Research and Prevention: Closing the Chronic Disease Gap in

Minority Populations

NIH Perspectives

Lawrence A. Tabak, DDS, PhD

Principal Deputy Director, NIH

Department of Health and Human Services

Closing the Gap: The View from NIH

Health Disparities Research

Minority Populations in Clinical Research

Diversity of the Biomedical Workforce

Closing the Gap: The View from NIH

Health Disparities Research

Minority Populations in Clinical Research

Diversity of the Biomedical Workforce

Health Disparities Research: The Plans

HHS Health Disparities Action

Plan

NIH Health Disparities Strategic Plan and

Budget

HHS Disparities Action PlanGoals, 2010–2015

Transform health care

Strengthen the nation’s Health and Human Services infrastructure and workforce

Advance the health, safety, and well-being of the American people

Advance scientific knowledge and innovation

Increase the efficiency, transparency, and accountability of HHS programs

NIH Health Disparities Strategic Plan Establishes principles for NIH’s health disparities agenda

Outlines projects to address minority health and health disparitieswithin each NIH Institute and Center, NIH Office of the Director

Sets three major goals for each NIH IC:

1. Conduct and support intensive research on factors underlying health disparities

2. Engage in aggressive, proactive, community outreach, information dissemination, and public health education

3. Expand and enhance research capacity to create a culturally sensitive and culturally competent workforce

Advance understanding of the development and progression of diseases and disabilities that contribute to health disparities among racial and ethnic minority, low-income, rural, and medically underserved populations

Develop new or improved approaches for detecting, diagnosing, preventing, delaying, or treating the onset or progression of diseases and disabilities that contribute to health disparities

Advance understanding of the causes of health disparities, e.g., non-biological bases of disease incidence and progression

NIH’s Health Disparities Research: Objectives

Research on Factors Underlying Health Disparities

Areas of Emphasis Clinical and Translational Research Comparative Effectiveness Research Social Determinants of Health Health Services Research Innovative Health Technologies Genetics and Biological Factors Behavioral and Social Sciences

U.S. rate of preterm births is >12%, far higher than many other developed nations

In 2009, 13.9% of Black infants were low birthweight, compared to 7.2% of White infants

NIH’s Maternal Fetal Medicine Units Network

14 clinical research centers

Research includes identifying factors associated with disparities in quality of obstetric care/outcomes

Significant findings to date:

Weekly progesterone injections for women with previous preterm delivery reduces risk of preterm birth

Magnesium sulfate before preterm birth provides neuroprotection

NIH Research on Prematurity and Health Disparities

Racial Disparities in Cardiovascular Disease (CVD)

Morehouse and Emory Team up to Eliminate Health Disparities (META-Health) study

African Americans experience a higher burden of CVD, while classification schema may underestimate CVD risk

Study Findings:

African Americans have higher levels of oxidative stress than whites (even after adjustment for differences in risk factors)

Racial differences in oxidative stress may play a key role in racial disparities in CVD

Metab Syndr Relat Disord. 2012 Mar 2. [Epub ahead of print]

Colorectal Cancer Disparities

Observation: Black men and women have higher incidence and mortality rates compared to white men and women

Study Design:

Screening sigmoidoscopy offered to study participants

Subjects with polyps or lesions were referred to personal physician for follow-up colonoscopy (cost not covered by the study)

Laiyemo et al, “Race and Colorectal Cancer Disparities: Health-Care Utilization vs Different Cancer Susceptibilities” JNCI 2010

Colorectal Cancer Disparities: Study Points to Healthcare Utilization Rates

Study Findings:

Blacks and whites equally likely to need follow-up colonoscopy after a screening sigmoidoscopy

Blacks less likely to receive the follow-up colonoscopy

No statistically significant difference in the risk of colorectal cancer by race based on colonoscopy results

Closing the Gap: The View from NIH

Health Disparities Research

Minority Populations in Clinical Research

Diversity of the Biomedical Workforce

Conclusions: We found very small differences in the willingness of minorities, most of whom were African-Americans and Hispanics in the US, to participate in health research compared to non-Hispanic whites. These findings, based on the research enrollment decisions of over 70,000 individuals, the vast majority from the US, suggest that racial and ethnic minorities in the US are as willing as non-Hispanic whites to participate in health research. Hence, efforts to increase minority participation in health research should focus on ensuring access to health research for all groups, rather than changing minority attitudes.

PLoS Med 3(2): e19. doi:10.1371/journal.pmed.0030019, 2005

Minority Enrollment in NIH Domestic Clinical Research

Closing the Gap: The View from NIH

Health Disparities Research

Minority Populations in Clinical Research

Diversity of the Biomedical Workforce

Diversity of the NIH-Funded Research Workforce

2010 US Census Bureau Report

2010 NIH Principal Investigators on RPGs

Sources: US Census Report 2010; IMPACII; AAMC

Hispanic or Latino (of any race) White

American Indian and Alaska Native Native Hawaiian and other Pacific Islander

Asian Other, unknown, not reported and more than one raceBlack or African American

Greater Diversity in Research Workforce

African Americans, Hispanics, and Native Americans:Represent 31% of U.S. college age population but only account for 14% of undergraduates in life sciences

And even fewer in later stages

Greater Diversity in Research Workforce:NIH Needs to Do More

Greater Diversity in Research Workforce

NIH’s Plan for Action: Evaluate current training programs

Phase out unsuccessful programs, expand successful ones

Increase number of early career reviewers, including those from underrepresented populations

Examine grant review process for bias and develop interventions

Improve support for grant applicants

Gather expert advice on additional action steps

ACD Working Group on Diversity in the Biomedical Research Workforce

Reed Tuckson, M.D., co-chair

UnitedHealth Group John Ruffin, Ph.D., co-chair

NIH Lawrence Tabak, D.D.S., Ph.D., co-chair

NIH Ann Bonham, Ph.D.

AAMC Jordan Cohen, M.D.

AAMC José Florez, M.D., Ph.D.

Harvard Medical School Gary Gibbons, M.D.

Morehouse School of Medicine Renee Jenkins, M.D.

Howard University

Tuajuanda Jordan, Ph.D. Lewis and Clark College

Wayne Riley, M.D., M.P.H., M.B.A.Meharry Medical College

Samuel Silverstein, M.D.Columbia University Medical Center

Dana Yasu Takagi, Ph.D.University of California, Santa Cruz

Maria Teresa Velez, Ph.D.University of Arizona

M. Roy Wilson, M.D., M.S.NIH

Keith Yamamoto, Ph.D.University of California, San Francisco

Clyde Yancy, M.D.Northwestern University

NIH Turning Discovery into Health

Lawrence.Tabak@nih.gov