Racial and Ethnic Disparities in Liver Disease in the WTC General Responder Cohort

WTC 一般应答者队列中肝病的种族和民族差异

• 批准号: 10749688
• 负责人: Andrea D. Branch
• 金额: $ 50万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-01 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10749688
• 关键词: Racial; Ethnic; Disparities; Liver; Disease

Racial and Ethnic Disparities in Liver Disease in the WTC General Responder Cohort: People of color experience persistent disparities in liver disease outcomes in the U.S. This project investigates how these dis- parities may affect members of the Mount Sinai WTC General Responder Cohort. Currently, the WTC Healthcare Program (WTCHP) covers liver cancer treatment, but it does not cover the diagnosis and treatment of other liver diseases or liver cancer surveillance These policies may create holes in the healthcare safety net that could disproportionately disadvantage African American Responders. Fortunately, WTC monitoring visits provide the data needed to calculate the Fibrosis-4 (FIB-4) score, a well-validated instrument for liver disease screening. We embedded a FIB-4 calculator in Mount Sinai’s EPIC electronic medical record (EMR). It is available to Mount Sinai WTCHP providers. In this project, we will introduce the calculator to Mount Sinai WTCHP providers. We will also analyze for disparities in mortality and study archived specimens to assess for toxins that were present in the WTC dust cloud. Environmental and workplace exposures to toxins can cause liver injury and cancer and they synergize with other sources of liver injury to magnify damage and liver cancer risk. The WTC dust cloud contained tons of debris and hepatotoxins, including particulates, polychlorinated biphenyls (PCBs) and other persistent organic pollutants (POPs). Adolescents exposed to WTC dust had elevated PCDD/F levels > 12 years after the attack, establishing that toxins in WTC dust remain detectable for long periods. Our research is expected to show that WTC exposure caused, aggravated, or contributed to liver disease (criteria for certification). Aim I: Disparities in mortality. The goal of SubAim1 is to collaborate with the WTCHP General Responder Data Center to rigorously identify all Mount Sinai WTC General Responders with cirrhosis and/or liver cancer. The goal of SubAim 2 is to test the hypothesis that among responders with cirrhosis and/or liver cancer, African American responders have higher all-cause and liver-related mortality than other responders. Aim II: A FIB-4 calculator to screen for liver disease in Mount Sinai General Responders. The goal of Aim II is to enable WTCHP providers to screen for liver disease. We will introduce the FIB-4 calculator to Mount Sinai WTCHP providers at some clinics and not others and test the hypothesis that education increases use of the calculator. We will also monitor for differences in rates of referral to hepatology between clinics in each arm. Aim III: WTC toxins in plasma and liver. The goal of SubAim 1 is to test the hypothesis that plasma levels of PCBs and other POPs are higher in GRC responders than in controls and are directly related to FIB-4 scores and inversely related to platelet counts. The goal of SubAim 2 is to compare particulates and granulomas be- tween archived liver specimens of WTC responders and controls matched for liver disease etiology. Impact: The long-term goals are to provide data to inform CDC/NIOSH decisions about whether liver diseases meet criteria for WTC certification and to address any disparities that may exist among General Responders.

世贸中心一般应答者队列中肝病的种族和民族差异：有色人种 在美国，肝病结果存在持续的差异。该项目调查了这些差异是如何 平价可能会影响西奈山世贸中心一般响应者群体的成员 目前，世贸中心医疗保健。 计划（WTCHP）涵盖肝癌治疗，但不涵盖其他肝癌的诊断和治疗 疾病或肝癌监测这些政策可能会在医疗保健安全网中造成漏洞，从而可能 幸运的是，世贸中心的监测访问为处于不利地位的非裔美国人提供了帮助。 计算 Fibrosis-4 (FIB-4) 评分所需的数据，这是一种经过充分验证的肝病筛查工具。 在 Mount Sinai 的 EPIC 电子病历 (EMR) 中嵌入了 FIB-4 计算器，Mount 可以使用它。 西奈山 WTCHP 提供商 在本项目中，我们将向西奈山 WTCHP 提供商介绍该计算器。 还将分析死亡率差异并研究存档样本以评估是否存在毒素 世贸中心粉尘云中的环境和工作场所接触毒素会导致肝损伤和癌症。 它们与其他肝损伤来源协同作用，放大损害和肝癌风险。 含有大量碎片和肝毒素，包括颗粒物、多氯联苯 (PCB) 和其他 持久性有机污染物 (POP) 接触世贸中心粉尘的青少年 PCDD/F 水平升高超过 12 年。 袭击发生后，我们的研究预计可以在很长一段时间内检测到世贸中心灰尘中的毒素。 证明 WTC 暴露导致、加重或促成肝病（认证标准）。 目标 I：死亡率差异 SubAim1 的目标是与 WTCHP 一般响应者合作。 数据中心严格识别所有患有肝硬化和/或肝癌的西奈山世贸中心普通响应者。 SubAim 2 的目标是检验以下假设：在患有肝硬化和/或肝癌的反应者中，非洲人 美国响应者的全因死亡率和肝脏相关死亡率高于其他响应者。 Aim II：用于筛查西奈山普通响应者肝病的 FIB-4 计算器 Aim 的目标。 II 是让 WTCHP 提供者能够筛查肝病 我们将向西奈山引入 FIB-4 计算器。 一些诊所而非其他诊所的 WTCHP 提供者检验了教育增加了对 WTCHP 的使用的假设 我们还将监测各组诊所之间转诊至肝病科的比率的差异。 目标 III：血浆和肝脏中的 WTC 毒素 SubAim 1 的目标是检验血浆水平的假设。 GRC 应答者中的 PCB 和其他 POP 含量高于对照组，并且与 FIB-4 分数直接相关 与血小板计数成反比。SubAim 2 的目标是比较颗粒物和肉芽肿。 将世贸中心响应者和对照的存档肝脏标本与肝病病因相匹配。 影响：长期目标是提供数据，以便 CDC/NIOSH 就是否患有肝脏疾病做出决策 满足 WTC 认证标准并解决一般响应者之间可能存在的任何差异。