Tomi Akinyemiju

Overview:

Area of Expertise: Epidemiology

Dr. Akinyemiju is a social and molecular cancer epidemiologist with expertise in epidemiologic methods, translational research, health disparities and global health.  Her research interests focus on identifying the impact of social (such as access to healthcare) and biological factors (such as metabolic dysregulation), on cancer related risk, tumor aggressiveness and survival. She has a specific interest in understanding the causes of cancer disparities among women of African descent in the US and sub-Saharan Africa, given their significantly higher risk of aggressive cancer subtypes relative to other racial groups. To achieve these research aims, she utilizes data from population-based cancer registries, administrative claims, and existing cohort studies. Dr. Akinyemiju also leads several primary epidemiologic research studies. She is the PI of a case-control study of newly diagnosed breast cancer patients and healthy women in Nigeria designed to elucidate the impact of metabolic dysregulation, highly prevalent due to the epidemiologic transition, on hormone-receptor negative breast cancer subtypes and associated epigenetic mechanisms. In addition, Dr. Akinyemiju leads an R01 study designed to characterize racial differences across multiple healthcare access dimensions among US ovarian cancer patients, and evaluate the impact of differential healthcare on quality of initial and supportive treatment, and quality of life. A parallel line of research focuses on identifying lifestyle intervention strategies to improve metabolic health among breast cancer patients as a mortality prevention strategy. Dr. Akinyemiju is also passionate about promoting inclusion and diversity in research, teaching and service, and serves as the Vice-Chair for Inclusion and Diversity at the Duke University Department of Population Health Sciences and as Associate Director for Community Outreach and Engagement at the Duke Cancer Institute. 

Positions:

Associate Professor in Population Health Sciences

Population Health Sciences
School of Medicine

Associate Research Professor of Global Health

Duke Global Health Institute
Institutes and Provost's Academic Units

Instructor in the Department of Obstetrics and Gynecology

Obstetrics and Gynecology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

Ph.D. 2012

University of Michigan, Ann Arbor

Grants:

Metabolic Syndrome and Epigenetic Markers of Breast Cancer in Nigerian Women

Administered By
Duke Global Health Institute
Awarded By
National Institutes of Health
Role
Principal Investigator
Start Date
End Date

Metabolic Syndrome and Epigenetic Markers of Breast Cancer in Nigerian Women

Administered By
Duke Global Health Institute
Awarded By
National Institutes of Health
Role
Principal Investigator
Start Date
End Date

Metabolic Syndrome and Epigenetic Markers of Breast Cancer in Nigerian Women

Administered By
Duke Global Health Institute
Awarded By
National Institutes of Health
Role
Principal Investigator
Start Date
End Date

Sociome: Integrating Social Determinants of Health and Multi-Omic Data to Predict Cancer Prognosis

Administered By
Population Health Sciences
Awarded By
Carnegie Mellon University
Role
Principal Investigator
Start Date
End Date

Publications:

Abstract PO-107: Racial differences in survival among advanced-stage non-small cell lung cancer patients who received immunotherapy: An analysis of the U.S. National Cancer Database (NCDB)

<jats:title>Abstract</jats:title> <jats:p>Background: Lung cancer is the most common cause of cancer death among men and women in the United States, with 85% of all cases characterized as non-small cell lung cancer (NSCLC). These cancers are often diagnosed at advanced stage due to inapparent clinical symptoms. In 2015, the Food and Drug Administration approved the first use of immunotherapy for NSCLC, and it has since become a standard modality for treatment among advanced-stage NSCLC patients. Although significant racial disparities have been documented in overall NSCLC survival, it is unclear whether these disparities persist upon equal utilization of immunotherapy. The purpose of this study was to evaluate the association between race and all-cause mortality among advanced-stage non-small cell lung (NSCLC) cancer patients who received immunotherapy. Methods: We obtained data from the 2016 National Cancer Database on patients diagnosed with advanced-stage (III-IV) NSCLC from 2015-2016. The NCDB is a joint project of the American Cancer Society and the Commission on Cancer of the American College of Surgeons, and captures 70% of all patients with newly diagnosed cancer in the United States. Multivariable Cox proportional hazards models were used to calculate hazard ratios (HR) and 95% confidence intervals (95% CI) by race/ethnicity. Additionally, we evaluated the interaction of race/ethnicity with Charlson-Deyo comorbidity score and area-level median income using stratified models and formal tests of interaction. Results: A total of 3,068 patients were included. NH-Black patients had a lower risk of death relative to NH-White patients (HR 0.85; 95% CI 0.74, 0.98) after adjusting for sociodemographic, clinical, and treatment factors. Formal tests of interaction evaluating race with Charlson-Deyo comorbidity score and race with area-level median income were nonsignificant. However, in stratified analyses, NH-Black vs. NH-White patients had a lower risk of death in models adjusted for sociodemographic factors among those with at least one comorbidity (HR 0.76; 95% CI 0.59, 0.98), and those living in regions within the two lowest quartiles of median income (HR 0.82; 95% CI 0.69, 0.98). Conclusions: Among advanced-stage NSCLC patients who received immunotherapy, NH-Black patients experienced higher survival compared to NH-White patients. We urge the implementation of policies and interventions that seek to equalize access to care as a means of addressing differences in overall NSCLC survival by race.</jats:p> <jats:p>Citation Format: Anjali Gupta, Tomi Akinyemiju. Racial differences in survival among advanced-stage non-small cell lung cancer patients who received immunotherapy: An analysis of the U.S. National Cancer Database (NCDB) [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-107.</jats:p>
MLA Citation
Gupta, Anjali, and Tomi Akinyemiju. “Abstract PO-107: Racial differences in survival among advanced-stage non-small cell lung cancer patients who received immunotherapy: An analysis of the U.S. National Cancer Database (NCDB).” Cancer Epidemiology, Biomarkers &Amp; Prevention, vol. 31, no. 1_Supplement, American Association for Cancer Research (AACR), 2022. Crossref, doi:10.1158/1538-7755.disp21-po-107.
URI
https://scholars.duke.edu/individual/pub1522196
Source
crossref
Published In
Cancer Epidemiology, Biomarkers & Prevention : a Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology
Volume
31
Published Date
DOI
10.1158/1538-7755.disp21-po-107

Abstract PO-113: Overall survival in ovarian cancer patients seeking care at more than one treatment facility

<jats:title>Abstract</jats:title> <jats:p>Purpose: Ovarian cancer is the most lethal gynecological cancer and despite advances in treatment, most patients are diagnosed at an advanced stage with poor prognosis. Black women have a lower 5 year survival than White women when diagnosed at the same stage, and while there are a number of contributing factors, quality of treatment center may play a significant role. Choice in treatment facility may be limited by insurance coverage, availability of high-volume hospitals or specialists, or ability to access high-quality facilities, and it is unclear how a change in treatment facility may impact ovarian cancer survival. Methods: Participant usage files from the National Cancer Database were used to interrogate the characteristics of patients that seek treatment at more than one Commission on Cancer accredited facility in the United States to determine the effect on overall survival. Multivariable Cox regression analysis models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CI) to determine risk of mortality for patients receiving all of their first course treatment at one facility vs those receiving first course treatment at more than one facility. The fully-adjusted model was then stratified by race/ethnicity (Non-Hispanic White, Non-Hispanic Black, Hispanic) and by facility type (Community, Comprehensive Community, Academic/Research, Integrative Network). Results: A total of 211,937 women were included in the analysis. Patients were more likely to receive all of their first course treatment at one facility (81%). Patents treated at more than one facility had a 26% increase in ovarian cancer mortality compared with those treated at a single facility (HR: 1.26, 95% CI: 1.24-1.28). When stratified by race, NH-Black patients had the lowest increase in overall survival (HR: 1.08, 95% CI: 1.03-1.14) when compared with NH-White (HR: 1.27, 95% CI: 1.25-1.29) and Hispanic (HR: 1.33, 95% CI: 1.28-1.39) patients. Stratification by facility type showed that among women receiving treatment at more than one facility, those switching to an academic research center had the highest mortality (HR: 1.31, 95% CI: 1.28-1.34). Conclusions: Ovarian cancer patients that received treatment at more than one facility had a higher rate of mortality than those who were treated at a single center. Our findings suggest the need for further investigation into the effects of continuity of care, including how race, facility type, and other socioeconomic factors may modulate those effects.</jats:p> <jats:p>Citation Format: April Deveaux, Jessica Islam, Tomi Akinyemiju. Overall survival in ovarian cancer patients seeking care at more than one treatment facility [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-113.</jats:p>
Authors
Deveaux, A; Islam, J; Akinyemiju, T
MLA Citation
Deveaux, April, et al. “Abstract PO-113: Overall survival in ovarian cancer patients seeking care at more than one treatment facility.” Cancer Epidemiology, Biomarkers &Amp; Prevention, vol. 31, no. 1_Supplement, American Association for Cancer Research (AACR), 2022. Crossref, doi:10.1158/1538-7755.disp21-po-113.
URI
https://scholars.duke.edu/individual/pub1522197
Source
crossref
Published In
Cancer Epidemiology, Biomarkers & Prevention : a Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology
Volume
31
Published Date
DOI
10.1158/1538-7755.disp21-po-113

Abstract PO-178: Metabolic syndrome and risk of breast cancer by molecular subtype: Analysis of the Mechanisms for Novel and Established Risk Factors for Breast Cancer in Women of Nigerian Descent (MEND) study

<jats:title>Abstract</jats:title> <jats:p>Background: The African continent experiences the highest age-standardized breast cancer mortality globally, with Nigeria reporting the highest rate within the continent. Breast cancer in Nigeria is characterized by several striking epidemiological features. These cancers are disproportionately pre-menopausal, diagnosed at late-stages with high-grade disease, and characterized by the highly-aggressive triple-negative subtype. However, few studies have focused on understanding the differentially patterned risk factors associated with high breast cancer burden among Nigerian women. Metabolic syndrome is characterized by a cluster of biological irregularities and is known to be a significant predictor of breast cancer incidence. The purpose of this analysis was to examine the association of metabolic syndrome with breast cancer and molecular subtypes among Nigerian women for first time. Methods: Metabolic syndrome was defined as having at least 3 out of 5 of: high blood pressure (≥130/85 mm Hg), reduced HDL (&amp;lt;50 mg/dL), elevated triglyceride (&amp;gt;150 mg/dL), high waist circumference (≥80 cm), and prior diagnosis of diabetes or elevated fasting glucose level (≥100 mg/dL). Among 296 newly diagnosed breast cancer cases and 259 healthy controls, multivariable logistic regression models were utilized to estimate adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) for the association between metabolic syndrome and breast cancer overall. Multinomial logistic regression models were used to evaluate each molecular subtype (Luminal A, Luminal B, HER2-enriched and triple-negative). Results: Cases compared to controls were significantly more likely to have metabolic syndrome (30% vs. 17%; p&amp;lt;0.001). After adjusting for age, socio-demographic and reproductive risk factors, there was a positive association between metabolic syndrome and breast cancer (aOR: 1.84, 95% CI: 1.07, 3.16). In stratified analyses, metabolic syndrome was associated with breast cancer regardless of BMI status; however, the estimate was significant only among normal weight women (aOR: 3.85; 95% CI: 1.25, 11.90). Metabolic syndrome was significantly associated with the triple-negative breast cancer subtype (aOR: 4.37, 95% CI: 1.67, 11.44); associations for other molecular subtypes were not statistically significant. Conclusions: Metabolic syndrome appears to be a robust risk factor for breast cancer, particularly for triple-negative breast cancer. Public health and clinical interventions can provide substantial benefits in reducing the burden of metabolic syndrome and preventing breast cancer among Nigerian women.</jats:p> <jats:p>Citation Format: Tomi Akinyemiju. Metabolic syndrome and risk of breast cancer by molecular subtype: Analysis of the Mechanisms for Novel and Established Risk Factors for Breast Cancer in Women of Nigerian Descent (MEND) study [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-178.</jats:p>
Authors
MLA Citation
Akinyemiju, Tomi. “Abstract PO-178: Metabolic syndrome and risk of breast cancer by molecular subtype: Analysis of the Mechanisms for Novel and Established Risk Factors for Breast Cancer in Women of Nigerian Descent (MEND) study.” Cancer Epidemiology, Biomarkers &Amp; Prevention, vol. 31, no. 1_Supplement, American Association for Cancer Research (AACR), 2022. Crossref, doi:10.1158/1538-7755.disp21-po-178.
URI
https://scholars.duke.edu/individual/pub1522198
Source
crossref
Published In
Cancer Epidemiology, Biomarkers & Prevention : a Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology
Volume
31
Published Date
DOI
10.1158/1538-7755.disp21-po-178

Abstract PO-123: Palliative care use among people living with HIV and cancer: An analysis of the National Cancer Database (2004-2018)

<jats:title>Abstract</jats:title> <jats:p>Background: Prior studies demonstrate that people living with HIV (PLWH) are less likely to receive any curative cancer treatment compared to their HIV-negative counterparts. Data regarding trends of palliative treatment use among PLWH with cancer are lacking. Timely intervention with palliative care can increase survival and improve patient-reported quality of life among all cancer patients, particularly those with metastatic disease. Our objective was to compare the use of palliative care by HIV status among patients with cancer in the United States. Methods: We used data from more than 19 million patients 18-90 years of age in the National Cancer Database diagnosed between 2004 and 2018. The eleven most common cancers diagnosed among PLWH were selected, including Kaposi Sarcoma, cancers of the head and neck, upper gastrointestinal tract, colorectum, anus, lung, female breast, cervix, and prostate, Hodgkin lymphoma, and diffuse large B-cell lymphoma (DLBCL). HIV status was determined from reported comorbidities using the ICD-9-CM diagnosis codes 04200-044.90, 07593, V0800 and ICD-10-CM codes B20-B22, B24, Z21. Palliative care was defined as any surgery, radiation, systemic therapy, or pain management treatment with non-curative intent. Multivariate logistic regression was used to examine associations between HIV-status and palliative care use by cancer site and stage-at diagnosis and adjusted for age at diagnosis, race/ethnicity, gender, insurance, geographic region, comorbidity index, and cancer diagnosis year. Results: The study population included 52,306 HIV-positive (Avg. age: 56.5 years) and 19,115, 520 HIV-negative (Avg. age: 63.7 years) cancer cases. PLWH with cancer were more likely to be Non-Hispanic (NH)-Black (35.1% vs. 10.8%, p&amp;lt;0.001) and Hispanic (11.2% vs. 5.6%, p&amp;lt;0.001) compared to HIV-negative cancer patients. PLWH with stage 1-3 cancer at diagnosis were more likely to receive palliative care compared to their HIV negative counterparts (aOR:1.96, 95% CI:1.80-2.14). Conversely, PLWH with stage-4 cancer at diagnosis were less likely to receive palliative care (aOR:0.70, 95% CI:0.66-0.74). When evaluated by cancer site, stage-4 lung (aOR:0.80, 95% CI: 0.73-0.87) and colorectal (aOR: 0.72, 95% CI: 0.54-0.95) HIV-positive cancer patients were less likely to receive palliative care than HIV-negative cancer patients. PLWH diagnosed with stage I-III cancer who received palliative care were less likely to receive curative cancer treatment (aOR:0.48, 95% CI:0.40-0.59). Conclusion: Overall, utilization of palliative care is low among PLWH with cancer. PLWH diagnosed with stage-four cancer, particularly lung and colorectal cancer patients, are less likely to receive palliative care compared to their HIV-negative counterparts. PLWH with non-metastatic disease are more likely to receive palliative care, reinforcing prior data that curative treatment is not offered. Efforts to address the overall low utilization and better understand disparate utilization by cancer stage among PLWH should be prioritized.</jats:p> <jats:p>Citation Format: Jessica Y. Islam, Leticia Nogueria, Gita Suneja, Anna Coghill, Tomi Akinyemiju. Palliative care use among people living with HIV and cancer: An analysis of the National Cancer Database (2004-2018) [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-123.</jats:p>
Authors
Islam, JY; Nogueria, L; Suneja, G; Coghill, A; Akinyemiju, T
MLA Citation
Islam, Jessica Y., et al. “Abstract PO-123: Palliative care use among people living with HIV and cancer: An analysis of the National Cancer Database (2004-2018).” Cancer Epidemiology, Biomarkers &Amp; Prevention, vol. 31, no. 1_Supplement, American Association for Cancer Research (AACR), 2022. Crossref, doi:10.1158/1538-7755.disp21-po-123.
URI
https://scholars.duke.edu/individual/pub1522199
Source
crossref
Published In
Cancer Epidemiology, Biomarkers & Prevention : a Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology
Volume
31
Published Date
DOI
10.1158/1538-7755.disp21-po-123

Association of aflatoxin B1 levels with mean CD4 cell count and uptake of ART among HIV infected patients: A prospective study.

BACKGROUND: Aflatoxin suppresses cellular immunity and accentuates HIV-associated changes in T- cell phenotypes and B- cells. OBJECTIVE: This prospective study was conducted to examine the association of aflatoxin levels with CD4 T-cell count and antiretroviral therapy uptake over time. METHODS: Sociodemographic and food data were collected from antiretroviral therapy naïve HIV-infected patients. CD4+ counts were collected from participants' medical records. Plasma samples were tested for aflatoxin B1 albumin adducts, hepatitis B surface antigen, and HIV viral load. Participants were separated into high and low aflatoxin groups based on the median aflatoxin B1 albumin adduct level of 10.4 pg/ml for data analysis. RESULTS: Participants with high aflatoxin B1 albumin adduct levels had lower mean CD4 at baseline and at each follow-up period. Adjusted multivariable logistic regression analysis showed that higher baseline aflatoxin B1 adduct levels were associated with statistically significant lower CD4 counts (est = -66.5, p = 0.043). Not starting ART and low/middle socioeconomic status were associated with higher CD4 counts (est = 152.2, p<0.001) and (est = 86.3, p = 0.027), respectively. CONCLUSION: Consistent correlations of higher aflatoxin B1 adduct levels with lower CD4 over time indicate that there is an independent early and prolonged effect of aflatoxin on CD4 even with the initiation of antiretroviral therapy. The prospective study design, evaluation of baseline and follow-up measures, extensive control for potential confounders, and utilization of objective measures of aflatoxin exposure and CD4 count provide compelling evidence for a strong epidemiologic association that deserves careful attention in HIV care and treatment programs.
Authors
Jolly, PE; Akinyemiju, TF; Sakhuja, S; Sheth, R
MLA Citation
Jolly, Pauline E., et al. “Association of aflatoxin B1 levels with mean CD4 cell count and uptake of ART among HIV infected patients: A prospective study.Plos One, vol. 17, no. 1, 2022, p. e0260873. Pubmed, doi:10.1371/journal.pone.0260873.
URI
https://scholars.duke.edu/individual/pub1510141
PMID
35085253
Source
pubmed
Published In
Plos One
Volume
17
Published Date
Start Page
e0260873
DOI
10.1371/journal.pone.0260873

Research Areas:

Cancer
Epidemiology
Epigenetics
Global health
Health Disparities
Molecular Epidemiology
Social Determinants of Health