A Meharry-Vanderbilt Alliance joint conference series related to health disparities was begun in 2003. The topics thus far have included diabetes, colorectal cancer, HIV-AIDS and infant mortality. Conferences are listed starting with the most recent, and dating back to 2003.
The 2007 conference was entitled “Diabetes Health Disparities: Determinants, Prevention, Treatment, and Policy”. Educational sponsors included NIDDK, the Office of Behavioral and Social Sciences Research (OD), and the CDC. The Chair and Co-chairs were Alvin Powers, M.D., Tom Elasy, M.D., M.P.H., Vanessa Elliott, Ph.D., Margaret K. Hargreaves, Ph.D., and David Schlundt, Ph.D.; the Keynote Address was given by The Honorable Jim Cooper, U.S. Congressman of TN who spoke on Public Policy Approaches to Eliminating Health Disparities. Griffin Rodgers, M.D., the Director of NIDDK opened the program. He spoke of the continuing rise in the number of obese individuals in the US, and the genetic/molecular as well as environmental factors which may promote this rise. Thus metformin was found to reduce the number of cases of diabetes per 100 person-years among all ethnic groups in a major study, while lifestyle changes produced a more dramatic drop. He also spoke of one of the major complications of diabetes – renal disease. Although the incidence of end-stage renal disease (ESRD) in diabetic whites has fallen since 1990, the number of African American diabetics with ESRD has markedly risen, such that the incidence is roughly 6 fold higher in blacks than in whites. Therefore he encouraged research in this area, and particularly encouraged underrepresented minority investigators to choose a field within one of NIDDK’s mission areas, including diabetes and/or renal disease.
In looking for answers and connections between the two (obesity and diabetes), another speaker, David Schlundt, Ph.D., showed that maps indicating the rates of diabetes and obesity in various zip codes throughout Nashville-Davidson County, TN, were similar; rates were higher in areas with lower housing values, suggesting that socioeconomic and environmental factors played a role. Dr. Guillermo Umpierrez reminded the audience that the US is the 3rd largest Latino country in the World, and that Latinos also have a higher incidence of diabetes and obesity than whites, which is complicated by language and access barriers. Other speakers looked at the effect of lack of insurance, and the success of targeting subjects, the community and its environment, or the healthcare provider/system in the prevention and management of diabetes.
The 2006 conference was entitled “Why Our Babies Die?”. Nancy C. Chescheir, M.D., and Valerie Montgomery Rice, M.D. from Vanderbilt and Meharry, respectively, were the co-chairs. Educational sponsors included NICHD, the Office of Women’s Health (OD), the State of Tennessee and the March of Dimes. Dr. William Walsh filled in for Keynote Speaker Mildred Stahlman, M.D., who had been hospitalized briefly for an injury. The program centered on the rates of infant morbidity/mortality nationally, with an emphasis on the causes of, and outcomes for low birth weight and pre-term infants. The disparities are such that black women are 2-3 times more likely to have a preterm birth than white women, and to experience the death of an infant within the first 28 days of life. Karla Damus of the March of Dimes spoke of their goal to increase public awareness of the problems of prematurity and to reduce the overall rate to 7.6% by 2010 (was 12.7% nationally in 2005). In the case of this disparity, there is growing evidence that genetic as well as environmental factors play a role. There is also provocative data that suggest progestogens may be useful in preventing spontaneous preterm births in some women. Other speakers spoke on programs that help such as the “First Steps” program of the State of Washington which enhanced prenatal care for Medicaid recipients, leading to a decrease in low birth weight babies and infant mortality rates in that State.
The 2005 Meharry-Vanderbilt national conference was entitled “Conquering Colorectal Cancer Disparities”.
Colorectal cancer is the second leading cause of all cancer-related deaths in the United States.
African Americans have a higher incidence and mortality rate due to colorectal cancer compared to all other ethnic and racial groups. African American males are particularly burdened with the disease. The National Cancer Institute reports that the incidence rate in African American males is 50% higher than in Hispanic/Latino males and 18% higher than in white males, and the death rate due to this cancer is 92% higher in African American males than in Hispanic/Latino males and 37% higher than in white males.
The intent of this conference was to evaluate the current extent of our knowledge about risk factors for colorectal cancer, the progress made in the areas of prevention and disease management, and to determine how to overcome remaining barriers in order to eliminate disparities and improve life for all.
Workshop on Disparities in the HIV Epidemic
The November 2004 national conference was entitled “Workshop on Disparities in the HIV Epidemic” and was co-chaired by Drs. David Grandison of Meharry and Richard D’ Aquila of Vanderbilt. Both investigators are collaborators on the Vanderbilt-Meharry Developmental CFAR (Center For AIDS Research)t, and the Meharry Center for Health Disparities Research in HIV projects.
As expressed by the opening speaker, Dr. Ellen Funkhouser of the University of Alabama in Birmingham, even though the rate of deaths due to HIV infection has been falling since the mid-1990′s, non-Hispanic blacks account for over 50% of all new AIDS cases in the United States (2002) despite the fact that this group accounts for only 13% of the population. The rate per 100,000 people of new HIV cases in non-Hispanic black males is 8-fold that seen in white males in the US. Although the overall number of cases of HIV/AIDS in women is lower than in men, in 2002 black women were 25 times more likely to develop HIV/AIDS than white women. In fact in 2001, the leading cause of death in black women, ages 25-34, was HIV. HIV/AIDS is also on the rise in Hispanics.
A significant finding was that the HIV/AIDS epidemic in the US is changing, in that it is increasingly seen in heterosexuals in the Southern region of the US, and notably in black heterosexual females in rural Southern areas with reduced access to medical care.
In addition to problems in access to care, speakers also spoke of disparities in outcomes following HIV treatment or treatment for co-morbid conditions such hepatitis C virus infection. Special sessions were also included for HIV-associated kidney disease, and the association of HIV and human genomics.
The inaugural Meharry-Vanderbilt research conference was entitled “Overcoming Diabetes Health Disparities”. Co-sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the National Center on Minority Health and Health Disparities (NCMHD), Nearly 200 scientists, health professionals and students attended the event, which was held in Nashville in November, 2003 and chaired by Daryl Granner, MD, then Director of the Vanderbilt Diabetes Center and co-chaired by Dean PonJola Coney of Meharry and Dean Steven Gabbe of Vanderbilt.
The opening public address was provided by James R. Gavin III, MD, PhD, then President of Morehouse School of Medicine, who spoke about the growing prevalence of type 2 diabetes in the society, noting that there has been a 41% increase from 1990-1999 with an estimated societal cost of 132 billion dollars (2001). Further the growing diabetic epidemic mirrors the growth in the obesity epidemic in the US.
He admitted that there is a strong genetic component which enhances risk for developing diabetes, but other factors including obesity and race/ethnicity can compound that risk. Those populations with the highest rates of diabetes in the United States include African Americans, Hispanics, Asian and Native Americans, and Pacific Islanders. African Americans per se, are roughly twice as likely to have diabetes as are non-Hispanic whites. Gavin said that the problem in blacks and Hispanics was not so much “genes” but “jeans”, and the fact that African American women and Hispanic men reach a state of obesity with advancing age faster than other groups in the US, increasing their risk of developing diabetes. He also spoke of the growing concern about obesity and type 2 diabetes in children.
African American diabetics also suffer from a higher rate of end-stage renal failure, a higher rate of lower extremity amputations, and a reduced insulin sensitivity compared to non-Hispanic whites, and there are more deaths due to coronary artery disease in young blacks compared to young whites. He concluded by saying that we need to develop pre-diabetic prevention programs to curb this epidemic of diabetes, especially in high-risk communities.
Other speakers spoke of the contribution of lifestyle or genetics to the development of diabetes, and about models being tested in African American, Native American and Hispanic communities to prevent and best manage diabetes.