Impact of Structural Racism and Discrimination on Liver Disease Disparities in High-Risk Asian American Populations

结构性种族主义和歧视对高危亚裔美国人肝病差异的影响

• 批准号: 10474736
• 负责人: GRACE X. MA
• 金额: $ 83.83万
• 依托单位: TEMPLE UNIV OF THE COMMONWEALTH
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-15 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10474736
• 关键词: Adult; Advanced Malignant Neoplasm; Advisory Committees; Advocacy; Affect; African American population; American; Asia; Asian; Asian Americans; Black race; COVID-19; COVID-19 pandemic; Caring; Centers for Disease Control and Prevention (U.S.); Chinese; Chinese American; Chinese population; Chronic Hepatitis B; Clinical; Communities; Community Health Systems; Community Surveys; Crime; Data; Data Analyses; Data Collection; Death Rate; Detection; Development; Diagnosis; Disadvantaged; Discrimination; Ethnic group; Federally Qualified Health Center; Funding; Goals; Health; Health Care Surveys; Health Disparities Research; Health Services Accessibility; Health system; Hepatitis; Hepatitis B; Hepatitis B Infection; Hepatitis B Prevalence; Hepatology; Immigrant; Immigration; Individual; Inequality; Infection; Institutional Racism; Insurance; Intervention; Interview; Koreans; Latinx; Linguistics; Link; Liver diseases; Longitudinal Studies; Low income; Malignant neoplasm of liver; Methods; Modeling; National Institute on Minority Health and Health Disparities; Neighborhood Health Center; Neighborhoods; Not Hispanic or Latino; Organizational Policy; Outcome; Patients; Philadelphia; Play; Population; Poverty; Preventive service; Primary Health Care; Procedures; Provider; Public Health; Quality of Care; Recommendation; Recording of previous events; Regional Cancer; Research; Resources; Role; Services; Shapes; Stereotyping; Structural Racism; Surveys; Time; Trauma; United States National Institutes of Health; Work; barrier to care; base; cancer diagnosis; cancer health disparity; community based participatory research; density; disease disparity; experience; hate crimes; health care availability; health care disparity; health care settings; health disparity; high risk; improved; infection risk; innovation; mortality; multidisciplinary; perceived discrimination; population based; protective factors; racial and ethnic; racial bias; racial disparity; racism; residence; residential segregation; resilience; screening; segregation; social; social cohesion; social norm; systematic review; theories; therapy design; uptake

Impact of Structural Racism and Discrimination on Liver Disease Disparities in High-Risk Asian American Populations Project Summary Structural racism and discrimination (SRD) play an important role in shaping persistent health disparities, including liver disease disparities among racialized Asian Americans (AAs). Despite comprising 7% of U.S. population, AAs account for more than half of all Hepatitis B (HBV) infections in the U.S. Of 2.4 million Americans infected with HBV, 58% are AAs who have the highest HBV prevalence of any racial/ethnic group. Despite CDC and U.S. Preventive Services Task Force recommendations to screen Asian adults who are at high risk for infection, a significant majority of AAs (~68-75%) have never been screened, remaining undiagnosed. SRD manifests in structural inequalities by limited access to care, culturally and linguistically appropriate services/resources, social segregation, mistrust of health system, anti-Asian racism, immigration and poverty in AAs. Most SRD research has examined how structural racism and multilevel determinants disadvantaged healthcare access for Black/African Americans and Latinx, few have included AAs. Our preliminary studies among Chinese, Korean and Vietnamese indicated that HBV screening and linkage to care disparities are attributable to the intersection of multilevel structural barriers. During COVID-19 pandemic, barriers to care for AAs are increasingly affected by anti-Asian racism, hate crimes and discrimination at each level, which impedes HBV screening and care and exacerbates liver disease disparities. The overall goal of this innovative and timely study is to identify structural racism and protective factors in relation to liver disease disparities and impact of SRD on health outcomes by Asian Americans. Guided by an adapted multilevel Socio-Ecological Model, we will leverage 20-year established Regional Cancer Health Disparities Networks to collaborate with community-based organizations and clinical partners in greater Philadelphia and NYC. Specifically, our multidisciplinary team will use mixed methods to: 1) examine the longitudinal association of individual-level SRD lived experiences (e.g., COVID-19 Anti-Asian racism, socio-historical trauma, cultural stereotype racism) and HBV screening and care among 2000 Asian Americans: Chinese, Korean and Vietnamese; 2) examine the impact of institutional-level SRD in healthcare settings (e.g., Anti-Asian racial bias, resources for patient navigators) on HBV screening uptake and care; and 3) elucidate the impact of community-level SRD (e.g., Anti-Asian racism/xenophobia and residential segregation) and protective factors (e.g. residence, social norms/advocacy and neighborhood social cohesion) on impeding or promoting screening and care. Finally, we conduct integrative analysis to examine whether individual, institutional and community-level SRD are associated with HBV screening uptake and linkage to care. This is the first multilevel, longitudinal study that will enable us to understand how structural racism drives HBV-related liver disease disparities among high-risk Asian Americans. Our study findings will identify culturally attuned strategies to mitigate SRD and design interventions to improve overall quality of chronic HBV care. Our study will likely result in a paradigm shift from individual level approach to eliminate Hepatitis B by 2030.

结构性种族主义和歧视对高危人群肝病差异的影响 亚裔美国人人口 项目概要 结构性种族主义和歧视（SRD）在形成持续的健康差异方面发挥着重要作用， 包括亚裔美国人 (AA) 之间的肝脏疾病差异。尽管占美国人口的 7% 在美国 240 万美国人中，AA 占所有乙型肝炎 (HBV) 感染的一半以上 感染 HBV 的人中，58% 是 AA，他们是所有种族/族裔群体中 HBV 患病率最高的。尽管疾病预防控制中心 和美国预防服务工作组建议对高风险亚洲成年人进行筛查 感染后，绝大多数 AA (~68-75%) 从未接受过筛查，仍未得到诊断。 SRD 表现为结构性不平等，即获得文化和语言适当的护理机会有限 服务/资源、社会隔离、对卫生系统的不信任、反亚裔种族主义、移民和贫困 AA。大多数SRD研究都探讨了结构性种族主义和多层次决定因素如何使人处于不利地位 黑人/非裔美国人和拉丁裔美国人的医疗保健服务很少包括 AA。我们的初步研究 中国、韩国和越南人的调查表明，乙肝病毒筛查及其与护理差异的联系 归因于多层次结构性障碍的交叉。在 COVID-19 大流行期间，护理面临的障碍 AA 越来越多地受到反亚裔种族主义、仇恨犯罪和各级歧视的影响，这阻碍了 乙肝病毒筛查和护理加剧了肝脏疾病的差异。这一创新且及时的总体目标 研究的目的是确定与肝病差异和影响有关的结构性种族主义和保护因素 SRD 对亚裔美国人健康结果的影响。在适应的多层次社会生态模型的指导下，我们将 利用 20 年建立的区域癌症健康差异网络与社区合作 大费城和纽约市的组织和临床合作伙伴。具体来说，我们的多学科团队将 使用混合方法：1）检查个人层面的 SRD 生活经历的纵向关联（例如， COVID-19 反亚裔种族主义、社会历史创伤、文化刻板印象种族主义）以及 HBV 筛查和护理 2000 名亚裔美国人中：中国人、韩国人和越南人； 2）考察机构层面的影响 医疗机构中关于 HBV 筛查的 SRD（例如，反亚裔种族偏见、患者导航资源） 吸收和照顾； 3) 阐明社区层面的 SRD 的影响（例如，反亚裔种族主义/仇外心理和 居住隔离）和保护因素（例如居住、社会规范/宣传和邻里社会 凝聚力）阻碍或促进筛查和护理。最后，我们进行综合分析来检验 个人、机构和社区层面的 SRD 是否与 HBV 筛查的采用和关联相关 去关心。这是第一个多层次的纵向研究，使我们能够了解结构性种族主义如何驱动 高危亚裔美国人中乙型肝炎相关肝病的差异。我们的研究结果将在文化上识别 协调策略以减轻 SRD 并设计干预措施以提高慢性乙型肝炎护理的整体质量。我们的 研究可能会导致从个人层面的方法到 2030 年消除乙型肝炎的范式转变。