The Groundwater of Racial and Ethnic Disparities Research
2021; Lippincott Williams & Wilkins; Volume: 14; Issue: 2 Linguagem: Inglês
10.1161/circoutcomes.121.007868
ISSN1941-7705
AutoresKhadijah Breathett, Erica S. Spatz, Daniel B. Kramer, Utibe R. Essien, Rishi K. Wadhera, Pamela N. Peterson, P. Michael Ho, Brahmajee K. Nallamothu,
Tópico(s)Racial and Ethnic Identity Research
ResumoHomeCirculation: Cardiovascular Quality and OutcomesVol. 14, No. 2The Groundwater of Racial and Ethnic Disparities Research Free AccessEditorialPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyRedditDiggEmail Jump toFree AccessEditorialPDF/EPUBThe Groundwater of Racial and Ethnic Disparities ResearchA Statement From Circulation: Cardiovascular Quality and Outcomes Khadijah Breathett, MD, MS, Erica S. Spatz, MD, MHS, Daniel B. Kramer, MD, MPH, Utibe R. Essien, MD, MPH, Rishi K. Wadhera, MD, MPP, MPhil, Pamela N. Peterson, MD, MSPH, P. Michael Ho, MD, PhD and Brahmajee K. Nallamothu, MD, MPH Khadijah BreathettKhadijah Breathett Khadijah K. Breathett, MD, MS, University of Arizona, Sarver Heart Center, 1501 N Campbell Ave, PO Box 245046; Tucson, AZ 85724. Email E-mail Address: [email protected] https://orcid.org/0000-0001-5397-6419 Division of Cardiovascular Medicine, Sarver Heart Center, University of Arizona, Tucson (K.B.). , Erica S. SpatzErica S. Spatz https://orcid.org/0000-0002-1557-7713 Division of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (E.S.S.). , Daniel B. KramerDaniel B. Kramer https://orcid.org/0000-0003-4241-3586 Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA (D.B.K., R.K.W.). , Utibe R. EssienUtibe R. Essien https://orcid.org/0000-0002-4494-5028 Division of General Internal Medicine, University of Pittsburgh School of Medicine, PA (U.R.E.). , Rishi K. WadheraRishi K. Wadhera https://orcid.org/0000-0003-1089-3896 Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA (D.B.K., R.K.W.). , Pamela N. PetersonPamela N. Peterson https://orcid.org/0000-0001-6864-2016 Division of Cardiovascular Medicine, University of Colorado, Anschutz Medical Campus, Aurora (P.N.P., P.M.H.). Division of Cardiology, Denver Health Medical Center, CO (P.N.P.). , P. Michael HoP. Michael Ho Division of Cardiovascular Medicine, University of Colorado, Anschutz Medical Campus, Aurora (P.N.P., P.M.H.). and Brahmajee K. NallamothuBrahmajee K. Nallamothu https://orcid.org/0000-0003-4331-6649 Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (B.K.N.). Originally published11 Feb 2021https://doi.org/10.1161/CIRCOUTCOMES.121.007868Circulation: Cardiovascular Quality and Outcomes. 2021;14:e007868Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: February 12, 2021: Ahead of Print February 11, 2021: Ahead of Print The Fish. The Pond. The Groundwater. Imagine that you have a personal pond filled with fish. When viewing your pond, you notice that one fish has died, floating belly-up. You decide that the fish must have been ill and think nothing more of it. The next day, you notice that half of the fish in your pond are now dead. You are alarmed and decide to contact the neighborhood management services to investigate your pond. Something must be wrong with the local system. The following day, however, you discover that all of your neighbors with ponds have noticed the same thing. In fact, half of the fish are dead throughout all waterways in the entire state. At this point, it is clear something deeper must be wrong. This is when you need to analyze the groundwater feeding these ponds. The fish are not at fault, and not even the local systems. Rather the underlying structures through which the fish seek life has failed. Imagine that instead of fish, we are discussing patients.1—Paraphrase of Groundwater Approach Metaphor by Love and Hayes-Greene of The Racial Equity Institute.When the same patient populations are repetitively suffering throughout the U.S. from disproportionate rates of cardiovascular disease and other forms of disease, we should consider the role that society—i.e., the groundwater—has on the outcome. For too long, racial and ethnic disparities in healthcare quality and outcomes reported by researchers in scientific journals have attributed such differences to individual factors or local systems with less attention paid to the underlying role of societal factors.2 Yet health equity will likely remain out of reach if such methods to understand and intervene upon racial and ethnic disparities do not intentionally address entrenched systematic challenges, such as structural racism. In a recent article in Health Affairs, Boyd et al3 proposed a call to action for scientific journals and the investigators they serve to take a broader perspective and methodically begin to examine structural factors including racism when studying racial and ethnic disparities. This is an important piece, and it led us to self-reflection. Scientific journals are a critical component of the groundwater of the research enterprise. In this editorial, we briefly address the role of scientific journals in reporting racial and ethnic disparities and describe our evolving view of best practices for publishing disparities research submitted to Circulation: Cardiovascular Quality and Outcomes. As always, this is an ongoing conversation in which we hope to engage with our readership over time to improve the publication process.Race is the child of racism, not the father—Ta-Nehisi Coates4,5Research on racial and ethnic disparities is a common and critical area of investigation in the health sciences. To best understand such disparities, scientific investigation and reporting need to recognize the historical foundation of race and take care to avoid perpetuating racism. Race is a social, not biological, construct that was designed to separate one population from another.2,5 Although the use of race has changed over the years—from justifying slavery to currently embedding separatism of economic, academic, and political opportunity—race has served to grant additional privileges to certain populations (ie, White race) at the exclusion of others, and this is a global phenomenon.2Race is rooted in the development of US health structures and healthcare delivery systems.2,5,6 For example, low-quality hospitals disproportionately serve Black patients, leading to the risk of poorer quality cardiovascular care.7 Additionally, the inclusion of race in risk calculations has been based (or justified) on epidemiological associations of race with outcomes, sometimes resulting in "interpreting racial disparities as immutable facts rather than as injustices that require intervention."8 Some risk calculators may exacerbate disparities by recommending underuse of therapeutic inventions and referrals to cardiologists among Black patients and has been observed in multiple datasets.8,9 Similarly models that use artificial intelligence are at risk for worsening racial disparities by including race as a factor without addressing systemic factors that contribute to racial and ethnic disparities. When faced with clinical uncertainty during simulations where only patient race varies, clinicians have demonstrated racial bias with recommendations for cardiovascular therapies such as heart catheterizations and heart transplants for White patients but not Black patients.10,11Racism is the belief that "different races possess distinct characteristics, abilities, or qualities, especially to distinguish them as inferior or superior to one another."12 Racism has multiple forms including individual racism—personal belief; institutional racism—legalized and normalized structure of disadvantaging racial groups within an institution; and structural racism—the "normalization and legitimization of an array of dynamics that are historical, cultural, institutional, and interpersonal that routinely advantage White individuals."2,13 With structural racism, one population is offered inherent privilege and benefits over others in a manner that is pervasive throughout society and culture.14 Structural racism underlies the widespread disparities in health and health outcomes that are ubiquitous in the published literature and thus must be at the forefront of disparities research.14Use and misuse of race (and similarly ethnicity) is an important issue for the disparities research that is commonly published in scientific journals. For example, a key first principle for such work relies on measuring race and ethnicity correctly. Ideally, this is done by enabling people to self-report race and ethnicity. This not only respects individuals' identities but provides a means of capturing individuals' lived experiences, which is critical for understanding and eradicating disparities. Instead, however, individuals or populations are often misclassified by administrative measures that may rely on staff labeling individuals based on physical appearance, geography, or ethnic-sounding names. These approaches are often inaccurate and can be used to make assumptions or even policy that is misguided.15 In a similar vein, how race is categorized after data collection occurs can also matter. For instance, describing subjects as White versus non-White upholds a belief that White race is the standard by which all other populations should be measured. Although this may not be the intention and may be due to underrepresentation of Black, Indigenous, and People of Color, it reflects tenets of structural racism.Finally, default attribution of racial and ethnic disparities to genetic causes demonstrates misunderstanding of what racial and ethnic populations represent. Race and ethnicity correlate with ancestry, and we do not discount important work being conducted on the role of genetic causes in health research. Yet in the absence of specific genetic admixture testing and hypotheses, it would be more constructive to also consider the role of societal factors in explaining observed differences.Race is associated with so much more than genetics and ancestry, including social determinants of health (eg, income, education, housing) that also are inextricably linked to systemic and structural racism.16 This is true not only in North America but also has been demonstrated in similar studies of health disparities across the world.17 In such studies, the focus should be primarily on the disparity that has been defined by the Institute of Medicine, now National Academy of Medicine, as racial and ethnic differences in the (1) operation of healthcare systems and legal and regulatory climates and (2) discrimination through bias, stereotyping, and unequal treatment in the setting of clinical uncertainty.2Best Practices for Scientific Manuscripts on Racial and Ethnic DisparitiesScientists and scientific journals have the opportunity to facilitate best practices and ultimately impact racial and ethnic disparities. The written interpretations of science by a few shape the future creation of history and science for many—that is, we can change the groundwater. Coinciding with this article, we at Circulation: Cardiovascular Quality and Outcomes are promoting forward change with new instructions for authors performing racial and ethnic disparities research. This information is concurrently available at https://www.ahajournals.org/disparities-research-guidelines. These are emerging guideposts and represent a small step toward a better direction for our journal and scientific publishing. To supplement these specific author instructions, we also provide more general insights below into how our editorial team has been considering research that tackles these important topics. To be most effective, we have realized that disparities research requires reframing all phases of the research protocol to ultimately achieve cardiovascular health equity. Although the focus is on racial and ethnic disparities, the principles described here may apply to other forms of disparities research (eg, gender or disability).Develop Questions and Methodological Strategies Informed by Conceptual FrameworksMuch of published disparities research has been descriptive rather than focusing on mechanisms and interventions to overcome enduring racial and ethnic disparities. To move the field forward requires a better application of conceptual frameworks that get at the underlying structures and processes that lead to disparities. Scientists can consider using frameworks such as the National Institute of Minority Health and Health Disparities Research Framework to develop study questions that consider domains of influence (eg, behavioral, sociocultural/environmental) with levels of influence (eg, individual, interpersonal, societal).18 They can also consider developing questions and methods informed by additional approaches like critical race theory, which is a multidisciplinary antiracist framework to "identify, understand, and undo the root causes of racial hierarchies."19 Other emerging theories may be suitable as well and advance the field.Explicitly Describe Rationale and Classification for Inclusion of Racial and Ethnic Patient Populations in the Methods SectionWe now require a clear description of how race and ethnicity were classified within data sources that were utilized. Of course, we recognize that the use of historical data sources may have limitations in some studies. Our goal is not to restrict publishing such work, as this could inadvertently diminish the field. Important work is still possible using this information, but such classifications must be defined. Our aspirational vision of what the future should hold is described in bullet points below.Specific, self-identified classifications similar to the 2020 U.S. Census are preferred when available, in which race is assessed separately from ethnicity, multiple choices can be selected, and write-in of specific origin is also offered (race: American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Pacific Islander, White, and additional write-in descriptions of origin; ethnicity: Hispanic or Latino and additional write-in descriptions of origin [eg, Cuban, Mexican]).20Potential limitations of existing data sources should also be explicitly described in the article, including whether or not the data are representative of the geographic location.Race and ethnicity should be capitalized when described in manuscripts and used as adjectives rather than nouns.Black, Indigenous, and People of Color should not be categorized as non-White. Ideally, the use of Other race and Minority race should be avoided as well because this can perpetuate White race as the standard. Describing the specific racial and ethnic populations are preferred and small population groupings by race/ethnicity should be used sparingly. A need for anonymity would be an appropriate exception.Lastly, the methods section should describe how race and ethnicity were analyzed in statistical models. In articles not dealing with health disparities directly, reasons for including or not including racial and ethnic populations as covariates in statistical models still should be described. Although race and ethnicity are important nonmodifiable variables to investigate, their relation to outcomes should be understood and conveyed as associations; causal inferences should be avoided. Too often, authors erroneously assign causal inference for disparities upon Black, Indigenous, and People of Color, which can suggest culpability. The statistical analyses and reporting should align with the selected conceptual model.Form Diverse and Inclusive Study Teams and Cite Their ScholarshipThe inclusion of diverse study team leaders and stakeholders who are familiar with the research area can elevate all phases of the research. Decades of community-based participatory research and patient-partnered research models underscore how patients, community leaders, and scientists that experience racial and ethnic disparities can provide unique perspectives based on lived experiences while simultaneously sharing knowledge and pushing the field towards equity. Adopting this model into all types of research, including epidemiological investigations and randomized controlled trials would promote more impactful research. As part of this approach, it is also essential to provide comprehensive attribution of prior work of scientists of color, who are often overlooked.21 We are considering the opportunity to include voluntary sections within articles that emphasize the goals of inclusiveness for a study akin to a pilot program being deployed at the scientific journal Cell.22Contextualize Discussion of Results Within Conceptual Frameworks and ModelsConceptual models can identify pathways to equity and should be included in the methods as above as well as the discussion when appropriate. Authors should focus on helping to move the field forward by identifying contributing factors and strategies for eradicating systemic barriers, such as institutional or structural racism. This also means examining social determinants of health and considering how next-step policies, interventions, and implementation science may promote more equitable health outcomes.Avoid Generalized Genetic Explanations for Racial and Ethnic DisparitiesRacial and ethnic groups are heterogeneous social constructs. We recognize that there is valuable work being done on the role of genetic ancestry and disease. Although race has some correlation with genetic ancestry, it also denotes important information on social determinants of health varying from environmental exposures to socioeconomic wealth to racism and discrimination.16 We encourage authors to avoid generalized ancestral genetic claims to explain results of social constructs unless the conceptual model specifically focuses on genetic data and addresses heterogeneous heritage and genetic admixture.Next Steps at Circulation: Cardiovascular Quality and OutcomesMoving from racial and ethnic disparities to cardiovascular health equity requires better standards and changes from within the journal. As an editorial team, we are interested in working with authors to incorporate these principles into their work and will use these best practices to evaluate future submissions on racial and ethnic disparities research. We hope to inspire more work in the field and know that we will learn important lessons with our authors during this process. We are dedicated to broadening the audience base and will provide additional outlets to promote disparities research through editorials and social media approaches (eg, CQO Commentators and Twitter Journal Clubs) that involve multiple thought leaders from diverse demographics and disciplines.Recognizing that achieving cardiovascular health equity requires promotion of diverse talent and ideas, it remains our priority to continue efforts to diversify our authorship, reviewers, and editorial teams. In this way, we have an ask for our authors and reviewers to help us collect appropriate categorizations of race, ethnicity, and other intersectional demographics. Although this may seem intrusive, it will be completely voluntary and not affect our decision-making around a submission. We view it as necessary to understand who we are and the collective diversity that is represented through our journal. As such, please take time to complete the journal profile form when you submit or review your next manuscript if you agree with this goal. Additional updates that allow for more expansive journal profile demographics from American Heart Association will be coming soon.We strive for excellence in cardiovascular quality and outcomes. Diverse representation extending beyond disparities research submissions will help us reach these goals at Circulation: Cardiovascular Quality and Outcomes. Together, and through efforts to change the international groundwater, we will work to achieve cardiovascular health equity for all racial and ethnic populations.Sources of FundingDr Breathett reports research funding from National Heart, Lung, and Blood Institute (NHLBI) K01HL142848, R25HL126146 subaward 11692sc, and L30HL148881; University of Arizona Health Sciences, Strategic Priorities Faculty Initiative Grant; and University of Arizona, Sarver Heart Center, Novel Research Project Award in the Area of Cardiovascular Disease and Medicine, Anthony and Mary Zoia Research Award; and Women As One.Disclosures Disclosures provided by Drs Breathett, Spatz, Ho, Peterson, and Nallamothu in compliance with American Heart Association's annual Journal Editor Disclosure Questionnaire are available at https://www.ahajournals.org/pb-assets/policies/COI_09_2020-1600719273583.pdf. The other authors report no conflicts.FootnotesKhadijah K. Breathett, MD, MS, University of Arizona, Sarver Heart Center, 1501 N Campbell Ave, PO Box 245046; Tucson, AZ 85724. Email [email protected]arizona.eduReferences1. Love B, Hayes-Greene D. The Groundwater Approach. Racial Equity Institute. 2018. Accessed August 7, 2020. https://www.racialequityinstitute.com/groundwaterapproach.Google Scholar2. Smedley B, Stith A, Nelson A. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (with CD). Institute of Medicine; National Academies Press; 2003.Google Scholar3. Boyd RW, Lindo EG, Weeks LD, McLemore MR. On Racism: A New Standard For Publishing On Racial Health Inequities | Health Affairs Blog. July 2, 2020. Accessed January 3, 2020. https://www.healthaffairs.org/do/10.1377/hblog20200630.939347/full/.Google Scholar4. Coates T-N. Between the World and Me. 1st edn. Spiegel & Grau; 2015.Google Scholar5. National Museum of African American History and Culture. Historical Foundations of Race.2019. Accessed December 1, 2020. https://nmaahc.si.edu/learn/talking-about-race/topics/historical-foundations-race.Google Scholar6. Breathett K, Jones J, Lum HD, Koonkongsatian D, Jones CD, Sanghvi U, Hoffecker L, McEwen M, Daugherty SL, Blair IV, et al.. Factors related to physician clinical decision-making for African-American and hispanic patients: a qualitative meta-synthesis.J Racial Ethn Health Disparities. 2018; 5:1215–1229. doi: 10.1007/s40615-018-0468-zCrossrefMedlineGoogle Scholar7. Capers Q, Sharalaya Z. Racial disparities in cardiovascular care: a review of culprits and potential solutions.J Racial Ethn Health Disparities. 2014; 1:171–180.CrossrefGoogle Scholar8. Vyas DA, Eisenstein LG, Jones DS. Hidden in plain sight - reconsidering the use of race correction in clinical algorithms.N Engl J Med. 2020; 383:874–882. doi: 10.1056/NEJMms2004740CrossrefMedlineGoogle Scholar9. Breathett K, Liu WG, Allen LA, Daugherty SL, Blair IV, Jones J, Grunwald GK, Moss M, Kiser TH, Burnham E, et al.. African Americans are less likely to receive care by a cardiologist during an intensive care unit admission for heart failure.JACC Heart Fail. 2018; 6:413–420. doi: 10.1016/j.jchf.2018.02.015CrossrefMedlineGoogle Scholar10. Schulman KA, Berlin JA, Harless W, Kerner JF, Sistrunk S, Gersh BJ, Dubé R, Taleghani CK, Burke JE, Williams S, et al.. The effect of race and sex on physicians' recommendations for cardiac catheterization.N Engl J Med. 1999; 340:618–626.CrossrefMedlineGoogle Scholar11. Breathett K, Yee E, Pool N, Hebdon M, Crist JD, Knapp S, Larsen A, Solola S, Luy L, Herrera-Theut K, et al.. Does Race Influence Decision Making for Advanced Heart Failure Therapies?J Am Heart Assoc. 2019; 8:e013592.LinkGoogle Scholar12. Lexico Dictionaries | English. Racism | Definition of Racism by Oxford Dictionary on Lexico.com also meaning of Racism.2021. Accessed January 7, 2021. https://www.lexico.com/en/definition/racism.Google Scholar13. Lawrence K, Keleher T. Chronic Disparity: Strong and Pervasive Evidence of Racial Inequalities.2004. Accessed January 11, 2021. https://www.intergroupresources.com/rc/Definitions%20of%20Racism.pdf.Google Scholar14. Churchwell K, Elkind MSV, Benjamin RM, Carson AP, Chang EK, Lawrence W, Mills A, Odom TM, Rodriguez CJ, Rodriguez F, et al.; American Heart Association. Call to action: structural racism as a fundamental driver of health disparities: a presidential advisory from the American Heart Association.Circulation. 2020; 142:e454–e468.LinkGoogle Scholar15. Eicheldinger C, Bonito A. More accurate racial and ethnic codes for Medicare administrative data.Health Care Financ Rev. 2008; 29:27–42.MedlineGoogle Scholar16. Borrell LN, Elhawary JR, Fuentes-Afflick E, Witonsky J, Bhakta N, Wu AHB, Bibbins-Domingo K, Rodríguez-Santana JR, Lenoir MA, Gavin JR, et al.. Race and genetic ancestry in medicine — a time for reckoning with racism.N Engl J Med. 2021; 384:474–480. doi: 10.1056/NEJMms2029562CrossrefMedlineGoogle Scholar17. Anderson I, Robson B, Connolly M, Al-Yaman F, Bjertness E, King A, Tynan M, Madden R, Bang A, Coimbra CE, et al.. Indigenous and tribal peoples' health (The Lancet-Lowitja Institute Global Collaboration): a population study.Lancet. 2016; 388:131–157. doi: 10.1016/S0140-6736(16)00345-7CrossrefMedlineGoogle Scholar18. NIMHD. NIMHD Research Framework.2018. Accessed January 4, 2021. https://www.nimhd.nih.gov/about/overview/research-framework/research-framework.html.Google Scholar19. Ford CL, Airhihenbuwa CO. Commentary: Just what is critical race theory and what's it doing in a progressive field like public health?Ethn Dis. 2018; 28(suppl 1):223–230. doi: 10.18865/ed.28.S1.223CrossrefMedlineGoogle Scholar20. Marks R, Jones N. Collecting and Tabulating Ethnicity and Race Responses in the 2020 Census.2020. Accessed January 4, 2021. https://www2.census.gov/about/training-workshops/2020/2020-02-19-pop-presentation.pdf.Google Scholar21. Ginther DK, Basner J, Jensen U, Schnell J, Kington R, Schaffer WT. Publications as predictors of racial and ethnic differences in NIH research awards.PLoS One. 2018; 13:e0205929. doi: 10.1371/journal.pone.0205929CrossrefMedlineGoogle Scholar22. Sweet DJ. New at Cell Press: the inclusion and diversity statement.Cell. 2021; 184:1–2. doi: 10.1016/j.cell.2020.12.019CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited ByLal B, Meschia J, Jones M, Aronow H, Lackey A, Lake R, Howard G and Brott T (2022) Health Screening Program to Enhance Enrollment of Women and Minorities in CREST-2, Stroke, 53:2, (355-361), Online publication date: 1-Feb-2022.Essien U, Kim N, Magnani J, Good C, Litam T, Hausmann L, Mor M, Gellad W and Fine M (2021) Association of Race and Ethnicity and Anticoagulation in Patients With Atrial Fibrillation Dually Enrolled in Veterans Health Administration and Medicare: Effects of Medicare Part D on Prescribing Disparities, Circulation: Cardiovascular Quality and Outcomes, 15:2, Online publication date: 1-Feb-2022.Gorelick P (2022) Community Engagement: Lessons Learned From the AAASPS and SDBA, Stroke, 53:3, (654-662), Online publication date: 1-Mar-2022.Kini V, Breathett K, Groeneveld P, Ho P, Nallamothu B, Peterson P, Rush P, Wang T, Zeitler E and Borden W (2022) Strategies to Reduce Low-Value Cardiovascular Care: A Scientific Statement From the American Heart Association, Circulation: Cardiovascular Quality and Outcomes, 15:3, Online publication date: 1-Mar-2022.Chrispin J, Frazier-Mills C, Sogade F, Wan E and Clair W (2021) Pandemic Highlights Disparities in Health Care, Circulation: Arrhythmia and Electrophysiology, 14:5, Online publication date: 1-May-2021.Wang X, Hidrue M, del Carmen M, Weiner R and Wasfy J (2021) Sociodemographic Disparities in Outpatient Cardiology Telemedicine During the COVID-19 Pandemic, Circulation: Cardiovascular Quality and Outcomes, 14:8, Online publication date: 1-Aug-2021.Lewsey S and Breathett K (2021) Equity in Heart Transplant Allocation: Intended Progress Up the Hill or an Impossibility?, Journal of the American Heart Association, 10:17, Online publication date: 7-Sep-2021.Tran A, Fonarow G, Arnold S, Jones P, Thomas L, Hill C, DeVore A, Butler J, Albert N and Spertus J (2021) Risk Adjustment Model for Preserved Health Status in Patients With Heart Failure and Reduced Ejection Fraction: The CHAMP-HF Registry, Circulation: Cardiovascular Quality and Outcomes, 14:10, (e008072), Online publication date: 1-Oct-2021.Ilyas S, Henkin S, Martinez‐Camblor P, Suckow B, Beach J, Stone D, Goodney P, Ebinger J, Creager M and Columbo J (2021) Sex‐, Race‐ and Ethnicity‐Based Differences in Thromboembolic Events Among Adults Hospitalized With COVID‐19, Journal of the American Heart Association, 10:23, Online publication date: 7-Dec-2021. February 2021Vol 14, Issue 2Article InformationMetrics Download: 3,670 © 2021 American Heart Association, Inc.https://doi.org/10.1161/CIRCOUTCOMES.121.007868PMID: 33567860 Originally publishedFebruary 11, 2021 Keywordsracial factorshealth equityethnic groupshealthcare disparitiesracismminority healthclinical researchPDF download Advertisement SubjectsDisparitiesHealth EquityRace and EthnicitySocial Determinants of Health
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