Utibe R. Essien, MD MPH Profile picture
Jun 3, 2021 11 tweets 8 min read Read on X
1/
In 2019, @jared_w_magnani & I were invited to give @PittGIM Grand Rounds on the social determinants of #AFib.

Today, thanks to our incredible co-authors, we published some of those thoughts in Nature! 👇🏾

A 🧵 on gaps & opportunities for future work.

nature.com/articles/s4156….
2/
The pandemic has taught us so much about our health system, but it has especially shone a bright light on the social determinants as key drivers of #HealthEquity. Our review focused on:
🔸 race/ethnicity
🔸 finances
🔸 rurality/neighborhood
🔸 health literacy
🔸 social network
3/
The social construct of race has been one of the most well-studied determinants of #AFib incidence, treatment (including our work in anticoagulation disparities), and outcomes. Here we discuss why such inequities exist across the AFib care continuum.

nature.com/articles/s4156….
4/
Our review also adds to a critical conversation on racial & ethnic representation in clinical trials, as well as observational & prospective cohort studies.

In the past decade, non-White racial/ethnic groups have been *very* underrepresented in #AFib studies. Room to improve!
5/
⬆️ income & wealth is related to better healthcare access, provider decision-making and clinical outcomes in #AFib while ⬇️ income has been related to higher rates of cardiac risk factors, adverse events & death.

We also dive into some reasons why.

nature.com/articles/s4156….
6/
Prior work has shown differences in CV health b/w folks living in rural vs. urban settings but few have studied this in #AFib.

Similarly we discuss how more work is needed to study the complex intersection b/w neighborhood-level factors & AF outcomes.
nature.com/articles/s4156…
7/
Low health literacy (and limited English proficiency) is related to ⬇️ awareness of #AFib, its treatment (including poor warfarin control) and its outcomes.

We need to improve capture of health literacy & understand its role in shared decision-making.
nature.com/articles/s4156…
8/
Little has been published on the relationship between social support (e.g., partners, caregivers) or social connectedness (or lack thereof) on #AFib.

We propose a pathway for the physical & psychological connection & highlight this area as another important future direction.
9/
In summary, we argue that #AFib offers an important opportunity to study the social determinants, including how they all overlap/interact at the patient, community, and policy level.

We also must acknowledge how structural racism drives many of the factors we discuss.
10/
Also, we didn’t get to mention factors such as access to safe neighborhoods & healthy food, allostatic load, adverse childhood events, housing instability & homelessness, incarceration, or immigration status given the lack of #AFib literature.

Future grant idea anyone? 🤔
11/11

🙏🏾 to @JKornej @AmberJohnsonMD @LucySchulson @EmeliaBenjamin @jared_w_magnani for joining me on this project these past 18 months (in the middle of a whole pandemic and daily onslaughts of racism).

Look forward to yall’s thoughts and future collaboration in this work. 💪🏾

• • •

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More from @UREssien

Apr 17, 2023
1/ 🧵 NEW Paper.

We asked: Are there racial & ethnic differences in barriers to applying to & enrolling in med school and do those affect med school diversity?

TL;DR: Black & Hispanic students were less likely to apply & enroll and faced more barriers.

jamanetwork.com/journals/jama-… ImageImage
2/ First, who did we study?

This was a study of >81,000 MCAT examinees (0.3% American Indian or Alaska Native, 21.3% Asian, 10.1% Black, 8.0% Hispanic, and 60.4% White) from 2015-2018.

I don’t know about y’all, but this was *the* hardest test I took. 😳

jamanetwork.com/journals/jama-… Image
3/ Next, what did we find?

1️⃣ Black (77.8%) & Hispanic examinees (71.3%) were ⬇️ likely than White examinees (80.2%) to apply to med school.

Black (40.6%) & Hispanic examinees (40.2%) were also ⬇️ likely than White examinees (45.0%) to matriculate.

jamanetwork.com/journals/jama-… Image
Read 12 tweets
Sep 8, 2022
Wow. 😧

If y’all read *one* thing today, might I suggest this new article in @NEJM?

“The belief that Black people have denser bones, more muscle, or thicker skin led radiologists and technicians to use higher radiation exposure during x-ray procedures.”

nejm.org/doi/full/10.10…
Read 5 tweets
Sep 7, 2022
1/ 🧵 NEW Editorial.

In the latest issue of @JAMA_current, my mentor Michael Fine, Donna Washington and I were invited to discuss a new 📝 on disparities in SGLT2i and GLP1-RA use for diabetes and what it means for the field of #Pharmacoequity research.

jamanetwork.com/journals/jama/… ImageImage
2/ As has been discussed frequently over the last month with the insulin co-pay provisions in the #InflationReductionAct, >37 million people in the US have #diabetes.

Regrettably, underrepresented racial and ethnic groups folks have ⬆️ rates of diabetes.

jamanetwork.com/journals/jama/… Image
3/ Even with the ⬆️ rates of diabetes, Black, Hispanic, and Asian patients in the US have been shown to have lower rates of #diabetes treatment, especially with the newer drugs available such as SGLT2i & GLP1-RAs.

SGLT2: jamanetwork.com/journals/jaman…

GLP1: jamanetwork.com/journals/jama-… ImageImage
Read 8 tweets
Jul 27, 2022
‼️ NEW Paper ‼️

In @JAMANetworkOpen, we found that VA patients with #AFib who experience homelessness had a 21% ⬇️ odds of receiving stroke-preventing anticoagulation (blood thinners).

Here's more on our journey to this #Pharmacoequity paper.

Link: ja.ma/3ODXdss

1/
Previously, if you looked up "homeless & atrial fibrillation" in PubMed, only 5 results came up.

This included a 2003 @JAMAInternalMed study that saw that Ohio Medicaid enrollees had ⬇️ use of warfarin if they had homelessness or inadequate housing.

ja.ma/3PFwj52

2/
We started digging into this in 2019, when 1st author, David Wilson, a PittMed student & Veteran, met with me for a summer research project.

We decided to use our national #AFib cohort to see if there was a relation b/w homelessness & AF treatment.

ja.ma/3ODXdss

3/
Read 12 tweets
Jul 25, 2022
1/ 🧵 NEW Paper!

As part of a special issue on 💊 costs & access, we wrote a broad review on “Pursuing #Pharmacoequity - Determinants, Drivers, and Pathways to Progress.

We talk social & health policy, research, patient & prescriber factors. 👇🏾👇🏾

Link: tinyurl.com/nvtamek8 Image
2/ Understanding the multilevel determinants that influence equitable access to medications (and trying to do so in <5000 words (!) was the goal of our review.

With so many factors out there, we know we only began to scratch the surface.

read.dukeupress.edu/jhppl/article/…

#Pharmacoequity Image
3/ A few topics we discussed:

🔴 Public transportation & geographic access to pharmacies

🔴 Income and wealth inequities

🔴 Research representation

🔴 Health insurance coverage (e.g., ACA & Medicare Part D)

🔴 Clinician bias & trustworthiness

🔴 Patient primary language
Read 6 tweets
Feb 10, 2022
1/ 🧵 Out today in @Health_Affairs.

On #Pharmacoequity and equitable access to novel #COVID19 treatment.

Led by future Dr. @rohankhaz, we dive into the challenges & opportunities in ensuring that patients and communities most affected by the pandemic can get the care they need.
2/ At risk of redundancy, we previously discussed the challenges in achieving #Pharmacoequity, including in the pandemic, noting, “…For example, treatment of patients with #COVID19 has revealed substantial inequities in access to life-saving treatments.”

jamanetwork.com/journals/jama/…
3/ That observation was supported by national CDC data from earlier this year, as well as a recent national analysis of Medicare enrollees that found that Black patients had a 23% ⬇️ odds of receiving monoclonal antibodies when diagnosed with #COVID19.

jamanetwork.com/journals/jama/…
Read 6 tweets

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