Faculty Bibliography

Introduction: Breast cancer is the most commonly diagnosed cancer among nearly every racial and ethnic group.With almost 40,000 fatalities every year, breast cancer is the second leading cause of death among women. Bettercare in the past 25 years has reduced breast cancer deaths by up to 34% in certain communities, but not allcommunities are benefiting equally from these improvements. To address these disparities, we launched anavigation-based program as a model to improve outcomes for medically underserved women with breast cancer byreducing barriers to quality care and advancing pioneering treatments for breast cancer. We look at the insurancestatus of the women educated and navigated over the past two years.
Method(s): The program has three objectives: (1) advance an effective and scalable community-based navigationmodel for reducing disparities in screening and diagnostic follow-up care in medically underserved women; (2)improve access to and use of high-quality breast cancer care and supportive services at Bellevue, Tisch, and NYUBrooklyn hospitals among underserved woman utilizing patient navigation; and (3) increase access to, andparticipation in, clinical trials for the most promising and innovative therapies for breast cancers among underservedwomen. Preliminary data were collected between August 2016 and April 2018 from women on their first encounterwith the navigator.
Result(s): Our community navigators have provided outreach to 144 unique sites in New York City, primarily inBrooklyn and lower Manhattan. Community navigators provided health outreach to 8,304 women, of whom 2071were eligible but not up to date on screening. 887 of these women enrolled in patient navigation and 711 womenprovided insurance information. 69% of our clients are AA, 25% Hispanic. 24% of our clients were uninsured, 19%had Medicaid, 10% had Medicare, and the remaining women had private insurance. The most salient reportedbarriers to screening addressed by our navigators included lack of adequate insurance, immigration status, housingand food insecurity, and lack of transportation and child care.
Discussion(s): Through a combination of outreach, education, and navigation, we have developed a novelinterdisciplinary model to reduce barriers for screening and treatment for breast cancer. While many of our clientsand patients had insurance, many still had formidable financial challenges. In our experience, comprehensiveassessment of financial, social, and logistical barriers is an integral component of the navigation process, and isnecessary to overcome the significant roadblocks to high-quality breast cancer screening, diagnosis, and treatmentthat underserved women face

Importance/UNASSIGNED:Black and Hispanic populations have higher rates of coronavirus disease 2019 (COVID-19) hospitalization and mortality than White populations but lower in-hospital case-fatality rates. The extent to which neighborhood characteristics and comorbidity explain these disparities is unclear. Outcomes in Asian American populations have not been explored. Objective/UNASSIGNED:To compare COVID-19 outcomes based on race and ethnicity and assess the association of any disparities with comorbidity and neighborhood characteristics. Design, Setting, and Participants/UNASSIGNED:This retrospective cohort study was conducted within the New York University Langone Health system, which includes over 260 outpatient practices and 4 acute care hospitals. All patients within the system's integrated health record who were tested for severe acute respiratory syndrome coronavirus 2 between March 1, 2020, and April 8, 2020, were identified and followed up through May 13, 2020. Data were analyzed in June 2020. Among 11 547 patients tested, outcomes were compared by race and ethnicity and examined against differences by age, sex, body mass index, comorbidity, insurance type, and neighborhood socioeconomic status. Exposures/UNASSIGNED:Race and ethnicity categorized using self-reported electronic health record data (ie, non-Hispanic White, non-Hispanic Black, Hispanic, Asian, and multiracial/other patients). Main Outcomes and Measures/UNASSIGNED:The likelihood of receiving a positive test, hospitalization, and critical illness (defined as a composite of care in the intensive care unit, use of mechanical ventilation, discharge to hospice, or death). Results/UNASSIGNED:Among 9722 patients (mean [SD] age, 50.7 [17.5] years; 58.8% women), 4843 (49.8%) were positive for COVID-19; 2623 (54.2%) of those were admitted for hospitalization (1047 [39.9%] White, 375 [14.3%] Black, 715 [27.3%] Hispanic, 180 [6.9%] Asian, 207 [7.9%] multiracial/other). In fully adjusted models, Black patients (odds ratio [OR], 1.3; 95% CI, 1.2-1.6) and Hispanic patients (OR, 1.5; 95% CI, 1.3-1.7) were more likely than White patients to test positive. Among those who tested positive, odds of hospitalization were similar among White, Hispanic, and Black patients, but higher among Asian (OR, 1.6, 95% CI, 1.1-2.3) and multiracial patients (OR, 1.4; 95% CI, 1.0-1.9) compared with White patients. Among those hospitalized, Black patients were less likely than White patients to have severe illness (OR, 0.6; 95% CI, 0.4-0.8) and to die or be discharged to hospice (hazard ratio, 0.7; 95% CI, 0.6-0.9). Conclusions and Relevance/UNASSIGNED:In this cohort study of patients in a large health system in New York City, Black and Hispanic patients were more likely, and Asian patients less likely, than White patients to test positive; once hospitalized, Black patients were less likely than White patients to have critical illness or die after adjustment for comorbidity and neighborhood characteristics. This supports the assertion that existing structural determinants pervasive in Black and Hispanic communities may explain the disproportionately higher out-of-hospital deaths due to COVID-19 infections in these populations.

BACKGROUND:Participation in clinical trials among people of color remains low, compared with white subjects. This protocol describes the development of "Advancing People of Color in Clinical Trials Now!" (ACT Now!), a culturally tailored website designed to influence clinical trial decision making among people of color. OBJECTIVE:This cluster randomized study aims to test the efficacy of a culturally tailored website to increase literacy, self-efficacy, and willingness to enroll in clinical trials among people of color. METHODS:ACT Now! is a randomized trial including 2 groups: (1) intervention group (n=50) with access to the culturally tailored website and (2) control group (n=50) exposed to a standard clinical recruitment website. Clinical trial literacy and willingness to enroll in a clinical trial will be measured before and after exposure to the website corresponding to their assigned group (intervention or control). Surveys will be conducted at baseline and during the 1-month postintervention and 3-month follow-up. Website architecture and wireframing will be informed by the literature and experts in the field. Statistical analysis will be conducted using a two-tailed t test, with 80% power, at .05 alpha level, to increase clinical trial literacy, self-efficacy, and willingness to enroll in clinical trials 3 months post intervention. RESULTS:We will design a culturally tailored website that will provide leverage for community stakeholders to influence clinical trial literacy, self-efficacy, and willingness to enroll in clinical trials among racial and ethnic groups. ACT Now! applies a community-based participatory research approach through the use of a community steering committee (CSC). The CSC provides input during the research study conception, development, implementation, and enrollment. CSC relationships help foster trust among communities of color. ACT Now! has the potential to fill a gap in clinical trial enrollment among people of color through an accessible web-based website. This study was funded in July 2017 and obtained institutional review board approval in spring 2017. As of December 2019, we had enrolled 100 participants. Data analyses are expected to be completed by June 2020, and expected results are to be published in fall 2020. CONCLUSIONS:ACT Now! has the potential to fill an important gap in clinical trial enrollment among people of color through an accessible web-based website. TRIAL REGISTRATION/BACKGROUND:ClinicalTrials.gov NCT03243071; https://clinicaltrials.gov/ct2/show/NCT00102401. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)/UNASSIGNED:DERR1-10.2196/17589.

Introduction/UNASSIGNED:Mentorship is crucial for academic success. And yet, there are few mentoring programs that address the needs of underrepresented, racially/ethnically diverse junior faculty conducting health-related research in the United States. Methods/UNASSIGNED:To expand mentoring capacity for these racially/ethnically diverse faculty, we developed a Peer Mentor Development Program (PMDP) to prepare near-peers, who have similar characteristics and personal experiences, to provide support to participants in an NIH-PRIDE funded Institute. The PMDP program is designed based on the 8-year experience of the Mentor Development Program of the NYU-Health and Hospitals Clinical Translational Science Institute. Annually, up to six alumni are selected into the PMDP, participate in the 12-hour program over 4 days, are paired with 1 to 3 scholar participants to mentor and join monthly PMDP conference calls during the ensuing year. Results/UNASSIGNED:We describe the program, participant experience and lessons learned from our first 18 peer mentors in three PMDP cohorts. Additionally, all 18 peer mentors completed a post-evaluation survey to assess the program. Overall, peers agreed that participating in the PMDP enhanced most of the specific skills targeted. Participants rated 53%-86% of skills as "more than before" participating in PMDP, demonstrating the appreciation and impact of the program. Conclusions/UNASSIGNED:The PMDP may be a model for higher education and academic medicine programs committed to mentoring and retaining racially/ethnically diverse faculty and ultimately contributing to reducing entrenched health disparities between majority and minority populations.

Members of the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community experience marginalization, bias, and discrimination, including in the world of academic medicine. People who are transgender and gender non-binary (TGNB) experience further marginalization compared to individuals who are lesbian, gay, bisexual, and queer. According to a recent survey, more than half of medical students who are TGNB chose not to disclose their gender identities during training due to fears of discrimination, feeling a lack of support, and concerns about future career options. Academic medicine has historically pathologized TGNB individuals, perpetuating discrimination structurally and reinforcing discriminatory behaviors in peers and faculty. In this Perspective, the authors provide a comprehensive overview of the challenges that administrators and educators face in creating a learning environment that is inclusive of TGNB trainees. They outline opportunities for change and provide strategies to address administrative and educational challenges, including those related to institutional climate, policies, data collection, physical spaces, health care, the curriculum, mentoring, and the evaluation of TGNB trainees. Finally, the authors issue a call to action for medical educators and administrators to create environments in which trainees who are TGNB can fulfill their primary mission: to learn the practice of medicine.

Background: Current guidelines for diabetes screening start at age 45, but disparities in certain subgroups exist and poor diabetic outcomes are known to cluster in specific neighborhoods. The objective of this study was to quantify disparities in the age distribution of patients with type 2 diabetes by sex, race/ethnicity, and geographic location. We also studied how patient age relates to diabetes-related hospital use and development of diabetic complications.
Method(s): Using all-payer hospital claims data, we performed a cross-sectional analysis of patients with type 2 diabetes. Our study included patients in New York City as identified by geocoded home address. Patients aged 10 to 100 years old were identified as having type 2 diabetes based on diagnosis codes from emergency claims data from 2011-2015. Our main measures included the estimated prevalence of type 2 diabetes at each year of life, the age distribution of patients as stratified by decade, and the comparison of patient age in geographic hotspots of frequent diabetes-related hospital use and diabetic complications.
Result(s): We identified 576,306 unique patients diagnosed with type 2 diabetes, which represented over half of all cases in New York City. Minority subgroups were on average 5.5 to 8.4 years younger than non-Hispanic White patients. Males with type 2 diabetes were 2.6 years younger than females. At 45 years of age, the estimated prevalence of type 2 diabetes was 10.9% among Black patients compared to 5.2% among White patients. In our geospatial analyses, patients with type 2 diabetes were on average 5.9 years younger in hotspots of diabetes-related emergency department use and inpatient hospitalizations. The average age of patients with type 2 diabetes was 1.5 to 2.2 years younger in hotspots of microvascular diabetic complications.
Conclusion(s): We identified profound disparities in the age of patients with type 2 diabetes among minorities and in neighborhoods with poor health outcomes. The younger age of these patients may be due to earlier onset of diabetes and/or earlier death from diabetes-related complications. Our findings demonstrate the need for geographically targeted interventions that promote earlier diagnosis and better glycemic control to reduce disparities in diabetes burden. [Figure Presented] Age Distribution of Patients with Type 2 Diabetes by Race and Ethnicity