladder cancer was performed using Pubmed. Ninety-seven articles were selected for analysis with the consensus of all authors. It has been shown that the gender difference in bladder cancer incidence is independent of differences in exposure risk, including smoking status. Potential molecular mechanisms include disparate metabolism of carcinogens by hepatic enzymes between men and women, resulting in differential exposure of the urothelium to carcinogens. In addition, the activity of the sex steroid hormone pathway may play a role in bladder cancer development, with demonstration that both androgens and estrogens have biologic effects in bladder cancer in vitro and in vivo. Importantly, gender differences exist in the timeliness and completeness of hematuria evaluation, with women experiencing a significantly greater delay in urologic referral and undergoing guideline-concordant imaging less frequently. Correspondingly, women have more advanced tumors at the time of bladder cancer diagnosis. Interestingly, higher cancer-specific mortality has been noted among women even after adjusting for tumor stage and treatment modality. Numerous potential biologic and epidemiologic factors probably underlie the gender differences observed for bladder cancer incidence, stage at diagnosis, and outcomes. Continued evaluation to define clinical applications for manipulation of the sex steroid pathway and to improve the standardization of hematuria

Reduced Disparities in Birth Rates Among Teens

Science.gov (United States)

... Teens Winnable Battles Social Media at CDC Reduced Disparities in Birth Rates among Teens Aged 15–19 ... Pregnancy Prevention Community-Wide Initiative. National Rates and Disparities Nationally, the teen birth rate (number of births ...

LGBT Populations' Barriers to Cancer Care.

Science.gov (United States)

Boehmer, Ulrike

2018-02-01

To describe lesbian, gay, bisexual, and transgender (LGBT) individuals' barriers to accessing and receiving quality cancer care. Published data on cancer care and studies of LGBT individuals. There is a clustering of barriers among LGBT individuals, which suggests multiple inequities exist in LGBT individuals' cancer care, although data on disparities along the cancer control continuum are not consistently available. Nurses can make a difference in LGBT individuals' cancer care by obtaining training on LGBT health and their cancer-related needs and by providing a welcoming and respectful relationship with LGBT patients. Copyright © 2017 Elsevier Inc. All rights reserved.

Targeting Tie2 to Increase Breast Cancer Responsiveness to Antiangiogenic Therapy

National Research Council Canada - National Science Library

Lee, William

2004-01-01

.... Results from human trials have been poorer than results from mouse testing. This disparity may be explained by more extensive coverage of vessels in human cancers, like breast cancer, by protective periendothelial mesenchymal cells (pericytes...

Disparities at the intersection of marginalized groups

Science.gov (United States)

Jackson, John W.; Williams, David R.; VanderWeele, Tyler J.

2016-01-01

Mental health disparities exist across several dimensions of social inequality, including race/ethnicity, socioeconomic status and gender. Most investigations of health disparities focus on one dimension. Recent calls by researchers argue for studying persons who are marginalized in multiple ways, often from the perspective of intersectionality, a theoretical framework applied to qualitative studies in law, sociology, and psychology. Quantitative adaptations are emerging but there is little guidance as to what measures or methods are helpful. Here, we consider the concept of a joint disparity and its composition, show that this approach can illuminate how outcomes are patterned for social groups that are marginalized across multiple axes of social inequality, and compare the insights gained with that of other measures of additive interaction. We apply these methods to a cohort of males from the National Longitudinal Survey of Youth, examining disparities for black males with low early life SES vs. white males with high early life SES across several outcomes that predict mental health, including unemployment, wages, and incarceration. We report striking disparities in each outcome, but show that the contribution of race, SES, and their intersection varies. PMID:27531592

Social determinants and sexually transmitted disease disparities.

Science.gov (United States)

Hogben, Matthew; Leichliter, Jami S

2008-12-01

Social determinants of health play an important role in sexually transmitted disease (STD) transmission and acquisition; consequently, racial and ethnic disparities among social determinants are influences upon disparities in STD rates. In this narrative review, we outline a general model showing the relationship between social determinants and STD outcomes, mediated by epidemiologic context. We then review 4 specific social determinants relevant to STD disparities: segregation, health care, socioeconomics and correctional experiences, followed by 2 facets of the resultant epidemiologic context: core areas and sexual networks. This review shows that disparities exist among the social determinants and that they are related to each other, as well as to core areas, sexual networks, and STD rates. Finally, we discuss the implications of our review for STD prevention and control with particular attention to STD program collaboration and service integration.

Racial/ethnic disparities in the risk of posttraumatic stress disorder symptoms among mothers of children diagnosed with cancer and Type-1 diabetes mellitus.

Science.gov (United States)

Greening, Leilani; Stoppelbein, Laura; Cheek, Kara

2017-05-01

Research findings have indicated that mothers of children diagnosed with life-threatening illnesses can be at risk for posttraumatic stress disorder (PTSD) symptoms (PTSS), with African American mothers being especially vulnerable because of evidence suggesting higher rates of PTSD among both African Americans and women. Race/ethnicity, past trauma exposure and the interaction of these variables were evaluated as risk factors for PTSS, depression, and state and trait anxiety among African American and Caucasian mothers of chronically ill children. Mothers of children (N = 91) diagnosed with a life-threatening illness (i.e., cancer or Type-I diabetes mellitus [T1DM]) completed standardized measures and provided a salivary cortisol sample while attending medical appointments for their ill children. A MANCOVA revealed that mothers of children diagnosed with T1DM had higher cortisol levels than mothers of children with cancer. There was no racial or ethnic disparity in the risk of PTSS among the mothers. These findings suggest that mothers of children with T1DM may be vulnerable to stress reactions, as reflected by cortisol, a biological marker. Clinicians and researchers might consider illness-specific features when evaluating the risk of stress reactions among mothers of children with life-threatening illnesses. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Health disparities in the immunoprevention of human papillomavirus infection and associated malignancies

Directory of Open Access Journals (Sweden)

Amira eBakir

2015-12-01

Full Text Available Human papillomavirus (HPV causes about 1.6% of the roughly 1.6 million new cancer cases that are diagnosed in the United States each year. Despite the proven safety and efficacy of currently available vaccines, HPV remains the most common sexually transmitted infection. Underlying the high prevalence of HPV infection is the poor adherence to the Centers for Disease Control (CDC recommendation that all 11-12 year old males and females be vaccinated. In fact, only about 38% and 14% of eligible females and males respectively, receive the complete, three-dose immunization.Many factors are associated with missed HPV vaccination opportunities, including race, age, family income and patient education, resulting in widespread disparities in vaccination rates and related health outcomes. Beyond patient circumstance, however, research indicates that the rigor and consistency of recommendation by primary care providers also plays a significant role in uptake of HPV immunization. Health disparities data are of vital importance to HPV vaccination campaigns because they can provide insight into how to address current problems and allocate limited resources where they are most needed. Furthermore, even modest gains in populations with low vaccination rates may yield great benefits because HPV immunization has been shown to provide herd immunity, indirect protection for non-immunized individuals achieved by limiting the spread of an infectious agent through a population. HPV vaccination campaigns face the challenge of stagnant HPV immunization rates, which are increasing slowly overall but remain far below target levels. Furthermore, gains in immunization are not equal across all groups and vaccination rates are strikingly disparate across the federal poverty level. To achieve the greatest impact, public health campaigns should focus on improving vaccination coverage where it is weakest. In addition to demographics, socioeconomic factors and attitudes of

Disparities in the use of screening magnetic resonance imaging of the breast in community practice by race, ethnicity, and socioeconomic status.

Science.gov (United States)

Haas, Jennifer S; Hill, Deirdre A; Wellman, Robert D; Hubbard, Rebecca A; Lee, Christoph I; Wernli, Karen J; Stout, Natasha K; Tosteson, Anna N A; Henderson, Louise M; Alford-Teaster, Jennifer A; Onega, Tracy L

2016-02-15

Uptake of breast magnetic resonance imaging (MRI) coupled with breast cancer risk assessment offers the opportunity to tailor the benefits and harms of screening strategies for women with differing cancer risks. Despite the potential benefits, there is also concern for worsening population-based health disparities. Among 316,172 women aged 35 to 69 years from 5 Breast Cancer Surveillance Consortium registries (2007-2012), the authors examined 617,723 negative screening mammograms and 1047 screening MRIs. They examined the relative risks (RRs) of MRI use by women with a college or technical school were 43% more likely and those who had at least a college degree were 132% more likely to receive an MRI compared with those with a high school education or less. Among women with a ≥20% lifetime risk, there was no statistically significant difference noted with regard to the use of screening MRI by race or ethnicity, but high-risk women with a high school education or less were less likely to undergo screening MRI than women who had graduated from college (RR, 0.40; 95% confidence interval, 0.25-0.63). Uptake of screening MRI of the breast into clinical practice has the potential to worsen population-based health disparities. Policies beyond health insurance coverage should ensure that the use of this screening modality reflects evidence-based guidelines. © 2015 American Cancer Society.

Health Psychology special series on health disparities

NARCIS (Netherlands)

Kazak, A.E.; Bosch, J.; Klonoff, E.A.

2012-01-01

With the initiation of this new ongoing special series in Health Psychology on health disparities, we will publish articles that highlight ways in which health psychology can contribute to understanding and ameliorating these disparities. We welcome articles for this new special series and

Assessing EphA2 and Ephrin-A as Novel Diagnostic and Prognostic Biomarkers of Prostate Cancer

Science.gov (United States)

2017-10-01

to facilitate optimal treatment selection for each patient; 3) Elucidation of the biological mechanisms behind the PCa health disparities that...affect minority men. During this last study period, we have enrolled 20 additional male patients into our study. We have optimized the RNA isolation... health disparities that affect African American men. 2. KEYWORDS: prostate cancer, biomarkers, racial disparity, health outcomes 3. ACCOMPLISHMENTS

Disparities in Oral Cancer Awareness: a Population Survey in Tehran, Iran.

Science.gov (United States)

Azimi, Somayyeh; Ghorbani, Zahra; Ghasemi, Erfan; Tennant, Marc; Kruger, Estie

2018-03-10

Oral cancer is a life-threatening disease with low survival rates, especially when diagnosed in an advanced stage. Lack of awareness about this cancer among the population is proposed as a possible reason for this diagnostic delay. The aim of this study was to evaluate oral cancer awareness, as well as the association of this with sociodemographic status in Tehran. In this cross-sectional population-based survey, 1800 self-administered questionnaires (collecting sociodemographic data, questions regarding oral cancer awareness and the source of information) were distributed through multistage stratified random sampling. Scores for questions ranged from 0 to 4, and totals were summed. The outcome of question responses was also analyzed separately. In total, 1312 questionnaires were available for analysis, from 788 females and 489 males (37.8 ± 9.02 years). Only 30% of the respondents were aware of oral cancer. The average score for awareness was 1.09 ± 1.6 with no significant differences between age groups and genders. Almost 6.5% of participants had complete awareness about oral cancer. A significant difference was found between mean scores in different levels of education and occupation (p = 0.0001). From 585 responses to the "source of information" question, "public media" was the most important source (almost 50%). Only 2% mentioned "dentists" as a source of information. This study indicated an alarming lack of oral cancer awareness and literacy in Tehran, Iran. Dentists should be obliged to practice their pivotal role in informing the public about oral cancer.

Depression and under-treatment of depression: potential risks and outcomes in black lung cancer patients

Science.gov (United States)

Traeger, Lara; Cannon, Sheila; Pirl, William F.; Park, Elyse R.

2015-01-01

In the U.S., black men are at higher risk than white men for lung cancer mortality whereas rates are comparable between black and white women. This paper draws from empirical work in lung cancer, mental health and health disparities to highlight that race and depression may overlap in predicting lower treatment access and utilization and poorer quality of life among patients. Racial barriers to depression identification and treatment in the general population may compound these risks. Prospective data are needed to examine whether depression plays a role in racial disparities in lung cancer outcomes. PMID:23514250

Rural Health Disparities

Science.gov (United States)

... in the Delta Region for specific data. U.S. – Mexico Border While life expectancy in many counties of ... documents the successes, challenges, and relevant information for planning. ... on rural/urban disparities see What sources cover health behaviors and ...

Challenges for Multilevel Health Disparities Research in a Transdisciplinary Environment

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Holmes, John H.; Lehman, Amy; Hade, Erinn; Ferketich, Amy K.; Sarah, Gehlert; Rauscher, Garth H.; Abrams, Judith; Bird, Chloe E.

2008-01-01

Numerous factors play a part in health disparities. Although health disparities are manifested at the level of the individual, other contexts should be considered when investigating the associations of disparities with clinical outcomes. These contexts include families, neighborhoods, social organizations, and healthcare facilities. This paper reports on health disparities research as a multilevel research domain from the perspective of a large national initiative. The Centers for Population Health and Health Disparities (CPHHD) program was established by the NIH to examine the highly dimensional, complex nature of disparities and their effects on health. Because of its inherently transdisciplinary nature, the CPHHD program provides a unique environment in which to perform multilevel health disparities research. During the course of the program, the CPHHD centers have experienced challenges specific to this type of research. The challenges were categorized along three axes: sources of subjects and data, data characteristics, and multilevel analysis and interpretation. The CPHHDs collectively offer a unique example of how these challenges are met; just as importantly, they reveal a broad range of issues that health disparities researchers should consider as they pursue transdisciplinary investigations in this domain, particularly in the context of a large team science initiative. PMID:18619398

Perspectives of Orthopedic Surgeons on Racial/Ethnic Disparities in Care.

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Adelani, Muyibat A; O'Connor, Mary I

2017-08-01

Racial/ethnic disparities in healthcare, including orthopedics, have been extensively documented. However, the level of knowledge among orthopedic surgeons regarding racial/ethnic disparities is unknown. The purpose of this study is to determine the views of orthopedic surgeons on (1) the extent of racial/ethnic disparities in orthopedic care, (2) patient and system factors that may contribute, and (3) the potential role of orthopedic surgeons in the reduction of disparities. Three hundred five members of the American Orthopaedic Association completed a survey to assess their knowledge of racial/ethnic disparities and their perceptions about the underlying causes. Twelve percent of respondents believe that patients often receive different care based on race/ethnicity in healthcare in general, while 9 % believe that differences exist in orthopedic care in general, 3 % believe that differences exist within their hospitals/clinics, and 1 % reported differences in their own practices. Despite this, 68 % acknowledge that there is evidence of disparities in orthopedic care. Fifty-one percent believe that a lack of insurance significantly contributes to disparities. Thirty-five percent believe that diversification of the orthopedic workforce would be a "very effective" strategy in addressing disparities, while 25 % percent believe that research would be "very effective" and 24 % believe that surgeon education would be "very effective." Awareness regarding racial/ethnic disparities in musculoskeletal care is low among orthopedic surgeons. Additionally, respondents were more likely to acknowledge disparities within the practices of others than their own. Increased diversity, research, and education may help improve knowledge of this problem.

Global health disparities: crisis in the diaspora.

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Cox, Raymond L.

2004-01-01

The United States spends more than the rest of the world on healthcare. In 2000, the U.S. health bill was 1.3 trillion dollars, 14.5% of its gross domestic product. Yet, according to the WHO World Health Report 2000, the United States ranked 37th of 191 member nations in overall health system performance. Racial/ethnic disparities in health outcomes are the most obvious examples of an unbalanced healthcare system. This presentation will examine health disparities in the United States and reveal how health disparities among and within countries affect the health and well-being of the African Diaspora. PMID:15101675

The disparity of health facilities in an urban area discourages proposed treatment application in inoperable lung cancer patients

International Nuclear Information System (INIS)

Hillas, Georgios; Bakakos, Petros; Trichas, Miltiadis; Vlastos, Fotis

2010-01-01

Patients with a newly diagnosed non-small cell lung cancer (NSCLC) stage IIIB are offered chemoradiotherapy, as proposed by the current guidelines. This combination treatment is facilitated by the coexistence of corresponding departments in the same establishment. The geographical disparity of these health facilities influences patients’ willingness to be treated and may influence their survival. This is an observational study that compares the survival of two groups of patients with NSCLC stage IIIB: those treated with chemoradiotherapy versus those treated only with chemotherapy. These two comparable groups were formed exclusively by patients’ and/or their families’ decisions. One hundred fifteen consecutive NSCLC stage IIIB patients were included in the study. All were hospitalized in the biggest Chest Disease Hospital in Athens and were offered sequential chemoradiotherapy. Only 54 patients opted for the proposed treatment, while 61 decided to be treated with chemotherapy only, denying continuing their treatment in another health care unit (radiotherapy). Their survival and related factors were analyzed. Mean overall survival was estimated 10 months (95% confidence interval [CI]: 7.96–12.04). Patients treated with chemoradiotherapy had almost double overall survival compared to those under chemotherapy (P = 0.001): 13.6 months (95% CI: 12.3–14.9) versus 7.5 (95% CI: 6.1–8.9). Patients aged ≤ 65 years (P < 0.001), smokers (P < 0.001), and those without a cancer history (P < 0.001) survived longer. The lack of a radiotherapy department in a hospital providing chemotherapy impedes the application of current guidelines advocating combined radiochemotherapy. When recommended radiotherapy after six chemo cycles, half of the patients are unwilling to be displaced and do not follow the recommendations. This has an impact on patient survival

Gender and regional disparities of tuberculosis in Hunan, China.

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Chen, Mengshi; Kwaku, Abuaku Benjamin; Chen, Youfang; Huang, Xin; Tan, Hongzhuan; Wen, Shi Wu

2014-04-27

Major efforts have been made to improve the health care system in Hunan province, China. The aims of this study were to assess whether and to what extent these efforts have impacted on gender and regional disparities of Tuberculosis (TB) incidence in recent years, especially for less developed areas. We obtained data from the 2005-2009 China Information System for Disease Control and Prevention (CISDCP)to conduct this study in Hunan province. Counties within the province were divided into four regions according to quartiles based on the 2007 per capita GDP. Index of Disparity (ID) and Relative Index of Inequality (RII) were used to measure the disparities of TB incidence in relation to gender and region. Bootstrap technique was used to increase the precision. The average annual incidence of TB was 111.75 per 100,000 in males and 43.44 per 100 000 in females in Hunan. The gender disparity was stable, with ID from 42.34 in 2005 to 43.92 in 2009. For regional disparity, ID, RII (mean) and RII (ratio) decreased significantly from 2005 to 2009 in males (P China, regional disparity in relation to incidence of TB decreased significantly, but the gender disparity remains in the Hunan province.

Stigma and Racial/Ethnic HIV Disparities: Moving toward Resilience

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Earnshaw, Valerie A.; Bogart, Laura M.; Dovidio, John F.; Williams, David R.

2013-01-01

Prior research suggests that stigma plays a role in racial/ethnic health disparities. However, there is limited understanding about the mechanisms by which stigma contributes to HIV-related disparities in risk, incidence and screening, treatment, and survival and what can be done to reduce the impact of stigma on these disparities. We introduce…

Ethnic and Racial Disparities in HPV Vaccination Attitudes.

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Otanez, Staci; Torr, Berna M

2017-12-20

There are substantial racial and ethnic disparities in the vaccination rate for human papillomavirus (HPV), which helps protect against cervical cancer. Using data from the 2007 Health Information National Trends Survey, we explore differences between Whites, Blacks, Hispanics, and Asians in attitudes toward vaccinating adolescent girls for HPV. We use logistic regression models to explore whether racial/ethnic differences in attitudes toward HPV vaccinations are explained by HPV knowledge, demographic and socioeconomic status, and/or general distrust of the healthcare system. We include interactions to explore whether the effects of HPV knowledge and doctor distrust vary by racial/ethnic group. We find that greater HPV knowledge increases general willingness to vaccinate for all groups except Blacks. Our findings point to a need for additional research and design of culturally appropriate interventions that address barriers to vaccination.

Premature mortality in Belgium in 1993-2009: leading causes, regional disparities and 15 years change.

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Renard, Françoise; Tafforeau, Jean; Deboosere, Patrick

2014-01-01

decrease in single cause is observed for stomach cancer (-48.4%), road accident (-44%), genital organs (-40.4%) and lung (-34.6%) cancers. On the opposite, liver cancer death rate increased by 16%. Among female, the most remarkable feature is the 50.2% increase in the lung cancer death rate. For most other causes, the decline is slightly weaker than in men. Despite a steady decrease over time, international comparisons of the premature mortality burden highlight the room for improvement in Belgium. The disadvantage in Wallonia and to some extent in Brussels suggest the role of socio-economic factors; well- designed health policies could contribute to reduce the regional disparities. The increase in female lung cancer mortality is worrying.

A quantitative measurement of binocular color fusion limit for different disparities

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Chen, Zaiqing; Shi, Junsheng; Tai, Yonghan; Huang, Xiaoqiao; Yun, Lijun; Zhang, Chao

2018-01-01

Color asymmetry is a common phenomenon in stereoscopic display system, which can cause visual fatigue or visual discomfort. When the color difference between the left and right eyes exceeds a threshold value, named binocular color fusion limit, color rivalry is said to occur. The most important information brought by stereoscopic displays is the depth perception produced by the disparity. As the stereo pair stimuli are presented separately to both eyes with disparities and those two monocular stimuli differ in color but share an iso-luminance polarity, it is possible for stereopsis and color rivalry to coexist. In this paper, we conducted an experiment to measure the color fusion limit for different disparity levels. In particular, it examines how the magnitude and sign of disparity affect the binocular color fusion limit that yields a fused, stable stereoscopic percept. The binocular color fusion limit was measured at five levels of disparities: 0, +/-60, +/-120 arc minutes for a sample color point which was selected from the 1976 CIE u'v' chromaticity diagram. The experimental results showed that fusion limit for the sample point varied with the level and sign of disparity. It was an interesting result that the fusion limit increased as the disparity decreases at crossed disparity direction (sign -), but there is almost no big change at uncrossed disparity direction (sign +). We found that color fusion was more difficult to achieve at the crossed disparity direction than at the uncrossed disparity direction.

Racial/Ethnic Disparities in Mental Health Care Utilization among U.S. College Students: Applying the Institution of Medicine Definition of Health Care Disparities.

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Hunt, Justin B; Eisenberg, Daniel; Lu, Liya; Gathright, Molly

2015-10-01

The authors apply the Institute of Medicine's definition of health care disparities to college students. The analysis pools data from the first two waves of the Healthy Minds Study, a multicampus survey of students' mental health (N = 13,028). A probit model was used for any past-year service utilization, and group differences in health status were adjusted by transforming the entire distribution for each minority population to approximate the white distribution. Disparities existed between whites and all minority groups. Compared to other approaches, the predicted service disparities were greater because this method included the effects of mediating SES variables. Health care disparities persist in the college setting despite improved access and nearly universal insurance coverage. Our findings emphasize the importance of investigating potential sources of disparities beyond geography and coverage.

Decomposing Racial/Ethnic Disparities in Influenza Vaccination among the Elderly

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Yoo, Byung-Kwang; Hasebe, Takuya; Szilagyi, Peter G.

2015-01-01

While persistent racial/ethnic disparities in influenza vaccination have been reported among the elderly, characteristics contributing to disparities are poorly understood. This study aimed to assess characteristics associated with racial/ethnic disparities in influenza vaccination using a nonlinear Oaxaca-Blinder decomposition method. We performed cross-sectional multivariable logistic regression analyses for which the dependent variable was self-reported receipt of influenza vaccine during the 2010–2011 season among community dwelling non-Hispanic African-American (AA), non-Hispanic White (W), English-speaking Hispanic (EH) and Spanish-speaking Hispanic (SH) elderly, enrolled in the 2011 Medicare Current Beneficiary Survey (MCBS) (un-weighted/weighted N= 6,095/19.2million). Using the nonlinear Oaxaca-Blinder decomposition method, we assessed the relative contribution of seventeen covariates—including socio-demographic characteristics, health status, insurance, access, preference regarding healthcare, and geographic regions —to disparities in influenza vaccination. Unadjusted racial/ethnic disparities in influenza vaccination were 14.1 percentage points (pp) (W-AA disparity, p.8). The Oaxaca-Blinder decomposition method estimated that the unadjusted W-AA and W-SH disparities in vaccination could be reduced by only 45% even if AA and SH groups become equivalent to Whites in all covariates in multivariable regression models. The remaining 55% of disparities were attributed to (a) racial/ethnic differences in the estimated coefficients (e.g., odds ratios) in the regression models and (b) characteristics not included in the regression models. Our analysis found that only about 45% of racial/ethnic disparities in influenza vaccination among the elderly could be reduced by equalizing recognized characteristics among racial/ethnic groups. Future studies are needed to identify additional modifiable characteristics causing disparities in influenza vaccination. PMID

Epidemiology, Policy, and Racial/Ethnic Minority Health Disparities

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Carter-Pokras, Olivia; Offutt-Powell, Tabatha; Kaufman, Jay S.; Giles, Wayne; Mays, Vickie

2013-01-01

Purpose Epidemiologists have long contributed to policy efforts to address health disparities. Three examples illustrate how epidemiologists have addressed health disparities in the U.S. and abroad through a “social determinants of health” lens. Methods To identify examples of how epidemiologic research has been applied to reduce health disparities, we queried epidemiologists engaged in disparities research in the U.S., Canada, and New Zealand, and drew upon the scientific literature. Results Resulting examples covered a wide range of topic areas. Three areas selected for their contributions to policy were: 1) epidemiology's role in definition and measurement, 2) the study of housing and asthma, and 3) the study of food policy strategies to reduce health disparities. While epidemiologic research has done much to define and quantify health inequalities, it has generally been less successful at producing evidence that would identify targets for health equity intervention. Epidemiologists have a role to play in measurement and basic surveillance, etiologic research, intervention research, and evaluation research. However, our training and funding sources generally place greatest emphasis on surveillance and etiologic research. Conclusions: The complexity of health disparities requires better training for epidemiologists to effectively work in multidisciplinary teams. Together we can evaluate contextual and multilevel contributions to disease and study intervention programs in order to gain better insights into evidenced-based health equity strategies. PMID:22626003

Quantifying the Cumulative Impact of Differences in Care on Prostate Cancer Outcomes

National Research Council Canada - National Science Library

Fesinmeyer, Megan

2007-01-01

... of the disparity in prostate cancer outcomes. This work involves first examining how care patterns are correlated throughout all phases of cancer care within racial groups in order to gain a fuller understanding of how racial differences across...

The Alaska Education and Research Towards Health (EARTH) Study: cancer risk factors.

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Lanier, Anne P; Redwood, Diana G; Kelly, Janet J

2012-04-01

The Alaska Education and Research Towards Health (EARTH) Study assessed cancer risk among 3,821 Alaska Native people (AN). We present the prevalence of selected cancer risk factors and comparison with Healthy People 2010 goals. Participants completed extensive computer-assisted self-administered questionnaires on diet, physical activity, tobacco and alcohol use, cancer screening, family history of cancer, and environmental exposures. Measurement data were collected on blood pressure, height, weight, waist/hip circumference, fasting serum lipids, and glucose. Cancer risk factors are high for the Alaska EARTH study population. For all risk factors studied except for vegetable consumption, Alaska EARTH Study participants did not meet Healthy People 2010 goals. This study is unique in providing questionnaire and measurement data of cancer risk factors on a larger study sample than any previous study among AN living in Alaska. Data show that the prevalence of most cancer risk factors exceeded national recommendations. Given the disease disparities that exist for the AN population, these data provide important baseline data that can be used to target health interventions and reduce health disparities.

Cigarette smoking disparities among sexual minority cancer survivors

Directory of Open Access Journals (Sweden)

Charles Kamen

2015-01-01

Conclusion: The current study offers preliminary evidence that sexual minority status is one variable among many that must be taken into account when assessing health behaviors post-cancer diagnosis. Future research should identify mechanisms leading from sexual minority status to increased rates of smoking and develop tailored smoking cessation interventions.

Disparities in Disability by Educational Attainment Across US States.

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Montez, Jennifer Karas; Zajacova, Anna; Hayward, Mark D

2017-07-01

To examine how disparities in adult disability by educational attainment vary across US states. We used the nationally representative data of more than 6 million adults aged 45 to 89 years in the 2010-2014 American Community Survey. We defined disability as difficulty with activities of daily living. We categorized education as low (less than high school), mid (high school or some college), or high (bachelor's or higher). We estimated age-standardized disability prevalence by educational attainment and state. We assessed whether the variation in disability across states occurs primarily among low-educated adults and whether it reflects the socioeconomic resources of low-educated adults and their surrounding contexts. Disparities in disability by education vary markedly across states-from a 20 percentage point disparity in Massachusetts to a 12-point disparity in Wyoming. Disparities vary across states mainly because the prevalence of disability among low-educated adults varies across states. Personal and contextual socioeconomic resources of low-educated adults account for 29% of the variation. Efforts to reduce disparities in disability by education should consider state and local strategies that reduce poverty among low-educated adults and their surrounding contexts.

Explaining Racial Disparities in Infant Health in Brazil

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Nyarko, Kwame A.; Lopez-Camelo, Jorge; Castilla, Eduardo E.

2015-01-01

Objectives. We sought to quantify how socioeconomic, health care, demographic, and geographic effects explain racial disparities in low birth weight (LBW) and preterm birth (PTB) rates in Brazil. Methods. We employed a sample of 8949 infants born between 1995 and 2009 in 15 cities and 7 provinces in Brazil. We focused on disparities in LBW (Public policies to improve children’s health should target prenatal care and geographic location differences to reduce health disparities between infants of African and European ancestries in Brazil. PMID:26313046

An Approach to Integrating Health Disparities within Undergraduate Biomedical Engineering Education.

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Vazquez, Maribel; Marte, Otto; Barba, Joseph; Hubbard, Karen

2017-11-01

Health disparities are preventable differences in the incidence, prevalence and burden of disease among communities targeted by gender, geographic location, ethnicity and/or socio-economic status. While biomedical research has identified partial origin(s) of divergent burden and impact of disease, the innovation needed to eradicate health disparities in the United States requires unique engagement from biomedical engineers. Increasing awareness of the prevalence and consequences of health disparities is particularly attractive to today's undergraduates, who have undauntedly challenged paradigms believed to foster inequality. Here, the Department of Biomedical Engineering at The City College of New York (CCNY) has leveraged its historical mission of access-and-excellence to integrate the study of health disparities into undergraduate BME curricula. This article describes our novel approach in a multiyear study that: (i) Integrated health disparities modules at all levels of the required undergraduate BME curriculum; (ii) Developed opportunities to include impacts of health disparities into undergraduate BME research projects and mentored High School summer STEM training; and (iii) Established health disparities-based challenges as BME capstone design and/or independent entrepreneurship projects. Results illustrate the rising awareness of health disparities among the youngest BMEs-to-be, as well as abundant undergraduate desire to integrate health disparities within BME education and training.

Disparities in vaccinations and cancer screening among U.S.- and foreign-born Arab and European American non-Hispanic White women.

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Dallo, Florence J; Kindratt, Tiffany B

2015-01-01

Disparities in vaccinations and cancer screening exist when comparing foreign-born and U.S.-born women collectively and disaggregated by race and ethnicity. The purpose of this study was to estimate and compare the age-adjusted prevalence of not receiving a flu or pneumonia vaccine, clinical breast examination, mammogram or Pap smear among U.S.- and foreign-born White women by region of birth and examine associations while controlling for potential confounders. We pooled 12 years of National Health Interview Survey data (n = 117,893). To approximate an "Arab-American" ethnicity, we identified 15 "Arab" countries from the Middle East region that comprise the Arab Nations. Data was requested from the National Center for Health Statistics Research Data Center. We used the χ(2) statistic to compare descriptive statistics and odds ratios (ORs) with 95% CIs were used for inferential statistics. Compared to U.S.-born, foreign-born Whites from the Arab Nations had higher estimates of not receiving recommended vaccinations and cancer screenings. In crude and adjusted analyses, foreign-born Arab-American women were less likely to report receiving a flu vaccine (OR, 0.34; 95% CI, 0.21-0.58), pneumonia vaccine (OR, 0.14; 95% CI, 0.06-0.32), Pap smear (OR, 0.13; 95% CI, 0.05-0.31), or clinical breast examination (OR, 0.16; 95% CI, 0.07-0.37) compared with U.S.-born White women. There were no differences for mammography. This national study examining uptake of flu and pneumonia vaccines and preventive cancer screenings suggests that estimates are lower for foreign-born Arab-American women compared with U.S.-born White women. Future studies should collect qualitative data that assess the cultural context surrounding prevention and screening behaviors among Arab-American women. Copyright © 2015 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

A reaction-diffusion model to capture disparity selectivity in primary visual cortex.

Directory of Open Access Journals (Sweden)

Mohammed Sultan Mohiuddin Siddiqui

Full Text Available Decades of experimental studies are available on disparity selective cells in visual cortex of macaque and cat. Recently, local disparity map for iso-orientation sites for near-vertical edge preference is reported in area 18 of cat visual cortex. No experiment is yet reported on complete disparity map in V1. Disparity map for layer IV in V1 can provide insight into how disparity selective complex cell receptive field is organized from simple cell subunits. Though substantial amounts of experimental data on disparity selective cells is available, no model on receptive field development of such cells or disparity map development exists in literature. We model disparity selectivity in layer IV of cat V1 using a reaction-diffusion two-eye paradigm. In this model, the wiring between LGN and cortical layer IV is determined by resource an LGN cell has for supporting connections to cortical cells and competition for target space in layer IV. While competing for target space, the same type of LGN cells, irrespective of whether it belongs to left-eye-specific or right-eye-specific LGN layer, cooperate with each other while trying to push off the other type. Our model captures realistic 2D disparity selective simple cell receptive fields, their response properties and disparity map along with orientation and ocular dominance maps. There is lack of correlation between ocular dominance and disparity selectivity at the cell population level. At the map level, disparity selectivity topography is not random but weakly clustered for similar preferred disparities. This is similar to the experimental result reported for macaque. The details of weakly clustered disparity selectivity map in V1 indicate two types of complex cell receptive field organization.

Disparities in the treatment and outcomes of lung cancer among HIV-infected individuals

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Suneja, Gita; Shiels, Meredith S.; Melville, Sharon K.; Williams, Melanie A.; Rengan, Ramesh; Engels, Eric A.

2013-01-01

Objectives HIV-infected people have elevated risk for lung cancer and higher mortality following cancer diagnosis than HIV-uninfected individuals. It is unclear whether HIV-infected individuals with lung cancer receive similar cancer treatment as HIV-uninfected individuals. Design/methods We studied adults more than 18 years of age with lung cancer reported to the Texas Cancer Registry (N = 156 930) from 1995 to 2009. HIV status was determined by linkage with the Texas enhanced HIV/AIDS Reporting System. For nonsmall cell lung cancer (NSCLC) cases, we identified predictors of cancer treatment using logistic regression. We used Cox regression to evaluate effects of HIV and cancer treatment on mortality. Results Compared with HIV-uninfected lung cancer patients (N = 156 593), HIV-infected lung cancer patients (N = 337) were more frequently young, black, men, and with non-Hispanic distant stage disease. HIV-infected NSCLC patients less frequently received cancer treatment than HIV-uninfected patients [60.3 vs. 77.5%; odds ratio 0.39, 95% confidence interval (CI) 0.30–0.52, after adjustment for diagnosis year, age, sex, race, stage, and histologic subtype]. HIV infection was associated with higher lung cancer-specific mortality (hazard ratio 1.34, 95% CI 1.15–1.56, adjusted for demographics and tumor characteristics). Inclusion of cancer treatment in adjusted models slightly attenuated the effect of HIV on lung cancer-specific mortality (hazard ratio 1.25; 95% CI 1.06–1.47). Also, there was a suggestion that HIV was more strongly associated with mortality among untreated than among treated patients (adjusted hazard ratio 1.32 vs. 1.16, P-interaction = 0.34). Conclusion HIV-infected NSCLC patients were less frequently treated for lung cancer than HIV-uninfected patients, which may have affected survival. PMID:23079809

Socioeconomic, Rural-Urban, and Racial Inequalities in US Cancer Mortality: Part I-All Cancers and Lung Cancer and Part II-Colorectal, Prostate, Breast, and Cervical Cancers

International Nuclear Information System (INIS)

Singh, K. G.; Williams, S. D.

2011-01-01

We analyzed socioeconomic, rural-urban, and racial inequalities in US mortality from all cancers, lung, colorectal, prostate, breast, and cervical cancers. A deprivation index and rural-urban continuum were linked to the 2003-2007 county-level mortality data. Mortality rates and risk ratios were calculated for each socioeconomic, rural-urban, and racial group. Weighted linear regression yielded relative impacts of deprivation and rural-urban residence. Those in more deprived groups and rural areas had higher cancer mortality than more affluent and urban residents, with excess risk being marked for lung, colorectal, prostate, and cervical cancers. Deprivation and rural-urban continuum were independently related to cancer mortality, with deprivation showing stronger impacts. Socioeconomic inequalities existed for both whites and blacks, with blacks experiencing higher mortality from each cancer than whites within each deprivation group. Socioeconomic gradients in mortality were steeper in nonmetropolitanlitan areas. Mortality disparities may reflect inequalities in smoking and other cancer-risk factors, screening, and treatment

Increased incidence and disparity of diagnosis of retinoblastoma patients in Guatemala

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Bendfeldt, Giovana; Lou, Hong; Giron, Veronica; Garrido, Claudia; Valverde, Patricia; Barnoya, Margarita; Castellanos, Mauricio

2014-01-01

Analysis of 327 consecutive cases at a pediatric referral hospital of Guatemala reveals that retinoblastoma accounts for 9.4% of all cancers and the estimated incidence is 7.0 cases/million children, higher than the United States or Europe. The number of familial cases is low, and there is a striking disparity in indigenous children due to late diagnosis, advanced disease, rapid progression and elevated mortality. Nine germline mutations in 18 patients were found; two known and five new mutations. Hypermethylation of RB1 was identified in 13% of the tumors. An early diagnosis program could identify cases at an earlier age and improve outcome of retinoblastoma in this diverse population. PMID:24814393

Racial and ethnic disparities in antidepressant drug use.

Science.gov (United States)

Chen, Jie; Rizzo, John A

2008-12-01

Little is known about racial and ethnic disparities in health care utilization, expenditures and drug choice in the antidepressant market. This study investigates factors associated with the racial and ethnic disparities in antidepressant drug use. We seek to determine the extent to which disparities reflect differences in observable population characteristics versus heterogeneity across racial and ethnic groups. Among the population characteristics, we are interested in identifying which factors are most important in accounting for racial and ethnic disparities in antidepressant drug use. Using Medical Expenditure Panel Survey (MEPS) data from 1996-2003, we have an available sample of 10,416 Caucasian, 1,089 African American and 1,539 Hispanic antidepressant drug users aged 18 to 64 years. We estimate individual out-of-pocket payments, total prescription drug expenditures, drug utilization, the probability of taking generic versus brand name antidepressants, and the share of drugs that are older types of antidepressants (e.g., TCAs and MAOIs) for these individuals during a calendar year. Blinder-Oaxaca decomposition techniques are employed to determine the extent to which disparities reflect differences in observable population characteristics versus unobserved heterogeneity across racial and ethnic groups. Caucasians have the highest antidepressant drug expenditures and utilization. African-Americans have the lowest drug expenditures and Hispanics have the lowest drug utilization. Relative to Caucasians and Hispanics, African-Americans are more likely to purchase generics and use a higher share of older drugs (e.g., TCAs and MAOIs). Differences in observable characteristics explain most of the racial/ethnic differences in these outcomes, with the exception of drug utilization. Differences in health insurance and education levels are particularly important factors in explaining disparities. In contrast, differences in drug utilization largely reflect unobserved

State-level differences in breast and cervical cancer screening by disability status: United States, 2008.

Science.gov (United States)

Armour, Brian S; Thierry, JoAnn M; Wolf, Lesley A

2009-01-01

Despite reported disparities in the use of preventive services by disability status, there has been no national surveillance of breast and cervical cancer screening among women with disabilities in the United States. To address this, we used state-level surveillance data to identify disparities in breast and cervical cancer screening among women by disability status. Data from the 2008 Behavioral Risk Factor Surveillance System were used to estimate disability prevalence and state-level differences in breast and cervical cancer screening among women by disability status. Overall, modest differences in breast cancer screening were found; women with a disability were less likely than those without to report receiving a mammogram during the past 2 years (72.2% vs. 77.8%; p < .001). However, disparities in breast cancer screening were more pronounced at the state level. Furthermore, women with a disability were less likely than those without a disability to report receiving a Pap test during the past 3 years (78.9% vs. 83.4%; p < .001). This epidemiologic evidence identifies an opportunity for federal and state programs, as well as other stakeholders, to form partnerships to align disability and women's health policies. Furthermore, it identifies the need for increased public awareness and resource allocation to reduce barriers to breast and cervical cancer screening experienced by women with disabilities.

Vector disparity sensor with vergence control for active vision systems.

Science.gov (United States)

Barranco, Francisco; Diaz, Javier; Gibaldi, Agostino; Sabatini, Silvio P; Ros, Eduardo

2012-01-01

This paper presents an architecture for computing vector disparity for active vision systems as used on robotics applications. The control of the vergence angle of a binocular system allows us to efficiently explore dynamic environments, but requires a generalization of the disparity computation with respect to a static camera setup, where the disparity is strictly 1-D after the image rectification. The interaction between vision and motor control allows us to develop an active sensor that achieves high accuracy of the disparity computation around the fixation point, and fast reaction time for the vergence control. In this contribution, we address the development of a real-time architecture for vector disparity computation using an FPGA device. We implement the disparity unit and the control module for vergence, version, and tilt to determine the fixation point. In addition, two on-chip different alternatives for the vector disparity engines are discussed based on the luminance (gradient-based) and phase information of the binocular images. The multiscale versions of these engines are able to estimate the vector disparity up to 32 fps on VGA resolution images with very good accuracy as shown using benchmark sequences with known ground-truth. The performances in terms of frame-rate, resource utilization, and accuracy of the presented approaches are discussed. On the basis of these results, our study indicates that the gradient-based approach leads to the best trade-off choice for the integration with the active vision system.

Integrative genomic analysis identifies ancestry-related expression quantitative trait loci on DNA polymerase β and supports the association of genetic ancestry with survival disparities in head and neck squamous cell carcinoma.

Science.gov (United States)

Ramakodi, Meganathan P; Devarajan, Karthik; Blackman, Elizabeth; Gibbs, Denise; Luce, Danièle; Deloumeaux, Jacqueline; Duflo, Suzy; Liu, Jeffrey C; Mehra, Ranee; Kulathinal, Rob J; Ragin, Camille C

2017-03-01

African Americans with head and neck squamous cell carcinoma (HNSCC) have a lower survival rate than whites. This study investigated the functional importance of ancestry-informative single-nucleotide polymorphisms (SNPs) in HNSCC and also examined the effect of functionally important genetic elements on racial disparities in HNSCC survival. Ancestry-informative SNPs, RNA sequencing, methylation, and copy number variation data for 316 oral cavity and laryngeal cancer patients were analyzed across 178 DNA repair genes. The results of expression quantitative trait locus (eQTL) analyses were also replicated with a Gene Expression Omnibus (GEO) data set. The effects of eQTLs on overall survival (OS) and disease-free survival (DFS) were evaluated. Five ancestry-related SNPs were identified as cis-eQTLs in the DNA polymerase β (POLB) gene (false discovery rate [FDR] ancestry (P = .002). An association was observed between these eQTLs and OS (P ancestry-related alleles could act as eQTLs in HNSCC and support the association of ancestry-related genetic factors with survival disparities in patients diagnosed with oral cavity and laryngeal cancer. Cancer 2017;123:849-60. © 2016 American Cancer Society. © 2016 American Cancer Society.

Racial and Ethnic Disparities in Health and Health Care: an Assessment and Analysis of the Awareness and Perceptions of Public Health Workers Implementing a Statewide Community Transformation Grant in Texas.

Science.gov (United States)

Akinboro, Oladimeji; Ottenbacher, Allison; Martin, Marcus; Harrison, Roderick; James, Thomas; Martin, Eddilisa; Murdoch, James; Linnear, Kim; Cardarelli, Kathryn

2016-03-01

Little is known about the awareness of public health professionals regarding racial and ethnic disparities in health in the United States of America (USA). Our study objective was to assess the awareness and perceptions of a group of public health workers in Texas regarding racial health disparities and their chief contributing causes. We surveyed public health professionals working on a statewide grant in Texas, who were participants at health disparities' training workshops. Multivariable logistic regression was employed in examining the association between the participants' characteristics and their perceptions of the social determinants of health as principal causes of health disparities. There were 106 respondents, of whom 38 and 35 % worked in health departments and non-profit organizations, respectively. The racial/ethnic groups with the highest incidence of HIV/AIDS and hypertension were correctly identified by 63 and 50 % of respondents, respectively, but only 17, and 32 % were knowledgeable regarding diabetes and cancer, respectively. Seventy-one percent of respondents perceived that health disparities are driven by the major axes of the social determinants of health. Exposure to information about racial/ethnic health disparities within the prior year was associated with a higher odds of perceiving that social determinants of health were causes of health disparities (OR 9.62; 95 % CI 2.77, 33.41). Among public health workers, recent exposure to information regarding health disparities may be associated with their perceptions of health disparities. Further research is needed to investigate the impact of such exposure on their long-term perception of disparities, as well as the equity of services and programs they administer.

Temporal Integration of Auditory Stimulation and Binocular Disparity Signals

Directory of Open Access Journals (Sweden)

Marina Zannoli

2011-10-01

Full Text Available Several studies using visual objects defined by luminance have reported that the auditory event must be presented 30 to 40 ms after the visual stimulus to perceive audiovisual synchrony. In the present study, we used visual objects defined only by their binocular disparity. We measured the optimal latency between visual and auditory stimuli for the perception of synchrony using a method introduced by Moutoussis & Zeki (1997. Visual stimuli were defined either by luminance and disparity or by disparity only. They moved either back and forth between 6 and 12 arcmin or from left to right at a constant disparity of 9 arcmin. This visual modulation was presented together with an amplitude-modulated 500 Hz tone. Both modulations were sinusoidal (frequency: 0.7 Hz. We found no difference between 2D and 3D motion for luminance stimuli: a 40 ms auditory lag was necessary for perceived synchrony. Surprisingly, even though stereopsis is often thought to be slow, we found a similar optimal latency in the disparity 3D motion condition (55 ms. However, when participants had to judge simultaneity for disparity 2D motion stimuli, it led to larger latencies (170 ms, suggesting that stereo motion detectors are poorly suited to track 2D motion.

Why should we investigate the morphological disparity of plant clades?

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Oyston, Jack W; Hughes, Martin; Gerber, Sylvain; Wills, Matthew A

2016-04-01

Disparity refers to the morphological variation in a sample of taxa, and is distinct from diversity or taxonomic richness. Diversity and disparity are fundamentally decoupled; many groups attain high levels of disparity early in their evolution, while diversity is still comparatively low. Diversity may subsequently increase even in the face of static or declining disparity by increasingly fine sub-division of morphological 'design' space (morphospace). Many animal clades reached high levels of disparity early in their evolution, but there have been few comparable studies of plant clades, despite their profound ecological and evolutionary importance. This study offers a prospective and some preliminary macroevolutionary analyses. Classical morphometric methods are most suitable when there is reasonable conservation of form, but lose traction where morphological differences become greater (e.g. in comparisons across higher taxa). Discrete character matrices offer one means to compare a greater diversity of forms. This study explores morphospaces derived from eight discrete data sets for major plant clades, and discusses their macroevolutionary implications. Most of the plant clades in this study show initial, high levels of disparity that approach or attain the maximum levels reached subsequently. These plant clades are characterized by an initial phase of evolution during which most regions of their empirical morphospaces are colonized. Angiosperms, palms, pines and ferns show remarkably little variation in disparity through time. Conifers furnish the most marked exception, appearing at relatively low disparity in the latest Carboniferous, before expanding incrementally with the radiation of successive, tightly clustered constituent sub-clades. Many cladistic data sets can be repurposed for investigating the morphological disparity of plant clades through time, and offer insights that are complementary to more focused morphometric studies. The unique structural and

Why does Jack, and not Jill, break his crown? Sex disparity in brain tumors.

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Sun, Tao; Warrington, Nicole M; Rubin, Joshua B

2012-01-25

It is often reported that brain tumors occur more frequently in males, and that males suffer a worse outcome from brain tumors than females. If correct, these observations suggest that sex plays a fundamental role in brain tumor biology. The following review of the literature regarding primary and metastatic brain tumors, reveals that brain tumors do occur more frequently in males compared to females regardless of age, tumor histology, or region of the world. Sexually dimorphic mechanisms that might control tumor cell biology, as well as immune and brain microenvironmental responses to cancer, are explored as the basis for this sex disparity. Elucidating the mechanisms by which sex chromosomes and sex hormones impact on brain tumorigenesis and progression will advance our understanding of basic cancer biology and is likely to be essential for optimizing the care of brain tumor patients.

78 FR 35837 - National Institute on Minority Health and Health Disparities Research Endowments

Science.gov (United States)

2013-06-14

... disparities research to close the disparity gap in the burden of illness and death experienced by racial and... Number NIH-2007-0931] RIN 0925-AA61 National Institute on Minority Health and Health Disparities Research... disparities research and other health disparities research. DATES: Comments must be received on or before...

Strategic use of communication to market cancer prevention and control to vulnerable populations.

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Kreps, Gary L

2008-01-01

There are significant challenges to communicating relevant cancer prevention and control information to health care consumers due both to the complexities of the health information to be communicated and the complexities of health communication, especially with vulnerable populations. The need for effective communication about cancer risks, early detection, prevention, care, and survivorship is particularly acute, yet also tremendously complex, for reaching vulnerable populations, those groups of people who are most likely to suffer significantly higher levels of morbidity and mortality from cancers than other segments of the population. These vulnerable populations, typically the poorest, lowest educated, and most disenfranchised members of modern society, are heir to serious cancer-related health disparities. Vulnerable populations often have health literacy difficulties, cultural barriers, and economic challenges to accessing and making sense of relevant health information. This paper examines these challenges to communicating relevant information to vulnerable populations and suggests strategies for effectively using different communication media for marketing cancer prevention and control to reduce health disparities and promote public health.

Recurrent connectivity can account for the dynamics of disparity processing in V1

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Samonds, Jason M.; Potetz, Brian R.; Tyler, Christopher W.; Lee, Tai Sing

2013-01-01

Disparity tuning measured in the primary visual cortex (V1) is described well by the disparity energy model, but not all aspects of disparity tuning are fully explained by the model. Such deviations from the disparity energy model provide us with insight into how network interactions may play a role in disparity processing and help to solve the stereo correspondence problem. Here, we propose a neuronal circuit model with recurrent connections that provides a simple account of the observed deviations. The model is based on recurrent connections inferred from neurophysiological observations on spike timing correlations, and is in good accord with existing data on disparity tuning dynamics. We further performed two additional experiments to test predictions of the model. First, we increased the size of stimuli to drive more neurons and provide a stronger recurrent input. Our model predicted sharper disparity tuning for larger stimuli. Second, we displayed anti-correlated stereograms, where dots of opposite luminance polarity are matched between the left- and right-eye images and result in inverted disparity tuning in the disparity energy model. In this case, our model predicted reduced sharpening and strength of inverted disparity tuning. For both experiments, the dynamics of disparity tuning observed from the neurophysiological recordings in macaque V1 matched model simulation predictions. Overall, the results of this study support the notion that, while the disparity energy model provides a primary account of disparity tuning in V1 neurons, neural disparity processing in V1 neurons is refined by recurrent interactions among elements in the neural circuit. PMID:23407952

Integrating intersectionality and biomedicine in health disparities research.

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Kelly, Ursula A

2009-01-01

Persisting health disparities have lead to calls for an increase in health research to address them. Biomedical scientists call for research that stratifies individual indicators associated with health disparities, for example, ethnicity. Feminist social scientists recommend feminist intersectionality research. Intersectionality is the multiplicative effect of inequalities experienced by nondominant marginalized groups, for example, ethnic minorities, women, and the poor. The elimination of health disparities necessitates integration of both paradigms in health research. This study provides a practical application of the integration of biomedical and feminist intersectionality paradigms in nursing research, using a psychiatric intervention study with battered Latino women as an example.

Vital Signs: Racial Disparities in Age-Specific Mortality Among Blacks or African Americans - United States, 1999-2015.

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Cunningham, Timothy J; Croft, Janet B; Liu, Yong; Lu, Hua; Eke, Paul I; Giles, Wayne H

2017-05-05

Although the overall life expectancy at birth has increased for both blacks and whites and the gap between these populations has narrowed, disparities in life expectancy and the leading causes of death for blacks compared with whites in the United States remain substantial. Understanding how factors that influence these disparities vary across the life span might enhance the targeting of appropriate interventions. Trends during 1999-2015 in mortality rates for the leading causes of death were examined by black and white race and age group. Multiple 2014 and 2015 national data sources were analyzed to compare blacks with whites in selected age groups by sociodemographic characteristics, self-reported health behaviors, health-related quality of life indicators, use of health services, and chronic conditions. During 1999-2015, age-adjusted death rates decreased significantly in both populations, with rates declining more sharply among blacks for most leading causes of death. Thus, the disparity gap in all-cause mortality rates narrowed from 33% in 1999 to 16% in 2015. However, during 2015, blacks still had higher death rates than whites for all-cause mortality in all groups aged blacks in age groups deaths among blacks (especially cardiovascular disease and cancer and their risk factors) across the life span and create equal opportunities for health.

Potential improvement of Lymantria dispar L. management by quercetin

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Perić-Mataruga Vesna

2014-01-01

Full Text Available Lymantria dispar, a polyphagous insect pest, copes with a wide variety of host-specific allelochemicals. Glutathione S-transferases (GST are important for catalyzing detoxification in L. dispar. Larval mortality, GST activity in midgut tissue and mass of L. dispar with different trophic adaptations (originating from two forests with a suitable host, Quercus robur, and an unsuitable host, Robinia pseudoacacia, differed after feeding on quercetin supplemented diets (2% or 5% w/w. Quercetin inhibited GST most potently in oak forest larvae that were less adapted to flavonoids in their diet. The larvicidal effect of quercetin on L. dispar larvae depended on the host-use history. We believe this is important in strategies for sustainable control of insect pests. [Projekat Ministarstva nauke Republike Srbije, br. 173027

Stereo Disparity through Cost Aggregation with Guided Filter

Directory of Open Access Journals (Sweden)

Pauline Tan

2014-10-01

Full Text Available Estimating the depth, or equivalently the disparity, of a stereo scene is a challenging problem in computer vision. The method proposed by Rhemann et al. in 2011 is based on a filtering of the cost volume, which gives for each pixel and for each hypothesized disparity a cost derived from pixel-by-pixel comparison. The filtering is performed by the guided filter proposed by He et al. in 2010. It computes a weighted local average of the costs. The weights are such that similar pixels tend to have similar costs. Eventually, a winner-take-all strategy selects the disparity with the minimal cost for each pixel. Non-consistent labels according to left-right consistency are rejected; a densification step can then be launched to fill the disparity map. The method can be used to solve other labeling problems (optical flow, segmentation but this article focuses on the stereo matching problem.

Cancer Screening Considerations and Cancer Screening Uptake for Lesbian, Gay, Bisexual, and Transgender Persons.

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Ceres, Marc; Quinn, Gwendolyn P; Loscalzo, Matthew; Rice, David

2018-02-01

To describe the current state of cancer screening and uptake for lesbian, gay, bisexual, and transgender (LGBT) persons and to propose cancer screening considerations for LGBT persons. Current and historic published literature on cancer screening and LGBT cancer screening; published national guidelines. Despite known cancer risks for members of the LGBT community, cancer screening rates are often low, and there are gaps in screening recommendations for LGBT persons. We propose evidence-based cancer screening considerations derived from the current literature and extant cancer screening recommendations. The oncology nurse plays a key role in supporting patient preventive care and screening uptake through assessment, counseling, education, advocacy, and intervention. As oncology nurses become expert in the culturally competent care of LGBT persons, they can contribute to the improvement of quality of care and overall well-being of this health care disparity population. Copyright © 2017 Elsevier Inc. All rights reserved.

Disparity Disambiguation by Fusion of Signal and Symbolic-Level Information

DEFF Research Database (Denmark)

Ralli, J.; Diaz, J.; Ros, E.

2012-01-01

We describe a method for resolving ambiguities in low-level disparity calculations in a stereo-vision scheme by using a recurrent mechanism that we call signal-symbol loop. Due to the local nature of low-level processing it is not always possible to estimate the correct disparity values produced...... at this level. Symbolic abstraction of the signal produces robust, high confidence, multimodal image features which can be used to interpret the scene more accurately and therefore disambiguate low-level interpretations by biasing the correct disparity. The fusion process is capable of producing more accurate...... dense disparity maps than the low- and symbolic-level algorithms can produce independently. Therefore we describe an efficient fusion scheme that allows symbolic- and low-level cues to complement each other, resulting in a more accurate and dense disparity representation of the scene....

Literacy and Health Disparities

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Prins, Esther; Mooney, Angela

2014-01-01

This chapter explores the relationship between literacy and health disparities, focusing on the concept of health literacy. Recommendations are provided for ways to bridge the health literacy gap for learners in adult basic education and family literacy programs.

At the United Nation Foundation's Social Good Summit, Vice President Biden Announces New Cancer Moonshot International Cooperation and Investments | Office of Cancer Clinical Proteomics Research

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This week, Vice President Joe Biden announced progress on his global vision for the Cancer Moonshot.  Announced were 10 new Memoranda of Understanding or Memoranda of Cooperation for international cancer research and care, as well as new efforts in the emerging scientific areas of precision oncology, the funding of collaborative research centers to address cancer disparities in low- and middle- income (LMIC) countries, and a strengthening of existing U.S. bilateral science and technology engagements around cancer.  

The association between racial disparity in income and reported sexually transmitted infections.

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Owusu-Edusei, Kwame; Chesson, Harrell W; Leichliter, Jami S; Kent, Charlotte K; Aral, Sevgi O

2013-05-01

We examined the association between racial disparity in income and reported race-specific county-level bacterial sexually transmitted infections (STIs) in the United States focusing on disparities between Blacks and Whites. Data are from the US 2000 decennial census. We defined 2 race-income county groups (high and low race-income disparity) on the basis of the difference between Black and White median household incomes. We used 2 approaches to examine disparities in STI rates across the groups. In the first approach, we computed and compared race-specific STI rates for the groups. In the second approach, we used spatial regression analyses to control for potential confounders. Consistent with the STI literature, chlamydia, gonorrhea, and syphilis rates for Blacks were substantially higher than were those for Whites. We also found that racial disparities in income were associated with racial disparities in chlamydia and gonorrhea rates and, to a lesser degree, syphilis rates. Racial disparities in household income may be a more important determinant of racial disparities in reported STI morbidity than are absolute levels of household income.

Increasing Cervical Cancer Screening in Underserved Populations.

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Dorsainvil, Merlyn A

The incidence of cervical cancer has declined dramatically due to Papanicolaou smear testing. However, some minority populations continue to suffer with high incidences and/or death rates of cervical cancer, due to lack of screening. This article updates on cervical cancer screening and prevention and discusses cultural impacts on screening. Knowledge deficits disproportionately affect ethnic minority groups and contribute to cancer incidence, whereas lack of healthcare coverage and low socioeconomic status contribute to screening disparities. Although minority women have cultural beliefs and practices that influence screening, recommendation and/or education from a provider often lead to screening.

Using Social Network Analysis to Evaluate Community Capacity Building of a Regional Community Cancer Network

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Luque, John; Tyson, Dinorah Martinez; Lee, Ji-Hyun; Gwede, Clement; Vadaparampil, Susan; Noel-Thomas, Shalewa; Meade, Cathy

2010-01-01

The Tampa Bay Community Cancer Network (TBCCN) is one of 25 Community Network Programs funded by the National Cancer Institute's (NCI's) Center to Reduce Cancer Health Disparities with the objectives to create a collaborative infrastructure of academic and community based organizations and to develop effective and sustainable interventions to…

CDC Health Disparities and Inequalities Report--U.S. 2013

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... Women's Health Health Literacy Health Equity CDC Health Disparities & Inequalities Report (CHDIR) Recommend on Facebook Tweet Share ... 2011 Report More Information CDC Releases Second Health Disparities & Inequalities Report - United States, 2013 CDC and its ...

Mentoring and Training of Cancer-Related Health Disparities Researchers Committed to Community-Based Participatory Research.

Science.gov (United States)

Felder, Tisha M; Braun, Kathryn L; Brandt, Heather M; Khan, Samira; Tanjasiri, Sora; Friedman, Daniela B; Armstead, Cheryl A; Okuyemi, Kolawole S; Hébert, James R

2015-01-01

The National Cancer Institute's (NCI) Community Networks Program Centers (CNPCs) provide community-based participatory research (CBPR)-oriented mentoring and training to prepare early-stage/midcareer investigators and student trainees (trainees) in disparities reduction. This paper describes the academic, mentoring, training, and work-life balance experiences of CNPC-affiliated trainees. We used a collaborative and iterative process to develop a 57-item, web-based questionnaire completed by trainees from the 23 CNPCs between August 2012 and February 2013. Their CNPC mentors completed a 47-item questionnaire. Descriptive statistics were calculated. The final analytic sample included 189 of 269 individuals (70%) identified as active participants in CNPC research or training/mentoring. Mentors (n=45) were mostly non-Hispanic White (77.8%) and 48.9% were male. Mentors published a median of 6 (interquartile range [IQR], 3-12) first-authored and 15 (IQR, 6-25) senior authored manuscripts, and secured 15 (IQR, 11-29) grants from the National Institutes of Health (NIH) and other sources in the previous 5 years. Most trainees (n=144) were female (79.2%), 43.7% were underrepresented racial/ethnic minorities, and 36.8% were first-generation college graduates. Over the previous 5 years, trainees reported a median of 4 (IQR, 1-6) publications as first author and 4 (IQR, 2-8) as co-author; 27.1% reported having one or more NIH R01s. Trainees reported satisfaction with their CNPC mentor (79.1%) and confidence in demonstrating most CBPR competencies. The CNPC training program consists of a scientifically productive pool of mentors and trainees. Trainees reported rates of scholarly productivity comparable to other national training programs and provided insights into relationships with mentors, academic pressures, and professional-personal life balance.

Mentoring and Training of Cancer-Related Health Disparities Researchers Committed to Community-Based Participatory Research

Science.gov (United States)

Felder, Tisha M.; Braun, Kathryn L.; Brandt, Heather M.; Khan, Samira; Tanjasiri, Sora; Friedman, Daniela B.; Armstead, Cheryl A.; Okuyemi, Kolawole S.; Hébert, James R.

2015-01-01

Background and Objective The National Cancer Institute’s (NCI) Community Networks Program Centers (CNPCs) provide community-based participatory research (CBPR)-oriented mentoring and training to prepare early-stage/midcareer investigators and student trainees (trainees) in disparities reduction. This paper describes the academic, mentoring, training, and work–life balance experiences of CNPC-affiliated trainees. Methods We used a collaborative and iterative process to develop a 57-item, web-based questionnaire completed by trainees from the 23 CNPCs between August 2012 and February 2013. Their CNPC mentors completed a 47-item questionnaire. Descriptive statistics were calculated. Results The final analytic sample included 189 of 269 individuals (70%) identified as active participants in CNPC research or training/mentoring. Mentors (n = 45) were mostly non-Hispanic White (77.8%) and 48.9% were male. Mentors published a median of 6 (interquartile range [IQR], 3–12) first-authored and 15 (IQR, 6–25) senior authored manuscripts, and secured 15 (IQR, 11–29) grants from the National Institutes of Health (NIH) and other sources in the previous 5 years. Most trainees (n = 144) were female (79.2%), 43.7% were underrepresented racial/ethnic minorities, and 36.8% were first-generation college graduates. Over the previous 5 years, trainees reported a median of 4 (IQR, 1–6) publications as first author and 4 (IQR, 2–8) as co-author; 27.1% reported having one or more NIH R01s. Trainees reported satisfaction with their CNPC mentor (79.1%) and confidence in demonstrating most CBPR competencies. Conclusion The CNPC training program consists of a scientifically productive pool of mentors and trainees. Trainees reported rates of scholarly productivity comparable to other national training programs and provided insights into relationships with mentors, academic pressures, and professional–personal life balance. PMID:26213409

Effectiveness of a social marketing media campaign to reduce oral cancer racial disparities.

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Watson, Jennifer M; Tomar, Scott L; Dodd, Virginia; Logan, Henrietta L; Choi, Youjin

2009-08-01

The purpose of this study was to provide a systematic evaluation of a theory-driven oral cancer awareness media campaign. We surveyed a cohort of residents in an intervention city (250) and a control city (250) immediately prior to and after the media campaign. Participants (125 black/African American and 125 white) in each city completed surveys at baseline and follow-up. Oral cancer campaign awareness was assessed in both cities, along with 4 hypothetical health campaigns. Oral cancer awareness, oral cancer exam awareness, intent to receive an oral cancer exam, interest in exam, and receipt of exam were also assessed in both cities, both at baseline and follow-up. Intervention city residents showed a significant increase in recognition of the campaign, awareness of the oral cancer exam, and interest in getting an exam, while no significant changes in those topics were found for the control city. Blacks/African Americans in the intervention city were significantly more likely than whites to demonstrate increases in awareness of the campaign, oral cancer awareness, and interest in receiving an oral cancer exam. A theory-driven media campaign was successful in increasing awareness of the oral cancer exam and interest in the exam among blacks/African Americans.

Gender Disparity in Education Enrollment in Pakistan

OpenAIRE

Shakil Quayes; Richard David Ramsey

2015-01-01

The paper examines the determinants of school enrollment in Pakistan. The likelihood of school enrollment is estimated using separate logistic regression models for three different age groups. The empirical results indicate severe gender disparity in school enrollment across all age groups, particularly among the older age groups. Although the rate of school enrollment is positively associated with household income, the gender disparity actually deteriorates with an increase in household inco...

Mind the gap: race/ethnic and socioeconomic disparities in obesity.

Science.gov (United States)

Krueger, Patrick M; Reither, Eric N

2015-11-01

Race/ethnic and socioeconomic status (SES) disparities in obesity are substantial and may widen in the future. We review nine potential mechanisms that recent research has used to explain obesity disparities. Those nine mechanisms fall into three broad groups-health behaviors, biological factors, and the social environment-which incorporate both proximate and upstream determinants of obesity disparities. Efforts to reduce the prevalence of obesity in the US population and to close race/ethnic and SES disparities in obesity will likely require the use of multifaceted interventions that target multiple mechanisms simultaneously. Unfortunately, relatively few of the mechanisms reviewed herein have been tested in an intervention framework.

Cancer Prevention in the Precision Medicine Era

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Dr. Rebbeck’s research focuses on the etiology and prevention of cancer, with an emphasis on cancers with a genetic etiology and those that are associated with disparities in incidence or mortality by race. He has directed multiple large molecular epidemiologic studies and international consortia that have been used to identify and characterize genes involved in cancer etiology, understand the relationship of allelic variation with biochemical or physiological traits, explore interactions of inherited and somatic genomic variation with epidemiological risk factors. His research also focuses on the roles of biological and social factors on prostate cancer disparities and prostate cancer in Africa through the Men of African Descent and Carcinoma of the Prostate (MADCaP) consortium. He has also led a number of consortia that study carriers of BRCA1 or BRCA2 mutations to understand breast, ovarian, and prostate cancer risk and precision prevention interventions that may reduce that risk. In addition to his research activities, Dr. Rebbeck leads a number of initiatives on the Harvard Campus. He serves as Associate Director for Equity and Engagement in the Dana-Farber / Harvard Cancer Center and Co-Director for the Collective Impact Program of Harvard Catalyst. In this role, he prioritizes the cancer research agenda to maximize disease prevention and risk reduction in Massachusetts. He also oversees a team charged with ensuring that this research engages with and positively impacts communities with the greatest disease burden.  As Director of Global Oncology at the Dana Farber Cancer Institute, Dr. Rebbeck oversees formal and informal training and research partnerships between Dana Farber investigators and trainees with international partners.

Socioeconomic Disparities in Breast Cancer Screening in Hawaii

OpenAIRE

Timothy Halliday, PhD; Deborah A. Taira, ScD; James Davis, PhD; Henry Chan

2007-01-01

Introduction Despite evidence that breast cancer screening reduces morbidity and mortality, many women do not obtain mammograms. Our objective was to analyze the relationship between income and mammography screening for members enrolled in a large health plan in Hawaii. Methods We analyzed claims data for women (N = 46,328) aged 50 to 70 years during 2003 and 2004. We used parametric and nonparametric regression techniques. We used probit estimation to conduct multivariate analysis. Results A...

Disparities in Receipt of FOBT versus Endoscopy among Filipino American Immigrants

Science.gov (United States)

Maxwell, Annette E.; Danao, Leda L.; Crespi, Catherine M.; Antonio, Cynthia; Garcia, Gabriel M.; Bastani, Roshan

2009-01-01

Background This report examines disparities associated with the type of colorectal screening test, fecal occult blood test (FOBT) versus endoscopy, within a particular racial/ethnic group, Filipino American immigrants. Methods Between July 2005 and October 2006, Filipino Americans age 50-75 from 31 community organizations in Los Angeles completed a 15-minute survey in English (65%) or Filipino (35%). Results Of the 487 respondents included in this analysis, 257 (53%) had never received any type of colorectal cancer (CRC) screening. Among the 230 subjects who had ever received a routine screening test, 78 had FOBT only (16% of the total sample) and 152 had endoscopy with or without FOBT (31% of the total sample). After controlling for access to care and key demographic variables in a multivariate analysis, only two characteristics distinguished between respondents who had FOBT only versus those who had endoscopy: acculturation, assessed by percent lifetime in the U.S. and language of interview, and income. Conclusions Our data suggest a two tier system, FOBT for less acculturated Filipino Americans with lower income versus endoscopy for Filipino immigrants with higher levels of acculturation and income. The disparity persists after adjusting for access to care. Instead of treating minority groups as monolithic, differences within groups need to be examined so that interventions can be appropriately targeted. PMID:18708385

African American Women: Surviving Breast Cancer Mortality against the Highest Odds

Directory of Open Access Journals (Sweden)

Shelley White-Means

2015-12-01

Full Text Available Among the country’s 25 largest cities, the breast cancer mortality disparity is highest in Memphis, Tennessee, where African American women are twice as likely to die from breast cancer as White women. This qualitative study of African-American breast cancer survivors explores experiences during and post treatment that contributed to their beating the high odds of mortality. Using a semi-structured interview guide, a focus group session was held in 2012 with 10 breast cancer survivors. Thematic analysis and a deductive a priori template of codes were used to analyze the data. Five main themes were identified: family history, breast/body awareness and preparedness to manage a breast cancer event, diagnosis experience and reaction to the diagnosis, family reactions, and impact on life. Prayer and family support were central to coping, and survivors voiced a cultural acceptance of racial disparities in health outcomes. They reported lack of provider sensitivity regarding pain, financial difficulties, negative responses from family/friends, and resiliency strategies for coping with physical and mental limitations. Our research suggested that a patient-centered approach of demystifying breast cancer (both in patient-provider communication and in community settings would impact how women cope with breast cancer and respond to information about its diagnosis.

African American Women: Surviving Breast Cancer Mortality against the Highest Odds

Science.gov (United States)

White-Means, Shelley; Rice, Muriel; Dapremont, Jill; Davis, Barbara; Martin, Judy

2015-01-01

Among the country’s 25 largest cities, the breast cancer mortality disparity is highest in Memphis, Tennessee, where African American women are twice as likely to die from breast cancer as White women. This qualitative study of African-American breast cancer survivors explores experiences during and post treatment that contributed to their beating the high odds of mortality. Using a semi-structured interview guide, a focus group session was held in 2012 with 10 breast cancer survivors. Thematic analysis and a deductive a priori template of codes were used to analyze the data. Five main themes were identified: family history, breast/body awareness and preparedness to manage a breast cancer event, diagnosis experience and reaction to the diagnosis, family reactions, and impact on life. Prayer and family support were central to coping, and survivors voiced a cultural acceptance of racial disparities in health outcomes. They reported lack of provider sensitivity regarding pain, financial difficulties, negative responses from family/friends, and resiliency strategies for coping with physical and mental limitations. Our research suggested that a patient-centered approach of demystifying breast cancer (both in patient-provider communication and in community settings) would impact how women cope with breast cancer and respond to information about its diagnosis. PMID:26703655

Geographic disparity in kidney transplantation under KAS.

Science.gov (United States)

Zhou, Sheng; Massie, Allan B; Luo, Xun; Ruck, Jessica M; Chow, Eric K H; Bowring, Mary G; Bae, Sunjae; Segev, Dorry L; Gentry, Sommer E

2017-12-12

The Kidney Allocation System fundamentally altered kidney allocation, causing a substantial increase in regional and national sharing that we hypothesized might impact geographic disparities. We measured geographic disparity in deceased donor kidney transplant (DDKT) rate under KAS (6/1/2015-12/1/2016), and compared that with pre-KAS (6/1/2013-12/3/2014). We modeled DSA-level DDKT rates with multilevel Poisson regression, adjusting for allocation factors under KAS. Using the model we calculated a novel, improved metric of geographic disparity: the median incidence rate ratio (MIRR) of transplant rate, a measure of DSA-level variation that accounts for patient casemix and is robust to outlier values. Under KAS, MIRR was 1.75 1.81 1.86 for adults, meaning that similar candidates across different DSAs have a median 1.81-fold difference in DDKT rate. The impact of geography was greater than the impact of factors emphasized by KAS: having an EPTS score ≤20% was associated with a 1.40-fold increase (IRR =  1.35 1.40 1.45 , P geographic disparities with KAS (P = .3). Despite extensive changes to kidney allocation under KAS, geography remains a primary determinant of access to DDKT. © 2017 The American Society of Transplantation and the American Society of Transplant Surgeons.

Determinants of health disparities between Italian regions

Directory of Open Access Journals (Sweden)

Giannoni Margherita

2010-06-01

Full Text Available Abstract Background Among European countries, Italy is one of the countries where regional health disparities contribute substantially to socioeconomic health disparities. In this paper, we report on regional differences in self-reported poor health and explore possible determinants at the individual and regional levels in Italy. Methods We use data from the "Indagine Multiscopo sulle Famiglie", a survey of aspects of everyday life in the Italian population, to estimate multilevel logistic regressions that model poor self-reported health as a function of individual and regional socioeconomic factors. Next we use the causal step approach to test if living conditions, healthcare characteristics, social isolation, and health behaviors at the regional level mediate the relationship between regional socioeconomic factors and self-rated health. Results We find that residents living in regions with more poverty, more unemployment, and more income inequality are more likely to report poor health and that poor living conditions and private share of healthcare expenditures at the regional level mediate socioeconomic disparities in self-rated health among Italian regions. Conclusion The implications are that regional contexts matter and that regional policies in Italy have the potential to reduce health disparities by implementing interventions aimed at improving living conditions and access to quality healthcare.

Association of a Policy Mandating Physician-Patient Communication With Racial/Ethnic Disparities in Postmastectomy Breast Reconstruction.

Science.gov (United States)

Mahmoudi, Elham; Lu, Yiwen; Metz, Allan K; Momoh, Adeyiza O; Chung, Kevin C

2017-08-01

With the stabilization of breast cancer incidence and substantial improvement in survival, more attention has focused on postmastectomy breast reconstruction (PBR). Despite its demonstrated benefits, wide disparities in the use of PBR remain. Physician-patient communication has an important role in disparities in health care, especially for elective surgical procedures. Recognizing this, the State of New York enacted Public Health Law (NY PBH Law) 2803-o in 2011 mandating that physicians communicate about reconstructive surgery with patients undergoing mastectomy. To evaluate whether mandated physician-patient communication is associated with reduced racial/ethnic disparities in immediate PBR (IPBR). This retrospective study used state inpatient data from January 1, 2008, through December 31, 2011, in New York and California to evaluate a final sample of 42 346 women aged 20 to 70 years, including 19 364 from New York (treatment group) and 22 982 from California (comparison group). The primary hypothesis tested the effect of the New York law on racial/ethnic disparities, using California as a comparator. The National Academy of Medicine's (formerly Institute of Medicine) definition of a disparity was applied, and a difference-in-differences method (before-and-after comparison design) was used to evaluate the association of NY PBH Law 2803-o mandating physician-patient communication with disparities in IPBR. Data were analyzed from July 1, 2016, to February 24, 2017. New York PBH Law 2803-o was implemented on January 1, 2011. The preexposure period included January 1, 2008, through December 31, 2010 (3 years); the postexposure period, January 1 through December 31, 2011 (1 year). The primary outcome was use of IPBR among white, African American, Hispanic, and other minority groups before and after the implementation of NY PBH Law 2803-o. Among the 42 346 women (mean [SD] age, 53 [10] years), 65.3% (27 654) were white, 12.7% (5365) were Hispanic, 9.4% (3976

Disparities in cervical cancer survival among Asian American women

Science.gov (United States)

Nghiem, Van T.; Davies, Kalatu R.; Chan, Wenyaw; Mulla, Zuber D.; Cantor, Scott B.

2015-01-01

Purpose We compared overall survival and influencing factors between Asian American women as a whole and by subgroup with white women with cervical cancer. Methods Cervical cancer data were from the Surveillance, Epidemiology, and End Results registry; socioeconomic information was from the Area Health Resource File. We used standard tests to compare characteristics between groups; the Kaplan-Meier method with log-rank test to assess overall survival and compare it between groups; and Cox proportional hazards models to determine the effect of race and other covariates on overall survival (with/without age-stratification). Results Being 3.3 years older than white women at diagnosis (pAsian American women were more likely to be in a spousal relationship, had more progressive disease, and were better off socioeconomically. Women of Filipino, Japanese, and Korean origin had similar clinical characteristics compared with white women. Asian American women had higher 36- and 60-month survival rates (p=0.004 and p=0.013, respectively), higher overall survival rates (p=0.049), and longer overall survival durations after adjusting for age and other covariates (hazard ratio=0.77, 95% confidence interval: 0.68–0.86). Overall survival differed across age strata between the two racial groups. With the exception of women of Japanese or Korean origin, Asian American women grouped by geographic origin had better overall survival than white women. Conclusions Although Asian American women, except those of Japanese or Korean origin, had better overall survival than white women, their older age at cervical cancer diagnosis suggests that they have less access to screening programs. PMID:26552330

Disparities in cervical cancer survival among Asian-American women.

Science.gov (United States)

Nghiem, Van T; Davies, Kalatu R; Chan, Wenyaw; Mulla, Zuber D; Cantor, Scott B

2016-01-01

We compared overall survival and influencing factors between Asian-American women as a whole and by subgroup with white women with cervical cancer. Cervical cancer data were from the Surveillance, Epidemiology, and End Results registry; socioeconomic information was from the Area Health Resource File. We used standard tests to compare characteristics between groups; the Kaplan-Meier method with log-rank test to assess overall survival and compare it between groups; and Cox proportional hazards models to determine the effect of race and other covariates on overall survival (with and/or without age stratification). Being 3.3 years older than white women at diagnosis (P Asian-American women were more likely to be in a spousal relationship, had more progressive disease, and were better off socioeconomically. Women of Filipino, Japanese, and Korean origin had similar clinical characteristics compared to white women. Asian-American women had higher 36- and 60-month survival rates (P = .004 and P = .013, respectively), higher overall survival rates (P = .049), and longer overall survival durations after adjusting for age and other covariates (hazard ratio = 0.77, 95% confidence interval: 0.68-0.86). Overall survival differed across age strata between the two racial groups. With the exception of women of Japanese or Korean origin, Asian-American women grouped by geographic origin had better overall survival than white women. Although Asian-American women, except those of Japanese or Korean origin, had better overall survival than white women, their older age at cervical cancer diagnosis suggests that they have less access to screening programs. Copyright © 2016 Elsevier Inc. All rights reserved.

Controlling disease and creating disparities: a fundamental cause perspective.

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Phelan, Jo C; Link, Bruce G

2005-10-01

The United States and other developed countries experienced enormous improvements in population health during the 20th century. In the context of this dramatic positive change, health disparities by race and socioeconomic status emerged for several potent killers. Any explanation for current health disparities must take these changing patterns into account. Any explanation that ignores large improvements in population health and fails to account for the emergence of disparities for specific diseases is an inadequate explanation of current disparities. We argue that genetic explanations and some prominent social causation explanations are incompatible with these facts. We propose that the theory of "fundamental causes" can account for both vast improvements in population health and the creation of large socioeconomic and racial disparities in mortality for specific causes of death over time. Specifically, we argue that it is our enormously expanded capacity to control disease and death in combination with existing social and economic inequalities that create health disparities by race and socioeconomic status: When we develop the ability to control disease and death, the benefits of this new-found ability are distributed according to resources of knowledge, money, power, prestige, and beneficial social connections. We present data on changing mortality patterns by race and socioeconomic status for two types of diseases: those for which our capacity to prevent death has increased significantly and those for which we remain largely unable to prevent death. Time trends in mortality patterns are consistent with the fundamental cause explanation.

Why does Jack, and not Jill, break his crown? Sex disparity in brain tumors

Directory of Open Access Journals (Sweden)

Sun Tao

2012-01-01

Full Text Available Abstract It is often reported that brain tumors occur more frequently in males, and that males suffer a worse outcome from brain tumors than females. If correct, these observations suggest that sex plays a fundamental role in brain tumor biology. The following review of the literature regarding primary and metastatic brain tumors, reveals that brain tumors do occur more frequently in males compared to females regardless of age, tumor histology, or region of the world. Sexually dimorphic mechanisms that might control tumor cell biology, as well as immune and brain microenvironmental responses to cancer, are explored as the basis for this sex disparity. Elucidating the mechanisms by which sex chromosomes and sex hormones impact on brain tumorigenesis and progression will advance our understanding of basic cancer biology and is likely to be essential for optimizing the care of brain tumor patients.

Drivers of advanced stage at breast cancer diagnosis in the multicountry African breast cancer – disparities in outcomes (ABC‐DO) study

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Zietsman, Annelle; Galukande, Moses; Anele, Angelica; Adisa, Charles; Parham, Groesbeck; Pinder, Leeya; Cubasch, Herbert; Joffe, Maureen; Kidaaga, Frederick; Lukande, Robert; Offiah, Awa U.; Egejuru, Ralph O.; Shibemba, Aaron; Schuz, Joachim; Anderson, Benjamin O.; dos Santos Silva, Isabel; McCormack, Valerie

2017-01-01

Breast cancer (BC) survival rates in sub‐Saharan Africa (SSA) are low in part due to advanced stage at diagnosis. As one component of a study of the entire journey of SSA women with BC, we aimed to identify shared and setting‐specific drivers of advanced stage BC. Women newly diagnosed in the multicountry African Breast Cancer–Disparities in Outcomes (ABC‐DO) study completed a baseline interview and their stage information was extracted from medical records. Ordinal logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) for advanced stage (I, II, III, IV) in relation to individual woman‐level, referral and biological factors. A total of 1795 women were included from Nigeria, Uganda, Zambia, and the multiracial populations of Namibia and South Africa, 1091 of whom (61%) were stage III/IV. Stage was lower in women with greater BC knowledge (OR 0.77 (95% CI: 0.70, 0.85) per point on a 6 point scale). More advanced stage was associated with being black (4.00 (2.79, 5.74)), having attended

Employment and Wage Disparities for Nurses With Activity Limitations.

Science.gov (United States)

Wilson, Barbara L; Butler, Richard J; Butler, Matthew J

2016-11-01

No studies quantify the labor market disparities between nurses with and without activity difficulties (physical impairment or disability). We explore disparate treatment of nurses with activity difficulties at three margins of the labor market: the ability to get a job, the relative wage rate offered once a nurse has a job, and the annual hours of work given that wage rate. Key variables from the American Community Survey (ACS) were analyzed, including basic demographic information, wages, hours of work, and employment status of registered nurses from 2006 to 2014. Although there is relatively little disparity in hourly wages, there is enormous disparity in the disabled's employment and hours of work opportunities, and hence a moderate amount of disparity in annual wages. This has significant implications for the nursing labor force, particularly as the nursing workforce continues to age and physical limitations or disabilities increase by 15-fold from 25 to 65 years of age.  Physical or psychological difficulties increase sharply over the course of a nurse's career, and employers must heighten efforts to facilitate an aging workforce and provide appropriate job accommodations for nurses with activity limitations. © 2016 Sigma Theta Tau International.

Healthcare barriers and supports for American Indian women with cancer.

Science.gov (United States)

Liddell, Jessica L; Burnette, Catherine E; Roh, Soonhee; Lee, Yeon-Shim

2018-05-18

Although American Indian (AI) women continue to experience cancer at higher rates and have not seen the same decline in cancer prevalence as the general U.S. population, little research examines how interactions with health care providers may influence and exacerbate these health disparities. The purpose of the study was to understand the experiences of AI women who receive cancer treatment, which is integral for eradication of AI cancer disparities among women. A qualitative descriptive methodology was used with a sample of 43 AI women with breast, cervical, colon, and other types of cancer from the Northern Plains region of South Dakota. Interviews were conducted from June 2014 to February 2015. Qualitative content analysis revealed that women experienced: (a) health concerns being ignored or overlooked; (b) lack of consistent and qualified providers; (c) inadequate healthcare infrastructure; (d) sub-optimal patient-healthcare provider relationships; (e) positive experiences with healthcare providers; and (f) pressure and misinformation about treatment. Results indicate the types of support AI women may need when accessing healthcare. Culturally informed trainings for healthcare professionals may be needed to provide high-quality and sensitive care for AI women who have cancer, and to support those providers already providing proper care.

Development tendencies of regional disparities in the Slovak Republic

Directory of Open Access Journals (Sweden)

Klamár Radoslav

2016-01-01

Full Text Available Presented paper deals with the issues of regional development and regional disparities in Slovakia in the years 2001-2014. Levelling respectively increase of regional disparities was evaluated through a set of 13 socio-economic indicators (gross birth rate, average monthly wage, monthly labour costs per employee, employment rate, unemployment rate, net monthly income and expenses per capita, completed dwellings, creation of GDP, labour productivity per employee in industry and construction, number of organizations focused on generating profit and number of freelancers which were used in the territorial units at the level of self-governing regions of the Slovak Republic (NUTS III level. In terms of the evaluation and comparison of regional disparities were used the Gini coefficient and the coefficient of variation for mutual comparison and validation of divergent or convergent tendencies of regional disparities in Slovakia.

Human papillomavirus in cervical cancer and oropharyngeal cancer: One cause, two diseases.

Science.gov (United States)

Berman, Tara A; Schiller, John T

2017-06-15

Human papillomavirus (HPV) causes greater than 5% of cancers worldwide, including all cervical cancers and an alarmingly increasing proportion of oropharyngeal cancers (OPCs). Despite markedly reduced cervical cancer incidence in industrialized nations with organized screening programs, cervical cancer remains the second most common cause of death from cancer in women worldwide, as developing countries lack resources for universal, high-quality screening. In the United States, HPV-related OPC is only 1 of 5 cancers with a rising incidence since 1975 and now has taken over the cervix as the most common site of HPV-related cancer. Similar trends follow throughout North America and Europe. The need for early detection and prevention is paramount. Despite the common etiologic role of HPV in the development of cervical cancer and HPV-associated OPC, great disparity exists between incidence, screening modalities (or lack thereof), treatment, and prevention in these 2 very distinct cohorts. These differences in cervical cancer and HPV-associated OPC and their impact are discussed here. Cancer 2017;123:2219-2229. © 2017 American Cancer Society. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

Black-white preterm birth disparity: a marker of inequality

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Purpose. The racial disparity in preterrn birth (PTB) is a persistent feature of perinatal epidemiology, inconsistently modeled in the literature. Rather than include race as an explanatory variable, or employ race-stratified models, we sought to directly model the PTB disparity ...

Genomic Basis of Prostate Cancer Health Disparity Among African-American Men

Science.gov (United States)

2013-07-01

prostatectomy or radiation therapy, the risk of metastasis is reduced, but erectile dysfunction, urinary incontinence , and rectal bleeding may occur...or radiation therapy, the risk of metastasis is reduced, but erectile dysfunction, urinary incontinence and rectal bleeding may occur, affecting the...ProstateCancer/index. 2. Dash A, Lee P, Zhou Q, Jean-Gilles J, Taneja S, Satagopan J, et al. Impact of socioeconomic factors on prostate cancer

Gender disparities in health care.

Science.gov (United States)

Kent, Jennifer A; Patel, Vinisha; Varela, Natalie A

2012-01-01

The existence of disparities in delivery of health care has been the subject of increased empirical study in recent years. Some studies have suggested that disparities between men and women exist in the diagnoses and treatment of health conditions, and as a result measures have been taken to identify these differences. This article uses several examples to illustrate health care gender bias in medicine. These examples include surgery, peripheral artery disease, cardiovascular disease, critical care, and cardiovascular risk factors. Additionally, we discuss reasons why these issues still occur, trends in health care that may address these issues, and the need for acknowledgement of the current system's inequities in order to provide unbiased care for women in the future. © 2012 Mount Sinai School of Medicine.

Mind the Gap: Race\\Ethnic and Socioeconomic Disparities in Obesity

OpenAIRE

Krueger, Patrick M.; Reither, Eric N.

2015-01-01

Race/ethnic and socioeconomic status (SES) disparities in obesity are substantial and may widen in the future. We review seven potential mechanisms that recent research has used to explain obesity disparities. Those seven mechanisms fall into three broad groups—health behaviors, biological and developmental factors, and the social environment—which incorporate both proximate and upstream determinants of obesity disparities. Efforts to reduce the prevalence of obesity in the U.S. population an...

Examining the Gap: Compensation Disparities between Male and Female Physician Assistants.

Science.gov (United States)

Smith, Noël; Cawley, James F; McCall, Timothy C

Compensation disparities between men and women have been problematic for decades, and there is considerable evidence that the gap cannot be entirely explained by nongender factors. The current study examined the compensation gap in the physician assistant (PA) profession. Compensation data from 2014 was collected by the American Academy of PAs in 2015. Practice variables, including experience, specialty, and hours worked, were controlled for in an ordinary least-squares sequential regression model to examine whether there remained a disparity in total compensation. In addition, the absolute disparity in compensation was compared with historical data collected by American Academy of PAs over the previous 1.5 decades. Without controlling for practice variables, a total compensation disparity of $16,052 existed between men and women in the PA profession. Even after PA practice variables were controlled for, a total compensation disparity of $9,695 remained between men and women (95% confidence interval, $8,438-$10,952). A 17-year trend indicates the absolute disparity between men and women has not lessened, although the disparity as a percent of male compensation has decreased in recent years. There remain challenges to ensuring pay equality in the PA profession. Even when compensation-relevant factors such as experience, hours worked, specialty, postgraduate training, region, and call are controlled for, there is still a substantial gender disparity in PA compensation. Remedies that may address this pay inequality include raising awareness of compensation disparities, teaching effective negotiation skills, assisting employers as they develop equitable compensation plans, having less reliance on past salary in position negotiation, and professional associations advocating for policies that support equal wages and opportunities, regardless of personal characteristics. Copyright © 2017 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Rate-distortion analysis of steganography for conveying stereovision disparity maps

Science.gov (United States)

Umeda, Toshiyuki; Batolomeu, Ana B. D. T.; Francob, Filipe A. L.; Delannay, Damien; Macq, Benoit M. M.

2004-06-01

3-D images transmission in a way which is compliant with traditional 2-D representations can be done through the embedding of disparity maps within the 2-D signal. This approach enables the transmission of stereoscopic video sequences or images on traditional analogue TV channels (PAL or NTSC) or printed photographic images. The aim of this work is to study the achievable performances of such a technique. The embedding of disparity maps has to be seen as a global rate-distortion problem. The embedding capacity through steganography is determined by the transmission channel noise and by the bearable distortion on the watermarked image. The distortion of the 3-D image displayed as two stereo views depends on the rate allocated to the complementary information required to build those two views from one reference 2-D image. Results from the works on the scalar Costa scheme are used to optimize the embedding of the disparity map compressed bit stream into the reference image. A method for computing the optimal trade off between the disparity map distortion and embedding distortion as a function of the channel impairments is proposed. The goal is to get a similar distortion on the left (the reference image) and the right (the disparity compensated image) images. We show that in typical situations the embedding of 2 bits/pixels in the left image, while the disparity map is compressed at 1 bit per pixel leads to a good trade-off. The disparity map is encoded with a strong error correcting code, including synchronisation bits.

Partnering health disparities research with quality improvement science in pediatrics.

Science.gov (United States)

Lion, K Casey; Raphael, Jean L

2015-02-01

Disparities in pediatric health care quality are well described in the literature, yet practical approaches to decreasing them remain elusive. Quality improvement (QI) approaches are appealing for addressing disparities because they offer a set of strategies by which to target modifiable aspects of care delivery and a method for tailoring or changing an intervention over time based on data monitoring. However, few examples in the literature exist of QI interventions successfully decreasing disparities, particularly in pediatrics, due to well-described challenges in developing, implementing, and studying QI with vulnerable populations or in underresourced settings. In addition, QI interventions aimed at improving quality overall may not improve disparities, and in some cases, may worsen them if there is greater uptake or effectiveness of the intervention among the population with better outcomes at baseline. In this article, the authors review some of the challenges faced by researchers and frontline clinicians seeking to use QI to address health disparities and propose an agenda for moving the field forward. Specifically, they propose that those designing and implementing disparities-focused QI interventions reconsider comparator groups, use more rigorous evaluation methods, carefully consider the evidence for particular interventions and the context in which they were developed, directly engage the social determinants of health, and leverage community resources to build collaborative networks and engage community members. Ultimately, new partnerships between communities, providers serving vulnerable populations, and QI researchers will be required for QI interventions to achieve their potential related to health care disparity reduction. Copyright © 2015 by the American Academy of Pediatrics.

Psychiatrists' attitudes toward and awareness about racial disparities in mental health care.

Science.gov (United States)

Mallinger, Julie B; Lamberti, J Steven

2010-02-01

Psychiatrists may perpetuate racial-ethnic disparities in health care through racially biased, albeit unconscious, behaviors. Changing these behaviors requires that physicians accept that racial-ethnic disparities exist and accept their own contributions to disparities. The purposes of this study were to assess psychiatrists' awareness of racial disparities in mental health care, to evaluate the extent to which psychiatrists believe they contribute to disparities, and to determine psychiatrists' interest in participating in disparities-reduction programs. A random sample of psychiatrists, identified through the American Psychiatric Association's member directory, was invited to complete the online survey. The survey was also distributed to psychiatrists at a national professional conference. Of the 374 respondents, most said they were not familiar or only a little familiar with the literature on racial disparities. Respondents tended to believe that race has a moderate influence on quality of psychiatric care but that race is more influential in others' practices than in their own practices. One-fourth had participated in any type of disparities-reduction program within the past year, and approximately one-half were interested in participating in such a program. Psychiatrists may not recognize the pervasiveness of racial inequality in psychiatric care, and they may attribute racially biased thinking to others but not to themselves. Interventions to eliminate racial-ethnic disparities should focus on revealing and modifying unconscious biases. Lack of physician interest may be one barrier to such interventions.

Race-Based Health Disparities and the Digital Divide: Implications for Nursing Practice.

Science.gov (United States)

Price, Zula

2015-12-01

Knowledge of the sources of race-based health disparities could improve nursing practice and education in minority underserved communities. This purpose of this paper was to consider if Black-nonBlack health disparities were at least in part explained by Black-nonBlack disparities in access to Internet-based health information. With data on the U.S. adult population from the 2012 General Social Survey, the parameters of a health production function in which computer usage as an input was estimated. It was found that while there are Black-nonBlack disparities in health, once computer usage was accounted for, Black-nonBlack health disparities disappeared. This suggests nursing and health interventions that improve Internet access for Black patients in underserved communities could improve the health of Black Americans and close the racial health disparities gap. These findings complement recent nursing researchfindings that suggest closing Black-nonBlack disparities in computer access, the "digital divide," can render nursing practice more effective in providing care to minority and underserved communities.

Rural-Urban Differences in Cancer Incidence and Trends in the United States.

Science.gov (United States)

Zahnd, Whitney E; James, Aimee S; Jenkins, Wiley D; Izadi, Sonya R; Fogleman, Amanda J; Steward, David E; Colditz, Graham A; Brard, Laurent

2017-07-27

Cancer incidence and mortality rates in the US are declining, but this decrease may not be observed in rural areas where residents are more likely to live in poverty, smoke, and forego cancer screening. However, there is limited research exploring national rural-urban differences in cancer incidence and trends. We analyzed data from the North American Association of Central Cancer Registries' public use dataset, which includes population-based cancer incidence data from 46 states. We calculated age-adjusted incidence rates, rate ratios, and annual percentage change (APC) for: all cancers combined; selected individual cancers; and cancers associated with tobacco use and human papillomavirus (HPV). Rural-urban comparisons were made by demographic, geographic, and socioeconomic characteristics for 2009 to 2013. Trends were analyzed for 1995 to 2013. Combined cancers incidence rates were generally higher in urban populations, except for the South, though the urban decline in incidence rate was greater than in rural populations (10.2% vs. 4.8%, respectively). Rural cancer disparities included higher rates of tobacco associated, HPV associated, lung and bronchus, cervical , and colorectal cancers across most population groups. Further, HPV-associated cancer incidence rates increased in rural areas (APC=0.724, purban areas. Cancer rates associated with modifiable risks - tobacco, HPV, and some preventive screening modalities (e.g. colorectal and cervical cancers) - were higher in rural compared to urban populations. Population-based, clinical, and/or policy strategies and interventions that address these modifiable risk factors could help reduce cancer disparities experienced in rural populations. Copyright ©2017, American Association for Cancer Research.

Lossless Compression of Stereo Disparity Maps for 3D

DEFF Research Database (Denmark)

Zamarin, Marco; Forchhammer, Søren

2012-01-01

Efficient compression of disparity data is important for accurate view synthesis purposes in multi-view communication systems based on the “texture plus depth” format, including the stereo case. In this paper a novel technique for lossless compression of stereo disparity images is presented...

Using temporal seeding to constrain the disparity search range in stereo matching

CSIR Research Space (South Africa)

Ndhlovu, T

2011-11-01

Full Text Available for reusing computed disparity estimates on features in a stereo image sequence to constrain the disparity search range. Features are detected on a left image and their disparity estimates are computed using a local-matching algorithm. The features...

Foreword: Big Data and Its Application in Health Disparities Research.

Science.gov (United States)

Onukwugha, Eberechukwu; Duru, O Kenrik; Peprah, Emmanuel

2017-01-01

The articles presented in this special issue advance the conversation by describing the current efforts, findings and concerns related to Big Data and health disparities. They offer important recommendations and perspectives to consider when designing systems that can usefully leverage Big Data to reduce health disparities. We hope that ongoing Big Data efforts can build on these contributions to advance the conversation, address our embedded assumptions, and identify levers for action to reduce health care disparities.

Racial disparities in the use of outpatient mastectomy.

Science.gov (United States)

Salasky, Vanessa; Yang, Rachel L; Datta, Jashodeep; Graves, Holly L; Cintolo, Jessica A; Meise, Chelsey; Karakousis, Giorgos C; Czerniecki, Brian J; Kelz, Rachel R

2014-01-01

Racial disparities exist within many domains of cancer care. This study was designed to identify differences in the use of outpatient mastectomy (OM) based on patient race. We identified patients in the American College of Surgeons National Surgical Quality Improvement Program Participant Use File (during the years 2007-2010) who underwent a mastectomy. The association between mastectomy setting, patient race, patient age, American Society of Anesthesiology physical status classification, functional status, mastectomy type, and hospital teaching status was determined using the chi-square test. A multivariable logistic regression analysis was developed to assess the relative odds of undergoing OM by race, with adjustment for potential confounders. We identified 47,318 patients enrolled in the American College of Surgeons National Surgical Quality Improvement Program Participant Use File who underwent a mastectomy during the study time frame. More than half (62.6%) of mastectomies were performed in the outpatient setting. All racial minorities had lower rates of OM, with 63.8% of white patients; 59.1% of black patients; 57.4% of Asian, Native Hawaiian, or Pacific Islander patients; and 43.9% of American Indian or Alaska Native patients undergoing OM (P black patients, American Indian or Alaska Native patients, and those of unknown race were all less likely to undergo OM (odds ratio [OR], 0.86; 95% confidence interval [CI], 0.80-0.93; OR, 0.55; 95% CI, 0.41-0.72; and OR, 0.70; 95% CI, 0.64-0.76, respectively) compared with white patients. Disparities exist in the use of OM among racial minorities. Further studies are needed to identify the role of cultural preferences, physician attitudes, and insurer encouragements that may influence these patterns of use. Copyright © 2014 Elsevier Inc. All rights reserved.

Cancer Incidence in Five Continents: Inclusion criteria, highlights from Volume X and the global status of cancer registration.

Science.gov (United States)

Bray, F; Ferlay, J; Laversanne, M; Brewster, D H; Gombe Mbalawa, C; Kohler, B; Piñeros, M; Steliarova-Foucher, E; Swaminathan, R; Antoni, S; Soerjomataram, I; Forman, D

2015-11-01

Cancer Incidence in Five Continents (CI5), a longstanding collaboration between the International Agency for Research on Cancer and the International Association of Cancer Registries, serves as a unique source of cancer incidence data from high-quality population-based cancer registries around the world. The recent publication of Volume X comprises cancer incidence data from 290 registries covering 424 populations in 68 countries for the registration period 2003-2007. In this article, we assess the status of population-based cancer registries worldwide, describe the techniques used in CI5 to evaluate their quality and highlight the notable variation in the incidence rates of selected cancers contained within Volume X of CI5. We also discuss the Global Initiative for Cancer Registry Development as an international partnership that aims to reduce the disparities in availability of cancer incidence data for cancer control action, particularly in economically transitioning countries, already experiencing a rapid rise in the number of cancer patients annually. © 2015 UICC.

Do HMO market level factors lead to racial/ethnic disparities in colorectal cancer screening? A comparison between high-risk Asian and Pacific Islander Americans and high-risk whites.

Science.gov (United States)

Ponce, Ninez A; Huh, Soonim; Bastani, Roshan

2005-11-01

Few studies have explored health care market structure and colorectal cancer (CRC) screening test use, and little is known whether market factors contribute to racial/ethnic screening disparities. We investigated whether HMO market level factors, controlling for individual covariates, differentially impact Asian American and Pacific Islander (AAPI) subjects' access to CRC screening compared with white subjects. We used random intercept hierarchical models to predict CRC test use. Individual-level survey data was linked to market data by metropolitan statistical areas from InterStudy. Insured first-degree relatives, ages 40-80, of a random sample of colorectal cancer cases identified from the California Cancer Registry: 515 white subjects and 396 AAPI subjects residing in 36 metropolitan statistical areas (MSAs). Dependent variables were receipt of (1) annual fecal occult blood test only; (2) sigmoidoscopy in the past 5 years; (3) colonoscopy in the past 10 years; and (4) any of these tests over the recommended time interval. Market characteristics were HMO penetration, HMO competition, and proportion of staff/group/network HMOs. Market characteristics were as important as individual-level characteristics for AAPI but not for white subjects. Among AAPI subjects, a 10% increase in the percent of group/staff/network model HMO was associated with a reduction in colonoscopy use (28.9% to 20.5%) and in receipt of any of the CRC tests (53.2% to 45.4%). The prevailing organizational structure of a health care market confers a penalty on access to CRC test use among high-risk AAPI subjects but not among high-risk white subjects. Identifying the differential effect of market structure on race/ethnicity can potentially reduce the cancer burden among disadvantaged racial groups.

African Breast Cancer-Disparities in Outcomes (ABC-DO): protocol of a multicountry mobile health prospective study of breast cancer survival in sub-Saharan Africa.

Science.gov (United States)

McKenzie, Fiona; Zietsman, Annelle; Galukande, Moses; Anele, Angelica; Adisa, Charles; Cubasch, Herbert; Parham, Groesbeck; Anderson, Benjamin O; Abedi-Ardekani, Behnoush; Schuz, Joachim; Dos Santos Silva, Isabel; McCormack, Valerie

2016-08-23

Sub-Saharan African (SSA) women with breast cancer (BC) have low survival rates from this potentially treatable disease. An understanding of context-specific societal, health-systems and woman-level barriers to BC early detection, diagnosis and treatment are needed. The African Breast Cancer-Disparities in Outcomes (ABC-DO) is a prospective hospital-based study of overall survival, impact on quality of life (QOL) and delays along the journey to diagnosis and treatment of BC in SSA. ABC-DO is currently recruiting in Namibia, Nigeria, South Africa, Uganda and Zambia. Women aged 18 years or older who present at participating secondary and tertiary hospitals with a new clinical or histocytological diagnosis of primary BC are invited to participate. For consented women, tumour characteristics, specimen and treatment data are obtained. Over a 2-year enrolment period, we aim to recruit 2000 women who, in the first instance, will be followed for between 1 and 3 years. A face-to-face baseline interview obtains information on socioeconomic, cultural and demographic factors, QOL, health and BC attitudes/knowledge, and timing of all prediagnostic contacts with caregivers in orthodox health, traditional and spiritual systems. Responses are immediately captured on mobile devices that are fed into a tailored mobile health (mHealth) study management system. This system implements the study protocol, by prompting study researchers to phone women on her mobile phone every 3 months and, failing to reach her, prompts contact with her next-of-kin. At follow-up calls, women provide updated information on QOL, care received and disease impacts on family and working life; date of death is asked of her next-of-kin when relevant. The study was approved by ethics committees of all involved institutions. All participants provide written informed consent. The findings from the study will be published in peer-reviewed scientific journals, presented to funders and relevant local

Unequal before the Law : Measuring Legal Gender Disparities across the World

OpenAIRE

Iqbal, Sarah; Islam, Asif; Ramalho, Rita; Sakhonchik, Alena

2016-01-01

Several economies have laws that treat women differently from men. This study explores the degree of such legal gender disparities across 167 economies around the world. This is achieved by constructing a simple measure of legal gender disparities to evaluate how countries perform. The average number of overall legal gender disparities across 167 economies is 17, ranging from a minimum of ...

A Review of Barriers to Minorities' Participation in Cancer Clinical Trials: Implications for Future Cancer Research.

Science.gov (United States)

Salman, Ali; Nguyen, Claire; Lee, Yi-Hui; Cooksey-James, Tawna

2016-04-01

To enhance nurses' awareness and competencies in practice and research by reporting the common barriers to participation of minorities in cancer clinical trials and discussing facilitators and useful strategies for recruitment. Several databases were searched for articles published in peer reviewed journals. Some of the barriers to minorities' participation in clinical trials were identified within the cultural social-context of cancer patients. The involvement of community networking was suggested as the most effective strategy for the recruitment of minorities in cancer clinical trials. Using culturally sensitive approaches to enhance ethnic minorities' participation is important for advancing cancer care and eliminating health disparities. Awareness of barriers and potential facilitators to the enrollment of ethnic minority cancer patients may contribute to enhancing nurses' competencies of recruiting ethnic minorities in nursing research, playing efficient roles in cancer clinical trials team, and providing culturally competent quality care.

The corporate role in reducing disparities: initiatives under way at Verizon.

Science.gov (United States)

Izlar, Audrietta C

2011-10-01

Major US employers have great influence on the health care system because of the large number of employees for whom they provide health benefits and the billions of dollars they spend on health care. These companies must find ways to promote and improve health and health care, including by addressing racial and ethnic disparities. The communications company Verizon 38 percent of whose workforce is made up of racial and ethnic minorities, does so through a variety of initiatives to educate employees and to partner with health plans to increase screenings, care management, and other interventions. These initiatives include on-site mammography screening for employees; mailings that describe heightened breast cancer risks for minority populations; and data analysis to determine whether special programs should be put in place to target cardiovascular and other disease risks for racial and ethnic minorities. Between 200 and 300 female employees each year for the past three years have been screened at Verizon for breast cancer as a result, and the company is carrying out additional analyses to determine the impact on morbidity, mortality, and spending for that and other programs.

Racial/ethnic disparity in obesity among US youth, 1999-2013.

Science.gov (United States)

An, Ruopeng

2015-11-04

One fundamental goal in the Healthy People 2020 is to achieve health equity and eliminate disparities. To examine the annual trends in racial/ethnic disparity in obesity among US youth from 1999 to 2013. Nationally representative sample of 108,811 students in grades 9th-12th from the Youth Risk Behavior Surveillance System (YRBSS) 1999-2013 surveys. Body mass index (BMI) was calculated based on self-reported height and weight. Obesity in youth is defined as BMI at or above 95th sex- and age-specific percentile of the 2000 Centers for Disease Control and Prevention growth charts. Multiple logistic regressions were conducted to estimate the annual prevalence of obesity by race/ethnicity, adjusted for gender and age group and accounted for the YRBSS survey design. Between-group variance (BGV) was used to measure absolute racial/ethnic disparity in obesity, and the mean log deviation (MLD) and the Theil Index (T) were used to measure relative racial/ethnic disparity in obesity, weighted by corresponding racial/ethnic population size. The obesity prevalence among non-Hispanic Whites, non-Hispanic African Americans, non-Hispanic other race or multi-race, and Hispanic increased from 10.05%, 12.31%, 10.25%, and 13.24% in 1999 to 13.14%, 15.76%, 10.87%, and 15.20% in 2013, respectively. Both absolute and relative racial/ethnic disparity in obesity increased initially since 1999 but then steadily declined starting from mid-2000s back to around its original level by 2013. The obesity epidemic in youth is marked by salient and persistent disparity pertaining to race/ethnicity. No improvement on racial/ethnic disparity in obesity among American youth was observed during 1999-2013.

Quality of Cancer Care Among Foreign-Born and US-Born Patients With Lung or Colorectal Cancer

DEFF Research Database (Denmark)

Nielsen, Signe Smith; He, Yulei; Ayanian, John Z.

2010-01-01

  BACKGROUND: Disparities in care have been documented for foreign-born cancer patients in the United States. However, few data are available regarding patients with lung and colorectal cancer. In the current study, the authors assessed whether patient-reported quality and receipt of recommended...... from 2003 through 2005. Logistic regression was used to assess the association between nativity and patient-reported quality of care and receipt of recommended treatments (adjuvant chemotherapy for stage III colon cancer, adjuvant chemotherapy and radiotherapy for stage II/III rectal cancer......, and curative surgery for stage I/II non-small cell lung cancer). The authors also assessed whether language explained any differences in care by nativity. RESULTS: Overall, 46% of patients reported excellent care, but foreign-born patients were less likely than US-born patients to report excellent quality...

The International Cancer Expert Corps: a unique approach for sustainable cancer care in low and lower-middle income countries

Directory of Open Access Journals (Sweden)

C Norman eColeman

2014-11-01

Full Text Available The growing burden of non-communicable diseases including cancer in low- and lower-middle income countries (LMICs and in geographic-access limited settings within resource-rich countries requires effective and sustainable solutions. The International Cancer Expert Corps is pioneering a novel global mentorship-partnership model to address workforce capability and capacity within cancer disparities regions built on the requirement for local investment in personnel and infrastructure. Radiation oncology will be a key component given its efficacy for cure even for the advanced stages of disease often encountered and for palliation. The goal for an ICEC Center within these health disparities settings is to develop and retain a high quality sustainable workforce who can provide the best possible cancer care, conduct research and become a regional center of excellence. The ICEC Center can also serve as a focal point for economic, social and healthcare system improvement. ICEC is establishing teams of Experts with expertise to mentor in the broad range of subjects required to establish and sustain cancer care programs. The Hubs are cancer centers or other groups and professional societies in resource-rich settings that will comprise the global infrastructure coordinated by ICEC Central. A transformational tenet of ICEC is that altruistic, human-service activity should be an integral part of a healthcare career. To achieve a critical mass of mentors ICEC is working with three groups: academia, private practice and senior mentors/retirees. While in-kind support will be important, ICEC seeks support for the career time dedicated to this activity through grants, government support, industry and philanthropy. Providing care for people with cancer in LMICs has been a recalcitrant problem. The alarming increase in the global burden of cancer in LMICs underscores the urgency and makes this an opportune time for novel and sustainable solutions to transform

The international cancer expert corps: a unique approach for sustainable cancer care in low and lower-middle income countries.

Science.gov (United States)

Coleman, C Norman; Formenti, Silvia C; Williams, Tim R; Petereit, Daniel G; Soo, Khee C; Wong, John; Chao, Nelson; Shulman, Lawrence N; Grover, Surbhi; Magrath, Ian; Hahn, Stephen; Liu, Fei-Fei; DeWeese, Theodore; Khleif, Samir N; Steinberg, Michael; Roth, Lawrence; Pistenmaa, David A; Love, Richard R; Mohiuddin, Majid; Vikram, Bhadrasain

2014-01-01

The growing burden of non-communicable diseases including cancer in low- and lower-middle income countries (LMICs) and in geographic-access limited settings within resource-rich countries requires effective and sustainable solutions. The International Cancer Expert Corps (ICEC) is pioneering a novel global mentorship-partnership model to address workforce capability and capacity within cancer disparities regions built on the requirement for local investment in personnel and infrastructure. Radiation oncology will be a key component given its efficacy for cure even for the advanced stages of disease often encountered and for palliation. The goal for an ICEC Center within these health disparities settings is to develop and retain a high-quality sustainable workforce who can provide the best possible cancer care, conduct research, and become a regional center of excellence. The ICEC Center can also serve as a focal point for economic, social, and healthcare system improvement. ICEC is establishing teams of Experts with expertise to mentor in the broad range of subjects required to establish and sustain cancer care programs. The Hubs are cancer centers or other groups and professional societies in resource-rich settings that will comprise the global infrastructure coordinated by ICEC Central. A transformational tenet of ICEC is that altruistic, human-service activity should be an integral part of a healthcare career. To achieve a critical mass of mentors ICEC is working with three groups: academia, private practice, and senior mentors/retirees. While in-kind support will be important, ICEC seeks support for the career time dedicated to this activity through grants, government support, industry, and philanthropy. Providing care for people with cancer in LMICs has been a recalcitrant problem. The alarming increase in the global burden of cancer in LMICs underscores the urgency and makes this an opportune time fornovel and sustainable solutions to transform cancer care

Male/Female Salary Disparity for Professors of Educational Administration.

Science.gov (United States)

Pounder, Diana G.

The earnings gap between male and female workers across all occupational groups has been well documented; full-time women workers earn, on average, approximately 65 percent of men's salaries. Although male/female salary disparity is largest across occupational groups, salary disparity within occupational groups still prevails. For example, the…

Objective quality assessment of stereoscopic images with vertical disparity using EEG

Science.gov (United States)

Shahbazi Avarvand, Forooz; Bosse, Sebastian; Müller, Klaus-Robert; Schäfer, Ralf; Nolte, Guido; Wiegand, Thomas; Curio, Gabriel; Samek, Wojciech

2017-08-01

Objective. Neurophysiological correlates of vertical disparity in 3D images are studied in an objective approach using EEG technique. These disparities are known to negatively affect the quality of experience and to cause visual discomfort in stereoscopic visualizations. Approach. We have presented four conditions to subjects: one in 2D and three conditions in 3D, one without vertical disparity and two with different vertical disparity levels. Event related potentials (ERPs) are measured for each condition and the differences between ERP components are studied. Analysis is also performed on the induced potentials in the time frequency domain. Main results. Results show that there is a significant increase in the amplitude of P1 components in 3D conditions in comparison to 2D. These results are consistent with previous studies which have shown that P1 amplitude increases due to the depth perception in 3D compared to 2D. However the amplitude is significantly smaller for maximum vertical disparity (3D-3) in comparison to 3D with no vertical disparity. Our results therefore suggest that the vertical disparity in 3D-3 condition decreases the perception of depth compared to other 3D conditions and the amplitude of P1 component can be used as a discriminative feature. Significance. The results show that the P1 component increases in amplitude due to the depth perception in the 3D stimuli compared to the 2D stimulus. On the other hand the vertical disparity in the stereoscopic images is studied here. We suggest that the amplitude of P1 component is modulated with this parameter and decreases due to the decrease in the perception of depth.

75 FR 29357 - National Center on Minority and Health Disparities; Notice of Closed Meeting

Science.gov (United States)

2010-05-25

... and Health Disparities; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory... and Health Disparities Special NCMHD Health Disparities Research on Minority and Underserved... Health and Health Disparities, 6707 Democracy Boulevard, Suite 800, Bethesda, MD 20892. (301) 594-8696...

The Characteristics of Effective Cancer Education Media Interventions among African Americans: A Systematic Review.

Science.gov (United States)

Adedoyin, A Christson; Sherr, Michael E; Adedoyin, Oreoluwa O; Royse, David D; Jackson, Mary S; Adu-Boahene, Akosua B

2016-01-01

Cancer incidence and mortality is a significant area of health disparity between African Americans and Caucasians. In the current article the authors used a systematic review design to examine the characteristics of different cancer media education intervention (CMEI) to increase access to cancer screenings for African Americans within a 30 year period (1980-2010). Ten computerized databases were searched using inclusion-exclusion criteria. Consequently, 179 potential studies were identified, and later reduced to 41 eligible studies through the inclusion-exclusion criteria. The eligible studies had a combined sample size of N = 12,764 respondents. The findings revealed that multi-media intervention strategies were the most common media intervention that led to increased cancer screenings among African Americans. The authors conclude with a call for social workers to be more involved in developing and following up with culturally appropriate media strategies that can increase the likelihood of early detection and successful treatment, thus reducing this important area of health disparity.

The Role of Binocular Disparity in Rapid Scene and Pattern Recognition

Directory of Open Access Journals (Sweden)

Matteo Valsecchi

2013-04-01

Full Text Available We investigated the contribution of binocular disparity to the rapid recognition of scenes and simpler spatial patterns using a paradigm combining backward masked stimulus presentation and short-term match-to-sample recognition. First, we showed that binocular disparity did not contribute significantly to the recognition of briefly presented natural and artificial scenes, even when the availability of monocular cues was reduced. Subsequently, using dense random dot stereograms as stimuli, we showed that observers were in principle able to extract spatial patterns defined only by disparity under brief, masked presentations. Comparing our results with the predictions from a cue-summation model, we showed that combining disparity with luminance did not per se disrupt the processing of disparity. Our results suggest that the rapid recognition of scenes is mediated mostly by a monocular comparison of the images, although we can rely on stereo in fast pattern recognition.

Semantic Modeling for SNPs Associated with Ethnic Disparities in HapMap Samples

Directory of Open Access Journals (Sweden)

HyoYoung Kim

2014-03-01

Full Text Available Single-nucleotide polymorphisms (SNPs have been emerging out of the efforts to research human diseases and ethnic disparities. A semantic network is needed for in-depth understanding of the impacts of SNPs, because phenotypes are modulated by complex networks, including biochemical and physiological pathways. We identified ethnicity-specific SNPs by eliminating overlapped SNPs from HapMap samples, and the ethnicity-specific SNPs were mapped to the UCSC RefGene lists. Ethnicity-specific genes were identified as follows: 22 genes in the USA (CEU individuals, 25 genes in the Japanese (JPT individuals, and 332 genes in the African (YRI individuals. To analyze the biologically functional implications for ethnicity-specific SNPs, we focused on constructing a semantic network model. Entities for the network represented by "Gene," "Pathway," "Disease," "Chemical," "Drug," "ClinicalTrials," "SNP," and relationships between entity-entity were obtained through curation. Our semantic modeling for ethnicity-specific SNPs showed interesting results in the three categories, including three diseases ("AIDS-associated nephropathy," "Hypertension," and "Pelvic infection", one drug ("Methylphenidate", and five pathways ("Hemostasis," "Systemic lupus erythematosus," "Prostate cancer," "Hepatitis C virus," and "Rheumatoid arthritis". We found ethnicity-specific genes using the semantic modeling, and the majority of our findings was consistent with the previous studies - that an understanding of genetic variability explained ethnicity-specific disparities.

76 FR 63310 - National Center On Minority and Health Disparities Notice of Closed Meetings

Science.gov (United States)

2011-10-12

... and Health Disparities Notice of Closed Meetings Pursuant to section 10(d) of the Federal Advisory... and Health Disparities Special Emphasis Panel; NIMHD Health Disparities Research (R01). Date: November... Disparities, National Institutes of Health, 6707 Democracy Blvd., MSC. 5465, Suite 800, Bethesda, MD 20892...

Disparities in abortion experience and access to safe abortion ...

African Journals Online (AJOL)

In Ghana, abortion mortality constitutes 11% of maternal mortality. Empirical studies on possible disparities in abortion experience and access to safe abortion services are however lacking. Based on a retrospective survey of 1,370 women aged 15-49 years in two districts in Ghana, this paper examines disparities in ...

Socioeconomic status and quality of life among Chinese American breast cancer survivors: The mediating roles of social support and social constraints.

Science.gov (United States)

You, Jin; Wang, Carol; Yeung, Nelson Chun Yiu; Lu, Qian

2018-03-30

Literature has well noted ethnic/racial disparities in cancer survival and cancer care. However, socioeconomic disparities in psychosocial adjustment to breast cancer have garnered little attention. This study addresses the research gap by investigating the associations between socioeconomic indicators (ie, education, annual personal, and household income) and quality of life (QOL) and the mediating roles of social support and social constraints (objective and subjective conditions that constrain individuals from disclosing cancer concerns) in these associations among Chinese American breast cancer survivors (CABCS). Ninety-six CABCS completed questionnaires assessing these variables. After controlling for stage of cancer, annual personal and household income had indirect effects on QOL through social support, and education showed indirect effect on QOL through social support and social constraints. Subscale analyses indicated that controlling for years of immigration, annual personal and household income showed indirect effect on functional well-being through social support. When controlling for stage of cancer and income, education showed indirect effects on physical well-being through social support and social constraints and showed both direct and indirect effects on breast cancer concerns through social constraints. This study suggested that socioeconomic indicators, education, and income could be associated with different aspects of QOL through unique interpersonal mechanisms among CABCS. Our findings implied that increasing social support and reducing social constraints when implementing psychosocial interventions for CABCS may help to address the SES-related health disparities. Copyright © 2018 John Wiley & Sons, Ltd.

Recruiting newly referred lung cancer patients to a patient navigator intervention (PACO)

DEFF Research Database (Denmark)

Kjær, Trille Kristina; Mellemgaard, Anders; Stensøe Oksen, Marianne

2017-01-01

OBJECTIVES: The incidence of and survival from lung cancer are associated with socioeconomic position, and disparities have been observed in both curative and palliative treatment for lung cancer. 'Patient navigation' is valuable in addressing health disparity, with timely treatment and transitio...... of internal and external obstacles to patients' recruitment. The study provides insight into the barriers to recruitment of socially disadvantaged cancer patients to clinical trials and will inform future trial designs....... to care. We conducted a pilot study to test the feasibility of a patient navigator program (PAtient COach) for newly diagnosed lung cancer. We present the trial, the findings from the pilot study and discuss factors that might have affected recruitment rates. MATERIAL AND METHODS: We invited 24 lung...... of 1 or 2 or be over 65 years of age. The patient navigators targeted four phases of treatment: planning, initiation, compliance and end of treatment. RESULTS: Six months after the start of the study, we had recruited only six patients, due mainly to inherent patient resistance and because only 50...

Socio-economic disparities in health system responsiveness in India.

Science.gov (United States)

Malhotra, Chetna; Do, Young Kyung

2013-03-01

To assess the magnitude of socio-economic disparities in health system responsiveness in India after correcting for potential reporting heterogeneity by socio-economic characteristics (education and wealth). Data from Wave 1 of the Study on Global Ageing and Adult Health (2007-2008) involving six Indian states were used. Seven health system responsiveness domains were considered for a respondent's last visit to an outpatient service in 12 months: prompt attention, dignity, clarity of information, autonomy, confidentiality, choice and quality of basic amenities. Hierarchical ordered probit models (correcting for reporting heterogeneity through anchoring vignettes) were used to assess the association of socio-economic characteristics with the seven responsiveness domains, controlling for age, gender and area of residence. Stratified analysis was also conducted among users of public and private health facilities. Our statistical models accounting for reporting heterogeneity revealed socio-economic disparities in all health system responsiveness domains. Estimates suggested that individuals from the lowest wealth group, for example, were less likely than individuals from the highest wealth group to report 'very good' on the dignity domain by 8% points (10% vs 18%). Stratified analysis showed that such disparities existed among users of both public and private health facilities. Socio-economic disparities exist in health system responsiveness in India, irrespective of the type of health facility used. Policy efforts to monitor and improve these disparities are required at the health system level.

A Narrative Review of the Confluence of Breast Cancer and Low-wage Employment and Its Impact on Receipt of Guideline-recommended Treatment.

Science.gov (United States)

Vanderpool, Robin C; Swanberg, Jennifer E; Chambers, Mara D

2013-09-01

Breast cancer is the leading cause of cancer among women in the United States, costing the healthcare system, employers, and society billions of dollars each year. Despite improvements in screening and treatment, significant breast cancer treatment and survivorship disparities exist among various groups of women. One variable that has not been explored extensively as a possible contributor to breast cancer treatment disparities is employment. This is concerning, given the changing economic and employment trends in the United States favoring low-wage employment. Currently, one-quarter to one-third of all US workers are considered to be working poor, and women are disproportionally represented in this group. Characteristics of low-wage work-limited paid time off, minimal health benefits, schedule inflexibility, and economic insecurity-may become even more significant in the event of a breast cancer diagnosis. To date, there has been limited research into how job conditions inherent to low-wage work may influence working poor survivors' receipt of guideline-recommended breast cancer treatment. Therefore, the purpose of this narrative review was to critically examine the current literature to further our understanding of how employment context may impact treatment decisions and adherence-and therefore receipt of guideline-recommended care-among newly diagnosed, working poor breast cancer survivors. After undertaking a comprehensive review, we failed to identify any published literature that explicitly addressed low-wage employment and receipt of guideline-recommended breast cancer treatment. Four articles reported circumstances where women delayed, missed, or quit treatments due to work interference, or alternatively, developed strategies that allowed them to continue to work and obtain their breast cancer treatment concurrent with medical and economic challenges. An additional five articles, while focused on other cancer and employment outcomes, described the need for

The Effects of Hurricane Katrina on Food Access Disparities in New Orleans

Science.gov (United States)

Bodor, J. Nicholas; Rice, Janet C.; Swalm, Chris M.; Hutchinson, Paul L.

2011-01-01

Disparities in neighborhood food access are well documented, but little research exists on how shocks influence such disparities. We examined neighborhood food access in New Orleans at 3 time points: before Hurricane Katrina (2004–2005), in 2007, and in 2009. We combined existing directories with on-the-ground verification and geographic information system mapping to assess supermarket counts in the entire city. Existing disparities for African American neighborhoods worsened after the storm. Although improvements have been made, by 2009 disparities were no better than prestorm levels. PMID:21233432

Effect of Medicaid Managed Care on racial disparities in health care access.

Science.gov (United States)

Cook, Benjamin Lê

2007-02-01

To evaluate the impact of Medicaid Managed Care (MMC) on racial disparities in access to care consistent with the Institute of Medicine (IOM) definition of racial disparity, which excludes differences stemming from health status but includes socioeconomic status (SES)-mediated differences. Secondary data from the Adult Samples of the 1997-2001 National Health Interview Survey, metropolitan statistical area (MSA)-level Medicaid Health Maintenance Organization (MHMO) market share from the 1997 to 2001 InterStudy MSA Trend Dataset, and MSA characteristics from the 1997 to 2001 Area Resource File. I estimate multivariate regression models to compare racial disparities in doctor visits, emergency room (ER) use, and having a usual source of care between enrollees in MMC and Medicaid Fee-for-Service (FFS) plans. To contend with potential selection bias, I use a difference-in-difference analytical strategy and assess the impact of greater MHMO market share at the MSA level on Medicaid enrollees' access measures. To implement the IOM definition of racial disparity, I adjust for health status but not SES factors using a novel method to transform the distribution of health status for minority populations to approximate the white health status distribution. MMC enrollment is associated with lowered disparities in having any doctor visit in the last year for blacks, and in having any usual source of care for both blacks and Hispanics. Increasing Medicaid HMO market share lowered disparities in having any doctor visits in the last year for both blacks and Hispanics. Although disparities in most other measures were not much affected, black-white ER use disparities exist among MMC enrollees and in areas of high MHMO market share. MMC programs' reduction of some disparities suggests that recent shifts in Medicaid policy toward managed care plans have benefited minority enrollees. Future research should investigate whether black-white disparities in ER use within MMC groups

Sexual Orientation Disparities in Papanicolaou Test Use Among US Women: The Role of Sexual and Reproductive Health Services

Science.gov (United States)

Krieger, Nancy; Austin, S. Bryn; Haneuse, Sebastien; Gottlieb, Barbara R.

2014-01-01

We investigated sexual orientation disparities in Papanicolaou screening among US women aged 21 to 44 years (n = 9581) in the 2006 to 2010 National Survey of Family Growth. The odds ratios for lesbian versus heterosexual women and women with no versus only male sexual partners were 0.40 and 0.32, respectively, and were attenuated after adjustment for sexual and reproductive health (SRH) care indicators. Administering Papanicolaou tests through mechanisms other than SRH services would promote cervical cancer screening among all women. PMID:24328650

Behavioral economics: "nudging" underserved populations to be screened for cancer.

Science.gov (United States)

Purnell, Jason Q; Thompson, Tess; Kreuter, Matthew W; McBride, Timothy D

2015-01-15

Persistent disparities in cancer screening by race/ethnicity and socioeconomic status require innovative prevention tools and techniques. Behavioral economics provides tools to potentially reduce disparities by informing strategies and systems to increase prevention of breast, cervical, and colorectal cancers. With an emphasis on the predictable, but sometimes flawed, mental shortcuts (heuristics) people use to make decisions, behavioral economics offers insights that practitioners can use to enhance evidence-based cancer screening interventions that rely on judgments about the probability of developing and detecting cancer, decisions about competing screening options, and the optimal presentation of complex choices (choice architecture). In the area of judgment, we describe ways practitioners can use the availability and representativeness of heuristics and the tendency toward unrealistic optimism to increase perceptions of risk and highlight benefits of screening. We describe how several behavioral economic principles involved in decision-making can influence screening attitudes, including how framing and context effects can be manipulated to highlight personally salient features of cancer screening tests. Finally, we offer suggestions about ways practitioners can apply principles related to choice architecture to health care systems in which cancer screening takes place. These recommendations include the use of incentives to increase screening, introduction of default options, appropriate feedback throughout the decision-making and behavior completion process, and clear presentation of complex choices, particularly in the context of colorectal cancer screening. We conclude by noting gaps in knowledge and propose future research questions to guide this promising area of research and practice.

Prioritizing health disparities in medical education to improve care

Science.gov (United States)

Awosogba, Temitope; Betancourt, Joseph R.; Conyers, F. Garrett; Estapé, Estela S.; Francois, Fritz; Gard, Sabrina J.; Kaufman, Arthur; Lunn, Mitchell R.; Nivet, Marc A.; Oppenheim, Joel D.; Pomeroy, Claire; Yeung, Howa

2015-01-01

Despite yearly advances in life-saving and preventive medicine, as well as strategic approaches by governmental and social agencies and groups, significant disparities remain in health, health quality, and access to health care within the United States. The determinants of these disparities include baseline health status, race and ethnicity, culture, gender identity and expression, socioeconomic status, region or geography, sexual orientation, and age. In order to renew the commitment of the medical community to address health disparities, particularly at the medical school level, we must remind ourselves of the roles of doctors and medical schools as the gatekeepers and the value setters for medicine. Within those roles are responsibilities toward the social mission of working to eliminate health disparities. This effort will require partnerships with communities as well as with academic centers to actively develop and to implement diversity and inclusion strategies. Besides improving the diversity of trainees in the pipeline, access to health care can be improved, and awareness can be raised regarding population-based health inequalities. PMID:23659676

Prioritizing health disparities in medical education to improve care.

Science.gov (United States)

Awosogba, Temitope; Betancourt, Joseph R; Conyers, F Garrett; Estapé, Estela S; Francois, Fritz; Gard, Sabrina J; Kaufman, Arthur; Lunn, Mitchell R; Nivet, Marc A; Oppenheim, Joel D; Pomeroy, Claire; Yeung, Howa

2013-05-01

Despite yearly advances in life-saving and preventive medicine, as well as strategic approaches by governmental and social agencies and groups, significant disparities remain in health, health quality, and access to health care within the United States. The determinants of these disparities include baseline health status, race and ethnicity, culture, gender identity and expression, socioeconomic status, region or geography, sexual orientation, and age. In order to renew the commitment of the medical community to address health disparities, particularly at the medical school level, we must remind ourselves of the roles of doctors and medical schools as the gatekeepers and the value setters for medicine. Within those roles are responsibilities toward the social mission of working to eliminate health disparities. This effort will require partnerships with communities as well as with academic centers to actively develop and to implement diversity and inclusion strategies. Besides improving the diversity of trainees in the pipeline, access to health care can be improved, and awareness can be raised regarding population-based health inequalities. © 2013 New York Academy of Sciences.

Development and evaluation of a web-based breast cancer cultural competency course for primary healthcare providers.

Science.gov (United States)

Palmer, Richard C; Samson, Raquel; Triantis, Maria; Mullan, Irene D

2011-08-15

To develop and evaluate a continuing medical education (CME) course aimed at improving healthcare provider knowledge about breast cancer health disparities and the importance of cross-cultural communication in provider-patient interactions about breast cancer screening. An interactive web-based CME course was developed and contained information about breast cancer disparities, the role of culture in healthcare decision making, and demonstrated a model of cross-cultural communication. A single group pre-/post-test design was used to assess knowledge changes. Data on user satisfaction was also collected. In all, 132 participants registered for the CME with 103 completing both assessments. Differences between pre-/post-test show a significant increase in knowledge (70% vs. 94%; p training was an appropriate tool to train healthcare providers about cultural competency and health disparities. There was an overall high level of satisfaction among all users. Users felt that learning objectives were met and the web-based format was appropriate and easy to use and suggests that web-based CME formats are an appropriate tool to teach cultural competency skills. However, more information is needed to understand how the CME impacted practice behaviors.

Racial Disparities in Access to Care Under Conditions of Universal Coverage.

Science.gov (United States)

Siddiqi, Arjumand A; Wang, Susan; Quinn, Kelly; Nguyen, Quynh C; Christy, Antony Dennis

2016-02-01

Racial disparities in access to regular health care have been reported in the U.S., but little is known about the extent of disparities in societies with universal coverage. To investigate the extent of racial disparities in access to care under conditions of universal coverage by observing the association between race and regular access to a doctor in Canada. Racial disparities in access to a regular doctor were calculated using the largest available source of nationally representative data in Canada--the Canadian Community Health Survey. Surveys from 2000-2010 were analyzed in 2014. Multinomial regression analyses predicted odds of having a regular doctor for each racial group compared to whites. Analyses were stratified by immigrant status--Canadian-born versus shorter-term immigrant versus longer-term immigrants--and controlled for sociodemographics and self-rated health. Racial disparities in Canada, a country with universal coverage, were far more muted than those previously reported in the U.S. Only among longer-term Latin American immigrants (OR=1.90, 95% CI=1.45, 2.08) and Canadian-born Aboriginals (OR=1.34, 95% CI=1.22, 1.47) were significant disparities noted. Among shorter-term immigrants, all Asians were more likely than whites, and among longer-term immigrants, South Asians were more like than whites, to have a regular doctor. Universal coverage may have a major impact on reducing racial disparities in access to health care, although among some subgroups, other factors may also play a role above and beyond health insurance. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Applying a gender lens on human papillomavirus infection: cervical cancer screening, HPV DNA testing, and HPV vaccination

NARCIS (Netherlands)

Brankovic, I; Verdonk, P.; Klinge, I.

2013-01-01

Background: Our aim is to provide a state-of-the-art overview of knowledge on sex (biological) and gender (sociocultural) aspects of Human papillomavirus (HPV) and cervical cancer for educational purposes. Considerable disparities exist in cervical cancer incidences between different subgroups of

Promoting Breast Cancer Screening through Storytelling by Chamorro Cancer Survivors

Science.gov (United States)

Manglona, Rosa Duenas; Robert, Suzanne; Isaacson, Lucy San Nicolas; Garrido, Marie; Henrich, Faye Babauta; Santos, Lola Sablan; Le, Daisy; Peters, Ruth

2017-01-01

The largest Chamorro population outside of Guam and the Mariana Islands reside in California. Cancer health disparities disproportionally affect Pacific Islander communities, including the Chamorro, and breast cancer is the most common cancer affecting women. To address health concerns such as cancer, Pacific Islander women frequently utilize storytelling to initiate conversations about health and to address sensitive topics such as breast health and cancer. One form of storytelling used in San Diego is a play that conveys the message of breast cancer screening to the community in a culturally and linguistically appropriate way. This play, Nan Nena’s Mammogram, tells the story of an older woman in the community who learns about breast cancer screening from her young niece. The story builds upon the underpinnings of Chamorro culture - family, community, support, and humor - to portray discussing breast health, getting support for breast screening, and visiting the doctor. The story of Nan Nena’s Mammogram reflects the willingness of a few pioneering Chamorro women to use their personal experiences of cancer survivorship to promote screening for others. Through the support of a Chamorro community-based organization, these Chamorro breast cancer survivors have used the success of Nan Nena’s Mammogram to expand their education activities and to form a new cancer survivor organization for Chamorro women in San Diego.

Gender disparities in completing school education in India: Analyzing regional variations

OpenAIRE

Husain, Zakir

2010-01-01

Is gender disparity greater in North India? This paper seeks to answer this question by examining gender differences in probability of completing school education across regions in India. A Gender Disparity Index is calculated using National Sample Survey Organization unit level data from the 61st Round and regional variations in this index analyzed to examine the hypothesis that gender disparity is greater in the North, comparative to the rest of India. This is followed by an econometric exe...

Variable disparity-motion estimation based fast three-view video coding

Science.gov (United States)

Bae, Kyung-Hoon; Kim, Seung-Cheol; Hwang, Yong Seok; Kim, Eun-Soo

2009-02-01

In this paper, variable disparity-motion estimation (VDME) based 3-view video coding is proposed. In the encoding, key-frame coding (KFC) based motion estimation and variable disparity estimation (VDE) for effectively fast three-view video encoding are processed. These proposed algorithms enhance the performance of 3-D video encoding/decoding system in terms of accuracy of disparity estimation and computational overhead. From some experiments, stereo sequences of 'Pot Plant' and 'IVO', it is shown that the proposed algorithm's PSNRs is 37.66 and 40.55 dB, and the processing time is 0.139 and 0.124 sec/frame, respectively.

The promise of prevention: the effects of four preventable risk factors on national life expectancy and life expectancy disparities by race and county in the United States.

Directory of Open Access Journals (Sweden)

Goodarz Danaei

2010-03-01

had been reduced to optimal levels. Disparities in the probabilities of dying from cardiovascular diseases and diabetes at different ages would decline by 69%-80%; the corresponding reduction for probabilities of dying from cancers would be 29%-50%. Individually, smoking and high blood pressure had the largest effect on life expectancy disparities.Disparities in smoking, blood pressure, blood glucose, and adiposity explain a significant proportion of disparities in mortality from cardiovascular diseases and cancers, and some of the life expectancy disparities in the US. Please see later in the article for the Editors' Summary.

75 FR 66114 - National Center on Minority Health and Health Disparities; Notice of Closed Meeting

Science.gov (United States)

2010-10-27

... Health and Health Disparities; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory... and Health Disparities Special Emphasis Panel; NCMHD Health Disparities Research on Minority and... Review Officer, National Institute on Minority Health and Health Disparities, 6707 Democracy Boulevard...

75 FR 12766 - National Center on Minority Health and Health Disparities; Notice of Closed Meetings

Science.gov (United States)

2010-03-17

... Health and Health Disparities; Notice of Closed Meetings Pursuant to section 10(d) of the Federal... and Health Disparities Special Emphasis Panel Loan Repayment Program for Health Disparities Research... Review, National Center on Minority Health and Health Disparities, 6707 Democracy Boulevard, Suite 800...

Use of Community Health Workers and Patient Navigators to Improve Cancer Outcomes Among Patients Served by Federally Qualified Health Centers: A Systematic Literature Review.

Science.gov (United States)

Roland, Katherine B; Milliken, Erin L; Rohan, Elizabeth A; DeGroff, Amy; White, Susan; Melillo, Stephanie; Rorie, William E; Signes, Carmita-Anita C; Young, Paul A

2017-01-01

Introduction: In the United States, disparities in cancer screening, morbidity, and mortality are well documented, and often are related to race/ethnicity and socioeconomic indicators including income, education, and healthcare access. Public health approaches that address social determinants of health have the greatest potential public health benefit, and can positively impact health disparities. As public health interventions, community health workers (CHWs), and patient navigators (PNs) work to address disparities and improve cancer outcomes through education, connecting patients to and navigating them through the healthcare system, supporting patient adherence to screening and diagnostic services, and providing social support and linkages to financial and community resources. Clinical settings, such as federally qualified health centers (FQHCs) are mandated to provide care to medically underserved communities, and thus are also valuable in the effort to address health disparities. We conducted a systematic literature review to identify studies of cancer-related CHW/PN interventions in FQHCs, and to describe the components and characteristics of those interventions in order to guide future intervention development and evaluation. Method: We searched five databases for peer-reviewed CHW/PN intervention studies conducted in partnership with FQHCs with a focus on cancer, carried out in the United States, and published in English between January 1990 and December 2013. Results: We identified 24 articles, all reporting positive outcomes of CHW/PNs interventions in FQHCs. CHW/PN interventions most commonly promoted breast, cervical, or colorectal cancer screening and/or referral for diagnostic resolution. Studies were supported largely through federal funding. Partnerships with academic institutions and community-based organizations provided support and helped develop capacity among FQHC clinic leadership and community members. Discussion: Both the FQHC system and CHW

Ethnicity and oral cancer.

Science.gov (United States)

Scully, C; Bedi, R

2000-09-01

Oral squamous-cell carcinoma, the main type of oral cancer, is among the ten most common cancers in the world. The aims of this paper were first, to consider whether there was evidence of marked ethnic variations in the incidence, management, and survival of oral cancer, and then, to review possible explanations for these variations. Evidence from the literature suggests that there is marked, inter-country variation in both the incidence and mortality from oral cancer. There is also growing evidence of intracountry ethnic differences, mostly reported in the UK and USA. These variations among ethnic groups have been attributed mainly to specific risk factors, such as alcohol and tobacco (smoking and smokeless), but dietary factors and the existence of genetic predispositions may also play a part. Variations in access to care services are also an apparent factor. The extent of ethnic differences in oral cancer is masked by the scarcity of information available. Where such data are accessible, there are clear disparities in both incidence and mortality of oral cancer between ethnic groups.

Disparities in criminal court referrals to drug treatment and prison for minority men.

Science.gov (United States)

Nicosia, Nancy; Macdonald, John M; Arkes, Jeremy

2013-06-01

We investigated the extent to which racial/ethnic disparities in prison and diversion to drug treatment were explained by current arrest and criminal history characteristics among drug-involved offenders, and whether those disparities decreased after California's Proposition 36, which mandated first- and second-time nonviolent drug offenders drug treatment instead of prison. We analyzed administrative data on approximately 170,000 drug-involved arrests in California between 1995 and 2005. We examined odds ratios from logistic regressions for prison and diversion across racial/ethnic groups before and after Proposition 36. We found significant disparities in prison and diversion for Blacks and Hispanics relative to Whites. These disparities decreased after controlling for current arrest and criminal history characteristics for Blacks. Proposition 36 was also associated with a reduction in disparities, but more so for Hispanics than Blacks. Disparities in prison and diversion to drug treatment among drug-involved offenders affect hundreds of thousands of citizens and might reinforce imbalances in criminal justice and health outcomes. Our study indicated that standardized criminal justice policies that improved access to drug treatment might contribute to alleviating some share of these disparities.

Feminist intersectionality: bringing social justice to health disparities research.

Science.gov (United States)

Rogers, Jamie; Kelly, Ursula A

2011-05-01

The principles of autonomy, beneficence, non-maleficence, and justice are well established ethical principles in health research. Of these principles, justice has received less attention by health researchers. The purpose of this article is to broaden the discussion of health research ethics, particularly the ethical principle of justice, to include societal considerations--who and what are studied and why?--and to critique current applications of ethical principles within this broader view. We will use a feminist intersectional approach in the context of health disparities research to firmly establish inseparable links between health research ethics, social action, and social justice. The aim is to provide an ethical approach to health disparities research that simultaneously describes and seeks to eliminate health disparities. © The Author(s) 2011

75 FR 9421 - National Center on Minority Health and Health Disparities; Notice of Closed Meeting

Science.gov (United States)

2010-03-02

... Health and Health Disparities; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory... and Health Disparities Special Emphasis Panel; Loan Repayment Program for Health Disparities Research..., National Center on Minority Health and Health Disparities, 6707 Democracy Boulevard, Suite 800, Bethesda...

Disparity in cancer prevention and screening in aboriginal populations: recommendations for action

OpenAIRE

Ahmed, S.; Shahid, R.K.; Episkenew, J.A.

2015-01-01

Historically, cancer has occurred at a lower rate in aboriginal populations; however, it is now dramatically increasing. Unless preventive measures are taken, cancer rates among aboriginal peoples are expected to soon surpass those in non-aboriginal populations. Because a large proportion of malignant disorders are preventable, primary prevention through socioeconomic interventions, environmental changes, and lifestyle modification might provide the best option for reducing the increasing bur...

Solving Disparities Through Payment And Delivery System Reform: A Program To Achieve Health Equity.

Science.gov (United States)

DeMeester, Rachel H; Xu, Lucy J; Nocon, Robert S; Cook, Scott C; Ducas, Andrea M; Chin, Marshall H

2017-06-01

Payment systems generally do not directly encourage or support the reduction of health disparities. In 2013 the Finding Answers: Solving Disparities through Payment and Delivery System Reform program of the Robert Wood Johnson Foundation sought to understand how alternative payment models might intentionally incorporate a disparities-reduction component to promote health equity. A qualitative analysis of forty proposals to the program revealed that applicants generally did not link payment reform tightly to disparities reduction. Most proposed general pay-for-performance, global payment, or shared savings plans, combined with multicomponent system interventions. None of the applicants proposed making any financial payments contingent on having successfully reduced disparities. Most applicants did not address how they would optimize providers' intrinsic and extrinsic motivation to reduce disparities. A better understanding of how payment and care delivery models might be designed and implemented to reduce health disparities is essential. Project HOPE—The People-to-People Health Foundation, Inc.

Local breast cancer spatial patterning: a tool for community health resource allocation to address local disparities in breast cancer mortality.

Directory of Open Access Journals (Sweden)

Dana M Brantley-Sieders

Full Text Available Despite available demographic data on the factors that contribute to breast cancer mortality in large population datasets, local patterns are often overlooked. Such local information could provide a valuable metric by which regional community health resources can be allocated to reduce breast cancer mortality. We used national and statewide datasets to assess geographical distribution of breast cancer mortality rates and known risk factors influencing breast cancer mortality in middle Tennessee. Each county in middle Tennessee, and each ZIP code within metropolitan Davidson County, was scored for risk factor prevalence and assigned quartile scores that were used as a metric to identify geographic areas of need. While breast cancer mortality often correlated with age and incidence, geographic areas were identified in which breast cancer mortality rates did not correlate with age and incidence, but correlated with additional risk factors, such as mammography screening and socioeconomic status. Geographical variability in specific risk factors was evident, demonstrating the utility of this approach to identify local areas of risk. This method revealed local patterns in breast cancer mortality that might otherwise be overlooked in a more broadly based analysis. Our data suggest that understanding the geographic distribution of breast cancer mortality, and the distribution of risk factors that contribute to breast cancer mortality, will not only identify communities with the greatest need of support, but will identify the types of resources that would provide the most benefit to reduce breast cancer mortality in the community.

Breast and cervical cancer screening disparity among Asian American women: does race/ethnicity matter [corrected]?

Science.gov (United States)

Lee, Hee Yun; Ju, Eunsu; Vang, Pa Der; Lundquist, Melissa

2010-10-01

Ethnic minorities are frequently considered as one homogeneous group in research, and this trend is particularly true for Asian Americans. This article seeks to uncover the intragroup differences in cancer screening behavior among subgroups of Asian American women by disaggregating them into six subgroups. The subgroups were compared with non-Latina white women to examine differences in breast and cancer screening rates and relevant factors associated with receiving these screenings. Three-year merged data from the 2001, 2003, and 2005 California Health Interview Survey (CHIS) were used to investigate the subgroup differences. Samples for the current study were restricted to non-Latina white and Asian American women whose age was ≥ 18 years (n = 58,000) for cervical cancer screening and ≥ 40 years (n = 43,518) for breast cancer screening at the time of the interview. Results showed marked differences in cancer screening rates among Asian American subgroups and between cancer types. Cervical cancer screening rates were noticeably higher than breast cancer screening rates in all groups. The Korean group consistently showed the lowest rates of both cancer screenings. Japanese ranked the highest (79.5%) in breast cancer screening but the second lowest (79.7%) in cervical cancer screening. Enabling factors, such as having private health insurance and a usual source of care, were found to be the strongest predictors of receiving both breast and cervical cancer screening. Screenings for both types of cancer increased if a woman was married or was born in the United States. The findings of this study illustrate the heterogeneity that exists among Asian American subgroups in their cancer screening behaviors. Further development of culturally relevant and ethnic-specific cancer prevention strategies and policies that address the subgroup differences within the larger racial/ethnic population are needed. Public health outreach and cancer education should be prioritized to

Disparities in Birth Weight and Gestational Age by Ethnic Ancestry in South American countries

Science.gov (United States)

Wehby, George L.; Gili, Juan A.; Pawluk, Mariela; Castilla, Eduardo E.; López-Camelo, Jorge S.

2015-01-01

Objective We examine disparities in birth weight and gestational age by ethnic ancestry in 2000–2011 in eight South American countries. Methods The sample included 60480 singleton live-births. Regression models were estimated to evaluate differences in birth outcomes by ethnic ancestry controlling for time trends. Results Significant disparities were found in seven countries. In four countries – Brazil, Ecuador, Uruguay, and Venezuela – we found significant disparities in both low birth weight and preterm birth. Disparities in preterm birth alone were observed in Argentina, Bolivia, and Colombia. Several differences in continuous birth weight, gestational age, and fetal growth rate were also observed. There were no systematic patterns of disparities between the evaluated ethnic ancestry groups across the study countries, in that no racial/ethnic group consistently had the best or worst outcomes in all countries. Conclusions Racial/ethnic disparities in infant health are common in several South American countries. Differences across countries suggest that racial/ethnic disparities are driven by social and economic mechanisms. Researchers and policymakers should acknowledge these disparities and develop research and policy programs to effectively target them. PMID:25542227

The first 50Myr of dinosaur evolution: macroevolutionary pattern and morphological disparity.

Science.gov (United States)

Brusatte, Stephen L; Benton, Michael J; Ruta, Marcello; Lloyd, Graeme T

2008-12-23

The evolutionary radiation of dinosaurs in the Late Triassic and Early Jurassic was a pivotal event in the Earth's history but is poorly understood, as previous studies have focused on vague driving mechanisms and have not untangled different macroevolutionary components (origination, diversity, abundance and disparity). We calculate the morphological disparity (morphospace occupation) of dinosaurs throughout the Late Triassic and Early Jurassic and present new measures of taxonomic diversity. Crurotarsan archosaurs, the primary dinosaur 'competitors', were significantly more disparate than dinosaurs throughout the Triassic, but underwent a devastating extinction at the Triassic-Jurassic boundary. However, dinosaur disparity showed only a slight non-significant increase after this event, arguing against the hypothesis of ecological release-driven morphospace expansion in the Early Jurassic. Instead, the main jump in dinosaur disparity occurred between the Carnian and Norian stages of the Triassic. Conversely, dinosaur diversity shows a steady increase over this time, and measures of diversification and faunal abundance indicate that the Early Jurassic was a key episode in dinosaur evolution. Thus, different aspects of the dinosaur radiation (diversity, disparity and abundance) were decoupled, and the overall macroevolutionary pattern of the first 50Myr of dinosaur evolution is more complex than often considered.

Calculating expected years of life lost for assessing local ethnic disparities in causes of premature death

Directory of Open Access Journals (Sweden)

Katcher Brian S

2008-04-01

Full Text Available Abstract Background A core function of local health departments is to conduct health assessments. The analysis of death certificates provides information on diseases, conditions, and injuries that are likely to cause death – an important outcome indicator of population health. The expected years of life lost (YLL measure is a valid, stand-alone measure for identifying and ranking the underlying causes of premature death. The purpose of this study was to rank the leading causes of premature death among San Francisco residents, and to share detailed methods so that these analyses can be used in other local health jurisdictions. Methods Using death registry data and population estimates for San Francisco deaths in 2003–2004, we calculated the number of deaths, YLL, and age-standardized YLL rates (ASYRs. The results were stratified by sex, ethnicity, and underlying cause of death. The YLL values were used to rank the leading causes of premature death for men and women, and by ethnicity. Results In the years 2003–2004, 6312 men died (73,627 years of life lost, and 5726 women died (51,194 years of life lost. The ASYR for men was 65% higher compared to the ASYR for women (8971.1 vs. 5438.6 per 100,000 persons per year. The leading causes of premature deaths are those with the largest average YLLs and are largely preventable. Among men, these were HIV/AIDS, suicide, drug overdose, homicide, and alcohol use disorder; and among women, these were lung cancer, breast cancer, hypertensive heart disease, colon cancer, and diabetes mellitus. A large health disparity exists between African Americans and other ethnic groups: African American age-adjusted overall and cause-specific YLL rates were higher, especially for homicide among men. Except for homicide among Latino men, Latinos and Asians have comparable or lower YLL rates among the leading causes of death compared to whites. Conclusion Local death registry data can be used to measure, rank, and

Patient-provider language concordance and colorectal cancer screening.

Science.gov (United States)

Linsky, Amy; McIntosh, Nathalie; Cabral, Howard; Kazis, Lewis E

2011-02-01

Patient-provider language barriers may play a role in health-care disparities, including obtaining colorectal cancer (CRC) screening. Professional interpreters and language-concordant providers may mitigate these disparities. DESIGN, SUBJECTS, AND MAIN MEASURES: We performed a retrospective cohort study of individuals age 50 years and older who were categorized as English-Concordant (spoke English at home, n = 21,594); Other Language-Concordant (did not speak English at home but someone at their provider's office spoke their language, n = 1,463); or Other Language-Discordant (did not speak English at home and no one at their provider's spoke their language, n = 240). Multivariate logistic regression assessed the association of language concordance with colorectal cancer screening. Compared to English speakers, non-English speakers had lower use of colorectal cancer screening (30.7% vs 50.8%; OR, 0.63; 95% CI, 0.51-0.76). Compared to the English-Concordant group, the Language-Discordant group had similar screening (adjusted OR, 0.84; 95% CI, 0.58-1.21), while the Language-Concordant group had lower screening (adjusted OR, 0.57; 95% CI, 0.46-0.71). Rates of CRC screening are lower in individuals who do not speak English at home compared to those who do. However, the Language-Discordant cohort had similar rates to those with English concordance, while the Language-Concordant cohort had lower rates of CRC screening. This may be due to unmeasured differences among the cohorts in patient, provider, and health care system characteristics. These results suggest that providers should especially promote the importance of CRC screening to non-English speaking patients, but that language barriers do not fully account for CRC screening rate disparities in these populations.

Can universal coverage eliminate health disparities? Reversal of disparate injury outcomes in elderly insured minorities.

Science.gov (United States)

Ramirez, Michelle; Chang, David C; Rogers, Selwyn O; Yu, Peter T; Easterlin, Molly; Coimbra, Raul; Kobayashi, Leslie

2013-06-15

Health outcome disparities in racial minorities are well documented. However, it is unknown whether such disparities exist among elderly injured patients. We hypothesized that such disparities might be reduced in the elderly owing to insurance coverage under Medicare. We investigated this issue by comparing the trauma outcomes in young and elderly patients in California. A retrospective analysis of the California Office of Statewide Health Planning and Development hospital discharge database was performed for all publicly available years from 1995 to 2008. Trauma admissions were identified by International Classification of Disease, Ninth Revision, primary diagnosis codes from 800 to 959, with certain exclusions. Multivariate analysis examined the adjusted risk of in-hospital mortality in young (<65 y) and elderly (≥65 y) patients, controlling for age, gender, injury severity as measured by the survival risk ratio, Charlson comorbidity index, insurance status, calendar year, and teaching hospital status. A total of 1,577,323 trauma patients were identified. Among the young patients, the adjusted odds ratio of death relative to non-Hispanic whites for blacks, Hispanics, Asians, and Native Americans/others was 1.2, 1.2, 0.90, and 0.78, respectively. The corresponding adjusted odds ratios of death for elderly patients were 0.78, 0.87, 0.92, and 0.61. Young black and Hispanic trauma patients had greater mortality risks relative to non-Hispanic white patients. Interestingly, elderly black and Hispanic patients had lower mortality risks compared with non-Hispanic whites. Copyright © 2013 Elsevier Inc. All rights reserved.

Trust in physicians and racial disparities in HIV care.

Science.gov (United States)

Saha, Somnath; Jacobs, Elizabeth A; Moore, Richard D; Beach, Mary Catherine

2010-07-01

Mistrust among African Americans is often considered a potential source of racial disparities in HIV care. We sought to determine whether greater trust in one's provider among African-American patients mitigates racial disparities. We analyzed data from 1,104 African-American and 201 white patients participating in a cohort study at an urban, academic HIV clinic between 2005 and 2008. African Americans expressed lower levels of trust in their providers than did white patients (8.9 vs. 9.4 on a 0-10 scale; p African Americans were also less likely than whites to be receiving antiretroviral therapy (ART) when eligible (85% vs. 92%; p = 0.02), to report complete ART adherence over the prior 3 days (83% vs. 89%; p = 0.005), and to have a suppressed viral load (40% vs. 47%; p = 0.04). Trust in one's provider was not associated with receiving ART or with viral suppression but was significantly associated with adherence. African Americans who expressed less than complete trust in their providers (0-9 of 10) had lower ART adherence than did whites (adjusted OR, 0.40; 95% CI, 0.25-0.66). For African Americans who expressed complete trust in their providers (10 of 10), the racial disparity in adherence was less prominent but still substantial (adjusted OR, 0.59; 95% CI, 0.36-0.95). Trust did not affect disparities in receipt of ART or viral suppression. Our findings suggest that enhancing trust in patient-provider relationships for African-American patients may help reduce disparities in ART adherence and the outcomes associated with improved adherence.

Histopathologic differences account for racial disparity in uterine cancer survival☆,☆☆

Science.gov (United States)

Smotkin, David; Nevadunsky, Nicole S.; Harris, Kimala; Einstein, Mark H.; Yu, Yiting; Goldberg, Gary L.

2013-01-01

Objective The incidence for uterine cancers has been reported to be higher among white women, whereas mortality is higher among black women. Reasons for the higher mortality among black women are not completely understood. The aim of our study is to examine the relationship between race/ethnicity, histopathologic subtype, and survival in uterine cancer. Methods We abstracted socio-demographic, treatment, and survival data for all women who were diagnosed with uterine cancer at Montefiore Medical Center from January 1999 through December 2009. Pathology records were reviewed. Results 984 patients were identified. Racial/ethnic distribution was 382 (39%) white, 308 (31%) black, 232 (24%) Hispanic, and 62 (6.3%) other races, mixed, or unknown. 592 (60%) patients had endometrioid histology. Blacks were much more likely than whites to have non-endometrioid histologies (p<0.001), including papillary serous, carcinosarcoma, and leiomyosarcoma. Blacks and Hispanics were at least as likely as whites to receive either chemotherapy or radiation therapy. The hazard ratio for death for black versus white patients was 1.94 (p<0.001) when all histological subtypes were included. The hazard ratio for Hispanics for death was 1.2 (p=0.32) compared to whites. However, when patients were divided into endometrioid and non-endometrioid histological subtypes, there was no significant difference in survival by race/ethnicity. Conclusion Black patients with uterine cancer are much more likely to die and are much more likely to have non-endometrioid histologies than white patients. There are no differences in survival among white, black, or Hispanic women with uterine cancer, after control for histological subtype. PMID:22940487

Age-Related Racial Disparity in Suicide Rates Among U.S. Youth

Science.gov (United States)

... May 30, 2018 Age-Related Racial Disparity in Youth Suicide Rates May 21, 2018 News by Year 2018 ... May 30, 2018 Age-Related Racial Disparity in Youth Suicide Rates May 21, 2018 News by Year 2018 ...

Biomarkers for bladder cancer management: present and future

Science.gov (United States)

Ye, Fei; Wang, Li; Castillo-Martin, Mireia; McBride, Russell; Galsky, Matthew D; Zhu, Jun; Boffetta, Paolo; Zhang, David Y; Cordon-Cardo, Carlos

2014-01-01

Accurate and sensitive detection of bladder cancer is critical to diagnose this deadly disease at an early stage, estimate prognosis, predict response to treatment, and monitor recurrence. In past years, laboratory diagnosis and surveillance of urinary bladder cancer have improved significantly. Although urine cytology remains the gold standard test, many new urinary biomarkers have been identified. Furthermore, recent advances in genomic studies of bladder cancer have helped to refine our understanding of the pathogenesis of the disease, the biological basis for outcome disparities, and to inform more efficient treatment and surveillance strategies. In this article, the established diagnostic tests, newly identified biomarkers and genomic landscape of bladder cancer will be reviewed. PMID:25374904

Friend Effects and Racial Disparities in Academic Achievement

Directory of Open Access Journals (Sweden)

Jennifer Flashman

2014-07-01

Full Text Available Racial disparities in achievement are a persistent fact of the US educational system. An often cited but rarely directly studied explanation for these disparities is that adolescents from different racial and ethnic backgrounds are exposed to different peers and have different friends. In this article I identify the impact of friends on racial and ethnic achievement disparities. Using data from Add Health and an instrumental variable approach, I show that the achievement characteristics of youths’ friends drive friend effects; adolescents with friends with higher grades are more likely to increase their grades compared to those with lower-achieving friends. Although these effects do not differ across race/ethnicity, given differences in friendship patterns, if black and Latino adolescents had friends with the achievement characteristics of white students, the GPA gap would be 17 to 19 percent smaller. Although modest, this effect represents an important and often overlooked source of difference among black and Latino youth.

Asthma Management Disparities: A Photovoice Investigation with African American Youth

Science.gov (United States)

Evans-Agnew, Robin

2016-01-01

Disparities in asthma management are a burden on African American youth. The objective of this study is to describe and compare the discourses of asthma management disparities (AMDs) in African American adolescents in Seattle to existing youth-related asthma policies in Washington State. Adolescents participated in a three-session photovoice…

75 FR 2552 - NIH State-of-the-Science Conference: Enhancing Use and Quality of Colorectal Cancer Screening

Science.gov (United States)

2010-01-15

... tests is available in the United States. The U.S. Preventive Services Task Force currently recommends... disparity are complex. Unlike most other preventive services, in colorectal cancer screening there are... access to the tests. Successful completion of colorectal cancer screening requires effort on the part of...

Social justice, health disparities, and culture in the care of the elderly.

Science.gov (United States)

Dilworth-Anderson, Peggye; Pierre, Geraldine; Hilliard, Tandrea S

2012-01-01

Older minority Americans experience worse health outcomes than their white counterparts, exhibiting the need for social justice in all areas of their health care. Justice, fairness, and equity are crucial to minimizing conditions that adversely affect the health of individuals and communities. In this paper, Alzheimer's disease (AD) is used as an example of a health care disparity among elderly Americans that requires social justice interventions. Cultural factors play a crucial role in AD screening, diagnosis, and access to care, and are often a barrier to support and equality for minority communities. The "conundrum of health disparities" refers to the interplay between disparity, social justice, and cultural interpretation, and encourages researchers to understand both (1) disparity caused by economic and structural barriers to access, treatment, and diagnosis, and (2) disparity due to cultural interpretation of disease, in order to effectively address health care issues and concerns among elderly Americans. © 2012 American Society of Law, Medicine & Ethics, Inc.

Organizational Change Management For Health Equity: Perspectives From The Disparities Leadership Program.

Science.gov (United States)

Betancourt, Joseph R; Tan-McGrory, Aswita; Kenst, Karey S; Phan, Thuy Hoai; Lopez, Lenny

2017-06-01

Leaders of health care organizations need to be prepared to improve quality and achieve equity in today's health care environment characterized by a focus on achieving value and addressing disparities in a diverse population. To help address this need, the Disparities Solutions Center at Massachusetts General Hospital launched the Disparities Leadership Program in 2007. The leadership program is an ongoing, year-long, executive education initiative that trains leaders from hospitals, health plans, and health centers to improve quality and eliminate racial and ethnic disparities in health care. Feedback from participating organizations demonstrates that health care leaders seem to possess knowledge about what disparities are and about what should be done to eliminate them. Data collection, performance measurement, and multifaceted interventions remain the tools of the trade. However, the barriers to success are lack of leadership buy-in, organizational prioritization, energy, and execution, which can be addressed through organizational change management strategies. Project HOPE—The People-to-People Health Foundation, Inc.

Linking Diversity and Disparity Measures

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Sahadeb Sarkar

2012-07-01

Full Text Available Normal 0 false false false EN-US X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman","serif";} The purpose of this paper is to examine links between the diversity measures (Patil and Taillie 1982 and the disparity measures (Lindsay 1994, quantities apparently developed for somewhat different purposes. We demonstrate that numerous diversity measures satisfying all the desirable criteria mentioned by Patil and Taillie can be defined by the generating functions of certain disparities and the associated residual adjustment functions. This provides the statistician and the ecologist a wide class of flexible indices for the statistical measurement of diversity.

Socioeconomic Disparities and Health: Impacts and Pathways

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Kondo, Naoki

2012-01-01

Growing socioeconomic disparity is a global concern, as it could affect population health. The author and colleagues have investigated the health impacts of socioeconomic disparities as well as the pathways that underlie those disparities. Our meta-analysis found that a large population has risks of mortality and poor self-rated health that are attributable to income inequality. The study results also suggested the existence of threshold effects (ie, a threshold of income inequality over which the adverse impacts on health increase), period effects (ie, the potential for larger impacts in later years, specifically after the 1990s), and lag effects between income inequality and health outcomes. Our other studies using Japanese national representative survey data and a large-scale cohort study of Japanese older adults (AGES cohort) support the relative deprivation hypothesis, namely, that invidious social comparisons arising from relative deprivation in an unequal society adversely affect health. A study with a natural experiment design found that the socioeconomic gradient in self-rated health might actually have become shallower after the 1997–98 economic crisis in Japan, due to smaller health improvements among middle-class white-collar workers and middle/upper-income workers. In conclusion, income inequality might have adverse impacts on individual health, and psychosocial stress due to relative deprivation may partially explain those impacts. Any study of the effects of macroeconomic fluctuations on health disparities should also consider multiple potential pathways, including expanding income inequality, changes in the labor market, and erosion of social capital. Further studies are needed to attain a better understanding of the social determinants of health in a rapidly changing society. PMID:22156290

Socioeconomic disparities and health: impacts and pathways.

Science.gov (United States)

Kondo, Naoki

2012-01-01

Growing socioeconomic disparity is a global concern, as it could affect population health. The author and colleagues have investigated the health impacts of socioeconomic disparities as well as the pathways that underlie those disparities. Our meta-analysis found that a large population has risks of mortality and poor self-rated health that are attributable to income inequality. The study results also suggested the existence of threshold effects (ie, a threshold of income inequality over which the adverse impacts on health increase), period effects (ie, the potential for larger impacts in later years, specifically after the 1990s), and lag effects between income inequality and health outcomes. Our other studies using Japanese national representative survey data and a large-scale cohort study of Japanese older adults (AGES cohort) support the relative deprivation hypothesis, namely, that invidious social comparisons arising from relative deprivation in an unequal society adversely affect health. A study with a natural experiment design found that the socioeconomic gradient in self-rated health might actually have become shallower after the 1997-98 economic crisis in Japan, due to smaller health improvements among middle-class white-collar workers and middle/upper-income workers. In conclusion, income inequality might have adverse impacts on individual health, and psychosocial stress due to relative deprivation may partially explain those impacts. Any study of the effects of macroeconomic fluctuations on health disparities should also consider multiple potential pathways, including expanding income inequality, changes in the labor market, and erosion of social capital. Further studies are needed to attain a better understanding of the social determinants of health in a rapidly changing society.

Racial/Ethnic Disparities in Nursing Home Quality of Life Deficiencies, 2001 to 2011

Directory of Open Access Journals (Sweden)

Lauren J. Campbell MA

2016-06-01

Full Text Available Objectives: Racial/ethnic disparities in nursing homes (NHs are associated with lower quality of care, and state Medicaid payment policies may influence NH quality. However, no studies analyzing disparities in NH quality of life (QoL exist. Therefore, this study aims to estimate associations at the NH level between average number of QoL deficiencies and concentrations of racial/ethnic minority residents, and to identify effects of state Medicaid payment policies on racial/ethnic disparities. Method: Multivariable Poisson regression with NH random effects was used to determine the association between NH minority concentration in 2000 to 2010 and average number of QoL deficiencies in 2001 to 2011 at the NH level, and the effect of state NH payment policies on QoL deficiencies and racial/ethnic disparities in QoL deficiencies across NH minority concentrations. Results: Racial/ethnic disparities in QoL between high and low minority concentration NHs decrease over time, but are not eliminated. Case mix payment was associated with an increased disparity between high and low minority concentration NHs in QoL deficiencies. Discussion: NH managers and policy makers should consider initiatives targeting minority residents or low-performing NHs with higher minority concentrations for improvement to reduce disparities and address QoL deficiencies.

The role of health-related behaviors in the socioeconomic disparities in oral health.

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Sabbah, Wael; Tsakos, Georgios; Sheiham, Aubrey; Watt, Richard G

2009-01-01

This study aimed to examine the socioeconomic disparities in health-related behaviors and to assess if behaviors eliminate socioeconomic disparities in oral health in a nationally representative sample of adult Americans. Data are from the US Third National Health and Nutrition Examination Survey (1988-1994). Behaviors were indicated by smoking, dental visits, frequency of eating fresh fruits and vegetables and extent of calculus, used as a marker for oral hygiene. Oral health outcomes were gingival bleeding, loss of periodontal attachment, tooth loss and perceived oral health. Education and income indicated socioeconomic position. Sex, age, ethnicity, dental insurance and diabetes were adjusted for in the regression analysis. Regression analysis was used to assess socioeconomic disparities in behaviors. Regression models adjusting and not adjusting for behaviors were compared to assess the change in socioeconomic disparities in oral health. The results showed clear socioeconomic disparities in all behaviors. After adjusting for behaviors, the association between oral health and socioeconomic indicators attenuated but did not disappear. These findings imply that improvement in health-related behaviors may lessen, but not eliminate socioeconomic disparities in oral health, and suggest the presence of more complex determinants of these disparities which should be addressed by oral health preventive policies.

Examining Sexual Orientation Disparities in Unmet Medical Needs among Men and Women

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Everett, Bethany G.; Mollborn, Stefanie

2013-01-01

Using the National Longitudinal Study of Adolescent Health (N = 13,810), this study examines disparities in unmet medical needs by sexual orientation identity during young adulthood. We use binary logistic regression and expand Andersen’s health care utilization framework to identify factors that shape disparities in unmet medical needs by sexual orientation. We also investigate whether the well-established gender disparity in health-seeking behaviors among heterosexual persons holds for sexu...

Gender Disparity at Elementary Education Level in Jammu and Kashmir: An Exploratory Study

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Gul, Showkeen Bilal Ahmad; Khan, Zebun Nisa

2014-01-01

This paper is based on a study to explore gender disparity at elementary education level in Jammu and Kashmir. Gender disparity in education refers to differences in outcomes observed between two sexes. Education disparities can be seen in different enrolment rates, dropout rates, and survival rates among the sexes. The central government and…

Trends in racial disparities for asthma outcomes among children 0 to 17 years, 2001-2010.

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Akinbami, Lara J; Moorman, Jeanne E; Simon, Alan E; Schoendorf, Kenneth C

2014-09-01

Racial disparities in childhood asthma have been a long-standing target for intervention, especially disparities in hospitalization and mortality. Describe trends in racial disparities in asthma outcomes using both traditional population-based rates and at-risk rates (based on the estimated number of children with asthma) to account for prevalence differences between race groups. Estimates of asthma prevalence and outcomes (emergency department [ED] visits, hospitalizations, and deaths) were calculated from national data for 2001 to 2010 for black and white children. Trends were calculated using weighted loglinear regression, and changes in racial disparities over time were assessed using Joinpoint. Disparities in asthma prevalence between black and white children increased from 2001 to 2010; at the end of this period, black children were twice as likely as white children to have asthma. Population-based rates showed that disparities in asthma outcomes remained stable (ED visits and hospitalizations) or increased (asthma attack prevalence, deaths). In contrast, analysis with at-risk rates, which account for differences in asthma prevalence, showed that disparities in asthma outcomes remained stable (deaths), decreased (ED visits, hospitalizations), or did not exist (asthma attack prevalence). Using at-risk rates to assess racial disparities in asthma outcomes accounts for prevalence differences between black and white children, and adds another perspective to the population-based examination of asthma disparities. An at-risk rate analysis shows that among children with asthma, there is no disparity for asthma attack prevalence and that progress has been made in decreasing disparities in asthma ED visit and hospitalization rates. Published by Elsevier Inc.

Implementing the Institute of Medicine definition of disparities: an application to mental health care.

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McGuire, Thomas G; Alegria, Margarita; Cook, Benjamin L; Wells, Kenneth B; Zaslavsky, Alan M

2006-10-01

In a recent report, the Institute of Medicine (IOM) defines a health service disparity between population groups to be the difference in treatment or access not justified by the differences in health status or preferences of the groups. This paper proposes an implementation of this definition, and applies it to disparities in outpatient mental health care. Health Care for Communities (HCC) reinterviewed 9,585 respondents from the Community Tracking Study in 1997-1998, oversampling individuals with psychological distress, alcohol abuse, drug abuse, or mental health treatment. The HCC is designed to make national estimates of service use. Expenditures are modeled using generalized linear models with a log link for quantity and a probit model for any utilization. We adjust for group differences in health status by transforming the entire distribution of health status for minority populations to approximate the white distribution. We compare disparities according to the IOM definition to other methods commonly used to assess health services disparities. Our method finds significant service disparities between whites and both blacks and Latinos. Estimated disparities from this method exceed those for competing approaches, because of the inclusion of effects of mediating factors (such as income) in the IOM approach. A rigorous definition of disparities is needed to monitor progress against disparities and to compare their magnitude across studies. With such a definition, disparities can be estimated by adjusting for group differences in models for expenditures and access to mental health services.

Occupational Therapy Use by Older Adults With Cancer

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Pergolotti, Mackenzi; Cutchin, Malcolm P.; Weinberger, Morris; Meyer, Anne-Marie

2014-01-01

Occupational therapy may significantly improve cancer survivors’ ability to participate in activities, thereby improving quality of life. Little is known, however, about the use of occupational therapy services by adults with cancer. The objective of this study was to understand what shapes patterns of occupational therapy use to help improve service delivery. We examined older (age >65 yr) adults diagnosed with breast, prostate, lung, or melanoma (skin) cancer between 2004 and 2007 (N = 27,131) using North Carolina Central Cancer Registry data linked to Medicare billing claims. Survivors who used occupational therapy within 1 yr before their cancer diagnosis were more likely to use occupational therapy after diagnosis but also experienced the highest levels of comorbidities. Survivors with Stage 4 cancers or lung cancer were less likely to use occupational therapy. These findings suggest possible disparities in utilization of occupational therapy by older adults with cancer. PMID:25184473

Northeast Regional Cancer Institute's Cancer Surveillance and Risk Factor Program

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Lesko, Samuel M.

2007-07-31

OBJECTIVES The Northeast Regional Cancer Institute is conducting a program of ongoing epidemiologic research to address cancer disparities in northeast Pennsylvania. Of particular concern are disparities in the incidence of, stage at diagnosis, and mortality from colorectal cancer. In northeast Pennsylvania, age-adjusted incidence and mortality rates for colorectal cancer are higher, and a significantly smaller proportion of new colorectal cancer cases are diagnosed with local stage disease than is observed in comparable national data. Further, estimates of the prevalence of colorectal cancer screening in northeast Pennsylvania are lower than the US average. The Northeast Regional Cancer Institute’s research program supports surveillance of common cancers, investigations of cancer risk factors and screening behaviors, and the development of resources to further cancer research in this community. This project has the following specific objectives: I. To conduct cancer surveillance in northeast Pennsylvania. a. To monitor incidence and mortality for all common cancers, and colorectal cancer, in particular, and b. To document changes in the stage at diagnosis of colorectal cancer in this high-risk, underserved community. II. To conduct a population-based study of cancer risk factors and screening behavior in a six county region of northeast Pennsylvania. a. To monitor and document changes in colorectal cancer screening rates, and b. To document the prevalence of cancer risk factors (especially factors that increase the risk of colorectal cancer) and to identify those risk factors that are unusually common in this community. APPROACH Cancer surveillance was conducted using data from the Northeast Regional Cancer Institute’s population-based Regional Cancer Registry, the Pennsylvania Cancer Registry, and NCI’s SEER program. For common cancers, incidence and mortality were examined by county within the region and compared to data for similar populations in the US

Clinical cultural competency and knowledge of health disparities among pharmacy students.

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Okoro, Olihe N; Odedina, Folakemi T; Reams, Romonia R; Smith, W Thomas

2012-04-10

To evaluate the level of competency and knowledge about health disparities among third-year doctor of pharmacy (PharmD) students at 2 Florida public colleges of pharmacy and to explore the demographic correlates of these variables. A cross-sectional survey study design was used to collect data from participants. The students had low health-disparities knowledge and moderate skills in dealing with sociocultural issues and cross-cultural encounters. Speaking a language(s) other than English and having exposure to cultural-competency instruction were the demographic variables found to be most significantly associated with clinical cultural competency and/or knowledge of health disparities. Clinical cultural competency and health-disparities instruction may not be adequately incorporated into the pharmacy school curricula in the institutions studied. Relevant education and training are necessary to enhance cultural competency among pharmacy students.

Area-socioeconomic disparities in mental health service use among children involved in the child welfare system.

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Kim, Minseop; Garcia, Antonio R; Yang, Shuyan; Jung, Nahri

2018-06-01

Relying on data from a nationally representative sample of youth involved in the child welfare system (CWS) in 1999-2000 (the National Survey of Child and Adolescent Well-Being, Cohort 1) and 2008-2009 (Cohort 2), this study implemented a diverse set of disparity indicators to estimate area-socioeconomic disparities in mental health (MH) services use and changes in area-socioeconomic disparities between the two cohorts. Our study found that there are area-socioeconomic disparities in MH service use, indicating that the rates of MH service use among youth referred to the CWS differ by area-socioeconomic positions defined by county-level poverty rates. We also found that area-socioeconomic disparities increased over time. However, the magnitude of the increase varied widely across disparity measures, suggesting that there are different conclusions about the trend and magnitude of area-socioeconomic disparities, depending upon which disparity measures are implemented. A greater understanding of the methodological differences among disparity measures is warranted, which will in turn impact how interventions are designed to reduce socioeconomic disparities among children in the CWS. Copyright © 2018. Published by Elsevier Ltd.

Disparities in Adherence to National Comprehensive Cancer Network Treatment Guidelines and Survival for Stage IB-IIA Cervical Cancer in California.

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Pfaendler, Krista S; Chang, Jenny; Ziogas, Argyrios; Bristow, Robert E; Penner, Kristine R

2018-05-01

To evaluate the association of sociodemographic and hospital characteristics with adherence to National Comprehensive Cancer Network treatment guidelines for stage IB-IIA cervical cancer and to analyze the relationship between adherent care and survival. This is a retrospective population-based cohort study of patients with stage IB-IIA invasive cervical cancer reported to the California Cancer Registry from January 1, 1995, through December 31, 2009. Adherence to National Comprehensive Cancer Network guideline care was defined by year- and stage-appropriate surgical procedures, radiation, and chemotherapy. Multivariate logistic regression, Kaplan-Meier estimate, and Cox proportional hazard models were used to examine associations between patient, tumor, and treatment characteristics and National Comprehensive Cancer Network guideline adherence and cervical cancer-specific 5-year survival. A total of 6,063 patients were identified. Forty-seven percent received National Comprehensive Cancer Network guideline-adherent care, and 18.8% were treated in high-volume centers (20 or more patients/year). On multivariate analysis, lowest socioeconomic status (adjusted odds ratio [OR] 0.69, 95% CI 0.57-0.84), low-middle socioeconomic status (adjusted OR 0.76, 95% CI 0.64-0.92), and Charlson-Deyo comorbidity score 1 or higher (adjusted OR 0.78, 95% CI 0.69-0.89) were patient characteristics associated with receipt of nonguideline care. Receiving adherent care was less common in low-volume centers (45.9%) than in high-volume centers (50.9%) (effect size 0.90, 95% CI 0.84-0.96). Death from cervical cancer was more common in the nonadherent group (13.3%) than in the adherent group (8.6%) (effect size 1.55, 95% CI 1.34-1.80). Black race (adjusted hazard ratio 1.56, 95% CI 1.08-2.27), Medicaid payer status (adjusted hazard ratio 1.47, 95% CI 1.15-1.87), and Charlson-Deyo comorbidity score 1 or higher (adjusted hazard ratio 2.07, 95% CI 1.68-2.56) were all associated with increased

Gender-Based Pay Disparities in Intercollegiate Coaching: The Legal Issues.

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Gaal, John; Glazier, Michael S.; Evans, Thomas S.

2002-01-01

Explores the legal issues surrounding pay disparities between men and women in intercollegiate coaching, including how courts have treated disparate wage claims under the Equal Pay Act, Title VII of the Civil Rights Act of 1964, and Title IX, and the defenses used by institutions. Offers suggestions for defending claims and a detailed review of…

Same-Sex and Race-Based Disparities in Statutory Rape Arrests.

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Chaffin, Mark; Chenoweth, Stephanie; Letourneau, Elizabeth J

2016-01-01

This study tests a liberation hypothesis for statutory rape incidents, specifically that there may be same-sex and race/ethnicity arrest disparities among statutory rape incidents and that these will be greater among statutory rape than among forcible sex crime incidents. 26,726 reported incidents of statutory rape as defined under state statutes and 96,474 forcible sex crime incidents were extracted from National Incident-Based Reporting System data sets. Arrest outcomes were tested using multilevel modeling. Same-sex statutory rape pairings were rare but had much higher arrest odds. A victim-offender romantic relationship amplified arrest odds for same-sex pairings, but damped arrest odds for male-on-female pairings. Same-sex disparities were larger among statutory than among forcible incidents. Female-on-male incidents had uniformly lower arrest odds. Race/ethnicity effects were smaller than gender effects and more complexly patterned. The findings support the liberation hypothesis for same-sex statutory rape arrest disparities, particularly among same-sex romantic pairings. Support for race/ethnicity-based arrest disparities was limited and mixed. © The Author(s) 2014.

Reducing time-to-treatment in underserved Latinas with breast cancer: the Six Cities Study.

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Ramirez, Amelie; Perez-Stable, Eliseo; Penedo, Frank; Talavera, Gregory; Carrillo, J Emilio; Fernández, María; Holden, Alan; Munoz, Edgar; San Miguel, Sandra; Gallion, Kipling

2014-03-01

The interaction of clinical and patient-level challenges following a breast cancer diagnosis can be a significant source of health care disparities. Failure to address specific cultural features that create or exacerbate barriers can lead to less-than optimal navigation results, specifically in Hispanic/Latino women. To address these disparities, the study leaders in San Antonio, Texas, and 5 other regional partners of the federally-funded Redes En Acción: The National Latino Cancer Research Network developed a culturally-tailored patient navigation intervention model for Latinas with breast cancer. Compared with control patients, a higher percentage of navigated subjects initiated treatment within 30 days (69.0% versus 46.3%, P = .029) and 60 days (97.6% versus 73.1%, P = .001) following their cancer diagnosis. Time from cancer diagnosis to first treatment was lower in the navigated group (mean, 22.22 days; median, 23.00 days) than controls (mean, 48.30 days; median, 33.00 days). These results were independent of cancer stage at diagnosis and numerous characteristics of cancer clinics and individual participants. Successful application of patient navigation increased the percentage of Latinas initiating breast cancer treatment within 30 and 60 days of diagnosis. This was achieved through navigator provision of services such as accompaniment to appointments, transportation arrangements, patient telephone support, patient-family telephone support, Spanish-English language translation, and assistance with insurance paperwork. © 2013 American Cancer Society.

The emerging role of the androgen receptor in bladder cancer.

Science.gov (United States)

Lombard, Alan P; Mudryj, Maria

2015-10-01

Men are three to four times more likely to get bladder cancer than women. The gender disparity characterizing bladder cancer diagnoses has been investigated. One hypothesis is that androgen receptor (AR) signaling is involved in the etiology and progression of this disease. Although bladder cancer is not typically described as an endocrine-related malignancy, it has become increasingly clear that AR signaling plays a role in bladder tumors. This review summarizes current findings regarding the role of the AR in bladder cancer. We discuss work demonstrating AR expression in bladder cancer and its role in promoting formation and progression of tumors. Additionally, we discuss the therapeutic potential of targeting the AR in this disease. © 2015 Society for Endocrinology.

When does power disparity help or hurt group performance?

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Tarakci, Murat; Greer, Lindred L; Groenen, Patrick J F

2016-03-01

Power differences are ubiquitous in social settings. However, the question of whether groups with higher or lower power disparity achieve better performance has thus far received conflicting answers. To address this issue, we identify 3 underlying assumptions in the literature that may have led to these divergent findings, including a myopic focus on static hierarchies, an assumption that those at the top of hierarchies are competent at group tasks, and an assumption that equality is not possible. We employ a multimethod set of studies to examine these assumptions and to understand when power disparity will help or harm group performance. First, our agent-based simulation analyses show that by unpacking these common implicit assumptions in power research, we can explain earlier disparate findings--power disparity benefits group performance when it is dynamically aligned with the power holder's task competence, and harms group performance when held constant and/or is not aligned with task competence. Second, our empirical findings in both a field study of fraud investigation groups and a multiround laboratory study corroborate the simulation results. We thereby contribute to research on power by highlighting a dynamic understanding of power in groups and explaining how current implicit assumptions may lead to opposing findings. (c) 2016 APA, all rights reserved).

Effects of Social, Economic, and Labor Policies on Occupational Health Disparities

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Siqueira, Carlos Eduardo; Gaydos, Megan; Monforton, Celeste; Slatin, Craig; Borkowski, Liz; Dooley, Peter; Liebman, Amy; Rosenberg, Erica; Shor, Glenn; Keifer, Matthew

2018-01-01

Background This article introduces some key labor, economic, and social policies that historically and currently impact occupational health disparities in the United States. Methods We conducted a broad review of the peer-reviewed and gray literature on the effects of social, economic, and labor policies on occupational health disparities. Results Many populations such as tipped workers, public employees, immigrant workers, and misclassified workers are not protected by current laws and policies, including worker’s compensation or Occupational Safety and Health Administration enforcement of standards. Local and state initiatives, such as living wage laws and community benefit agreements, as well as multiagency law enforcement contribute to reducing occupational health disparities. Conclusions There is a need to build coalitions and collaborations to command the resources necessary to identify, and then reduce and eliminate occupational disparities by establishing healthy, safe, and just work for all. PMID:23606055

76 FR 18566 - National Center on Minority and Health Disparities; Notice of Closed Meeting

Science.gov (United States)

2011-04-04

... and Health Disparities; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory... and Health Disparities Special Emphasis Panel, NIMHD Conference Grant Application (R13) Review. Date... Health and Health Disparities, 6707 Democracy Boulevard, Suite 800, Bethesda, MD 20892, (301) 451-9536...

The History and Use of Cancer Registry Data by Public Health Cancer Control Programs in the United States

Science.gov (United States)

White, Mary C.; Babcock, Frances; Hayes, Nikki S.; Mariotto, Angela B.; Wong, Faye L.; Kohler, Betsy A.; Weir, Hannah K.

2018-01-01

Because cancer registry data provide a census of cancer cases, registry data can be used to: 1) define and monitor cancer incidence at the local, state, and national levels; 2) investigate patterns of cancer treatment; and 3) evaluate the effectiveness of public health efforts to prevent cancer cases and improve cancer survival. The purpose of this article is to provide a broad overview of the history of cancer surveillance programs in the United States, and illustrate the expanding ways in which cancer surveillance data are being made available and contributing to cancer control programs. The article describes the building of the cancer registry infrastructure and the successful coordination of efforts among the 2 federal agencies that support cancer registry programs, the Centers for Disease Control and Prevention and the National Cancer Institute, and the North American Association of Central Cancer Registries. The major US cancer control programs also are described, including the National Comprehensive Cancer Control Program, the National Breast and Cervical Cancer Early Detection Program, and the Colorectal Cancer Control Program. This overview illustrates how cancer registry data can inform public health actions to reduce disparities in cancer outcomes and may be instructional for a variety of cancer control professionals in the United States and in other countries. PMID:29205307