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人群肝病差异的影响 亚裔美国人 项目摘要 结构性种族主义和歧视在形成持续的健康差距方面发挥了重要作用， 包括种族化亚裔美国人（AAs）之间的肝病差异。尽管占美国的7%。 在240万美国人中，AA占美国所有B型肝炎（HBV）感染的一半以上 在感染HBV的人群中，58%是AA，他们在任何种族/民族中HBV患病率最高。尽管CDC 和美国预防服务工作组建议筛查亚洲成年人谁是高风险的， 感染，绝大多数AA（~68-75%）从未进行过筛查，仍然未被诊断。SRD 表现为结构性不平等，即获得护理的机会有限， 服务/资源，社会隔离，对卫生系统的不信任，反亚洲种族主义，移民和贫困， 原子吸收法SRD的大多数研究都审查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/非裔美国人和拉丁美洲人的医疗保健服务，很少包括AA。我们的初步研究 在中国人、韩国人和越南人中， 这是由于多层次结构性障碍的交叉。2019冠状病毒病大流行期间， AAs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 HBV筛查和护理加剧了肝病的差异。这一创新和及时的总体目标 研究旨在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， 亚裔美国人健康结果的SRD。在适应性多层次社会生态模型的指导下，我们将 利用20年来建立的区域癌症健康差异网络与社区合作， 组织和临床合作伙伴在大费城和纽约。具体而言，我们的多学科团队将 使用混合方法来：1）检查个体水平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）和HBV筛查和护理 在2000名亚裔美国人中：中国人，韩国人和越南人; 2）研究机构层面的影响 医疗保健环境中的SRD（例如，抗亚洲种族偏见，患者导航资源）对HBV筛查的影响 吸收和护理; 3）阐明社区一级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（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，我们进行了综合分析， 个人、机构和社区层面的SRD是否与HBV筛查摄取和联系相关 在意这是第一个多层次的纵向研究，将使我们能够了解结构性种族主义如何驱动 高风险亚裔美国人中HBV相关肝病的差异我们的研究结果将从文化上确定 协调战略，以减轻SRD和设计干预措施，以提高慢性HBV护理的整体质量。我们 这项研究可能会导致从个人层面的方法到2030年消除B型肝炎的模式转变。

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.