Emory-led Lancet review highlights racial disparities in sudden cardiac arrest and death among athletes
Emory Health Sciences
A recent major review of data published by the Lancet and led by Emory sports cardiologist Jonathan Kim, MD, shows that Black athletes are approximately five times more likely to experience sudden cardiac arrest (SCA) and sudden cardiac death (SCD) compared to White athletes, despite some evidence of a decline in rates of SCD overall. SCA and SCD have historically been a leading cause of mortality among athletes, particularly those involved in high-intensity sports.
The disparities in SCA/D rates highlights the need for increased research into the social determinants of health in younger athletes, a topic that remains understudied, according to Kim.
After examining a repository of national and international data focused on SCA/D in athletes accumulated over the last 30 years, Kim and colleagues from Lausanne University Hospital, Morristown Medical, Massachusetts General Hospital, and other prominent institutions reviewed the significant racial disparities that also persist in athlete electrocardiography (ECG) screenings, which have become a standard practice for competitive athletes.
These screenings often yield more false positives in Black athletes, which means that athletes may be wrongly identified as having a serious heart condition. For those with limited access to comprehensive follow-up testing this is especially problematic as these individuals may face unnecessary stress and may not be able to receive follow-up care to confirm whether results are accurate.
Social determinants of health, such as economic stability, proximity to health care facilities, access to health information, and experiences with discrimination can play a significant role in disparities in health outcomes, even in young athletes. By incorporating social determinants of health into future research, Kim says we may be better poised to understand how to mitigate the impacts on young athletes in particular.
“To truly address these disparities, it’s not enough to just screen for potential problems,” Kim says. “There needs to be an understanding on how to tackle the underlying social determinants of health that puts these athletes at a greater risk.”
In the Lancet review, Kim and colleagues stress that proper management of sudden cardiac arrest in athletes starts with adequate pre-participation evaluation (PPE) which involves careful planning and sufficient resources. “We need to look for potential underlying health conditions. We also need to consider all the environmental stressors that young individuals have to deal with and also where they grow up,” says Kim. An effective PPE history and physical examination should include appropriate follow-up, especially if ECG is included and abnormalities detected.
Looking ahead, the growing focus on this topic marks a substantial shift. “Just five to ten years ago, I doubt many were thinking about social determinants of health and impacts on young athletes,” says Kim. Asking these critical questions is a major step in the right direction. moving forward its essential to continue raising these questions but also taking action to address them.
Journal
The Lancet
Method of Research
Systematic review
Subject of Research
People
Article Title
A contemporary review of sudden cardiac arrest and death in competitive and recreational athletes
Article Publication Date
28-Nov-2024
How race impacts patients’ response to cancer immunotherapy
First large-scale analysis finds immune checkpoint inhibitors are equally effective in Black, white patients; Black patients have fewer side effects
ANN ARBOR, Michigan — Clinical trials testing cancer immunotherapies significantly under-represented Black patients. So while these treatments have resulted in dramatically improved outcomes for some patients, researchers from the University of Michigan Rogel Cancer Center wanted to understand whether that success holds true for patients who are Black.
Researchers pulled electronic medical record data from 26,398 patients receiving immune checkpoint inhibitors through the Veteran Health Administration in 2020-2023. The cohort was comprised of 81% white patients and 19% Black patients. The study was based on data from the VHA’s Million Veterans Program. Patients were treated with one or a combination of immune checkpoint inhibitors for any of the nearly 20 cancer types for which these treatments are FDA-approved.
The study, published in The Lancet Oncology, found identical two-year overall survival rates of 36.5% for both Black and white patients. Black patients stayed on the treatment longer than white patients and experienced fewer severe side effects, including lower risk of colitis or thyroid disorders.
“Despite widespread use of immune checkpoint inhibitors in racially diverse populations, studies have not looked at the efficacy and safety of these drugs in large groups of non-white patients. While we found no evidence for lower efficacy of immunotherapy among Black patients, our study raises crucial questions about why Black patients had fewer immune-related side effects than white patients,” said senior study author Alex K. Bryant, M.D., M.A.S., assistant professor of radiation oncology at Michigan Medicine.
The authors urge prospective validation studies that represent all races and sexes are needed to understand these differences.
Additional authors: Sean Miller, Ralph Jiang, Matthew Schipper, Lars G. Fritsche, Garth Strohbehn, Beth Wallace, Daria Brinzevich, Virginia Falvello, Benjamin H. McMahon, Rafael Zamora-Resendiz, Nithya Ramnath, Xin Dai, Kamya Sankar, Donna M. Edwards, Steven G. Allen, Shinjae Yoo, Silvia Crivelli, Michael D. Green
Funding for this work is from LUNGevity, Million Veterans Program grant MVP064, VA Office of Research and Development grant CX002430
Disclosure: None
Paper cited: “Effectiveness and safety of immune checkpoint inhibitors in Black patients versus White patients in a US national health system: a retrospective cohort study,” The Lancet Oncology. DOI: 10.1016.S1470-2045(24)00528-X
Resources:
University of Michigan Rogel Cancer Center, www.rogelcancercenter.org
Michigan Medicine Cancer AnswerLine, 800-865-1125
# # #
Nov. 25, 2024
For more information, contact:
Nicole Fawcett, nfawcett@umich.edu
For immediate release
How race impacts patients’ response to cancer immunotherapy
First large-scale analysis finds immune checkpoint inhibitors are equally effective in Black, white patients; Black patients have fewer side effects
ANN ARBOR, Michigan — Clinical trials testing cancer immunotherapies significantly under-represented Black patients. So while these treatments have resulted in dramatically improved outcomes for some patients, researchers from the University of Michigan Rogel Cancer Center wanted to understand whether that success holds true for patients who are Black.
Researchers pulled electronic medical record data from 26,398 patients receiving immune checkpoint inhibitors through the Veteran Health Administration in 2020-2023. The cohort was comprised of 81% white patients and 19% Black patients. The study was based on data from the VHA’s Million Veterans Program. Patients were treated with one or a combination of immune checkpoint inhibitors for any of the nearly 20 cancer types for which these treatments are FDA-approved.
The study, published in The Lancet Oncology, found identical two-year overall survival rates of 36.5% for both Black and white patients. Black patients stayed on the treatment longer than white patients and experienced fewer severe side effects, including lower risk of colitis or thyroid disorders.
“Despite widespread use of immune checkpoint inhibitors in racially diverse populations, studies have not looked at the efficacy and safety of these drugs in large groups of non-white patients. While we found no evidence for lower efficacy of immunotherapy among Black patients, our study raises crucial questions about why Black patients had fewer immune-related side effects than white patients,” said senior study author Alex K. Bryant, M.D., M.A.S., assistant professor of radiation oncology at Michigan Medicine.
The authors urge prospective validation studies that represent all races and sexes are needed to understand these differences.
Additional authors: Sean Miller, Ralph Jiang, Matthew Schipper, Lars G. Fritsche, Garth Strohbehn, Beth Wallace, Daria Brinzevich, Virginia Falvello, Benjamin H. McMahon, Rafael Zamora-Resendiz, Nithya Ramnath, Xin Dai, Kamya Sankar, Donna M. Edwards, Steven G. Allen, Shinjae Yoo, Silvia Crivelli, Michael D. Green
Funding for this work is from LUNGevity, Million Veterans Program grant MVP064, VA Office of Research and Development grant CX002430
Disclosure: None
Paper cited: “Effectiveness and safety of immune checkpoint inhibitors in Black patients versus White patients in a US national health system: a retrospective cohort study,” The Lancet Oncology. DOI: 10.1016.S1470-2045(24)00528-X
Resources:
University of Michigan Rogel Cancer Center, www.rogelcancercenter.org
Michigan Medicine Cancer AnswerLine, 800-865-1125
# # #
Journal
The Lancet Oncology
Method of Research
Meta-analysis
Subject of Research
Not applicable
Article Title
Effectiveness and safety of immune checkpoint inhibitors in Black patients versus White patients in a US national health system: a retrospective cohort study
Article Publication Date
24-Nov-2024
Race and ethnicity, gender, and promotion of physicians in academic medicine
JAMA Network Open
About The Study:
The findings of this study indicate that preferential promotion of white men within academic medicine continues to persist in the new millennium, with racially and ethnically diverse women experiencing greater underpromotion. To achieve a workforce that reflects the diversity of the U.S. population, this study suggests that academic medicine needs to transform its culture and practices surrounding faculty appointments and promotions.
Corresponding Author: To contact the corresponding author, Lauren Clark, MS, email lclark5@kumc.edu.
To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/
(doi:10.1001/jamanetworkopen.2024.46018)
Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.
Embed this link to provide your readers free access to the full-text article This link will be live at the embargo time http://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2024.46018?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=112724
Journal
JAMA Network Open
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