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肝病差异的影响 亚裔美国人人口 项目摘要 结构性种族主义和歧视（SRD）在塑造持续的健康差异方面起着重要作用， 包括种族的亚裔美国人（AAS）中的肝病差异。尽管占美国7％的 人口，AAS占美国240万美国人的所有丙型肝炎（HBV）感染的一半以上 感染了HBV，有58％的AA是任何种族/族裔HBV患病率最高的AA。尽管CDC 以及美国预防服务工作队建议，以筛查有高风险的亚洲成年人 感染，大部分AA（约68-75％）从未筛选，但仍未诊断。 Srd 通过有限的护理，在文化和语言上适当的护理，表现出结构上的不平等现象 服务/资源，社会隔离，卫生系统的不信任，反亚洲种族主义，移民和贫困 AAS。大多数SRD研究都研究了结构性种族主义和多层次决定因素如何处境不利 黑人/非裔美国人和拉丁裔的医疗保健访问，很少有人包括AAS。我们的初步研究 在中国，韩国和越南语中表明，HBV筛查和与护理差异的联系是 归因于多层结构屏障的交点。在Covid-19-19大流行期间，关心的障碍 AA越来越受到反亚洲种族主义，仇恨犯罪和歧视的影响，这会阻碍 HBV筛查和护理以及加剧肝病差异。这种创新和及时的总体目标 研究是为了确定与肝病差异有关的结构性种族主义和保护因素 亚裔美国人的健康结果。在改编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）检查个体级别的SRD生活经验的纵向关联（例如， Covid-19反亚洲种族主义，社会历史创伤，文化刻板印象种族主义）和HBV筛查和关怀 在2000年的亚裔美国人中：中国，韩国和越南人； 2）检查机构级别的影响 HBV筛查中的医疗保健环境中的SRD（例如，反亚洲种族偏见，患者导航员的资源） 吸收和关怀； 3）阐明社区级SRD的影响（例如，反亚洲种族主义/仇外心理和 住宅隔离）和保护因素（例如居住，社会规范/倡导和社区社会 凝聚力）在阻碍或促进筛查和护理方面。最后，我们进行综合分析以检查 个人，机构和社区级别的SRD是否与HBV筛查的吸收和联系有关 关心。这是第一项多层次的纵向研究，它将使我们能够了解结构性种族主义如何驱动 高危亚裔美国人与HBV相关的肝病差异。我们的研究发现将在文化上确定 调整了减轻SRD和设计干预措施的策略，以提高慢性HBV护理的整体质量。我们的 研究可能会导致到2030年消除丙型肝炎的范式转变。