Self-reported racial/ethnic discrimination and bronchodilator response in African American youth with asthma

<div><p>Importance</p><p>Asthma is a multifactorial disease composed of endotypes with varying risk profiles and outcomes. African Americans experience a high burden of asthma and of psychosocial stress, including racial discrimination. It is unknown which endotypes of asthma are vulnerable to racial/ethnic discrimination.</p><p>Objective</p><p>We examined the association between self-reported racial/ethnic discrimination and bronchodilator response (BDR) among African American youth with asthma ages 8 to 21 years (n = 576) and whether this association varies with tumor necrosis factor alpha (TNF-α) level.</p><p>Materials and methods</p><p>Self-reported racial/ethnic discrimination was assessed by a modified Experiences of Discrimination questionnaire as none or any. Using spirometry, BDR was specified as the mean percentage change in forced expiratory volume in one second before and after albuterol administration. TNF-α was specified as high/low levels based on our study population mean. Linear regression was used to examine the association between self-reported racial/ethnic discrimination and BDR adjusted for selected characteristics. An interaction term between TNF-α levels and self-reported racial/ethnic discrimination was tested in the final model.</p><p>Results</p><p>Almost half of participants (48.8%) reported racial/ethnic discrimination. The mean percent BDR was higher among participants reporting racial/ethnic discrimination than among those who did not (10.8 versus 8.9, p = 0.006). After adjustment, participants reporting racial/ethnic discrimination had a 1.7 (95% CI: 0.36–3.03) higher BDR mean than those not reporting racial/ethnic discrimination. However, we found heterogeneity of this association according to TNF-α levels (p-interaction = 0.040): Among individuals with TNF-α high level only, we observed a 2.78 higher BDR mean among those reporting racial/ethnic discrimination compared with those not reporting racial/ethnic discrimination (95%CI: 0.79–4.77).</p><p>Conclusions</p><p>We found BDR to be increased in participants reporting racial/ethnic discrimination and this association was limited to African American youth with TNF-α high asthma, an endotype thought to be resistant to traditional asthma medications. These results support screening for racial/ethnic discrimination in those with asthma as it may reclassify disease pathogenesis.</p></div

Selected characteristics of participants with asthma according to self-reported racial/ethnic discrimination in SAGE II (2006–2014).

<p>Selected characteristics of participants with asthma according to self-reported racial/ethnic discrimination in SAGE II (2006–2014).</p

Mean difference in bronchodilator response^a and 95% CI for reports of racial/ethnic discrimination and according to TNF-α status for SAGE II participants with asthma (2006–2014).

<p>Mean difference in bronchodilator response<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0179091#t002fn001" target="_blank">^a</a> and 95% CI for reports of racial/ethnic discrimination and according to TNF-α status for SAGE II participants with asthma (2006–2014).</p

Insights from studies conducted in diverse race/ethnic groups.

<p>Insights from studies conducted in diverse race/ethnic groups.</p

Table1_Enhancing physicians’ radiology diagnostics of COVID-19’s effects on lung health by leveraging artificial intelligence.docx

Introduction: This study aimed to develop an individualized artificial intelligence model to help radiologists assess the severity of COVID-19’s effects on patients’ lung health.Methods: Data was collected from medical records of 1103 patients diagnosed with COVID-19 using RT- qPCR between March and June 2020, in Hospital Madrid-Group (HM-Group, Spain). By using Convolutional Neural Networks, we determine the effects of COVID-19 in terms of lung area, opacities, and pulmonary air density. We then combine these variables with age and sex in a regression model to assess the severity of these conditions with respect to fatality risk (death or ICU).Results: Our model can predict high effect with an AUC of 0.736. Finally, we compare the performance of the model with respect to six physicians’ diagnosis, and test for improvements on physicians’ performance when using the prediction algorithm.Discussion: We find that the algorithm outperforms physicians (39.5% less error), and thus, physicians can significantly benefit from the information provided by the algorithm by reducing error by almost 30%.</p

Adjusted effect of <i>rs2227631</i>, infection and <i>rs2227631</i> gene-infection interaction on asthma exacerbations.

<p>Adjusted effect of <i>rs2227631</i>, infection and <i>rs2227631</i> gene-infection interaction on asthma exacerbations.</p

Demographic and clinical characteristics of subjects.

<p>Demographic and clinical characteristics of subjects.</p

Joint association of early life lower respiratory tract infection and <i>PAI-1</i> risk genotype (<i>rs2227631</i>) with Asthma.

<p>LRI indicates subjects who were diagnosed with a lower respiratory tract infection requiring medical attention before age 2 years old. Adjusted for age, sex, ethnicity, ancestry, socioeconomic factors, environmental factors (history of farm animal exposure and received antibiotics during first year), family history of asthma and recruitment site.</p

Adjusted effect of <i>rs2227631</i>, infection and <i>rs2227631</i>gene-infection interaction on lung function in asthmatic subjects.

<p>Adjusted effect of <i>rs2227631</i>, infection and <i>rs2227631</i>gene-infection interaction on lung function in asthmatic subjects.</p

Joint association of bronchiolitis/ RSV and <i>PAI-1</i> risk genotype (<i>rs2227631</i>) with Asthma.

<p>RSV indicates subjects who were diagnosed with bronchiolitis or RSV before age 2 years old. Adjusted for age, sex, ethnicity, ancestry, socioeconomic factors, environmental factors (history of farm animal exposure and received antibiotics during first year), family history of asthma and recruitment site.</p