# Impact of Structural Racism and Discrimination on Liver Disease Disparities in High-Risk Asian American Populations

> **NIH NIH R01** · TEMPLE UNIV OF THE COMMONWEALTH · 2022 · $838,349

## Abstract

Impact of Structural Racism and Discrimination on Liver Disease Disparities in High-Risk
 Asian American Populations
Project Summary
Structural racism and discrimination (SRD) play an important role in shaping persistent health disparities,
including liver disease disparities among racialized Asian Americans (AAs). Despite comprising 7% of U.S.
population, AAs account for more than half of all Hepatitis B (HBV) infections in the U.S. Of 2.4 million Americans
infected with HBV, 58% are AAs who have the highest HBV prevalence of any racial/ethnic group. Despite CDC
and U.S. Preventive Services Task Force recommendations to screen Asian adults who are at high risk for
infection, a significant majority of AAs (~68-75%) have never been screened, remaining undiagnosed. SRD
manifests in structural inequalities by limited access to care, culturally and linguistically appropriate
services/resources, social segregation, mistrust of health system, anti-Asian racism, immigration and poverty in
AAs. Most SRD research has examined how structural racism and multilevel determinants disadvantaged
healthcare access for Black/African Americans and Latinx, few have included AAs. Our preliminary studies
among Chinese, Korean and Vietnamese indicated that HBV screening and linkage to care disparities are
attributable to the intersection of multilevel structural barriers. During COVID-19 pandemic, barriers to care for
AAs are increasingly affected by anti-Asian racism, hate crimes and discrimination at each level, which impedes
HBV screening and care and exacerbates liver disease disparities. The overall goal of this innovative and timely
study is to identify structural racism and protective factors in relation to liver disease disparities and impact of
SRD on health outcomes by Asian Americans. Guided by an adapted multilevel Socio-Ecological Model, we will
leverage 20-year established Regional Cancer Health Disparities Networks to collaborate with community-based
organizations and clinical partners in greater Philadelphia and NYC. Specifically, our multidisciplinary team will
use mixed methods to: 1) examine the longitudinal association of individual-level SRD lived experiences (e.g.,
COVID-19 Anti-Asian racism, socio-historical trauma, cultural stereotype racism) and HBV screening and care
among 2000 Asian Americans: Chinese, Korean and Vietnamese; 2) examine the impact of institutional-level
SRD in healthcare settings (e.g., Anti-Asian racial bias, resources for patient navigators) on HBV screening
uptake and care; and 3) elucidate the impact of community-level SRD (e.g., Anti-Asian racism/xenophobia and
residential segregation) and protective factors (e.g. residence, social norms/advocacy and neighborhood social
cohesion) on impeding or promoting screening and care. Finally, we conduct integrative analysis to examine
whether individual, institutional and community-level SRD are associated with HBV screening uptake and linkage
to care. This is the first multilevel,...

## Key facts

- **NIH application ID:** 10474736
- **Project number:** 1R01MD017521-01
- **Recipient organization:** TEMPLE UNIV OF THE COMMONWEALTH
- **Principal Investigator:** GRACE X. MA
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $838,349
- **Award type:** 1
- **Project period:** 2022-09-15 → 2027-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10474736

## Citation

> US National Institutes of Health, RePORTER application 10474736, Impact of Structural Racism and Discrimination on Liver Disease Disparities in High-Risk Asian American Populations (1R01MD017521-01). Retrieved via AI Analytics 2026-06-01 from https://api.ai-analytics.org/grant/nih/10474736. Licensed CC0.

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