February is Black History Month
© iStock/Vitalii Abakumov
In honor of Black History Month, we are highlighting the strong commitment of VA research toward making sure that the VA healthcare system provides equal and excellent care to all of our nation’s Veterans. One of the top priorities of VA research is to “actively promote diversity, equity, and inclusion within our sphere of influence.” As part of this effort, VA’s Office of Research and Development has established a Diversity, Equity and Inclusion (DEI) Working Group that will work to:
- Develop a diverse scientific workforce through training and funding opportunities;
- Stimulate research focused on minority health and reducing health disparities; and
- Promote a culture of inclusion that will increase the value of VA research to Veterans.
VA's Health Services Research & Development Service (HSR&D) has a strong history of – and an ongoing commitment to research on equity and diversity. In addition to individual investigators and studies that focus on racial disparities, HSR&D funds the Center for Health Equity Research & Promotion (CHERP), whose mission it is to advance the quality and equity of health and healthcare for Veterans, as well as the Charleston Health Equity and Rural Outreach Innovation Center (HEROIC), which works to improve access and equity in healthcare for Veterans by eliminating geographic, racial/ethnic, and gender-based disparities. In addition, HSR&D supports the Health Equity QUERI Center, which partnered with VA’s Office of Health Equity in creating VA’s first National Veterans Health Equity Report, assessing disparities in the effect of COVID-19 in racial/ethnic minorities and other vulnerable VA patient populations.
HSR&D Researchers in the Field of Diversity
Utibe Essien, MD, MPH, a researcher with HSR&D’s Center for Health Equity Research & Promotion (CHERP), was recently selected by Business Insider as one of “30 young leaders who are forging a new future for healthcare in the pandemic’s shadow.” Individuals were selected due to their involvement in issues ranging from the development of treatments for COVID-19 to new approaches to women’s health. Dr. Essien was selected for his work on racial disparities in healthcare, which is particularly relevant because COVID-19 disproportionately affects people of color. An internist at the VA Pittsburgh Health Care system and Assistant Professor of Medicine at the University of Pittsburgh School of Medicine, Dr. Essien conducts research on racial and ethnic health disparities, and is particularly interested in variations in access to treatment and care for vulnerable populations.
Donna Washington, MD, MPH received a 2019 Congressional Black Caucus Veterans Braintrust Award. The Congressional Black Caucus Veterans Braintrust (CBCVB) serves as an advisory group for the entire Congressional Black Caucus, members of Congress, and Veterans’ organizations on the many issues that specifically impact the African American Veteran community. Dr. Washington is an investigator with the HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy and, working with VA’s Office of Health Equity, she leads the Health Equity QUERI National Partnered Evaluation Initiative. In addition, she serves as a physician at the VA Greater Los Angeles Healthcare System. Dr. Washington has devoted her career to addressing the healthcare needs of vulnerable and underserved populations.
Studies on Diversity by HSR&D Researchers
Blacks and Hispanics Twice as Likely as White Veterans to Test Positive for COVID-19
There is accumulating evidence that racial and ethnic minority communities in the US are experiencing a disproportionate burden of COVID-19. However, studies to date have focused on those who tested positive or hospitalized patients. This retrospective cohort study examined racial and ethnic disparities in patterns of COVID-19 testing (i.e., who received testing and who tested positive) and subsequent 30-day mortality for Veterans receiving VA healthcare (all testing and services in this study were provided within VA). Using VA data, investigators identified 5.8 million Veterans (74% non-Hispanic White, 19% non-Hispanic Black, and 7% Hispanic) in VA care. Of this study cohort, 254,595 Veterans were tested for COVID-19 between February 8 and July 22, 2020, of whom 16,317 tested positive and 1,057 died.
- Black Veterans were more likely to be tested (rate per 1,000 patients, 60.0) than Hispanic (52.7) or White Veterans (38.6).
- Among those tested, both Black and Hispanic Veterans were twice as likely to test positive than White Veterans, even after accounting for all adjusting variables.
Findings suggest a substantial excess burden of COVID-19 infection in U.S. minority communities. Understanding what is driving these disparities is vital so that state- and local-level strategies can be tailored to curb the disproportionate epidemics in racial and ethnic minority communities.
Rentsch C, Kidwai-Khan F, Tate J, et al. Patterns of COVID-19 testing and mortality by race and ethnicity among United States Veterans: A nationwide cohort study. PLoS Medicine. September 22, 2020;17(9):e1003379.
Racial Differences in Conservative Management of Prostate Cancer among Veterans
Conservative management (active surveillance or watchful waiting) of low- or intermediate-risk prostate cancer is a guideline-based alternative to definitive therapy (i.e., prostatectomy, radiation). However, the possibility of race-based biological differences in low-risk prostate cancer has led to a debate about whether African Americans should be candidates for conservative management. This study sought to determine whether there are any racial differences in the receipt and duration of conservative management among Veterans treated in the VA healthcare system. Using VA data from January 2004 through December 2018, investigators identified 51,543 Veterans (14,830 or 29% were African American) with low- or intermediate-risk prostate cancer who received either definitive therapy or conservative management.
- African American Veterans were slightly less likely to receive conservative management than White Veterans with localized prostate cancer. [Adjusted relative risk of 0.95 for Veterans with low-risk disease and 0.92 for those with intermediate-risk disease.]
- Among patients receiving conservative management, African American Veterans had a higher risk of receiving definitive therapy within five years of diagnosis than White Veterans. The median time to definitive treatment was 719 days for African American Veterans and 787 days for White Veterans.
Conservative management for low- and intermediate-risk prostate cancer may be less durable for African American Veterans compared to White Veterans. Future research should study the effectiveness of conservative management in African American men to determine if race-specific recommendations regarding conservative management are warranted.
Parikh R, Robinson K, Chhatre S, et al. Comparison by Race of Conservative Management for Low-Risk and Intermediate-Risk Prostate Cancers in Veterans: 2004-2018. JAMA Network Open. September 28, 2020;3(9):e2018318.
Further, HSR&D funds several ongoing studies on topics that include but are not limited to: Racial/Ethnic Disparities in End-of-Life Care for Veterans; Factors Underlying VA Racial/Ethnic Disparities in COVID-19 Infection and Complications; Diabetes Disparities: Texting to Extend Treatment; Therapeutic Interventions to Access Outcomes and Disparities in Chronic Kidney Disease; and Supporting Hypertension Self-Management among African American Veterans.