Addressing Disparities in Outcomes of Screening for Colorectal Cancer in Community-Based Settings
This study will evaluate the colorectal cancer screening continuum — tests, screening quality, follow-up care, and health outcomes — over a 20-year time period that covers before, during, and after implementation of an organized colorectal cancer screening at KPNC and…
Prioritizing diversity in polygenic risk prediction of primary open-angle glaucoma
Primary open-angle glaucoma (POAG) is a leading cause of irreversible vision loss, yet much of the genetic risk remains unaccounted for, especially in African-Americans, who have a higher risk for developing POAG. This proposal aims to bring together the largest…
Empowering Latinas to Obtain Guideline-Concordant Breast Cancer Screenings
This project will compare the effects of 2 intervention approaches (empowerment+navigation, education+navigation) and underlying mechanisms on guideline concordant breast cancer screening among non-adherent Latinas. We will also compare the effects of the 2 intervention approaches and underlying mechanisms on guideline…
Collaboration on Studies Examining Health Conditions in Pediatric and Adult Populations Focused on Asians and Asian Subgroups
The ethnic diversity of younger and older US populations is continuing to increase. This research program supported by the Stanford Center for Asian Health Research and Education will support the continuation of existing studies within our team examining cardiometabolic and…
Understanding the role of adipose tissue distribution and adipokine-related RNA expression in the tumor microenvironment on breast cancer outcomes in a racially and ethnically diverse sample
We will test the central hypothesis that adipose tissue depots (visceral vs. subcutaneous), measured using computed tomography scans, have differing associations with adipokine and adipokine receptor gene expression profiles and related gene signatures in the breast tumor microenvironment, which can…
Understanding facilitators and barriers to achieving glycemic control among a diverse population with gestational diabetes
The SUNRISE project capitalizes on our previous qualitative research that demonstrated our ability to identify facilitators and barriers that contribute to health engagement among patients with gestational diabetes. The proposed supplement widens the potential impact of the parent project beyond…
TRANSFORM3: Evaluation of Implementation Strategies of Teaching, Technology, and Teams to Optimize Medical Therapy in Cardiovascular Disease (“T3”)
This initiative evaluates strategies (including technology-based decision support, referral to a virtual guideline-directed medical therapy team, and general educational tools/resources for clinicians and patients) to improve use of guideline-directed therapeutics known to lower cardiovascular events among patients with heart failure,…
Evaluating patient engagement in “KP Connected Pregnancy Care” and its association with utilization, perinatal outcomes and patient satisfaction.
This cohort study evaluates a new prenatal care delivery pathway, KP Connected Pregnancy Care (KPCPC). KPCPC is an opt-in hybrid in-person and virtual care model using digital tools to expand remote patient monitoring and virtual visits for low-risk prenatal care…
Genetic and Environmental Factors in Hyperlipidemia and Its Treatment
Study has 3 aims: Identify and characterize common and rare genetic variants and environmental factors underlying untreated LDL-cholesterol, HDL-cholesterol, triglycerides and total cholesterol in each of four race/ethnicity groups; identify common and rare genetic variants and environmental factors underlying response…
Hip Fracture Risk and Outcomes in Older Black Women
This study examines hip fracture risk and outcome in older Black women using data from Kaiser Permanente Northern California. The study will examine the predictors of hip fracture, fracture risk prediction, and morbidity and mortality following hip fracture.
Adams, Alyce S.
Comparison of Survival Rates Across Racial/Ethnic Groups Among Young Adults Diagnosed with Early-Onset Colorectal Cancer in a Large, Community-Based Population.
This study will examine racial differences in overall survival among young adults 50 years of age diagnosed with early-onset colorectal cancer in a large, community- based, fully insured population with access to complete primary and specialty care to identify differences…
Trends in Diabetes Screening, Risk Factors and Incidence Before and After the SARS-CoV-2 Pandemic Between the California Medi-Cal and Commercially-Insured Populations
Using quasi-experimental research methods, this study is assessing the extent to which disparities in type 2 diabetes prevention and outcomes were exacerbated during the coronavirus disease 2019 (COVID-19) pandemic between the Medi-Cal and commercially-insured populations. The career development plan for…
Effect of reproductive history on longitudinal change in cardiac, vascular, and lipid parameters
The NHLBI NGHS enrolled 871 girls (50% Black and 50% white) in 1987 at age 9 or 10 and examined them up to 17 times, to age 27. This resulted in 7 echocardiogram reports from ages 20-27, multiple saved samples,…
Multilevel Determinants of Racial/Ethnic Disparities in Lung Cancer Screening Utilization
Lung cancer screening has been underutilized nationally to date, with growing evidence suggesting that screening rates differ by race. This research aims to identify multilevel factors that influence disparities in utilization of lung cancer screening from eligibility determination to screening…
Do health and health care indicators differ by preferred language in Latinx and Chinese Adults? A health and health care disparities study.
Limited English proficiency may be an important social determinant of health and health care access. This study will use electronic health record data to describe and compare health risks, chronic health conditions, quality metrics, and health care use by language…
2021 Health Equity Research Supplement to Conduct Focus Groups with Black and White Women who Self-Report Cannabis Use During Pregnancy
Qualitative data are critically needed to better understand knowledge gaps, preferences, and social and cultural factors that differentially contribute to prenatal cannabis use among Black and White women. To address these important gaps in knowledge, we will conduct race-matched virtual…
Comparative Effectiveness of Treating Genital Herpes Infection to Reduce Racial Disparities in the Risk of Severe Maternal Morbidity (SMM)
The goals of the study are to determine whether treating GHSV infection in pregnancy, especially earlier in pregnancy, is effective in mitigating the racial disparities in SMM, and GHSV infection, if untreated, contribute to racial disparities in the risk of…
Social Risk Screening and Social Risk Prediction: Research Consultation and Planning
Kaiser Permanente has set a national goal to increase social health screening among members. Dr. Grant and his DOR Complex Care Team will work with KP National Office of Community Health in a consultative role to address barriers and facilitators…
Perceived Discrimination, Nativity, and Cognitive Performance in a Multi-ethnic Study of Older Adults: Findings from the Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) Study
Despite growing research on the association between discrimination and disparities in cognitive aging, an evidence gap remains on how the association varies by racial/ethnic group. This study evaluates the associations of experiences of discrimination with cognitive function and whether these…
Measuring cognitive health in ethnically diverse older adults
Understanding racial/ethnic disparities in late-life cognitive health is a public health imperative. We used baseline data from the Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) study to examine how age, education, gender, and clinical diagnosis, a proxy for brain…
Lifecourse health, cerebral pathology and ethnic disparities in dementia (KHANDLE Study)
The Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) Study, a collaborative study between DOR and UC Davis, follows a diverse cohort of Kaiser Permanente Northern California members who participated in at least one optional check-up (Multiphasic Health Checkups) during…
An Expanded National Cohort Study of Transgender People
The Study of Transition, Outcomes and Gender (STRONG) is an ongoing cohort study of transgender people enrolled in Kaiser Permanente (KP) integrated health care plans in Georgia (KPGA), Northern California (KPNC) and Southern California (KPSC), and includes 6,459 members for…
Quantifying Racial/ethnic Differences in the Relationship Between Glucose Concentrations and Hemoglobin A1c
Physicians rely on hemoglobin A1c (A1C), an integrated measure of glycemia (blood glucose), to make treatment decisions for patients with diabetes. There is evidence that, given comparable glycemia, A1C results in African Americans can be significantly higher than in whites…
Tailoring initial type 2 diabetes care to meet the needs of younger Latinx adults: A randomized pilot study
Our goal is to evaluate the effectiveness of a proactive, tailored care intervention in improving early outcomes for Latinx individuals with younger-onset type 2 diabetes. We will also conduct post-intervention interviews with study participants to identify components of the intervention…
The Impact of Racial Residential Segregation on the Mental Health of Pregnant Women
We will create a large diverse cohort of more than 360,000 pregnant Black, Hispanic, Asian and white women to: examine the relationship between racial residential segregation and prenatal depression, anxiety and trauma (Aim 1); and prenatal depressive severity (Aim 2).…
Influence of Comorbidities and Inflammatory Biomarkers in Disparities in Ovarian Cancer Treatment, Treatment Response, and Survival
This project examines racial and ethnic disparities in ovarian cancer patients diagnosed and treated in KPNC from 2000 to 2023. It is an ancillary study to an NCI-funded research project (R01 CA243188) led by MPIs Kushi, Doherty (University of Utah),…
Contributions of COVID-19 Pandemic-Related Stressors to Racial and Ethnic Disparities in Mental Health During Pregnancy
This study aimed to identify racial and ethnic disparities in prenatal mental health and identify COVID-19 pandemic-related health/healthcare and economic contributors to these disparities, using an established framework for disparity investigation. This cross-sectional study includes 10,930 pregnant people at Kaiser…
Regional and sociodemographic differences in average BMI among US children in the ECHO program
The aim of this study was to describe the association of individual-level characteristics (sex, race/ethnicity, birth weight, maternal education) with child BMI within each US Census region and variation in child BMI by region. This study used pooled data from…
Disparities in Risks of Inadequate and Excessive Intake of Micronutrients during Pregnancy
Inadequate or excessive intake of micronutrients in pregnancy has potential to negatively impact maternal/offspring health outcomes. The aim was to compare risks of inadequate or excessive micronutrient intake in diverse females with singleton pregnancies by strata of maternal age, race/ethnicity,…
Diabetes Research for Equity through Advanced Multilevel Science Center for Diabetes Translational Research (DREAMS-CDTR)
The Diabetes Research for Equity through Advanced Multilevel Science Center for Diabetes Translational Research(DREAMS-CDTR) supports diabetes translational research through mentoring and supporting junior faculty, and by fostering collaborations between investigators and health care systems. This is an infrastructure and training…
Tuberculosis Epidemiologic Studies Consortium III
This study will identify primary care systems and settings that serve non-U.S.-born persons at risk for latent tuberculosis infection (LTBI) and tuberculosis disease; collect retrospective and prospective electronic medical record data; design and implement clinical care-based interventions to improve performance…
Leveraging Diversity in Cancer Epidemiology Cohorts and Novel Methods to Improve Polygenic Risk Scores
Inadequate representation of diverse racial/ethnic populations in genetic studies is hindering the translational potential of polygenic risk scores (PRS) in cancer risk prediction. To address this shortcoming, we aim to construct and evaluate PRS for cancer and estimate the absolute…
Disparities in REsults of Immune Checkpoint Inhibitor Treatment (DiRECT): A Prospective Cohort Study of Cancer Survivors Treated with anti-PD-1/anti-PD-L1 in a Community Oncology Setting
This project will establish a prospective cohort of white and Black cancer patients treated with immune checkpoint inhibitors, leveraging the NCI Community Oncology Research Program network infrastructure, to investigate racial differences in immune-related adverse events and their predictors, treatment delay…
Barriers and Facilitators to TracFone/CareLink Implementation in Two Kaiser Permanente Regions
This study will evaluate TracFone/CareLink program within Kaiser Permanente (KP) Digital Health Equity portfolio. It will involve engaging local leaders, end users, and KP members in the planning, implementation, and initial assessment of barriers and facilitators of the TracFone/CareLink program.
Tailoring care to meet the needs of younger Latinx adults with newly diagnosed type 2 diabetes
We will evaluate a culturally responsive community health worker (CHW) intervention targeting younger-onset Latinx individuals with a new type 2 diabetes (T2D) diagnosis (AURORA [Active Outreach to Younger Latinx]). The AURORA strategy centers on a CHW who will proactively conduct…
Skeletal Health Outcomes among US Asian Women
The burden of osteoporosis has increased as the US population over age 65 years has increased. Ethnic diversity in the U.S. has also increased. This is the first large scale US study of fracture outcomes among Asians and ethnic subgroups…
Women’s Multi-Ethnic Health and Lifestyle Survey
We propose to survey White, Black, Latina, Filipina, Chinese, South Asian, Vietnamese, and Japanese women aged 35-79 to characterize and compare these racial/ethnic groups on behaviors and risks related to 7 lifestyle medicine domains (diet, physical activity, sleep, stress management,…
Young Adult and Midlife Transitions in Physical Activity and Sedentary Behavior with Heart Failure Risk and Progression: Coronary Artery Risk Development in Young Adults (CARDIA)
This CARDIA ancillary study will examine the longitudinal relations of 35-year changes in reported physical activity from young adulthood to late midlife with indicators of subclinical heart failure collected at late midlife, and evaluate interaction in these relations by race,…
Opportunities to Integrate Mobile App-Based Interventions Into Mental Health and Substance Use Disorder Treatment Services in the Wake of COVID-19
The COVID-19 pandemic has heightened concerns about the impact of depression, anxiety, alcohol, and drug use on public health. Mobile apps to address these problems were increasingly popular even before the pandemic, and may help reach people who otherwise have…
Attention-Deficit/Hyperactivity Disorder Medication Adherence in the Transition to Adulthood: Associated Adverse Outcomes for Females and Other Disparities
The purpose of this study was to assess the association between attention-deficit/hyperactivity disorder (ADHD) medication adherence and adverse health outcomes in older adolescents transitioning to adulthood. In a cohort of 17-year-old adolescents with ADHD at Kaiser Permanente Northern California, we…
Cancer screening in the U.S. through the COVID-19 pandemic, recovery, and beyond
COVID-19 has proved enormously disruptive to the provision of cancer screening, which does not just represent an initial test but an entire process, including risk detection, diagnostic follow-up, and treatment. Successful delivery of services at all points in the process…
Algorithmic prognostication in critical care: a promising but unproven technology for supporting difficult decisions
Patients, surrogate decision makers, and clinicians face weighty and urgent decisions under uncertainty in the ICU, which could be aided by risk prediction. Although emerging artificial intelligence/machine learning (AI/ML) algorithms could reduce uncertainty surrounding these life and death decisions, certain…
Characterization of HIV Preexposure Prophylaxis Use Behaviors and HIV Incidence Among US Adults in an Integrated Health Care System
Long-term follow-up is needed to evaluate gaps in HIV preexposure prophylaxis (PrEP) care delivery and to identify individuals at risk for falling out of care. To characterize the PrEP continuum of care, including prescription, initiation, discontinuation, and reinitiation, and evaluate…
Sex Differences in Cardiovascular Outcomes in CKD: Findings From the CRIC Study
Cardiovascular events are less common in women than men in general populations; however, studies in chronic kidney disease (CKD) are less conclusive. We evaluated sex-related differences in cardiovascular events and death in adults with CKD. Prospective cohort study. 1,778 women…
mHealth Mindfulness Intervention for Pregnant Black and Latina Women at Risk of Postpartum Depression
This randomized controlled trial of an mHealth mindfulness intervention designed for Black and Latinx pregnant women at risk of developing postpartum depression will compare outcomes (depression, stress, sleep) of participants in the intervention with those in the control arm.
COVID-19 Vaccination Coverage Among Insured Persons Aged ≥16 Years, by Race/Ethnicity and Other Selected Characteristics – Eight Integrated Health Care Organizations, United States, December 14, 2020-May 15, 2021
COVID-19 vaccination is critical to ending the COVID-19 pandemic. Members of minority racial and ethnic groups have experienced disproportionate COVID-19-associated morbidity and mortality (1); however, COVID-19 vaccination coverage is lower in these groups (2). CDC used data from CDC's Vaccine…
Engagement in perinatal depression treatment: a qualitative study of barriers across and within racial/ethnic groups
To better understand previously observed racial/ethnic disparities in perinatal depression treatment rates we examined care engagement factors across and within race/ethnicity. Obstetric patients and women's health clinician experts from a large healthcare system participated in this qualitative study. We conducted focus…
Equitably Allocating Resources During Crises: Racial Differences in Mortality Prediction Models
Rationale: Crisis standards of care (CSCs) guide critical care resource allocation during crises. Most recommend ranking patients on the basis of their expected in-hospital mortality using the Sequential Organ Failure Assessment (SOFA) score, but it is unknown how SOFA or…
Operationalizing Social Environments in Cognitive Aging and Dementia Research: A Scoping Review
Social environments are a contributing determinant of health and disparities. This scoping review details how social environments have been operationalized in observational studies of cognitive aging and dementia. A systematic search in PubMed and Web of Science identified studies of…
The Role of Community-Based Organizations in Improving Chronic Care for Safety-Net Populations
Social determinants of health (SDoH) influence health outcomes and contribute to disparities in chronic disease in vulnerable populations. To inform health system strategies to address SDoH, we conducted a multi-stakeholder qualitative study to capture the multi-level influences on health for…
Racial, ethnic, and gender disparities in hospitalizations among persons with HIV in the United States and Canada, 2005-2015
To examine recent trends and differences in all-cause and cause-specific hospitalization rates by race, ethnicity, and gender among persons with HIV (PWH) in the United States and Canada. HIV clinical cohort consortium. We followed PWH at least 18 years old in…
Mediation analysis of racial disparities in triple-negative breast cancer incidence among postmenopausal women
Triple-negative breast cancer (TNBC) is disproportionately higher in Black women relative to White women. The objective of this study was to examine to what extent the association between race/ethnicity and risk of TNBC is mediated by potentially modifiable factors. A…
Racial Disparities in COVID-19 Testing and Outcomes : Retrospective Cohort Study in an Integrated Health System
Racial disparities exist in outcomes after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. To evaluate the contribution of race/ethnicity in SARS-CoV-2 testing, infection, and outcomes. Retrospective cohort study (1 February 2020 to 31 May 2020). Integrated health care delivery…
Initiation and adherence to adjuvant endocrine therapy among urban, insured American Indian/Alaska Native breast cancer survivors
It has been shown that racial/ethnic disparities exist with regard to initiation of and adherence to adjuvant endocrine therapy (AET). However, the relationship among American Indian/Alaska Native (AIAN) individuals is poorly understood, particularly among those who reside in urban areas.…
Adverse Pregnancy Outcomes and Cardiovascular Disease Risk: Unique Opportunities for Cardiovascular Disease Prevention in Women: A Scientific Statement From the American Heart Association
This statement summarizes evidence that adverse pregnancy outcomes (APOs) such as hypertensive disorders of pregnancy, preterm delivery, gestational diabetes, small-for-gestational-age delivery, placental abruption, and pregnancy loss increase a woman's risk of developing cardiovascular disease (CVD) risk factors and of developing…
Implementation of Alcohol Screening and Brief Intervention in a Health System: Sustainability, Fidelity and Patient Outcomes, Covid-19 Supplement
This study examines the increase in alcohol consumption during the Covid-19 pandemic and the major shift to virtual treatment modalities for alcohol problems, with a focus on potential disparities in treatment access, by race, ethnicity, age and gender. Understanding potential…
Racial/Ethnic Disparities in Ovarian Cancer Treatment and Survival: An Integrative Approach
We reported previously that African American and Hispanic women have worse survival after ovarian cancer diagnosis than white women, and Asian women have similar survival. We will investigate reasons for these disparities, focusing on tumor subtypes, health care, and neighborhood-level…
Cardiovascular Health Associations with Minority Stress: Behavioral Evaluations and Self-Reported Sociopsychological Outcomes by SOGI Status (CHAMBERS)
In CARDIA Year 35 exam: Assess whether sexual minority and gender minority (SGM) individuals in CARDIA have increased odds of objectively-determined traditional cardiovascular disease (CVD) risk factors and poorer CVD outcomes compared to their non-SGM counterparts. Determine whether self and/or…
Evaluation of sex differences in preschool children with and without autism spectrum disorder enrolled in the study to explore early development
Research in school-aged children, adolescents, and adults with autism spectrum disorder (ASD) has found sex-based differences in behavioral, developmental, and diagnostic outcomes. These findings have not been consistently replicated in preschool-aged children. We examined sex-based differences in a large sample…
Influence of patient immigrant status on physician trainee diabetes treatment decisions: a virtual patient experimental study
To determine the effect of patient immigrant status on physician trainees' diabetes treatment decisions. Participants were 140 physician trainees ('providers'). Providers viewed videos and vignettes of virtual patients differing in immigrant status (born in Mexico or U.S.; other characteristics held…
Racial/Ethnic Disparities in Young Adulthood and Midlife Cardiovascular Risk Factors and Late-life Cognitive Domains: The Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) Study
Midlife cardiovascular risk factors (CVRF) increase dementia risk. Less is known about whether CVRF identified before midlife impact late-life cognition in diverse populations. Linear regression models examined hypertension, hyperlipidemia, and overweight/obesity at ages 30 to 59 with late-life executive function,…
Age-Related Development of Cardiac Remodeling and Dysfunction in Young Black and White Adults: the Coronary Artery Risk Development in Young Adults Study
Little is known about the timing of preclinical heart failure (HF) development, particularly among blacks. The primary aims of this study were to delineate age-related left ventricular (LV) structure and function evolution in a biracial cohort and to test the…
Do the Benefits of Educational Attainment for Late-life Cognition Differ by Racial/Ethnic Group?: Evidence for Heterogenous Treatment Effects in the Kaiser Healthy Aging and Diverse Life Experience (KHANDLE) Study
Educational attainment is associated with late-life cognitive performance and dementia; few studies have examined diverse racial/ethnic groups to assess whether the association differs by race/ethnicity. We investigated whether the association between educational attainment and cognition differed between White, Black, Asian,…
Building an Evidence Case for Capturing Educational Attainment in the EHR as a Social Determinant of Health
Educational attainment is an important social determinant of health, but it is not included in the electronic health records of a majority of adults. When the information is available, it is frequently not captured in a way that makes it…
Tools for Outpatient and Population Management of SARS-COV-2 Infection (TOPS2)
This project aims to improve The Permanente Medical Group's capability for outpatient and population management of adults with COVID-19. It will identify the spatial, temporal, and racial distribution of coronavirus infections; characterize the clinical progression of coronavirus infection; and synthesize…
Barriers to Obstetric/Gynecological Health Care for Women with Autism Spectrum Disorders
This study will identify the sociodemographic and health factors associated with low utilization of obstetrics/gynecology services among adult women with autism spectrum disorders and explore whether these women are at higher risk of adverse maternal and birth outcomes than women…
Racial/ethnic disparities in survival after breast cancer diagnosis by estrogen and progesterone receptor status: A pooled analysis
Limited studies have investigated racial/ethnic survival disparities for breast cancer defined by estrogen receptor (ER) and progesterone receptor (PR) status in a multiethnic population. Using multivariable Cox proportional hazards models, we assessed associations of race/ethnicity with ER/PR-specific breast cancer mortality…
Urban-Rural Disparities and Temporal Trends in Peptic Ulcer Disease Epidemiology, Treatment, and Outcomes in the United States
The incidence of peptic ulcer disease (PUD) has been decreasing over time with Helicobacter pylori eradication and use of acid-suppressing therapies. However, PUD remains a common cause of hospitalization in the United States. We aimed to evaluate contemporary national trends…
COVID-19 prevalence, symptoms, and sociodemographic disparities in infection among insured pregnant women in Northern California
Research on COVID-19 during pregnancy has mainly focused on women hospitalized for COVID-19 or other reasons during their pregnancy. Little is known about COVID-19 in the general population of pregnant women. To describe the prevalence of COVID-19, symptoms, consequent healthcare…
Trans-ancestry genome-wide association meta-analysis of prostate cancer identifies new susceptibility loci and informs genetic risk prediction
Prostate cancer is a highly heritable disease with large disparities in incidence rates across ancestry populations. We conducted a multiancestry meta-analysis of prostate cancer genome-wide association studies (107,247 cases and 127,006 controls) and identified 86 new genetic risk variants independently…
Community Health Behaviors and Geographic Variation in Early-Onset Colorectal Cancer Survival Among Women
Despite overall reductions in colorectal cancer (CRC) morbidity and mortality, survival disparities by sex persist among young patients (age
Impact of nulliparity, hypertensive disorders of pregnancy, and gestational diabetes on vasomotor symptoms in midlife women
To determine whether women with a history of nulliparity, hypertensive disorders of pregnancy (HDP), or gestational diabetes mellitus (GDM) have a higher odds of reporting vasomotor symptoms (VMS) at midlife. A longitudinal analysis was performed with 2,249 women with pregnancy…
Health care utilization and HIV clinical outcomes among newly enrolled patients following Affordable Care Act implementation in a California integrated health system: a longitudinal study
The Affordable Care Act (ACA) has increased insurance coverage for people with HIV (PWH) in the United States. To inform health policy, it is useful to investigate how enrollment through ACA Exchanges, deductible levels, and demographic factors are associated with…
Interventions Targeting Racial/Ethnic Disparities in Stroke Prevention and Treatment
Systemic racism is a public health crisis. Systemic racism and racial/ethnic injustice produce racial/ethnic disparities in health care and health. Substantial racial/ethnic disparities in stroke care and health exist and result predominantly from unequal treatment. This special report aims to…
Long-term follow-up of a racially and ethnically diverse population of men with localized prostate cancer who did not undergo initial active treatment
There is limited research on the racial/ethnic differences in long-term outcomes for men with untreated, localized prostate cancer. Men diagnosed with localized, Gleason ≤7 prostate cancer who were not treated within 1 year of diagnosis from 1997-2007 were identified. Cumulative incidence…
An Electronic Health Record-Based Tool to Identify Newly Diagnosed Breast Cancer Patients at Risk of Low Social Support
Goals of the project are to: 1) Identify terms from content in the EHR, based on theory and prior literature, and informed by clinical stakeholders in BC care, that measure structural and/or functional social support, have been associated with BC…
Understanding Racial/Ethnic Disparities in Physical Performance in Mid-Life Women: Findings from SWAN (Study of Women’s Health Across the Nation)
Evaluate degree to which racial/ethnic differences in physical performance are mediated by sociodemographic, health, behavioral, and psychosocial factors. Physical performance was evaluated using a decile score derived from grip strength, timed 4 m walk, and timed repeat chair stand in…
Addressing Disparities in Lung Cancer Screening Eligibility and Healthcare Access. An Official American Thoracic Society Statement
Background: There are well-documented disparities in lung cancer outcomes across populations. Lung cancer screening (LCS) has the potential to reduce lung cancer mortality, but for this benefit to be realized by all high-risk groups, there must be careful attention to…
Body mass index versus bioelectrical impedance analysis for classifying physical function impairment in a racially diverse cohort of midlife women: the Study of Women’s Health Across the Nation (SWAN)
Body composition strongly influences physical function in older adults. Bioelectrical impedance analysis (BIA) differentiates fat mass from skeletal muscle mass, and may be more useful than body mass index (BMI) for classifying women on their likelihood of physical function impairment.…
Patient experiences with Value-Based Insurance Designs (VBID) in Kaiser Permanente: Plan Knowledge and Medication Behavior
The study will examine patient knowledge and experience in a Value-based insurance designs plan by surveying 1,000 patients newly enrolling in a VBID plan. The survey will collect patient knowledge of their plan, patient-reported medication behavior (including specific cost barriers…
Age- and race/ethnic-based disparities in diabetes outcomes among younger adults with newly diagnosed Type 2 Diabetes
This study will conduct focus groups with KPNC members (age 45) with newly diagnosed Type 2 diabetes to learn about members’ experiences with this new diagnosis and to identify early facilitators of and barriers to effective diabetes management in this…
Racial/Ethnic Disparities in Perinatal Depression Treatment Utilization
The study will characterize racial/ethnic differences in perinatal depression treatment utilization, treatment engagement, and continued care by assembling a retrospective cohort of KPNC members entering prenatal care between 2012-2016. The study will also identify barriers to and facilitators of treatment…
Understanding racial-ethnic disparities in preterm birth sub-types and prenatal care utilization
The study will examine racial-ethnic disparities in the risk of preterm birth overall and by preterm birth sub-types. It will also study whether the racial-ethnic disparities in preterm births and preterm birth sub-types are modified by the level of prenatal…
Prevalence of Social Risks and Association of Social Risks with Health and Well-Being Among Non-Safety Net Middle-Aged and Older Adult Members in Kaiser Permanente Northern California
This study will gather data to estimate the prevalence of several different social and financial risk factors among adults aged 35-84 and assess whether risk factor prevalence significantly differs across age, race, health status, and income groups.
Understanding Racial/Ethnic Disparities in Lung Cancer Screening Utilization
This study proposes to understand patterns and multilevel determinants of racial/ethnic disparities in Lung Cancer Screening utilization from 2017 onward at KPNC.
Heterogeneous trends in burden of heart disease mortality by subtypes in the United States, 1999-2018: observational analysis of vital statistics
To describe trends in the burden of mortality due to subtypes of heart disease from 1999 to 2018 to inform targeted prevention strategies and reduce disparities. Serial cross sectional analysis of cause specific heart disease mortality rates using national death…
Social Relationships and Risk of Type 2 Diabetes Among Postmenopausal Women
We examined whether social relationship variables (social support, social strain, social network size, and stressful life events) were associated with risk of developing type 2 diabetes among postmenopausal women. 139,924 postmenopausal women aged 50-79 years without prevalent diabetes at baseline…
Obesity and Mortality Among Patients Diagnosed With COVID-19: Results From an Integrated Health Care Organization
Obesity, race/ethnicity, and other correlated characteristics have emerged as high-profile risk factors for adverse coronavirus disease 2019 (COVID-19)-associated outcomes, yet studies have not adequately disentangled their effects. To determine the adjusted effect of body mass index (BMI), associated comorbidities, time,…
Association of Racial Residential Segregation Throughout Young Adulthood and Cognitive Performance in Middle-aged Participants in the CARDIA Study
Neighborhood-level residential segregation is implicated as a determinant for poor health outcomes in black individuals, but it is unclear whether this association extends to cognitive aging, especially in midlife. To examine the association between cumulative exposure to residential segregation during…
Leveraging Machine Learning to Improve Risk Prediction for Chemotherapy Induced Neuropathy
Chemotherapy-associated peripheral neuropathy (CPN) affects nearly 70% of cancer patients. An estimated 30% of cancer survivors have persistent CPN, which can have a devastating impact on their quality of life and functioning. Our objective is to develop and validate a…
Neighborhood socioeconomic status and risk of hospitalization in patients with chronic kidney disease: A chronic renal insufficiency cohort study
Patients with chronic kidney disease (CKD) experience significantly greater morbidity than the general population. The hospitalization rate for patients with CKD is significantly higher than the general population. The extent to which neighborhood-level socioeconomic status (SES) is associated with hospitalization…
Remission From Unhealthy Drinking Among Patients With an Alcohol Use Disorder: A Longitudinal Study Using Systematic, Primary Care-Based Alcohol Screening Data
Using electronic health record (EHR) data from a systematic, primary care-based alcohol screening, brief intervention, and referral to treatment (SBIRT) initiative within a health system, we examined correlates of remission from unhealthy drinking among patients with an alcohol use disorder…
Hospital Characteristics and Breast Cancer Survival in the California Breast Cancer Survivorship Consortium
Racial/ethnic disparities in breast cancer survival are well documented, but the influence of health care institutions is unclear. We therefore examined the effect of hospital characteristics on survival. Harmonized data pooled from 5 case-control and prospective cohort studies within the…
Glycemic Control and Dementia: The Role of Pharmacotherapy and Vascular Complications
About 25% of people over the age of 65 are living with diabetes, with 90% of them managing type 2 diabetes. Studies have shown that older individuals with type 2 diabetes have a 51-62% higher risk of dementia than those…
Racial and Ethnic Disparities in Diabetes Care Quality among Women of Reproductive Age in an Integrated Delivery System
Diabetes is increasingly prevalent among women of reproductive age, yet little is known about quality of diabetes care for this population at increased risk of diabetes complications and poor maternal and infant health outcomes. Previous studies have identified racial/ethnic disparities…
Association Between Blood Pressure and Later-Life Cognition Among Black and White Individuals
Black individuals are more likely than white individuals to develop dementia. Whether higher blood pressure (BP) levels in black individuals explain differences between black and white individuals in dementia risk is uncertain. To determine whether cumulative BP levels explain racial…
Characterizing the Human Immunodeficiency Virus Care Continuum Among Transgender Women and Cisgender Women and Men in Clinical Care: A Retrospective Time-series Analysis
Prior studies suggest that transgender women (TW) with human immunodeficiency virus (HIV) are less likely to be virally suppressed than cisgender women (CW) and cisgender men (CM). However, prior data are limited by small sample sizes and cross-sectional designs. We…
Sedentary Time and Physical Activity Across Occupational Classifications
To examine differences in activity patterns across employment and occupational classifications. Cross-sectional. A 2005-2006 Coronary Artery Risk Development in Young Adults (CARDIA) study. Participants with valid accelerometry data (n = 2068). Uniaxial accelerometry data (ActiGraph 7164), accumulated during waking hours,…
Race and Mortality in CKD and Dialysis: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study
Few studies have investigated racial disparities in survival among dialysis patients in a manner that considers risk factors and mortality during the phase of kidney disease before maintenance dialysis. Our objective was to explore racial variations in survival among dialysis…
Prevalence and treatment of opioid use disorders among primary care patients in six health systems
The U.S. experienced nearly 48,000 opioid overdose deaths in 2017. Treatment of opioid use disorder (OUD) with buprenorphine is a recommended part of primary care, yet little is known about current U.S. practices in this setting. This observational study reports…
Cervical cancer risk in women living with HIV across four continents: A multicohort study
We compared invasive cervical cancer (ICC) incidence rates in Europe, South Africa, Latin and North America among women living with HIV who initiated antiretroviral therapy (ART) between 1996 and 2014. We analyzed cohort data from the International Epidemiology Databases to…
Mental Health Research Network III
The Mental Health Research Network (MHRN) is a consortium of 13 health system research centers, embedded in large and diverse healthcare systems, dedicated to improving patient mental health through research, practice, and policy; with expertise in mental health research as…
Variation in Colorectal Cancer Stage and Mortality across Large Community-Based Populations: PORTAL Colorectal Cancer Cohort
Colorectal cancer (CRC) incidence and mortality can be reduced by effective screening and/or treatment. However, the influence of health care systems on disparities among insured patients is largely unexplored. To evaluate insured patients with CRC diagnosed between 2010 and 2014…
Racial-ethnic differences in prevalence of social determinants of health and social risks among middle-aged and older adults in a Northern California health plan
Social determinants of health (SDoHs) and social risks (SRs) have been associated with adverse health and healthcare utilization and racial/ethnic disparities. However, there is limited information about the prevalence of SRs in non-"safety net" adult populations and how SRs differ…
The South Asian Paradox
For several decades we have studied health outcomes in identified Asian American (ASAM) ethnic groups, comparing ASAM subgroups to whites and to each other. The most striking disparities we found involved South Asians (SAs). The SA individuals had higher coronary…
Racial/Ethnic Differences in Sleep Quality among Older Adults: Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) Study
We assessed cross-sectional differences in sleep quality and risk factors among Asian, Black, Latino, and White participants in the Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) Study. KHANDLE enrolled community-dwelling adults aged ≥65 years living in northern California. Participants…
Genetic ancestry does not explain increased atopic dermatitis susceptibility or worse disease control among African American subjects in 2 large US cohorts
Atopic dermatitis (AD) is more common among African American children. Whether there are racial/ethnic difference among adults with AD and the causes for those disparities are unclear. We sought to examine the relationship between self-reported race/ethnicity and AD and determine…
LIFE EXPECTANCY DISPARITIES AMONG ADULTS WITH HIV IN THE UNITED STATES AND CANADA: THE IMPACT OF A REDUCTION IN DRUG- AND ALCOHOL-RELATED DEATHS USING THE LIVES SAVED SIMULATION (LISSO) MODEL
Improvements in life expectancy among people living with human immunodeficiency virus (PLWH) receiving antiretroviral treatment in the United States and Canada might differ among key populations. Given the difference in substance use among key populations and the current opioid epidemic,…
The associations of anthropometric, behavioural and sociodemographic factors with circulating concentrations of IGF-I, IGF-II, IGFBP-1, IGFBP-2, and IGFBP-3 in a pooled analysis of 16,024 men from 22 studies
Insulin-like growth factors (IGFs) and insulin-like growth factor binding proteins (IGFBPs) have been implicated in the aetiology of several cancers. To better understand whether anthropometric, behavioural and sociodemographic factors may play a role in cancer risk via IGF signalling, we…
Use of >100,000 NHLBI Trans-Omics for Precision Medicine (TOPMed) Consortium whole genome sequences improves imputation quality and detection of rare variant associations in admixed African and Hispanic/Latino populations
Most genome-wide association and fine-mapping studies to date have been conducted in individuals of European descent, and genetic studies of populations of Hispanic/Latino and African ancestry are limited. In addition, these populations have more complex linkage disequilibrium structure. In order…
Racial/Ethnic Disparities in the Prevalence of Diabetes and Prediabetes by BMI: Patient Outcomes Research To Advance Learning (PORTAL) Multisite Cohort of Adults in the U.S
To examine racial/ethnic disparities in the prevalence of diabetes and prediabetes by BMI category. In a consortium of three U.S. integrated health care systems, 4,906,238 individuals aged ≥20 years during 2012-2013 were included. Diabetes and prediabetes were ascertained by diagnosis…
Effect of Sex, Age and Positivity Threshold on Fecal Immunochemical Test Accuracy: a Systematic Review and Meta-Analysis
Quantitative fecal immunochemical tests (FITs) for hemoglobin are commonly used for colorectal cancer (CRC) screening. We aimed to quantify the change in CRC and advanced adenoma detection and number of positive test results at different positivity thresholds and by sex…
Understanding racial disparities in renal cell carcinoma incidence: estimates of population attributable risk in two US populations
Renal cell carcinoma (RCC) incidence is higher among black than white Americans. The reasons for this disparity remain unclear. We calculated race- and sex-specific population attributable risk percentages (PAR%) and their 95% confidence intervals (CI) for hypertension and chronic kidney…
Rural-urban differences e-cigarette ever use, the perception of harm, and e-cigarette information seeking behaviors among U.S. adults in a nationally representative study.
Adults living in rural areas, compared to their urban counterparts, are at an increased risk of using tobacco-related products and mortality due to tobacco-related diseases. The harms and benefits of e-cigarette use are mixed, and similarly obscure messaging about these…
“They were just waiting for me to mess up”: A critical discourse analysis of immigrant Latinx teens’ perceptions of power dynamics.
This paper explores Latinx adolescents' perceptions of power dynamics with authority around them. We seek to inform how community-based professionals engage with and seek to understand members of this population. We conducted a critical discourse analysis of data collected during…
Environmental Tobacco Smoke Exposure in Relation to Family Characteristics, Stressors and Chemical Co-Exposures in California Girls
Childhood environmental tobacco smoke (ETS) exposure is a risk factor for adverse health outcomes and may disproportionately burden lower socioeconomic status groups, exacerbating health disparities. We explored associations of demographic factors, stressful life events, and chemical co-exposures, with cotinine levels,…
Locus of Control and Cognition in Older Adults With Type I Diabetes: Evidence For Sex Differences From the Study of Longevity in Diabetes (SOLID)
Life expectancy for individuals with type 1 diabetes mellitus (T1DM) has increased recently; however, it is unknown how diabetes care attitudes affect late-life brain health. The Study of Longevity in Diabetes (SOLID) consists of 734 older adults with T1DM, reporting…
Prevalence of human papillomavirus (HPV)-vaccine types by race/ethnicity and sociodemographic factors in women with high-grade cervical intraepithelial neoplasia (CIN2/3/AIS), Alameda County, California, United States
We evaluated racial/ethnic differences in prevalence of oncogenic HPV types targeted by the quadrivalent HPV vaccine (16/18) and nonavalent HPV vaccine (31/33/45/52/58) in women diagnosed with CIN2/3/AIS after quadrivalent HPV vaccine introduction (2008-2015). Typing data from 1810 cervical tissue specimen…
Is it possible to overcome the ‘long arm’ of childhood socioeconomic disadvantage through upward socioeconomic mobility?
Socioeconomically disadvantaged children have worse adult health; we test if this 'long arm' of childhood disadvantage can be overcome through upward socioeconomic mobility in adulthood. Four SES trajectories (stable low, upwardly mobile, downwardly mobile and stable high) were created from…
Drug Benefit Design and Adherence Disparities in Older Adults
Our prior study examined the impact of one aspect of Medicare Part D, the removal of limits on the number of reimbursable prescriptions per month (drug caps) on racial differences in chronic disease treatment among dual Medicare and Medicaid enrollees…
Contributions of Educational Quality and Occupational Complexity on Racial and Ethnic Inequities in Brain Health and Alzheimer’s Disease and Related Dementia
This study utilizes a lifecourse approach to evaluate the roles of education quality and occupational complexity on dementia risk and cognitive decline and to examine if patterns of educational quality and occupational complexity across the lifecourse drive racial and ethnic…
Sex and Race/Ethnicity-specific Multilevel Factors Influencing Pubertal Trajectories: A Population-based Study
The goal of this project is to describe the normative distributions of pubertal development among boys and girls by race/ethnicity and to investigate early-life risk factors affecting pubertal onset and tempo (velocity of transition between onset and maturation). We will…
Alzheimer’s Disease and Related Dementias in a Diverse Cohort of Asian Americans
This study considers the extent to which immigration history, social factors, cardiometabolic health, and genetic factors contribute to heterogeneity in dementia incidence between Asian American subgroups and between Asian Americans and whites.
Mental and Physical Quality of Life by Age Groups in People Living With HIV
Quality of life (QoL) is relevant to people living with HIV (PLWH) with increased life expectancy because of antiretroviral therapy. Our cross-sectional study examined associations between sociodemographic, HIV-related and psychological variables, and QoL, overall and by age. PLWH (n =…
Healthy Eating as a Means for Active Living in Heart Failure (HEAL-HF) Study
There is an unmet clinical need to better understand the impact of lifestyle choices with respect to diet and nutrition in high-risk heart failure patients who have been recently hospitalized. We will conduct a survey-based project using a combination of…
Do breast quadrants explain racial disparities in breast cancer outcomes?
PURPOSE: Tumors of the inner quadrants of the breast are associated with poorer survival than those of the upper-outer quadrant. It is unknown whether racial differences in breast cancer outcomes are modified by breast quadrant, in addition to comparisons among…
A Seat at the Table: Strategic Engagement in Service Activities for Early Career Faculty From Underrepresented Groups in the Academy
Many academic institutions strive to promote more diverse and inclusive campuses for faculty, staff, and students. As part of this effort, these institutions seek to include individuals from historically underrepresented groups (URGs)-such as women, people from racial/ethnic minority populations, persons…
Disparities in Residual Risk in Patients Receiving Statins for Primary or Secondary Prevention at an Integrated Health Care Delivery System
Patients with risk factors for or established atherosclerotic cardiovascular disease (ASCVD) remain at high risk for first-time or recurrent nonfatal and fatal events, despite guideline-directed medical therapy for primary and secondary prevention. In fact, even among patients who are appropriately…
A Systematic Review and Meta-analysis of Associations between Clinical Prostatitis and Prostate Cancer: New Estimates Accounting for Detection Bias.
BACKGROUND: Previous meta-analyses have estimated summary positive associations between clinical prostatitis and prostate cancer. However, none have accounted for detection bias, the possibility for increased prostate cancer screening and detection in men with clinical prostatitis, in their pooled estimates.METHODS: We…
Stressors in Midlife and Risk of Dementia: The Role of Race and Education
Posttraumatic stress disorder is associated with increased dementia risk but less is known about stress because of everyday problems in diverse populations. A total of 9605 health care plan members who provided information regarding midlife stressors in 1972 to 1973…
Association of Fitness With Racial Differences in Chronic Kidney Disease
Non-white minorities are at higher risk for chronic kidney disease than non-Hispanic whites. Better cardiorespiratory fitness is associated with slower declines in estimated glomerular filtration rate and a lower incidence of chronic kidney disease. Little is known regarding associations of…
Disparities in knowledge and use of tobacco treatment among smokers in California following healthcare reform
The Affordable Care Act (ACA) promised to narrow smoking disparities by expanding access to healthcare and mandating comprehensive coverage for tobacco treatment starting in 2014. We examined whether two years after ACA implementation disparities in receiving clinician advice to quit…
Perceived and objective characteristics of the neighborhood environment are associated with accelerometer-measured sedentary time and physical activity, the CARDIA Study
We investigated cross-sectional and longitudinal associations of neighborhood environment characteristics with accelerometer-measured sedentary time (SED), light-intensity physical activity (LPA), and moderate-to-vigorous intensity physical activity (MVPA). Participants were 2120 men and women in the year 20 (2005-2006) and year 30 CARDIA…
Strategies for Building Delivery Science in an Integrated Health Care System
Health systems today have increasing opportunities and imperatives to conduct delivery science, which is applied research that evaluates clinical or organizational practices that systems can implement or encourage. Examples include research on eliminating racial/ethnic disparities in hypertension management and on…
Disparities in Health Information-Seeking Behaviors and Fatalistic Views of Cancer by Sexual Orientation Identity: A Nationally Representative Study of Adults in the United States.
Purpose: A lack of national data makes it difficult to estimate, but LGB adults appear to have a higher risk of cancer. Although limited research exists to explain the disparity, we aimed to explore potential differences in access to and…
Hepatitis C treatment uptake and response among human immunodeficiency virus/hepatitis C virus-coinfected patients in a large integrated healthcare system.
U.S. guidelines recommend that patients coinfected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) be prioritized for HCV treatment with direct-acting antiviral agents (DAAs), but the high cost of DAAs may contribute to disparities in treatment uptake and…
Time to Follow-up After Colorectal Cancer Screening by Health Insurance Type
The purpose of this study was to test the hypothesis that patients with Medicaid insurance or Medicaid-like coverage would have longer times to follow-up and be less likely to complete colonoscopy compared with patients with commercial insurance within the same…
Barriers to preexposure prophylaxis use among individuals with recently acquired HIV infection in Northern California
Barriers to HIV preexposure prophylaxis (PrEP) use have not been well-characterized in people who became HIV-infected, all of whom could have benefited from PrEP. We invited Kaiser Permanente Northern California members diagnosed with HIV during 2014-2016, following a negative HIV…
Early-onset triple-negative breast cancer in multiracial/ethnic populations: Distinct trends of prevalence of truncation mutations
Young black women are at higher risk of triple-negative breast cancer (TNBC); however, a majority of the genetic studies on cancer predisposition were carried out in White populations. The underrepresentation of minority racial/ethnic populations in cancer genetic studies may have…
Incidence of dementia after age 90 in a multiracial cohort
Little is known about dementia incidence in diverse populations of oldest-old, the age group with highest dementia incidence. Incident dementia diagnoses from 1/1/2010 to 9/30/2015 were abstracted from medical records for 2350 members of an integrated health care system in…
Poor diet quality in pregnancy is associated with increased risk of excess fetal growth: a prospective multi-racial/ethnic cohort study
Nutritional perturbations during pregnancy may impact fetal and long-term childhood growth, although there are limited data on overall diet quality. We investigated whether diet quality, measured by the Healthy Eating Index-2010 (HEI-2010), during pregnancy was related to birthweight z-score (BWZ)…
Prevalence and Factors Influencing Use of Internet and Electronic Health Resources by Middle-Aged and Older Adults in a US Health Plan Population: Cross-Sectional Survey Study
Health care organizations are increasingly using electronic health (eHealth) platforms to provide and exchange health information and advice (HIA). There is limited information about how factors beyond internet access affect use of eHealth resources by middle-aged and older adults. We…
Study of Healthy Aging in African Americans (STAR)
Rates of dementia and Alzheimer’s disease are 40% to 100% higher among African Americans compared to non-Hispanic whites. STAR is a longitudinal cohort study of lifecourse vascular risk and brain aging in 700 African Americans ages 50 and older. The goals…
Kaiser Healthy Aging and Diverse Life Experiences Study (KHANDLE)
Although there are marked ethnic disparities in rates of dementia, almost nothing is known about early-life contributors to dementia in ethnic minority groups, nor if the trajectory of cognitive decline or transition to cognitive impairment varies across ethnic groups. We…
Social Networks and Disparities in Health Behaviors and Breast Cancer Outcomes in Immigrant Women
The goals of this study are to evaluate associations between: 1) immigrant status and social networks at the neighborhood level and at the individual level, overall and by race/ethnicity, further evaluating associations among Asian/Pacific Islander and Hispanic, relative to non-Hispanic…
Life After 90
Alzheimer’s disease and other dementias affect 15 percent of those aged 65 and older, by age 90 and older this number increases to a startling 40 to 50 percent. The oldest-old, people aged 90 and older, are the fastest growing…
Racial Differences in Maintaining Optimal Health Behaviors Into Middle Age
Earlier development of cardiovascular disease risk factors in blacks versus whites may result from differences in maintaining health behaviors. Age-specific racial differences in maintaining health behaviors from ages 18 to 50 years were determined. In 1985-1986, the population-based Coronary Artery…
Lifecourse Health, Cerebral Pathology, and Ethnic Disparities in Dementia
Although there are marked ethnic disparities in rates of dementia, almost nothing is known about early-life contributors to dementia in ethnic minority groups, nor if the trajectory of cognitive decline or transition to cognitive impairment varies across ethnic groups. This…
One Size Fits (n)One: The Influence of Sex, Age, and Sexual Human Immunodeficiency Virus (HIV) Acquisition Risk on Racial/Ethnic Disparities in the HIV Care Continuum in the United States
The United States National HIV/AIDS Strategy established goals to reduce disparities in retention in human immunodeficiency virus (HIV) care, antiretroviral therapy (ART) use, and viral suppression. The impact of sex, age, and sexual HIV acquisition risk (ie, heterosexual vs same-sex…
Sexual Orientation Disparities in Physical Activity: Results From Insured Adults in California
The majority of adults in the United States fail to meet the Centers for Disease Control and Prevention (CDC) physical activity (PA) guideline recommendations for health promotion. Despite evidence of disparities by sexual orientation in adverse health outcomes related to…
Understanding Housing Insecurity and Risk for Homelessness in the Kaiser Permanente Northern California Member Population
This project will examine patient and community-level correlates of housing instability and homelessness using observational data sources. These formative analyses will develop variables to operationalize housing instability using administrative and clinical data, and explore potential predictors of housing stability and…
Racial discrimination in medical care settings and opioid pain reliever misuse in a U.S. cohort: 1992 to 2015
In the United States whites are more likely to misuse opioid pain relievers (OPRs) than blacks, and blacks are less likely to be prescribed OPRs than whites. Our objective is to determine whether racial discrimination in medical settings is protective…
Patterns of Health Care Utilization Before First Episode Psychosis in Racial and Ethnic Groups
To compare patterns of health care utilization associated with first presentation of psychosis among different racial and ethnic groups of patients. The study was a retrospective observational design. The study was conducted in five health care systems in the western…
Sociodemographic Determinants of Health and Well-Being Among Adults Residing in the Combined Kaiser Permanente Regions
Kaiser Permanente commissioned a health and well-being (HWB) survey of adult members and nonmembers in its 8 Regions. To estimate the prevalence of HWB indicators and evaluate differences in prevalence of excellent/very good (E/VG) health and thriving overall in life…
Knowing How to Ask Good Questions: Comparing Latinos and Non-Latino Whites Enrolled in a Cardiovascular Disease Prevention Study
Latinos face unique challenges engaging with their health care providers for risk management of cardiovascular disease (CVD). To better understand differences in how Latinos and non-Latino whites (NLWs) experience CVD care. We examined self-reported activation, engagement, confidence, and communication comparing…
Links between age at menarche, antral follicle count, and body mass index in African American and European American women
To examine the relationships between age at menarche, antral follicle count (AFC), and body mass index (BMI) in a multi-ethnic population of women. Community-based, cross-sectional study. Academic setting. A total of 245 African American women and 273 European American women,…
Shake Rattle & Roll – Design and rationale for a pragmatic trial to improve blood pressure control among blacks with persistent hypertension
In Kaiser Permanente Northern California (KPNC), members had similar access to care and a very high overall rate of hypertension control. However, blacks had poorer blood pressure (BP) control than whites. The Shake Rattle & Roll (SRR) trial aimed to…
Birth in High Infant Mortality States and Dementia Risk in a Cohort of Elderly African American and White Health Care Members
Birth in areas with high infant mortality rates (IMRs) has been linked to worse long-term health outcomes, yet it is completely unknown if it impacts dementia risk. In total 6268 health care members were followed for dementia diagnosis from 1996…
Optimizing a Scalable Intervention to Maximize Guideline-recommended Diabetes Testing after Gestational Diabetes Mellitus
Guideline-recommended postpartum screening is a critical step toward diabetes prevention after a diagnosis of gestational diabetes mellitus (GDM). However, patient uptake of postpartum screening remains suboptimal and uneven across racial/ethnic groups. This creates a missed opportunity for diabetes prevention or…
Particulate Air Pollution, Cardiovascular Events, and Susceptibility Factors (PACES)
This is a retrospective cohort study of 5 million adult members of Kaiser Permanente Northern California during 2000 to 2012, linked to state-of-the-art estimates of exposure to PM2.5 (particulate matter less than 2.5 micrometers in diameter) generated at 1km x…
Patterns of medication adherence in a multi-ethnic cohort of prevalent statin users diagnosed with breast, prostate, or colorectal cancer
To investigate the implications of a cancer diagnosis on medication adherence for pre-existing comorbid conditions, we explored statin adherence patterns prior to and following a new diagnosis of breast, colorectal, or prostate cancer among a multi-ethnic cohort. We identified adults…
Disparities in the Receipt of Tobacco Treatment Counseling within the US Context of the Affordable Care Act and Meaningful Use Implementation
Disparities in receiving advice to quit smoking and other tobacco use from health professionals may contribute to the continuing gap in smoking prevalence among priority populations. Under the Affordable Care Act (ACA), beginning in 2010, tobacco cessation services are currently…
Examining the role of access to care: Racial/ethnic differences in receipt of resection for early-stage non-small cell lung cancer among integrated system members and non-members
To examine the role of uniform access to care in reducing racial/ethnic disparities in receipt of resection for early stage non-small cell lung cancer (NSCLC) by comparing integrated health system member patients to demographically similar non-member patients. Using data from…
Evaluating the Impact of Eliminating Copayments for Tobacco Cessation Pharmacotherapy
We examined the impact of the Affordable Care Act-mandated elimination of tobacco cessation pharmacotherapy (TCP) copayments on patient use of TCP, overall and by income. Electronic health record data captured any and combination (eg, nicotine gum plus patch) TCP use…
Similarities and Differences in Health Indicators and Health Care Use Among Asian Ethnic Groups
This study will examine whether significant differences across Asian ethnic groups in prevalence of chronic diseases, behavioral/psychosocial risk factors, preventive service use, and patient portal use are masked when statistics are reported for “Asians.” It will utilize electronic health records…
Predicting Successful Onboarding in the Medi-Cal Population
The purpose of this project is to examine quality indicators for key chronic conditions such as diabetes and asthma for the Medi-Cal population served by Kaiser Permanente Northern California and to see how these indicators vary by different population definitions/denominators.…
Predicting and Reducing Future Health Disparities for U.S. Adults with Diabetes
The clinical and financial impact of diabetes-related interventions and policies may not be quantifiable without the use of simulation models that reflect the long-term course of disease and its complications. Models of diabetes complications are used by healthcare delivery systems…
Mobile-accessible personal health records increase the frequency and timeliness of PHR use for patients with diabetes
Personal health records (PHRs) offer patients a portal to view lab results, communicate with their doctors, and refill medications. Expanding PHR access to mobile devices could increase patients' engagement with their PHRs. We examined whether access to a mobile-optimized PHR…
Depression Screening Rates and Symptom Severity by Alcohol Use Among Primary Care Adult Patients
Hazardous alcohol use with depression may exacerbate health conditions and complicate medical care. We examined the rate of depression screening by alcohol use severity among primary care patients screened for hazardous alcohol use and, among those screened, examined patterns of…
Language barriers and LDL-C/SBP control among Latinos with diabetes
Language barriers in healthcare are associated with worse glycemic control among Latino patients with limited English proficiency and diabetes. We examined the association of patient-physician language concordance with lipid (low-density lipoprotein cholesterol [LDL-C]) and systolic blood pressure (SBP) control. Retrospective…
Association of behavioral health factors and social determinants of health with high and persistently high healthcare costs
A high proportion of U.S. health care costs are attributable to a relatively small proportion of patients. Understanding behavioral and social factors that predict initial and persistent high costs for these "high utilizers" is critical for health policy-makers. This prospective…
Cumulative Incidence of Hypertension by 55 Years of Age in Blacks and Whites: The CARDIA Study
Blacks have higher blood pressure levels compared with whites beginning in childhood. Few data are available on racial differences in the incidence of hypertension from young adulthood through middle age. We calculated the cumulative incidence of hypertension from age 18…
Common mitochondrial haplogroups and cutaneous squamous cell carcinoma risk
Background: Cutaneous squamous cell carcinoma (cSCC) is the second most common cancer in United States, and its incidence is substantially higher in men than women, but the reasons for the difference are unknown. We explored whether common mitochondrial DNA (mtDNA)…
Disparities in Initiation of Direct-Acting Antiviral Agents for Hepatitis C Virus Infection in an Insured Population
The cost of direct-acting antiviral agents (DAAs) for hepatitis C virus (HCV) infection may contribute to treatment disparities. However, few data exist on factors associated with DAA initiation. We conducted a retrospective cohort study of HCV-infected Kaiser Permanente Northern California…
Manuscript title: Can survival bias explain the age attenuation of racial inequalities in stroke incidence? A simulation study
In middle age, stroke incidence is higher among black than white Americans. For unknown reasons, this inequality decreases and reverses with age. We conducted simulations to evaluate whether selective survival could account for observed age patterning of black-white stroke inequalities.…
Patient and System Characteristics Associated with Performance on the HEDIS Measures of Alcohol and Other Drug Treatment Initiation and Engagement
Understand patient and system characteristics associated with performance on the Healthcare Effectiveness Data and Information Set (HEDIS) Alcohol and Other Drug (AOD) Initiation and Engagement of Treatment (IET) measures. This mixed-methods study linked patient and health system data from four…
Mapping hot spots of breast cancer mortality in the United States: place matters for Blacks and Hispanics.
PURPOSE: The goals of this study were to identify geographic and racial/ethnic variation in breast cancer mortality, and evaluate whether observed geographic differences are explained by county-level characteristics.METHODS: We analyzed data on breast cancer deaths among women in 3,108 contiguous…
10-year changes in accelerometer-based physical activity and sedentary time during midlife: CARDIA Study
To describe 10-year changes in accelerometer-determined physical activity (PA) and sedentary time in a midlife cohort, within and by race/sex groups. Coronary Artery Risk Development in Young Adults participants (n = 962) who wore the accelerometer with valid wear (≥4…
Implementation Research to Address the United States Health Disadvantage: Report of a National Heart, Lung, and Blood Institute Workshop
Four decades ago, U.S. life expectancy was within the same range as other high-income peer countries. However, during the past decades, the United States has fared worse in many key health domains resulting in shorter life expectancy and poorer health-a…
Cardiovascular disease incidence in adolescent and young adult cancer survivors: a retrospective cohort study
Few population-based studies have focused on cardiovascular disease (CVD) risk in adolescent and young adult (AYA; 15-39 years) cancer survivors and none have considered whether CVD risk differs by sociodemographic factors. Analyses focused on 79,176 AYA patients diagnosed with 14 first…
Identifying Geographic Disparities in Diabetes Prevalence Among Adults and Children Using Emergency Claims Data
Geographic surveillance can identify hotspots of disease and reveal associations between health and the environment. Our study used emergency department surveillance to investigate geographic disparities in type 1 and type 2 diabetes prevalence among adults and children. Using all-payer emergency…
An Empirical Dietary Inflammatory Pattern Score Is Associated with Circulating Inflammatory Biomarkers in a Multi-Ethnic Population of Postmenopausal Women in the United States
The empirical dietary inflammatory pattern (EDIP) score has been associated with concentrations of circulating inflammatory biomarkers in European Americans. We used the EDIP score, a weighted sum of 18 food groups that characterizes dietary inflammatory potential based on circulating concentrations…
A recursive partitioning approach to investigating correlates of self-rated health: The CARDIA Study
Self-rated health (SRH) is an independent predictor of mortality; studies have investigated correlates of SRH to explain this predictive capability. However, the interplay of a broad array of factors that influence health status may not be adequately captured with parametric…
Girls’ Sleep Trajectories Across the Pubertal Transition: Emerging Racial/Ethnic Differences
This study aims to examine the longitudinal association between puberty and sleep in a diverse sample of girls and explore racial/ethnic differences in this association. Using latent growth curve modeling, the present study measured pubertal development (timing and rate) and…
Racial disparities in family-provider interactions for pediatric asthma care
Black and Latino children experience significantly worse asthma morbidity than their white peers for multifactorial reasons. This study investigated differences in family-provider interactions for pediatric asthma, based on race/ethnicity. This was a cross-sectional study of parent surveys of asthmatic children…
Older adults’ readiness to engage with eHealth patient education and self-care resources: a cross-sectional survey
This study examined access to digital technologies, skills and experience, and preferences for using web-based and other digital technologies to obtain health information and advice among older adults in a large health plan. A primary aim was to assess the…
Does Combining Asians Into One Group Mask Important Ethnic Group Differences in Health and Health Care Use?
This study will examine whether significant differences across Asian ethnic groups in prevalence of chronic diseases, behavioral and psychosocial risk factors, preventive service use, and patient-portal use are masked when statistics are reported for Asians. We will use a very…
Low Cancer Risk of South Asians: A Brief Report
South Asians (ancestry in India, Pakistan, Bangladesh, or Sri Lanka) may have lower cancer risk than other racial-ethnic groups. To supplement published cohort data suggesting low cancer risk in South Asians. Logistic regression models with 7 covariates to study cancer…
Associations of overweight/obesity and socioeconomic status with hypertension prevalence across racial and ethnic groups
Racial/ethnic disparities in the prevalence of diagnosed hypertension are persistent but may be partially explained by racial/ethnic differences in weight category and neighborhood socioeconomic status. The authors compared hypertension prevalence rates among 4 060 585 adults with overweight or obesity across 10…
Research Strategies for Nutritional and Physical Activity Epidemiology and Cancer Prevention
Very large international and ethnic differences in cancer rates exist, are minimally explained by genetic factors, and show the huge potential for cancer prevention. A substantial portion of the differences in cancer rates can be explained by modifiable factors, and…
Race Disparities in Social Networks, and Breast Cancer Treatment, Prognosis
The goal of this research is to determine, through the use of mixed qualitative and quantitative methods, how the social environment influences women's breast cancer treatment, decisions about treatment, and subsequent survival, and how these relationships may help to explain…
Feasibility and Acceptability of Screening for Adverse Childhood Experiences in Prenatal Care
Adverse childhood experiences (ACEs) are common among pregnant women and contribute to increased risk for negative perinatal outcomes, yet few clinicians screen prenatal patients for ACEs. The purpose of this study was to evaluate the feasibility and acceptability of screening…
Using Neighborhood-Level Census Data to Predict Diabetes Progression in Patients with Laboratory-Defined Prediabetes
Research on predictors of clinical outcomes usually focuses on the impact of individual patient factors, despite known relationships between neighborhood environment and health. To determine whether US census information on where a patient resides is associated with diabetes development among…
Diabetes Screening among Antipsychotic-Treated Adults with Severe Mental Illness in an Integrated Delivery System: A Retrospective Cohort Study
Severe mental illness (SMI) is associated with increased risk for type 2 diabetes, partly due to adverse metabolic effects of antipsychotic medications. In public health care settings, annual screening rates are 30%. We measured adherence to national diabetes screening guidelines…
Association Between Gestational Diabetes and Incident Maternal CKD: The Coronary Artery Risk Development in Young Adults (CARDIA) Study
Gestational diabetes mellitus (GDM) is associated with increased risk for diabetes mellitus, metabolic syndrome, and cardiovascular disease. We evaluated whether GDM is associated with incident chronic kidney disease (CKD), controlling for prepregnancy risk factors for both conditions. Prospective cohort. Of…
Detecting Risk of Low Health Literacy in Disadvantaged Populations Using Area-based Measures.
Introduction: Socio-economic status (SES) and low health literacy (LHL) are closely correlated. Both are directly associated with clinical and behavioral risk factors and healthcare outcomes. Learning healthcare systems are introducing small-area measures to address the challenges associated with maintaining patient-reported…
Using Peer Support To Aid in PRevention and Treatment in Prediabetes (UPSTART)
This intervention trial has three specific aims: 1) To implement and test the effectiveness of a peer support model to initiate and sustain healthy diabetes-prevention behaviors in a lower-income, diverse population of prediabetes patients across three different care settings (Kaiser…
Predictive Modeling of the Risk of Age-related Macular Degeneration
The focus of this project is to examine the role of known genetic risk factors for age-related macular degeneration in African American subjects through whole-genome-sequencing of samples from the Research Program on Genes, Environment and Health collection.
Epidemiology of Age-related Dementia, Mild Cognitive Impairment, and Brain Pathology in a Multiethnic Cohort of Oldest-Old
Alzheimer's disease and other dementias affect 15 percent of those aged 65 and up; by age 90 and up, this number increases to a startling 40 to 50 percent. The oldest-old, people aged 90 and -older, are the fastest-growing segment…
Disparities in Prostate, Lung, Breast, and Colorectal Cancer Survival and Comorbidity Status among Urban American Indians and Alaskan Natives
Cancer is the second leading cause of death among American Indians and Alaskan Natives (AIAN), although cancer survival information in this population is limited, particularly among urban AIAN. In this retrospective cohort study, we compared all-cause and prostate, breast, lung,…
Effects of Transitioning to Medicare Part D on Access to Drugs for Medical Conditions among Dual Enrollees with Cancer
To evaluate the impact of transitioning from Medicaid to Medicare Part D drug coverage on the use of noncancer treatments among dual enrollees with cancer. We leveraged a representative 5% national sample of all fee-for-service dual enrollees in the United…
Contemporary rates and correlates of statin use and adherence in nondiabetic adults with cardiovascular risk factors: The KP CHAMP study
Statin therapy is highly efficacious in the prevention of fatal and nonfatal atherosclerotic events in persons at increased cardiovascular risk. However, its long-term effectiveness in practice depends on a high level of medication adherence by patients. We identified nondiabetic adults…
Associations of Race and Ethnicity with Patient-Reported Outcomes and Health Care Utilization among Older Adults Initiating a New Episode of Care for Back Pain
Secondary analysis of the Back Pain Outcomes using Longitudinal Data (BOLD) cohort study. To characterize associations of self-reported race/ethnicity with back pain (BP) patient-reported outcomes (PROs) and health care utilization among older adults with a new episode of care for…
Barriers to Health Care in a Latino Population with Autism Spectrum Disorder
This study will identify barriers to the use of recommended assessment, diagnostic, and treatment services among Latino children and adolescents with autism spectrum disorder. The study population will comprise Kaiser Permanente Northern California Latino members, and comparisons will be made…
Hispanic Chronic Renal Insufficiency Cohort (HCRIC) Study
This is a renewal of an ongoing ancillary study to the Chronic Renal Insufficiency Cohort (CRIC) Study to examine whether rates of loss of kidney function and subclinical and clinical cardiovascular disease varies among Hispanics versus other race/ethnic groups, after…
Does Free Medicines Coverage Improve Diabetes Self-Care and Outcomes for Diverse Populations?
A quasi-experimental longitudinal study to evaluate the impact of KPHI WellRx -- a program intended to engage patients more effectively in their self-care -- among a diverse cohort of patients with diabetes. The study will evaluate: (1) the offering of…
Predictive Modeling to Aid Clinical Decision-Making and Improve Diabetic Peripheral Neuropathy Outcomes
This 18-month research project will bring together a multidisciplinary team of scientists and clinicians from four Kaiser Permanente regions (Kaiser Permanente Northern California, Kaiser Permanente Colorado, Kaiser Permanente Hawaii, and Kaiser Permanente of the Mid-Atlantic States) to identify patients most…
Cohort Study of ECG Left Ventricular Hypertrophy Trajectories: Ethnic Disparities, Associations With Cardiovascular Outcomes, and Clinical Utility
ECG left ventricular hypertrophy (LVH) is a well-known predictor of cardiovascular disease. However, no prior study has characterized patterns of presence/absence of ECG LVH ("ECG LVH trajectories") across the adult lifespan in both sexes and across ethnicities. We examined: (1)…
The Incidence and Prevalence of Systemic Lupus Erythematosus in San Francisco County, California: The California Lupus Surveillance Project
Estimates of the incidence and prevalence of systemic lupus erythematosus (SLE) in the US have varied widely. The purpose of this study was to conduct the California Lupus Surveillance Project (CLSP) to determine credible estimates of SLE incidence and prevalence,…
Ethnic disparities in renal cell carcinoma: An analysis of Hispanic patients in a single-payer healthcare system
To investigate differences between Hispanics and non-Hispanic whites diagnosed with and treated for renal cell carcinoma in an equal access healthcare system. We carried out a retrospective cohort study within the Kaiser Permanente healthcare system using records from renal cell…
Urine leakage during sexual activity among ethnically diverse, community-dwelling middle-aged and older women
Urinary incontinence is associated with decreased female sexual function, but little is known about the prevalence, predictors, and impact of urine leakage during sexual activity among women in the community. The purpose of this study was to evaluate the prevalence…
CHILDHOOD SOCIOECONOMIC POSITION AND PUBERTAL ONSET IN A COHORT OF MULTIETHNIC GIRLS: IMPLICATIONS FOR BREAST CANCER
Background: Higher socioeconomic position (SEP) has been associated with increased risk of breast cancer. Its relationship with earlier age of pubertal onset, a risk factor for breast cancer, is less clear.Methods: We studied the relationship of SEP to pubertal onset…
Genetic contributors to variation in alcohol consumption vary by race/ethnicity in a large multi-ethnic genome-wide association study
Alcohol consumption is a complex trait determined by both genetic and environmental factors, and is correlated with the risk of alcohol use disorders. Although a small number of genetic loci have been reported to be associated with variation in alcohol…
Racial and ethnic differences in hip fracture outcomes in men
To examine temporal trends and racial/ethnic differences in hip fracture incidence and mortality outcome in older men. Retrospective cohort study. We ascertained men 50 years or older with a hip fracture during 2000 to 2010 in a diverse northern California…
Association Between Birth in a High Stroke Mortality State, Race, and Risk of Dementia
Birth in a group of predominantly southern US states is robustly linked to increased stroke risk. Given the role of cerebrovascular disease in dementia risk, geographic patterning may also occur for dementia incidence. To determine whether birth in 9 high…
Heterogeneity in national U.S. mortality trends within heart disease subgroups, 2000-2015
The long-term downward national U.S. trend in heart disease-related mortality slowed substantially during 2011-2014 before turning upward in 2015. Examining mortality trends in the major subgroups of heart disease may provide insight into potentially more targeted and effective prevention and…
Association of Changes in Neighborhood-Level Racial Residential Segregation With Changes in Blood Pressure Among Black Adults: The CARDIA Study
Despite cross-sectional evidence linking racial residential segregation to hypertension prevalence among non-Hispanic blacks, it remains unclear how changes in exposure to neighborhood segregation may be associated with changes in blood pressure. To examine the association of changes in neighborhood-level racial…
Heterogeneity in 14-year Dementia Incidence Between Asian American Subgroups
Asian Americans are a rapidly growing and diverse population. Prior research on dementia among Asian Americans focused on Japanese Americans or Asian Americans overall, although marked differences in cardiometabolic conditions between subgroups have been documented. We compared dementia incidence among…
Association Between Neighborhood Supermarket Presence and Glycated Hemoglobin Levels Among Patients With Type 2 Diabetes Mellitus
We estimated associations between neighborhood supermarket gain or loss and glycemic control (assessed by glycated hemoglobin (HbA1c) values) in patients from the Kaiser Permanente Northern California Diabetes Registry (n = 434,806 person-years; 2007-2010). Annual clinical measures were linked to metrics from a…
Comparison of recruitment and retention among demographic subgroups in a large diverse population study of diet
We examined the feasibility of conducting a longitudinal study of diet among diverse populations by comparing rates of response throughout recruitment and retention phases by demographic and other characteristics. Using quota sampling, participants were recruited from 3 geographically and demographically…
Making a difference in medical trainees’ attitudes toward Latino patients: A pilot study of an intervention to modify implicit and explicit attitudes.
Negative attitudes and discrimination against Latinos exist in the dominant U.S. culture and in healthcare systems, contributing to ongoing health disparities. This article provides findings of a pilot test of Yo Veo Salud (I See Health), an intervention designed to…
Food Environment and Weight Change: Does Residential Mobility Matter?: The Diabetes Study of Northern California (DISTANCE)
Associations between neighborhood food environment and adult body mass index (BMI; weight (kg)/height (m)2) derived using cross-sectional or longitudinal random-effects models may be biased due to unmeasured confounding and measurement and methodological limitations. In this study, we assessed the within-individual…
Population Health Management for Diabetes: Health Care System-Level Approaches for Improving Quality and Addressing Disparities
Population care approaches for diabetes have the potential to improve the quality of care and decrease diabetes-related mortality and morbidity. Population care strategies are particularly relevant as accountable care organizations (ACOs), patient-centered medical homes (PCMH), and integrated delivery systems are…
High rates of severe hypoglycemia among African American patients with diabetes: the surveillance, prevention, and Management of Diabetes Mellitus (SUPREME-DM) network
Seven-year surveillance study (2005-2011) to evaluate race/ethnic differences in the trends in rates of severe hypoglycemia (SH) in a population of insured, at-risk adults with diabetes. SH events were identified via any primary or principal diagnosis from emergency department or…
Socioeconomic differences in adolescent substance abuse treatment participation and long-term outcomes
Socioeconomic status (SES) has been consistently linked to poorer access, utilization and outcomes of health care services, but this relationship has been understudied in adolescent substance abuse treatment research. This study examined SES differences in adolescent's treatment participation and long-term…
Racial Differences in Associations of Blood Pressure Components in Young Adulthood With Incident Cardiovascular Disease by Middle Age: Coronary Artery Risk Development in Young Adults (CARDIA) Study
Data are sparse regarding which blood pressure (BP) components in young adulthood optimally determine cardiovascular disease (CVD) by middle age. To assess which BP components best determine incident CVD events in young adults and determine whether these associations vary by…
Beyond the Great Recession: Was the Foreclosure Crisis Harmful to the Health of Individuals With Diabetes?
The housing foreclosure crisis was harmful to the financial well-being of many households. In the present study, we investigated the health effects of the housing foreclosure crisis on glycemic control within a population of patients with diabetes. We hypothesized that…
Racial-Ethnic Differences in Fall Prevalence among Older Women: A Cross-Sectional Survey Study
Falls are the leading cause of hip fracture in older women, with important public health implications. Fall risk increases with age and other clinical factors, and varies by race/ethnicity. International studies suggest that fall risk is lower in Asians, although…
Cumulative receipt of an anti-poverty tax credit for families did not impact tobacco smoking among parents
The effect of anti-poverty tax credit interventions on tobacco consumption is unclear. Previous studies have estimated short-term effects, did not isolate the effects of cumulative dose of tax credits, produced conflicting results, and used methods with limited control for some…
Racial/ethnic differences in preterm perinatal outcomes.
BACKGROUND: Racial disparities in preterm birth and infant death have been well documented. Less is known about racial disparities in neonatal morbidities among infants who are born at
Racial/ethnic differences in obesity and comorbidities between safety-net- and non safety-net integrated health systems
Previous research shows that patients in integrated health systems experience fewer racial disparities compared with more traditional healthcare systems. Little is known about patterns of racial/ethnic disparities between safety-net and non safety-net integrated health systems.We evaluated racial/ethnic differences in body…
Association of Patient-Physician Language Concordance and Glycemic Control for Limited-English Proficiency Latinos With Type 2 Diabetes
Providing culturally competent care to the growing number of limited-English proficiency (LEP) Latinos with diabetes in the United States is challenging. To evaluate changes in risk factor control among LEP Latinos with diabetes who switched from language-discordant (English-only) primary care…
Effect of Race and Ethnicity on Antihypertensive Medication Utilization Among Women in the United States: Study of Women’s Health Across the Nation (SWAN)
Antihypertensive medication use may vary by race and ethnicity. Longitudinal antihypertensive medication use patterns are not well described in women. Participants from the Study of Women's Health Across the Nation (SWAN), a prospective cohort of women (n=3302, aged 42-52), who…
Neighborhood Differences in Post-Stroke Mortality
BACKGROUND: Post-stroke mortality is higher among residents of disadvantaged neighborhoods, but it is not known whether neighborhood inequalities are specific to stroke survival or similar to mortality patterns in the general population. We hypothesized that neighborhood disadvantage would predict higher…
Lifecourse Health, Cerebral Pathology and Ethnic Disparities in Dementia
Although there are marked ethnic disparities in rates of dementia, almost nothing is known about early life contributors to dementia in ethnic minority groups, nor if the trajectory of cognitive decline or transition to cognitive impairment varies across ethnic groups.…
Early Vascular Contributions to Dementia Risk in African-Americans – DUPLICATED DO NOT ACTIVATE
This is a life-course study of vascular risk and brain aging in a well-characterized population of 1,200 elderly African-Americans that will close the gap in knowledge regarding midlife risk and protective factors for cognitive decline. We will conduct cognitive testing…
Novel Air Pollution Mapping and Health Disparities in Oakland, CA
The Environmental Defense Fund is collecting air pollution data for high resolution air quality mapping. The study region will include areas of East, West and downtown Oakland, as defined by the boundaries of the data collected by the Environmental Defense…
Genetic Studies of Blood Cell Traits in Multi-Ethnic Cohorts
Blood cell traits, including red blood cell count (RBC), hemoglobin, white blood cell count (WBC) and platelet count, are important intermediate clinical phenotypes for a variety of cardiovascular, hematologic, oncogenic, immunologic and infectious diseases. The goal of this project is…
CARDIA Brain MRI Microbiome Study
Despite growing evidence that gut microbiota may play an important role in phenotypes related to cardiovascular (CVD) risk, there remains a lack of data from large-scale, population-based cohorts, and particularly, among racial minorities at high CVD risk, such as African-Americans.…
Health Disparities in Cardiovascular Disease Risk: From Genes to Neighborhoods
Specific aim 1: To examine cross-sectional associations between genetic and neighborhood factors, and their interactions (socioeconomic, physical/built, social) in relation to obesity and BMI; Specific aim 2: To examine longitudinal associations between genetic and neighborhood factors, and their interactions (socioeconomic,…
Actigraphic Sleep Patterns of U.S. Hispanics: The Hispanic Community Health Study/Study of Latinos
To assess the extent to which objective sleep patterns vary among U.S. Hispanics/Latinos. We assessed objective sleep patterns in 2087 participants of the Hispanic Community Health Study/Study of Latinos from 6 Hispanic/Latino subgroups aged 18-64 years who underwent 7 days…
Measurement equivalence of the Consumer Assessment of Healthcare Providers and Systems (CAHPS(�)) Medicare survey items between Whites and Asians
Asians report worse experiences with care than Whites. This could be due to true differences in care received, expectations about care, or survey response styles. We examined responses to the Consumer Assessment of Healthcare Providers and Systems (CAHPS(®)) Medicare survey…
Discovering Healthcare Innovations to Address Disparties in Stroke (DIADS)
Blood pressure control rates are known to differ by race and are likely be an important contributor to racial disparities in stroke, particularly for young African American adults in whom a disturbing increase in stroke rates has occurred in recent…
Global Variations in Patient Populations and Outcomes in Heart Failure Clinical Trials.
PURPOSE OF REVIEW: Heart failure is a global pandemic and there has been a growing effort to enroll patients from different geographical regions in randomized controlled trials. In this review, we examined regional variation in both patient characteristics and outcomes…
Engaging At-Risk Minority Women in Health System Diabetes Prevention Programs – DUPLICATED DO NOT ACTIVATE
The potential for efficacious lifestyle interventions to prevent type 2 diabetes hinges on patient engagement in real-world healthcare settings. Yet patient engagement strategies are suboptimal and attrition is often high, particularly for ethnic minority women who bear disproportionate burdens of…
Multiethnic Study of Breast Arterial Calcium Gradation and CVD – DUPLICATED DO NOT ACTIVATE
To establish a multi-ethnic cohort (n=5,400) between the ages of 60 and 79 years with equal representation of white (n=1,350; 25%), African-American (n=1,350; 25%), Asian (n=1,350; 25%) and Hispanic/Latina (n=1,350; 25%) women. All participants will be recruited at the time…
The Next Frontier in Communication and the ECLIPPSE Study: Bridging the Linguistic Divide in Secure Messaging
Health systems are heavily promoting patient portals. However, limited health literacy (HL) can restrict online communication via secure messaging (SM) because patients' literacy skills must be sufficient to convey and comprehend content while clinicians must encourage and elicit communication from…
Racial Differences in HIV and HCV Risk Behaviors, Transmission, and Prevention Knowledge among Non-Treatment-Seeking Individuals with Opioid Use Disorder.
In light of New York's recently reinforced strategy to end the AIDS epidemic by expanding testing, treatment, and access to pre-exposure prophylaxis (PrEP), we assessed drug use and sexual risk behaviors, along with HIV/Hepatitis C virus (HCV) transmission and prevention…
Characteristics associated with self-rated health in the CARDIA study: Contextualising health determinants by income group
An understanding of factors influencing health in socioeconomic groups is required to reduce health inequalities. This study investigated combinations of health determinants associated with self-rated health (SRH), and their relative importance, in income-based groups. Cross-sectional data from year 15 (2000 - 2001)…
Applying ethnic-specific bone mineral density T-scores to Chinese women in the USA
Caucasian reference data are used to classify bone mineral density in US women of all races. However, use of Chinese American reference data yields lower osteoporosis prevalence in Chinese women. The reduction in osteoporosis labeling may be relevant for younger…
Examining racial variation in antiemetic use and post-chemotherapy health care utilization for nausea and vomiting among breast cancer patients
Racial minority cancer patients may experience underuse of antiemetic medications to prevent chemotherapy-induced nausea and vomiting (CINV). In addition to its adverse implications for quality of life, antiemetic underuse may contribute to observed disparities in acute illness during chemotherapy. To…
Trends in cancer survivors’ experience of patient-centered communication: results from the Health Information National Trends Survey (HINTS)
Two Institute of Medicine reports almost a decade apart suggest that cancer survivors often feel "lost in transition" and experience suboptimal quality of care. The six core functions of patient-centered communication: managing uncertainty, responding to emotions, making decisions, fostering healing…
Association of Acculturation and Health Literacy with Prevalent Dysglycemia and Diabetes Control Among Latinos in the Boston Area Community Health (BACH) Survey
This study assessed the effect of acculturation on type 2 diabetes and whether health literacy may mediate this association. The Boston Area Community Health cohort is a multi-stage stratified random sample of adults from Boston including 744 Latinos. We defined…
Race/Ethnicity and Adoption of a Population Health Management Approach to Colorectal Cancer Screening in a Community-Based Healthcare System
Screening outreach programs using population health management principles offer services uniformly to all eligible persons, but racial/ethnic colorectal cancer (CRC) screening patterns in such programs are not well known. To examine the association between race/ethnicity and the receipt of CRC…
CKD Progression and Mortality among Hispanics and Non-Hispanics
Although recommended approaches to CKD management are achieved less often in Hispanics than in non-Hispanics, whether long-term outcomes differ between these groups is unclear. In a prospective longitudinal analysis of participants enrolled into the Chronic Renal Insufficiency Cohort (CRIC) and…
Heart Failure Clinical Trials in East and Southeast Asia: Understanding the Importance and Defining the Next Steps.
Heart failure (HF) is a major and increasing global public health problem. In Asia, aging populations and recent increases in cardiovascular risk factors have contributed to a particularly high burden of HF, with outcomes that are poorer than those in…
Risk of cancer in Asian Americans: a Kaiser Permanente cohort study
To supplement published cohort data about incident cancer in Asian Americans (Asians) including risk of specific Asian ethnic groups. A cohort study in 124,193 persons (13,344 Asians) with baseline examination data in 1978-1985 used Cox proportional hazards models with seven…
Race/Ethnicity and Cardiovascular Outcomes in Adults With CKD: Findings From the CRIC (Chronic Renal Insufficiency Cohort) and Hispanic CRIC Studies
Non-Hispanic blacks and Hispanics with end-stage renal disease have a lower risk for death than non-Hispanic whites, but data for racial/ethnic variation in cardiovascular outcomes for non-dialysis-dependent chronic kidney disease are limited. Prospective cohort. 3,785 adults with entry estimated glomerular…
Relation of longitudinal changes in body mass index with atherosclerotic cardiovascular disease risk scores in middle-aged black and white adults: the Coronary Artery Risk Development in Young Adults (CARDIA) Study
We assessed whether longitudinal changes in body mass index (BMI) are positively associated with changes in 10-year American College of Cardiology/American Heart Association atherosclerotic cardiovascular disease (ASCVD) risk scores in middle-aged blacks compared to whites. Data were from 1691 participants…
The Digital Divide and Patient Portals: Internet Access Explained Differences in Patient Portal Use for Secure Messaging by Age, Race, and Income
Online access to health records and the ability to exchange secure messages with physicians can improve patient engagement and outcomes; however, the digital divide could limit access to web-based portals among disadvantaged groups. To understand whether sociodemographic differences in patient…
Racial disparities in renal cell carcinoma: a single-payer healthcare experience
Significant racial disparities in survival for renal cell carcinoma (RCC) exist between white and black patients. Differences in access to care and comorbidities are possible contributors. To investigate if racial disparities persist when controlling for access to care, we analyzed…
A nested case-control study of dietary factors and the risk of incident cytological abnormalities of the cervix
Several earlier case-control studies reported inverse associations of cervical squamous intraepithelial lesions (SIL) with high dietary or biomarker levels of carotenoids, folate, and vitamins C and E. However, most studies did not measure the primary causal factor, cancer-associated genital human…
Characteristics of women refusing follow-up for tests or symptoms suggestive of breast cancer
BACKGROUND: Delay in diagnosis of breast cancer can occur at several points on the diagnostic pathway. We examined characteristics of women with breast cancer who before diagnosis actively refused recommended follow-up of tests or symptoms suggestive of breast cancer. METHODS:…
Late-stage breast cancer among women with recent negative screening mammography: do clinical encounters offer opportunity for earlier detection?
BACKGROUND: Opportunities to prevent late-stage breast cancer within the course of usual care are needed. We evaluate whether clinical encounters offer such opportunities. METHODS: Within seven health care plans, we identified 1298 women aged more than 50 years with early…
Investigation of Racial Disparities in Early Supportive Medication Use and End-of-Life Care Among Medicare Beneficiaries With Stage IV Breast Cancer
PURPOSE:Early supportive care may improve quality of life and end-of-life care among patients with cancer. We assessed racial disparities in early use of medications for common cancer symptoms (depression, anxiety, insomnia) and whether these potential disparities modify end-of-life care.METHODS:We used…
The effect of patient and contextual characteristics on racial/ethnic disparity in breast cancer mortality
Racial/ethnic disparity in breast cancer-specific mortality in the United States is well documented. We examined whether accounting for racial/ethnic differences in the prevalence of clinical, patient, and lifestyle and contextual factors that are associated with breast cancer-specific mortality can explain…
Is a reduction in distance to nearest supermarket associated with BMI change among type 2 diabetes patients?
We examined whether residing within 2 miles of a new supermarket opening was longitudinally associated with a change in body mass index (BMI). We identified 12 new supermarkets that opened between 2009 and 2010 in 8 neighborhoods. Using the Kaiser…
Health-Specific Information and Communication Technology Use and Its Relationship to Obesity in High-Poverty, Urban Communities: Analysis of a Population-Based Biosocial Survey
More than 35% of American adults are obese. For African American and Hispanic adults, as well as individuals residing in poorer or more racially segregated urban neighborhoods, the likelihood of obesity is even higher. Information and communication technologies (ICTs) may…
Cancer-Related Information Seeking Among Cancer Survivors: Trends Over a Decade (2003-2013)
The demonstrated benefits of information seeking for cancer patients, coupled with increases in information availability, underscore the importance of monitoring patient information seeking experiences over time. We compared information seeking among cancer survivors to those with a family history of…
Communication Barriers and the Clinical Recognition of Diabetic Peripheral Neuropathy in a Diverse Cohort of Adults: The DISTANCE Study
The purpose of this study was to explore communication barriers as independent predictors and potential mediators of variation in clinical recognition of diabetic peripheral neuropathy (DPN). In this cross-sectional analysis, we estimated the likelihood of having a DPN diagnosis among…
Neighborhood deprivation, race/ethnicity, and urinary metal concentrations among young girls in California
Although metals can adversely impact children's health, the distribution of exposures to many metals, particularly among vulnerable subpopulations, is not well characterized. We sought to determine whether neighborhood deprivation was associated with urinary concentrations of thirteen metals and whether observed…
Ethnic Differences in Risk of Coronary Heart Disease in a Large Contemporary Population
Racial/ethnic differences in diabetes and cardiovascular disease are well documented, but disease estimates are often confounded by differences in access to quality health care. The objective of this study was to evaluate the ethnic differences in risk of future coronary…
Investigating racial disparities in use of NK1 receptor antagonists to prevent chemotherapy-induced nausea and vomiting among women with breast cancer
Chemotherapy-induced nausea and vomiting (CINV) is a major concern for cancer patients and, if uncontrolled, can seriously compromise quality of life (QOL) and other treatment outcomes. Because of the expense of antiemetic medications used to prevent CINV (particularly oral medications…
Financial Strain and Medication Adherence among Diabetes Patients in an Integrated Health Care Delivery System: The Diabetes Study of Northern California (DISTANCE)
To examine self-reported financial strain in relation to pharmacy utilization adherence data. Survey, administrative, and electronic medical data from Kaiser Permanente Northern California. Retrospective cohort design (2006, n = 7,773). We compared survey self-reports of general and medication-specific financial strain…
Inequalities in dementia incidence between six racial and ethnic groups over 14years
Reducing racial/ethnic disparities is a primary objective of the National Alzheimer's Plan (NAPA), yet direct comparisons within large samples representing diversity of the United States are lacking. Dementia incidence from January 1, 2000 to December 31, 2013 and a 25-year…
Predictive Models for Characterizing Disparities in Exclusive Breastfeeding Performance in a Multi-ethnic Population in the US.
OBJECTIVES: Maternal lactation performance varies across populations, yet the relative impact of maternal sociodemographics, perinatal factors, and birth outcomes on disparities in exclusive breastfeeding (XBR) outcomes is not well known. We aimed to develop predictive models and compare the relative…
Medication Adherence Does Not Explain Black-White Differences in Cardiometabolic Risk Factor Control among Insured Patients with Diabetes
Among patients with diabetes, racial differences in cardiometabolic risk factor control are common. The extent to which differences in medication adherence contribute to such disparities is not known. We examined whether medication adherence, controlling for treatment intensification, could explain differences…
Bridging the Gap: Determinants of Undiagnosed or Untreated Urinary Incontinence in Women
More than a third of middle-aged or older women suffer from urinary incontinence, but less than half undergo evaluation or treatment for this burdensome condition. With national organizations now including an assessment of incontinence as a quality performance measure, providers…
Racial Differences in the Performance of Existing Risk Prediction Models for Incident Type 2 Diabetes: The CARDIA Study
In 2010, the American Diabetes Association (ADA) added hemoglobin A1c (A1C) to the guidelines for diagnosing type 2 diabetes. However, existing models for predicting diabetes risk were developed prior to the widespread adoption of A1C. Thus, it remains unknown how…
Neighborhood-level social processes and substantiated cases of child maltreatment
Child maltreatment is a preventable public health problem. Research has demonstrated that neighborhood structural factors (e.g. poverty, crime) can influence the proportion of a neighborhood's children who are victims of maltreatment. A newer strategy is the identification of potentially modifiable…
Psychosocial Clusters and their Associations with Well-Being and Health: An Empirical Strategy for Identifying Psychosocial Predictors Most Relevant to Racially/Ethnically Diverse Women’s Health
Strategies for identifying the most relevant psychosocial predictors in studies of racial/ethnic minority women's health are limited because they largely exclude cultural influences and they assume that psychosocial predictors are independent. This paper proposes and tests an empirical solution. Hierarchical…
Obesity Severity, Dietary Behaviors, and Lifestyle Risks Vary by Race/Ethnicity and Age in a Northern California Cohort of Children with Obesity
Identification of modifiable behaviors is important for pediatric weight management and obesity prevention programs. This study examined obesogenic behaviors in children with obesity in a Northern California obesity intervention program using data from a parent/teen-completed intake questionnaire covering dietary and…
Intersection of Race/Ethnicity and Socioeconomic Status in Mortality After Breast Cancer
We investigated social disparities in breast cancer (BC) mortality, leveraging data from the California Breast Cancer Survivorship Consortium. The associations of race/ethnicity, education, and neighborhood SES (nSES) with all-cause and BC-specific mortality were assessed among 9372 women with BC (diagnosed…
Development and Use of a Traditional Mexican Diet Score in Relation to Systemic Inflammation and Insulin Resistance among Women of Mexican Descent
Women of Mexican descent are disproportionally affected by obesity, systemic inflammation, and insulin resistance (IR). Available approaches used to give scores to dietary patterns relative to dietary guidelines may not effectively capture traditional diets of Mexicans, who comprise the largest…
The HIV Care Cascade Measured Over Time and by Age, Sex, and Race in a Large National Integrated Care System
HIV care cascades can evaluate programmatic success over time. However, methodologies for estimating cascade stages vary, and few have evaluated differences by demographic subgroups. We examined cascade performance over time and by age, sex, and race/ethnicity in , providing HIV…
Does well-child care have a future in pediatrics?
The most common adult chronic diseases affect 1 in 3 adults and account for more than three-quarters of US health care spending. The major childhood drivers of adult disease are distinctly nonmedical: poverty, poor educational outcomes, unhealthy social and physical…
Implicit Racial/Ethnic Bias Among Health Care Professionals and Its Influence on Health Care Outcomes: A Systematic Review.
BACKGROUND: In the United States, people of color face disparities in access to health care, the quality of care received, and health outcomes. The attitudes and behaviors of health care providers have been identified as one of many factors that…
Cancer survivors’ receipt of treatment summaries and implications for patient-centered communication and quality of care
The Institute of Medicine recommends cancer survivors completing treatment be provided with a treatment summary to facilitate delivery of patient-centered survivorship care. However, the relationship between treatment summary receipt and patient-centered communication (PCC) and overall quality of care (QOC) are…
Leukocyte Telomere Length and Risks of Incident Coronary Heart Disease and Mortality in a Racially Diverse Population of Postmenopausal Women
Telomeres are regions at the ends of chromosomes that maintain chromosomal structural integrity and genomic stability. In studies of mainly older, white populations, shorter leukocyte telomere length (LTL) is associated with cardiometabolic risk factors and increased risks of mortality and…
A large multi-ethnic genome-wide association study of prostate cancer identifies novel risk variants and substantial ethnic differences
A genome-wide association study (GWAS) of prostate cancer in Kaiser Permanente health plan members (7,783 cases, 38,595 controls; 80.3% non-Hispanic white, 4.9% African-American, 7.0% East Asian, and 7.8% Latino) revealed a new independent risk indel rs4646284 at the previously identified…
Sex and Age Differences in Global Pain Status Among Patients Using Opioids Long Term for Chronic Noncancer Pain
The use of chronic opioid therapy (COT) has risen dramatically in recent years, especially among women. However, little is known about factors influencing overall pain and function (global pain status) among COT users. Characterizing the typical experiences of COT patients…
Ethnic Differences in Geriatric Conditions and Diabetes Complications Among Older, Insured Adults With Diabetes: The Diabetes and Aging Study
The aim of this study was to evaluate ethnic differences in burden of prevalent geriatric conditions and diabetic complications among older, insured adults with diabetes. An observational study was conducted among 115,538 diabetes patients, aged ³60, in an integrated health…
Reach and Validity of an Objective Medication Adherence Measure Among Safety Net Health Plan Members with Diabetes: A Cross-Sectional Study
With the expansion of Medicaid and low-cost health insurance plans among diverse patient populations, objective measures of medication adherence using pharmacy claims could advance clinical care and translational research for safety net care. However, safety net patients may experience fluctuating…
Building Equity Improvement into Quality Improvement: Reducing Socioeconomic Disparities in Colorectal Cancer Screening as Part of Population Health Management
Improving colorectal cancer (CRC) screening rates for patients from socioeconomically disadvantaged backgrounds is a recognized public health priority. Our aim was to determine if implementation of a system-wide screening intervention could reduce disparities in the setting of improved overall screening…
Age and sex differences in long-term outcomes following implantable cardioverter-defibrillator placement in contemporary clinical practice: findings from the cardiovascular research network
Patient sex and age may influence rates of death after receiving an implantable cardioverter-defibrillator for primary prevention. Differences in outcomes other than mortality and whether these differences vary by heart failure symptoms, etiology, and left ventricular ejection fraction are not…
The Complex Relationship of Race to Outcomes in Heart Failure with Preserved Ejection Fraction
An improved understanding of racial differences in the natural history, clinical characteristics, and outcomes of heart failure will have important clinical and public health implications. We assessed how clinical characteristics and outcomes vary across racial groups (whites, blacks, and Asians)…
Does Food Vendor Density Mediate the Association Between Neighborhood Deprivation and BMI?: A G-computation Mediation Analysis
In previous research, neighborhood deprivation was positively associated with body mass index (BMI) among adults with diabetes. We assessed whether the association between neighborhood deprivation and BMI is attributable, in part, to geographic variation in the availability of healthful and…
Racial/Ethnic and Socioeconomic Differences in Short-Term Breast Cancer Survival Among Women in an Integrated Health System
We examined the combined influence of race/ethnicity and neighborhood socioeconomic status (SES) on short-term survival among women with uniform access to health care and treatment. Using electronic medical records data from Kaiser Permanente Northern California linked to data from the…
Racial/Ethnic differences in health care visits made before suicide attempt across the United States
Suicide is a public health concern, but little is known about the patterns of health care visits made before a suicide attempt, and whether those patterns differ by race/ethnicity. To examine racial/ethnic variation in the types of health care visits…
Multi-Ethnic Genome-Wide Association Study of Cerebral White Matter Hyperintensities on MRI
The burden of cerebral white matter hyperintensities (WMH) is associated with an increased risk of stroke, dementia, and death. WMH are highly heritable, but their genetic underpinnings are incompletely characterized. To identify novel genetic variants influencing WMH burden, we conducted…
Longitudinal study of acculturation and BMI change among Asian American men
Cross-sectional studies examining the association between Western acculturation and BMI in Asians have been inconsistent, and studies on BMI change are lacking. This study examined the associations between indicators of acculturation (generational status, length of US residence, and age at…
Significant Racial Disparities Exist in Noncardia Gastric Cancer Outcomes Among Kaiser Permanente’s Patient Population
Racial and ethnic differences in gastric cancer are not well understood. This study sought to compare the clinicopathological features and survival of noncardia gastric adenocarcinoma (NCGA) patients with different racial/ethnic backgrounds in Kaiser Permanente Northern California (KPNC), a large integrated…
Race-Ethnic and Sex Differences in Left Ventricular Structure and Function: The Coronary Artery Risk Development in Young Adults (CARDIA) Study
We investigated race-ethnic and sex-specific relationships of left ventricular (LV) structure and LV function in African American and white men and women at 43 to 55 years of age. The Coronary Artery Risk Development in Young Adults (CARDIA) Study enrolled…
Effects of Eliminating Drug Caps on Racial Differences in Antidepressant Use Among Dual Enrollees With Diabetes and Depression
Black patients with diabetes are at greater risk of underuse of antidepressants even when they have equal access to health insurance. This study aimed to evaluate the impact of removing a significant financial barrier to prescription medications (drug caps) on…
Does adopting a prenatal substance use protocol reduce racial disparities in CPS reporting related to maternal drug use? A California case study
This study examined whether adopting a standardized prenatal substance use protocol (protocol) in a hospital labor and delivery unit reduced racial disparities in reporting to child protective services (CPS) related to maternal drug use during pregnancy. This study used an…
Diabetes and other comorbidities in breast cancer survival by race/ethnicity: The California Breast Cancer Survivorship Consortium (CBCSC)
The role of comorbidities in survival of patients with breast cancer has not been well studied, particularly in non-white populations. We investigated the association of specific comorbidities with mortality in a multiethnic cohort of 8,952 breast cancer cases within the…
Treatment patterns for ductal carcinoma in situ from 2000-2010 across six integrated health plans
Considerable debate exists about the optimal treatment of ductal carcinoma in situ (DCIS). Using electronic data sources, we examined first course treatment patterns among women aged 18 years and older diagnosed with DCIS between 2000-2010 from six Kaiser Permanente (KP)…
Accuracy of parent-reported information for estimating prevalence of overweight and obesity in a race-ethnically diverse pediatric clinic population aged 3 to 12
There is conflicting evidence about the accuracy of estimates of childhood obesity based on parent-reported data. We assessed accuracy of child height, weight, and overweight/obesity classification in a pediatric clinic population based on parent data to learn whether accuracy differs…
Longitudinal study of body mass index in Asian men who immigrate to the US
Cross-sectional studies indicate that adaptation to Western norms, especially at a younger age, might explain the higher average body mass index (BMI) among Asians living in the United States (US) compared to Asians living in Asia. However, migrants differ from…
Representativeness of breast cancer cases in an integrated health care delivery system
Integrated health care delivery systems, with their comprehensive and integrated electronic medical records (EMR), are well-poised to conduct research that leverages the detailed clinical data within the EMRs. However, information regarding the representativeness of these clinical populations is limited, and…
Creating patient-centered health care systems to improve outcomes and reduce disparities
Health care delivery systems that are designed to understand and meet patient preferences for care have the potential to improve health outcomes and reduce disparities. Studies that rigorously assess patient care preferences in minority and underserved populations, stakeholder engagement, and…
Genome-wide association and admixture analysis of glaucoma in the Women’s Health Initiative
We report a genome-wide association study (GWAS) and admixture analysis of glaucoma in 12 008 African-American and Hispanic women (age 50-79 years) from the Women's Health Initiative (WHI). Although GWAS of glaucoma have been conducted on several populations, this is…
Impact of age on clinicopathological features and survival of patients with noncardia gastric adenocarcinoma
Gastric cancer often occurs in the elderly but is uncommon in young individuals. Whether young patients have different clinical behaviors and outcomes from those of older patients remain unclear. We identified 1,366 cases of newly diagnosed noncardia gastric adenocarcinoma from…
Relation of serum uric acid levels and outcomes among patients hospitalized for worsening heart failure with reduced ejection fraction (from the efficacy of vasopressin antagonism in heart failure outcome study with tolvaptan trial).
We investigated the clinical profiles associated with serum uric acid (sUA) levels in a large cohort of patients hospitalized for worsening chronic heart failure with ejection fraction (EF) ≤40%, with specific focus on gender, race, and renal function based interactions.…
Racial/ethnic differences in hip and diaphyseal femur fractures
Contemporary femur fracture rates were examined in northern California women and compared by race/ethnicity. During 2006-2012, hip fracture rates declined, but diaphyseal fracture rates increased, especially in Asians. Women with diaphyseal fracture were younger and more likely to be bisphosphonate-treated.…
Association of African genetic ancestry with fasting glucose and HbA1c levels in non-diabetic individuals: the Boston Area Community Health (BACH) Prediabetes Study
To test among diabetes-free urban community-dwelling adults the hypothesis that the proportion of African genetic ancestry is positively associated with glycaemia, after accounting for other continental ancestry proportions, BMI and socioeconomic status (SES). The Boston Area Community Health cohort is…
The Association of Gender to Cardiovascular Outcomes After Coronary Artery Revascularization in Patients With End-Stage Renal Disease
Inadequate recruitment of women and an exclusion of patients with end-stage renal disease (ESRD) in coronary revascularization trials have led to knowledge gaps of gender-based outcomes. Women have equivalent cardiovascular outcomes when compared to men. We conducted a retrospective observational…
Update on Health Literacy and Diabetes
Inadequate literacy is common among patients with diabetes and may lead to adverse outcomes. The authors reviewed the relationship between literacy and health outcomes in patients with diabetes and potential interventions to improve outcomes. We reviewed 79 articles covering 3…
Associations Between Antidepressant Adherence and Shared Decision-Making, Patient-Provider Trust, and Communication Among Adults with Diabetes: Diabetes Study of Northern California (DISTANCE)
Depression and adherence to antidepressant treatment are important clinical concerns in diabetes care. While patient-provider communication patterns have been associated with adherence for cardiometabolic medications, it is unknown whether interpersonal aspects of care impact antidepressant medication adherence. To determine whether…
Maternal Acculturation and the Prenatal Care Experience
Acculturation may influence women's perceptions of health care experiences and may explain the epidemiologic paradox, whereby foreign-born women have lower rates of adverse birth outcomes than United States (US)-born women. We evaluated the relationship between maternal acculturation and specific dimensions…
Changes in Use of Lipid-lowering Medications Among Black and White Dual Enrollees With Diabetes Transitioning From Medicaid to Medicare Part D Drug Coverage
The use of lipid-lowering agents is suboptimal among dual enrollees, particularly blacks. To determine whether the removal of restrictive drug caps under Medicare Part D reduced racial differences among dual enrollees with diabetes. An interrupted time series with comparison series…
Prescription medication burden in patients with newly diagnosed diabetes: A SUrveillance, PREvention, and ManagEment of Diabetes Mellitus (SUPREME-DM) study
To understand the burden of medication use for patients with newly diagnosed diabetes both before and after diabetes diagnosis and to identify subpopulations of patients with newly diagnosed diabetes who face a relatively high drug burden. Retrospective cohort study. 11…
Considering the Value of Dietary Assessment Data in Informing Nutrition-Related Health Policy
Dietary assessment has long been known to be challenged by measurement error. A substantial amount of literature on methods for determining the effects of error on causal inference has accumulated over the past decades. These methods have unrealized potential for…
Mortality caused by chronic liver disease among american indians and alaska natives in the United States, 1999-2009
We compared chronic liver disease (CLD) mortality from 1999 to 2009 between American Indians and Alaska Natives (AI/ANs) and Whites in the United States after improving CLD case ascertainment and AI/AN race classification. We defined CLD deaths and causes by…
Low Socioeconomic Status is Associated with Increased Risk for Hypoglycemia in Diabetes Patients: The Diabetes Study of Northern California (DISTANCE)
Social risk factors for hypoglycemia are not well understood. Cross-sectional analysis from the DISTANCE study, a multi-language, ethnically-stratified random sample of adults in the Kaiser Permanente Northern California diabetes registry, conducted in 2005-2006 (response rate 62%). Exposures were income and…
Intrinsic subtypes from PAM50 gene expression assay in a population-based breast cancer cohort: Differences by age, race, and tumor characteristics
Data are lacking to describe gene expression-based breast cancer intrinsic subtype patterns for population-based patient groups. We studied a diverse cohort of women with breast cancer from the Life After Cancer Epidemiology and Pathways studies. RNA was extracted from 1…
Cardiorespiratory fitness and cognitive function in middle age: The CARDIA Study
To investigate whether greater cardiorespiratory fitness (CRF) is associated with better cognitive function 25 years later. We studied 2,747 participants in the community-based Coronary Artery Risk Development in Young Adults Study of black and white men and women aged 18…
Television viewing, bedroom television, and sleep duration from infancy to mid-childhood.
BACKGROUND: Television and insufficient sleep are associated with poor mental and physical health. This study assessed associations of TV viewing and bedroom TV with sleep duration from infancy to midchildhood.METHOD: We studied 1864 children in Project Viva. Parents reported children's…
Racial/ethnic differences in dementia risk among older type 2 diabetes patients: The Diabetes and Aging Study
OBJECTIVE Although patients with type 2 diabetes have double the risk of dementia, potential racial/ethnic differences in dementia risk have not been explored in this population. We evaluated racial/ethnic differences in dementia and potential explanatory factors among older diabetic patients.…
Race and breast cancer survival by intrinsic subtype based on PAM50 gene expression
To evaluate whether differences in PAM50 breast cancer (BC) intrinsic (Luminal A, Luminal B, Basal-like, and HER2-enriched) subtypes help explain the Black-White BC survival disparity. Utilizing a stratified case-cohort design, this study included 1,635 women from the Pathways and Life…
Long-term outcomes among African-American and white women with breast cancer: what is the impact of comorbidity?
OBJECTIVES: We examined the association between comorbidity and long-term mortality from breast cancer and other causes among African-American and white women with breast cancer.METHODS: A total of 170 African-American and 829 white women aged 40-84years were followed for up to…
Asthma and physical activity in multiracial girls from three US sites
Studies comparing physical activity levels in children with and without asthma have had mixed results. Our objective was to investigate the association between asthma diagnosis and physical activity and to examine differences in these associations by race/ethnicity, weight status and…
Childhood family psychosocial environment and carotid intima media thickness: The CARDIA study
Little is known about whether the childhood family psychosocial environment (characterized by cold, unaffectionate interactions, conflict, aggression, neglect and/or low nurturance) affects coronary heart disease (CHD) risk. Objectives were to evaluate associations of childhood family psychosocial environment with carotid intima…
Racial and Ethnic Differences in Health Care Utilization and Outcomes Among Ulcerative Colitis Patients in an Integrated Health-Care Organization
Current knowledge of racial disparities in healthcare utilization and disease outcomes for ulcerative colitis (UC) is limited. We sought to investigate these differences among Caucasian, African American, Asian, and Hispanic patients with ulcerative colitis in Kaiser Permanente, a large integrated…
HIV/HCV coinfection ameliorates the atherogenic lipoprotein abnormalities of HIV infection
Higher levels of small low-density lipoprotein (LDL) and lower levels of high-density lipoprotein (HDL) subclasses have been associated with increased risk of cardiovascular disease. The extent to which HIV infection and HIV/hepatitis C virus (HCV) coinfection are associated with abnormalities…
Obesity and Mortality After Breast Cancer by Race/Ethnicity: The California Breast Cancer Survivorship Consortium
We investigated body size and survival by race/ethnicity in 11,351 breast cancer patients diagnosed from 1993 to 2007 with follow-up through 2009 by using data from questionnaires and the California Cancer Registry. We calculated hazard ratios and 95% confidence intervals…
Spatial pattern of body mass index among adults in the diabetes study of Northern California (DISTANCE)
The role that environmental factors, such as neighborhood socioeconomics, food, and physical environment, play in the risk of obesity and chronic diseases is not well quantified. Understanding how spatial distribution of disease risk factors overlap with that of environmental (contextual)…
Diabetes care and outcomes for American Indians and Alaska natives in commercial integrated delivery systems: a SUrveillance, PREvention, and ManagEment of Diabetes Mellitus (SUPREME-DM) Study
To compare cardiovascular disease risk factor testing rates and intermediate outcomes of care between American Indian/Alaska Native (AI/AN) patients with diabetes and non-Hispanic Caucasians enrolled in nine commercial integrated delivery systems in the USA. We used modified Poisson regression models…
The Multigroup Ethnic Identity Measure-Revised: Measurement Invariance Across Racial and Ethnic Groups
The Multigroup Ethnic Identity Measure-Revised (MEIM-R), a brief instrument assessing affiliation with one's ethnic group, is a promising advance in the ethnic identity literature. However, equivalency of its measurement properties across specific racial and ethnic groups should be confirmed before…
Onset of Breast Development in a Longitudinal Cohort
There is growing evidence of pubertal maturation occurring at earlier ages, with many studies based on cross-sectional observations. This study examined age at onset of breast development (thelarche), and the impact of BMI and race/ethnicity, in the 3 puberty study…
Self-Reported physical functioning and mortality among individuals with type 2 diabetes: insights from TRIAD
To examine the association between physical functioning and mortality in people with type 2 diabetes, and determine if this association differs by race/ethnicity in managed care. We studied 7894 type 2 diabetic patients in Translating Research Into Action for Diabetes…
The impact of functional limitations on long-term outcomes among African-American and white women with breast cancer: a cohort study.
OBJECTIVES: We examined the impact of functional limitations and functional decline during the first year following breast cancer diagnosis on the risk of mortality from breast cancer and other causes among African-American and white women, respectively.DESIGN: The Health and Functioning…
Socioeconomic Status and Lung Cancer: Unraveling the Contribution of Genetic Admixture
OBJECTIVES: We examined the relationship between genetic ancestry, socioeconomic status (SES), and lung cancer among African Americans and Latinos. METHODS: We evaluated SES and genetic ancestry in a Northern California lung cancer case-control study (1998-2003) of African Americans and Latinos.…
The California Breast Cancer Survivorship Consortium (CBCSC): prognostic factors associated with racial/ethnic differences in breast cancer survival
Racial/ethnic disparities in mortality among US breast cancer patients are well documented. Our knowledge of the contribution of lifestyle factors to disease prognosis is based primarily on non-Latina Whites and is limited for Latina, African American, and Asian American women.…
African American race but not genome-wide ancestry is negatively associated with atrial fibrillation among postmenopausal women in the Women’s Health Initiative
Atrial fibrillation (AF) is the most common arrhythmia in women and is associated with higher rates of stroke and death. Rates of AF are lower in African American subjects compared with European Americans, suggesting European ancestry could contribute to AF…