Clozapine rechallenge after neutropenia: a retrospective cohort study in the UK.

SAT0474 Racial differences in ssc disease presentation: a european scleroderma trials and research group study

Health disparities in regional anesthesia and analgesia for the management of acute pain in trauma patients.

Race, ovarian responsiveness, and live birth after in vitro fertilization

Background: REASSURE (NCT02141438) is a global, prospective, single-arm, observational study of Ra-223 use in patients with mCRPC with bone metastases within routine clinical settings. Using data from the second planned interim analysis, we compared baseline characteristics, survival, and safety outcomes among White, Black, and Asian patients treated with Ra-223 in the US subset of REASSURE. Methods: In this descriptive analysis (data collection 8-20-2014 to 3-20-2019), we examined baseline characteristics, OS, and safety outcomes for the US subset enrolled into REASSURE stratified by race (White, Black, Asian). Results: Of the 498 men in the US subset, 414 (83.1%) reported as White, 58 (11.7%) as Black, and 10 (2.0%) as Asian; race was not reported for 16 (3.2%) patients. Median age at study entry was 74.0, 69.5, and 71.0 years for White, Black, and Asian men, respectively. The proportion of patients whose prostate cancer was American Joint Committee on Cancer (AJCC) 7th edition stage III or IV at initial diagnosis was 45.2%, 58.6%, and 60.0% for White, Black, and Asian patients, respectively. The proportion of patients who completed 6 Ra-223 injections was similar across groups. Median duration of observation from the start of Ra-223 treatment was 11.3 months (range 0.4-41.3 months) for White patients, 14.9 months (range 0.7-39.1 months) for Black patients, and 20.5 months (range 4-27.7 months) for Asian patients. Median OS for White, Black, and Asian patients was 17.3 months (95% CI, 15.2-19.2 months), 19.5 months (95% CI, 12.9-27.1 months), and 21.8 months (95% CI, 3.58 months-not applicable), respectively. Any treatment-emergent drug related AE, treatment-emergent SAE, or drug-related SAE occurred in 45.2%, 41.4%, and 10.0% of White, Black, and Asian patients, respectively. Any-grade and grade ≥3 drug-related hematological TEAEs occurred in 8.4% and 5.3% of White patients, respectively, 15.5% and 12.1% of Black patients, respectively, and were not observed in Asian patients. Incidence of bone fractures was 4.1%, 3.4%, and 0% in White, Black and Asian patients respectively. Conclusions: This descriptive analysis of REASSURE found that Black patients were younger and presented with later-stage disease at diagnosis compared with White patients. A trend toward longer OS was seen in Black and Asian patients compared with White patients. AEs occurred at similar rates among groups. Drug-related hematological TEAEs, which have been reported with Ra-223 treatment, were more common in Black patients compared with White and Asian patients. Given the very small number of Asian patients enrolled in REASSURE, comparisons with this group should be interpreted with caution. Citation Format: Peter S. Conti, Oliver Sartor, Mary-Ellen Taplin, Daniel Y. Song, Saby George, Jeffrey Tomaszewski, John Sylvester, Constantine Mantz, Robert W. Given, Robert Brookland, Jeff Meltzer, Matthew J. Korn, Richard Andres, Svetlana Babajanyan, Celestia Higano. Baseline characteristics, safety, and efficacy of Radium-223 in metastatic castration resistant prostate cancer by race: Insights from the REASSURE US subset [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C160.

Risk factors for venous thromboembolism (VTE) in elderly patients with acute myeloid leukemia (AML) are not known by race. The aim of this study was to determine the association of VTE with known risk factors and the impact of VTE on mortality in elderly white, black and Asian patients with AML. The merged SEER-Medicare database (2000-2015) was used for patients aged at least 65 years diagnosed with AML. Multivariable logistic regression was used to examine the association of VTE with known risk factors and Cox proportional hazards regression was used to evaluate the association of VTE with mortality in white, black and Asian patients. Among 21 403 AML patients aged at least 65years, VTE was diagnosed in 10.6% of 18 731 white patients, 13.4% of 1362 black and 5.6% of 1310 Asian patients. Overall, the adjusted risk of VTE in black patients was similar to white patients, but Asian patients had a lower risk of VTE. Risk factors for VTE in white patients were age less than 75 years, female sex, chemotherapy and comorbid medical conditions, including hypertension, anemia, chronic kidney and lung disease, hyperlipidemia, heart failure and obesity. In black patients, hyperlipidemia, and heart failure and in Asian patients, age less than 75 years, female sex, chemotherapy and hypertension and myocardial infarction were associated with VTE. Central venous catheter placement was a predictor of VTE in all three races. Our study identified risk factors for VTE by race in elderly white, black and Asian AML patients.

Racial and ethnic differences in the presentation and outcomes of patients wait-listed with acute liver failure (ALF) have not been explored. Adult patients with ALF wait-listed for liver transplantation (LT) from 2002 to 2016 were investigated using the United Network for Organ Sharing database. Clinical characteristics and causative etiologies were compared between white, black, Hispanic, and Asian patients with ALF who were wait-listed as status 1. A competing risk analysis was used to explore differences in LT and wait-list removal rates. Kaplan-Meier survival curves were used to explore differences in 1-year posttransplant survival. There were 8208 patients wait-listed with a primary diagnosis of ALF; 4501 were wait-listed as status 1 (55.3% of whites, 64.4% of blacks, 51.6% of Hispanics, 40.7% of Asians; P<0.001). Black patients had higher bilirubin and Model for End-Stage Liver Disease at wait-listing than other groups. White patients were the most likely to have acetaminophen toxicity as a causative etiology, whereas black patients were the most likely to have autoimmune liver disease. Black patients were significantly more likely to undergo LT than white patients (hazard ratio, 1.20; 95% confidence interval, 1.08-1.30). There was no difference in wait-list removal because of death or clinical deterioration among racial/ethnic groups. The 1-year posttransplant survival was lowest in black patients (79.6%) versus white (82.8%), Hispanic (83.9%), and Asian (89.3%) patients (P=0.02). In conclusion, etiologies of ALF vary by race and ethnicity. Black patients with ALF were more likely to be wait-listed as status 1 and undergo LT than white patients, but they were sicker at presentation. The 1-year posttransplant survival rate was lowest among black patients.

Uptake of Novel Agents (NAs) As First-Line Treatments for Black and White Patients with Chronic Lymphocytic Leukemia (CLL) in the Veterans Health Administration (VHA): A Retrospective Cohort Study

Objective: Black endometrial cancer patients are more than twice as likely to die from their disease as White patients. This study sought to identify alterations in the proteome and transcriptome of primary tumor tissues from White and Black endometrioid endometrial cancer (EEC) patients associated with differential outcome. Methods: An integrated proteomic and transcriptomic analysis (LC-MS/MS and RNA-seq) was performed on White (n=13) and Black (n=17) EEC patient tissues. Significant and concordantly altered protein and transcript candidates were validated against publicly available RNA-seq data (TCGA UCEC) from White (n=216) and Black (n=49) EEC patients. Validated candidates were further correlated with overall (OS, n=356 White and Black patients) and progression-free survival (PFS, n=331 White and Black patients) to identify candidates significantly associated with differential disease outcome. Alterations of outcome-associated candidates were validated in an independent cohort of White (n=115) and Black (n=17) EEC patient transcript expression data. Results: We identified and validated 89 proteins and transcripts significantly altered between White vs Black EEC patients. Pathway analyses revealed candidates elevated in White EEC patients correlated with marked activation of molecular signaling pathways regulating viral infection, but inhibition of those regulating cell death and necrosis. Candidates elevated in Black EEC patients largely correlated with activation of cell viability and nucleic acid metabolism, but inhibition of cell death, glucose metabolism disorder and inflammatory signaling. Correlation with patient outcome measures revealed 11 candidates significantly associated with differential OS and 8 candidates with differential PFS in EEC patients. All outcome-associated candidates elevated in White patients significantly correlated with a low risk of poor OS and poor PFS (Hazard Ratio (HR) &amp;lt; 1, Wald p-value &amp;lt; 0.05). Conversely, the majority of outcome-associated candidates (88%) elevated in Black patients correlated with a high risk of poor OS and poor PFS (HR &amp;gt; 1, Wald p-value &amp;lt; 0.05). Several OS (27%) and PFS (75%) candidates remained significant after adjustment for disease stage and grade as well as myometrial invasion. Alteration trends for several OS (27%) and PFS (25%) candidates were validated in an independent cohort of White and Black EEC patients. Conclusions: Our analyses identified and confirmed molecular alterations between White and Black EEC patients, including outcome-associated candidates largely supportive of better outcome in White patients, but poor outcome in Black patients. These findings define molecular alterations in White and Black EEC patients consistent with the historic disparity of poor outcome for Black patients warranting further investigation of these candidates in Black EEC disease pathology. Citation Format: Nicholas W. Bateman, Elizabeth Dubil, Guisong Wang, Brian L. Hood, Tracy Litzi, Julie Oliver, Kathleen M. Darcy, Chad A. Hamilton, Thomas P. Conrads, George L. Maxwell. Proteome and transcriptome alterations in black endometrial cancer patients correlate with poor disease outcome [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5277. doi:10.1158/1538-7445.AM2017-5277

RATIONALE: Race and ethnicity affect sepsis outcomes in unclear ways. Existing data is conflicting, with some studies suggesting minority patients do worse, while others did not show a difference in outcomes between these groups. We sought to investigate whether inequalities exist in sepsis outcomes for different racial and ethnic groups in our large hospital system and to characterize how they may manifest. METHODS: We performed a retrospective cohort study of adults diagnosed with sepsis and discharged from any of Providence's 52 hospitals between January 1 and December 31, 2023. We grouped patients into ten different race/ethnicity groups including White, Black, Hispanic/Latinx, Black, Asian, Middle Eastern/North African, American Indian/Alaska Native, and other/unknown/chose not to disclose. Patient age, gender, insurance payer, and medical comorbidity groups were determined. In-hospital mortality, hospital length of stay (LOS), 30-day readmission rate, lactic acid level, sepsis order set usage, and initial, final, and maximum sequential organ failure assessment (SOFA) scores were abstracted from the electronic medical record. RESULTS: We identified 44,443 sepsis patients, of whom the mean age was 65.3 years and 52.7% were male. 65.2% were White, 17.0% were Hispanic/Latinx, 5.2% were Asian, 4.1% were Black, and 1.3% were Native American. White (67.9 years) and Asian (68.1 years) patients were of similar average age, while Black (59.4 years), Hispanic (57.2 years), and Native American (54.4 years) patients were younger. Hispanic/Latinx patients had a 2.46% lower mortality rate (p &amp;lt; 0.0001) than White patients. Black patients had a LOS of 0.63 days longer (p &amp;lt; 0.0001) than White patients on average, while Hispanic patients had a 0.51-day shorter LOS (p&amp;lt; 0.0001). Readmission rates were similar across groups. Black and Asian patients had higher initial, maximum, and final SOFA scores than Whites (p &amp;lt; 0.0001). Asian patients also had a higher lactic acid level by 0.13 mmol/L (p = 0.0001) than White patients. CONCLUSIONS: We noted a significant difference in the average age of each race/ethnicity group, meaning that despite similar mortality rates, Black and Native American patients on average present and die younger of sepsis than White patients. Similarly, age may account for much of the mortality benefit associated with the Hispanic/Latinx group. Further study investigating years of potential life lost may help better elucidate these disparities. Disparities in the severity of presenting illness of Black and Asian patients may be due to delayed recognition in the prehospital setting.

Racial factors play a significant role in SSc. We evaluated differences in SSc presentations between white patients (WP), Asian patients (AP) and black patients (BP) and analysed the effects of geographical locations. SSc characteristics of patients from the EUSTAR cohort were cross-sectionally compared across racial groups using survival and multiple logistic regression analyses. The study included 9162 WP, 341 AP and 181 BP. AP developed the first non-RP feature faster than WP but slower than BP. AP were less frequently anti-centromere (ACA; odds ratio (OR) = 0.4, P < 0.001) and more frequently anti-topoisomerase-I autoantibodies (ATA) positive (OR = 1.2, P = 0.068), while BP were less likely to be ACA and ATA positive than were WP [OR(ACA) = 0.3, P < 0.001; OR(ATA) = 0.5, P = 0.020]. AP had less often (OR = 0.7, P = 0.06) and BP more often (OR = 2.7, P < 0.001) diffuse skin involvement than had WP. AP and BP were more likely to have pulmonary hypertension [OR(AP) = 2.6, P < 0.001; OR(BP) = 2.7, P = 0.03 vs WP] and a reduced forced vital capacity [OR(AP) = 2.5, P < 0.001; OR(BP) = 2.4, P < 0.004] than were WP. AP more often had an impaired diffusing capacity of the lung than had BP and WP [OR(AP vs BP) = 1.9, P = 0.038; OR(AP vs WP) = 2.4, P < 0.001]. After RP onset, AP and BP had a higher hazard to die than had WP [hazard ratio (HR) (AP) = 1.6, P = 0.011; HR(BP) = 2.1, P < 0.001]. Compared with WP, and mostly independent of geographical location, AP have a faster and earlier disease onset with high prevalences of ATA, pulmonary hypertension and forced vital capacity impairment and higher mortality. BP had the fastest disease onset, a high prevalence of diffuse skin involvement and nominally the highest mortality.

Racial differences in epithelial ovarian cancer (EOC) might result in survival inequities. To evaluate enrollment and outcomes by race in Gynecologic Oncology Group (GOG) randomized clinical trials (RCTs) among patients with EOC. This cohort study used ancillary data from completed RCTs using protocols GOG-111, GOG-114, GOG-158, and GOG-172 under a data sharing agreement with National Research Group Oncology. Patients with stage III or IV EOC in first-line RCT protocol GOG-111 had suboptimally resected disease, whereas those in GOG-114, GOG-158, or GOG-172 had optimally resected disease. RCTs were conducted and published between 1996 and 2006, and data for this study were analyzed in August 2024. Race was categorized as Asian, Black or African American (Black), or White or Caucasian (White). Patients of other races were excluded. Spanish ethnicity and additional details regarding residual disease status were not available for analysis. Overall survival (OS) was the primary end point and progression-free survival (PFS) was the secondary end point, evaluated using multivariable Cox proportional-hazards modeling and log-rank testing. Statistical significance was set at P < .05. This study included 1903 evaluable participants, of whom 35 (1.84%) self-identified as Asian, 121 (6.36%) as Black, and 1747 (91.80%) as White. Black patients had lower OS (median [IQR], 36.8 [19.2-73.4] months) than Asian (50.9 [23.9-109.2] months) or White (48.4 [24.5-93.4] months) patients (P = .03), with a higher risk of death than White patients (adjusted hazard ratio, 1.30; 95% CI, 1.06-1.59; P = .01). PFS and adjusted risk of disease progression were statistically similar across racial groups. Median (IQR) PFS was 18.9 (9.7-84.6), 18.0 (9.1-34.0), and 19.7 (11.5-43.3) months among Asian, Black, and White patients, respectively (P = .08). Adjusted risk of disease progression was similar for Black patients compared with White patients (adjusted hazard ratio, 1.21; 95% CI, 1.00-1.47; P = .06). In this cohort study, Black and Asian patients were underrepresented in RCT trial populations. Black patients had lower OS than White and Asian patients but similar PFS. Equitable enrollment in clinical trials ensures access to cutting-edge treatments and can lead to outcomes comparable to those of White counterparts. Sustained efforts to improve RCT diversity remain essential to long-term equity in cancer care and survival.

Black and Hispanic populations have higher rates of coronavirus disease 2019 (COVID-19) hospitalization and mortality than White populations but lower in-hospital case-fatality rates. The extent to which neighborhood characteristics and comorbidity explain these disparities is unclear. Outcomes in Asian American populations have not been explored. To compare COVID-19 outcomes based on race and ethnicity and assess the association of any disparities with comorbidity and neighborhood characteristics. This retrospective cohort study was conducted within the New York University Langone Health system, which includes over 260 outpatient practices and 4 acute care hospitals. All patients within the system's integrated health record who were tested for severe acute respiratory syndrome coronavirus 2 between March 1, 2020, and April 8, 2020, were identified and followed up through May 13, 2020. Data were analyzed in June 2020. Among 11 547 patients tested, outcomes were compared by race and ethnicity and examined against differences by age, sex, body mass index, comorbidity, insurance type, and neighborhood socioeconomic status. Race and ethnicity categorized using self-reported electronic health record data (ie, non-Hispanic White, non-Hispanic Black, Hispanic, Asian, and multiracial/other patients). The likelihood of receiving a positive test, hospitalization, and critical illness (defined as a composite of care in the intensive care unit, use of mechanical ventilation, discharge to hospice, or death). Among 9722 patients (mean [SD] age, 50.7 [17.5] years; 58.8% women), 4843 (49.8%) were positive for COVID-19; 2623 (54.2%) of those were admitted for hospitalization (1047 [39.9%] White, 375 [14.3%] Black, 715 [27.3%] Hispanic, 180 [6.9%] Asian, 207 [7.9%] multiracial/other). In fully adjusted models, Black patients (odds ratio [OR], 1.3; 95% CI, 1.2-1.6) and Hispanic patients (OR, 1.5; 95% CI, 1.3-1.7) were more likely than White patients to test positive. Among those who tested positive, odds of hospitalization were similar among White, Hispanic, and Black patients, but higher among Asian (OR, 1.6, 95% CI, 1.1-2.3) and multiracial patients (OR, 1.4; 95% CI, 1.0-1.9) compared with White patients. Among those hospitalized, Black patients were less likely than White patients to have severe illness (OR, 0.6; 95% CI, 0.4-0.8) and to die or be discharged to hospice (hazard ratio, 0.7; 95% CI, 0.6-0.9). In this cohort study of patients in a large health system in New York City, Black and Hispanic patients were more likely, and Asian patients less likely, than White patients to test positive; once hospitalized, Black patients were less likely than White patients to have critical illness or die after adjustment for comorbidity and neighborhood characteristics. This supports the assertion that existing structural determinants pervasive in Black and Hispanic communities may explain the disproportionately higher out-of-hospital deaths due to COVID-19 infections in these populations.

Risk factors and mortality associated with venous thromboembolism in the elderly US population with chronic lymphocytic leukemia

Racial and ethnic disparities in uterine cancer survival are well-documented; however, limited data exist regarding the interplay of geography, diversity, and race and ethnicity in survival disparities. To examine associations of race and ethnicity with uterine cancer-specific survival according to geographic region and regional diversity. This retrospective cohort study included patients with uterine cancer diagnosed from 2000 to 2019, from 17 Surveillance, Epidemiology, End Results registries, grouped by US location and ranked according to the US Census Bureau's Diversity Index (DI; range, 0%-100%; higher values indicate greater diversity), a metric of racial and ethnic composition. Analyses were conducted from June 8, 2024 to October 30, 2024. Race and ethnicity of patients with uterine cancer, categorized as Asian, Black, Hispanic, and White. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% CIs for multivariable-adjusted associations of race and ethnicity with uterine cancer-specific survival (primary outcome) in the overall sample and stratified by location. Location-stratified models were used to examine whether associations of race and ethnicity with survival varied by tumor characteristics. Among 162 500 patients with uterine cancer (median [IQR] age at diagnosis, 61 [54-69] years), there were 12 226 Asian patients (7.5%), 14 007 Black patients (8.6%), 20 799 Hispanic patients (12.8%), and 115 468 White patients (71.1%). Cancer-specific survival was better among Asian patients (HR, 0.91; 95% CI, 0.86-0.97), worse among Black patients (HR, 1.34; 95% CI, 1.28-1.40), and not different among Hispanic patients (HR, 1.01; 95% CI, 0.97-1.06) compared with White patients. Location-stratified analyses found worse uterine cancer-specific survival among Black patients compared with White patients in both higher DI locations (California: HR, 1.34; 95% CI, 1.25-1.44; DI, 69.7%; New Jersey: HR, 1.34; 95% CI, 1.21-1.50; DI, 65.8%; Georgia: HR, 1.39; 95% CI, 1.26-1.53; DI = 64.1%) and lower DI locations (Louisiana: HR, 1.34; 95% CI, 1.16-1.54; DI = 58.6%; Connecticut: HR, 1.42; 95% CI, 1.17-1.72; DI, 55.7%; Iowa: HR, 1.71; 95% CI, 1.01-2.89; DI, 30.8%). Hispanic patients, compared with White patients, had worse survival in Hawaii (HR, 2.09; 95% CI, 1.28-3.42) and Georgia (HR, 1.44; 95% CI, 1.13-1.82), whereas Asian patients had better survival than White patients in California (HR, 0.91; 95% CI, 0.84-0.97). In locations demonstrating survival disparities between Black and White patients, these patterns were evident in most tumor characteristic-defined strata. In this cohort study of patients with uterine cancer, racial and ethnic disparities in survival within specific geographic areas were identified. Targeted research may reduce national disparities.

Ethical Considerations Regarding the Use of Race in Pulmonary Function Testing