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Utibe R. Essien, MD MPH Profile picture
@UREssien
Apr 17, 2023 • 12 tweets • 14 min read • Read on X
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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
4/ 2️⃣ We found that American Indian / Alaska Native, Black & Hispanic students had more barriers to med school:

🚩⬇️ Parents with a college degree
🚩⬆️ Premed loans
🚩⬆️ Difficulty affording test prep
🚩⬇️ College lab / MD shadowing
🚩⬆️ Advisor negative about becoming 👩🏾‍⚕️👨🏽‍⚕️ Image
5/ 3️⃣ We found that Black (13%) and Hispanic (39%) examiners were less likely to apply and less likely to matriculate (17% & 18% respectively).

But when we add the financial, education & discrimination barriers to our model, those differences disappear.

jamanetwork.com/journals/jama-… Image
6/ Finally, why does this matter & what can we do?

1️⃣ Diversity in medicine saves lives. We’ve now had several studies to support this.

We have to preserve race-conscious admissions. And since the Supreme Court won’t do it, what will your med school do?

jamanetwork.com/journals/jaman… ImageImage
7/ 2️⃣ We have to eliminate economic barrier to applying to and matriculating at medical school.

@davidevelasqu puts in perfectly in his NYT OpEd.

And with the unequal distribution of wealth in our country, this is absolutely a racial Justice issue.

nytimes.com/2019/11/25/hea… ImageImage
8/ 3️⃣ Finally, we need bold, antiracist approaches to every single step in the med school admissions process (and likely *much* earlier).

NEJM: nejm.org/doi/full/10.10…

JAMA: jamanetwork.com/journals/jama/…

STAT: statnews.com/2020/01/16/bla… @uche_blackstock

CNN: amp.cnn.com/cnn/2023/02/21… ImageImageImageImage
9/9 🙏🏾 Dr. Faiz (@im_jesssayinn) and Ly (@meddly) for leading us on this 📝.

Many did not need another study to highlight something “we been knew” but it’s important for science to support our stories.

cc @oni_blackstock @ushamcfarling @ElohoUfomata

jamanetwork.com/journals/jama-… ImageImage
P.S. For more context on our paper, check out the commentary from @jayaaysola @SIbrahimMD: jamanetwork.com/journals/jama-…

Also, don’t miss the @UCLAHealth press release with some great quotes from our fearless leader @im_jesssayinn: uclahealth.org/news/students-… ImageImage
PPS. Check out the summary from @vlocarmen @Forbes on our findings. 👇🏾

cc @EbonyJHilton_MD @mayaaking @LarryRJacksonII @DarilynMoyer @InginiaGenao @AliciaFMD @KBibbinsDomingo @KemiDoll @Rasheeda_HallMD @IssakaMD @teni_brown @DrAlethaMaybank @DrKamLeigh

forbes.com/sites/victorlo…
PPPS. If one 🧵 wasn’t enough, here’s @im_jesssayinn’s thread on our paper, sharing the journey from research idea to published manuscript, all inspired by a career committed to #DiversityinMedicine.👇🏾

As someone who went thru fellowship without a single 📝, this is a 🔥 feat!

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More from @UREssien

Utibe R. Essien, MD MPH Profile picture
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…
I had no clue about this history... Curious if others did?

cc @uche_blackstock @oni_blackstock @ushamcfarling @LundyBraun @ruha9 @DarshaliVyas @haw95 @DrAlethaMaybank @AmakaEMD @CamaraJones @AMLandryMD @DrRayMD @ElohoUfomata @gr8vision @DrJRMarcelin @gradydoctor @AmberJohnsonMD
For folks interested in learning more of this history, see the excellent thread from 1st author @ibavli: 👇🏾


cc @arghavan_salles @meganranney @jeremyfaust @FutureDocs @ETSshow @MDaware @GYamey @Bob_Wachter @EugeneDaniels2 @LizSzabo @RoniNYTimes @choo_ek
Read 5 tweets
Utibe R. Essien, MD MPH Profile picture
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
Utibe R. Essien, MD MPH Profile picture
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
Utibe R. Essien, MD MPH Profile picture
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
Utibe R. Essien, MD MPH Profile picture
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
Utibe R. Essien, MD MPH Profile picture
Feb 1, 2022
1/🧵 It’s #BlackHistoryMonth.

A time for us to re-learn and re-discover our history.

A history beyond the chapter on Civil Rightsin our high school textbooks.

A history beyond the Emancipation Proclamation and Brown v. Board of Education.

So what are you reading this month? Image
2/ The ship grew larger & more terrifying w. each stroke of the paddle. The smells grew stronger, the sounds louder, crying & wailing from one quarter, low singing from another; the anarchic noise of children given an underbeat by hands drumming on wood.”

nytimes.com/2022/01/28/opi…
3/ One of the best essays I’ve read.

“Locked out of the greatest opportunity for wealth accumulation in history, African Americans who were able to afford homes found themselves consigned to communities where their investments were affected by the FHA.”

theatlantic.com/magazine/archi…
Read 12 tweets

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