Browsing by Subject "Ethnic Groups"
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Item Does diversity in medicine REALLY enhance quality?: a multiple-choice quiz(2021-02-26) Capers, Quinn, IVItem Ethnic differences in coronary artery disease: presentation, progression and prognosis(1999-12-16) Hobbs, Helen H.Item Genetics and autoimmunity(1982-05-20) Stastny, PeterPages 29-42 are not available for public access due to publisher restrictions. These pages included a journal article from the American Journal of Medicine. The pages have been removed from the publicly-accessible version of the protocol. The abstract of that article is available through PubMed (https://pubmed.ncbi.nlm.nih.gov/6362407/).Item Hispanic Ethnicity Is Associated with Early Presentation and Advanced Stage of Gastric Adenocarcinoma(2019-01-22) Paul, Subhadeep; Hester, Caitlin; Wang, Sam; Polanco, Patricio; Yopp, Adam; Augustine, Mathew; Mansour, John; Zeh, Herbert; Porembka, MatthewINTRODUCTION: Gastric adenocarcinoma (GA) is a heterogeneous disease with variable presentation and progression between ethnic groups. We aimed to assess factors related to the early age of GA presentation (< 45 years) between racial and ethnic groups. METHODS: Using the National Cancer Database, patients with GA and upfront surgery were selected. Those receiving neoadjuvant therapy were excluded to ensure accurate pathologic stage. Clinicopathologic data was correlated to factors associated with age at diagnosis. Ethnicity was classified into Non-Hispanic White (NHW), Hispanic (HS), African American (AA) and Asian (AS). Univariate and multivariate linear regression models were used to determine factors associated with age of presentation. Overall survival was estimated using the Kaplan-Meier method and compared using log-rank tests. RESULTS: Between 2006 and 2013, 13392 patients with GA and upfront surgery were identified. Median age was 67 years (IQR: 57-76) and 61% were male. Mean age at diagnosis was variable between ethnicity (NHW: 7609, 57%, 68 years, HS: 1720, 13%, 61 years, AA: 2727, 20%, 64 years and AS: 1336, 10%, 64 years; p<0.01). HS and AA presented with more advanced stage (Stage 4: HS 20.8%, AA 19.2%, NHW 17.8%, AS 16.2%; p<0.05). On univariate analysis, female gender, HS race, uninsured status, Medicaid, advanced pathologic stage, and poorly differentiated tumor grade were associated with young presentation (p<0.01). On multivariate analysis, factors associated with young presentation included female gender (1.52, 95%CI: 1.31-1.76), minority race compared to NHW (HS: 2.30 95%CI: 1.92-2.86; AA: 1.37 95%CI: 1.24-1.67), and poorly (2.40, 95%CI: 1.34-4.29) or undifferentiated grade (3.56, 95%CI: 1.84-6.99). Median survival was significantly different between races (NHW 23 months, HS 41 months, AA 26 months, AS 50 months, p<0.001). CONCLUSION: Young presentation of GA is associated with HS race, female gender, and advanced tumors. Despite HS presenting at a young age with more advanced disease, median survival was prolonged compared to AA/NHW. Further research is necessary to determine underlying biologic basis of ethnic variation observed in GA.Item Liver Fibrosis and Steatosis in HIV-Infected Patients: Impact of Race/Ethnicity, Gender, BMI, and ART(2019-04-02) Rucker, Danielle; Cutrell, James; Bedimo, Roger; Luque, AmnerisBACKGROUND: The advent of antiretroviral therapy (ART) led to a decline in morbidity and mortality related to AIDS and its related complications. With this decline, an increasing proportion of morbidity and mortality in people living with HIV (PLWH) is secondary to liver and cardiovascular disease. Previous studies have shown that PLWH have traditional risk factors for these diseases, such as obesity, as well as risk factors that are unique to their population, including direct metabolic effects of HIV and ART. Several factors, such as race, ethnicity, gender, and BMI, have been shown to have an impact on the course of liver steatosis and fibrosis in general population. The impact of these factors on the course of liver steatosis and fibrosis in the setting of hepatitis B and C co-infections in PLWH have been studied, but there is a paucity of literature detailing the impact in the absence of viral hepatitis co-infection. NAFLD, APRI, and FIB-4 scores have been shown to be effective noninvasive markers for clinically significant liver steatosis and fibrosis. However, these non-invasive markers have not been validated for use in patients without viral hepatitis co-infection. This study aims to determine if race, ethnicity, gender, BMI, and the specific ART regimen have a differential impact on non-invasive markers of liver steatosis and fibrosis in PLWH. OBJECTIVE: Determine if race, ethnicity, gender, BMI, and specific ART regimen will modulate changes in non-invasive markers of liver steatosis and fibrosis. METHODS: All patients initiating ART at the Parkland Memorial Hospital HIV clinic from 2009-2017 were analyzed. Exposure to ART was defined as concurrent receipt of at least two nucleoside reverse transcriptase inhibitor (NRTI) drugs plus at least one protease inhibitor (PI), non-nucleoside reverse transcriptase inhibitor (NNRTI), or integrase inhibitor (INSTI). The existing patient database includes demographics (notably, gender, race, and ethnicity), CD4 and HIV RNA levels, co-morbidities, laboratory values (most notably, liver function tests), ART regimen, and body mass index (BMI). An analysis of yearly changes in BMI was calculated based on specific ART drugs, and differences between groups stratified by gender or race/ethnicity were compared. For subjects who meet certain pre-determined liver function test minimums, non-invasive markers for liver fibrosis (APRI, NAFLD, and FIB-4 scores) will be utilized and trended over time. Manual chart extraction will be examined for patients with clinically-indicated imaging (abdominal ultrasound, computed tomography, or magnetic resonance imaging) to estimate the incidence and prevalence of liver fibrosis or steatosis in this population and to determine whether race/ethnicity or gender modifies these risks. RESULTS: The difference in yearly BMI change was statistically significant for the INSTI dolutegravir (DTG; p=<0.01) between Blacks and non-Hispanic whites (NHW) but not for any other ART drugs tested. The difference in yearly BMI change showed a trend for statistical significance for DTG (p=0.06) between Hispanics and NHW but not for any other ART drugs tested. The difference in yearly BMI change by ART drug in men versus women was statistically significant for atazanavir (ATV; p=0.03), darunavir (DRV;p=<0.01), lopinavir (LPV; p=0.03), and dolutegravir (DTG; p=<0.01) but not with elvitegravir (EVG; p=0.72). CONCLUSIONS AND NEXT STEPS: Our preliminary results indicate that particular ART drugs, principally the INSTI DTG, appear to be associated with greater BMI gains than other agents. Additionally, in PLWH on ART, women demonstrated greater BMI gains than men, and Blacks and Hispanics demonstrated greater BMI gains than NHW in our cohort. The next steps will be to analyze the trends of APRI, FIB-4, and NAFLD scores over time in our cohort as non-invasive markers of liver fibrosis and to determine the demographic, HIV, and ART-related factors associated with higher rates of liver fibrosis. We will also conduct a review of clinically-indicated abdominal imaging for evidence of hepatic fibrosis in a subset of our cohort to validate the use of these non-invasive markers in PLWH without viral hepatitis. Given that HIV has been transformed into a chronic disease and that PLWH are now living decades on these ART regimens, it is of paramount importance to determine the long-term metabolic and hepatic consequences of these medications to better inform patient care and practice guidelines. We believe that our large cohort of demographically diverse PLWH on contemporary ART regimens and with detailed clinical follow-up data offers an important population to further our understanding of these critical issues.Item [UT Southwestern Medical Center News](2007-04-23) McKenzie, Aline