Faculty Bibliography

BACKGROUND:While payers and health systems are increasingly interested in addressing health-related social needs (HRSNs) to reduce health care use and align with value-based care incentives and regulatory requirements, limited evidence enables actionable strategies to manage and address social needs across population groups. OBJECTIVES/OBJECTIVE:To understand the relationship between HRSNs and health care access and use for adults with Medicare, Medicaid, and private health insurance coverage. RESEARCH DESIGN/METHODS:Survey data from adult participants from the All of Us Research Program (2017-2023; n=126,490) and logistic regression were used to examine the association between food insecurity and housing instability and having a usual source of care, seeing a health care provider, and forgoing care due to cost-stratified by payer type. RESULTS:The prevalence of HRSNs varied substantially by insurance: food insecurity affected 49.20% of Medicaid beneficiaries 18-64 years of age, 11.89% of privately insured adults 18-64 years of age, and 5.20% of Medicare beneficiaries 65 years of age and older; housing instability affected 54.61%, 25.18%, and 14.99%, respectively. Food insecurity was associated with lower odds of having a usual source of care for Medicaid and privately insured adults, lower odds of use for privately insured adults, and higher odds of forgone care for all 3 payer types. Housing instability was associated with lower odds of having a usual source of care for all 3 papers and with higher odds of forgone care for all groups. CONCLUSIONS:HRSNs like food insecurity and housing instability vary substantially by payer type and influence health care access and utilization in different ways. This can inform the design of payer-specific health management strategies that incorporate HRSNs.

BackgroundCervical cancer is a preventable disease, and reaching populations who are under-screened and/or at highest risk is essential to the goal of disease elimination. Hispanic women in the US have a disproportionately higher incidence rate than non-Hispanic women.ObjectivePost hoc analysis of the SELF-CERV study of the unique experience and preferences among Hispanic compared to non-Hispanic participants with the goal of facilitating and improving screening and follow-up in more vulnerable populations.MethodsWomen 25 to 65 years who were enrolled performed self-collection (SC) of vaginal samples for high-risk human papillomavirus (hrHPV) testing using a unique device in a simulated at-home environment. For method comparison, a clinician-collected (CC) sample was obtained. Participants also completed usability and screening preference surveys.ResultsA total of 609 participants were consented and 603 used the SC device. Of the 603 SC users, 115 (19.1%) identified themselves as Hispanic/Latinx. Compared to non-Hispanic women, Hispanic women, had significantly lower annual income (p < .001), a lower percentage of private insurance with more uninsured (p < .001) and lower levels of education (p < .001). There was no significant difference between Hispanic and non-Hispanic women in understanding the purpose of cervical cancer screening. No difference was noted in delaying screening, although English Not Primary speaking Hispanic women were somewhat more likely to delay (p = 0.22). Financial barriers were observed to be more of an impediment to Hispanic women compared to non-Hispanic women (p = 0.016). Negative experiences with in-clinic speculum exams were similar; however, Hispanic women (78%) expressed a significantly higher endorsement of SC than non-Hispanic women (62%), (p = 0.001). Both populations reported that they would be more likely to stay up to date with cervical cancer screening with the at-home SC device, but non-Hispanic women to a significantly lesser degree (p = 0.002). In terms of assessing utility of telemedicine in screening, both populations reported similar engagement in healthcare activities, willingness to try new technology and current use of smartphones. Hispanic and non-Hispanic women were both nearly equally divided as to their preference for in-clinic visits vs telehealth.ConclusionsFacilitating screening uptake is especially critical for Hispanic women, who bear a disproportionate burden of cervical cancer diagnoses and mortality while facing more obstacles to screening than non-Hispanic women. A clinically validated and accessible at-home SC alternative holds potential for meaningful impact and improved health outcomes within this community.

APG157DS is a multi-component investigational drug which is currently the subject of multiple cancer trials. It has shown promising efficacy in patients with head and neck cancer. We report its immuno-modulatory effect in a syngeneic mouse model of glioblastoma (GBM). Long-term treatment with APG157DS led to durable tumor remission in 50% of mice, while all vehicle-treated mice reached humane endpoints within 42 days. Mechanistically, the drug induced selective repolarization of tumor-associated macrophages (TAMs) from an immunosuppressive Arg1^high/iNOS^low phenotype to a tumoricidal Arg1^low/iNOS^high state, accompanied by increased intratumoral recruitment of activated (NKp46+) natural killer cells and CD8+ cytotoxic T-cells. APG157DS also suppressed vascular endothelial growth factor (VEGF) and Hypoxia-inducible factor 1-alpha (HIF-1α) expression in tumors, further impairing tumor growth. Notably, APG157DS did not elicit off-target macrophage activation in peripheral tissues such as the spleen, highlighting its selective immune targeting. These findings provide a mechanistic rationale for further clinical development of APG157DS in GBM and potentially other immune-evasive cancers.

OBJECTIVE:Cesarean delivery (CD) remains a key obstetric quality metric, particularly among nulliparous, term, singleton, vertex (NTSV) pregnancies. In 2024, NTSV CD rate at NYU-LI was 32.9%, exceeding The Joint Commission (TJC) benchmark of ≤30% and demonstrating racial and ethnic disparities. This study aimed to reduce the institutional NTSV CD rate to ≤30% through a multidisciplinary QI initiative while prospectively monitoring safety outcomes and racial disparities. STUDY DESIGN/METHODS:A single-site QI initiative was implemented from 2024-2025 incorporating provider education, patient-centered interventions (TeamBirth and structured labor huddles), standardized labor management, and performance monitoring through monthly case review, clinician feedback, and quarterly equity-focused data review. Outcome measures included monthly overall and quarterly race- and ethnicity-stratified NTSV CD rates. Process measures assessed adherence to evidence-based labor dystocia criteria. Balancing measures included postpartum hemorrhage (PPH) and TJC PC-06 rates. Temporal trends were evaluated using multivariable Poisson regression with adjustment for maternal age, gestational age at delivery, and body mass index. RESULTS:The overall NTSV CD rate decreased from 32.9% in 2024 to 27.8% in 2025, remaining below TJC benchmark in 10 of 12 months. Across the 8-quarter study period, there was a significant decline in the outcome over time (aRR per quarter 0.97, 95% CI 0.95-0.99, p=0.003). Reductions were observed across racial and ethnic groups, including among Black non-Hispanic patients (44.0% to 40.0%) and Asian non-Hispanic patients (37.0% to 29.6%). Adherence to evidence-based labor dystocia criteria remained high, while PPH and PC-06 rates remained stable. CONCLUSIONS:A standardized, multidisciplinary QI initiative was associated with NTSV cesarean delivery rate below the Joint Commission benchmark without increases in maternal or neonatal adverse outcomes. The initiative was also associated with partial reduction in racial disparities in cesarean delivery rates, although persistent inequities remained. Future PDSA cycles will focus on sustaining standardized care and advancing equitable obstetric outcomes.

BACKGROUND/UNASSIGNED:Healthcare is a major contributor to greenhouse gases. One of the most widely used healthcare services in the USA is colorectal cancer (CRC) screening, indicated for 134 million adults. Recommended screening includes annual faecal immunochemical tests (FITs), CT colonographies every 5 years or colonoscopies every 10 years. OBJECTIVE/UNASSIGNED:To compare the environmental impacts of these tests for CRC screening. DESIGN/UNASSIGNED:We conducted a comparative life cycle assessment of three CRC screening strategies at UCSF. We performed on-site audits to document the resources used for each screening test. We estimated the environmental impacts of these procedures, measured by global warming potential (GWP) and damage to human health. We computed 10-year impacts of each screening strategy using a Markov model. We accounted for uncertainty using hierarchical Monte Carlo simulations. RESULTS/UNASSIGNED:FITs had the lowest environmental impacts, roughly 20 percentage points superior to colonoscopies, and this was robust on sensitivity analyses. Across tests, the biggest cause of environmental harm was car-based transportation of patients and staff. Prioritising FITs over colonoscopies in the USA could enhance population health by 5.2 million disability-adjusted life-years per decade. Transitioning to electric vehicles could reduce the GWP of all screening tests by 15%-20%. CONCLUSIONS/UNASSIGNED:Given the similar efficacy and safety of these tests, payors should probably prioritise FITs for low-risk patients. Governments should decarbonise transportation and mandate environmental product declarations. We call for a closer look at resource-intensive preventative health strategies, which could result in more harm than good if applied to a low-risk population.

Idasanutlin is a small molecule inhibitor that restores p53 activity, triggering apoptosis. Two trials (phase 1/2) of idasanutlin therapy in polycythemia vera patients that were intolerant or refractory to hydroxyurea resulted in substantial clinical and molecular responses. Here the long term outcomes of these patients are reported.

Background Obesity is a global epidemic. The prevalence of obesity has significantly increased in recent decades and is expected to impact a large portion of the US population. Hypertension continues to be one of the most common complications associated with obesity, and the overlap between these two conditions has been growing over time. However, mortality trends in patients with obesity and hypertension have not been investigated in the literature. Objectives This study aimed to investigate mortality trends, stratified by sex, race, age groups, and geographic distribution, in the US population between 1999 and 2020. Methods Death certificates from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) were examined and analyzed between 1999 and 2020 for patients with obesity and hypertension as the contributing causes of death. The age-adjusted mortality rates (AAMRs) and annual percent changes (APCs) per 100000 people were calculated by sex, race, age group, and geographic region. Results Among individuals aged ≥15, a total of 294854 deaths occurred in individuals with obesity and hypertension between 1999 and 2020. The overall AAMR increased from 1.08 in 1999 to 12.14 in 2020. The AAMR has steadily increased since 1999, with a sudden spike occurring between 2018 and 2020 during the COVID-19 pandemic. This trend has been observed across nearly all variables analyzed in our study. Our results exhibited a 28% increase in mortality related to obesity and hypertension during the early years of the COVID-19 pandemic. During the study period, men had a higher overall AAMR than women (men, 5.92; women, 4.32). Mortality was highest among the 55-74-year-old age group, followed by the 75-plus-year-old, 35-54-year-old, and finally 15-34-year-old age groups, which displayed the lowest AAMR (AAMR: 55-74, 11.76; 75+, 10.83; 35-54, 4.73; and 15-34, 0.54). Among the races, non-Hispanic (NH) Blacks had the highest overall AAMR (9.81), followed by NH American Indians or Alaskan Natives (6.01), NH Whites (4.64), Hispanics (4.08), and NH Asians or Pacific Islanders (1.17). However, NH Whites showed the highest average APC (AAPC) (11.44), indicating a possible future shift in mortality. By geographic region, the Southern United States had the highest AAMR, followed by the Western, Midwestern, and Northeastern regions. Non-metropolitan areas had consistently higher obesity- and hypertension-related AAMRs (5.63 overall) compared to metropolitan areas (4.99 overall). Conclusion In our retrospective analysis of death certificate data from 1999 to 2020, we found that age-adjusted mortality rates among individuals with both obesity and hypertension consistently displayed an increasing trend across all demographic groups. The overall rising AAMRs, compounded by the disproportionately high average annual percent changes among White individuals and those aged 15-34, raise serious concerns for the healthcare system. These findings have significant implications for public health policy. Focused interventions are essential to curb the upward trajectory of mortality in this population, as early intervention can greatly help tackle the dual burden of obesity and hypertension, which are largely preventable.