Ashanda R. Esdaille’s research while affiliated with Emory University and other places

Simple Summary Racial healthcare disparities, driven by adverse living conditions, environmental factors, and systemic biases, significantly affect Black Americans, and they are associated with increased oxidative stress, inflammation, and, in turn, chronic diseases like cardiovascular disease and cancer. Addressing these disparities requires comprehensive systemic reforms alongside additional strategies such as increased exercise, stress reduction, and anti-inflammatory diets. This review highlights the relevant literature and aims to encourage further research on this important topic. Abstract The impact of racial healthcare disparities has been well documented. Adverse social determinants of health, such as poverty, inadequate housing, and limited access to healthcare, are intricately linked to these disparities and negative health outcomes, highlighting the profound impact that social and economic factors have on individuals’ overall well-being. Recent evidence underscores the role of residential location on individual health outcomes. Despite the importance of a healthy lifestyle, regular physical activity, balanced nutrition, and stress management for favorable health outcomes, individuals living in socioeconomically disadvantaged areas may face obstacles in achieving these practices. Adverse living conditions, environmental factors, and systemic biases against Black Americans perpetuate allostatic load. This, compounded by decreased physical activity and limited healthy food options, may contribute to increased oxidative stress and inflammation, fundamental drivers of morbidities such as cardiovascular disease and cancer. Herein, we perform a narrative review of associations between healthcare disparities, chronic stress, allostatic load, inflammation, and cancer in Black Americans, and we discuss potential mechanisms and solutions. Additional research is warranted in the very important area of cancer disparities.

Objective: To evaluate factors associated with perioperative outcomes in a multi-institutional cohort of patients treated with CN. Methods: Data was analyzed for metastatic renal cell carcinoma (mRCC) patients treated with CN at 6 tertiary academic centers from 2005-2019. Outcomes included: Clavien-Dindo complications, mortality, length of hospitalization, 30-day readmission rate, and time to systemic therapy. Univariate and multivariable models evaluated associations between outcomes and prognostic variables including the year of surgery. Results: A total of 1,272 consecutive patients were treated with CN. Patients treated in 2015-2019 vs 2005-2009 had better performance status (p<0.001), higher level of comorbidities (p<0.001), higher pathologic N stage (p=0.04), higher percentage of non-clear cell RCC subtypes (p=0.02), more lymph node dissections (p<0.001), and less frequent pre-surgical therapy (p=0.02). Patients treated in 2015-2019 vs 2005-2009 had lower overall and major complications from surgery, 22% vs 39%, p<0.001 and 10% vs 16%, p=0.02. Mortality at 90 days was higher for patients treated 2005-2009 vs 2015-2019; 10% vs 5%, p=0.02. After multivariable analysis, independent predictors of major complications and 90-day mortality were the surgical time period and presence of thrombus. After multivariable analysis, independent predictors of major complications and 90-day mortality were the surgical time period and presence of tumor thrombus. Conclusion: In this novel analysis postoperative complications and mortality rates were significantly lower in patients treated within the most recent time period.

Background: Delayed access to care may contribute to disparities in prostate cancer (PCa). The Affordable Care Act (ACA) aimed at increasing access and reducing healthcare disparities, but its impact on timely treatment initiation for PCa men is unknown. Methods: Men with intermediate- and high-risk PCa diagnosed 2010-2016 and treated with curative surgery or radiotherapy were identified in the National Cancer Database. Multivariable logistic regression modeled the effect of race and insurance type on treatment delay >180 days after diagnosis. Cochran-Armitage test measured annual trends in delays, and joinpoint regression assessed if 2014, the year the ACA became fully operationalized, was significant for inflection in crude rates of major delays. Results: Of 422,506 eligible men, 18,720 (4.4%) experienced >180-day delay in treatment initiation. Compared to White patients, Black (OR 1.79, 95% CI 1.72-1.87, p < 0.001) and Hispanic (OR 1.37, 95% CI 1.28-1.48, p < 0.001) patients had higher odds of delay. Compared to uninsured, those with Medicaid had no difference in odds of delay (OR 0.94, 95% CI 0.84-1.06, p = 0.31), while those with private insurance (OR 0.57, 95% CI 0.52-0.63, p < 0.001) or Medicare (OR 0.64, 95% CI 0.58-0.70, p < 0.001) had lower odds of delay. Mean time to treatment significantly increased from 2010 to 2016 across all racial/ethnic groups (trend p < 0.001); 2014 was associated with a significant inflection for increase in rates of major delays. Conclusions: Non-White and Medicaid-insured men with localized PCa are at risk of treatment delays in the United States. Treatment delays have been consistently rising, particularly after implementation of the ACA.

Purpose of review: Currently, the increasing diversity of our society is poorly reflected in the urology workforce. In this review, we sought to address this disparity by highlighting key components involved in forming an academic urology department and training program that is focused on diversity, equity, and inclusion (DEI) as well as recruitment and retention of underrepresented in medicine (URiM) trainees and faculty. Recent findings: We identified obstacles and provided approaches to enhance the ability of a department in creating a DEI-based curriculum and recruitment strategy with a key focus on understanding and addressing unconscious biases and microaggressions in the workplace. Substantive changes in the level of diversity within the urologic community can be made through the organization of a structured approach to increasing DEI. It starts with a commitment from each department to form achievable goals surrounding early mentorship of URiM students and trainees, an inclusive curriculum that is rooted in DEI, and targeted benchmarks for recruitment and retention of diverse staff.