Health disparities disproportionately affect communities of color, other vulnerable and marginalized populations, as well as rural populations.
Diversity in the medical workforce improves our ability to interact with our communities and contributes to excellence in patient care, community interaction and service and decreases health disparities.
The foundation of health disparities research includes evaluation of the intersection of social, biologic, and environmental forces as well as justice and access to healthcare.
Faculty Spotlight: Rashmi Sharma
Dr. Sharma's research and clinical work is focused on understanding and addressing health inequities in the care of patients with serious illness.
Melanoma outcomes in ethnic groups and bias in skin tone representation in medical education
Drs. Ata Moshiri and Masaoki Kawasumi (Dermatology) are currently exploring outcomes in melanoma treatment and survival in different ethnic groups.
Dr. Moshiri is also working with medical students to evalutate photographs from dermatology textbooks and assess for bias in skin tone representation.
Socially disadvantaged populations bear the greatest burden of risk for transmission, morbidity, and mortality. However, in more than half of US cases, relevant race and ethnicity data are missing. Drs. Sarah Struthers and Sarah Sanghavi (Nephrology) are studying the association between socioeconomic status (SES) and COVID- 19, information required to contextualize identified racial and ethnic disparities.
Race, ethnicity, poverty and other social determinants of health can dictate COVID-19 risk and outcomes. In communities with more racial and ethnic minorities and those living in poverty, individuals are infected at higher rates, and hospitalizations and deaths have been higher. Dr. Joshua Liao (General Internal Medicine) works on value- and systems-based interventions to improve the health of patients and populations.
Our researchers found that despite the availability of interpreter services across clinical locations, non–English-speaking patients in our health system were tested less frequently for COVID-19 and had significantly higher burden of infection. This excess risk was observed across multiple languages and in the 3 largest non–English-speaking groups—Spanish, Vietnamese, and Amharic—reflecting the larger immigrant communities in King County, WA. Dr. H. Nina Kim (Allergy and Infectious Diseases) is lead author of the results, published in JAMA.
Dr. Rashmi Sharma presents Medicine Grand Rounds to discuss the drivers of health disparities and inequities, demographic data for Limited-English Proficiency (LEP) population, and the literature on LEP status and health outcomes, and LEP status and outcomes for patients with serious illness and their families.
Achieving health equity in colorectal cancer screening
Dr. Rachel Issaka is a gastroenterologist and clinical researcher focused on decreasing the mortality associated with colorectal cancer, with a special focus on medically underserved populations. Screening can prevent colorectal cancer by detecting and simultaneously removing precancerous polyps, small lesions that over time can grow and become cancerous.
“Screening is a way to not only prevent disease but reduce racial and economic disparities. We need to close that gap so that every citizen can benefit from the advances in cancer care and prevention.”
Jackson Heart Study
Dr. Bessie Young has brought together a working group composed of national experts on Chronic Kidney Disease (CKD) epidemiological research and biostatistics through the Jackson Heart Study. This Jackson Heart Study project is an important next step in advancing the nephrological and cardiovascular wellness of African Americans.
Racial inequities in end-of-life healthcare
Dr. Crystal Brown (Pulmonary, Critical Care and Sleep Medicine) has been awarded a K23 from the National Institute on Minority Health and Health Disparities to investigate racial inequities in end-of-life healthcare.
Brown will determine how perceived discrimination affects communication and decision-making during serious illness.
Dr. Paul Crane (General Internal Medicine) and Eric Larson (Kaiser) lead the Adult Changes in Thought (ACT) study focused on late life brain functioning and dementia and Alzheimer's disease. Modern genetic studies require thousands of people, and no single study (including ACT) has sufficient numbers of African American participants on its own for adequately powered genetic work. ACT has partnered with many other studies across the country to specifically assess the genetics of Alzheimer's disease in African Americans.
Expanding access to lifesaving AML treatments
Acute myeloid leukemia (AML) is one of the most common, and aggressive, types of blood cancer that strike adults. Dr. Johnnie Orozco is developing safer, more targeted therapies to treat people with AML, which will also help expand access to potential cures for underserved populations.
LatinX Diabetes Clinic
This clinic was established to decrease healthcare disparities in LatinX patients with diabetes, address cultural and linguistic barriers to high quality care, increase opportunities for medical trainees to understand the cultural and sociological aspects of the prevention and management of diabetes and its complications in this community, and improve the overall health of the LatinX community, regionally and nationally, through increased clinical and basic science research in the prevention and treatment of diabetes.
The clinic is led by Dr. Lorena Alarcon-Casas Wright (Metabolism, Endocrinology and Nutrution), who says that her dream is to provide health services that incorporate psychosocial and cultural understanding as part of the treatment plan.
Liver cancer disparities in American Indian/Alaska Native People
Led by Dr. George Ioannou, professor (Gastroenterology), researchers are studying ways to improve screening and early detection of liver cancer in American Indian/Alaska Native People. This effort is a collaboration between the University of Washington, Fred Hutchinson Cancer Research Center, the Alaska Native Tribal Health Consortium and the Cherokee Nation Health Service.
Bias assessment for cognitive and other tests: differential item functioning (DIF) research
Item bias detection is an important area in assessment, to ensure that the measures reflect only the underlying factor intended by the items in aggregate and not construct-irrelevant factors that could bias test results.
Dr. Paul Crane (General Internal Medicine) and his research group have pioneered analysis techniques that can account for items with diferential item functioning (DIF), as opposed to removing items with DIF.
The DIF-related tools they have developed have been implemented in research studies of diverse populations across the country and around the world.
The Value & Systems Science Lab (VSSL) was created to transform data and ideas into actionable insight that improves health outcomes. To achieve that mission, the Lab recently added several new equity-focused projects to its portfolio of work evaluating how healthcare payment, delivery, and decisions come together to impact outcomes.
Addressing disparities in the response to patient harm
Experiencing harm from medical care is among the most difficult and challenging circumstances a patient can face. Racial bias, limited English proficiency, differing cultural norms, disability, or a lack of stable housing can make such harm even more traumatic for patients and their families. They may feel they are not heard or fear that “complaining” may affect their care, making them less likely to signal harm. Those who do seek to address harm may face obstacles, including implicit bias, power asymmetry, and the inability to obtain representation in litigation.
These disparities in respect, dignity, and accountability have serious implications for the individuals affected and for society as a whole.
Dr. Thomas H. Gallagher (Center for Scholarship in Patient Care Safety and Quality and the Collaborative for Accountability and Improvement) is collaborating with Marcia Rhodes and Tracy Deskin in UW Medicine’s Clinical Risk Management Department, as well as Dr. Urmimala Sarkar at the University of California San Francisco and Michelle Mello at Stanford University, to develop a proposal using Community Based Participatory Research (CBPR) to adapt the Communication and Resolution Program (CRP) model to better support the needs of marginalized patients after care breakdowns.
Addressing Health Disparities in Infectious Diseases
The 2020 Infectious Diseases Society of America (ISDA) Women of ID campaign has featured Dr. Anna Wald, professor and head (Allergy and Infectious Diseases), as one of five women honorees who are leading the way for future generations to come for addressing health disparities in infectious diseases.