Personalized medicine and Hispanic health: improving health outcomes and reducing health disparities – a National Heart, Lung, and Blood Institute workshop report

Persons of Hispanic/Latino descent may represent different ancestries, ethnic and cultural groups and countries of birth. In the U.S., the Hispanic/Latino population is projected to constitute 29% of the population by 2060. A personalized approach focusing on individual variability in genetics, environment, lifestyle and socioeconomic determinants of health may advance the understanding of some of the major factors contributing to the health disparities experienced by Hispanics/Latinos and other groups in the U.S., thus leading to new strategies that improve health care outcomes. However, there are major gaps in our current knowledge about how personalized medicine can shape health outcomes among Hispanics/Latinos and address the potential factors that may explain the observed differences within this heterogeneous group, and between this group and other U.S. demographic groups. For that purpose, the National Heart, Lung, and Blood Institute (NHLBI), in collaboration with the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), and the Food and Drug Administration (FDA), held a workshop in which experts discussed (1) potential approaches to study medical treatments and health outcomes among Hispanics/Latinos and garner the necessary evidence to fill gaps of efficacy, effectiveness and safety of therapies for heart, lung, blood and sleep (HLBS) disorders and conditions--and their risk factors; (2) research opportunities related to personalized medicine to improve knowledge and develop effective interventions to reduce health disparities among Hispanics/Latinos in the U.S.; and (3) the incorporation of expanded sociocultural and socioeconomic data collection and genetic/genomic/epigenetic information of Hispanic/Latino patients into their clinical assessments, to account for individual variability in ancestry; physiology or disease risk; culture; environment; lifestyle; and socioeconomic determinants of health. The experts also provided recommendations on: sources of Hispanic/Latino health data and strategies to enhance its collection; policy; genetics, genomics and epigenetics research; and integrating Hispanic/Latino health research within clinical settings.

[1]  P. Sorlie,et al.  Abnormal Blood Glucose and Coronary Heart Disease: The Puerto Rico Heart Health Program , 1983, Diabetes Care.

[2]  M Rosenthal,et al.  Sex difference in the effects of sociocultural status on diabetes and cardiovascular risk factors in Mexican Americans. The San Antonio Heart Study. , 1984, American journal of epidemiology.

[3]  K. Markides,et al.  The health of Hispanics in the southwestern United States: an epidemiologic paradox. , 1986, Public health reports.

[4]  R. Hamman,et al.  Methods and prevalence of non-insulin-dependent diabetes mellitus in a biethnic Colorado population. The San Luis Valley Diabetes Study. , 1989, American journal of epidemiology.

[5]  J. L. Delgado,et al.  Hispanic Health and Nutrition Examination Survey: methodological considerations. , 1990, American journal of public health.

[6]  D. Labarthe,et al.  Greater case-fatality after myocardial infarction among Mexican Americans and women than among non-Hispanic whites and men. The Corpus Christi Heart Project. , 1994, American journal of epidemiology.

[7]  D. Williamson,et al.  Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. , 1998, American journal of preventive medicine.

[8]  K. Tucker,et al.  Type 2 diabetes is prevalent and poorly controlled among Hispanic elders of Caribbean origin. , 2000, American journal of public health.

[9]  G. Ostir,et al.  Obesity and health conditions in elderly Mexican Americans: the Hispanic EPESE. Established Population for Epidemiologic Studies of the Elderly. , 2000, Ethnicity & disease.

[10]  J W Rowe,et al.  Allostatic load as a marker of cumulative biological risk: MacArthur studies of successful aging , 2001, Proceedings of the National Academy of Sciences of the United States of America.

[11]  Jordan J. Cohen,et al.  The case for diversity in the health care workforce. , 2002, Health affairs.

[12]  B. Davis,et al.  Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). , 2002, JAMA.

[13]  Steven Piantadosi,et al.  A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema. , 2003, The New England journal of medicine.

[14]  Stephen B. Johnson,et al.  Central challenges facing the national clinical research enterprise. , 2003, JAMA.

[15]  In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce , 2004 .

[16]  Xiao-Li Meng,et al.  Considering context, place and culture: the National Latino and Asian American Study , 2004, International journal of methods in psychiatric research.

[17]  B. Zsembik,et al.  Ethnic variation in health and the determinants of health among Latinos. , 2005, Social science & medicine.

[18]  Andrea Brandolini,et al.  Income and Poverty in the United States in Comparative Perspective: The Role of Income and Wealth in Guaranteeing Economic Security in Old Age , 2006 .

[19]  P. Crane,et al.  Routine collection of patient-reported outcomes in an HIV clinic setting: the first 100 patients. , 2007, Current HIV research.

[20]  Brian Hazlehurst,et al.  Automating Quality Measurement: A System for Scalable, Comprehensive, and Routine Care Quality Assessment , 2009, AMIA.

[21]  R. Platt,et al.  The new Sentinel Network--improving the evidence of medical-product safety. , 2009, The New England journal of medicine.

[22]  Lloyd E Chambless,et al.  Design and implementation of the Hispanic Community Health Study/Study of Latinos. , 2010, Annals of epidemiology.

[23]  Kevin A Peterson,et al.  Effects of Intensive Blood-Pressure Control in Type 2 Diabetes Mellitus , 2011 .

[24]  S. Ooi,et al.  Disparities in breast cancer characteristics and outcomes by race/ethnicity , 2011, Breast Cancer Research and Treatment.

[25]  Medicaid Services,et al.  International Classification of Diseases, Ninth Revision, Clinical Modification , 2011 .

[26]  E. Grigorenko,et al.  Childhood adversity and DNA methylation of genes involved in the hypothalamus–pituitary–adrenal axis and immune system: Whole-genome and candidate-gene associations , 2012, Development and Psychopathology.

[27]  S. Suglia,et al.  Cumulative Social Risk and Obesity in Early Childhood , 2012, Pediatrics.

[28]  W. Baine,et al.  The Agency for Healthcare Research and Quality , 2006, Italian Journal of Public Health.

[29]  N. Schneiderman,et al.  Prevalence of major cardiovascular risk factors and cardiovascular diseases among Hispanic/Latino individuals of diverse backgrounds in the United States. , 2012, JAMA.

[30]  Donna J Cartwright,et al.  ICD-9-CM to ICD-10-CM Codes: What? Why? How? , 2013, Advances in wound care.

[31]  Jodi G. Daniel,et al.  Re: Request for Comment: Food and Drug Administration Safety and Innovation Act (FDASIA): Request for Comments on the Development of a Risk-Based Regulatory Framework and Strategy for Health Information Technology , 2013 .

[32]  J. DeVoe,et al.  The OCHIN Community Information Network: Bringing Together Community Health Centers, Information Technology, and Data to Support a Patient-Centered Medical Village , 2013, The Journal of the American Board of Family Medicine.

[33]  N. Schneiderman,et al.  Prevalence of hypertension, awareness, treatment, and control in the Hispanic Community Health Study/Study of Latinos. , 2014, American journal of hypertension.

[34]  E. Perez-stable,et al.  Smoking among U.S. Hispanic/Latino adults: the Hispanic community health study/study of Latinos. , 2014, American journal of preventive medicine.

[35]  V. Stevens,et al.  Documentation of the 5 as for smoking cessation by PCPs across distinct health systems. , 2014, The American journal of managed care.

[36]  Reesa Laws,et al.  The Community Health Applied Research Network (CHARN) Data Warehouse: a Resource for Patient-Centered Outcomes Research and Quality Improvement in Underserved, Safety Net Populations , 2014, EGEMS.

[37]  S. Kakar,et al.  Significant Racial Disparities Exist in Noncardia Gastric Cancer Outcomes Among Kaiser Permanente’s Patient Population , 2015, Digestive Diseases and Sciences.

[38]  N. Schneiderman,et al.  Prevalence of Diabetes Among Hispanics/Latinos From Diverse Backgrounds: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) , 2014, Diabetes Care.

[39]  N. Schneiderman,et al.  Dyslipidemia patterns among Hispanics/Latinos of diverse background in the United States. , 2014, American Journal of Medicine.

[40]  N. Schneiderman,et al.  Prevalence of Metabolic Syndrome Among Hispanics/Latinos of Diverse Background: The Hispanic Community Health Study/Study of Latinos , 2014, Diabetes Care.

[41]  Megan J. Hoopes,et al.  Using electronic health record data to evaluate preventive service utilization among uninsured safety net patients. , 2014, Preventive medicine.

[42]  Rachel Gold,et al.  The ADVANCE network: accelerating data value across a national community health center network , 2014, Journal of the American Medical Informatics Association : JAMIA.

[43]  Raanan Arens,et al.  Sleep-disordered breathing in Hispanic/Latino individuals of diverse backgrounds. The Hispanic Community Health Study/Study of Latinos. , 2014, American journal of respiratory and critical care medicine.

[44]  D. Meyers,et al.  Pharmacogenetics: implications of race and ethnicity on defining genetic profiles for personalized medicine. , 2014, The Journal of allergy and clinical immunology.

[45]  C. Rock,et al.  Food-group and nutrient-density intakes by Hispanic and Latino backgrounds in the Hispanic Community Health Study/Study of Latinos. , 2014, The American journal of clinical nutrition.

[46]  E. Simões,et al.  Increased risk for colorectal cancer under age 50 in racial and ethnic minorities living in the United States , 2015, Cancer medicine.

[47]  Sasha Colby,et al.  Projections of the Size and Composition of the U.S. Population: 2014 to 2060. Population Estimates and Projections. Current Population Reports. P25-1143. , 2015 .

[48]  Rachel Gold,et al.  Supporting health insurance expansion: do electronic health records have valid insurance verification and enrollment data? , 2015, J. Am. Medical Informatics Assoc..

[49]  G. Condorelli,et al.  Epigenetic modifications and noncoding RNAs in cardiac hypertrophy and failure , 2015, Nature Reviews Cardiology.

[50]  Timothy W. Collins,et al.  The Hispanic health paradox across generations: the relationship of child generational status and citizenship with health outcomes. , 2015, Public health.

[51]  Sarah M. Greene,et al.  Integrating Research into Health Care Systems: Executives' Views , 2015 .

[52]  Christian N. Hill,et al.  Feasibility and impact of implementing a private care system’s diabetes quality improvement intervention in the safety net: a cluster-randomized trial , 2015, Implementation Science.

[53]  N. Powe,et al.  Diversity in Clinical and Biomedical Research: A Promise Yet to Be Fulfilled , 2015, bioRxiv.

[54]  Man-Huei Chang,et al.  Vital Signs: Leading Causes of Death, Prevalence of Diseases and Risk Factors, and Use of Health Services Among Hispanics in the United States — 2009–2013 , 2015, MMWR. Morbidity and mortality weekly report.

[55]  Jian Yang,et al.  Heart Failure: Advanced Development in Genetics and Epigenetics , 2015, BioMed research international.

[56]  Brian Hazlehurst,et al.  CER Hub: An informatics platform for conducting comparative effectiveness research using multi-institutional, heterogeneous, electronic clinical data , 2015, Int. J. Medical Informatics.

[57]  Jackson T. Wright,et al.  A Randomized Trial of Intensive versus Standard Blood-Pressure Control. , 2016, The New England journal of medicine.

[58]  Tammy Toney-Butler,et al.  Behavioral Risk Factor Surveillance System (BRFSS) , 2015 .

[59]  Tobias Kollmann,et al.  Early infancy microbial and metabolic alterations affect risk of childhood asthma , 2015, Science Translational Medicine.

[60]  Kevin R. Fahey The Pioneering Role of the Vaccine Safety Datalink Project (VSD) to Advance Collaborative Research and Distributed Data Networks , 2015, EGEMS.

[61]  L. Geiss,et al.  Prevalence of and Trends in Diabetes Among Adults in the United States, 1988-2012. , 2015, JAMA.

[62]  F. Collins,et al.  A new initiative on precision medicine. , 2015, The New England journal of medicine.

[63]  G. Nichols,et al.  The High Prevalence of Diabetes in a Large Cohort of Patients Drawn From Safety Net Clinics , 2016, Preventing chronic disease.

[64]  S. Montgomery,et al.  What Do We Know About Chagas Disease in the United States? , 2016, The American journal of tropical medicine and hygiene.

[65]  K. Mayer,et al.  HIV and Hepatitis C Virus Screening Practices in a Geographically Diverse Sample of American Community Health Centers. , 2016, AIDS patient care and STDs.

[66]  K. Fiscella,et al.  Medication-assisted treatment for substance use disorders within a national community health center research network , 2016, Substance abuse.

[67]  W. Willett,et al.  Diet Quality and Its Association with Cardiometabolic Risk Factors Vary by Hispanic and Latino Ethnic Background in the Hispanic Community Health Study/Study of Latinos. , 2016, The Journal of nutrition.

[68]  How generalizable are the SEER registries to the cancer populations of the USA? , 2016, Cancer Causes & Control.

[69]  N. Lv,et al.  Precision Lifestyle Medicine: A New Frontier in the Science of Behavior Change and Population Health. , 2016, American journal of preventive medicine.

[70]  T. Akinyemiju,et al.  Racial disparities in individual breast cancer outcomes by hormone-receptor subtype, area-level socio-economic status and healthcare resources , 2016, Breast Cancer Research and Treatment.

[71]  Kathleen F. Kerr,et al.  Genetic Diversity and Association Studies in US Hispanic/Latino Populations: Applications in the Hispanic Community Health Study/Study of Latinos. , 2016, American journal of human genetics.

[72]  M. Marino,et al.  In Low-Income Latino Patients, Post-Affordable Care Act Insurance Disparities May Be Reduced Even More than Broader National Estimates: Evidence from Oregon , 2017, Journal of Racial and Ethnic Health Disparities.

[73]  M. Leo,et al.  Impact of Social Determinants of Health on Patients with Complex Diabetes Who Are Served by National Safety-Net Health Centers , 2016, The Journal of the American Board of Family Medicine.

[74]  Zachary A. Szpiech,et al.  Challenges and disparities in the application of personalized genomic medicine to populations with African ancestry , 2016, Nature Communications.

[75]  Rachel Gold,et al.  "Community vital signs": incorporating geocoded social determinants into electronic records to promote patient and population health , 2016, J. Am. Medical Informatics Assoc..

[76]  C. Escobar Cervantes,et al.  [A randomized trial of intensive versus standard blood pressure control]. , 2016, Semergen.

[77]  Comentário a: «The SPRINT Research Group. A Randomized Trial of Intensive versus Standard Blood‐Pressure Control» , 2016 .

[78]  Joseph E. Carroll,et al.  Pneumococcal Vaccination in Low-Income Latinos: An Unexpected Trend in Oregon Community Health Centers , 2016, Journal of health care for the poor and underserved.

[79]  J. Fradkin,et al.  NIH Precision Medicine Initiative: Implications for Diabetes Research , 2016, Diabetes Care.

[80]  A. Keshavarzian,et al.  Lower Neighborhood Socioeconomic Status Associated with Reduced Diversity of the Colonic Microbiota in Healthy Adults , 2016, PloS one.

[81]  R. Kaplan,et al.  Pulmonary Disease and Age at Immigration among Hispanics. Results from the Hispanic Community Health Study/Study of Latinos. , 2016, American journal of respiratory and critical care medicine.

[82]  R. Kaplan,et al.  Local Ancestry Inference in a Large US-Based Hispanic/Latino Study: Hispanic Community Health Study/Study of Latinos (HCHS/SOL) , 2016, G3: Genes, Genomes, Genetics.

[83]  Differential methylation between ethnic sub-groups reflects the effect of genetic ancestry and environmental exposures , 2016 .

[84]  S. Fullerton,et al.  Genomics is failing on diversity , 2016, Nature.

[85]  Noah Zaitlen,et al.  Differential methylation between ethnic sub-groups reflects the effect of genetic ancestry and environmental exposures , 2016, bioRxiv.

[86]  Sanjay R. Patel,et al.  Whole genome sequence association analysis of sleep-disordered breathing traits in trans-omics for precision medicine (topmed) , 2017 .

[87]  S. Loukides,et al.  Asthma phenotypes in children and stratified pharmacological treatment regimens , 2016, Expert review of clinical pharmacology.