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: 10633201
• 负责人: GRACE X. MA
• 金额: $ 80.15万
• 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/10633201
• 关键词: Adult; Advanced Malignant Neoplasm; Advocacy; Affect; African American population; American; Asia; Asian; Asian Americans; Black race; COVID-19; COVID-19 pandemic; Caring; Chinese; Chronic Hepatitis B; Cities; Clinical; Collaborations; Communities; Community Surveys; Crime; Data; Data Analyses; Data Collection; Death Rate; Detection; Development; Diagnosis; Disadvantaged; Discrimination; Disparity; Ethnic Origin; Ethnic Population; 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; Incidence; Individual; Inequality; Infection; Institution; 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; Procedures; Provider; Public Health; Quality of Care; Race; Recommendation; Recording of previous events; Regional Cancer; Research; Resources; Role; Services; Shapes; Stereotyping; Structural Racism; Surveys; Trauma; United States National Institutes of Health; United States Preventative Services Task Force; Vietnamese; Work; anti-Asian; barrier to care; cancer diagnosis; cancer health disparity; community based participatory research; community organizations; density; disease disparity; experience; hate crimes; health care availability; health care settings; health disparity; high risk; improved; infection risk; innovation; mortality; multidisciplinary; patient navigator; perceived discrimination; poor health outcome; population based; primary health center; protective factors; racial bias; racial disparity; racial population; racism; residence; residential segregation; resilience; screening; segregation; social; social cohesion; social norm; structural determinants; 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 亚裔美国人口 项目摘要 结构性种族主义和歧视(SRD)在形成持续的健康差距方面发挥着重要作用， 包括被种族主义的亚裔美国人(AA)之间的肝病差异。尽管占美国人口的7%， 人口，在美国240万美国人中，AA占所有乙肝(乙肝)感染的一半以上 在感染了乙肝病毒的人中，58%的人是所有种族/民族中乙肝病毒感染率最高的AAA。尽管疾控中心 和美国预防服务工作组建议筛查高危亚裔成年人 在感染方面，绝大多数(约68-75%)的AAA从未进行过筛查，仍未得到诊断。SRD 结构性不平等的表现为有限的获得适当的文化和语言上的护理 年的服务/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 美国医学会。大多数SRD研究都考察了结构性种族主义和多层次决定因素如何使不利 黑人/非裔美国人和拉丁裔美国人的医疗保健机会，很少包括AAS。我们的初步研究 在中国、韩国和越南人中，乙肝病毒筛查和与护理相关的差异是 这可归因于多层结构性障碍的交叉。新冠肺炎大流行期间，关爱障碍 反亚裔协会越来越多地受到反亚洲种族主义、仇恨犯罪和各级歧视的影响，这阻碍了 乙肝病毒筛查和护理，并加剧了肝病的差异。这一创新和适时的总体目标 这项研究旨在确定结构性种族主义和保护性因素与肝病差异和 关于亚裔美国人健康结果的SRD。在适应的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 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 使用混合方法来：1)检查个体级别的SRD生活体验的纵向关联(例如， 新冠肺炎(反亚洲种族主义、社会历史创伤、文化刻板印象种族主义)和乙肝病毒筛查和护理 在2000名亚裔美国人中：中国人、韩国人和越南人；2)考察制度层面的影响 关于乙肝筛查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) 3)阐明社区一级可持续发展的影响(例如，反亚裔种族主义/仇外心理和 居住隔离)和保护因素(例如居住、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来检验 个人、机构和社区层面的SRD是否与乙肝病毒筛查、吸收和联系有关 去关心。这是第一个多层次的纵向研究，将使我们能够理解结构性种族主义是如何驱动的 高危亚裔美国人中与乙肝病毒相关的肝病差异。我们的研究结果将在文化上 协调战略，以减轻SRD和设计干预措施，以提高慢性乙肝护理的整体质量。我们的 这项研究可能会导致范式的转变，从个人层面的方法到2030年消除乙肝。