COVID-19 impacts on the breast cancer care pathway among systemically marginalized communities in Ontario.

358 The Impact of COVID-19 on Diabetic Ketoacidosis Patients

Questions have existed as to whether residential segregation is a mediator of racial/ethnic disparities in breast cancer care and breast cancer mortality, or has a differential effect by race/ethnicity. Data from the Surveillance, Epidemiology, and End Results-Medicare database on white, black, and Hispanic women aged 66 to 85 years with breast cancer were examined for the receipt of adequate breast cancer care. Blacks were less likely than whites to receive adequate breast cancer care (odds ratio [OR], 0.78; 95% confidence interval [CI], 0.71-0.86). Individuals, both black and white, who lived in areas with greater black segregation were less likely to receive adequate breast cancer care (OR, 0.73; 95% CI, 0.64-0.82). Black segregation was a mediator of the black/white disparity in breast cancer care, explaining 8.9% of the difference. After adjustment, adequate care for Hispanics did not significantly differ from whites, but individuals, both Hispanic and white, who lived in areas with greater Hispanic segregation were less likely to receive adequate breast cancer care (OR, 0.73; 95% CI, 0.61-0.89). Although Blacks experienced greater breast cancer mortality than whites, black segregation did not substantially mediate the black-white disparity in survival, and was not significantly associated with mortality (hazards ratio, 1.03; 95% CI, 0.87-1.21). Breast cancer mortality did not differ between Hispanics and whites. Among seniors, segregation mediates some of the black-white disparity in breast cancer care, but not mortality. Individuals who live in more segregated areas are less likely to receive adequate breast cancer care.

The purpose of this workshop was to bring together diverse stakeholders from the breast cancer research community to discuss critical issues related to disparities in breast cancer care and to identify potential strategies for reducing disparities and inequities in care through research. The workshop format included a series of formal content presentations, participation in break out groups that focused on specific topics highlighted in the content presentations, reporting back of findings and a facilitated discussion that focused on shaping a research agenda. The workshop members concluded that numerous groups of women are at increased risk for disparities in breast cancer care: many patients and survivors suffer disproportionately from inadequate access to high-quality diagnosis and treatment, resulting in more frequent and severe adverse outcomes from the disease. Research on breast cancer disparities provides a major opportunity for reducing the burden of breast cancer. Thus, it is important for the Breast Cancer Research Foundation and other research funders to consider how to best promote research focused on ensuring breast cancer health equity.

Aim: To evaluate clinical characteristics and alterations in the of patients admitted to the ocular emergency department (ED) of a tertiary hospital during coronavirus disease period in 2019 (COVID-19) and pre-pandemic period. Also, we intended to share our strategy and experience to prevent disease transmission to health-care staff during patient submission. Material and Method: In this study, 45901 patients who applied to ED between January and May in 2020 were reviewed retrospectively for ocular manifestations. The five months divided into two groups as the pre-pandemic period and the pandemic period. Clinical and demographic data were collected. The proportion of urgent and non-urgent cases in the pre-pandemic and pandemic period was compared. Results: A total of 30,576 patients (66.6%) admitted to ED before COVID-19 and 15,325 patients admitted (33.4%) during COVID-19 era. Five hundred thirty-eight (1.8%) of cases admitted in the pre-pandemic period, and 395 (2.6%) of the cases admitted in the pandemic period were in the real urgent category. Conjunctivitis, blepharitis and hordeolum, dry eye diseases, corneal diseases were the most common conditions in both pre-pandemic and pandemic periods. Conclusion: This study showed that admissions to ED for ocular conditions during the pandemic period decreased significantly, and the rate of real urgent cases increased. Yet even during the pandemic period, non-urgent patients continue to come to the ED.

IntroductionConflicting reports of increases and decreases in rates of preterm birth (PTB) and stillbirth in the general population during the COVID‐19 pandemic have surfaced. The objective of our study was to conduct a living systematic review and meta‐analyses of studies reporting pregnancy and neonatal outcomes by comparing the pandemic and pre‐pandemic periods.Material and methodsWe searched PubMed and Embase databases, reference lists of articles published up until 14 May 2021 and included English language studies that compared outcomes between the COVID‐19 pandemic time period and pre‐pandemic time periods. Risk of bias was assessed using the Newcastle–Ottawa scale. We conducted random‐effects meta‐analysis using the inverse variance method.ResultsThirty‐seven studies with low‐to‐moderate risk of bias, reporting on 1 677 858 pregnancies during the pandemic period and 21 028 650 pregnancies during the pre‐pandemic period, were included. There was a significant reduction in unadjusted estimates of PTB (28 studies, unadjusted odds ratio [uaOR] 0.94, 95% confidence [CI] 0.91–0.98) but not in adjusted estimates (six studies, adjusted OR [aOR] 0.95, 95% CI 0.80–1.13). The reduction was noted in studies from single centers/health areas (uaOR 0.90, 95% CI 0.86–0.94) but not in regional/national studies (uaOR 0.99, 95% CI 0.95–1.03). There was reduction in spontaneous PTB (five studies, uaOR 0.89, 95% CI 0.82–0.98) and induced PTB (four studies, uaOR 0.90, 95% CI 0.81–1.00). There was no reduction in PTB when stratified by gestational age <34, <32 or <28 weeks. There was no difference in stillbirths between the pandemic and pre‐pandemic time periods (21 studies, uaOR 1.08, 95% CI 0.94–1.23; four studies, aOR 1.06, 95% CI 0.81–1.38). There was an increase in birthweight (six studies, mean difference 17 g, 95% CI 7–28 g) during the pandemic period. There was an increase in maternal mortality (four studies, uaOR 1.15, 95% CI 1.05–1.26), which was mostly influenced by one study from Mexico. There was significant publication bias for the outcome of PTB.ConclusionsThe COVID‐19 pandemic time period may be associated with a reduction in PTB; however, referral bias cannot be excluded. There was no difference in stillbirth between the pandemic and pre‐pandemic period.

Impacts of the COVID-19 Pandemic on Assessment of M-Protein and Free Light Chain Levels in Patients with Multiple Myeloma

Background: Recent literature highlights the troubling racial divide in breast cancer mortality that continues to widen in most major cities across the country. Although significant progress has been made in improving overall breast cancer survival, disparities among racial, ethnic, and underserved groups still exist. Previous studies examine the breast cancer mortality disparity in the 50 largest U.S. cities, and Memphis demonstrates the largest breast cancer mortality disparity for African Americans (AA). The goal of this investigation is to quantify racial disparities in the context of breast cancer treatment in order to reduce disparities in recurrence and mortality for breast cancer in the city of Memphis, Tennessee. Methods: Patients with a biopsy- proven diagnosis of breast cancer over a 10 year period ending December 31, 2012 were obtained from the tumor registry of a university hospital system. Females of Caucasian and African-American race were included, while males, patients less than eighteen years of age, and patients with unknown histology, clinical stage, or type of surgery were excluded. Primary outcomes measured included overall survival and recurrence. Secondary outcomes examined were stage at diagnosis by race and time from diagnosis to surgery. Results: 3072 breast cancer patients were reviewed (41% AA). AA patients were more likely to have advanced (Stages II, III, or IV) clinical stage of breast cancer at diagnosis versus Caucasian patients. Of the 113 recurrences, 62% occurred in AA. Of the 676 deaths, 54% occurred in AA. After adjusting for race and clinical stage of breast cancer, AA breast cancer patients had a 2.0 higher odds of recurrence when compared to Caucasian breast cancer patients (95% CI 1.4, 3.0). AA breast cancer patients were 1.5 more likely to die compared to Caucasian breast cancer patients (95% CI: 1.2, 1.8), after adjusting for race, age at diagnosis, clinical stage of breast cancer, ER, PR, and HER2 status, and recurrence. AA women with stages 0, I, II, and III breast cancer all had a statistically significant longer median time from diagnosis to surgery (TDS) than Caucasian women. Conclusions: African-American patients were more likely to have advanced clinical stages of breast cancer at diagnosis versus Caucasian patients on a citywide level in Memphis. African-American breast cancer patients have a higher odds of recurrence and mortality when compared to Caucasian breast cancer patients, after adjusting for appropriate demographic and clinical attributes. Several factors have been suggested for the disparities including racial differences in access to and utilization of screening and treatment, risk factors distributed by race and socioeconomic status (SES), biological differences such as tumor aggressiveness, and cultural factors. More work is needed to develop, evaluate, and disseminate interventions to decrease inequities in timeliness of care for breast cancer patients. Citation Format: Elena M Paulus, Frances E Pritchard, Simonne S Nouer, Elizabeth A Tolley, Brandon S Boyd, Jesse T Davidson, Gitonga Munene, Martin D Fleming. Understanding disparities in breast cancer care in Memphis, Tennessee [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P4-14-07.

Rise in Blood Pressure Observed Among US Adults During the COVID-19 Pandemic

The association of the COVID-19 pandemic with the quality of ambulatory care is unknown. Hospitalizations for ambulatory care-sensitive conditions (ACSCs) are a well-studied measure of the quality of ambulatory care; however, they may also be associated with other patient-level and system-level factors. To describe trends in hospital admissions for ACSCs in the prepandemic period (March 2019 to February 2020) compared with the pandemic period (March 2020 to February 2021). This cross-sectional study of adults enrolled in a commercial health maintenance organization in Michigan included 1 240 409 unique adults (13 011 176 person-months) in the prepandemic period and 1 206 361 unique adults (12 759 675 person-months) in the pandemic period. COVID-19 pandemic (March 2020 to February 2021). Adjusted relative risk (aRR) of ACSC hospitalizations and intensive care unit stays for ACSC hospitalizations and adjusted incidence rate ratio of the length of stay of ACSC hospitalizations in the prepandemic (March 2019 to February 2020) vs pandemic (March 2020 to February 2021) periods, adjusted for patient age, sex, calendar month of admission, and county of residence. The study population included 1 240 409 unique adults (13 011 176 person-months) in the prepandemic period and 1 206 361 unique adults (12 759 675 person-months) in the pandemic period, in which 51.3% of person-months (n = 6 547 231) were for female patients, with a relatively even age distribution between the ages of 24 and 64 years. The relative risk of having any ACSC hospitalization in the pandemic period compared with the prepandemic period was 0.72 (95% CI, 0.69-0.76; P < .001). This decrease in risk was slightly larger in magnitude than the overall reduction in non-ACSC, non-COVID-19 hospitalization rates (aRR, 0.82; 95% CI, 0.81-0.83; P < .001). Large reductions were found in the relative risk of respiratory-related ACSC hospitalizations (aRR, 0.54; 95% CI, 0.50-0.58; P < .001), with non-statistically significant reductions in diabetes-related ACSCs (aRR, 0.91; 95% CI, 0.83-1.00; P = .05) and a statistically significant reduction in all other ACSC hospitalizations (aRR, 0.79; 95% CI, 0.74-0.85; P < .001). Among ACSC hospitalizations, no change was found in the percentage that included an intensive care unit stay (aRR, 0.99; 95% CI, 0.94-1.04; P = .64), and no change was found in the length of stay (adjusted incidence rate ratio, 1.02; 95% CI, 0.98-1.06; P = .33). In this cross-sectional study of adults enrolled in a large commercial health maintenance organization plan, the COVID-19 pandemic was associated with reductions in both non-ACSC and ACSC hospitalizations, with particularly large reductions seen in respiratory-related ACSCs. These reductions were likely due to many patient-level and health system-level factors associated with hospitalization rates. Further research into the causes and long-term outcomes associated with these reductions in ACSC admissions is needed to understand how the pandemic has affected the delivery of ambulatory and hospital care in the US.

Diabetic ketoacidosis (DKA) - a potentially preventable complication of type 1 diabetes mellitus (T1D) - is one of the most common chronic childhood diseases, and is associated with a significant risk of morbidity and mortality. The limited use of healthcare services due to fear of Coronavirus disease-2019 (COVID-19) transmission during the pandemic has raised concerns of delays in T1D diagnosis, among other diseases. This study investigated the presenting characteristics of newly diagnosed T1D patients assessed in a single clinic during the pandemic and compares them with the pre-pandemic period. For the purpose of this study, the first year of the pandemic is referred to as the “pandemic period”, and the previous three years as the “pre-pandemic period”. Patient files were reviewed retrospectively, the demographic and clinical characteristics and laboratory findings of the patients were recorded, and the findings from both periods were compared. The number of patients diagnosed with T1D in the pandemic period was 44, and in the pre-pandemic period 39 in 2017, 22 in 2018 and 18 in 2019. The two groups had similar age, sex, pubertal stage and anthropometric characteristics (p>0.05). Regarding the type of presentation, the frequency of DKA was significantly higher in the pandemic period (68.2%) than in the pre-pandemic period (40.5%) (p=0.006), and this difference was also observed in the comparison by years (p=0.016). The duration of symptoms (16.5±10.7 vs. 23.5±17.6 days) and the length of hospital stay (10±3.9 vs. 15.2±5.5 days) were significantly shorter in the pandemic period (p=0.032, and p<0.001, respectively). There was no difference in the frequency of severe DKA between the pandemic (46.7%) and the pre-pandemic (37.5%) periods (p>0.05). However, pH (7.17±0.16 vs. 7.26±0.14) and bicarbonate (12.8±6.3 vs. 16.6±6.3) levels were significantly lower in the pandemic period (p<0.005). Additional signs of infection on admission were less frequent in the pandemic period (9.1%) than in the pre-pandemic period (27.8%) (p=0.027). The groups did not differ in terms of hemoglobin A1c, C-peptide, concurrent thyroid autoantibodies and tissue transglutaminase antibodies (p>0.05). The rate of anti-glutamic acid decarboxylase positivity was higher in the pandemic period (73.8% vs. 39.2%) (p=0.001) while the frequency of other diabetes-associated autoantibodies was similar between the groups (p>0.05). The polymerase chain reaction test for COVID-19 was negative in six patients with a history of contact. There was an increased frequency and severity of DKA in children with newly diagnosed T1D in the pandemic period, and these findings justify concerns related to the diagnosis of other diseases during the pandemic. Studies to raise awareness of diabetes symptoms during the pandemic should be continued regularly to reach all segments of society. Our study provides an additional contribution to the literature in its coverage of the one-year period during the pandemic and its comparison with the previous three years.

To examine whether interpersonal aspects of patient-clinician interactions, such as patient-perceived medical discrimination, clinician mistrust, and treatment decision-making contribute to racial/ethnic/educational disparities in breast cancer care. A telephone interview was administered to 542 Asian/Pacific Islander (API), Black, Hispanic, and White women identified through the Greater Bay Area Cancer Registry, ages 20 and older diagnosed with a first primary invasive breast cancer. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated from logistic regression models that assessed associations between race/ethnicity/education, medical discrimination, clinician mistrust, and treatment decision-making with concordance to breast cancer treatment guidelines (guideline-concordant treatment) and perceived quality of care (pQoC). Approximately three-quarters of women received treatment that was guideline-concordant (76.6%) and reported that their breast cancer care was excellent (72.1%). Non-college-educated Black women had lower odds of guideline-concordant care (aOR (CI) = 0.29 (0.12-0.67)) vs. college-educated White women. Odds of excellent pQoC were lower among the following: college-educated Hispanic women (aOR (CI) = 0.09 (0.02-0.47)) and API women regardless of education (aORs ≤ 0.50) vs. college-educated White women, women reporting low and moderate levels of discrimination (aORs ≤ 0.44) vs. none, and women reporting any clinician mistrust (aOR (CI) = 0.50 (0.29-0.88)) vs. none. Disparities in guideline-concordant care and pQoC persisted after controlling for medical discrimination, clinician mistrust, and decision-making. Interpersonal aspects of the patient-clinician interaction had an impact on pQoC but not receipt of guideline-concordant treatment and did not explain disparities in either outcome. Although breast cancer survivors' interpersonal interactions with clinicians did not influence receipt of appropriate treatment, intervention strategies to improve patient-clinician relations may help attenuate disparities in survivors' pQoC.

Via bibliometric analysis, the research identifies the contextual vectors of the healthcare financial provision effectiveness. Moreover, we broaden the empirical substantiation of panel data regression modelling for 34 European countries. In particular, we define performance of public (budgetary) and private financing to reduce the mortality rate and raise life expectancy in pre-pandemic and pandemic periods. The systematization of existing literature sources and approaches to solving the problem is implemented by means of bibliometric and monographic analysis. Consequently, there are 6 contextual clusters of scientific research on determining the healthcare financial provision effectiveness in the modern science. Within the analysed works, researchers mainly study general prerequisites of the healthcare financial provision effectiveness. The optimal cost formation of medical services for diagnosing and treating diseases is reproduced as well. The issue urgency consists in analysing the efficient patterns of spending various funds to decrease the mortality rate and increase life expectancy in the pre-pandemic and pandemic periods. Subsequently, we detect some general parameters of healthcare resistance to counter shocks similar to the COVID-19 pandemic. In this paper, we show statistical analysis of mortality indexes (total and COVID-19). Among 34 European countries, the highest and lowest efficiency levels were identified within these parameters. The study empirical block constructs 8 regression models on panel data. They differ in dependent (mortality rate or life expectancy) or independent variables (block 1: current and capital healthcare expenditures in GDP; block 2: current healthcare expenditures), and modelling period (pre-pandemic – 2000-2019, pandemic– 2020-2022 or the current period). The modelling results represent financial drivers and change inhibitors of the mortality rate and life expectancy during the pandemic and pre-pandemic periods. Therefore, we established the most effective groups of healthcare expenditures, which is based on the country epidemiological situation. The obtained results can be useful for scientists, representatives of state and local authorities.

e17541 Background: The COVID-19 pandemic presented challenges for patients with ovarian cancer (OC). The objectives of this study were to compare patient remission outcomes following first-line treatment before and after the onset of the pandemic, and to evaluate potential racial/ethnic disparities in remission outcomes during the pandemic. Methods: This retrospective cohort study was conducted at Kaiser Permanente Southern California (KPSC), a large, integrated healthcare delivery system. Patients diagnosed with Stage I-IV epithelial ovarian cancer 01/01/2017-06/30/2021 were included. Pre and post pandemic periods were designated using 03/04/2020 as the cut-off. Data on cancer characteristics and treatment were obtained from KPSC’s electronic medical records. Chart review was conducted to collect data on complete and clinical remission (complete + partial remission) after first course of treatment. Imaging showing no evidence of disease and normal CA 125 values were used to define complete remission. Partial remission was defined as an incomplete response to therapy documented by the treating physician. Other variables included age and stage at diagnosis, race/ethnicity, Charlson’s comorbidity index, neighborhood deprivation index and prior membership. Modified Poisson regression with robust error variance was used to evaluate the association for the pandemic period and race/ethnicity with the remission outcomes. Results: Of 728 patients included, 531 and 197 patients were diagnosed in the pre-pandemic and pandemic periods, respectively. The distributions of the patients’ age, race, and stage were similar between the pre-pandemic and pandemic period. The cohort was racially/ethnically diverse: 46.0% White, 33.5% Hispanic, 7.4% Black, and 13.1% Asian. Complete remission was observed in 406 (76.5%) patients in the pre-pandemic period compared to 149 (75.6%) patients in the pandemic period (p=0.82). Clinical remission was observed in 473 (89.1%) patients in per-pandemic and 176 (89.34%) patients in pandemic period (p=0.92). No statistically significant associations were found between the remission outcomes and the pandemic in the adjusted models. Black patients had lower complete remission rates (but not lower clinical remission rates) compared to White patients in the pandemic period (p=0.06). Of note, Black patients had 67.6% complete remission rate in the pre-pandemic period whereas only 35.3% achieved complete remission in the pandemic period (p=0.01). However, the number of Black patients in the pandemic period was small (N=17). Conclusions: Overall, patients diagnosed with ovarian cancer achieved similar complete and clinical remission rates between the pre-pandemic and pandemic period. Complete remission varies across subgroups of patients. This finding needs to be further investigated with a larger sample.

The rate of patients undergoing tomography in the emergency department has increased in the last two decades. In the last few years, there has been a more significant increase due to the effects of the pandemic. This study aimed to determine the rate of patients who underwent chest imaging in the emergency department, the preferred imaging method, and the demographic characteristics of the patients undergoing imaging during the pre-pandemic and post-pandemic periods. This retrospective cross-sectional study included patients admitted to the emergency department between January 2019 and March 2023. The number of female, male, and total emergency admissions, the rate of patients who underwent chest X-ray (CXR) and chest computed tomography (CCT), and the age and gender distribution of the cases who underwent chest imaging were compared according to the pre-pandemic (January 2019-February 2020), pandemic (March 2020-March 2022), and post-pandemic (April 2022-March 2023) periods. Total emergency admissions were similar in the pre-pandemic and post-pandemic periods (pre-pandemic period: 21,984 ± 2087; post-pandemic period: 22,732 ± 1701). Compared to the pre-pandemic period, the CCT rate increased (pre-pandemic period: 4.9 ± 0.9, post-pandemic period: 7.46 ± 1.2), and the CXR rate decreased (pre-pandemic period: 16.6 ± 1.7%, post-pandemic period: 13.3 ± 1.9%) in the post-pandemic period (p < 0.001). The mean age of patients who underwent chest imaging (CXR; Pre-pandemic period: 56.6 ± 1.1 years; post-pandemic period: 53.3 ± 5.6 years. CCT; Pre-pandemic period: 68.5 ± 1.7 years; post-pandemic period: 61 ± 4.0 years) in the post-pandemic period was lower than in the pre-pandemic period (p < 0.001). Chest imaging preferences in the emergency department have changed during the post-pandemic period. In the post-pandemic period, while younger patients underwent chest imaging in the emergency department, CCT was preferred, and the rate of CXR decreased. It is alarming for public health that patients are exposed to higher doses of radiation at a younger age.

The purpose of the work is to study the process of formation of business structures in different regions of the world in the pre-pandemic and pandemic periods. The object of the study is the process of formation of business structures as integrated subjects of the global network economy. Methodology. The study uses the systematic method of cognition of processes and phenomena in their interconnection and development, as well as methods of statistical analysis used in the analysis of the formation of business structures in the pre-pandemic and pandemic periods. The results of the study reveal the features of the formation of new integration formations of network economy - business structures, which are understood as a complex open integrated system functioning in a dynamic globalized environment based on a combination of material and immaterial interests of member companies to accelerate joint development by accelerating the commercialization. joint innovation activities. It was found that the formation of business structures has become a modern global trend resulting from mergers and acquisitions (M&amp;A) of several enterprises. Practical implications. The practical results of the study allow us to analyze the formation of global business structures in the pre-pandemic period (2015-2018) and the pandemic period (2019-2020). Thus, in the pre-pandemic period there was an annual increase in the number of global business structures by an average of 5%. However, their value in 2018 compared to 2015 decreased by 5.85% to USD 0.449 trillion. The number of global business structures in the regional aspect for 2015-2020, despite the impact of the COVID-19 pandemic, increased annually only in North America (8.4% in 2020 compared to 2015). Other regions of the world saw an annual decline in the number of business structures. It was found that since 2019, due to the impact of the COVID-19 pandemic, the number and value of business structures in the world has continued to decline, which has become rapid. The annual decline in the number of global business structures during the 2019-2020 pandemic averaged 6.37%, and the annual decline in their value averaged 33.19%. The regions that lost the most business during the 2019-2020 pandemic were Western Europe (2%), Southeast Asia (1.2%), and Eastern Europe (0.8%). Value/originality. The value of the study lies in the fact that it allows to analyze global trends in the formation of business structures in the pre-pandemic and pandemic periods and to identify further prospects for their formation in different regions of the world, given the rapid decline in the number of business structures in the world.