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1.
Artigo em Inglês | MEDLINE | ID: mdl-34697057

RESUMO

Background Asian Americans (AA) are the fastest growing ethnic group in the US with high proportions of immigrants. Nativity is important as cancer risk factors vary by country. We sought to understand differences in cancer mortality among AAs by nativity (foreign-born vs. US-born). Methods 98,826 AA (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese) decedents with cancer-related deaths from US death certificates (2008-2017) were analyzed. Thirteen cancers that contribute significantly to AA cancer mortality were selected and categorized by etiology: tobacco-related, screen-detected, diet/obesity-related, and infection-related. 10-year age-adjusted mortality rates [AAMR (95% CI); per 100,00] and standardized mortality ratios [SMR (95% CI)] using foreign-born as the reference group were calculated. Results Overall, foreign-born AAs had higher mortality rates than US-born. Japanese US-born males had the highest tobacco-related mortality rates (Foreign-born AAMR: 43.02 [38.72, 47.31], US-born AAMR: 55.38 [53.05, 57.72]). Screen-detected death rates were higher for foreign-born than US-born, except for among Japanese males [SMR 1.28 (1.21-1.35)]. Diet/obesity-related AAMRs were higher among females than males and highest among foreign-born females. Foreign-born males and females had higher infection-related AAMRs than US-born; the highest rates were foreign-born males: Korean (AAMR 41.54 [39.54, 43.53]) and Vietnamese (AAMR 41.39 [39.68, 43.09]). Conclusions We observed substantial heterogeneity in mortality rates across AA groups and by nativity. Contrary to the Healthy Immigrant Effect, most foreign-born Asians were dying at higher rates than US-born AAs. Impact: Disaggregated analysis of AA cancers, targeted and culturally tailored cancer screening, and treatments for infections among foreign-born Asians is critical for cancer prevention efforts.

2.
Nat Rev Dis Primers ; 7(1): 74, 2021 10 14.
Artigo em Inglês | MEDLINE | ID: mdl-34650078
3.
J Gen Intern Med ; 2021 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-34505981

RESUMO

BACKGROUND: There remains uncertainty regarding optimal primary atherosclerotic cardiovascular disease (ASCVD) prevention practices for older adults. OBJECTIVE: To assess statin treatment patterns and incident ASCVD among older patients for primary prevention across the spectrum of ASCVD risk. DESIGN: Retrospective cohort study of participants without ASCVD aged 65-79 years. Patients were stratified by age (65-69, 70-75, > 75 years) and 10-year ASCVD risk category (low/borderline, intermediate, high) based on the Pooled Cohort Equations. Multivariable logistic regressions were used to identify predictors of moderate- or high-intensity statin prescriptions. Cox proportional models were used to estimate hazard ratios (HRs) for incident ASCVD. PARTICIPANTS: Patients aged 65-79 years without ASCVD from a Northern California health system. MAIN MEASURES: Statin prescriptions and incident ASCVD events. KEY RESULTS: There were 54,066 patients, with 10,288 (19%) aged > 75 years and 57% women. Compared with younger groups, adults > 75 years were less likely to be prescribed moderate- or high-intensity statin prescriptions across ASCVD risk groups (all p < 0.001); this persisted after multivariable adjustment including for ASCVD risk (odds ratio [OR] 0.80, 95% confidence interval [CI] 0.74-0.86). Adults > 75 years were more likely to experience incident ASCVD (HR 1.42, 95% CI 1.23-1.63). Women (OR 0.85, 95% CI 0.81-0.89) and underweight older adults (OR 0.45, 95% CI 0.33-0.61) were also less likely to receive moderate- or high-intensity statins. CONCLUSIONS: Among older adults aged 65-79 years without prior ASCVD, those > 75 years of age were less likely to receive moderate- or high-intensity statins regardless of ASCVD risk compared with their younger counterparts, while experiencing more incident ASCVD. Efforts are warranted to study the reasons for age-based differences in statin use in older adults, particularly those at highest ASCVD risk.

4.
J Thorac Cardiovasc Surg ; 162(2): e183-e353, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33972115
6.
Artigo em Inglês | MEDLINE | ID: mdl-33909281

RESUMO

INTRODUCTION: Asian Americans suffer high rates of smoking and tobacco-related deaths, varying by ethnic group. Trends of cigarette and alternative tobacco product use among Asian Americans, specifically considering ethnic group, sex, and nativity, are infrequently reported. METHODS: Using National Health Interview Survey (NHIS) data from 2006-2018 and the 2016-2018 alternative tobacco supplement (e-cigarettes, cigars, smokeless tobacco, pipes), we explored cigarette and alternative tobacco product use by Asian ethnic group (Asian Indian (n = 4373), Chinese (n = 4736), Filipino (n = 4912)) in comparison to non-Hispanic Whites (NHWs (n = 275,025)), adjusting for socioeconomic and demographic factors. RESULTS: Among 289,046 adults, 12% of Filipinos were current smokers, twice the prevalence in Asian Indians and Chinese (p < 0.001). The male-female gender difference was fivefold for Chinese (10.3% vs. 2.2%; p < 0.001), eightfold for Asian Indians (8.7% vs. 1.1%; p < 0.001), and twofold for Filipinos (16.8% vs. 9.0%). Moreover, 16.3% of US-born and 10.3% of foreign-born Filipinos were current smokers. Odds of ever using e-cigarettes, cigars, smokeless tobacco, and pipes in comparison to NHWs were lowest for Chinese (ORs 0.6, 0.5, 0.2, and 0.5). DISCUSSION: Filipinos had the highest current smoking rates of Asian ethnic groups. Though more Asian men were current smokers, the high rate of current smoking among Filipinas is concerning. More US-born Filipinos were current smokers than foreign-born, despite rates typically decreasing for US-born Asians. Investigating cultural factors contributing to less frequent use of tobacco products, such as alternative tobacco products among Chinese, may aid campaigns in curbing tobacco usage.

7.
Am J Cardiol ; 149: 132-139, 2021 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-33757787

RESUMO

Patients with diabetes mellitus (DM) frequently present reduced exercise capacity. We aimed to explore the extent to which peripheral extraction relates to exercise capacity in asymptomatic patients with DM. We prospectively enrolled 98 asymptomatic patients with type-2 DM (mean age of 59 ± 11 years and 56% male sex), and compared with 31 age, sex and body mass index-matched normoglycemic controls. Cardiopulmonary exercise testing with resting followed by stress echocardiography was performed. Exercise response was assessed using peak oxygen uptake (peak VO2) and ventilatory efficiency was measured using the slope of the relationship between minute ventilation and carbon dioxide production (VE/VCO2). Peripheral extraction was calculated as the ratio of VO2 to cardiac output. Cardiac function was evaluated using left ventricular longitudinal strain, E/e', and relative wall thickness. Among patients with DM, 26 patients (27%) presented reduced percent-predicted-peak VO2(<80%) and 18 (18%) presented abnormal VE/VCO2slope (>34). There was no significant difference in peak cardiac output; however, peripheral extraction was lower in patients with DM compared to controls. Higher peak E/e' (beta = -0.24, p = 0.004) was associated with lower peak VO2 along with age, sex and body mass index (R2 = 0.53). A cluster analysis found left ventricular longitudinal strain, E/e', relative wall thickness and peak VO2 in different clusters. In conclusion, impaired peripheral extraction may contribute to reduced peak VO2in asymptomatic patients with DM. Furthermore, a cluster analysis suggests that cardiopulmonary exercise testing and echocardiography may be complementary for defining subclinical heart failure in patients with DM.


Assuntos
Débito Cardíaco/fisiologia , Diabetes Mellitus Tipo 2/fisiopatologia , Tolerância ao Exercício/fisiologia , Insuficiência Cardíaca/fisiopatologia , Consumo de Oxigênio/fisiologia , Oxigênio/metabolismo , Idoso , Doenças Assintomáticas , Índice de Massa Corporal , Estudos de Casos e Controles , Análise por Conglomerados , Diabetes Mellitus Tipo 2/metabolismo , Ecocardiografia sob Estresse , Teste de Esforço , Feminino , Insuficiência Cardíaca/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
9.
BMC Fam Pract ; 22(1): 28, 2021 02 02.
Artigo em Inglês | MEDLINE | ID: mdl-33530939

RESUMO

BACKGROUND: Humanwide was precision health embedded in primary care aiming to leverage high-tech and high-touch medicine to promote wellness, predict and prevent illness, and tailor treatment to individual medical and psychosocial needs. METHODS: We conducted a study assessing implementation outcomes to inform spread and scale, using mixed methods of semi-structured interviews with diverse stakeholders and chart reviews. Humanwide included: 1) health coaching; 2) four digital health tools for blood-pressure, weight, glucose, and activity; 3) pharmacogenomic testing; and 4) genetic screening/testing. We examined implementation science constructs: reach/penetration, acceptability, feasibility, and sustainability. Chart reviews captured preliminary clinical outcomes. RESULTS: Fifty of 69 patients (72%) invited by primary care providers participated in the Humanwide pilot. We performed chart reviews for the 50 participating patients. Participants were diverse overall (50% non-white, 66% female). Over half of the participants were obese and 58% had one or more major cardiovascular risk factor: dyslipidemia, hypertension, diabetes. Reach/penetration of Humanwide components varied: pharmacogenomics testing 94%, health coaching 80%, genetic testing 72%, and digital health 64%. Interview participants (n=27) included patients (n=16), providers (n=9), and the 2 staff who were allocated dedicated time for Humanwide patient intake and orientation. Patients and providers reported Humanwide was acceptable; it engaged patients holistically, supported faster medication titration, and strengthened patient-provider relationships. All patients benefited clinically from at least one Humanwide component. Feasibility challenges included: low provider self-efficacy for interpreting genetics and pharmacogenomics; difficulties with data integration; patient technology challenges; and additional staffing needs. Patient financial burden concerns surfaced with respect to sustainability. CONCLUSION: This is the first report of implementation of a multi-component precision health model embedded in team-based primary care. We found acceptance from both patients and providers; however, feasibility barriers must be overcome to enable broad spread and sustainability. We found that barriers to implementation of precision health in a team-based primary care clinic are mundane and straightforward, though not necessarily easy to overcome. Future implementation endeavors should invest in basics: education, workflow, and reflection/evaluation. Strengthening fundamentals will enable healthcare systems to more nimbly accept the responsibility of meeting patients at the crossroads of innovative science and routinized clinical systems.


Assuntos
Medicina de Família e Comunidade , Medicina de Precisão , Atenção à Saúde , Feminino , Pessoal de Saúde , Humanos , Masculino , Atenção Primária à Saúde
10.
Int J Cancer ; 148(12): 2954-2963, 2021 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-33527405

RESUMO

Asian Americans (AAs) are heterogeneous, and aggregation of diverse AA populations in national reporting may mask high-risk groups. Gastrointestinal (GI) cancers constitute one-third of global cancer mortality, and an improved understanding of GI cancer mortality by disaggregated AA subgroups may inform future primary and secondary prevention strategies. Using national mortality records from the United States from 2003 to 2017, we report age-standardized mortality rates, standardized mortality ratios and annual percent change trends from GI cancers (esophageal, gastric, colorectal, liver and pancreatic) for the six largest AA subgroups (Asian Indians, Chinese, Filipinos, Japanese, Koreans and Vietnamese). Non-Hispanic Whites (NHWs) are used as the reference population. We found that mortality from GI cancers demonstrated nearly 3-fold difference between the highest (Koreans, 61 per 100 000 person-years) and lowest (Asian Indians, 21 per 100 000 person-years) subgroups. The distribution of GI cancer mortality demonstrates high variability between subgroups, with Korean Americans demonstrating high mortality from gastric cancer (16 per 100 000), and Vietnamese Americans demonstrating high mortality from liver cancer (19 per 100 000). Divergent temporal trends emerged, such as increasing liver cancer burden in Vietnamese Americans, which exacerbated existing mortality differences. There exist striking differences in the mortality burden of GI cancers by disaggregated AA subgroups. These data highlight the need for disaggregated data reporting, and the importance of race-specific and personalized strategies of screening and prevention.


Assuntos
Americanos Asiáticos/estatística & dados numéricos , Neoplasias Gastrointestinais/classificação , Neoplasias Gastrointestinais/mortalidade , Idoso , Idoso de 80 Anos ou mais , China/etnologia , Atestado de Óbito , Feminino , Neoplasias Gastrointestinais/etnologia , Humanos , Japão/etnologia , Masculino , Pessoa de Meia-Idade , República da Coreia/etnologia , Estados Unidos/etnologia , Vietnã/etnologia
11.
J Am Geriatr Soc ; 69(4): 979-985, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33410499

RESUMO

BACKGROUND/OBJECTIVES: Older adults (>75 years of age) represent two-thirds of atherosclerotic cardiovascular disease (ASCVD) deaths. The 2013 and 2018 American multi-society cholesterol guidelines recommend using at least moderate intensity statins for older adults with ASCVD. We examined annual trends and statin prescribing patterns in a multiethnic population of older adults with ASCVD. DESIGN: Retrospective longitudinal study using electronic health record (EHR) data from 2007 to 2018. SETTING: A large multi-specialty health system in Northern California. PARTICIPANTS: A total of 24,651 adults older than 75 years with ASCVD. MEASUREMENTS: Statin prescriptions for older adults with known ASCVD were trended over time. Multivariable regression models were used to identify predictors of statin prescription (logistic) after controlling for relevant demographic and clinical factors. RESULTS: The study cohort included 24,651 patients older than 75 years; 48% were women. Although prescriptions for moderate/high intensity statins increased over time for adults over 75, fewer than half of the patients (45%) received moderate/high intensity statins in 2018. Women (odds ratio (OR) = 0.77; 95% confidence interval (CI) = 0.74, 0.80), patients who had heart failure (OR = 0.69; 95% CI = 0.65, 0.74), those with dementia (OR = 0.88; 95% CI = 0.82, 0.95) and patients who were underweight (OR = 0.64; 95% CI = 0.57, 0.73) were less likely to receive moderate/high intensity statins. CONCLUSIONS: Despite increasing prescription rates between 2007 and 2018, guideline-recommended statins remained underused in older adults with ASCVD, with more pronounced disparities among women and those with certain comorbidities. Future studies are warranted to examine reasons for statin underuse in older adults with ASCVD.


Assuntos
Aterosclerose , Doenças Cardiovasculares , Mau Uso de Serviços de Saúde/estatística & dados numéricos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Idoso , Aterosclerose/tratamento farmacológico , Aterosclerose/epidemiologia , California/epidemiologia , Doenças Cardiovasculares/tratamento farmacológico , Doenças Cardiovasculares/epidemiologia , Comorbidade , Feminino , Fidelidade a Diretrizes/normas , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/classificação , Estudos Longitudinais , Masculino , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Prevenção Secundária/métodos , Prevenção Secundária/normas , Acidente Vascular Cerebral/prevenção & controle
12.
J Pers Med ; 10(4)2020 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-33142667

RESUMO

In the current marketplace, there are now more than a dozen commercial companies providing pharmacogenetic tests. Each company varies in the panel of genes they test and the variants they are able to screen for. The reports generated by these companies provide phenotypic interpretations of pharmacogenes and clinically actionable gene-drug interactions based on internally curated data and proprietary algorithms. The freedom to choose the types of evidence to include versus exclude in interpreting genomics has created reporting discrepancies in the industry. The case report presented here reveals the discordant phenotype analysis provided by two pharmacogenetic testing companies. The uncertainty and unnecessary distress experienced by the patient highlights the need for consensus in phenotype reporting within the industry.

13.
NPJ Digit Med ; 3: 125, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33043149

RESUMO

The pooled cohort equations (PCE) predict atherosclerotic cardiovascular disease (ASCVD) risk in patients with characteristics within prespecified ranges and has uncertain performance among Asians or Hispanics. It is unknown if machine learning (ML) models can improve ASCVD risk prediction across broader diverse, real-world populations. We developed ML models for ASCVD risk prediction for multi-ethnic patients using an electronic health record (EHR) database from Northern California. Our cohort included patients aged 18 years or older with no prior CVD and not on statins at baseline (n = 262,923), stratified by PCE-eligible (n = 131,721) or PCE-ineligible patients based on missing or out-of-range variables. We trained ML models [logistic regression with L2 penalty and L1 lasso penalty, random forest, gradient boosting machine (GBM), extreme gradient boosting] and determined 5-year ASCVD risk prediction, including with and without incorporation of additional EHR variables, and in Asian and Hispanic subgroups. A total of 4309 patients had ASCVD events, with 2077 in PCE-ineligible patients. GBM performance in the full cohort, including PCE-ineligible patients (area under receiver-operating characteristic curve (AUC) 0.835, 95% confidence interval (CI): 0.825-0.846), was significantly better than that of the PCE in the PCE-eligible cohort (AUC 0.775, 95% CI: 0.755-0.794). Among patients aged 40-79, GBM performed similarly before (AUC 0.784, 95% CI: 0.759-0.808) and after (AUC 0.790, 95% CI: 0.765-0.814) incorporating additional EHR data. Overall, ML models achieved comparable or improved performance compared to the PCE while allowing risk discrimination in a larger group of patients including PCE-ineligible patients. EHR-trained ML models may help bridge important gaps in ASCVD risk prediction.

14.
Genes (Basel) ; 11(11)2020 10 26.
Artigo em Inglês | MEDLINE | ID: mdl-33114567

RESUMO

Digital health (DH) is the use of digital technologies and data analytics to understand health-related behaviors and enhance personalized clinical care. DH is increasingly being used in clinical trials, and an important field that could potentially benefit from incorporating DH into trial design is pharmacogenetics. Prospective pharmacogenetic trials typically compare a standard care arm to a pharmacogenetic-guided therapeutic arm. These trials often require large sample sizes, are challenging to recruit into, lack patient diversity, and can have complicated workflows to deliver therapeutic interventions to both investigators and patients. Importantly, the use of DH technologies could mitigate these challenges and improve pharmacogenetic trial design and operation. Some DH use cases include (1) automatic electronic health record-based patient screening and recruitment; (2) interactive websites for participant engagement; (3) home- and tele-health visits for patient convenience (e.g., samples for lab tests, physical exams, medication administration); (4) healthcare apps to collect patient-reported outcomes, adverse events and concomitant medications, and to deliver therapeutic information to patients; and (5) wearable devices to collect vital signs, electrocardiograms, sleep quality, and other discrete clinical variables. Given that pharmacogenetic trials are inherently challenging to conduct, future pharmacogenetic utility studies should consider implementing DH technologies and trial methodologies into their design and operation.


Assuntos
Informática Médica/métodos , Farmacogenética/métodos , Testes Farmacogenômicos/métodos , Medicina de Precisão/métodos , Biologia Computacional/métodos , Humanos , Reconhecimento Automatizado de Padrão/métodos , Telemedicina/métodos , Dispositivos Eletrônicos Vestíveis
15.
BMC Health Serv Res ; 20(1): 678, 2020 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-32698825

RESUMO

BACKGROUND: Patient satisfaction is increasingly being used to assess, and financially reward, provider performance. Previous studies suggest that race/ethnicity (R/E) may impact satisfaction, yet few practices adjust for patient R/E. The objective of this study is to examine R/E differences in patient satisfaction ratings and how these differences impact provider rankings. METHODS: Patient satisfaction survey data linked to electronic health records from two large outpatient centers in northern California - a non-profit organization of community-based clinics (Site A) and an academic medical center (Site B) - was collected and analyzed. Participants consisted of adult patients who received outpatient care at Site A from December 2010 to November 2014 and Site B from March 2013 to August 2014, and completed Press-Ganey Medical Practice Survey questionnaires (N = 216,392 (Site A) and 30,690 (Site B)). Self-reported non-Hispanic white (NHW), Black, Latino, and Asian patients were studied. For six questions each representing a survey subdomain, favorable ratings were defined as top-box ("very good") compared to all other categories ("very poor," "poor," "fair," and "good"). Using multivariable logistic regression with provider random effects, we assessed whether the likelihood of giving favorable ratings differed by patient R/E, adjusting for patient age and sex. RESULTS: Asian, younger and female patients provided less favorable ratings than other R/E, older and male patients. After adjustment, Asian patients were less likely than NHW patients to provide top-box ratings to the overall assessment question "likelihood of recommending this practice to others" (Site A: Asian predicted probability (PP) 0.680, 95% confidence interval (CI): 0.675-0.685 compared to NHW PP 0.820, 95% CI: 0.818-0.822; Site B: Asian PP 0.734, 95% CI: 0.733-0.736 compared to NHW PP 0.859, 95% CI: 0.859-0.859). The effect sizes for Asian R/E were greater than the effect sizes for older age and female sex. An absolute 3% decrease in mean composite score between providers serving different percentages of Asian patients translated to an absolute 40% drop in national ranking. CONCLUSIONS: Patient satisfaction scores may need to be adjusted for patient R/E, particularly for providers caring for high panel percentages of Asian patients.


Assuntos
Grupo com Ancestrais do Continente Asiático/psicologia , Satisfação do Paciente/etnologia , Centros Médicos Acadêmicos , Adolescente , Adulto , Idoso , Assistência Ambulatorial , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , California , Centros Comunitários de Saúde , Grupos de Populações Continentais/psicologia , Grupos de Populações Continentais/estatística & dados numéricos , Grupos Étnicos/psicologia , Grupos Étnicos/estatística & dados numéricos , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente/estatística & dados numéricos , Adulto Jovem
16.
Eur Heart J Cardiovasc Imaging ; 21(8): 876-884, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32386203

RESUMO

AIMS: Resting echocardiography is a valuable method for detecting subclinical heart failure (HF) in patients with diabetes mellitus (DM). However, few studies have assessed the incremental value of diastolic stress for detecting subclinical HF in this population. METHODS AND RESULTS: Asymptomatic patients with Type 2 DM were prospectively enrolled. Subclinical HF was assessed using systolic dysfunction (left ventricular longitudinal strain <16% at rest and <19% after exercise in absolute value), abnormal cardiac morphology, or diastolic dysfunction (E/e' > 10). Metabolic equivalents (METs) were calculated using treadmill speed and grade, and functional capacity was assessed by percent-predicted METs (ppMETs). Among 161 patients studied (mean age of 59 ± 11 years and 57% male sex), subclinical HF was observed in 68% at rest and in 79% with exercise. Among characteristics, diastolic stress had the highest yield in improving detection of HF with 57% of abnormal cases after exercise and 45% at rest. Patients with revealed diastolic dysfunction during stress had significantly lower exercise capacity than patients with normal diastolic stress (7.3 ± 2.1 vs. 8.8 ± 2.5, P < 0.001 for peak METs and 91 ± 30% vs. 105 ± 30%, P = 0.04 for ppMETs). On multivariable modelling found that age (beta = -0.33), male sex (beta = 0.21), body mass index (beta = -0.49), and exercise E/e' >10 (beta = -0.17) were independently associated with peak METs (combined R2 = 0.46). A network correlation map revealed the connectivity of peak METs and diastolic properties as central features in patients with DM. CONCLUSION: Diastolic stress test improves the detection of subclinical HF in patients with diabetes mellitus.


Assuntos
Cardiomiopatias , Diabetes Mellitus Tipo 2 , Insuficiência Cardíaca , Disfunção Ventricular Esquerda , Idoso , Diabetes Mellitus Tipo 2/complicações , Diástole , Teste de Esforço , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Disfunção Ventricular Esquerda/diagnóstico por imagem , Função Ventricular Esquerda
18.
J Am Heart Assoc ; 9(10): e014362, 2020 05 18.
Artigo em Inglês | MEDLINE | ID: mdl-32390539

RESUMO

Background Prior data demonstrate significant heterogeneity regarding coronary artery disease risk factors and outcomes among Asians in the United States, but no studies have yet examined coronary artery disease treatment patterns or outcomes among disaggregated Asian American subgroups. Methods and Results From a total of 772 882 patients with known race/ethnicity and sex who received care from a mixed-payer healthcare organization in Northern California between 2006 and 2015, a retrospective analysis was conducted on 6667 adults with coronary artery disease. Logistic regression was used to examine medical and procedural therapies and outcomes by race/ethnicity, with adjustment for age, sex, income, and baseline comorbidities. Compared with non-Hispanic whites, Chinese were more likely to undergo stenting (50.9% versus 60.8%, odds ratio [OR] 1.39 [95% CI, 1.04-1.87], p=0.005), whereas Filipinos were more likely to receive bypass surgery (6.9% versus 20.5%, OR 2.65 [95% CI, 1.75-4.01], P<0.0001). After stenting, Chinese, Filipinos, and Japanese were more likely than non-Hispanic whites to be prescribed clopidogrel (86.2%, 83.0%, and 91.4% versus 74.5%, ORs 1.86 [95% CI, 1.13-3.04], 1.86 [95% CI, 1.01-3.44], and 4.37 [95% CI, 1.02-18.67], respectively, P<0.0001). Lastly, Chinese and Asian Indians were more likely than non-Hispanic whites to be diagnosed with a myocardial infarction within 1 year postangiography (15.6% and 17.4% versus 11.2%, ORs 1.49 [95% CI, 1.02-2.19] and 1.68 [95% CI, 1.21-2.34], respectively, P<0.0001). Conclusions Disaggregation of Asian Americans with coronary artery disease into individual racial/ethnic subgroups reveals significant variability in treatment patterns and outcomes. Further investigation into these differences may expose important opportunities to mitigate disparities and improve quality of care in this diverse population.


Assuntos
Americanos Asiáticos , Doença da Artéria Coronariana/etnologia , Doença da Artéria Coronariana/terapia , Grupo com Ancestrais do Continente Europeu , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/etnologia , Padrões de Prática Médica/tendências , Idoso , California/epidemiologia , Comorbidade , Angiografia Coronária/tendências , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/tendências , Doença da Artéria Coronariana/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/instrumentação , Intervenção Coronária Percutânea/tendências , Inibidores da Agregação Plaquetária/uso terapêutico , Prevalência , Fatores Raciais , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Resultado do Tratamento
19.
Cancer Epidemiol Biomarkers Prev ; 29(5): 903-909, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32152216

RESUMO

BACKGROUND: Asian Americans are at higher risk for noncardia gastric cancers (NCGC) relative to non-Hispanic Whites (NHW). Asian Americans are genetically, linguistically, and culturally heterogeneous, yet have mostly been treated as a single population in prior studies. This aggregation may obscure important subgroup-specific cancer patterns. METHODS: We utilized data from 13 regional United States cancer registries from 1990 to 2014 to determine secular trends in incidence and survivorship from NCGC. Data were analyzed for NHWs and the six largest Asian American subgroups: Chinese, Japanese, Filipino, Korean, Vietnamese, and South Asian (Indian/Pakistani). RESULTS: There exists substantial heterogeneity in NCGC incidence between Asian subgroups, with Koreans (48.6 per 100,000 person-years) having seven-fold higher age-adjusted incidence than South Asians (7.4 per 100,000 person-years). Asians had generally earlier stages of diagnosis and higher rates of surgical resection compared with NHWs. All Asian subgroups also demonstrated higher 5-year observed survival compared with NHWs, with Koreans (41.3%) and South Asians (42.8%) having survival double that of NHWs (20.1%, P < 0.001). In multivariable regression, differences in stage of diagnosis and rates of resection partially explained the difference in survivorship between Asian subgroups. CONCLUSIONS: We find substantial differences in incidence, staging, histology, treatment, and survivorship from NCGC between Asian subgroups, data which challenge our traditional perceptions about gastric cancer in Asians. Both biological heterogeneity and cultural/environmental differences may underlie these findings. IMPACT: These data are relevant to the national discourse regarding the appropriate role of gastric cancer screening, and identifies high-risk racial/ethnic subgroups who many benefit from customized risk attenuation programs.


Assuntos
Americanos Asiáticos/estatística & dados numéricos , Sobreviventes de Câncer/estatística & dados numéricos , Programas de Rastreamento/normas , Neoplasias Gástricas/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Americanos Asiáticos/genética , Diversidade Cultural , Feminino , Heterogeneidade Genética , Humanos , Incidência , Idioma , Masculino , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Medição de Risco/estatística & dados numéricos , Programa de SEER/estatística & dados numéricos , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/patologia , Neoplasias Gástricas/terapia , Análise de Sobrevida , Estados Unidos/epidemiologia
20.
Clin Transl Sci ; 13(5): 861-870, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32100936

RESUMO

Asians as a group comprise > 60% the world's population. There is an incredible amount of diversity in Asian and admixed populations that has not been addressed in a pharmacogenetic context. The known pharmacogenetic differences in Asian subgroups generally represent previously known variants that are present at much lower or higher frequencies in Asians compared with other populations. In this review we summarize the main drugs and known genes that appear to have differences in their pharmacogenetic properties in certain Asian populations. Evidence-based guidelines and summary statistics from the US Food and Drug Administration and the Clinical Pharmacogenetics Implementation Consortium were analyzed for ethnic differences in outcomes. Implicated drugs included commonly prescribed drugs such as warfarin, clopidogrel, carbamazepine, and allopurinol. The majority of these associations are due to Asians more commonly being poor metabolizers of cytochrome P450 (CYP) 2C19 and carriers of the human leukocyte antigen (HLA)-B*15:02 allele. The relative risk increase was shown to vary between genes and drugs, but could be > 100-fold higher in Asians. Specifically, there was a 172-fold increased risk of Stevens-Johnson syndrome and toxic epidermal necrolysis with carbamazepine use among HLA-B*15:02 carriers. The effects ranged from relatively benign reactions such as reduced drug efficacy to severe cutaneous skin reactions. These reactions are severe and prevalent enough to warrant pharmacogenetic testing and appropriate changes in dose and medication choice for at-risk populations. Further studies should be done on Asian cohorts to more fully understand pharmacogenetic variants in these populations and to clarify how such differences may influence drug response.


Assuntos
Grupo com Ancestrais do Continente Asiático/genética , Citocromo P-450 CYP2C19/genética , Antígeno HLA-B15/genética , Variantes Farmacogenômicos , Síndrome de Stevens-Johnson/epidemiologia , Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Anticoagulantes/farmacocinética , Anticonvulsivantes/administração & dosagem , Anticonvulsivantes/efeitos adversos , Anticonvulsivantes/farmacocinética , Antidepressivos/administração & dosagem , Antidepressivos/efeitos adversos , Antidepressivos/farmacocinética , Antifúngicos/administração & dosagem , Antifúngicos/efeitos adversos , Antifúngicos/farmacocinética , Antineoplásicos/administração & dosagem , Antineoplásicos/efeitos adversos , Antineoplásicos/farmacocinética , Antivirais/administração & dosagem , Antivirais/efeitos adversos , Antivirais/farmacocinética , Citocromo P-450 CYP2C19/metabolismo , Carga Global da Doença , Heterozigoto , Humanos , Incidência , Testes Farmacogenômicos , Inibidores da Agregação Plaquetária/administração & dosagem , Inibidores da Agregação Plaquetária/efeitos adversos , Inibidores da Agregação Plaquetária/farmacocinética , Síndrome de Stevens-Johnson/genética , Síndrome de Stevens-Johnson/imunologia
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