You Have to C It 2 Dream It

Established in October 2021, C2DREAM is the Center for Chronic Disease Reduction and Equity Promotion Across Minnesota. It’s a collaboration between the University of Minnesota (U of M), Mayo Clinic, and Hennepin Healthcare Research Institute (HHRI), which seeks to explore the effects of interpersonal and structural racism on cardiovascular health inequities for people who are Black, Indigenous and people of color (BIPOC).

C2DREAM is one of nine nationwide initiatives to receive a $19,436,475 award from NIH’s National Institute on Minority Health and Health Disparities (NIMDH) for a 5-year study on researching health disparities and inequities. Research topics include looking at individual and community health practices that contribute to cardiovascular diseases such as diet, exercise, and smoking. It will also explore the root causes of health inequities, engage with community leaders, and develop the next generation of researchers.

Sandra Japuntich, PhD, LP; Andrew Busch, PhD, LP; Warren McKinney, PhD; Kate Diaz Vickery, MD, MSc; and Guillaume Onyeaghala, PhD, are leading the C2DREAM research at HHRI. Dr. Sandra Japuntich is a Clinical Psychologist Researcher in the Clinical Pharmacology and Toxicology Department, where she tackles how health systems can better address health inequities, tobacco use, and behavioral change. Dr. Andrew Busch is a Clinical Psychologist and Investigator in the Behavioral Health Equity Research Group digging into smoking cessation and behavioral clinical trials. Dr. Diaz Vickery is a Principal and Clinical Investigator and Co-Director of the Health, Homelessness, and Criminal Justice Lab, designing behavioral trials to measure the effectiveness of how behavioral and social needs are integrated into medical coverage.

As part of HHRI’s ongoing commitment to the career development of minority researchers, we are highlighting two early-stage BIPOC investigators at HHRI, Dr. McKinney and Dr. Onyeaghala, who are spearheading two of the C2DREAM pilot projects. Dr. McKinney is the Principal Investigator (PI) on a project researching “Cardiovascular disease and inactive status: a single center pilot to evaluate racial disparities in access to kidney transplant after being waitlisted.” Dr. Onyeaghala is the PI on the project “Identifying barriers and opportunities in microbiome research among African American kidney transplant recipients in Minnesota.”

Dr. McKinney’s equity research and working with the community

Dr. McKinney is a nonclinical nephrology researcher and the VP of Equity in Research at HHRI. He primarily focuses on organ transplantation and was initially recruited into the C2DREAM initiative under the wing of Dr. Japuntich working on one of the core projects around smoking cessation to create and tailor study materials to be more culturally sensitive, aligned, and responsive to communities of color.

He does this by getting user feedback, using inclusive, non-shaming language, and being mindful of larger systemic issues. Dr. McKinney shared his perspective, saying, “When you know you are targeting a community that’s experienced specific types of discrimination or historical, structural racism, then again, this is all going to change and be guided by the specific question. There are phrasings that might put the onus of disease progression on an individual rather than some type of social factor.”

After extensive pre-work, the smoking cessation study is about ready to start collecting patient data. Dr. McKinney continued, “…What we’re really trying to change is how the health system interacts with different patient groups, and to make sure that the best most recent evidence-based therapy is equitably provided to all groups. So, the disparities are not disparities because people of color are doing anything differently. It’s because something is being denied to them or not being provided, equitably, and without that support, they aren’t able to achieve the outcomes that you see [in] other groups.”

In addition to his work on smoking cessation, Dr. McKinney was awarded the pilot study to look at the link between cardiovascular disease and kidney transplant waitlist statuses. African Americans make up the largest group of minorities in need of an organ transplant from the U.S. Department of Health and Human Services HRSA, U.S. Organ Procurement and Transplantation Network (OPTN) as of October 31, 2022.

According to the data, “In 2021, non-Hispanic blacks made up 12.1 percent of the national population. [Yet], while 28.6 percent of the total candidates currently waiting for transplants are non-Hispanic blacks, they comprised 15.1 percent of organ donors in 2021.”

As part of this study, Dr. McKinney will be using community outreach as a tool to educate those affected most about the risk factors and treatment for heart and chronic kidney disease. To do this, he has partnered with the Twin Cities chapter of The Links.

The Links is one of the largest and oldest predominantly African American, not-for-profit service organizations in the United States with chapters across the globe. Through its mission of service, The Links is committed to helping the most vulnerable people in a community advance economically and culturally. One of their program areas is Health and Human Services to promote and facilitate programs that support good health and eliminate chronic health disparities that persist in African American communities.

Dr. McKinney and Dr. Onyeaghala participated in The Links event entitled, “EmpowHer for Heart & Kidney Health” on February 11 at Fellowship Missionary Baptist Church in Minneapolis, which was facilitated by The Links member and Hennepin Healthcare Family Medicine physician Allyson Brotherson, MD.

One thing Dr. McKinney has noticed in transplant research is the disparity between races in terms of active versus non-active time on organ transplant wait lists due to a number of factors like social support, declining health, and financial or housing instability.

“Our studies have shown that there are disparities and [around] how much inactive time people have based on race. So generally speaking, African Americans have more inactive time than non-African Americans, Latinos have more inactive time than non-Latino or non-African-Americans and my goal is to really get a better sense as to what is causing these transitions to inactive status, and then what can be done to reduce the time that patients are inactive,” he said.

What does Dr. McKinney hope for the overall future of the C2DREAM initiative? Communities of color have been underrepresented in many clinical trials, so that’s a big motivator for this initiative to drive more research and data around how people of color are impacted. “I think, at the close of the [smoking cessation] study…it is a significant accomplishment to have conducted and completed a study recruiting just people of color,” he said.

Dr. Onyeaghala is hopeful for the future of research

Dr. Onyeaghala is a microbiome and chronic disease researcher focusing on its connection to cancer, kidney disease, and chronic disease in general. He’s passionate about how the C2DREAM project can harness the positive and negative lived experiences and knowledge of everyday folks in the BIPOC community to create better health outcomes. He first noticed these health disparities when he began his first research project on the link between adverse events in kidney transplants and immunosuppressant dosages.

For example, if drug trials were primarily conducted on the Caucasian populations versus communities of color, the efficacy and dosages of the treatments could vary greatly based on different distributions of genes in these groups. Genetic makeup can influence how drugs are metabolized in the body. However, if the sample size of your data doesn’t represent those different factors, you’re not able to get accurate drug dosages, which creates more negative health outcomes for communities of color.

“…if 25% of your population is African American, but in all of your studies, you have five or 10% representation, you’re taking a chance that those five or 10% are actually representative of your population, but you don’t know, right? And also, how can we improve how we’re currently doing things so that you feel represented in our research?”

Dr. Onyeaghala is hopeful about how listening to the feedback from the C2DREAM research studies can create more trust, input, and involvement in the community most impacted by this research. Hennepin County Medical Center (HCMC) is the perfect place to do this research as it serves the most diverse patient population in Minnesota with interpreters on staff speaking 71 languages. Listening and implementing community feedback will, in turn, create more honesty, transparency, and learning to ask better questions to get better results in serving the community: better results like the most effective pre-op and post-op treatment dosages for kidney transplant recipients in communities of color partnering with community organizations like The Links to cascade their learnings will help spread the word.

“If we don’t figure out a good way to get that [new research findings] into the hands of the community that…will benefit from it, [the knowledge will be limited]. This is a very exciting time for microbiome research and kidney transplantation. And that when we talk about it, you know, we stop saying, oh, African Americans have worse outcomes. But now we can say no, we have the tools to make sure that we did get the best outcomes possible.”