Disparities in Access and Outcomes of Bilateral Reduction Mammaplasty (BRM): A Systematic Review.

P90. Racial disparities in surgical access and outcomes for oncologic spinal pathology: a multicenter study

Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder with significant racial and ethnic disparities in prevalence, disease severity, and outcomes. Cardiovascular complications, including pericarditis, myocarditis, valvular disease, and conduction abnormalities, contribute to increased morbidity and mortality in SLE patients. This study examines racial and ethnic disparities in cardiovascular outcomes among hospitalized SLE patients in the United States. Methods: This retrospective study utilized the National Inpatient Sample (NIS) database from 2016 to 2021 to analyze hospitalizations of adult patients (≥18 years) with a primary or secondary diagnosis of SLE. Patients were stratified into racial/ethnic groups: White, Black, Hispanic, Asian, Native American, and Other. Primary outcomes include major adverse cardiovascular events (MACEs), which are a composite of in-hospital mortality, myocardial infarction (MI), sudden cardiac death, and other SLE-related outcomes including cardiac, pulmonary, and renal involvement. Statistical analyses included multivariable logistic regression models adjusted for demographic, socioeconomic, and hospital-related factors to assess racial disparities. Results: The study included 514,750 White, 321,395 Black, and 146,600 Hispanic patients, with smaller proportions of Asian, Native American, and Other racial groups. Black patients had significantly higher odds of in-hospital mortality (OR = 1.17, 95% CI = 1.08–1.26, p < 0.001) and sudden cardiac death (OR = 1.64, 95% CI = 1.46–1.85, p < 0.001) compared to White patients. Asian patients also exhibited increased mortality risk (OR = 1.37, 95% CI = 1.14–1.63, p = 0.001) as compared to Whites. Conversely, Black (OR = 0.90, 95% CI = 0.85–0.96, p = 0.01) and Hispanic (OR = 0.87, 95% CI = 0.80–0.96, p = 0.03) patients had lower odds of MI. Racial disparities in access to care, socioeconomic status, and comorbidity burden may contribute to these differences. Conclusion: Significant racial and ethnic disparities exist in cardiovascular outcomes among hospitalized SLE patients. Black and Asian individuals face higher in-hospital all-causes mortality and sudden cardiac death risks, while Black and Hispanic patients exhibit lower MI rates. Addressing social determinants of health, improving access to specialized care, and implementing targeted interventions may reduce disparities and improve outcomes in minority populations with SLE.

Prior studies have demonstrated racial disparities in access to liver transplantation, but the determinants of these disparities remain poorly understood. We used geographic catchment areas for transplant centers (transplant referral regions, TRRs) to characterize transplant environment contributors to racial and ethnic disparities in liver transplant access. Data were obtained from the Scientific Registry for Transplant Recipients and the National Center for Health Statistics from 2015 to 2021. The primary outcome was the difference in the listing-to-end-stage liver disease death ratio between Black, Hispanic, and non-Hispanic White patients for each TRR. We accounted for demographics, socioeconomic status, health care access, organ availability, and transplant center competition using multivariable linear regression. We examined intra-TRR differences in waitlist composition using Levene's test of variance. Across the 66 included TRRs, Black patients had lower listing-to-end-stage liver disease death ratios than White patients in 80% of TRRs, while Hispanic patients had equal or higher listing-to-end-stage liver disease death ratios compared to White patients in 56% of TRRs. The majority of variation in racial disparities across TRRs remained unexplained by multivariable models. Disparities were attenuated after excluding patients with HCC-associated mortality. Among the 27 TRRs that contained more than one transplant center, variance across TRRs was statistically significant for Black and Hispanic waitlist composition. We observed substantial geographic variation in the magnitude of racial disparities in liver transplant access across the United States. Findings highlight the need for targeted health equity interventions in regions with high disparities and the development of disparity-sensitive access metrics for transplant centers.

e23097 Background: Cholangiocarcinoma presents significant treatment challenges, with racial and ethnic disparities influencing clinical outcomes. This study analyzes data from the National Inpatient Sample (NIS) from 2016 to 2021 to investigate racial disparities in major adverse cardiovascular and cerebrovascular events outcomes, mortality, and healthcare resource utilization among hospitalized cholangiocarcinoma patients. Methods: A retrospective cohort analysis was performed using the NIS database to identify adult cholangiocarcinoma patients. Demographic and clinical characteristics, including race, age, sex, socioeconomic status, and comorbidities, were compared across racial groups. Key outcomes included in-hospital mortality, myocardial infarction (MI), atrial fibrillation (A-fib), stroke, intracranial hemorrhage, and healthcare resource utilization. Multivariable logistic regression models adjusted for potential confounders to assess racial disparities in these outcomes. Results: Among 139 patients with cholangiocarcinoma, the racial distribution was White (67.4%), Black (10.8%), Hispanic (12.2%), Asian or Pacific Islander (6.2%), Native American (0.6%), and Other (3.6%). Black patients had significantly higher odds of mortality (OR 1.438, p < 0.001) and sudden cardiac arrest (OR 2.159, p < 0.001) compared to White patients. Hispanic patients had a lower risk of MI (OR 0.726, p = 0.046), while Black patients were more likely to experience stroke (OR 1.763, p < 0.001). Atrial fibrillation was significantly less common in Black (OR 0.469, p < 0.001), Hispanic (OR 0.492, p < 0.001), and Asian or Pacific Islander (OR 0.591, p < 0.001) patients. Black patients had the longest LOS compared to White patients (0.942 days, p < 0.001), while Native Americans had significantly longer LOS (1.64 days, p = 0.017). Hispanic and Asian groups had higher total hospital charges compared to White patients ($20,619.25, $18,181.22, and $24,200.53, respectively, p < 0.001). Conclusions: This study highlights significant racial disparities in cholangiocarcinoma outcomes, with Black, Native American, and Other racial groups experiencing higher mortality and adverse cardiovascular events. The lower incidence of MI and A-fib in Hispanic and Asian patients suggests potential protective factors, though disparities in stroke and sudden cardiac arrest persist.

e16165 Background: Esophageal cancer is a highly lethal malignancy with significant racial and ethnic disparities in clinical outcomes and healthcare utilization. Cardiovascular and cerebrovascular events, including myocardial infarction (MI), arrhythmias, and sudden cardiac arrest, add to the disease burden. This study uses the National Inpatient Sample (NIS) from 2016–2021 to investigate racial disparities in MACCE outcomes, mortality, and healthcare resource utilization among hospitalized esophageal cancer patients. Methods: A retrospective cohort analysis was performed using the NIS database to identify adult esophageal cancer patients. Demographic and clinical characteristics, including race, socioeconomic status, and comorbidities, were compared across racial groups. Primary outcomes included in-hospital mortality, MI, sudden cardiac arrest, stroke, and arrhythmia. Healthcare utilization metrics, including length of stay (LOS) and total charges, were also analyzed. Multivariable logistic regression models adjusted for potential confounders were used to assess racial disparities in these outcomes. Results: Among 229,963 esophageal cancer patients, the racial distribution included White (80.5%), Black (10.0%), Hispanic (6.2%), Asian or Pacific Islander (2.4%), Native American (0.5%), and Other (2.2%). Black (OR 1.148, p = 0.014) and Asian or Pacific Islander (OR 1.228, p = 0.038) patients had significantly higher odds of mortality compared to White patients. Black patients had a lower risk of MI (OR 0.72, p = 0.008) but were significantly more likely to experience sudden cardiac arrest (OR 2.206, p < 0.001). Hispanic (OR 1.398, p = 0.021) and Other racial groups (OR 1.688, p = 0.025) also had increased odds of sudden cardiac arrest. Atrial fibrillation was significantly less common in Black (OR 0.627, p < 0.001), Hispanic (OR 0.52, p < 0.001), and Asian or Pacific Islander (OR 0.476, p < 0.001) patients. Length of stay was significantly longer for Black (8.25 days), Hispanic (7.34 days), and Other (7.71 days) racial groups compared to White patients (6.79 days, p < 0.001). Hospital charges were highest among Hispanic ($107,531) and Asian or Pacific Islander ($109,164.6) patients compared to White patients ($84,753.53, p < 0.001). Conclusions: This study identifies significant racial disparities in esophageal cancer outcomes, with Black and Asian patients experiencing higher mortality and Black patients demonstrating an increased risk of sudden cardiac arrest. Differences in length of stay and hospital charges underscore healthcare inequities. These findings emphasize the need for targeted interventions to reduce cardiovascular risks and improve equitable healthcare access and outcomes for racial and ethnic minority populations with esophageal cancer.

Disparities in vascular surgery: Is it biology or environment?

Background: Therapeutic advances in breast cancer (BC) have led to an improved prognosis. However, significant differences in survival outcomes across diverse ethnicities exist. We aim to investigate the differences in demographics, tumor characteristics (cts) and survival outcomes among Hispanic patients (pts) as compared to Non-Hispanic White (NHW) pts. Methods: BC pts diagnosed between 1975-2016 were identified using the Surveillance, Epidemiology, and End Results (SEER) database, and demographic and clinical cts were analyzed. Cox regression models were used for univariate (UV) and multivariable (MV) analyses to evaluate the associations of race with disease-specific survival (DSS) and overall survival (OS) Results: A total of 806,704 (n=720,144 NHW, n=86,560 Hispanic) pts were analyzed. At the time of diagnosis, Hispanic pts were younger [median age 55 years (yrs) vs. 62 yrs], had a higher stage (III/IV=21.3% vs. 16.3%) and a higher grade (grade III/IV=43.3% vs. 35.3%) as compared to NHW pts (p<0.001). Hispanic pts were more likely to present with triple-negative BC (TNBC) (14.2% vs. 11.1%) and Her-2 receptor + BC (6.7% vs. 4.7%) than NHW pts (p<0.001). Hispanic pts were more likely to live in urban areas (95.6% vs. 87.9%) but had similar access to hospitals with oncology services/million population (4.1 vs 4.6) than NHW pts (p<0.001). Hispanic pts were more likely to be uninsured (4% vs.1.1%) with lower odds of undergoing BC surgery (92.8% vs. 95.4%) than NHW pts (p<0.001). On UV analysis, Hispanic pts had a slightly worse DSS [Hazard Ratio (HR) 1.05, 95% CI 1.03-1.07)], but had a better OS (HR 0.84, 95% CI=0.83-0.85) as compared to NHW pts (p<0.0001). On MV analysis controlling for demographic, tumor acts, and disparities in health care access, no significant differences were noted in DSS (HR 0.98, 95% CI=0.96-0.99) and OS (HR 0.99, 95% CI=0.98-1.01) between both groups. However, in pts age<50 yrs, Hispanic pts had a worse DSS (HR 1.17, 95% CI 1.13, 1.20) and OS (HR 1.16, 95% CI 1.13-1.19) than NHW pts. Additionally, worse DSS but not OS was noted in Hispanic pts with hormone receptor+/HER2- BC, pts who received chemotherapy and or surgery and married pts. Conclusions: Our study highlights that Hispanic BC pts appear to have a more aggressive tumor biology than NHW pts with younger age at onset, higher stage, and predominance of TNBC and Her 2+ BC. Although both ethnicities had similar access to health care services, lack of insurance might be a barrier for adequate health care utilization. Despite differences in disease biology, we observed similar survival rates in Hispanic and NHW pts. Interestingly, in pts age<50 yrs, Hispanic pts had a worse DSS and OS than NHW pts. Our findings suggest that racial disparities in outcomes could be related to differences in tumor biology, social status, treatment, and healthcare utilization patterns, especially in younger pts. Further studies are needed to elucidate the causes of racial disparities especially among the younger pt population and develop strategies to mitigate them. Citation Format: Medhavi Gupta, Rohit Gosain, Maithreyi Sarma, Stuthi Perimbeti, Attwood Kristopher, Wenyan Ji, Shipra Gandhi, Yara Abdou. Racial disparities in breast cancer characteristics and outcomes among Hispanic and White patients [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-221.

Is Race a Real Issue in Colectomy for Ulcerative Colitis?

Racial and socioeconomic disparities in health access and outcomes for many conditions is well known. However, for time-sensitive high-acuity diseases such as traumatic injuries, disparities in access and outcomes should be significantly diminished. Our primary objective was to characterize racial disparities across majority, mixed-race, and minority hospitals for African American ([AA] vs White) males with high-grade splenic injuries. Data from the National Trauma Data Bank were utilized from 2007 to 2015; 24 855 AA or White males with high-grade splenic injuries were included. Multilevel mixed-effects regression analysis was used to evaluate disparities in outcomes and resource allocation. Mortality was significantly higher for AA males at mixed-race (OR 1.6; 95% CI 1.3-2.1; P < .001) and minority (OR 2.1; 95% CI 1.5-3.0; P < .001) hospitals, but not at majority hospitals. At minority hospitals, AA males were significantly less likely to be admitted to the intensive care unit (OR 0.7; 95% CI, 0.49-0.97; P = .04) and experienced a significantly longer time to surgery (IRR 1.5; P = .02). Minority hospitals were significantly more likely to have failures from angiographic embolization requiring operative intervention (OR 2.2, P = .009). At both types of nonmajority hospitals, AA males with penetrating injuries were more likely to be managed with angiography (mixed-race hospitals: OR 1.7; P = .046 vs minority hospitals: OR 1.6; P = .08). While multiple studies have shown that minority hospitals have increased mortality compared to majority hospitals, this study found this disparity only existed for AAs.

Racial and socioeconomic disparities in health access and outcomes for many conditions are well known. However, for time-sensitive high-acuity diseases such as traumatic injuries, disparities in access and outcomes should be significantly diminished. Our primary objective was to characterize racial disparities across majority, mixed-race, and minority hospitals for African American (AA) versus white males with high-grade splenic injuries. Data from the National Trauma Data Bank was utilized from 2007 to 2015. A total of 24 855 AA or white males with high-grade splenic injuries were included. Multilevel mixed effects regression analysis was used to evaluate disparities in outcomes and resource allocation. Mortality was significantly higher for AA males at mixed-race (odds ratio [OR] 1.6; 95% CI 1.3-2.1; P < .001) and minority (OR 2.1; 95% CI 1.5-3.0; P < .001) hospitals, but not at majority hospitals. At minority hospitals, AA males were significantly less likely to be admitted to the intensive care unit (OR 0.7; 95% CI 0.49-0.97; P = .04) and experienced a significantly longer time to surgery (IRR 1.5; P = .02). Minority hospitals were significantly more likely to have failures from angiographic embolization requiring operative intervention (OR 2.2; P = .009). At both types of nonmajority hospitals, AA males with penetrating injuries were more likely to be managed with angiography (mixed-race hospitals: OR 1.7; P = .046 vs minority hospitals: OR 1.6; P = .08). While multiple studies have shown that minority hospitals have increased mortality compared to majority hospitals, this study found this disparity only existed for AAs.

Disparities in treatment timing and access to care in chronic lymphoytic leukemia

The volume-outcome relationship in lung cancer surgery: The impact of the social determinants of health care delivery.

e16466 Background: Pancreatic cancer is a lethal malignancy, and racial disparities in outcomes remain a major public health concern. Comorbidities such as cardiovascular and cerebrovascular events can significantly affect survival and quality of care. We utilized the National Inpatient Sample (NIS) from 2016–2021 to evaluate racial disparities in major adverse cardiovascular and cerebrovascular events (MACCE) and healthcare resource utilization in hospitalized pancreatic cancer patients. Methods: A retrospective cohort study was conducted using the NIS database to identify adult pancreatic cancer patients between 2016 and 2021. Demographic and clinical characteristics, including race, age, sex, socioeconomic factors, and comorbidities, were compared. Outcomes included mortality, myocardial infarction (MI), atrial fibrillation (A-fib), intracranial hemorrhage, and healthcare resource utilization metrics (length of stay [LOS] and total charges [TOTCHG]). Multivariable logistic regression models were employed to assess racial disparities in these outcomes, adjusted for potential confounders. Results: Among 622,379 pancreatic cancer patients, the racial distribution was White (73.3%), Black (14.3%), Hispanic (8.6%), Asian or Pacific Islander (3.5%), Native American (0.4%), and Other (3.1%). Black patients experienced significantly higher odds of mortality (OR 1.44, p &lt; 0.001) and sudden cardiac arrest (OR 2.271, p &lt; 0.001) compared to Whites. Similarly, Asian or Pacific Islander patients had elevated odds of mortality (OR 1.371, p &lt; 0.001) and intracranial hemorrhage (OR 1.701, p = 0.008). Hispanic patients exhibited protective odds for MI (OR 0.839, p = 0.035) and acute congestive heart failure (OR 0.502, p = 0.044) compared to Whites. Across racial groups, atrial fibrillation was significantly less common in Black (OR 0.559, p &lt; 0.001), Hispanic (OR 0.516, p &lt; 0.001), and Asian or Pacific Islander (OR 0.567, p &lt; 0.001) patients. Black and Other racial groups had significantly longer LOS compared to Whites (0.992 and 0.687 days, p &lt; 0.001, respectively). Notably, Hispanic and Asian patients had significantly higher TOTCHG compared to Whites ($17,802.97 and $23,022.9, respectively, p &lt; 0.001). Conclusions: This study reveals striking racial disparities in pancreatic cancer outcomes and associated MACCE, with Black and Asian patients experiencing worse outcomes, including higher mortality and increased rates of severe complications. In contrast, Hispanic patients demonstrated a lower risk for certain cardiovascular events. Disparities in LOS and healthcare charges further underscore inequities in care delivery. These findings emphasize the need for targeted interventions to address systemic healthcare inequities, optimize resource allocation, and improve outcomes for minority populations with pancreatic cancer.

1525 Background: The trials of bispecific antibodies to treat diffuse large B-cell lymphoma (DLBCL) have increased exponentially. However, there is a geographic limitation to offering these trials and universal access appears to be limited. Here, we investigate the geographical and racial disparities in accessing bispecific antibodies trials for DLBCL. Methods: We searched ClinicalTrials.gov using the terms for DLBCL and bispecific antibodies. A total of 13 out of 51 clinical trials with one or more open sites in the United States (US) were included in this systematic review. 2020 US Census Bureau data was used to obtain data on race and ethnicity. Analysis for this study was performed using SPSS version 26. Results: The majority of the included trials were Phase I (62%) followed by Phase II (23%), and Phase I/II (15%). A total of 885 participants were either enrolled or expected to enroll in these clinical trials. Nine (69%) clinical trials were only open in the US while 4 (31%) clinical trials were open in the US and other countries. The majority of the trials were funded by the pharmaceutical industry 62%. There were 50 unique study sites distributed over 24 states with a 2.4 (1-10) mean number of trials per state and 9.9 (1-39) mean number of sites per trial. Study sites were distributed in 24 different states. Midwestern states had the highest number of trials 28%, followed by Southern 26%, Northeastern 24%, and Western 22%. The highest number of study locations (10) and the highest number of open studies (10) were in California. Twenty-seven states had no open bispecific antibodies trials including three in the Northeast (Maine, Rhode Island, and Vermont), five in the Midwest (Illinois, Indiana, Nebraska, North and South Dakota), eight in the South (Delaware, Virginia, District of Columbia, West Virginia, Mississippi, Arkansas, Louisiana, and Oklahoma), and eleven in the West (Arizona, Colorado, Idaho, New Mexico, Montana, Nevada, Wyoming, Alaska, Hawaii, Oregon, and Washington). Using US Census Bureau data, only 20% of African Americans (AA) (8 349 699 of 41 104 200) lived in a county with a bispecific antibodies trial. There were only five states (21%) with 50% or more of the AA population living in a county with an open bispecific antibodies trial and seven states (29%) with 30-49.9% of their AA county residents. Five states (21%) had less than 10% of the AA population living in a county with an open bispecific antibodies trial. Nine (90%) out of ten states with the highest proportion of AA residents (18.6%-41.4%) have no (five states) or only one clinical trial site (four states). Conclusions: There is significant geographic and racial disparity in accessing bispecific antibodies trials for DLBCL. Strategies should be framed to address the causes of the observed disparities and to improve access to these trials.

Geographic and Racial Disparities in Chimeric Antigen Receptor-T Cells and Bispecific Antibodies Trials Access for Diffuse Large B-Cell Lymphoma