Adherence to Cardiovascular Disease Medications: Does Patient-Provider Race/Ethnicity and Language Concordance Matter?

BACKGROUND: Patient–physician race/ethnicity and language concordance may improve medication adherence and reduce disparities in cardiovascular disease (CVD) by fostering trust and improved patient–physician communication. OBJECTIVE: To examine the association of patient race/ethnicity and language and patient–physician race/ethnicity and language concordance on medication adherence rates for a large cohort of diabetes patients in an integrated delivery system. DESIGN: We studied 131,277 adult diabetes patients in Kaiser Permanente Northern California in 2005. Probit models assessed the effect of patient and physician race/ethnicity and language on adherence to CVD medications, after controlling for patient and physician characteristics. RESULTS: Ten percent of African American, 11 % of Hispanic, 63% of Asian, and 47% of white patients had same race/ethnicity physicians.24% of Spanish-speaking patients were linguistically concordant with their physicians. African American (46%), Hispanic (49%) and Asian (52%) patients were significantly less likely than white patients (58%) to be in good adherence to all of their CVD medications (p<0.001). Spanish-speaking patients were less likely than English speaking patients to be in good adherence (51%versus 57%, p<0.001). Race concordance for African American patients was associated with adherence to all their CVD medications (53% vs. 50%, p<0.05). Language concordance was associated with medication adherence for Spanish-speaking patients (51% vs. 45%, p<0.05). CONCLUSION: Increasing opportunities for patient– physician race/ethnicity and language concordance may improve medication adherence for African American and Spanish-speaking patients, though a similar effect was not observed for Asian patients or Englishproficient Hispanic patients

Promoting inclusive metrics of success and impact to dismantle a discriminatory reward system in science

“The most dangerous phrase in the language is: We’ve always done it this way.” —Rear Admiral Grace HopperSuccess and impact metrics in science are based on a system that perpetuates sexist and racist “rewards” by prioritizing citations and impact factors. These metrics are flawed and biased against already marginalized groups and fail to accurately capture the breadth of individuals’ meaningful scientific impacts. We advocate shifting this outdated value system to advance science through principles of justice, equity, diversity, and inclusion. We outline pathways for a paradigm shift in scientific values based on multidimensional mentorship and promoting mentee well-being. These actions will require collective efforts supported by academic leaders and administrators to drive essential systemic change.Peer reviewe

Search for eccentric black hole coalescences during the third observing run of LIGO and Virgo

Despite the growing number of confident binary black hole coalescences observed through gravitational waves so far, the astrophysical origin of these binaries remains uncertain. Orbital eccentricity is one of the clearest tracers of binary formation channels. Identifying binary eccentricity, however, remains challenging due to the limited availability of gravitational waveforms that include effects of eccentricity. Here, we present observational results for a waveform-independent search sensitive to eccentric black hole coalescences, covering the third observing run (O3) of the LIGO and Virgo detectors. We identified no new high-significance candidates beyond those that were already identified with searches focusing on quasi-circular binaries. We determine the sensitivity of our search to high-mass (total mass M&gt;70 M⊙) binaries covering eccentricities up to 0.3 at 15 Hz orbital frequency, and use this to compare model predictions to search results. Assuming all detections are indeed quasi-circular, for our fiducial population model, we place an upper limit for the merger rate density of high-mass binaries with eccentricities 0&lt;e≤0.3 at 0.33 Gpc−3 yr−1 at 90\% confidence level

Ultralight vector dark matter search using data from the KAGRA O3GK run

Among the various candidates for dark matter (DM), ultralight vector DM can be probed by laser interferometric gravitational wave detectors through the measurement of oscillating length changes in the arm cavities. In this context, KAGRA has a unique feature due to differing compositions of its mirrors, enhancing the signal of vector DM in the length change in the auxiliary channels. Here we present the result of a search for U(1)B−L gauge boson DM using the KAGRA data from auxiliary length channels during the first joint observation run together with GEO600. By applying our search pipeline, which takes into account the stochastic nature of ultralight DM, upper bounds on the coupling strength between the U(1)B−L gauge boson and ordinary matter are obtained for a range of DM masses. While our constraints are less stringent than those derived from previous experiments, this study demonstrates the applicability of our method to the lower-mass vector DM search, which is made difficult in this measurement by the short observation time compared to the auto-correlation time scale of DM

Racial and Ethnic Differences in Cardiovascular Disease Medication Management for Patients with Diabetes

Racial and Ethnic Differences in Cardiovascular Disease Medication Management for Patients with DiabetesbyAna Helena TraylorDoctor of Philosophy in Public PolicyUniversity of California, BerkeleyProfessor Stephen Raphael, ChairExtensive research documents inequities in the quality of health care provided to members of racial and ethnic minority groups in the United States. Cultural differences between patients and health care providers may contribute to health disparities by increasing the likelihood of physician bias, patient distrust and patient-provider miscommunication. This dissertation uses data from Kaiser Permanente's Northern California Diabetes Registry of 2005 to 1) examine racial and ethnic disparities in cardiovascular disease (CVD) risk factor management for patients with diabetes, 2) explore the prevalence and predictors of patient-physician racial/ethnic match and 3) examine the association between racial and ethnic match and CVD risk factor management for patients with diabetes. I use a cross-sectional observational design and conduct a series of logistic regression models that adjust for patient, physician and medical facility characteristics.I found significant differences in CVD risk factor control, treatment intensification for patients in poor control and CVD risk factor medication adherence. Compared to white patients, African American patients were less likely to be at target for diabetes (Hemoglobin A1c), hyperlipidemia (LDL-c) and Hypertension (SBP). Latino and Asian patients were less likely to be at target A1c levels, but more likely to be at target LDL levels. Spanish speaking patients were also less likely to be at target A1c levels. Racial differences in treatment intensification were complex. When not at target levels, African American and Asian patients were less likely than white patients to have treatment intensified for A1c medications. However, African American patients were more likely to have treatment intensified for SBP and Asian patients were more likely than white patients to have treatment intensified for LDL and SBP medications. There were no disparities in intensification for Latinos patients; in fact Latino patients were more likely to have treatment for LDL intensified. Similarly, Spanish-speaking patients were more likely to have treatment intensified for LDL. I found that African American and Latino patients were least likely to be racial matched, though Spanish speaking Latino patients were more likely than English speaking Latino patients to have a same race physician. Compared with patients who were assigned a physician by the health care organization, patients who chose their physicians were more likely to have a same race provider. While statistically significant for all racial and ethnic groups, this relationship was strongest for African American and Latino patients. Availability of a same race provider was the strongest predictor of patient-physician race concordance for African American and Latino patients. I examined the association between race concordance and intermediate CVD risk factor outcomes for African American and Latino patients. Race and language concordance did not impact risk factor control or treatment intensification. However, race/ethnicity concordance was marginally associated with better adherence to medication for African American patients and language concordance was marginally associated with adherence for Spanish speaking Latino patients. By allowing for more race and language concordance between patients and providers, increased minority representation in the medical professions is hypothesized to improve the cultural competence of health care delivery. Given wide and persistent disparities in health for African American and Latino patients, this dissertation examined the hypothesis that by increasing opportunities for race, ethnicity and language concordance, race-conscious medical school and workforce diversity efforts might lead to improvements in public health and a reduction in health disparities.The results further highlight the need for continued efforts to measure, understand and address racial and ethnic disparities. The results presented here suggest that increasing the number and proportion of underrepresented minorities might lead to important improvements in patient adherence to medication. However, these efforts alone, will not eliminate gaps in CVD medication management for patients with diabetes

Racial and Ethnic Differences in Cardiovascular Disease Medication Management for Patients with Diabetes

Extensive research documents inequities in the quality of health care provided to members of racial and ethnic minority groups in the United States. Cultural differences between patients and health care providers may contribute to health disparities by increasing the likelihood of physician bias, patient distrust and patient-provider miscommunication. This dissertation uses data from Kaiser Permanente's Northern California Diabetes Registry of 2005 to 1) examine racial and ethnic disparities in cardiovascular disease (CVD) risk factor management for patients with diabetes, 2) explore the prevalence and predictors of patient-physician racial/ethnic match and 3) examine the association between racial and ethnic match and CVD risk factor management for patients with diabetes. I use a cross-sectional observational design and conduct a series of logistic regression models that adjust for patient, physician and medical facility characteristics. I found significant differences in CVD risk factor control, treatment intensification for patients in poor control and CVD risk factor medication adherence. Compared to white patients, African American patients were less likely to be at target for diabetes (Hemoglobin A1c), hyperlipidemia (LDL-c) and Hypertension (SBP). Latino and Asian patients were less likely to be at target A1c levels, but more likely to be at target LDL levels. Spanish speaking patients were also less likely to be at target A1c levels. Racial differences in treatment intensification were complex. When not at target levels, African American and Asian patients were less likely than white patients to have treatment intensified for A1c medications. However, African American patients were more likely to have treatment intensified for SBP and Asian patients were more likely than white patients to have treatment intensified for LDL and SBP medications. There were no disparities in intensification for Latinos patients; in fact Latino patients were more likely to have treatment for LDL intensified. Similarly, Spanish-speaking patients were more likely to have treatment intensified for LDL. I found that African American and Latino patients were least likely to be racial matched, though Spanish speaking Latino patients were more likely than English speaking Latino patients to have a same race physician. Compared with patients who were assigned a physician by the health care organization, patients who chose their physicians were more likely to have a same race provider. While statistically significant for all racial and ethnic groups, this relationship was strongest for African American and Latino patients. Availability of a same race provider was the strongest predictor of patient-physician race concordance for African American and Latino patients. I examined the association between race concordance and intermediate CVD risk factor outcomes for African American and Latino patients. Race and language concordance did not impact risk factor control or treatment intensification. However, race/ethnicity concordance was marginally associated with better adherence to medication for African American patients and language concordance was marginally associated with adherence for Spanish speaking Latino patients. By allowing for more race and language concordance between patients and providers, increased minority representation in the medical professions is hypothesized to improve the cultural competence of health care delivery. Given wide and persistent disparities in health for African American and Latino patients, this dissertation examined the hypothesis that by increasing opportunities for race, ethnicity and language concordance, race-conscious medical school and workforce diversity efforts might lead to improvements in public health and a reduction in health disparities. The results further highlight the need for continued efforts to measure, understand and address racial and ethnic disparities. The results presented here suggest that increasing the number and proportion of underrepresented minorities might lead to important improvements in patient adherence to medication. However, these efforts alone, will not eliminate gaps in CVD medication management for patients with diabetes