@article {13742, title = {Does the revised LDCT lung cancer screening guideline bridge the racial disparities gap: Results from the health and retirement study.}, journal = {Journal of the National Medical Association}, year = {Forthcoming}, abstract = {

PURPOSE: This study examined racial/ethnic disparities in lung cancer screening eligibility rates using 2013 US Preventive Services Task Force (USPSTF) guidelines for lung cancer with low-dose computed tomography (LDCT) and the revised 2021 guidelines.

METHODS: The study utilized a retrospective and cross-sectional research design by analyzing data from the Health and Retirement Study (HRS). N = 2,823 respondents aged 50-80 who self-reported current smoking were included in the analyses. Binary logistic regression analysis was conducted to examine the changed status of LDCT screening eligibility based on the revised 2021 guidelines by race/ethnicity after adjusting for respondent demographics.

RESULTS: Our study found substantial increases in screening eligibility rates across racial and ethnic groups when comparing the original and revised guidelines. The largest increase was observed among Black people (174\%), Hispanics (152\%), those in the other category (118\%), and Whites who smoke (80.8\%). When comparing original screening guidelines to revised guidelines, Whites who smoke had the highest percentage of changes from "not eligible" to "eligible" (28.3\%), followed by individuals in the "other" category (28.1\%), Black people (23.2\%) and Hispanics who smoke (18.3\%) (p < 0.001). Binary logistic regression results further showed that Black people who smoke (OR = 0.71, p = 0.001), as well as Hispanics who smoke (OR=0.54, p < 0.001), were less likely to change from not eligible to eligible for screening compared to Whites who smoke after adopting the revised screening guidelines. Based on the absolute differences in screening eligibility rates between Whites and other racial/ethnic groups, the disparities may have widened under the new guidelines, particularly with larger absolute differences observed between Whites, Black people, and Hispanics.

CONCLUSIONS: Our study highlights racial/ethnic disparities in LDCT screening eligibility among people who currently smoke. While the revised USPSTF guidelines increased screening eligibility for racial and ethnic minorities, they did not eliminate these disparities and may have widened under the new guidelines. Targeted interventions and policies are necessary to address barriers faced by underrepresented populations and promote equitable access to lung cancer screening.

}, keywords = {Disparities, Lung cancer screening, Race/ethnicity, Uscreening guidelines}, issn = {1943-4693}, doi = {10.1016/j.jnma.2024.01.008}, author = {Li, Chien-Ching and Manella, Jason and Kefi, Safa El and Matthews, Alicia K} } @article {11559, title = {Trajectories of Multiple Behavioral Risk Factors and Their Associations With Cognitive Function Trajectories Among Older African Americans and White Americans.}, journal = {Journal of Aging and Health}, volume = {33}, year = {2021}, pages = {674-684}, abstract = {

This study examined the joint trajectories of behavioral risk factors (smoking, alcohol drinking, and body mass index) and their associations with cognitive function trajectories among older African Americans and white Americans. Data from the Health and Retirement Study (1998-2014) were used. Group-based mixture modeling and multinomial logistic regression analysis were performed. Three joint trajectories of behavioral risk factors (overweight, smoking and drinking, and drinking and overweight) and three cognitive function trajectories (low, moderate, and high) were identified. A significantly higher percentage of African Americans were in the "overweight," "smoking and drinking," and "low" cognitive functioning groups as measured by the total cognition composite score compared to white Americans. After accounting for covariates, the "drinking and overweight" group was associated with the "moderate" or "high" cognitive functioning group. Future interventions targeting the combinations of behavioral risk factors are needed to promote healthy aging among high-risk populations.

}, keywords = {behavioral risk factor, cognitive function, Health Disparities}, issn = {1552-6887}, doi = {10.1177/08982643211005905}, author = {Li, Chien-Ching and Chen, Yi-Fan and Jersey Liang and Alicia K Matthews and Lisa L. Barnes} } @article {9944, title = {Racial disparities in eligibility for low-dose computed tomography lung cancer screening among older adults with a history of smoking.}, journal = {Cancer Causes \& Control}, volume = {30}, year = {2019}, pages = {235-240}, abstract = {

PURPOSE: Lung cancer early detection screening has been demonstrated to decrease lung cancer mortality among high-risk smokers. This study aimed to examine whether current screening guidelines may disproportionately exclude African American smokers who are at higher overall risk for lung cancer.

METHODS: Data from the 2014 Health and Retirement Study were analyzed. Older African Americans and Whites with a history of smoking were included in the analyses (n = 7,348). Eligibility criteria established by the U.S. Preventive Services Task Force (USPSTF) for LDCT lung cancer screening were used. Multivariate logistic regression analyses were conducted to examine racial differences in eligibility for LDCT lung cancer screening.

RESULTS: Overall, 21.1\% of current and 10.5\% of former smokers met USPSTF{\textquoteright}s eligibility criteria for LDCT screening. In multivariate logistic regression analyses, African American smokers were less likely to be eligible for LDCT lung cancer screening compared to Whites (odds ratio = 0.5; p < 0.001).

CONCLUSION: African American smokers were less likely to meet established lung cancer screening eligibility criteria compared to Whites. Current lung cancer screening criteria may not adequately capture African Americans at risk and may widen the health disparities in African Americans. Further longitudinal studies are needed to evaluate the efficacy of current lung cancer screening guideline.

}, keywords = {Cancer, Cancer screenings, Racial/ethnic differences, Smoking}, issn = {1573-7225}, doi = {10.1007/s10552-018-1092-2}, author = {Li, Chien-Ching and Alicia K Matthews and Mantle M Rywant and Hallgren, Emily and Raj C Shah} } @mastersthesis {6407, title = {Health services use and health status among people with diabetes mellitus and cardiovascular diseases}, volume = {Ph.D.}, year = {2012}, school = {Saint Louis University}, address = {Saint Louis, MO}, abstract = {In the United States, Diabetes Mellitus (DM) becomes an important public health issue and has a great impact on health care costs. Diabetic patients are at a higher risk of developing cardiovascular diseases (CVD) compared to people without DM. This study adopted the Andersen{\textquoteright}s Behavioral Model of Health Services Utilization as a framework to examine health services uses and to further identify the association of health services uses and subsequent health outcomes within a representative sample of community-dwelling adults aged 51 years and older through a longitudinal analysis of the Health and Retirement Study data from 1998 through 2008. Results showed that less discretionary health services use (hospitalization and home health care) was more likely to be influenced by need factors. More discretionary health services use (doctor visits) was more likely to be influenced by predisposing factors. Although most health services uses were associated with worse or declined status in activities of daily living (ADL), instrumental activities of daily living (IADL), or self-rated health, certain health services use were found to be associated with less worse or not declined health status. The use of outpatient surgery among people with CVD only and the use of home health care among people with DM and CVD were associated with not declined IADL and self-rated health, respectively. In addition, the association between nursing home care and ADL, prescription drug use and IADL, and home health care and self-rated health was found to be different by health groups. Most health services uses were associated with higher risk of 10-year mortality. People with DM and CVD had the greater hazard to death compared with people with DM only. The association between mortality and doctor visits after baseline, and hospitalizations after baseline was different by health groups. Our study findings can provide health care professionals and health care administrators the insight required for improving the health care practice and the quality of health care in the U.S.}, keywords = {Health Conditions and Status, Healthcare, Public Policy}, isbn = {9781267642875}, author = {Li, Chien-Ching} }