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Clinical Gastroenterology and... Feb 2023Young adults diagnosed with colorectal cancer (CRC) comprise a growing, yet understudied, patient population. We estimated 5-year relative survival of early-onset CRC...
BACKGROUND
Young adults diagnosed with colorectal cancer (CRC) comprise a growing, yet understudied, patient population. We estimated 5-year relative survival of early-onset CRC and examined disparities in survival by race-ethnicity in a population-based sample.
METHODS
We used the National Cancer Institute's Surveillance, Epidemiology, and End Results program of cancer registries to identify patients diagnosed with early-onset CRC (20-49 years of age) between January 1, 1992, and December 31, 2013. For each racial-ethnic group, we estimated 5-year relative survival, overall and by sex, tumor site, and stage at diagnosis. To illustrate temporal trends, we compared 5-year relative survival in 1992-2002 vs 2003-2013. We also used Cox proportional hazards regression models to examine the association of race-ethnicity and all-cause mortality, adjusting for age at diagnosis, sex, county type (urban vs rural), county-level median household income, tumor site, and stage at diagnosis.
RESULTS
We identified 33,777 patients diagnosed with early-onset CRC (58.5% White, 14.0% Black, 13.0% Asian, 14.5% Hispanic). Five-year relative survival ranged from 57.6% (Black patients) to 69.1% (White patients). Relative survival improved from 1992-2002 to 2003-2013 for White patients only; there was no improvement for Black, Asian, or Hispanic patients. This pattern was similar by sex, tumor site, and stage at diagnosis. In adjusted analysis, Black (adjusted hazard ratio [aHR], 1.42; 95% confidence interval [CI], 1.36-1.49), Asian (aHR, 1.06; 95% CI, 1.01-1.12), and Hispanic (aHR, 1.16; 95% CI, 1.10-1.21) race-ethnicity were associated with all-cause mortality.
CONCLUSION
Our study adds to the well-documented disparities in CRC in older adults by demonstrating persistent racial-ethnic disparities in relative survival and all-cause mortality in patients with early-onset CRC.
Topics: Young Adult; Humans; Aged; White People; Ethnicity; Hispanic or Latino; Racial Groups; Colorectal Neoplasms
PubMed: 35716905
DOI: 10.1016/j.cgh.2022.05.035 -
Schizophrenia Bulletin Jul 2021This article aims to evaluate "racial", ethnic, and population diversity-or lack thereof-in psychosis research, with a particular focus on socio-environmental studies....
This article aims to evaluate "racial", ethnic, and population diversity-or lack thereof-in psychosis research, with a particular focus on socio-environmental studies. Samples of psychosis research remain heavily biased toward Western, Educated, Industrialized, Rich, and Democratic (WEIRD) societies. Furthermore, we often fail to acknowledge the lack of diversity, thereby implying that our findings can be generalized to all populations regardless of their social, ethnic, and cultural background. This has major consequences. Clinical trials generate findings that are not generalizable across ethnicity. The genomic-based prediction models are far from being applicable to the "Majority World." Socio-environmental theories of psychosis are solely based on findings of the empirical studies conducted in WEIRD populations. If and how these socio-environmental factors affect individuals in entirely different geographic locations, gene pools, social structures and norms, cultures, and potentially protective counter-factors remain unclear. How socio-environmental factors are assessed and studied is another major shortcoming. By embracing the complexity of environment, the exposome paradigm may facilitate the evaluation of interdependent exposures, which could explain how variations in socio-environmental factors across different social and geographical settings could contribute to divergent paths to psychosis. Testing these divergent paths to psychosis will however require increasing the diversity of study populations that could be achieved by establishing true partnerships between WEIRD societies and the Majority World with the support of funding agencies aspired to foster replicable research across diverse populations. The time has come to make diversity in psychosis research more than a buzzword.
Topics: Biomedical Research; Ethnicity; Humans; Population Groups; Psychotic Disorders; Research Subjects
PubMed: 33948664
DOI: 10.1093/schbul/sbab048 -
BMJ Open May 2022To explore the barriers to and options for improving access to quality healthcare for the urban poor in Nairobi, Kenya.
OBJECTIVE
To explore the barriers to and options for improving access to quality healthcare for the urban poor in Nairobi, Kenya.
DESIGN AND PARTICIPANTS
This was a qualitative approach. In-depth interviews (n=12), focus group discussions with community members (n=12) and key informant interviews with health providers and policymakers (n=25) were conducted between August 2019 and September 2020. Four feedback and validation workshops were held in December 2019 and April-June 2021.
SETTING
Korogocho and Viwandani urban slums in Nairobi, Kenya.
RESULTS
The socioe-conomic status of individuals and their families, such as poverty and lack of health insurance, interact with community-level factors like poor infrastructure, limited availability of health facilities and insecurity; and health system factors such as limited facility opening hours, health providers' attitudes and skills and limited public health resources to limit healthcare access and perpetuate health inequities. Limited involvement in decision-making processes by service providers and other key stakeholders was identified as a major challenge with significant implications on how limited health system resources are managed.
CONCLUSION
Despite many targeted interventions to improve the health and well-being of the urban poor, slum residents are still unable to obtain quality healthcare because of persistent and new barriers due to the COVID-19 pandemic. In a devolved health system, paying attention to health services managers' abilities to assess and respond to population health needs is vital. The limited use of existing accountability mechanisms requires attention to ensure that the mechanisms enhance, rather than limit, access to health services for the urban slum residents. The uniqueness of poor urban settings also requires in-depth and focused attention to social determinants of health within these contexts. To address individual, community and system-level barriers to quality healthcare in this and related settings and expand access to health services for all, multisectoral strategies tailored to each population group are needed.
Topics: COVID-19; Health Facilities; Health Services Accessibility; Humans; Kenya; Pandemics; Population Groups; Qualitative Research
PubMed: 35523490
DOI: 10.1136/bmjopen-2021-057484 -
JAMA Network Open Mar 2023With the increasing delivery of neoadjuvant chemotherapy (NACT) for patients with breast cancer in the US, it is important to know whether there is differential response...
IMPORTANCE
With the increasing delivery of neoadjuvant chemotherapy (NACT) for patients with breast cancer in the US, it is important to know whether there is differential response to NACT by race and ethnicity and the potential long-term outcomes.
OBJECTIVE
To examine whether there were any racial and ethnic differences in pathologic complete response (pCR) rate following NACT and, if so, whether they varied by molecular subtype and were associated with survival.
DESIGN, SETTING, AND PARTICIPANTS
A retrospective cohort study was conducted including patients with stage I to III breast cancer diagnosed between January 2010 and December 2017 who underwent surgery and received NACT; median follow-up was 5.8 years, and data analysis was conducted from August 2021 to January 2023. Data were obtained from the National Cancer Data Base, a nationwide, facility-based, oncology data set that captures approximately 70% of all newly diagnosed cases of breast cancer in the US.
MAIN OUTCOMES AND MEASURES
Pathologic complete response, defined as ypT0/Tis ypN0, was modeled using logistic regression. Racial and ethnic differences in survival were analyzed using a Weibull accelerated failure time model. Mediation analysis was conducted to measure whether racial and ethnic differences in the pCR rate affect survival.
RESULTS
The study included 107 207 patients (106 587 [99.4%] women), with a mean (SD) age of 53.4 (12.1) years. A total of 5009 patients were Asian or Pacific Islander, 18 417 were non-Hispanic Black, 9724 were Hispanic, and 74 057 were non-Hispanic White. There were significant racial and ethnic differences in pCR rates, but the differences were subtype-specific. In hormone receptor-negative (HR-)/erb-b2 receptor tyrosine kinase 2 (ERBB2; formerly HER2 or HER2/neu)-positive (ERBB2+) subtype, Asian and Pacific Islander patients achieved the highest pCR rate (56.8%), followed by Hispanic (55.2%) and non-Hispanic White (52.3%) patients with the lowest pCR rate seen in Black patients (44.8%). In triple-negative breast cancer, Black patients had a lower pCR rate (27.3%) than other racial and ethnic groups (all >30%). In HR+/ERBB2- subtype, Black patients had a higher pCR rate (11.3%) than other racial/ethnic groups (all ≤10%). In mediation analysis, racial and ethnic differences in achieving pCR after NACT could explain approximately 20% to 53% of the subtype-specific survival differences across racial and ethnic groups.
CONCLUSIONS AND RELEVANCE
In this cohort study of patients with breast cancer receiving NACT, Black patients had a lower pCR rate for triple-negative and HR-/ERBB2+ breast cancer but a higher pCR rate for HR+/ERBB2- diseases, whereas Asian and Pacific Islander patients had a higher pCR rate for HR-/ERBB2+ diseases. Tumor grade and ERBB2 copy number could account for some of these within-subtype disparities, but further studies are warranted. Inability to achieve a pCR can mediate in part, but not entirely, the worse survival outcomes experienced by Black patients.
Topics: Female; Humans; Middle Aged; Cohort Studies; Neoadjuvant Therapy; Retrospective Studies; Triple Negative Breast Neoplasms; White; Population Groups, US; Survival Rate; Ethnicity; Racial Groups; Adult; Aged; Health Status Disparities
PubMed: 36995711
DOI: 10.1001/jamanetworkopen.2023.5834 -
Health & Place Jan 2022A scoping review was performed to identify how Organisation for Economic Co-operation and Development (OECD) countries measure overall health for sub-national... (Review)
Review
A scoping review was performed to identify how Organisation for Economic Co-operation and Development (OECD) countries measure overall health for sub-national geographies within each country. Sixty publications were selected from MEDLINE, Scopus and Google Scholar, plus information extracted from 37 of 38 OECD countries statistical agency and/or public health institute websites that were available in English. Data sources varied by categorisation into national statistical agency mortality (n = 7) or population-level survey morbidity (n = 5) health indicators. Region was the most common geographic scale (e.g., eight indicators for 26 countries), slightly fewer indicators for urban areas (max countries per most frequent indicator = 24), followed by municipality (range of 1-14 countries per indicator). Other geographies, particularly those at smaller granularity, were infrequently available across health indicators and countries. Wider availability of health indicators at smaller, and non-administrative, geographies is needed to explore the best way to measure comparative population health in local areas.
Topics: Data Collection; Humans; Organisation for Economic Co-Operation and Development; Population Groups
PubMed: 34929525
DOI: 10.1016/j.healthplace.2021.102731 -
Frontiers in Public Health 2023Tuberculosis (TB) is a significant public health problem among the Saharia community, an underprivileged tribal group in the west-central part of India. There are... (Review)
Review
Tuberculosis (TB) is a significant public health problem among the Saharia community, an underprivileged tribal group in the west-central part of India. There are several challenges for India's TB control program to curtail TB in the Saharia tribe. Malnutrition, poor health sector facilities, lower socio-economic status, and substance abuse are interconnected and synergistic factors contributing to a high burden of TB in the Saharia tribe. In this review, efforts are made to collate the findings of previous studies discussing the causes of high burden of TB in the Saharia tribe, social gaps for mitigating these preventable risk factors of TB in the Saharia tribe, and the plausible solutions for closing these gaps. The concept of and intersectoral co-ordination is needed for the reduction of TB in the Saharia tribe and to make India TB-free by the year 2025.
Topics: Humans; Tuberculosis, Pulmonary; Population Groups; Prevalence; Tuberculosis; Risk Factors
PubMed: 37920577
DOI: 10.3389/fpubh.2023.1226980 -
BMC Public Health Jul 2023Vaccination efforts are a vital part of controlling the spread of diseases, however, lack of vaccine acceptance undermines the efficacy of this public health effort....
BACKGROUND
Vaccination efforts are a vital part of controlling the spread of diseases, however, lack of vaccine acceptance undermines the efficacy of this public health effort. Current evidence suggests that the most effective interventions to support vaccination uptake and positive vaccination beliefs are multicomponent, and dialogue based. Peer-based education interventions are such a strategy that involves an individual within the same group to act as the vaccine educator.
OBJECTIVE
This review aims to consolidate the quantitative evidence surrounding the effectiveness and experience of peer-based education initiatives to improve vaccination beliefs and behaviors.
METHODS
We conducted a systematic search of PubMed, Web of Science, and a hand reference search. The search was conducted between April and June 2022. The inclusion criteria encompassed using peers, being education based, and being an intervention that addresses vaccination beliefs and behaviors (e.g. vaccination uptake).
RESULTS
Systematic screening revealed 16 articles in the final review. Half of the studies focused on students as their study population. The human papillomavirus vaccine was the most common vaccine assessed in the studies, followed by COVID and influenza vaccines. 11 out of 16 of the articles reported a positive impact of the peer intervention and two studies had mixed results. Six studies suggest a mixed peer- healthcare expert approach.
CONCLUSIONS
Despite reported positive effects of using peer-education based initiatives to improve vaccine uptake and beliefs, this systematic review reveals that there is limited existing research in support of this strategy. The strategies that initially appear the most effect are those with a combined peer and health-expert approach, and those that have more group specific and long-term peer interventions. More research is needed to confirm these results and to assess the effectiveness of a peer-based education intervention in a wider variety of settings and for other vaccine types.
Topics: Humans; COVID-19; Vaccination; Influenza Vaccines; Patient Acceptance of Health Care; Population Groups
PubMed: 37452295
DOI: 10.1186/s12889-023-16294-3 -
Current Oncology (Toronto, Ont.) Dec 2021Much of the existing Indigenous cancer research focuses on First Nation populations or reports on pan-Indigenous data that include First Nations, Métis, and Inuit... (Review)
Review
Much of the existing Indigenous cancer research focuses on First Nation populations or reports on pan-Indigenous data that include First Nations, Métis, and Inuit metrics together, which fails to capture the distinct lived realities, experiences of colonialism, and culture of each Indigenous group. The purpose of this scoping review was to summarize existing knowledge on cancer among Métis peoples in Canada, offering direction to researchers, institutions, and policymakers for future actions that enhance Métis-specific cancer surveillance and cancer care. We searched Embase, Medline, iPortal, and Proquest Theses and Dissertations databases, Google Scholar and Google, alongside ten websites relevant to cancer and Métis peoples. Two reviewers gathered 571 records. After screening, 77 records were included. Data show that Métis peoples experience higher behavioral risk factors, lower screening participation, higher cancer incidence for some cancers, and higher mortality rates compared to the non-Indigenous population. Existing research is piece-meal and researchers emphasize that there is inadequate Métis-specific cancer data. There is a need for targeted, Peoples-specific cancer control interventions to reduce these health inequities and a coordinated, Peoples-specific approach to cancer research. These efforts must involve collaboration among Métis Nations and organizations, provincial governments and agencies, researchers, and policymakers.
Topics: Canada; Delivery of Health Care; Humans; Indigenous Peoples; Neoplasms; Policy; Population Groups
PubMed: 34940068
DOI: 10.3390/curroncol28060429 -
BMC Medicine Oct 2022The ongoing opioid epidemic and increases in alcohol-related mortality are key public health concerns in the USA, with well-documented inequalities in the degree to...
Trends in mortality from alcohol, opioid, and combined alcohol and opioid poisonings by sex, educational attainment, and race and ethnicity for the United States 2000-2019.
BACKGROUND
The ongoing opioid epidemic and increases in alcohol-related mortality are key public health concerns in the USA, with well-documented inequalities in the degree to which groups with low and high education are affected. This study aimed to quantify disparities over time between educational and racial and ethnic groups in sex-specific mortality rates for opioid, alcohol, and combined alcohol and opioid poisonings in the USA.
METHODS
The 2000-2019 Multiple Cause of Death Files from the National Vital Statistics System (NVSS) were used alongside population counts from the Current Population Survey 2000-2019. Alcohol, opioid, and combined alcohol and opioid poisonings were assigned using ICD-10 codes. Sex-stratified generalized least square regression models quantified differences between educational and racial and ethnic groups and changes in educational inequalities over time.
RESULTS
Between 2000 and 2019, there was a 6.4-fold increase in opioid poisoning deaths, a 4.6-fold increase in combined alcohol and opioid poisoning deaths, and a 2.1-fold increase in alcohol poisoning deaths. Educational inequalities were observed for all poisoning outcomes, increasing over time for opioid-only and combined alcohol and opioid mortality. For non-Hispanic White Americans, the largest educational inequalities were observed for opioid poisonings and rates were 7.5 (men) and 7.2 (women) times higher in low compared to high education groups. Combined alcohol and opioid poisonings had larger educational inequalities for non-Hispanic Black men and women (relative to non-Hispanic White), with rates 8.9 (men) and 10.9 (women) times higher in low compared to high education groups.
CONCLUSIONS
For all types of poisoning, our analysis indicates wide and increasing gaps between those with low and high education with the largest inequalities observed for opioid-involved poisonings for non-Hispanic Black and White men and women. This study highlights population sub-groups such as individuals with low education who may be at the highest risk of increasing mortality from combined alcohol and opioid poisonings. Thereby the findings are crucial for the development of targeted public health interventions to reduce poisoning mortality and the socioeconomic inequalities related to it.
Topics: Male; United States; Female; Humans; Ethnicity; Analgesics, Opioid; Educational Status; White People; Ethanol
PubMed: 36280833
DOI: 10.1186/s12916-022-02590-z -
Roczniki Panstwowego Zakladu Higieny 2021Overweight and obesity are defined as abnormal or excessive fat accumulation that may impair health. Obesity is associated with many chronic diseases, including...
BACKGROUND
Overweight and obesity are defined as abnormal or excessive fat accumulation that may impair health. Obesity is associated with many chronic diseases, including cardiovascular disease and diabetes, and recently the role of overweight and obesity in lung disease has received new interest. Chronic obstructive lung disease is the third-leading cause of death globally, and both obesity and diet appear to play roles in its pathophysiology. Cross-sectional studies have demonstrated an inverse association between obesity and the prevalence of chronic obstructive pulmonary disease (COPD).
OBJECTIVE
Objective. This study aims to evaluate the relationship between smoking, lipid profile and obesity (body composition changes) in a selected groups of population (30 non-smokers, 30 smokers and 60 COPD patients).
MATERIAL AND METHODS
We evaluated fat mass, fat free mass, body mass index and lipid profile in a group of 120 randomly selected probands (60 COPD patients; 30 smokers without COPD; 30 non-smokers without COPD) to identify possible negative relationships of smoking to body composition. To the measurement of fat mass (FM) and fat free mass (FFM) was used a device Bodystat Quadscan 4000 (Bodystat Ltd, British Isles). The device works by using four-frequency bioelectrical impedance analysis. Laboratory parameters as total cholesterol (T-C), high-density cholesterol (HDL-C), low-density cholesterol (LDL-C) and triacylglycerols (TG) were investigated by automated clinical chemistry analyzer LISA 200th. The measured values were statistically processed and evaluated in a statistical program STATISTICA Cz. Version 7.1. (Kruskall-Wallis test).
RESULTS
A comparison of the mean fat mass we found statistically highly significant differences between the group of COPD patients and non-smokers (P <0.001) and insignificant differences (P ≥ 0.05) between the other groups of our experiment. A comparison of the mean fat mass values of all three groups of the experiment shows a steady increase in fat from non-smokers (17.66 ± 10.04 kg) to COPD patients with the highest mean value (25.08 ± 10.14 kg). In the group of COPD patients we recorded the lowest average value of FFM (51.76 ± 13.84 kg), in group of smokers the middle (56.06 ± 10.76 kg) and in non-smokers the highest average value of FFM (59.91 ± 9.90 kg) at relatively the same body weight in the groups. Based on calculated body mass index (BMI), we found in group of COPD patients overweight in 15 cases (25%), obesity in 7 patients (11.67%), severe obesity in 14 patients (23.3%) and morbid obesity in 2 patients (3.33%); in the group of smokers overweight in 16 cases (53.33%), obesity in 5 cases (16.6%) and severe obesity in 1 case (3.33%); in non-smokers we recording overweight in 14 cases (46.67%), obesity in 5 cases (16.67%) and severe obesity in 2 cases (6.67%). In the lipid profile of the monitored groups of probands, we observed statistically significant differences only for LDL cholesterol (LDL-C). There was a statistically significant difference (P <0.001) between the group with COPD and smokers, as well as between the group of smokers and non-smokers (P < 0.05).
CONCLUSIONS
In the vast majority of patients with COPD, the lung damage that leads to COPD is caused by long-term cigarette smoking. The presence and absence of risk factors such as smoking, inappropriate lipid profile and obesity (amount of fat mass) in selected population groups were observed. Additional studies to explore both the quantitative and qualitative changes in body composition with disease process of COPD are required.
Topics: Body Composition; Body Mass Index; Cross-Sectional Studies; Humans; Obesity; Population Groups; Smoking
PubMed: 34553883
DOI: 10.32394/rpzh.2021.0173