J Natl Med Assoc
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The increased COVID-19 mortality for Black individuals over White individuals may be explained by the known racial disparities in access to insurance. ⋯ National trends of racial disparities in COVID-19 mortality may be partially explained by disparities in insurance.
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Evaluate racial and ethnic representation in clinical trials compared to the disease burden for diabetic retinopathy (DR) and diabetic macular edema (DME) within the United States (US). Diabetic retinopathy (DR) is currently the leading cause of blindness in American adults, affecting over 7.7 million individuals and disproportionately affecting Black Americans. Black patients represent 38.3 ± 16.5% of DME within the US population while White patients represented 44.6 ± 18.3% of the DME population in the US. ⋯ Black patients are under-represented by a 3.0-fold disparity in NIH trials and 4.5-fold disparity in industry trials for DME, while White patients are overrepresented. In industry-funded DR trials, there is a 2.1-fold disparity compared to disease burden. Clinical trials for diabetic eye disease should aim to recruit patients based on the disease burden, which enables measurements of treatment outcomes by race and promotes health equity.
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Sickle cell disease (SCD) is the most common inherited blood disorder in the United States. The Cure Sickle Cell Initiative (CureSCi) was created by the National Heart, Lung and Blood Institute (NHLBI) to improve the lives of people with SCD by accelerating the advancement of safe and promising genetic therapies, engaging the SCD community and healthcare providers, and encouraging collaboration among stakeholders. CureSCi is a collaborative, patient-focused research effort that includes patients at every level of the Initiative. Patient engagement is a key component, particularly during the development of clinical trials. ⋯ Lessons learned from the community have helped to influence recommendations for clinical trial design and key messaging development for the Cure Sickle Cell Initiative.
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Rural populations have known challenges to both emergency and ambulatory care access resulting in delayed presentation and poorer outcomes for stroke and heart attack patients. Conditions such as diabetes and hypertension are known to be more common among rural populations. However, it is unclear whether there are any differences in underlying clinical factors and outcomes among patients presenting to a tertiary care center for advanced cardiac procedures from rural versus urban areas. ⋯ Our study identified rural-urban differences in baseline factors and procedural outcomes in patients presenting to a tertiary care center for cardiac procedures. Providers should anticipate that health disparities may be associated with more intervention and worse outcomes in their rural patients. Being aware of such differences may also help policy makers in directing health care funding to lower gaps in health care and access ultimately leading to better health outcomes.
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Diabetic retinopathy is a progressive disease and primary retinal vascular complication of diabetes mellitus, the third leading cause of blindness in the United States. Racial and ethnic minorities are more likely to suffer from diabetic retinopathy and diabetic macular edema, and typically undergo less screening. Lack of screening is due to a variety of factors, such as patient, provider, and institutional barriers. ⋯ It is imperative to understand the barriers and social determinants of health limiting visual outcomes in minority populations. Diabetic retinopathy and its complications are often preventable if detected and treated early. Advances in screening technology and intravitreal anti-VEGF injections have changed the landscape in preventing vision loss in diabetic patients.