Capstone 2016 – Asra Khalid

Presented December 15, 2016, Asra Khalid’s Capstone explored treatment utilization among patients with—the most common form of liver cancer in the U.S.—Hepatocellular Carcinoma (HCC). Over the past few decades, the incidence rate has increased over three-fold. While early detection and treatment remains the key goal in improving outcomes for patients with this form of cancer, significant racial/ethnic and socioeconomic disparities complicate progress.

Asra’s objective was to compare receipt of HCC treatment and overall mortality by race and income characteristics using a large commercial insurance database. Conducting a cross-sectional analysis, the data revealed that even when insured at the same level, significant racial and income disparities exist in treatment utilization among patients with HCC

Significant discoveries include:

• HCC treatment is underutilized even in a large population of insured patients with a treatment rate of only 35.57%. 
• Out of the total population, whites are more likely to receive treatment as compared to other racial groups even after adjusting for comorbidities and other patient factors.
• Patients with high income level (i.e. 400% above the Federal Poverty Level) are 60% more likely to receive treatment than patients with low income level (i.e. at or below Federal Poverty Level)  
• Whites and patients with high income level are more likely to receive curative treatment rather than noncurative treatment. 

While disparities in treatment selection and outcomes may be influenced by biological, health care utilization and insurance status reasons, consideration for racial/ethnic and socioeconomic differences is essential to developing successful prevention, screening and treatment initiatives in the future.

Learn more about Asra's Capstone experience. 

Asra Khalid

What led you to your topic? 

I initially started working with Dr. Steve Scaglione (Hepatologist at Loyola University Medical Center) on hepatology research. He introduced me to Leanne Metcalfe (Senior Director of the HealthCare Services Corporation’s (HCSC) Center for Collaborative Research). I was offered a graduate research fellowship at HCSC. There, I assisted in investigating the epidemiology, risk-factors and healthcare utilization of patients with chronic liver disease. My capstone project—aimed at leveraging the large employer-based, health insurance claims data to evaluate racial and income disparities in treatment utilization among patients with HCC—came almost naturally.

What did you enjoy most about completing your project? 

I enjoyed working closely with the HCSC analytical team on evaluating and reporting claims data based on the study objectives. HCSC’s dedicated analytical team works diligently to deliver valuable insights based on a lot of data. These insights are then translated into practices that improve patient’s health. The fellowship provided me with an opportunity to use my qualitative and quantitative skills for various research projects.

Why did you choose to pursue an MPH? 

I’ve always believed that an individual’s health status should not be a reflection of his or her ethnicity, income status, gender or neighborhood. Everyone, irrespective of their racial or socioeconomic background, should have equal access to adequate health care. I wanted to pursue an MPH as a means of addressing the issue of health disparities on a grand scale. During the program, I worked with various healthcare and non-profit organizations on issues of diversity, inclusion, and cultural competence. I have extensively researched healthcare disparities, focusing on diversity in clinical trials and treatment utilization. 

Where are you headed with your career? 

I accepted an Epidemiologist position with the State of Tennessee’s Health Department. I’ll be responsible for helping in data management and conducting various epidemiological evaluations and studies on population health. I’m confident the knowledge and abilities gained in my MPH program will serve me well as I hope to reduce population disparities in the future.

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A student’s Capstone project is a professional presentation, which demonstrates his/her ability to apply the program learning to a specific public health topic. Selected by the student, the project reflects a culmination of the course curriculum, field experience and independent study. This experience helps students explore their academic passions while preparing them for a competitive job market.