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.

WTC一般响应者队列中肝病的种族和种族差异：有色人种 在美国，经验经验持续存在肝病结局的差异 平民可能会影响西奈山WTC一般响应者队列的成员。目前，WTC医疗保健 程序（WTCHP）涵盖肝癌治疗，但不涵盖其他肝脏的诊断和治疗 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 不成比例的劣势非裔美国人响应者。幸运的是，WTC监视访问提供了 计算纤维化4（FIB-4）评分所需的数据，这是一种验证肝脏疾病筛查的仪器。我们 在西奈山的Epic电子病历（EMR）中嵌入了一个FIB-4计算器。可以安装 西奈WTCHP提供商。在这个项目中，我们将向Sinai WTCHP山提供者介绍计算器。我们 还将分析死亡率和研究的归档标本的差异，以评估存在的毒素 在WTC尘埃云中。环境和工作场所暴露于毒素会导致肝损伤和癌症，以及 它们与其他肝损伤来源协同作用，以放大损害和肝癌风险。 WTC尘埃云 含有大量的碎屑和肝毒素，包括成分，多氯联苯（PCB）和其他 持续的有机污染物（POPS）。暴露于WTC粉尘的青少年的PCDD/F水平升高> 12年 攻击后，确定WTC粉尘中的毒素长期可以检测到。我们的研究是可以的 为了表明WTC暴露导致，汇总或促成肝病（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 数据中心严格地识别所有西奈山WTC普通响应者患有肝硬化和/或肝癌。 Subaim 2的目的是检验以下假设：肝硬化和/或肝癌的反应者，非洲 美国响应者的全因死亡率高于其他响应者。 AIM II：一个FIB-4计算器，用于筛选西奈山总反应者中的肝病。目标的目标 II将使WTCHP提供者能够筛查肝病。我们将介绍fib-4计算器到西奈山 某些诊所的WTCHP提供商，而不是其他诊所，并检验了教育增加使用的假设 计算器。我们还将监视每个ARM诊所之间转介肝病学率的差异。 AIM III：血浆和肝脏中的WTC毒素。 Subaim 1的目的是检验血浆水平的假设 GRC响应者中的PCB和其他POP比对照组高，并且与FIB-4分数直接相关 与血小板计数成反比。 Subaim 2的目标是比较细节和肉芽瘤。 WTC响应者和对照组的Tweet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，以告知CDC/NIOSH关于肝病是否存在的决定 符合WTC认证的标准，并解决一般响应者之间可能存在的任何分布。