Research and Prevention: Closing the Chronic Disease Gap in Minority Populations
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Transcript of Research and Prevention: Closing the Chronic Disease Gap in Minority Populations
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) WhiteAmerican Indian and Alaska Native Native Hawaiian and other Pacific IslanderAsian 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