U of A-led NHLBI Workshop explores disparities in pulmonary hypertension

Disparities in medicine could have as much, if not more, to do with your socioeconomic upbringing than your racial ancestry, making social determinants of health as well as social justice issues key compass points on how well a person is able to navigate their medical wellbeing, according to recent pulmonary hypertension studies said Franz Rischard, DO, who’ll host a national workshop on the topic this week.

For him, the subject is personal, as his son is Black, but 25% of Irish descent, Dr. Rischard points out. Those one-quarter Irish or three-quarters Black roots could be very telling of likely health issues he might face throughout his life – or will they? A paper he wrote last year in the journal Circulation: Heart Failure touched on that issue. See a Q&A below for further discussion on the point.

Dr. Rischard, a professor and director of the Pulmonary Hypertension Program in the Department of Medicine’s Division of Pulmonary, Allergy, Critical Care & Sleep Medicine at the University of Arizona College of Medicine – Tucson, will host a free virtual workshop Oct. 22-23, sponsored by the National Heart, Lung, and Blood Institute, a unit of the National Institutes of Health, to explore various disparities in pulmonary vascular disease, including PH.  

The NHLBI workshop, “Health Disparities Across the Spectrum of Pulmonary Vascular Disease,” will take place from 7 a.m.-2:30 p.m. AZT (10 a.m.-5:30 p.m. EDT) on both days. Race and ethnicity are important factors in pulmonary hypertension because they can affect the type of PH a patient has, the severity of the disease, and how it’s treated.

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Serving as chair of the workshop, Dr. Rischard also is site principal investigator for the U of A on the Pulmonary Vascular Disease Phenomics, or PVDOMICS, study, through the Pulmonary Hypertension Association. He’ll layout the event’s goals and objectives at 7:15 a.m. on Tuesday, Oct. 22, and present on “Self-Reported Racial and Ethnic Differences Among participants in the PVDOMICS Cohort,” at 10:30 a.m. AZT, Wednesday, Oct. 23. 

Also from the U of A, Chris Lim, PhD, an assistant professor in the Department of Community, Environment and Policy at the Mel & Enid Zuckerman College of Public Health, will present on “Air Pollution, Social Determinants of Health, and Pulmonary Hypertension Outcomes in the PVDOMICS Cohort,” 7:30 a.m. AZT, Oct. 23. And Karim El-Kersh, MD, a professor and head of the Pulmonary Hypertension Program at the U of A College of Medicine – Phoenix, was among six PVD and social disparties experts invited as workshop discussants.

To learn more about how the ancestry versus race debate has unfolded, see the following Q&A:

Q: What’s the premise behind this particular workshop?

Dr. Rischard: So, a couple things. One, we’d like to highlight the disparities that we know and the disparities we don’t know with regard to all different types of gender, sex and race or ethnicity outcomes in pulmonary hypertension. Another key aspect of this program is to highlight, especially with respect to race and ethnicity, the new information regarding precision-based medicine and how to approach scientific investigations in that context as more ancestry rather than race. That’s something that’s highlighted by the recent position statement last year from the National Academy of Sciences, Engineering & Medicine working group. [NOTE: See the first reference in this editorial on the NASEM statement.] 

Q: How does that differentiate things from how they were done in the past?

Dr. Rischard: So, previously, we’ve looked, say, at race as sort of a homogeneous surrogate for genetic similarity, meaning that we could define that you are Black by your genetics, right? That’s the example there. Whereas evidence tends to indicate that racial disparities and other disease states are more applicable to structural racism than they are actually to genetic variation, and genetic variation is higher, or at least as high, within racial categories as it is between racial categories. The third thing is that ancestries, which is distinctly different, of course may be more telling. So, for example, my son, who’s black, is 25% of Irish ancestry.

Q: That’s kind of like me. I’m half Hispanic, my father was from South America, and half of Anglo-European descent. But still, I have nieces and nephews that are Asian-American and African-American as well. And, although I’m white, there are a lot of Latinos who are largely Black racially.

Dr. Rischard: Yeah. So, there you go. That’s a perfect example. And what you do and where you work, and what those types of things presented to you in your life are what we call your social determinants of health. Those may be more applicable and chosen by you because of, perhaps, your particular exposures with your family or whatever, right? And those exposures may define your health outcomes to some degree, but not your racially defined genetics. If we are to study genetics, it’s more pertinent, I think, to study the ancestral origins of you versus someone else, say, 25% Irish for my son, right? Or for you, it might be much different, but it may be nevertheless more important to look at that heterogeneity within individuals than it is necessarily thinking of racial categories as homogeneous.

Q: I’m thinking of how the phrase, "It’s a small world," might come into play here. By that, I mean, where it used to be we talked about the American melting pot, now it’s somewhat more the global melting pot today. Is that a good way of saying it?

Dr. Rischard: Yeah. I mean, a figure comes to mind from the slides we’ve seen so far for this workshop, because we’re getting those pulled together now, and Victor Ortega, MD, PhD, who’s one of the editors for JAMA, is one of our genetic speakers on ancestry. And he has a slide where he shows the world and shows genetic or ancestral migrations and how diversity comes from those ancestral migrations. And, I think, it’s important to keep that in context. And, so, another objective of the workshop also is to examine the social determinants of health and how they interact with genetics to define racial and ethnic health disparities. And, then, lastly, what we call this whole burgeoning field now of what’s called implementation science, which is basically, how do we operationalize these various different things to go from actually a concept to an intervention, something that’s actually going to work, something that’s going to actually be pragmatic and feasible.

Q: I’m guessing you mean sort of like the translational aspect of theory versus application, correct?

Dr. Rischard: Yep, yep. So, all these things that we’re talking about, it can be applied, I think. And this is sort of why I wanted to broadcast this event out on a global level. A lot of the speakers are just talking from their own area of expertise, which might be completely unrelated to pulmonary hypertension. But, I think, nevertheless, we can sort of narrow the scope down towards the end of their talk. And it may be that the subject matter might be broadly applicable to other fields and people who are interested in DEI initiatives, health disparities, etcetera. You know, researchers, oftentimes, even basic scientists, are interested in this. And it has a lot to do, as I mentioned, with the way that we think about and hypothesize our genetic based research. Right? It’s about how we start a project from the get-go and how we conceive of the organization of a project.

Q: It sounds a little bit like the advice you were giving the early-career faculty who attended a week or so ago the inaugural DOM Research Career Development Workshop. In a sense, it’s like there are new ways to do things, and you have to think about them and look also at the old ways in which you did things, and see if you find biases in how you did it, to see if there are disparities in how you’re looking at things or resulting from the way you looked at it or didn’t previously.

Dr. Rischard: Yeah.

Q: Is there anything you’re hoping to achieve out of this? What happens afterwards? Do you write up a paper or what?

Dr. Rischard: Yeah, so NHLBI actually has a writing staff. Dr. Jane Leopold, from Brigham & Women’s Hospital, and I will ask for an update on presenters’ abstracts. We’ll collate that as well as discussion that occurs. We go out for ample time for discussion, and they’ll be taking minutes and things of that sort. NHLBI, that is. And,then, the staff writer from NHLBI starts a position paper, basically a workshop summary, and our hope is that it’s going to foster more collaboration between investigators, as well as potentially new grants, new opportunities through NHLBI to study and define these issues more clearly to improve future research.

See the event summary, full agenda and register at this link.

• Day 1 event listing for NHLBI workshop.
• Day 2 event listing for NHLBI workshop.

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“Inaugural DOM Research Career Development Workshop with Dr. Franz Rischard” | Posted Sept. 20, 2024