Doctor of Medicine
College of Medicine
Jasmine R. Marcelin, MD and Sara H. Bares, MD
Ishani Ganguli, MD, MPH
Kathleen A. McManus, MD, MSc
Over the last four years, I have developed a research focus examining the intersections of race, place, and health. My M.D. Honors Thesis reflects a snapshot of these efforts. In this collection of brief research reports, I leverage area-based measures to investigate structural inequities in three contexts: the HIV epidemic in our hyperlocal community, the early stages of the COVID-19 pandemic, and clinical trials for novel COVID-19 therapeutics. I apply novel social epidemiologic tools to measure and explore disparate outcomes. And, in reflecting upon my findings, I discuss concrete implications for clinicians, researchers, and policymakers alike.
Chapter 1: Neighborhood-Level Deprivation and Racial Inequities in HIV Viral Suppression
Human immunodeficiency virus (HIV) is a treatable chronic disease. Yet, geographic and racial inequities across the HIV care continuum are persistent, even in the U.S. Midwest. Using the Area Deprivation Index, a novel measure of neighborhood-level disadvantage, I showed that Black-White disparities in HIV viral suppression among our clinic population are explained by neighborhood deprivation. Our findings highlighted how structural racism, through longstanding place-based disinvestment, directly contributes to disparate HIV outcomes.
Chapter 2: County-Level Social Vulnerability and COVID-19 Cases & Deaths
While it is now widely recognized that the COVID-19 pandemic has had an outsized impact on marginalized and minoritized communities, the pandemic’s inequitable trajectory was not as obvious during the early stages. Leveraging publicly available data as of mid-April 2020 and the validated CDC/ATSDR Social Vulnerability Index, I showed how greater prevalence of population-level characteristics like racial/ethnic minority status, limited English proficiency, poverty, unemployment, crowded housing, and poor transportation access are directly associated with disease incidence and death. Our findings informed risk prioritization efforts across the country and offer an evidence-based framework for allocation of scarce resources.
Chapter 3: Census Tract-Level Inequities in Access to COVID-19 Therapeutic Trials
Geography is a key determinant of access to health care yet is often unexplored as a determinant of clinical trial enrollment. Using publicly available data from ClinicalTrials.gov, I geocoded the locations of 2,095 COVID-19 biomedical trial sites and calculated the driving distance from each U.S. Census tract center of population to the nearest site. I identified that nearly one-third of the overall US population, over one-half of the Native American population, and over three-fourths of the rural population lived more than an hour away from the nearest trial site. Of further concern, Black and Hispanic populations lived closer to trial sites than other populations, yet several studies highlighted the underrepresentation of these populations in major COVID-19 trials. Our findings demonstrated that geographic accessibility alone may not improve representative trial enrollment in the absence of additional structural interventions.
Khazanchi, Rohan, "Interrogating Race and Place-Based Inequities in HIV and COVID-19" (2022). MD Honors Theses. 1.
Demography, Population, and Ecology Commons, Epidemiology Commons, Geographic Information Sciences Commons, Health Services Research Commons, Inequality and Stratification Commons, Medical Education Commons, Medicine and Health Commons, Pharmacy Administration, Policy and Regulation Commons, Place and Environment Commons, Race and Ethnicity Commons, Social Justice Commons