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：有色人种 在美国经历肝病结果的持续差异。该项目调查了这些差异是如何产生的。 奇偶校验可能会影响西奈山世贸中心一般反应队列的成员。目前，WTC Healthcare 计划（WTCHP）涵盖肝癌治疗，但不涵盖其他肝脏疾病的诊断和治疗。 这些政策可能会在医疗保健安全网上造成漏洞， 不成比例地使非裔美国人处于不利地位。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，这是一种经过充分验证的肝病筛查工具。我们 在西奈山的EPIC电子病历（EMR）中嵌入了FIB-4计算器。它可用于安装 西奈WTCHP供应商。在这个项目中，我们将介绍计算器西奈山WTCHP供应商。我们 还将分析死亡率的差异，并研究存档标本，以评估存在的毒素 世贸中心的尘埃云里环境和工作场所暴露于毒素会导致肝损伤和癌症， 它们与其他肝损伤来源协同作用，放大损伤和肝癌风险。世贸中心的尘云 含有成吨的碎片和肝毒素，包括颗粒物、多氯联苯和其他 持久性有机污染物。暴露于世贸中心灰尘的青少年PCDD/F水平升高> 12年 在袭击发生后，确定世贸中心灰尘中的毒素在很长一段时间内仍然可以检测到。我们的研究预计 表明WTC暴露导致、加重或促成肝病（认证标准）。 目标一：死亡率差异。SubAim 1的目标是与WTCHP General Responder协作 数据中心严格识别所有患有肝硬化和/或肝癌的西奈山世贸中心一般反应者。 SubAim 2的目标是检验以下假设：在肝硬化和/或肝癌的应答者中，非洲人 美国应答者的全因和肝脏相关死亡率高于其他应答者。 目的二：一个FIB-4计算器来筛选西奈山一般应答者的肝脏疾病。Aim的目标 II是使WTCHP提供者能够筛查肝脏疾病。我们将介绍FIB-4计算器西奈山 WTCHP提供者在一些诊所，而不是其他和测试的假设，教育增加使用的 计算器。我们还将监测每组诊所之间转诊至肝病科的比率差异。 目的III：血浆和肝脏中的WTC毒素。SubAim 1的目的是检验以下假设： 多氯联苯和其他持久性有机污染物在GRC反应者中高于对照组，并与FIB-4评分直接相关 与血小板计数呈负相关。SubAim 2的目标是比较颗粒和肉芽肿， 肝脏疾病病因匹配的WTC应答者和对照的存档肝脏标本之间。 影响：长期目标是提供数据，告知CDC/NIOSH关于肝病是否 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.