Between Reality and Representation: Exclusion of Subpopulations in Anti‐Amyloid Therapy

23 Background: Disparities in prostate cancer-specific mortality (PCSM) between African American and non-Hispanic White (White) patients have been attributed to biological differences; however, recent data suggest poorer outcomes may be related to barriers to medical care from the healthcare system in which patients receive care. We sought to evaluate potential drivers of disparities by comparing outcomes between African American and White men in the Surveillance, Epidemiology and End Results (SEER) national cancer registry and a relatively equal-access healthcare system, the Veterans Health Administration (VHA). Methods: We identified African American and White patients diagnosed with prostate cancer between 2004-2015 in the SEER and VHA databases. We analyzed metastatic disease at diagnosis with multivariable logistic regression, and PCSM with cumulative incidence analysis and sequential competing-risks regression adjusting for disease and sociodemographic factors. Results: The SEER cohort included 306,609 men (57,994 [18.9%] African American and 248,615 [81.1%] White) with a median follow-up of 5.3 years (interquartile range [IQR] 2.6-8.1 years), and the VHA cohort included 90,749 men (27,412 [30.2%] African American and 63,337 [69.8%] White) with a median follow-up of 4.7 years (IQR 2.4-7.6 years). In SEER, African American men were significantly more likely to present with metastatic disease (African American 4.3% versus White 3.0%, p< 0.001; multivariable odds ratio [OR] 1.25, 95% confidence interval [CI] 1.19-1.32, p< 0.001), whereas in the VHA, African American men were not significantly more likely to present with metastatic disease (African-American 3.2% versus White 3.3%, p= 0.26; multivariable OR 1.07, 95% CI 0.98-1.17, p= 0.12). In SEER, the 8-year cumulative incidence of PCSM was significantly higher for African American compared with White men (6.9% versus 5.1%, p< 0.001), whereas in the VHA, African American compared with White men did not have a significantly higher 8-year cumulative incidence of PCSM (5.5% versus 5.4%, p= 0.93). African American race was significantly associated with an increased risk of PCSM in SEER (univariable subdistribution hazard ratio [SHR] 1.39, 95% CI 1.33-1.45, p< 0.001), but was not significantly associated with PCSM on uni- and multivariable regression in the VHA. When adjusted for disease characteristics at diagnosis in SEER, disease extent, PSA, and Gleason score contributed to 85% of the risk of PCSM for African American men (adjusted SHR 1.06, 95% CI 1.02-1.12, p= 0.008). Conclusions: Racial disparities in PCSM were present in a national cohort, SEER, but not as pronounced in a relatively equal-access healthcare system, the VHA, potentially due to differences in metastatic disease at diagnosis among African American and White men between cohorts. These findings may be attributable to reduced barriers to care in the VHA.

Experts Shine Spotlight on Racial Differences in Illness

MP30-18 RACIAL DISPARITIES IN RENAL TRANSPLANTATION

Differences in ocular anatomy may contribute to ethnic differences in glaucoma risk. Because the trabecular meshwork (TM) plays an important role in aqueous outflow, its anatomy in relation to at-risk populations may provide insight into a potential contributor to elevated intraocular pressure and thus to probability of glaucoma development. To investigate whether differences exist in TM height between ethnic groups. This prospective study took place from January 1, 2012, to December 31, 2013. Adult patients who self-reported as being of white, Asian, Hispanic, or African American ethnicity were recruited from ophthalmology clinics at the University of California, San Francisco. The TM height was assessed using spectral-domain anterior segment optical coherence tomography. Trabecular meshwork height was measured from the scleral spur to the Schwalbe line. We hypothesized that ethnicities with a higher prevalence of glaucoma would tend to have shorter TM heights. We collected data from 460 eyes of 291 participants after excluding 34 optical coherence tomographic scans owing to poor image quality. The final sample was 32.2% white, 45.1% Asian, 10.5% African American, and 12.1% Hispanic. There were 64.2% women, and the mean age was 68.1 years. The mean (SD) TM height among all eyes included in the study was 836 (131) μm. The mean (SD) TM height was characterized among white (851 [131] μm), Asian (843 [126] μm), Hispanic (822 [147] μm), and African American (771 [118] μm) persons. Ethnicity was not associated with TM height overall (P = .23, linear mixed regression model). However, the TM heights of African American participants (771 μm) were shorter than those of white (851 μm; adjusted difference 95% CI, -119.8 to -8.1; P = .02) and Asian (843 μm; adjusted difference 95% CI, -117.4 to -10.8; P = .02) participants. Although TM height is not associated with ethnicity overall, African American individuals have shorter TM heights compared with Asian and white persons. Trabecular meshwork size may play a role in ethnic differences of glaucoma risk and be a new risk factor to consider in primary open-angle glaucoma.

BackgroundKidney cancer (KC) is a significant contributor to cancer mortality worldwide, with gender, racial, and ethnic disparities impacting outcomes. While previous studies have investigated the outcomes of diverse patient populations, gaps in knowledge remain. The incidence of KC has been rising steadily, and it is essential to understand the patterns of mortality to identify and address disparities in healthcare. Therefore, this study aimed to investigate trends in age-adjusted mortality rates (ASMR) by gender, race, and ethnicity in the US at national levels.MethodsThe Center for Disease Control Wonder database was used to extract national KC mortality data (ICD-10 C64) from 1999-2020. ASMR and 95% confidence intervals (CI) were extracted based on gender and race reported per 100,000 population. Absolute percentage changes were calculated. Joinpoint Command Line Version 4.5.0.1 was used to apply a Joinpoint regression analysis and calculate Average Annual Percentage Change (AAPC). IRB approval was not needed as CDC is an open-source database with de-identified information.ResultsOver twenty years, 284,224 KC deaths were reported, with an overall decrease in ASMR in recent years. Males had significantly higher ASMR throughout the study period, with a lower decrease than females. Female mortality rates for all racial and ethnic groups declined over the study period, with the largest decrease observed in American Indian/Alaskan Native females (-34.3%). However, American Indian/Alaskan Native females still had the highest mortality rates in 2020. Asian females had the lowest mortality rates throughout the study period, but they only decreased slightly (-8.3%). African American and white females had similar mortality rates that decreased by 25% and 22.2%, respectively. Among males, there was a general decline in mortality rates across all racial and ethnic groups, with the largest decrease observed in American Indian/Alaskan Native males (-44.3%). Despite having lower mortality rates than most other groups, White males had the highest age-adjusted mortality rate (ASMR) of 5.7 in 2020 due to the lack of significant decline. When considering the average annual percentage change (AAPC) over the entire period, the decline in mortality rate was statistically significant for all groups except Asian females. The AAPC ranged from -2.1% for American Indian/Alaskan Native females to -0.4% for Asian females. The steepest decline was observed in American Indian/Alaskan Native males (-2.1%), followed by American Indian/Alaskan Native females (-1.8%) and African American females (-1.7%).ASMR; 95% CI19902020Percentage changeAAPCOverall4.0; 3.9-4.13.4; 3.4-3.5-15.0Female2.7; 2.6-2.72.1; 2.0-2.1-22.2American Indians/Alaskan Natives females3.5; 2.3-5.22.3;1.7-3.1-34.3-1.8 (-2.9 - -0.8)Asian females1.2; 0.8-1.61.1; 0.9-1.2-8.3-0.9 (-1.6 – -0.2)African Americans females2.8; 2.5-3.12.1; 1.9-2.3-25.0-1.7(-2.1 - -1.3)White females2.7; 2.6-2.72.1; 2.0-2.2-22.2-1.1 (-1.5 - -0.8)Male5.8; 5.7-5.95.0; 4.9-5.1-13.8American Indians/Alaskan Natives males8.8; 6.3-12.04.9; 3.9-6.1-44.3-2.1 (-3.1 - -1.1)Asian males2.5; 2.0-3.22.3; 2.0-2.6-8.0-0.4 (-1.7 – 0.9)African Americans males6.0; 5.5-6.54.9; 4.5-5.2-18.3-1.2 (-1.4 - -0.9)White males5.8; 5.7-6.05.7; 5.7-5.7-1.7-0.7 (-1.3 - -0.1)ConclusionsIn conclusion, our study highlights significant gender, racial, and ethnic disparities in kidney cancer mortality rates in the US. Our study underscores the importance of targeted interventions to reduce mortality rates among American Indian/Alaskan Native populations, who consistently had the highest mortality rates in kidney cancer throughout the study period. Additionally, our findings highlight the need for continued attention to male mortality rates at the gender level. The results of this study can inform healthcare policies and practices that aim to address the disparities in kidney cancer mortality rates and ultimately improve the health outcomes of all populations.CDMRP DOD Funding: no

The safety of active surveillance (AS) for African American men compared with non-Hispanic White (White) men with intermediate-risk prostate cancer is unclear. The authors identified patients with modified National Comprehensive Cancer Network favorable ("low-intermediate") and unfavorable ("high-intermediate") intermediate-risk prostate cancer diagnosed between 2001 and 2015 and initially managed with AS in the Veterans Health Administration database. They analyzed definitive treatment, disease progression, metastases, prostate cancer-specific mortality (PCSM), and all-cause mortality by using cumulative incidences and multivariable competing-risks (disease progression, metastasis, and PCSM) or Cox (all-cause mortality) regression. The cohort included 1007 men (African Americans, 330 [32.8%]; Whites, 677 [67.2%]) followed for a median of 7.7years; 773 (76.8%) had low-intermediate-risk disease, and 234 (23.2%) had high-intermediate-risk disease. The 10-year cumulative incidences of definitive treatment were not significantly different (African Americans, 83.5%; 95% confidence interval [CI], 78.5%-88.7%; Whites, 80.6%; 95% CI, 76.6%-84.4%; P=.17). Among those with low-intermediate-risk disease, there were no significant differences in the 10-year cumulative incidences of disease progression (African Americans, 46.8%; 95% CI, 40.0%-53.3%; Whites, 46.9%; 95% CI, 42.1%-51.5%; P=.91), metastasis (African Americans, 7.1%; 95% CI, 3.7%-11.8%; Whites, 10.8%; 95% CI, 7.6%-14.6%; P=.17), or PCSM (African Americans, 3.8%; 95% CI, 1.6%-7.5%; Whites, 3.8%; 95% CI, 2.0%-6.3%; P=.69). In a multivariable regression including the entire cohort, African American race was not associated with increased risks of definitive treatment, disease progression, metastasis, PCSM, or all-cause mortality (all P>.30). Outcomes in the Veterans Affairs Health System were similar for African American and White men treated for low-intermediate-risk prostate cancer with AS.

There is limited information on the effects of vitamin D on serum 25 hydroxyvitamin D (25OHD) in young people and none on African Americans. The main objective of this trial was to measure the effect of different doses of vitamin D3 on serum 25OHD and serum parathyroid hormone (PTH) in young women with vitamin D insufficiency (serum 25OHD ≤ 20 ng/mL (50 nmol/L). A randomized double-blind placebo-controlled trial of vitamin D3 was conducted in young white and African American women, age 25 to 45 years. A total of 198 healthy white (60%) and African American (40%) women were randomly assigned to placebo, or to 400, 800, 1600, or 2400 IU of vitamin D3 daily. Calcium supplements were added to maintain a total calcium intake of 1000 to 1200 mg daily. The primary outcomes of the study were the final serum 25OHD and PTH levels at 12 months. The absolute increase in serum 25OHD with 400, 800, 1600, and 2400 IU of vitamin D daily was slightly greater in African American women than in white women. On the highest dose of 2400 IU/d, the mixed model predicted that mean 25OHD increased from baseline 12.4 ng/mL (95% confidence interval [CI], 9.2-15.7) to 43.2 ng/mL (95% CI, 38.2-48.1) in African American women and from 15.0 ng/mL (95% CI, 12.3-17.6) to 39.1 ng/mL (95% CI, 36.2-42.0) in white women. There was no significant effect of vitamin D dose on serum PTH in either race but there was a significant inverse relationship between final serum PTH and serum 25OHD. Serum 25OHD exceeded 20 ng/mL in 97.5% of whites on the 400 IU/d dose and between 800 and 1600 IU/d for African Americans. The recommended dietary allowance (RDA) suggested by the Institute of Medicine for young people is 600 IU daily. The increase in serum 25OHD after vitamin D supplementation was similar in young and old, and in white and African American women.

What is already known about this subject African Americans are disproportionately affected by obesity and other metabolic risk factors in comparison to White Americans. Increasing prevalence of obesity has been associated with concomitant increases in childhood hypertension, dyslipidaemia and type 2 diabetes. Oxidative stress is associated with obesity in both adults and children. What this study adds Oxidative stress is positively associated with total body fat and truncal fat, but not with body mass index (BMI) or BMI z-score in healthy youth. Oxidative stress is associated with diastolic blood pressure in African American but not in White American healthy youth. Oxidative stress is elevated in obese youth, but less is known regarding racial disparities in the relationship of oxidative stress with metabolic risk factors. To determine the relationship between oxidative stress and metabolic risk factors, adiposity, leptin, adiponectin and cardiovascular fitness (VO2PEAK ) in healthy African American and White American youth. A marker of oxidative stress (F2 -isoprostane), validated markers of metabolic risk factors, fitness and body composition were measured in African American (n = 82) and White American (n = 76) youth (8-17 years old) recruited over a range of BMI percentiles (4th to 99th). F2 -isoprostane concentration was positively correlated with percentage body fat (r = 0.198) and percentage truncal fat (r = 0.173), but was not different between African American and White American males and females (P = 0.208). African American youth had significantly higher mean systolic and diastolic blood pressure (P = 0.023 and P = 0.011, respectively), body weight, BMI percentile and Tanner stage. After adjusting for gender, age, BMI and Tanner stage, African American youth varied from White Americans in the association of F2 -isoprostane with diastolic blood pressure (P = 0.047), but not with systolic blood pressure, triglycerides, VO2PEAK or homeostatic model assessment for insulin resistance (all P > 0.05). Oxidative stress, as measured by urinary F2 -isoprostane concentrations, was positively associated with percent body fat and truncal fat in youth. Oxidative stress levels were similar among African American and White American youth. Among markers of the metabolic syndrome, a significant difference between African American and White American youth was demonstrated only in the association of oxidative stress with diastolic blood pressure.

Plasma high density lipoprotein cholesterol (HDL-C) concentrations are higher in African American men than in white men, but the mechanism(s) responsible for this ethnic difference has not been elucidated. This study examined the relationship between hepatic lipase activity, plasma HDL-C concentrations, and a hepatic lipase polymorphism (–514T) in African American and white American men. Consistent with previous reports, plasma HDL-C concentrations were significantly higher in African American men than in white American men. Mean post-heparin plasma hepatic lipase activity was significantly lower in African American than in white American men (27 ± 12 vs. 44 ± 17 mmol • h–1 •l–1, P < 0.001). The –514T hepatic lipase allele was associated with low hepatic lipase activity in both populations, and was 3-fold more common among African Americans than white Americans. Taken together, these data suggest that genetic differences in hepatic lipase activity contribute to the differences in plasma HDL-C concentrations between African American men and white American men.—Vega, G. L., L. T. Clark, A. Tang, S. Marcovina, S. M. Grundy, and J. C. Cohen. Hepatic lipase activity is lower in African American men than in white American men: effects of 5′ flanking polymorphism in the hepatic lipase gene (LIPC). J. Lipid Res. 1998. 39: 228–232.

BackgroundGiven the high prevalence of Alzheimer’s disease (AD) and historic underrepresentation of African Americans and Hispanics in AD clinical trials, there is a critical need to advance understanding of inclusive clinical trial considerations. ENVISION was a confirmatory study designed to validate clinical efficacy of aducanumab, which included specific goals for African American and Hispanic population enrollment in the United States. In our pursuit, we found a 90% screen failure rate among African Americans and Hispanics compared to 75% in non‐Hispanic whites. In this analysis, the documented reasons for screen failure among African American and Hispanic participants were evaluated. These data are shared to foster a dialogue that encourages the development of more inclusive trial design in future AD studies.MethodENVISION (NCT05310071) was a multicenter, randomized, double‐blind, placebo‐controlled, phase 3b/4 confirmatory study of aducanumab in participants with mild cognitive impairment (MCI) and mild dementia AD. Data from the ENVISION screen failure population of African Americans (N = 75) and Hispanics (N = 110) within the United States were analyzed, and reasons for screening failure based on inclusion‐exclusion criteria and health characteristics are reported.ResultNot meeting the inclusion requirement for MCI or mild AD according to NIA‐AA criteria was the most common reason for screen failure at 55% and 58%, for African Americans and Hispanics respectively. The remaining causes of screen failures include unconfirmed amyloid beta pathology (African Americans, Hispanics: 7%, 14%), brain MRI exclusionary findings (1%, 6%), and the lack of an identified care partner (3%,1%). However unspecified reasons in the opinion of the investigator represent 19% of African Americans and 8% of Hispanics. Assessment of baseline physical health characteristics known to be AD risk factors revealed a higher incidence of elevated levels of hemoglobin A1c and blood pressure among the screen failed population of African Americans and Hispanics compared to randomized participants.ConclusionThe screen failed population of African Americans and Hispanics represent a group of individuals that are eager to participate in AD clinical trials, but unable to. This hypothesis generating analysis provides insight for new avenues of future exploration in clinical trial design for better inclusion of underrepresented populations.

This study critically evaluates the effectiveness of public health policies and programs targeting Alzheimer's and dementia care in the United States, with a specific emphasis on early detection, disparities in access to care, and variations in service quality between urban and rural healthcare facilities. The research utilizes a representative sample sourced from national databases, including the World Bank’s Quality of Government (QoG) dataset, CDC’s Alzheimer’s Disease and Healthy Aging Data Portal, and the Alzheimer's Association. Logistic regression models were employed to assess the influence of early detection programs on patient outcomes, while disparities in access to care were analyzed through regression models that incorporated demographic and geographic data from the National Institute on Aging and the CDC. The study also conducted extensive surveys targeting patients and healthcare providers across various settings to evaluate service quality. The findings reveal that while early detection programs are indispensable, their mere availability does not guarantee improved patient outcomes unless accompanied by high-quality implementation strategies. Significant disparities in access to care were identified, particularly along the lines of age and race, with minority groups and younger populations experiencing more significant barriers. Additionally, the study revealed pronounced differences in service quality between urban and rural areas, with rural healthcare facilities lagging in patient satisfaction, staff qualifications, and facility resources. The study recommends several targeted interventions: enhancing the quality and implementation of early detection programs, particularly in underserved areas; addressing disparities in care access by expanding Medicaid coverage and increasing funding for community health initiatives; and investing in rural healthcare infrastructure to bridge the gap in service quality and improve the overall care and support for Alzheimer’s and dementia patients, particularly in marginalized communities.

Introduction and Objective: African American (AA) race has been identified to have a higher incidence of chronic kidney disease (CKD) and worse renal cancer survival compared with Caucasian Americans (CA), irrespective of tumor size, pathologic type, and surgical procedure. We aimed to compare the outcomes between CA and AA patients undergoing minimally invasive partial nephrectomy (PN) at our high-volume center. Materials and Methods: We queried our PN data repository from 2007 to 2017. We identified 981 cases of PN (robotic n = 943 and laparoscopic n = 38), of which there were 852 CA and 129 AA patients. We compared age, sex, body mass index (BMI), operative time, estimated blood loss (EBL), nephrometry score, tumor size, pre- and postoperative estimated glomerular filtration rate (eGFR), length of stay, Charlson Comorbidity Index (CCI), tumor characteristics, and 30-day complication rate. We then estimated the overall survival and disease-specific survival. Results: Age, BMI, operative time, EBL, nephrometry score, tumor size, CCI, length of stay, and sex were not statistically different. The mean preoperative eGFR was higher in the AA cohort (91.4 mL/min/1.73 m2 vs 86.1 mL/min/1.73 m2, p = 0.007); however, at 1 year, there was no mean difference (76.8 mL/min/1.73 m2 vs 74.5 mL/min/1.73 m2, p = 0.428). There was a higher percentage of Fuhrman Grade 3/4 in the AA cohort (33.3% vs 22.5%, p = 0.044). The AA cohort had a 2.66 × higher incidence of papillary renal cell carcinoma (RCC) (34.9% vs 13.1%, p < 0.001) and unclassified RCC (3.9% vs 0.4%, p = 0.001). There was no difference in tumor stage (p = 0.260) or incidence of benign histology (15.3% vs 11.6%, p = 0.278). There were no differences in 30-day complications (p = 0.330). The median follow-up was 43.2 months. By using Kaplan-Meier curves, there was no observed difference in overall survival (p = 0.752) or disease-free survival (p = 0.403). Conclusions: Our cohort of AA and CA patients with intermediate follow-up showed no worse outcomes for CKD or survival when undergoing laparoscopic or robotic PN. For low-stage renal cancer, there was no difference in overall survival and disease-free survival at a median follow-up of 43.2 months among AA patients, despite having higher grade tumors and a higher percentage of unclassified RCC. Our cohort of AA patients did have a higher incidence of papillary RCC. The equivalent overall survival and disease-free survival could be due to the earlier discovery of lower stage renal masses incidentally identified on imaging studies performed equally for other reasons in both AA and CA patients.

Purpose: The purpose of this study was to use data collected from a recent Metropolitan Chicago Breast Cancer Task Force (MCBCTF) survey to explore racial/ethnic and socioeconomic disparities in access to screening and diagnostic services for breast cancer in Illinois and to compare equitable access to services for Chicago versus the rest of the state. Methods: Facilities that performed mammography were recruited to participate in a quality improvement project that included completing a facility survey. Participants who completed surveys received an increased mammogram reimbursement for Medicaid patients to equal the Medicare rate from the Illinois Department of Healthcare and Family Service. The survey included the following data elements: number of digital and analog machines, number of radiologists dedicated (&amp;gt;75% of their time) to breast imaging and number of general radiologists, number of dedicated and general mammography technicians, monthly volumes of screening and diagnostic mammograms, and whether breast ultrasound, MRI, or image-guided biopsy services were available at the site. In addition, sites reported the percentage of patients who were African-American (AA) or Hispanic, and the percentage of patients who were uninsured and on Medicaid, in categories of &amp;gt;10, 10-25, 25-40, 40-60, 60-75, 75-90, and &amp;gt;90%. Within each patient group defined by ethnicity and health insurance status, we estimated the number of screening mammograms performed separately for facilities with none, partial and sole reliance on dedicated radiologists, and separately by facility availability of breast MRI and image-guided biopsy. In all, 156 out of 359 facilities accredited by the Food and Drug Administration completed the survey, representing approximately 8.2 million screening mammograms conducted in calendar year 2012 in Illinois. Results: Overall, about 3/4 of screening mammograms were performed in nH whites and 4/5 in privately insured patients. Within the city of Chicago, 47% and 30% were performed in ethnic minorities and those without private insurance, compared to 21% and 15% in the rest of the state. Within Chicago, mammograms were more than twice as likely to be performed at facilities relying solely on dedicated radiologists when compared to the rest of the state (39% vs. 17%). In Chicago, non-Hipanic Whites were more likely than their AA and Hispanic counterparts to be screened at facilities relying solely on dedicated radiologists (50% vs. 27% and 15%, respectively) and at facilities with MRI (90% vs. 57% and 71%) and biopsy services (92% vs. 63% and 79%). In a similar manner, privately insured patients were more likely than Medicaid and uninsured patients to be screened at facilities that relied solely on dedicated radiologists (44% vs. 13% and 18%, respectively). When examining equitable access to these services for the rest of the state as a whole, very little was noted in the way of disparities by race/ethnicity or insurance status. Conclusions: Disparities in equitable access to breast cancer screening and diagnostic services exist within Chicago that are generally absent outside of the city. The concentration of academic medical centers within Chicago, while increasing access to quality breast healthcare, has also introduced racial/ethnic and socioeconomic disparities due to unequal access to these academic medical centers. Citation Format: Bethliz Irizarry, Katherine Y. Tossas-Milligan, Garth Rauscher, Anne Marie Murphy. Racial/ethnic and socioeconomic disparities in access to screening mammograms in a statewide sample of mammography facilities in Illinois. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B84.

Health disparities, or preventable differences in burden of disease, injury and violence, or opportunities ... experienced by socially disadvantaged racial, ethnic, and other populations groups and communities, remain a serious problem in United States (Centers for Disease Control and Prevention, 2008). The grim figures are well known to social workers (NASW, 2009). Compared with white Americans, African Americans have shorter life expectancies and higher rates of disease and death. Although Hispanic Americans, particularly those born in other countries, are in better than nonimmigrant white Americans for at least one generation after immigrating, they lag behind in some measures (Kimbro, Bzostek, Goldman, & Rodriquez, 2008; Russell, 2009; U.S. Department of Health and Human Services [HHS], 2010). Racial and ethnic minorities, including Hispanic Americans, also generally have less access to care than white Americans, and when they get it, it is often inferior (HHS, 2010). Much less is known about disparities from Asian Americans, Arab Americans, and other racial and ethnic groups. During presidential campaign, candidates Obama and Biden pledged to tackle root causes of disparities by addressing differences in access to coverage and promoting prevention and public health (Obama Biden, n.d.). The Obama administration has also pledged to take steps to address disparities (Council on Social Work Education, 2010). Yet, what has been done to date? Thus far, one feat has been enactment of Patient Protection and Affordable Care Act (PPACA) (EL. 111-148) by Congress in March 2010. This article examines potential impact of PPACA on two kinds of disparities: racial and ethnic disparities and class (as determined or influenced by socioeconomic status) disparities. PPACA AND RACIAL AND ETHNIC DISPARITIES A central issue facing many racial and ethnic minorities is lack of access to care. In 2008, 10.8 percent of non-Hispanic white Americans lacked insurance, whereas 19.l percent of African Americans and 30.7 percent of Hispanic Americans no coverage (these figures provide a rough measure of uninsured population at a point in time, not entire year) (U.S. Census Bureau, 2009). If implemented as planned, PPACA ameliorate this problem by providing tax credits and other subsidies to individuals and families earning less than 400 percent of poverty line to assist them in buying coverage through new exchanges (Kaiser Family Foundation, 2010). Because approximately 80 percent of nonelderly blacks, Hispanics, and American Indians and Alaska Natives (compared with 57 percent of white Americans) had incomes below 400 percent of poverty, new law should help reduce disparities in access (Families USA, 2010). The legislation also extend Medicaid coverage to children and adults with incomes below 133 percent of poverty line. PPACA also should decrease group differences in by expanding funding for community centers, which have played a critical role in effort to stem the nation's growing flood of uninsured (Iglehart, 2010, p. 343). Former president George W. Bush described these centers, which grew out of antipoverty efforts of 1960s, as integral part of a care system because they provide care for low-income, for newly arrived, and they take pressure off of our hospital emergency rooms (cited in Iglehart, 2010, p. 343). In 2008, 61 percent of 20 million people served by community were African American or Hispanic American (National Association of Community Health Centers, 2009). The legislation provide $11 billion over five years, an investment that will approximately double number of people seen in centers (Wakefield, 2010). Also, plans be required to offer free preventive and wellness coverage, which many African Americans, Hispanic Americans, and others with high rates of uninsurance often go without (Health Reform for African Americans, n. …

African Americans have a greater prevalence of hypertension and diabetes compared with white Americans, and both autonomic dysregulation and inflammation have been implicated in the etiology of these disease states. The purpose of this study was to examine the cardiac autonomic and systemic inflammatory response to resistance training in young African-American and white men. Linear (time and frequency domain) and nonlinear (sample entropy) heart rate variability, baroreflex sensitivity, tonic and reflex vagal activity, and postexercise heart rate recovery were used to assess cardiac vagal modulation. C-reactive protein (CRP) and white blood cell count were used as inflammatory markers. Twenty two white and 19 African-American men completed 6 wk of resistance training followed by 4 wk of exercise detraining (Post 2). Sample entropy, tonic and reflex vagal activity, and heart rate recovery were increased in white and African-American men following resistance training (P < 0.05). Following detraining (Post 2), sample entropy, tonic and reflex vagal activity, and heart rate recovery returned to baseline values in white men but remained above baseline in African-American men. While there were no changes in white blood cell count or CRP in white men, these inflammatory markers decreased in African-American men following resistance training, with reductions being maintained following detraining (P < 0.05). In conclusion, resistance training improves cardiac autonomic function and reduces inflammation in African-American men, and these adaptations remained after the cessation of training. Resistance training may be an important lifestyle modification for improving cardiac autonomic health and reducing inflammation in young African-American men.