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

WTC综合应答者队列中肝病的种族和民族差异：有色人种 在美国肝病预后方面的持续差异。该项目调查这些差异是如何 奇数可能会影响西奈山WTC一般响应者队列的成员。目前，WTC医疗保健 计划(WTCHP)包括肝癌治疗，但不包括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安全网上造成漏洞，可能 非裔美国人的应答者不成比例地处于劣势。幸运的是，世贸中心的监测访问提供了 计算纤维化-4(FIB-4)评分所需的数据，这是一种经过良好验证的肝病筛查工具。我们 在西奈山史诗般的电子病历(EMR)中嵌入了FIB-4计算器。它可用于挂载 西奈WTCHP供应商。在这个项目中，我们将把计算器介绍给西奈山的WTCHP供应商。我们 还将分析死亡率的差异，并研究存档样本以评估存在的毒素 在世贸中心的尘埃云中。环境和工作场所暴露于毒素会导致肝脏损伤和癌症，以及 它们与其他肝损伤来源协同作用，放大损伤和肝癌风险。世贸中心的尘埃云 含有数吨的碎片和肝毒素，包括颗粒、多氯联苯和其他 持久性有机污染物(POPs)。接触WTC粉尘的青少年PCDD/F水平升高&>12岁 袭击发生后，确定WTC粉尘中的毒素在很长一段时间内仍可检测到。我们的研究是值得期待的 表明暴露于WTC导致、加重或促成了肝病(认证标准)。 目标一：死亡率的差异。SubAim1的目标是与WTCHP General Responder协作 数据中心，以严格识别所有患有肝硬变和/或肝癌的西奈山WTC综合应答者。 SubAim 2的目标是检验一种假设，即在患有肝硬变和/或肝癌的应答者中，非洲人 与其他急救员相比，美国急救员的全因死亡率和肝脏相关死亡率更高。 目的II：一台FIB-4计算器，用于在西奈山综合应答器中筛查肝病。目标的目标 第二个目的是使WTCHP供应商能够筛查肝病。我们将把FIB-4计算器引入西奈山 一些诊所的WTCHP提供者，而不是其他诊所的提供者，并测试教育增加对 计算器。我们还将监测每个分支机构的诊所之间转诊到肝病的比率的差异。 目的III：血浆和肝脏中的WTC毒素。SubAim 1的目标是测试以下假设：血浆中 多氯联苯和其他POP在GRC应答者中高于对照组，并与FIB-4得分直接相关 与血小板计数呈负相关。SubAim 2的目标是将颗粒物和肉芽肿进行比较- 在WTC应答者和与肝病病因学相匹配的对照组的存档肝脏样本之间进行比较。 影响：长期目标是提供数据，为CDC/NIOSH关于肝脏疾病是否 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。

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.