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1.
Cancer Med ; 13(10): e7297, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38770636

RESUMO

BACKGROUND: Medical mistrust, rooted in unethical research, is a barrier to cancer-related health care for Black/African American (AA) persons. Understanding trust, mistrust, and health care experiences is crucial, especially in multiple myeloma (MM), which disproportionately burdens Black/AA persons in incidence and survival. STUDY PURPOSE: This study qualitatively examines the experiences of Black/AA and White dyads (patient with MM and adult caregiver) to gain insights into these phenomena. METHODS: From November 2021 to April 2022, we recruited 21 dyads from the UNC Lineberger Comprehensive Cancer Center. Participants completed a sociodemographic survey and a 60-90 min semi-structured interview. We used ATLAS.ti v9 for project management and to facilitate data analysis using the Sort and Sift, Think and Shift approach (ResearchTalk Inc). RESULTS: We interviewed 21 racially concordant dyads (11 Black/AA, 10 White) with mean patient ages of 70 (Black/AA) and 72 (White) at enrollment. Both Black/AA and White caregivers had a mean enrollment age of 68. The mean duration from MM diagnosis to enrollment for all patients was 5.5 years. Four key themes emerged: (1) knowledge and trust, (2) heightened emotions and discomfort, (3) differing mental constructs of health care experiences, and (4) mitigating mistrust, which varied by self-identified race. Black/AA participants had greater knowledge of historical events like the U.S. Public Health Service Untreated Syphilis Study at Tuskegee and carried the emotional burden longer. They also emphasized self-learning and self-guided research about MM for informed medical decision-making. Both Black/AA and White dyads emphasized the pivotal role of patient-provider relationships and effective communication in fostering trust and addressing concerns. CONCLUSION: Our study offers contextual insights into the enduring challenges of medical mistrust, particularly within the Black/AA community, and its implications for patients and caregivers accessing and receiving MM-related care. Future studies should leverage these insights to guide the development of multilevel interventions addressing medical mistrust within the Black/AA community.


Assuntos
Negro ou Afro-Americano , Cuidadores , Mieloma Múltiplo , Confiança , População Branca , Humanos , Mieloma Múltiplo/psicologia , Mieloma Múltiplo/terapia , Masculino , Feminino , Idoso , Cuidadores/psicologia , Negro ou Afro-Americano/psicologia , Pessoa de Meia-Idade , População Branca/psicologia , Idoso de 80 Anos ou mais , Pesquisa Qualitativa
2.
Cancer Med ; 13(10): e7027, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38770622

RESUMO

BACKGROUND: Black men and men with end-stage kidney disease have lower rates of treatment and higher mortality for prostate cancer. We studied the interaction of end-stage kidney disease (ESKD) with Black race for treatment rates and mortality for men with prostate cancer. METHODS AND RESULTS: We included 516 Black and 551 White men with ESKD before prostate cancer 22,299 Black men, and 141,821 White men without ESKD who were 40 years or older from the Surveillance, Epidemiology, and End-Results-Medicare data (2004-2016). All Black men with or without ESKD and White men with ESKD had higher prostate-specific antigen levels at diagnosis than White men without ESKD. Black men with ESKD had the lowest rates for treatment in both local and advanced stages of prostate cancer (age-adjusted risk ratio: 0.76, 95% Confidence Interval (CI): 0.71-0.82 for local stage and age-adjusted risk ratio: 0.82, 95% CI: 0.76-0.9 for advanced stages) compared to White men without ESKD. Compared to White men without ESKD, prostate cancer-specific mortality was higher in White men with ESKD for both local and advanced stages (age-adjusted hazard ratio: 1.8, 95% CI: 1.2-2.8 and HR: 1.6, 95% CI: 1.2-2.2) and it was higher for ESKD Black men only in advanced stage prostate cancer (age-adjusted hazard ratio: 2.4, 95% CI: 1.5-3.6). CONCLUSION: Our findings suggest that having a comorbidity such as ESKD makes Black men more vulnerable to racial disparities in prostate cancer treatment and mortality.


Assuntos
Negro ou Afro-Americano , Disparidades em Assistência à Saúde , Falência Renal Crônica , Neoplasias da Próstata , Programa de SEER , População Branca , Humanos , Masculino , Neoplasias da Próstata/mortalidade , Neoplasias da Próstata/terapia , Neoplasias da Próstata/patologia , Neoplasias da Próstata/etnologia , Idoso , Falência Renal Crônica/mortalidade , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/terapia , Negro ou Afro-Americano/estatística & dados numéricos , Estados Unidos/epidemiologia , População Branca/estatística & dados numéricos , Idoso de 80 Anos ou mais , Antígeno Prostático Específico/sangue , Pessoa de Meia-Idade , Medicare/estatística & dados numéricos
3.
PLoS One ; 19(5): e0300455, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38771867

RESUMO

The number of Americans with multiple jobs is increasing and multiple jobholders work more hours per week. However, the associations between multiple jobholding and hypertension are unknown. The aim of this study was to examine the associations of multiple jobholding with hypertension and determine whether weekly working hours moderated this association. Data from the 2015 National Health Interview Survey on adults (age ≥18 years) were used and included participants who self-identified as non-Hispanic Asian, non-Hispanic Black, Hispanic, or non-Hispanic White in the U.S. (n = 16,926), The associations of multiple jobholding with self-reported hypertension by sex were assessed using modified Poisson regressions. Both the number of working hours per week and race/ethnicity were assessed as moderators using multiplicative interaction terms. Multiple jobholding was not associated with hypertension among women. However, there was a significant three-way interaction such that multiple jobholding was associated with hypertension among non-Hispanic Black men who worked ≥55 hours per week (relative risk = 1.02, 95% confidence interval = 1.01-1.05). The results suggest that the associations between multiple jobholding, number of working hours, and hypertension should be examined at the intersection of race/ethnicity and sex. Future studies should further characterize multiple jobholding and hypertension among non-Hispanic Black men.


Assuntos
Hipertensão , Humanos , Masculino , Hipertensão/epidemiologia , Hipertensão/etnologia , Feminino , Adulto , Pessoa de Meia-Idade , Emprego/estatística & dados numéricos , Estados Unidos/epidemiologia , Fatores Sexuais , Etnicidade/estatística & dados numéricos , Adulto Jovem , Hispânico ou Latino/estatística & dados numéricos , Negro ou Afro-Americano/estatística & dados numéricos , Adolescente , Idoso , População Branca/estatística & dados numéricos
4.
Neurology ; 102(11): e209432, 2024 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-38776524

RESUMO

BACKGROUND AND OBJECTIVES: Ultra-processed foods (UPFs) are linked to cardiometabolic diseases and neurologic outcomes, such as cognitive decline and stroke. However, it is unclear whether food processing confers neurologic risk independent of dietary pattern information. We aimed to (1) investigate associations between UPFs and incident cognitive impairment and stroke and (2) compare these associations with other commonly recommended dietary patterns in the REasons for Geographic and Racial Differences in Stroke study. This prospective, observational cohort study enrolled Black and White adults in the United States from 2003 to 2007. METHODS: The NOVA system was used to categorize items from a baseline food frequency questionnaire according to the level of processing. Participants with incomplete or implausible self-reported dietary data were excluded. Consumption for each category (grams) was normalized to total grams consumed. Scores quantifying adherence to a Mediterranean, Dietary Approaches to Stop Hypertension (DASH), and Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet were also calculated. Incident cognitive impairment was defined using performance relative to a normative sample on memory and fluency assessments. Incident stroke was identified through adjudicated review of medical records. RESULTS: The cognitive impairment cohort (n = 14,175) included participants without evidence of impairment at baseline who underwent follow-up testing. The stroke cohort (n = 20,243) included participants without a history of stroke. In multivariable Cox proportional hazards models, a 10% increase in relative intake of UPFs was associated with higher risk of cognitive impairment (hazard ratio [HR] = 1.16, 95% CI 1.09-1.24, p = 1.01 × 10-5) and intake of unprocessed or minimally processed foods with lower risk of cognitive impairment (HR = 0.88, 95% CI 0.83-0.94, p = 1.83 × 10-4). Greater intake of UPFs (HR = 1.08, 95% CI 1.02-1.14, p = 1.12 × 10-2) and unprocessed or minimally processed foods (HR = 0.91, 95% CI 0.86-0.95, p = 2.13 × 10-4) were also associated with risk of stroke in multivariable Cox models. The effect of UPFs on stroke risk was greater among Black than White participants (UPF-by-race interaction HR = 1.15, 95% CI 1.03-1.29, p = 1.50 × 10-2). Associations between UPFs and both cognitive impairment and stroke were independent of adherence to the Mediterranean, DASH, and MIND diets. DISCUSSION: Food processing may be important to brain health in older adults independent of known risk factors and adherence to recommended dietary patterns.


Assuntos
Fast Foods , Acidente Vascular Cerebral , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Idoso , Estudos Prospectivos , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/prevenção & controle , Fast Foods/efeitos adversos , População Branca , Estados Unidos/epidemiologia , Dieta Mediterrânea , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/etiologia , Estudos de Coortes , Abordagens Dietéticas para Conter a Hipertensão , Incidência , Fatores de Risco , Adulto , Manipulação de Alimentos , Alimento Processado
6.
JAMA Netw Open ; 7(5): e2411726, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38753328

RESUMO

Importance: Disparities in outcomes exist between Black and White patients with acute myeloid leukemia (AML), with Black patients experiencing poorer prognosis compared with their White counterparts. Objective: To assess whether varying intensity of induction therapy to treat pediatric AML is associated with reduced disparities in treatment outcome by race. Design, Setting, and Participants: A comparative effectiveness analysis was conducted of 86 Black and 359 White patients with newly diagnosed AML who were enrolled in the AML02 trial from 2002 to 2008 or the AML08 trial from 2008 to 2017. Statistical analysis was conducted from July 2023 through January 2024. Interventions: Patients in AML02 were randomly assigned to receive standard low-dose cytarabine-based induction therapy or augmented high-dose cytarabine-based induction therapy, whereas patients in AML08 received high-dose cytarabine-based therapy. Main Outcomes and Measures: Cytarabine pharmacogenomic 10-single-nucleotide variant (ACS10) scores were evaluated for association with outcome according to race and treatment arm. Results: This analysis included 86 Black patients (mean [SD] age, 8.8 [6.5] years; 54 boys [62.8%]; mean [SD] leukocyte count, 52 600 [74 000] cells/µL) and 359 White patients (mean [SD] age, 9.1 [6.2] years; 189 boys [52.6%]; mean [SD] leukocyte count, 54 500 [91 800] cells/µL); 70 individuals with other or unknown racial and ethnic backgrounds were not included. Among all patients without core binding factor AML who received standard induction therapy, Black patients had significantly worse outcomes compared with White patients (5-year event-free survival rate, 25% [95% CI, 9%-67%] compared with 56% [95% CI, 46%-70%]; P = .03). By contrast, among all patients who received augmented induction therapy, there were no differences in outcome according to race (5-year event-free survival rate, Black patients, 50% [95% CI, 38%-67%]; White patients, 48% [95% CI, 42%-55%]; P = .78). Among patients who received standard induction therapy, those with low ACS10 scores had a significantly worse 5-year event-free survival rate compared with those with high scores (42.4% [95% CI, 25.6%-59.3%] and 70.0% [95% CI, 56.6%-83.1%]; P = .004); however, among patients who received augmented induction therapy, there were no differences in 5-year event-free survival rates according to ACS10 score (low score, 60.6% [95% CI, 50.9%-70.2%] and high score, 54.8% [95% CI, 47.1%-62.5%]; P = .43). Conclusions and Relevance: In this comparative effectiveness study of pediatric patients with AML treated in 2 consecutive clinical trials, Black patients had worse outcomes compared with White patients after treatment with standard induction therapy, but this disparity was eliminated by treatment with augmented induction therapy. When accounting for ACS10 scores, no outcome disparities were seen between Black and White patients. Our results suggest that using pharmacogenomics parameters to tailor induction regimens for both Black and White patients may narrow the racial disparity gap in patients with AML.


Assuntos
Citarabina , Leucemia Mieloide Aguda , População Branca , Humanos , Leucemia Mieloide Aguda/tratamento farmacológico , Leucemia Mieloide Aguda/genética , Masculino , Criança , Feminino , Citarabina/uso terapêutico , Resultado do Tratamento , Pré-Escolar , População Branca/estatística & dados numéricos , População Branca/genética , Farmacogenética , Adolescente , Antimetabólitos Antineoplásicos/uso terapêutico , Negro ou Afro-Americano/estatística & dados numéricos , Quimioterapia de Indução/métodos
7.
Neurol Neuroimmunol Neuroinflamm ; 11(4): e200255, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38728608

RESUMO

OBJECTIVES: To estimate the incidence of anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis. METHODS: We conducted a retrospective cohort study of >10 million person-years of observation from members of Kaiser Permanente Southern California, 2011-2022. The electronic health record of individuals with text-string mention of NMDA and encephalitis were reviewed to identify persons who met diagnostic criteria for anti-NMDAR encephalitis. Age-standardized and sex-standardized incidences stratified by race and ethnicity were estimated according to the 2020 US Census population. RESULTS: We identified 70 patients who met diagnostic criteria for anti-NMDAR encephalitis. The median age at onset was 23.7 years (IQR = 14.2-31.0 years), and 45 (64%) were female patients. The age-standardized and sex-standardized incidence of anti-NMDAR encephalitis per 1 million person-years was significantly higher in Black (2.94, 95% CI 1.27-4.61), Hispanic (2.17, 95% CI 1.51-2.83), and Asian/Pacific Island persons (2.02, 95% CI 0.77-3.28) compared with White persons (0.40, 95% CI 0.08-0.72). Ovarian teratomas were found in 58.3% of Black female individuals and 10%-28.6% in other groups. DISCUSSION: Anti-NMDA receptor encephalitis disproportionately affected Black, Hispanic, or Asian/Pacific Island persons. Ovarian teratomas were a particularly common trigger in Black female individuals. Future research should seek to identify environmental and biological risk factors that disproportionately affect minoritized individuals residing in the United States.


Assuntos
Encefalite Antirreceptor de N-Metil-D-Aspartato , Humanos , Encefalite Antirreceptor de N-Metil-D-Aspartato/etnologia , Encefalite Antirreceptor de N-Metil-D-Aspartato/epidemiologia , Feminino , Adulto , Masculino , Incidência , Adulto Jovem , Estudos Retrospectivos , Adolescente , California/epidemiologia , Hispânico ou Latino/estatística & dados numéricos , Disparidades nos Níveis de Saúde , População Branca/etnologia , Negro ou Afro-Americano/etnologia , Neoplasias Ovarianas/etnologia , Neoplasias Ovarianas/epidemiologia , Teratoma/epidemiologia , Teratoma/etnologia , Pessoa de Meia-Idade , Etnicidade
8.
BMC Med ; 22(1): 194, 2024 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-38735916

RESUMO

BACKGROUND: The reason for higher incidence of atrial fibrillation (AF) in Europe compared with East Asia is unclear. We aimed to investigate the association between modifiable lifestyle factors and lifetime risk of AF in Europe and East Asia, along with race/ethnic similarities and disparities. METHODS: 1:1 propensity score matched pairs of 242,763 East Asians and 242,763 White Europeans without AF were analyzed. Modifiable lifestyle factors considered were blood pressure, body mass index, cigarette smoking, diabetes, alcohol consumption, and physical activity, categorized as non-adverse or adverse levels. Lifetime risk of AF was estimated from the index age of 45 years to the attained age of 85 years, accounting for the competing risk of death. RESULTS: The overall lifetime risk of AF was higher in White Europeans than East Asians (20.9% vs 15.4%, p < 0.001). The lifetime risk of AF was similar between the two races in individuals with non-adverse lifestyle factor profiles (13.4% vs 12.9%, p = 0.575), whereas it was higher in White Europeans with adverse lifestyle factor profiles (22.1% vs 15.8%, p < 0.001). The difference in the lifetime risk of AF between the two races increased as the burden of adverse lifestyle factors worsened (1 adverse lifestyle factor; 4.3% to ≥ 3 adverse lifestyle factors; 11.2%). Compared with East Asians, the relative risk of AF in White Europeans was 23% and 62% higher for one (hazard ratio [HR] 1.23, 95% confidence interval [CI] 1.16-1.29) and ≥ 3 adverse lifestyle factors (HR 1.62, 95% CI 1.51-1.75), respectively. CONCLUSIONS: The overall higher lifetime risk of AF in White Europeans compared with East Asians might be attributable to adverse lifestyle factors. Adherence to healthy lifestyle factors was associated with the lifetime risk of AF of about 1 in 8 regardless of race/ethnicity.


Assuntos
Fibrilação Atrial , Estilo de Vida , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fibrilação Atrial/epidemiologia , Bancos de Espécimes Biológicos , Estudos de Coortes , Estudos Longitudinais , República da Coreia/epidemiologia , Fatores de Risco , Biobanco do Reino Unido , Reino Unido/epidemiologia , População Branca , População do Leste Asiático
9.
Hepatol Commun ; 8(6)2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38727677

RESUMO

BACKGROUND: Polygenic Risk Scores (PRS) based on results from genome-wide association studies offer the prospect of risk stratification for many common and complex diseases. We developed a PRS for alcohol-associated cirrhosis by comparing single-nucleotide polymorphisms among patients with alcohol-associated cirrhosis (ALC) versus drinkers who did not have evidence of liver fibrosis/cirrhosis. METHODS: Using a data-driven approach, a PRS for ALC was generated using a meta-genome-wide association study of ALC (N=4305) and an independent cohort of heavy drinkers with ALC and without significant liver disease (N=3037). It was validated in 2 additional independent cohorts from the UK Biobank with diagnosed ALC (N=467) and high-risk drinking controls (N=8981) and participants in the Indiana Biobank Liver cohort with alcohol-associated liver disease (N=121) and controls without liver disease (N=3239). RESULTS: A 20-single-nucleotide polymorphisms PRS for ALC (PRSALC) was generated that stratified risk for ALC comparing the top and bottom deciles of PRS in the 2 validation cohorts (ORs: 2.83 [95% CI: 1.82 -4.39] in UK Biobank; 4.40 [1.56 -12.44] in Indiana Biobank Liver cohort). Furthermore, PRSALC improved the prediction of ALC risk when added to the models of clinically known predictors of ALC risk. It also stratified the risk for metabolic dysfunction -associated steatotic liver disease -cirrhosis (3.94 [2.23 -6.95]) in the Indiana Biobank Liver cohort -based exploratory analysis. CONCLUSIONS: PRSALC incorporates 20 single-nucleotide polymorphisms, predicts increased risk for ALC, and improves risk stratification for ALC compared with the models that only include clinical risk factors. This new score has the potential for early detection of heavy drinking patients who are at high risk for ALC.


Assuntos
Estudo de Associação Genômica Ampla , Cirrose Hepática Alcoólica , Herança Multifatorial , Polimorfismo de Nucleotídeo Único , População Branca , Humanos , Cirrose Hepática Alcoólica/genética , Masculino , Feminino , Pessoa de Meia-Idade , População Branca/genética , Idoso , Medição de Risco , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/genética , Adulto , Fatores de Risco , Predisposição Genética para Doença , Reino Unido , Estratificação de Risco Genético
10.
Nutrients ; 16(9)2024 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-38732605

RESUMO

Healthy dietary patterns rich in flavonoids may benefit cognitive performance over time. Among socioeconomically disadvantaged groups, the association between flavonoid intake and measures of cognition is unclear. This study sought to identify associations between flavonoid intake and cognitive performance among Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study participants (n = 1947) across three study visits. Flavonoid intakes were assessed via two 24-h dietary recalls. Cognitive performance was assessed via the Trail Making Test (TMT)-A and TMT-B, which provide measures of attention and executive function, respectively. Mixed effects linear regression was used to model TMT scores over three study visits against visit 1 (v1) flavonoid intake, time (years from v1), and the interaction between v1 flavonoid intake and time, capturing both the cross-sectional association between flavonoid intake and time at v1 as well as the longitudinal association between v1 flavonoid intake and the change in TMT scores over time. Prior to adjustment, inverse cross-sectional associations at v1 were observed between (1) anthocyanidin intake and TMT-A scores for the overall sample and (2) total flavonoid, anthocyanidin, flavan-3-ol, flavone, and flavonol intake and TMT-B scores for the overall sample and among White adults. Only the association between anthocyanidin intake and TMT-B at v1 among White adults persisted after adjustment (for demographic characteristics such as age). One possible explanation for the few significant associations is universally low flavonoid intakes resulting from the consumption of an unhealthy dietary pattern.


Assuntos
Negro ou Afro-Americano , Cognição , Função Executiva , Flavonoides , Envelhecimento Saudável , População Branca , Humanos , Masculino , Feminino , Flavonoides/administração & dosagem , Cognição/efeitos dos fármacos , Pessoa de Meia-Idade , Função Executiva/efeitos dos fármacos , Idoso , Estudos Transversais , Dieta/estatística & dados numéricos , Antocianinas/administração & dosagem , Características de Residência
11.
PLoS One ; 19(5): e0303971, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38781158

RESUMO

BACKGROUND: MASLD is a prevalent chronic liver condition with substantial clinical implications. This study aimed to assess the effectiveness of three new, elastography-based, scoring systems for advanced fibrosis ≥F3 (Agile 3+), cirrhosis F4 (Agile 4), and fibrotic NASH: NASH + NAS ≥4 + F≥2 (FAST score), in a cohort of biopsy-proven NAFLD meeting MASLD criteria. Our secondary aim was to compare their diagnostic performances with those of other fibrosis prediction tools: LSM-VCTE alone, and common, easily available scores (FIB-4 or APRI). METHODS: Single-center, retrospective study, on consecutive patients with baseline laboratory tests, liver biopsy, and reliable LSM-VCTE measurements. The discrimination between tests was evaluated by analyzing the AUROCs. Dual cut-off approaches were applied to rule-out and rule-in ≥F3, F4 and fibrotic NASH. We tested previously reported cut-off values and provided our best thresholds to achieve Se ≥85%, Se ≥90%, and Sp ≥90%, Sp ≥95%. RESULTS: Among 246 patients, 113 (45.9%) were women, and 75 (30.5%) presented diabetes. Agile 3+ and Agile 4 demonstrated excellent performance in identifying ≥F3 and F4, achieving AUROCs of 0.909 and 0.968, while the FAST score yielded acceptable results in distinguishing fibrotic NASH. When compared to FIB-4 and LSM-VCTE, both Agile 3+ and Agile 4 performed better than FIB-4 and had a similar performance to LSM-VCTE, but with higher diagnostic accuracy, hence reducing the grey zone. CONCLUSION: Agile 3+ and Agile 4 are reliable, non-invasive tests for identifying advanced fibrosis or cirrhosis in MASLD patients, while FAST score demonstrates moderate performance in identifying fibrotic NASH.


Assuntos
Técnicas de Imagem por Elasticidade , Cirrose Hepática , Hepatopatia Gordurosa não Alcoólica , Humanos , Hepatopatia Gordurosa não Alcoólica/patologia , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Feminino , Masculino , Pessoa de Meia-Idade , Biópsia/métodos , Técnicas de Imagem por Elasticidade/métodos , Estudos Retrospectivos , Cirrose Hepática/patologia , Cirrose Hepática/diagnóstico , Adulto , Fígado/patologia , População Branca , Índice de Gravidade de Doença , Idoso
12.
Sci Rep ; 14(1): 11949, 2024 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-38789467

RESUMO

Rosacea is often considered a cosmetic problem but is known to be associated with a variety of comorbidities. To identify such risks, we generated two age- and sex-matched real-world cohorts of 122,444 patients each with and without rosacea. In contrast to earlier studies, we found significant associations with malignant melanoma (OR 6.02, 95% CI 5.76-6.32). This association does not exist for an Asian sub-cohort, which could explain previous inconclusive or conflicting reports. Several strongly associated comorbidities like visual disturbances (ICD-10: H53-H54; OR 4.80, 4.68-4.92), metabolic disorders (E73-E79; OR 3.17, 3.11-3.22), joint problems (M25; OR 4.16, 4.08-4.25) and type 2 diabetes (E11; OR 1.62, 1.58-1.65) should be watched as a risk for rosacea patients. Rosacea is associated with some comorbidities and ethnicity may be a risk factor in melanoma development. The retrospective nature of this study and the sole use of ICD-10 code based filtering calls for future validation of our findings. Additionally, confounding factors such as skin type and previous UV exposure should be included in future studies.


Assuntos
Melanoma , Rosácea , População Branca , Humanos , Rosácea/epidemiologia , Melanoma/epidemiologia , Melanoma/etiologia , Feminino , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Adulto , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/etiologia , Idoso , Comorbidade , Estudos Retrospectivos
13.
Acta Neuropathol Commun ; 12(1): 81, 2024 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-38790074

RESUMO

Cerebrovascular and α-synuclein pathologies are frequently observed alongside Alzheimer disease (AD). The heterogeneity of AD necessitates comprehensive approaches to postmortem studies, including the representation of historically underrepresented ethnic groups. In this cohort study, we evaluated small vessel disease pathologies and α-synuclein deposits among Hispanic decedents (HD, n = 92) and non-Hispanic White decedents (NHWD, n = 184) from three Alzheimer's Disease Research Centers: Columbia University, University of California San Diego, and University of California Davis. The study included cases with a pathological diagnosis of Intermediate/High AD based on the National Institute on Aging- Alzheimer's Association (NIA-AA) and/or NIA-Reagan criteria. A 2:1 random comparison sample of NHWD was frequency-balanced and matched with HD by age and sex. An expert blinded to demographics and center origin evaluated arteriolosclerosis, cerebral amyloid angiopathy (CAA), and Lewy bodies/Lewy neurites (LBs/LNs) with a semi-quantitative approach using established criteria. There were many similarities and a few differences among groups. HD showed more severe Vonsattel grading of CAA in the cerebellum (p = 0.04), higher CAA density in the posterior hippocampus and cerebellum (ps = 0.01), and increased LBs/LNs density in the frontal (p = 0.01) and temporal cortices (p = 0.03), as determined by Wilcoxon's test. Ordinal logistic regression adjusting for age, sex, and center confirmed these findings except for LBs/LNs in the temporal cortex. Results indicate HD with AD exhibit greater CAA and α-synuclein burdens in select neuroanatomic regions when compared to age- and sex-matched NHWD with AD. These findings aid in the generalizability of concurrent arteriolosclerosis, CAA, and LBs/LNs topography and severity within the setting of pathologically confirmed AD, particularly in persons of Hispanic descent, showing many similarities and a few differences to those of NHW descent and providing insights into precision medicine approaches.


Assuntos
Doença de Alzheimer , Hispânico ou Latino , Corpos de Lewy , População Branca , Humanos , Doença de Alzheimer/patologia , Doença de Alzheimer/etnologia , Feminino , Masculino , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Corpos de Lewy/patologia , Angiopatia Amiloide Cerebral/patologia , Angiopatia Amiloide Cerebral/etnologia , alfa-Sinucleína/metabolismo , Encéfalo/patologia , Doenças de Pequenos Vasos Cerebrais/patologia , Doenças de Pequenos Vasos Cerebrais/etnologia , Arteriolosclerose/patologia
14.
J Alzheimers Dis ; 99(2): 787-797, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38701147

RESUMO

Background: Plasma amyloid-ß (Aß) has emerged as an important tool to detect risks of Alzheimer's disease and related dementias, although research in diverse populations is lacking. Objective: We compared plasma Aß42/40 by race with dementia risk over 15 years among Black and White older adults. Methods: In a prospective cohort of 997 dementia-free participants (mean age 74±2.9 years, 55% women, 54% Black), incident dementia was identified based on hospital records, medication, and neurocognitive test over 15 years. Plasma Aß42/40 was measured at Year 2 and categorized into low, medium, and high tertile. We used linear regression to estimate mean Aß42/40 by race and race-stratified Cox proportional hazards models to assess the association between Aß42/40 tertile and dementia risk. Results: Black participants had a lower age-adjusted mean Aß 42/40 compared to White participants, primarily among APOE ɛ4 non-carriers (Black: 0.176, White: 0.185, p = 0.035). Among Black participants, lower Aß 42/40 was associated with increased dementia risk: 33% in low (hazard ratios [HR] = 1.77, 95% confidence interval 1.09-2.88) and 27% in medium tertile (HR = 1.67, 1.01-2.78) compared with 18% in high Aß 42/40 tertile; Increased risks were attenuated among White participants: 21% in low (HR = 1.43, 0.81-2.53) and 23% in medium tertile (HR = 1.27, 0.68-2.36) compared with 15% in high Aß 42/40 tertile. The interaction by race was not statistically significant. Conclusions: Among community-dwelling, non-demented older adults, especially APOE ɛ4 non-carriers, Black individuals had lower plasma Aß 42/40 and demonstrated a higher dementia risk with low Aß42/40 compared with White individuals.


Assuntos
Peptídeos beta-Amiloides , Negro ou Afro-Americano , Demência , Fragmentos de Peptídeos , População Branca , Humanos , Feminino , Peptídeos beta-Amiloides/sangue , Masculino , Idoso , Demência/sangue , Demência/epidemiologia , Demência/etnologia , Fragmentos de Peptídeos/sangue , Estudos Prospectivos , Idoso de 80 Anos ou mais , Estudos de Coortes , Apolipoproteína E4/genética , Biomarcadores/sangue
15.
J Am Med Inform Assoc ; 31(6): 1303-1312, 2024 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-38713006

RESUMO

OBJECTIVES: Racial disparities in kidney transplant access and posttransplant outcomes exist between non-Hispanic Black (NHB) and non-Hispanic White (NHW) patients in the United States, with the site of care being a key contributor. Using multi-site data to examine the effect of site of care on racial disparities, the key challenge is the dilemma in sharing patient-level data due to regulations for protecting patients' privacy. MATERIALS AND METHODS: We developed a federated learning framework, named dGEM-disparity (decentralized algorithm for Generalized linear mixed Effect Model for disparity quantification). Consisting of 2 modules, dGEM-disparity first provides accurately estimated common effects and calibrated hospital-specific effects by requiring only aggregated data from each center and then adopts a counterfactual modeling approach to assess whether the graft failure rates differ if NHB patients had been admitted at transplant centers in the same distribution as NHW patients were admitted. RESULTS: Utilizing United States Renal Data System data from 39 043 adult patients across 73 transplant centers over 10 years, we found that if NHB patients had followed the distribution of NHW patients in admissions, there would be 38 fewer deaths or graft failures per 10 000 NHB patients (95% CI, 35-40) within 1 year of receiving a kidney transplant on average. DISCUSSION: The proposed framework facilitates efficient collaborations in clinical research networks. Additionally, the framework, by using counterfactual modeling to calculate the event rate, allows us to investigate contributions to racial disparities that may occur at the level of site of care. CONCLUSIONS: Our framework is broadly applicable to other decentralized datasets and disparities research related to differential access to care. Ultimately, our proposed framework will advance equity in human health by identifying and addressing hospital-level racial disparities.


Assuntos
Algoritmos , Negro ou Afro-Americano , Disparidades em Assistência à Saúde , Transplante de Rim , População Branca , Humanos , Estados Unidos , Disparidades em Assistência à Saúde/etnologia , Adulto , Masculino , Feminino , Rejeição de Enxerto/etnologia , Pessoa de Meia-Idade
16.
J Am Heart Assoc ; 13(10): e034364, 2024 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-38726919

RESUMO

BACKGROUND: Comprehensive blood lipoprotein profiles and their association with incident coronary heart disease (CHD) among racially and geographically diverse populations remain understudied. METHODS AND RESULTS: We conducted nested case-control studies of CHD among 3438 individuals (1719 pairs), including 1084 White Americans (542 pairs), 1244 Black Americans (622 pairs), and 1110 Chinese adults (555 pairs). We examined 36 plasma lipids, lipoproteins, and apolipoproteins, measured by nuclear magnetic resonance spectroscopy, with incident CHD among all participants and subgroups by demographics, lifestyle, and metabolic health status using conditional or unconditional logistic regression adjusted for potential confounders. Conventionally measured blood lipids, that is, total cholesterol, triglycerides, low-density lipoprotein-cholesterol, and high-density lipoprotein-cholesterol, were each associated with incident CHD, with odds ratios (ORs) being 1.33, 1.32, 1.24, and 0.79 per 1-SD increase among all participants. Seventeen lipoprotein biomarkers showed numerically stronger associations than conventional lipids, with ORs per 1-SD among all participants ranging from 1.35 to 1.57 and a negative OR of 0.78 (all false discovery rate <0.05), including apolipoprotein B100 to apolipoprotein A1 ratio (OR, 1.57 [95% CI, 1.45-1.7]), low-density lipoprotein-triglycerides (OR, 1.55 [95% CI, 1.43-1.69]), and apolipoprotein B (OR, 1.49 [95% CI, 1.37-1.62]). All these associations were significant and consistent across racial groups and other subgroups defined by age, sex, smoking, obesity, and metabolic health status, including individuals with normal levels of conventionally measured lipids. CONCLUSIONS: Our study highlighted several lipoprotein biomarkers, including apolipoprotein B/ apolipoprotein A1 ratio, apolipoprotein B, and low-density lipoprotein-triglycerides, strongly and consistently associated with incident CHD. Our results suggest that comprehensive lipoprotein measures may complement the standard lipid panel to inform CHD risk among diverse populations.


Assuntos
Apolipoproteínas , Biomarcadores , Negro ou Afro-Americano , Doença das Coronárias , Lipoproteínas , População Branca , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Doença das Coronárias/sangue , Doença das Coronárias/epidemiologia , Doença das Coronárias/etnologia , Doença das Coronárias/diagnóstico , Estudos Prospectivos , Estudos de Casos e Controles , Lipoproteínas/sangue , Idoso , Apolipoproteínas/sangue , Biomarcadores/sangue , Lipídeos/sangue , Incidência , Asiático/estatística & dados numéricos , Adulto , Estados Unidos/epidemiologia , Fatores de Risco , Medição de Risco , Espectroscopia de Ressonância Magnética , Triglicerídeos/sangue
17.
Nat Genet ; 56(5): 819-826, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38741014

RESUMO

We performed genome-wide association studies of breast cancer including 18,034 cases and 22,104 controls of African ancestry. Genetic variants at 12 loci were associated with breast cancer risk (P < 5 × 10-8), including associations of a low-frequency missense variant rs61751053 in ARHGEF38 with overall breast cancer (odds ratio (OR) = 1.48) and a common variant rs76664032 at chromosome 2q14.2 with triple-negative breast cancer (TNBC) (OR = 1.30). Approximately 15.4% of cases with TNBC carried six risk alleles in three genome-wide association study-identified TNBC risk variants, with an OR of 4.21 (95% confidence interval = 2.66-7.03) compared with those carrying fewer than two risk alleles. A polygenic risk score (PRS) showed an area under the receiver operating characteristic curve of 0.60 for the prediction of breast cancer risk, which outperformed PRS derived using data from females of European ancestry. Our study markedly increases the population diversity in genetic studies for breast cancer and demonstrates the utility of PRS for risk prediction in females of African ancestry.


Assuntos
População Negra , Neoplasias da Mama , Predisposição Genética para Doença , Estudo de Associação Genômica Ampla , Polimorfismo de Nucleotídeo Único , Humanos , Feminino , Estudo de Associação Genômica Ampla/métodos , Neoplasias da Mama/genética , População Negra/genética , Estudos de Casos e Controles , Fatores de Risco , Neoplasias de Mama Triplo Negativas/genética , Alelos , Herança Multifatorial/genética , Pessoa de Meia-Idade , Loci Gênicos , População Branca/genética
18.
J Am Heart Assoc ; 13(10): e031695, 2024 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-38752519

RESUMO

BACKGROUND: We examined the association of multilevel social determinants of health with incident apparent treatment-resistant hypertension (aTRH). METHODS AND RESULTS: We analyzed data from 2774 White and 2257 Black US adults from the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study taking antihypertensive medication without aTRH at baseline to estimate the association of social determinants of health with incident aTRH. Selection of social determinants of health was guided by the Healthy People 2030 domains of education, economic stability, social context, neighborhood environment, and health care access. Blood pressure (BP) was measured during study visits, and antihypertensive medication classes were identified through a pill bottle review. Incident aTRH was defined as (1) systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg, or systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg for those with diabetes or chronic kidney disease while taking ≥3 classes of antihypertensive medication or (2) taking ≥4 classes of antihypertensive medication regardless of BP level, at the follow-up visit. Over a median 9.5 years of follow-up, 15.9% of White and 24.0% of Black adults developed aTRH. A percent of the excess aTRH risk among Black versus White adults was mediated by low education (14.2%), low income (16.0%), not seeing a friend or relative in the past month (8.1%), not having someone to care for them if ill or disabled (7.6%), lack of health insurance (10.6%), living in a disadvantaged neighborhood (18.0%), and living in states with poor public health infrastructure (6.0%). CONCLUSIONS: Part of the association between race and incident aTRH risk was mediated by social determinants of health.


Assuntos
Anti-Hipertensivos , Negro ou Afro-Americano , Hipertensão , Determinantes Sociais da Saúde , População Branca , Humanos , Determinantes Sociais da Saúde/etnologia , Masculino , Estados Unidos/epidemiologia , Feminino , Hipertensão/tratamento farmacológico , Hipertensão/etnologia , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Pessoa de Meia-Idade , Anti-Hipertensivos/uso terapêutico , Negro ou Afro-Americano/estatística & dados numéricos , População Branca/estatística & dados numéricos , Idoso , Incidência , Fatores de Risco , Pressão Sanguínea/efeitos dos fármacos , Resistência a Medicamentos , Disparidades nos Níveis de Saúde , Escolaridade , Acessibilidade aos Serviços de Saúde
19.
J Affect Disord ; 358: 422-431, 2024 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-38750800

RESUMO

BACKGROUND: Evidence links major depressive disorder (MDD) with aging, but it's unclear if MDD accelerates aging and what factors mediate this transition. METHODS: Two-sample Mendelian randomization (MR) analyses were applied to estimate the causal association between MDD and frailty index (FI), telomere length (TL), and appendicular lean mass (ALM) from available genome-wide association studies in populations of European ancestry. Furthermore, we conducted mediation MR analyses to assess the mediating effects of 31 lifestyle factors or diseases on the causal relationship between MDD and aging. RESULTS: MDD was significantly causally associated with increased FI (ßIVW = 0.23, 95 % CI = 0.18 to 0.28, p = 1.20 × 10-17), shorter TL (ßIVW = -0.04, 95 % CI = -0.07 to -0.01, p = 0.01), and decreased ALM (ßIVW = -0.07, 95 % CI = -0.11 to -0.03, p = 3.54 × 10-4). The mediation analysis through two-step MR revealed smoking initiation (9.09 %), hypertension (6.67 %) and heart failure (5.36 %) mediated the causal effect of MDD on FI. Additionally, alcohol use disorders and alcohol dependence on the causal relationship between MDD and TL were found to be 17.52 % and 17.13 % respectively. LIMITATIONS: Confounding, statistical power, and Euro-centric focus limit generalization. CONCLUSION: Overall, individuals with MDD may be at a higher risk of experiencing premature aging, and this risk is partially influenced by the pathways involving smoking, alcohol use, and cardiovascular health. It underscores the importance of early intervention and comprehensive health management in individuals with MDD to promote healthy aging and overall well-being.


Assuntos
Transtorno Depressivo Maior , Estudo de Associação Genômica Ampla , Análise da Randomização Mendeliana , Humanos , Transtorno Depressivo Maior/genética , Masculino , Feminino , Fragilidade/genética , Senilidade Prematura/genética , Envelhecimento/genética , Pessoa de Meia-Idade , Estilo de Vida , População Branca/genética , População Branca/estatística & dados numéricos , Idoso
20.
Ann Epidemiol ; 94: 91-99, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38710240

RESUMO

INTRODUCTION: Suicide deaths among Black youth in the US have increased rapidly over the past decade. Direct or vicarious racial trauma experienced through exposure to police brutality may underlie these concerning trends. METHODS: We obtained nationally aggregated monthly counts of suicides for non-Hispanic Black and White youth (age ≤ 24 years) and adults (age > 24 years) from the National Mortality Vital Statistics restricted-use data files provided by the Centers for Disease Control and Prevention, from 2013 to 2019. Monthly counts of Black youth suicides constituted our main outcome. We defined our exposure as the monthly counts of police killings of unarmed Black persons over 84 months (2013 to 2019), retrieved from the Mapping Police Violence database. We used ARIMA (AutoRegressive Integrated Moving Average) time-series analyses to examine whether Black youth suicides increased within 0 to 3 months following police killings of unarmed Black persons, controlling for autocorrelation and corresponding series of White youth suicides. RESULTS: Suicides among Black youth increase by ∼1 count three months following an increase in police killings of unarmed Black persons (exposure lag 0 coefficient = 0.16, p > 0.05; exposure lag 1 coefficient = -0.70, p > 0.05; exposure lag 2 coefficient = -0.54, p > 0.05; exposure lag 3 coefficient = 0.95, p < 0.05). The observed increase in suicides concentrates among Black male youth (exposure lag 3 coefficient = 0.88, p < 0.05).


Assuntos
Negro ou Afro-Americano , Polícia , Suicídio , Humanos , Polícia/estatística & dados numéricos , Masculino , Negro ou Afro-Americano/estatística & dados numéricos , Negro ou Afro-Americano/psicologia , Feminino , Suicídio/estatística & dados numéricos , Suicídio/etnologia , Adolescente , Estados Unidos/epidemiologia , Adulto Jovem , Adulto , População Branca/estatística & dados numéricos , Homicídio/estatística & dados numéricos , Homicídio/etnologia , Violência/estatística & dados numéricos , Violência/etnologia
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