Conversation with Dr. Yun-Chi Chen, Morgan State University

Applying a Diverse Scholarly Background to Health Disparities Research in Baltimore City

NIMHD’s Conversations with Researchers Advancing Health Equity

May is Asian American, Native Hawaiian and Pacific Islander Heritage Month. As we celebrate the significant contributions to America—from its history through present day—by people who represent Asian American and Pacific Islander communities, we recognize researchers who are promoting health equity through their work to advance the science of minority health and health disparities.

Meet Yun-Chi Chen, Ph.D., principal investigator in minority health and health disparities research.

Dr. Yun-Chi Chen

Dr. Yun-Chi Chen is an associate professor of biology at Morgan State University and the PI for the ongoing project, “HIV/HCV-related health disparities in Baltimore: from community to lab bench,” one of the research projects associated with the NIMHD-funded “RCMI@Morgan: Center for Urban Health Disparities Research and Innovation.”

His research career spans multiple areas of biology, including immunology, virology, microbiology, molecular and cellular biology, vaccinology, epidemiology and preventive medicine. His Master’s research into dengue earned him multiple invitations to speak at international dengue conferences and a place within the top ten finalists worldwide in the Bill and Melinda Gates Foundation Dengue Vaccine Initiative grant competition. While at Oxford, he successfully conceived and proved innovative ways of generating a viral vaccine that is much more immunogenic and, at the same time, a lot less toxic than what was currently available. In 2012, he presented at the 41st Autumn Immunology Conference in Chicago, IL, and won the “Nature Immunology Award.”

In his current position at Morgan State University, he has appeared as the first author or senior author on numerous papers in 2016, 2019, 2020, and 2022. Much of his current research focuses on working with a cohort of people living with or at risk of HIV in urban Baltimore and rural Maryland to study hepatitis C, sexually transmitted infections, and drug use.

His group is also working with a cohort of hospitalized COVID-19 patients to study various aspects of health disparities. On May 13, 2021, Dr. Chen presented his talk, “Hepatitis C in HIV-infected Men: A Health Disparities Perspective,” organized by the NIH. This research combines his varied academic background with his passion for positively impacting the lives of communities that have been historically disadvantaged by the medical community.

He earned his Ph.D. in virology and immunology from the University of Oxford, his M.S. in epidemiology from National Taiwan University, and two B.S. degrees, one in biochemical sciences and the other in zoology from National Taiwan University.

Q&A with Dr. Chen

What inspired you to become a researcher in minority health, health disparities, and health equity?
I have been most inspired by the visions of the late Dr. Clara I. Adams, President Dr. David Wilson, and Provost Dr. Hongtao Yu at Morgan State University. The power of their example motivates me to determinedly work to raise the caliber of education and research for people from minority communities.

I have always been interested in different social issues related to people from racial and ethnic minority communities, people from medically disadvantaged backgrounds, as well as the LGBTQ+ community. Thus, when I started my own lab, I was contemplating what research projects I should pursue that not only combine my diverse academic training and expertise but also would make important contributions and impact on the health of medically disadvantaged populations. I was inspired to take the city of Baltimore as my big lab and research the pressing health issues of the city. Thus, I decided to perform research on HIV and hepatitis, as Baltimore and Maryland are among those with the highest prevalence of these health problems.

HIV and hepatitis C virus not only disproportionately affect people of various racial and ethnic minority backgrounds but further deepen the health disparities among those who are infected. When the COVID-19 pandemic hit, which inevitably magnified the existing disparities in populations most at risk of severe COVID-19 infection, I took on the unprecedented challenges and tasks and initiated several new research projects to tackle the health equity issues imposed by the pandemic.

What is your research goal, purpose and aim?
My research goal is to employ a multipronged approach to perform clinical, epidemiological, and basic biomedical studies to make important translational impact on the health disparities issues of HIV, hepatitis C, and other infectious diseases.

For hepatitis C research, we have studied the trends and factors associated with HCV acquisition, disease progression, and treatment uptake and effectiveness. Our published results provided important insights into the factors that caused the health disparities in hepatitis C in multiple risk groups and populations experiencing health disparities, especially among people living with HIV. Thus, my group has recently established two large community-based longitudinal study cohorts of people living with HIV and people at risk of HIV in urban Baltimore and several rural areas in Maryland. We will use these study cohorts to assess the trends of ongoing HCV epidemics and the uptake of the highly effective HCV treatment. Our goal is to monitor and determine whether “micro-elimination” of hepatitis C could be achieved in these longitudinal study cohorts.

In terms of HIV research, two of the major barriers to reduce health disparities among people living with HIV are the lack of a cure and increased inflammation-induced comorbidities. Thus, my lab is actively researching an important cellular reservoir for HIV, the monocytes/macrophages. We believe that a deeper understanding of the HIV reservoir will help identify innovative strategies to eliminate these reservoirs and potential cure strategies.

In addition, my lab has also been analyzing multiple inflammatory biomarkers and the distribution of monocyte subsets among HIV-infected and HIV-uninfected individuals in our study cohort. We wish to identify the relationship of the inflammatory biomarkers with the modulation of monocyte subsets to identify possible targets for ameliorating inflammation in HIV-infected individuals.

In addition, we are also using our study cohorts to determine the trends, factors, and barriers associated with the uptake of HIV pre-exposure prophylaxis (PrEP) for prevention of infection among people at elevated risks of HIV.

Regarding COVID-19 research, my lab has recently established a large longitudinal study cohort of patients who were ever hospitalized due to COVID-19, in collaboration with a large health care system with multiple hospitals situated in areas with major health disparities in Baltimore and Maryland. Our goal is to identify factors—especially social determinants of health associated with SARS-CoV-2 infection, COVID-19 hospitalization and mortality, as well as the disparities in occurrence of “long COVID”—over time.

How is your work advancing health equity? Are you seeing specific changes in the health disparities experienced by particular communities or groups?
Health disparities may have different root causes for different diseases and for different minorities or groups. Although HIV and HCV shared similar transmission routes, the populations that experience health disparities and the causes and strategies to mitigate the disparities are quite different. My ongoing work is to identify these differences for these two diseases to identify tailored strategies to tackle the disparities and improve health equity.

For example, HIV occurs disproportionately among gay men, especially young men of color, whereas hepatitis C is more likely to occur among those with drug use behaviors. Although there is an effective cure for HCV, a cure for HIV is yet to be developed. By contrast, although HIV PrEP is effective in preventing HIV infection, there are no vaccines or other prophylaxis available so far to prevent HCV.

These differences are further complicated by varying social determinants of health, health care access, and outcome continuums for the LGBTQ+ community, people of color, drug users, and those belonging to more than one of these groups. The complex relationships between the risk behaviors, prevention and treatment, and structural discrimination further stress the importance of using tailored and multipronged approaches to address and tackle different issues of health disparities. These are the reasons that I believe that my research will advance the health equity of people living with HIV, HCV, or both through identification of the unique root causes as well as “the disparities within and among disparities.”

One of the most encouraging findings in my work is that we identified a continuous and dramatic decline in the prevalence of hepatitis C among Black HIV-infected men over time since 2004, in a large community-based cohort of people living with HIV in urban Baltimore and the rural Eastern Shore of Maryland. This declining trend is especially remarkable among Black men younger than 40, but not observed among men of other racial groups. As a result, the disparities in HCV prevalence between Black individuals and people of other racial backgrounds continued to decrease and became minimal in recent years.

Our findings support the contention that racial health disparities could be mitigated and racial health equity achieved for an infectious disease. More importantly, we also identified that the decrease in HCV prevalence among young Black HIV-infected men correlated with a reduction in injection drug use and an increased proportion of men who had attained a higher level of education. Thus, our findings support that improving a social determinant of health (e.g., education) could have crucial impact on health equity through eliminating behavioral risks (e.g., injection drug use). Likewise, one of our published papers also reported that higher educational attainment was associated with hepatitis C treatment initiation among HIV-infected men.

However, some of our findings were alarming. Our analyses also found a surge in incident HCV infection in recent years among HIV-infected homosexual men, regardless of race, who did not inject drugs but had recreational “polydrug use.” Notably, high-risk sexual behaviors not only resulted in HIV and HCV, but also multiple other sexually transmitted infections.

Furthermore, one of our findings showed an emerging HCV epidemic among young White men living with HIV in rural Maryland, which appeared to correlate with increased prevalence of injection drug use and to coincide with the opioid epidemic.

From the research you are doing, what has surprised you about the discoveries from your lab and its impact?
For this, I would like to use some examples from our research on COVID-19 health disparities through a comprehensive systematic review and meta-analysis. We analyzed the racial disparities in the COVID-19 outcome continuum (i.e., infection, hospitalization, ICU admission, and mortality), comparing African American communities with other groups as well as Hispanic communities with other individual non-Hispanic racial groups. Our analyses revealed the somewhat surprising “African American paradox” and “Hispanic paradox” in different COVID-19 health outcomes.

For African American communities, the risks of getting the infection, hospitalization, and infection fatality were higher compared with other racial and ethnic communities. However, there was no differences between racial and ethnic communities once the patients received hospital care. More importantly, our results showed that the disparities for African American communities for all COVID-19 health outcomes were mitigated later in the pandemic, possibly due to controlling for certain social determinants of health.

Remarkably, although Hispanic communities had the highest risk of becoming infected, they had lower risks in all other COVID-19 health outcomes compared to all other non-Hispanic groups. In addition, the prevalence of most of the comorbidities were also lower among Hispanic communities. After adjusting for comorbidities and COVID-19 clinical presentations—but not social determinants of health—the lower risks of hospitalization, infection fatality, and in-hospital mortality among Hispanic communities were no longer observed.

Thus, social determinants of health played a more dominant role than comorbidities in worsened COVID-19 outcomes among African American communities, but not Hispanic communities, whereas lower prevalence of comorbidities contributes more than social determinants of health to the improved COVID-19 outcomes among Hispanic communities. Our findings suggest that COVID-19 racial health disparities and their causes are complex and vary among racial and ethnic groups. More studies are warranted.

How do we encourage the next generation of scientists?
First, diversify and do not limit your research interests, trainings, and capabilities. Health disparity and health equity are complex issues that require research in multiple aspects and from different angles. These issues will be most effectively addressed at different levels by using different research approaches.

Although my Ph.D. and postdoctoral trainings were in the basic sciences of virology and immunology, I had solid training in epidemiology for my M.S. degree from National Taiwan University. The expertise proved very useful when I entered the field of health disparities research. The “diversity” in my expertise and research capabilities will enable translational research from basic biomedical sciences to clinical and epidemiological studies, and vice versa.

In addition, collaborations with experienced colleagues of high caliber will be very helpful. In this regard, I am very fortunate and most grateful for having wonderful collaborators Dr. Chloe Thio and Dr. Andrea Cox at Johns Hopkins University School of Medicine. They are not only my collaborators, but, more importantly, also my role models in my endeavors in HCV and HIV research. Their research contributes to the fields of HIV and HCV at many levels, from clinical medicine, population health, to basic biomedical sciences. I am most inspired by them and their research and will follow suit to make important contributions to health disparities research in HIV and hepatitis C.

What do you envision as the future of minority health, health disparities, and health equity research?
To achieve the best outcomes and largest impact of health disparity/equity research, it will require translational and multipronged research approaches that cut across different disciplines and “translate” research results in multiple directions. To this end, the efforts should aim at training the next generation of scientists in diverse areas of research expertise and fostering collaborations and forming networks of researchers with different expertise and from diverse disciplines to tackle a particular and well-defined issue of minority health and health disparities/equity.

In fact, disparities exist in almost all disease and health issues. Thus, researchers working on different fields of biomedical and health research should either address the issues of health disparities in their topics of research or at least put their research questions, hypotheses, results, and/or findings in the context and perspectives of minority health and health disparities/equity. It may prove effective for biomedical/health/health care funding agencies to request a statement of relevance to these issues in every research proposal. As such, more insights will be gained into the causes of and solutions to health disparities and strategies to improve minority health and health equity.

Page updated Jan. 12, 2024