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