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

2 Jun
1/
Today I received the Larry E. Davis Excellence in Race Research from @PittCRSP.

I met Dr. Davis when I first got to Pitt and was amazed by his fierce & enduring commitment to racial justice. He is greatly missed in our community and I am incredibly honored for this award. 🙏🏾
2/
I am grateful for my community here @PittTweet, especially the Black Pittsburgh #COVID19 Equity Coalition that has truly been *doing the work* this past year to help keep our communities of color healthy, safe, informed (and now vaccinated) throughout the pandemic.
3/
I am grateful to so many who have inspired, collaborated with, and taught me so much over the past year, pushing my thinking and scholarship on #HealthEquity, justice, and examining racism as a driver of health in the US, during & beyond the pandemic.

jamanetwork.com/journals/jama-…
Read 4 tweets
1 Jun
1/
“In 1918, Frissell Memorial Hospital was built at 314 E. Brady St. for Black medical providers to serve Black residents.

The brick building near the bustling Black Wall Street was reduced to rubble and ash during the race massacre three years later.”
tulsaworld.com/persistent-hea…
2/
“Since then, the healthcare landscape in north Tulsa has mirrored the economic trends, with hospitals and private practices expanding to the south. The perceived inequalities became factual with a report showing ~14-year gap between the north 74126 zipcode and the south 74137” Image
3/
“In 1920, before the massacre, Greenwood was home to 9,000 Black residents, their medical needs were served by at least 17 doctors, including renowned surgeon, Dr. A.C. Jackson. The neighborhood had its own hospital and 4 well-equipped drugstores...”
wsj.com/articles/in-no…
Read 5 tweets
17 May
1/ Folks have recommended Richard Rothstein’s “The Color of Law” to me for a minute now. Finally had a chance to finish it this weekend.

Absolutely rocked.

The insidiousness of state & federal policy to maintain racial segregation in the US is devastating.

A thread of quotes.
2/ “...said that black students were concentrated in the city, not spread throughout the Detroit suburbs because of ‘unknown and perhaps unknowable factors such as in/migration, birthrates, economic changes, or cumulative acts of private racial fears.’”

wdet.org/posts/2019/11/…
3/ “That the SF region was segregated by policy is striking bc in contrast to other metropolitan areas, Northern CA had few African-Americans before migrants arrived during WWII for jobs. The government was not following pre-existing racial patterns...”
a24films.com/films/the-last…
Read 11 tweets
19 Oct 20
Inpatient Lesson of the Day 7:

I remember the findings from this 2018 @NEJM study that aspirin ⬆️ bleeding risk but didn't ⬇️ CVD risk in the elderly.

What I didn't remember is that "elderly" was defined as >70 for White and >65 for Black/Hispanic.

🧵1/ nejm.org/doi/10.1056/NE…
According to the study Supplement, the following eligibility criteria were provided:

"...the age differential was permitted to ensure that Black and Hispanic populations could be represented in the trial, given evidence of higher burden of disease necessitating aspirin use." 2/
According the study design manuscript, "minority recruitment has been challenging due to a ⬇️ number of minorities w/o prior cardiovascular events, disability or dementia, who are not taking aspirin, and a reluctance to cease aspirin..." 3/
ncbi.nlm.nih.gov/pmc/articles/P…
Read 7 tweets
17 May 20
🚨New Paper (Pre-Print)🚨

As many have noted, one of the keys to addressing the racial disparities in #COVID19 is ensuring comprehensive race/ethnicity data. Yet, as late as mid-April, 22 states were still not reporting such data on mortality. Here's what else we found...

1/
As of April 21st, of the 28 states reporting race/ethnicity data related to #COVID19 mortality, we found significant variation in the quality of such reporting, with some states reporting as high as >40% missingness in these data.

2/
Among the states (any NYC) that reported race/ethnicity data, we estimated a 3.5-fold higher mortality rate in Blacks vs. whites and a nearly 2-fold higher mortality rate in the Latinx vs. white population.

3/
Read 5 tweets
28 Apr 20
The health inequities observed in the #COVID19 pandemic have been devastatingly alarming.

Grateful my friend and one of the smartest people I know, ⁦@atheendar⁩ joined me to share some solutions to address this problem in ⁦@JAMAHealthForum⁩. jamanetwork.com/channels/healt…
"Now, emerging data illustrate that Black and Hispanic Americans are dying at far higher rates from Covid-19 than any other groups in the nation. These disparities are just the most recent manifestation of centuries’ worth of racial and ethnic gaps in health outcomes." 2/
"The prevalence of cardiometabolic disease in black and Hispanic communities has continued to rise. However, focusing on individual clinical factors may mislead from identifying the true root causes of racial and ethnic disparities observed in COVID-19 mortality." 3/
Read 8 tweets

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