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

M Larissa Avilés-Santa, John Heintzman, Nangel M Lindberg, Rafael Guerrero-Preston, Kenneth Ramos, Ana L Abraído-Lanza, Jonca Bull, Adolph Falcón, Mary Ann McBurnie, Ernest Moy, George Papanicolaou, Ileana L Piña, Jennifer Popovic, Shakira F Suglia, Miguel A Vázquez, M Larissa Avilés-Santa, John Heintzman, Nangel M Lindberg, Rafael Guerrero-Preston, Kenneth Ramos, Ana L Abraído-Lanza, Jonca Bull, Adolph Falcón, Mary Ann McBurnie, Ernest Moy, George Papanicolaou, Ileana L Piña, Jennifer Popovic, Shakira F Suglia, Miguel A Vázquez

Abstract

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.

Conflict of interest statement

Competing interests

The authors have no conflicts of interest to disclose.

The views expressed in this manuscript are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute; the National Institutes of Health; or the U.S. Department of Health and Human Services.

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References

    1. Collins FS, Varmus H. A new initiative in precision medicine. N Eng J Med. 2015;372(9):793–795. doi: 10.1056/NEJMp1500523.
    1. Fradkin JE, Hanlon MC, Rodgers GP. NIH precision medicine initiative: implications for diabetes research. Diabetes Care. 2016;39:1080–1084. doi: 10.2337/dc16-0541.
    1. Kessler MD, Yerges-Armstrong L, Taub MA, Shetty AC, Maloney K, Jeng LJ, Ruczinski I, Levin AM, Williams LK, Beaty TH, Mathias RA, Barnes KC. Consortium on Asthma among African-ancestry Populations in the Americas (CAAPA)., O'Connor TD. Challenges and disparities in the application of personalized genomic medicine to populations with African ancestry. Nat Commun. 2016;7:12521. doi: 10.1038/ncomms12521.
    1. Ortega VE, Meyers DA. Pharmacogenetics: implications of race and ethnicity on defining genetic profiles for personalized medicine. J Allergy Clin Immunol. 2014;133:16–26. doi: 10.1016/j.jaci.2013.10.040.
    1. United States Census Bureau: Profile America Facts for Features, CB16-FF.16 Hispanic Heritage Month 2016. . Accessed 31 Aug 2017.
    1. Colby SL, Ortman JM, Projections of the Size and Composition of the U.S. Population: 2014 to 2060, Current Population Reports, P25–1143, U.S. Census Bureau, Washington, DC, 2014.
    1. Lopez MH, Hispanic or Latino? Many don’t care, except in Texas. Pew Research Center, October 28, 2013. . Accessed 31 Aug 2017.
    1. Lopez MH, Hispanic Identity. Pew Research Center Hispanic Trends, October 22, 2013. . Accessed 31 Aug 2017.
    1. Personalized Medicine and Hispanic Health Workshop – July 2016 (Day 1). . Accessed 31 Aug 2017.
    1. Personalized Medicine and Hispanic Health Workshop – July 2016 (Day 2). . Accessed 31 Aug 2017.
    1. Delgado JL, Johnson CL, Treviño FM. Hispanic Health Nutrition and Examination Survey: Methodological Considerations. Am J Public Health. 1990;80(Suppl):6–10. doi: 10.2105/AJPH.80.Suppl.6.
    1. Menke A, Casagrande S, Geiss L, Cowie CC. Prevalence of and trends in diabetes among adults in the US, 1988–2012. JAMA. 2016;314:1021–1029. doi: 10.1001/jama.2015.10029.
    1. Stern MP, Rosenthal M, Haffner SM, Hazuda HP, Franco LJ. Sex difference in the effect of sociocultural status on diabetes and cardiovascular risk factors in Mexican Americans: The San Antonio Heart Study. Am J Epidemiol. 1984;120:834–851. doi: 10.1093/oxfordjournals.aje.a113956.
    1. Hamman RF, Marshall JA, Baxter J, Kahn LB, Mayer EJ, Orleans M, Murphy JR, Lezotte DC. Methods and prevalence of non-insulin dependent diabetes mellitus in a biethnic Colorado population: The San Luis Valley Diabetes Study. Am J Epidemiol. 1989;129:295–311. doi: 10.1093/oxfordjournals.aje.a115134.
    1. Goff DC, Ramsey DJ, Labarthe DR, Nichaman MZ. Greater case fatality after myocardial infarction among Mexican Americans and women than among non-Hispanic whites and men: The Corpus Christi Heart Project. Am J Epidemiol. 1994;139:474–483. doi: 10.1093/oxfordjournals.aje.a117030.
    1. Ostir GV, Markides KS, Freeman DH, Goodwin JS. Obesity and health conditions in elderly Mexican Americans: the Hispanic EPESE. Established Population for Epidemiologic Studies of the Elderly. Ethn Dis 2000; 10: 31–38, PMID: 10764128.
    1. Tucker KL, Bermudez OI, Castaneda C. Type 2 diabetes is prevalent and poorly controlled among Hispanic elders of Caribbean origin. Am J Public Health. 2000;90:1288–1293. doi: 10.2105/AJPH.90.8.1288.
    1. Vidal CM, García-Palmieri MR, Costas R, Sorlie PD, Havlik RJ. Abnormal blood glucose and coronary heart disease: the Puerto Rico Heart Health Program. Diab Care. 1983;6:556–561. doi: 10.2337/diacare.6.6.556.
    1. Alegria M, Takeuchi D, Canino G, Duan N, Shrout P, Meng X-L, Vega W, Zane N, Vila D, Woo M, Vera M, Guarnaccia P, Aguilar-Gaxiola S, Sue S, Escobar J, Lin K-M, Gong F. Considering place, context and culture: the National Latino and Asian American Study. Int J Methods Psych Res. 2004;13:208–220. doi: 10.1002/mpr.178.
    1. Sorlie PD, Avilés-Santa ML, Wassertheil-Smoller S, Kaplan RC, Daviglus ML, Giachello A, Schneiderman N, Raij L, Talavera G, Allison M, LaVange LM, Chambless LE, Heiss G. Design and implementation of the Hispanic Community Health Study/ Study of Latinos. Ann Epidemiol. 2010;20:629–641. doi: 10.1016/j.annepidem.2010.03.015.
    1. Heron M. Deaths: Leading causes for 2014. National vital statistics reports; Vol 65 no 5. Hyattsville, MD: National Center for Health Statistics. 2016.
    1. Daviglus ML, Talavera GA, Avilés-Santa ML, Allison M, Cai J, Criqui MH, Gellman M, Giachello AL, Gouskova N, Kaplan RC, LaVange L, Penedo F, Perreira K, Pirzada A, Schneiderman N, Wassertheil-Smoller S, Sorlie PD, Stamler J. Prevalence of major cardiovascular risk factors and cardiovascular diseases among Hispanic/Latino individuals of diverse backgrounds in the United States. JAMA. 2012;308:1775–1784. doi: 10.1001/jama.2012.14517.
    1. Schneiderman N, Llabre M, Cowie CC, Barnhart J, Carnethon M, Gallo LC, Giachello AL, Heiss G, Kaplan RC, LM LV, Teng Y, Villa-Caballero L, Avilés-Santa ML. Prevalence of diabetes among Hispanics/Latinos from diverse backgrounds: the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Diabetes Care. 2014;37:2233–2239. doi: 10.2337/dc13-2939.
    1. Sorlie PD, Allison MA, Avilés-Santa ML, Cai J, Daviglus ML, Howard AG, Kaplan R, Lavange LM, Raij L, Schneiderman N, Wassertheil-Smoller S, Talavera GA. Prevalence of hypertension, awareness, treatment, and control in the Hispanic Community Health Study/Study of Latinos. Am J Hypertension. 2014;27:793–800. doi: 10.1093/ajh/hpu003.
    1. Siega-Riz AM, Sotres-Alvarez D, Ayala GX, Ginsberg M, Himes JH, Liu K, Loria CM, Mossavar-Rahmani Y, Rock CL, Rodriguez B, Gellman MD, Van Horn L. Food-group and nutrient-density intakes by Hispanic and Latino backgrounds in the Hispanic Community Health Study/Study of Latinos. Am J Clin Nutr. 2014;99:1487–1498. doi: 10.3945/ajcn.113.082685.
    1. Mattei J, Sotres-Alvarez D, Daviglus ML, Gallo LC, Gellman M, Hu FB, Tucker KL, Willett WC, Siega-Riz AM, Van Horn L, Kaplan RC. 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. J Nutr. 2016;146:2035–2044. doi: 10.3945/jn.116.231209.
    1. Rodriguez CJ, Daviglus ML, Swett K, González HM, Gallo LC, Wassertheil-Smoller S, Giachello AL, Teng Y, Schneiderman N, Talavera GA, Kaplan RC. Dyslipidemia patterns among Hispanics/Latinos of diverse background in the United States. Am J Med. 2014;127:1186–1194. doi: 10.1016/j.amjmed.2014.07.026.
    1. Heiss G, Snyder ML, Teng Y, Schneiderman N, Llabre MM, Cowie C, Carnethon M, Kaplan R, Giachello A, Gallo L, Loehr L, Avilés-Santa L. Prevalence of metabolic syndrome among Hispanics/Latinos of diverse background: the Hispanic Community Health Study/Study of Latinos. Diab Care. 2014;37:2391–2399. doi: 10.2337/dc13-2505.
    1. Kaplan RC, Bangdiwala SI, Barnhart JM, Castañeda SF, Gellman MD, Lee DJ, Pérez-Stable EJ, Talavera GA, Youngblood ME, Giachello AL. Smoking among U.S. Hispanic/Latino adults: the Hispanic community health study/study of Latinos. Am J Prev Med. 2014;46:496–506. doi: 10.1016/j.amepre.2014.01.014.
    1. Redline S, Sotres-Alvarez D, Loredo J, Hall M, Patel SR, Ramos A, Shah N, Ries A, Arens R, Barnhart J, Youngblood M, Zee P, Daviglus ML. Sleep-disordered breathing in Hispanic/Latino individuals of diverse backgrounds. The Hispanic Community Health Study/Study of Latinos. Am J Respir Crit Care Med. 2014;189:335–344. doi: 10.1164/rccm.201309-1735OC.
    1. Barr RG, Avilés-Santa L, Davis SM, Aldrich TK, Gonzalez F, Henderson AG, Kaplan RC, LaVange L, Liu K, Loredo JS, Mendes ES, Ni A, Ries A, Salathe M, Smith LJ. Pulmonary disease and age at immigration among Hispanics. Am J Respiratory Critical Care Med. 2016;193:386–395. doi: 10.1164/rccm.201506-1211OC.
    1. Conomos MP, Laurie CA, Stilp AM, Gogarten SM, McHugh CP, Nelson SC, Sofer T, Fernandez-Rhodes L, Justice AE, Graff M, et al. Genetic diversity and association studies in US Hispanic/Latino populations: applications in the Hispanic Community Health Study/Study of Latinos. Am J Human Genetics. 2016;98:165–184. doi: 10.1016/j.ajhg.2015.12.001.
    1. Browning SR, Grinde K, Plantinga A, Gogarten SM, Stilp A, Kaplan RC, Aviles-Santa ML, Browning BL, Laure CC. Local ancestry inference in a large US-based Hispanic/Latino Study: the Hispanic Community Health Study/Study of Latinos. G3. 2016;6:1525–1534. doi: 10.1534/g3.116.028779.
    1. Montgomery SP, Parise ME, Dotson EM, Bialek SR. What Do We Know about Chagas Disease in the United States. Am J Trop Med Hyg. 2016;95:1225–1227. doi: 10.4269/ajtmh.16-0213.
    1. Bautista MC, Jiang SF, Armstrong AM, Kakar S, Postlethwaite D, Li D. Significant Racial Disparities Exist in Noncardia Gastric Cancer Outcomes Among Kaiser Permanente’s Patient Population. Dig Dis Sci. 2015;60:984–995. doi: 10.1007/s10620-014-3409-7.
    1. Quality and Disparities in Quality of Health Care. National Healthcare Quality and Disparities Report and 5th Anniversary Update on the National Quality Strategy. Rockville, MD: Agency for Healthcare Research and Quality; 2015. . Accessed 31 Aug 2017.
    1. 2014 National Healthcare Quality and Disparities Report chartbook on health care for Hispanics. Rockville, MD: Agency for Healthcare Research and Quality; September 2015. AHRQ Pub. No. 15–0007-11-EF. . Accessed 31 Aug 2017.
    1. The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group 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) JAMA. 2002;288(23):2981–2997. doi: 10.1001/jama.288.23.2981.
    1. The SPRINT Research Group A randomized trial of intensive versus standard blood pressure control. N Eng J Med. 2015;373:2103–2116. doi: 10.1056/NEJMoa1511939.
    1. The ACCORD Study Group Effects of Intensive Blood-Pressure Control in Type 2 Diabetes Mellitus. N Engl J Med. 2010;362:1575–1585. doi: 10.1056/NEJMoa1001286.
    1. National Emphysema Treatment Trial Research Group A Randomized Trial Comparing Lung-Volume–Reduction Surgery with Medical Therapy for Severe Emphysema. N Engl J Med. 2003;348:2059–2073. doi: 10.1056/NEJMoa030287.
    1. U.S. Food and Drug Administration, Regulatory Information. Food and Drug Administration Safety and Innovation Act (FDASIA). . Accessed 1 Sept 2017.
    1. FDA Report: Collection, Analysis, and Availability of Demographic Subgroup Data for FDA-Approved Medical Products, issued August 2013, required under FDASIA Section 907. . Accessed 31 Aug 2017.
    1. FDA Report: FDA Action Plan to enhance the collection and availability of demographic and subgroup data, August 2014 . Accessed 31 Aug 2017.
    1. Collection of Race and Ethnicity Data in Clinical trials: Guidance for Industry and Food and Drug Administration Staff, October 26, 2016. . Accessed 31 Aug 2017.
    1. Platt R, Wilson M, Chan A, Benner JS, Marchibroda J, McClellan M. The new Sentinel Network – improving the evidence of medical-product safety. N Engl J Med. 2009;361:645–647. doi: 10.1056/NEJMp0905338.
    1. Fahey KR. The Pioneering Role of the Vaccine Safety Datalink Project (VSD) to Advance Collaborative Research and Distributed Data Networks. EGEMS (Wash DC) 2015;3:1195.
    1. Laws R, Gillespie S, Puro J, Van Rompaey S, Quach T, Carroll J, Weir RC, Crawford P, Grasso C, Kaleba E, McBurnie MA. The Community Health Applied Research Network (CHARN) data warehouse: A resource for patient-centered outcomes research and quality improvement in underserved, safety net populations. EGEMS. 2014;2:1097. doi: 10.13063/2327-9214.1097.
    1. Nichols GA, McBurnie MA, Paul L, Potter JE, McCann S, Mayer K, Melgar G, D’Amato S, DeVoe JE. The high prevalence of diabetes among a large cohort of patients drawn from safety net clinics. Prev Chronic Dis. 2016;13:E78. doi: 10.5888/pcd13.160056.
    1. Mayer KH, Crawford P, Dant L, Gillespie S, Singal R, Vandermeer M, Muench J, Long T, Quach T, Chaudhry A, Crane HM, Lembo D, Mills R, McBurnie MA. HIV and Hepatitis C virus screening practices in a geographically diverse sample of American community health centers. AIDS Patient Care STDS. 2016;30:237–246. doi: 10.1089/apc.2015.0314.
    1. Li V, McBurnie MA, Simon M, Crawford P, Leo M, Rachman F, Cottrell E, Dant L, Oneha M, Chang WR. Impact of social determinants of health on patients with complex diabetes who are served by national safety-net health centers. J Am Board Fam Med. 2016;29:356–370. doi: 10.3122/jabfm.2016.03.150226.
    1. Rieckmann T, Muench J, McBurnie MA, Leo MC, Crawford P, Ford D, Stubbs J, O'Cleirigh C, Mayer KH, Fiscella K, Wright N, Doe-Simkins M, Cuddeback M, Salisbury-Afshar E, Nelson C. Medication-assisted treatment for substance use disorders within a national community health center research network. Subst Abus. 2016;37:625–634. doi: 10.1080/08897077.2016.1189477.
    1. Bazemore AW, Cottrell EK, Gold R, Hughes LS, Phillips RL, Angier H, Burdick TE, Carrozza MA, DeVoe JE. "Community vital signs": incorporating geocoded social determinants into electronic records to promote patient and population health. J Am Med Inform Assoc. 2016;23:407–412. doi: 10.1093/jamia/ocv088.
    1. DeVoe JE, Gold R, Cottrell E, Bauer V, Brickman A, Puro J, Nelson C, Mayer KH, Sears A, Burdick T, Merrell J, Matthews P, Fields S. The ADVANCE network: accelerating data value across a national community health center network. J Am Med Inform Assoc. 2014;21:591–595. doi: 10.1136/amiajnl-2014-002744.
    1. DeVoe JE, Sears A. The OCHIN community information network: bringing together community health centers, information technology, and data to support a patient-centered medical village. J Am Board Fam Med. 2013;26:271–278. doi: 10.3122/jabfm.2013.03.120234.
    1. Heintzman J, Bailey SR, DeVoe J, Cowburn S, Kapka T, Duong TV, Marino M. In Low-Income Latino Patients, Post-Affordable Care Act Insurance Disparities May Be Reduced Even More than Broader National Estimates: Evidence from Oregon. J Racial Ethn Health Disparities. 2017;4:329–336. doi: 10.1007/s40615-016-0232-1.
    1. Heintzman J, Marino M, Hoopes M, Bailey S, Gold R, Crawford C, Cowburn S, O’Malley J, Nelson C, DeVoe JE. Using electronic health record data to evaluate preventive service utilization among uninsured safety net patients. Prev Med. 2014;67:306–310. doi: 10.1016/j.ypmed.2014.08.006.
    1. Heintzman J, Marino M, Hoopes M, Bailey SR, Gold R, O'Malley J, Angier H, Nelson C, Cottrell E, DeVoe JE. Supporting health insurance expansion: do electronic health records have valid insurance verification and enrollment data? J Am Med Inform Assoc. 2015;22:909–913. doi: 10.1093/jamia/ocv033.
    1. Heintzman JB, Bailey SR, Cowburn S, Dexter E, Carroll J, Marino M. Pneumococcal Vaccination in Low-Income Latinos: An Unexpected Trend in Oregon Community Health Centers. J Health Care Poor Underserved. 2016;27:1733–1744. doi: 10.1353/hpu.2016.0159.
    1. All of Us Research Program. National Institutes of Health. . Accessed 31 Aug 2017.
    1. Akinyemiju T, Moore JX, Ojesina AI, Waterbor JW, Altekruse SF. Racial disparities in individual breast cancer outcomes by hormone-receptor subtype, area-level socio-economic status and healthcare resources. Breast Cancer Res Treat. 2016;157(3):575–586. doi: 10.1007/s10549-016-3840-x.
    1. Ooi SL, Martinez ME, Li CI. Disparities in breast cancer characteristics and outcomes by race/ethnicity. Breast Cancer Res Treat. 2011;127(3):729–738. doi: 10.1007/s10549-010-1191-6.
    1. Rahman R, Schmaltz C, Jackson CS, Simoes EJ, Jackson-Thompson J, Ibdah JA. Increased risk for colorectal cancer under age 50 in racial and ethnic minorities living in the United States. Cancer Med. 2015;4:1863–1870. doi: 10.1002/cam4.560.
    1. Surveillance, Epidemiology, and End Results (SEER) Program). SEER*Stat Database: Incidence - SEER 9 Regs Research Data, Nov 2015 Sub (1973–2013) − Linked To County Attributes - Total U.S., 1969–2014 Counties. 2015. Retrieved from . Accessed 31 Aug 2017.
    1. Kuo TM, Mobley LR. How generalizable are the SEER registries to the cancer populations of the USA. Cancer Causes Control. 2016;27:1117–1126. doi: 10.1007/s10552-016-0790-x.
    1. Cartwright DJ. ICD-9-CM to ICD-10-CM Codes: What? Why? How. Adv Wound Care. 2013;2:588–592. doi: 10.1089/wound.2013.0478.
    1. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). National Center for Health Statistics. . Accessed 29 Aug 2017.
    1. What is CPT? American Academy of Professional Coders. . Accessed 29 Aug 2017.
    1. Current Procedural Terminology. American Medical Association. . Accessed 29 Aug 2017.
    1. U.S. Food & Drug Administration, National Drug Code Directory (. Accessed 29 Aug 2017.
    1. Hazlehurst BL, Kurtz SE, Masica A, Stevens VJ, McBurnie MA, Puro JE, Vijayadeva V, Au DH, Brannon ED, Sittig DF. CER Hub: An informatics platform for conducting comparative effectiveness research using multi-institutional, heterogeneous, electronic clinical data. Int J Med Inform. 2015;84:763–773. doi: 10.1016/j.ijmedinf.2015.06.002.
    1. Hazlehurst B, McBurnie MA, Mularski RA, Puro JE, Chauvie SL. Automating quality measurement: a system for scalable, comprehensive, and routine care quality assessment. AMIA Annu Symp Proc. 2009;2009:229–233.
    1. Williams RJ, Masica AL, McBurnie MA, Solberg LI, Bailey SR, Hazlehurst B, Kurtz SE, Williams AE, Puro JE, Stevens VJ. Documentation of the 5 as for smoking cessation by PCPs across distinct health systems. Am J Manag Care. 2014;20:e35–e42.
    1. Markides KS, Coreil J. The health of Hispanics in the southwestern United States: an epidemiologic paradox. Public Health Rep. 1986;101:253–265.
    1. Balcazar AJ, Grineski SE, Collins TW. The Hispanic health paradox across generations: the relationship of child generational status and citizenship with health outcomes. Public Health. 2015;129:691–697. doi: 10.1016/j.puhe.2015.04.007.
    1. Galanter JM, Gignoux CR, Oh SS, Torgerson D, Pino-Yanes M, Thakur N, Eng C, Hu D, Huntsman S, Farber HJ, Avila PC, Brigino-Buenaventura E, LeNoir MA, Meade K, Serebrisky D, Rodriguez-Cintron W, Kumar R, Rodriguez-Santana JR, Seibold MA, Borrell LN, Burchard EG, Zaitien N: Differential methylation between ethnic sub-groups reflects the effect of genetic ancestry and environmental exposures. Elife 2017;3(6). doi: 10.7554/eLife.20532.
    1. Bick J, Naumova O, Hunter S, Barbot B, Lee M, Luthar SS, Raefski A, Grigorenko EL. Childhood adversity and DNA methylation of genes involved in the hypothalamus-pituitary-adrenal axis and immune system: whole-genome and candidate-gene associations. Dev Psychopathol. 2012;24:1417–1425. doi: 10.1017/S0954579412000806.
    1. Arrieta MC, Stiemsma LT, Dimitriu PA, Thorson L, Russelll S, Yurist-Doutsch S, Kuzeljevic B, Gold MJ, Britton HM, Lefebvre DL, Subbarao P, Mandhane P, Becker A, McNagny KM, Sears MR, Kollman T. CHILD Study Investigators, Mohn WW, Turvey SE, Finlay BB: Early infancy microbial and metabolic alterations affect risk of childhood asthma. Sci Transl Med. 2015;7:3–7. doi: 10.1126/scitranslmed.aab2271.
    1. Miller GE, Engen PA, Gillevet PM, Shaikh M, Sikaroodi M, Forsyth CB, Mutlu E, Keshavarzian A. Lower neighborhood socioeconomic status associated with reduced diversity of the colonic microbiota in healthy adults. PLoS ONE. 2016;11:e0148952. doi: 10.1371/journal.pone.0148952.
    1. Seeman TE, McEwen BS, Rowe JW, Singer BH. Allostatic load as a marker of cumulative biological risk: MacArthur studies of successful aging. Proc Natl Acad Sci U S A 2001 Apr 10;98(8):4770–4775. Epub 2001 Apr 3.
    1. Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med. 1998;14:245–258. doi: 10.1016/S0749-3797(98)00017-8.
    1. Suglia SF, Duarte CS, Chambers E, Boynton-Jarrett R. Cumulative Social Risk and Childhood Obesity. Pediatrics. 2012;129(5):e1173–e1179. doi: 10.1542/peds.2011-2456.
    1. Ma J, Rosas LG, Lv N. Precision lifestyle medicine: A new frontier in the science of behavior change and population health. Am J Prev Med. 2016;50:395–397. doi: 10.1016/j.amepre.2015.09.035.
    1. EHR incentive program. Eligible professional Meaningful Use Core Measures, Measure 9 or 13. Stage 1 (2014 Definition). Last updated: May 2014: Recording smoking status. Centers for Medicare and Medicaid. . Accessed 31 Aug 2017.
    1. HRSA Health Center Program: Uniform Data System: Reporting Instructions for 2016 Health Center Data. Table 3B Demographic Characteristics -Patients by Sexual Orientation and Gender Identity. 2016 UDS Manual – November 4, 2016 V1.1, OMB Number: 0915–0193, Expiration Date: 02/28/2018. . Accessed 31 Aug 2017.
    1. Patient identification and matching: final report. Office of the National Coordinator for Health Information Technology, 2014. . Accessed 31 Aug 2017.
    1. . Building data infrastructure to support patient centered outcomes research (PCOR). Patient matching, aggregating and linking (PMAL). . Accessed 31 Aug 2017.
    1. Jones NA: Update on the U.S. Census Bureau’s race and ethnic research for the 2020 Census. . Accessed 31 Aug 2017.
    1. NIH Policy and Guidelines on The Inclusion of Women and Minorities as Subjects in Clinical Research Effective, March 1994; (. Amended Oct 2001. . Accessed 31 Aug 2017.
    1. Oh SS, Galanter J, Thakur N, Pino-Yanes M, Barcelo NE, White MJ, De Bruin DM, Greenblatt RM, Bibbins-Domingo K, Wu AH, Borrell LN, Gunter C, Powe NR, Burchard EG. Diversity in Clinical and Biomedical Research: A Promise Yet to Be Fulfilled. PLoS Med. 2015;12:e1001918. doi: 10.1371/journal.pmed.1001918.
    1. Yang J, Xu WW, Hu SJ. Heart failure: advanced development in genetics and epigenetics. Biomed Res Int. 2015;2015:352734.
    1. Greco CM, Condorelli G. Epigenetic modifications and noncoding RNAs in cardiac hypertrophy and failure. Nat Rev Cardiol. 2015;12:488–497. doi: 10.1038/nrcardio.2015.71.
    1. Iordanidou M, Loukides S, Paraskakis E. Asthma phenotypes in children and stratified pharmacological treatment regimens. Expert Rev Clin Pharmacol. 2017;10:293–303.
    1. Popejoy AB, Fullerton SM. Genomics is failing on diversity (comment) Nature. 2016;538:161–164. doi: 10.1038/538161a.
    1. Trans-Omics for Precision Medicine (TOPMed) Program. . Accessed 29 Aug 2017.
    1. Dominguez K, Penman-Aguilar A, Chang M, Moonesinghe R, Castellanos T, Rodriguez-Lainz A, Schieber R. 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. Morb Mortal Wkly Rep. 2015;64:469–478.
    1. Zsembik BA, Fennell D. Ethnic variation in health and the determinants of health among Latinos. Soc Sci Med. 2005;61:53–63. doi: 10.1016/j.socscimed.2004.11.040.
    1. Ennis SR, Ríos-Vargas M, Albert N: 2010 Census briefs: the Hispanic population: 2010. May 2011, U.S. Department of Commerce, economics and statistics administration. CR2010BR-04.
    1. Behavioral Risk Factor Surveillance System (BRFSS). . Accessed 29 Aug 2017.
    1. National Health Nutrition and Examination Survey (NHANES). . Accessed 29 Aug 2017.
    1. Multi-Ethnic Study of Atherosclerosis (MESA). . Accessed 29 Aug 2017.
    1. Crane HM, Lober W, Webster E, Harrington RD, Crane PK, Davis TE, Kitahata MM. Routine collection of patient-reported outcomes in an HIV clinic setting: the first 100 patients. Curr HIV Res. 2007;5:109–118. doi: 10.2174/157016207779316369.
    1. Gold R, Nelson C, Cowburn S, Bunce A, Hollombe C, Davis J, Muench J, Hill C, Mital M, Puro J, Perrin N, Nichols G, Turner A, Mercer M, Jaworski V, Howard C, Abiles E, Shah A, Dudl J, Chan W, DeVoe J. Feasibility and impact of implementing a private care system's diabetes quality improvement intervention in the safety net: a cluster-randomized trial. Implement Sci. 2015;10:83. doi: 10.1186/s13012-015-0259-4.
    1. Johnson K, Grossmann C, Anau J, Greene S, Kimbel K, Larson E, Newton K. Integrating research into health care systems: executive’s views. Perspectives, Discussion Paper: Institute of Medicine; 2015. . Accessed 31 Aug 2017.
    1. Proctor BD, Semega JL, Kollar MA. U.S. Census Bureau, Current Population Reports, P60–256(RV), Income and Poverty in the United States: 2015, U.S. Government Printing Office, Washington, DC, 2016.
    1. Sung NS, Crowley WF, Genel M, Salber P, Sandy L, Sherwood LM, Johnson SB, Catanese V, Tilson H, Getz K, Larson EL, Scheinberg D, Reece EA, Slavkin H, Dobs A, Grebb J, Martinez RA, Korn A, Rimoin D. Central challenges facing the national clinical research enterprise. JAMA. 2003;289:1278–1287. doi: 10.1001/jama.289.10.1278.
    1. Cohen JJ, Gabriel BA, Terrel C. The case for diversity in the healthcare workforce. Health Aff. 2002;21:90–102. doi: 10.1377/hlthaff.21.5.90.
    1. Smedley BD, Stith Butler A, Bristow LR, editors. In the Nation’s Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Institute of Medicine (US) Committee on Institutional and Policy-Level Strategies for Increasing Diversity of the U.S. Healthcare Workforce. National Academies Press, Washington, DC, 2004.

Source: PubMed

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