Biostatistician Krystal Hunter Delves into Health Disparities

Krystal Hunter '21, Ph.D., is a biostatistician at Cooper Research Institute, where she plays a pivotal role in shaping the statistical framework of clinical studies. Her expertise ensures that data collected in research is robust and reliable, helping physicians and researchers accurately test their hypotheses and avoid misleading results. Hunter delves into critical issues like health disparities, and her work seeks to uncover and address these inequities. Through her research, Hunter aims to bridge the gaps in maternal and general health, advocating for a more holistic approach to understanding and improving patient outcomes.

She received her bachelor's in Economics from Spelman College in Atlanta, Georgia, her MBA from Rutgers University Graduate School of Management, and her Ph.D. in Business Data Science at NJIT.

Q: What is your role as the lead biostatistician for a research hospital?

A: If a physician notices a phenomenon in a segment of the patient population, he or she may initiate a research study to examine the characteristics of those affected by it. A surgeon may notice, for example, a high rate of surgical site infections with a type of suture. As a biostatistician, I help set up the statistical plan for the study, including the statistical tests that will be run to test the hypothesis. I also provide a sample size to ensure that there is enough data within the study to avoid a false negative result due to a lack of sample.

At the end, I analyze the numbers using the methodology I outlined. I also help administer survey studies where I quality-check the data (looking out for double-barreled or confusing questions) in research and process improvement surveys of patients and staff.

Q: What's at stake?

A: Making sure that we collect the correct data that will enable the team to answer their research question. What if we spend years collecting data and can't use it? Not only does that waste resources, it also can present an ethical issue as we either exposed study participants to risk without reporting a result or we risked confidentiality when doing a review study of health records. It's also important that we look at the collected data and are aware of confounders.

Let's say we're looking at the relationship between the outcome of chronic pain and age and find a statistically significant relationship between the two. But we also have another explanatory variable of arthritis. People with arthritis tend to be older. This bears the question: Is it truly age that is affecting chronic pain or is it the age-effect of arthritis?

Q: What is your focus as a researcher?

A: I'm focused on health disparities, and birth outcomes in particular. With pre-term births, for example, there's always been a disparity between white women and Black women, who are at higher risk. This includes Black women with high economic status. The gap between high and low economic status white women is large, but it's much tighter with Black women. Foreign-born Black women from sub-Saharan Africa have comparable rates of low-birth-weight babies with white women. Unfortunately, a study of low birth weight showed that foreign Black women were the only group where with each succeeding generation, their risk increases. The goal is to bridge those gaps.

Q: Did you unearth any data in your research that surprised you?

A: I found that with women of lower economic status, their optimal weight during pregnancy is slightly obese, indicating an obesity paradox. Being underweight or even a normal weight increases the risk of a pre-term birth with this group of women. The answer is not, however, to gain weight! These outcomes could be connected to malnourishment, substance abuse or other conditions contributing to weight loss. The obesity paradox has also been cited in cardiac patients. Another finding is that the disparity between low-risk Black and white women declined at freestanding clinics manned by midwives.

This could be that midwives take a more holistic approach to health and spend more time with their patients. They're also more cost effective, although insurance won't always pay for them.

Q: Are there possible factors we've yet to explore?

A: We need to look at health issues more holistically. While physical health is important, it's also important to examine social determinants of health, nutrition, mental health and lifestyle factors. As a researcher, I would love to examine the effect of systematic disadvantage over generations on birth outcomes in the United States and in other countries. Social disadvantage affects most aspects of life and affects access to opportunities. I believe that may account for disparities in maternal health, and health in general.

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