Provider Communication and Vaccine Acceptance: Analysis of Vaccine Conversations Between Pregnant Women and Health Care Providers

Racial and Ethnic Disparities in Excess Deaths Among Persons With Kidney Failure During the COVID-19 Pandemic, March-July 2020

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

Unmasking Disparities in Kidney Replacement Therapy Among Young Patients—A Call to Action

Introduction Racial and ethnic disparities in stroke treatment are well‐documented, with Non‐Hispanic Black (NHB) and Hispanic patients often experiencing longer delays in care compared to Non‐Hispanic White (NHW) patients. This study evaluates differences in pre‐hospital metrics (dispatch pathway and dispatch location), both of which have potential to influence racial disparities in stroke management. Methods This retrospective cross‐sectional study included patients with acute stroke symptoms enrolled in BEST MSU, a cluster randomized trial with patients treated in Mobile Stroke Units (MSUs) or Emergency Medical Services (EMS) from August 2014 to August 2020. Patients were evaluated by EMS or MSU in alternating weeks. Data on race, ethnicity, education, insurance status, dispatch pathways (direct dispatch via patient/family via 911, on‐scene first responder, MSU monitoring EMS ratios and adding themselves onto call) dispatch locations (home, public area, chronic healthcare facility, and outpatient healthcare setting) were collected. We focused comparisons on NHB, NHW, and Hispanic patients. Variables were described using frequency and percentages. Results A total of 1,420 ischemic stroke patients were analyzed: NHW (n=557), NHB (n=277), and Hispanic (n=586). Hispanic patients had the highest uninsured rates (26.9% MSU, 37.9% EMS), followed by NHB patients (14.6% MSU, 13.2% EMS), while NHW patients had the lowest (3.4% MSU, 3.8% EMS). Hispanic patients also had the lowest educational attainment, with over 50% having less than a high school education, compared to 19.5% of NHB and 6.6% of NHW patients. NHW patients were the oldest group (median age: 74.0 MSU, 71.0 EMS), while NHB and Hispanic patients were younger (median age: 63 MSU, 63.5 EMS). Direct dispatch of MSU was more likely for NHW (54.8), compared to NHB (36.5) and Hispanic (43.5) patients (p<0.001). In contrast, NHB (50.2) and Hispanic (43.5) patients were more dependent on on‐scene first responders for MSU dispatch compared to NHW (34.6) patients. Regarding dispatch location, EMS/MSU was more likely to be called from “home” for NHW patients (48.3), and Hispanic patients (47.8%) compared to NHB (43.7%) patients. Dispatches for NHB patients most often came from public areas (49.5%). Conclusion Racial and ethnic differences in dispatch pathway and dispatch location exist. In BEST MSU, NHW patients were more likely to have direct dispatch of MSU to the home location. For NHB and Hispanic patients, MSU was dispatched by first responders. Finally, NHB patients enrolled in BEST MSU were more likely to be identified in public areas compared to home. More studies are needed to understand the possible reasons for these findings including differences in baseline demographic and social factors, disparities in stroke knowledge, or disparities in EMS utilization in BEST MSU. Further investigation is needed to understand whether these differences contribute to racial and ethnic disparities in treatment metrics and thrombolytic therapy utilization and to design targeted interventions to address these disparities.

Racial and Ethnic Differences in Outcomes of Multiple Myeloma Patients Treated with Idecabtagene Vicleucel or Ciltacabtagene Autoleucel

Background: Influenza and tetanus, diphtheria, and pertussis (Tdap) vaccinations during pregnancy protect mother and infant. However, acceptance of these vaccines during pregnancy is suboptimal, especially among Black women in the United States. We characterize vaccine intentions and opinions of pregnant patients at two prenatal care clinics before and after reading informational text. Methods: A survey was distributed to pregnant patients at prenatal clinics in Winchester, Virginia, and Jacksonville, Florida. The survey assessed patient demographics and vaccine opinions and acceptance before and after patients read informational text about the vaccines. Associations between demographics and vaccine opinions and acceptance were assessed using Chi-square; Principal Component Analysis was used to produce an influenza vaccine opinion score. Differences in the opinion score between groups were assessed by ANOVA and ANCOVA. Results: Respondents (n = 654) who identified as Black and with lower educational attainment reported lower receipt of the influenza vaccine outside of pregnancy and receipt of or plans to receive the influenza and Tdap vaccines during pregnancy (p < 0.001). Respondents' influenza vaccine practices outside of pregnancy were associated with their likelihood of getting the vaccine while pregnant. Most respondents found the informational text useful; among women not yet vaccinated, 26% reported they were more likely to receive the influenza vaccine and 49.9% more likely to receive the Tdap vaccine after reading the text. Conclusions: Women have varying opinions and make different decisions about immunization, with race and educational level being significant correlates. Participants generally welcomed information about vaccines, and many were influenced positively, especially for Tdap.

Background: Intracerebral hemorrhage (ICH) is associated with an increased risk of ischemic stroke. Whether there are racial and ethnic disparities in the risk of ischemic stroke after ICH is poorly understood. Hypothesis: Non-Hispanic Black and Hispanic ICH patients have a higher risk of ischemic stroke compared to White ICH patients. Methods: We retrospectively analyzed data from the Healthcare Cost and Utilization Project on all hospitalizations at all nonfederal hospitals in Florida from 2005 to 2018 and New York from 2006 to 2016. We included patients with an ICH, and without a prior or concomitant diagnosis of ischemic stroke. ICH and ischemic stroke were ascertained using validated ICD-9-CM and ICD-10-CM codes. Using Cox proportional hazard models, we studied the relationship between race and risk of ischemic stroke, after adjustment of demographics and comorbidities. Results: We included 55,582 patients with ICH- 66% Non-Hispanic White, 19% Non-Hispanic Black, and 13% Hispanic. Black and Hispanic patients were younger and had a higher prevalence of cardiovascular comorbidities; however, atrial fibrillation was more prevalent among White patients. During a median follow up period of 3.6 years (IQR 0.7-7.2), an incident ischemic stroke occurred in 3,361 (9%) Non-Hispanic White, 1,308 (12%) Non-Hispanic Black, and 858 (12%) Hispanic patients (p&lt;.001). In adjusted Cox models, the risk of an ischemic stroke was significantly higher among Non-Hispanic Black patients (HR 1.6; 95% CI,1.4-1.7) and Hispanic patients (HR 1.4; 95% CI,1.2-1.5]), compared to non-Hispanic White patients. Conclusions: Among patients with ICH, Non-Hispanic Black and Hispanic patients had a significantly higher risk of ischemic stroke compared to Non-Hispanic White patients.

To characterize disease manifestations in Hispanic American patients with systemic sclerosis (SSc) in comparison with non-Hispanic White and Black patients. Longitudinal clinical characteristics were collected prospectively in the Genetics versus Environment in Scleroderma Outcome Study cohort. All patients fulfilled the classification criteria for SSc and had a disease duration less than five years at enrollment. A cohort of 427 patients, consisting of 124 Hispanic, 220 non-Hispanic White, and 83 non-Hispanic Black participants were examined. At enrollment, Hispanic patients were significantly younger but had longer disease duration, higher frequency of U1-RNP positivity as well as concurrent systemic lupus erythematosus (SLE) diagnosis, and lower income and educational levels in comparison to non-Hispanic White patients. Compared with non-Hispanic Black patients, Hispanic patients had more frequently limited cutaneous involvement and anticentromere antibodies. In the longitudinal analysis, Hispanic patients had significantly lower forced vital capacity percents predicted (point estimate, -9.3%; P < 0.001) than non-Hispanic White but not Black patients. Hispanic patients had similar longitudinal modified Rodnan Skin Scores like non-Hispanic White patients but lower measurements than non-Hispanic Black patients (point estimate, -3.2; P = 0.029). Hispanic patients had significantly higher serially obtained perceived functional disability scores than White patients (point estimate, 0.29; P < 0.001). Hispanic patients also had higher mortality rates than White Americans even after adjustment for age, gender, and socioeconomic statuses. Hispanic patients have higher likelihood of having U1-RNP positivity and SLE overlap, more severe restrictive lung disease, as well as higher rate of mortality than non-Hispanic White patients.

12102 Background: Patient-provider communication is essential for improving patient experience and understanding. Given significant care coordination in cancer treatment, effective communication is crucial to ensure timely care, optimal patient outcomes, and shared decision making. Improved patient-provider communication also provides opportunities to promote equitable cancer care. We used national survey data to assess racial/ethnic differences in perceptions of provider communication among patients with cancer. Methods: 2011-2021 biannual data from the US Medical Expenditure Panel Survey was used to select cancer survivors aged ≥18. Primary outcomes included how often patients reported their providers (1) treated them with respect, (2) listened carefully, (3) explained things in a way they understood, and (4) spent enough time. Survey-adjusted percentages with chi-square tests characterized differences in patient-reported communication by racial/ethnic group. Multivariable ordinal logistic regression (MVA) models adjusting for survey year, insurance status, income level, geography, sex, and age generated adjusted odds ratios (aORs) with 95% CI to examine associations of race/ethnicity and provider communication. Results: 5,085 patients representing 10,950,670 survivors met inclusion criteria. American Indian (AI) survivors reported the lowest rates of effective provider communication across all four domains (55%: always listened, 42%: always spent enough time, 58%: always showed respect, and 50%: always explained; p&lt;.001), while non-Hispanic Black (NHB) patients reported the highest rates of effective communication in listening (72%), explaining (70%), respect (74%), and spending enough time (63%; p&lt;.001). On MVA, NHB, non-Hispanic Asian (NHA), and Hispanic (HSP) patients were more likely to report feeling listened to (NHB: OR 1.54 95% CI 1.19-1.98; NHA: OR 1.87 95% CI 1.14-3.05; HSP: OR 1.39 95% CI 1.06-1.83) when compared to non-Hispanic White (NHW) patients. NHB and HSP patients reported feeling more respected (NHB: OR 1.40 95% CI 1.109-1.81; HSP: OR 1.39 95% CI 1.04-1.86) when compared to NHW patients. NHB patients were more likely to report that doctors explained well (OR: 1.31 95% CI 1.02-1.67). Conclusions: This national analysis finds that cancer survivors from historically (and presently) marginalized groups – including Black, Asian, and Hispanic patients - were more likely to perceive effective provider communication when compared to non-Hispanic White patients. Considering known disparities in cancer care access and outcomes, these results may reflect differing patient expectations of effective provider communication or the positive results of concerted efforts to improve provider communication to marginalized groups. Univariate analysis also revealed less effective communication for AI patients, suggesting potential unmet needs.

Racial and Ethnic Disparities in Kidney Replacement Therapies Among Adults With Kidney Failure: An Observational Study of Variation by Patient Age

Examining Disparities By Race, Ethnicity, and Socioeconomic Factors in Children and Young Adults with Relapsed Acute Lymphoblastic Leukemia: A Report from the Children's Oncology Group

Although discharges against medical advice (DAMA) are associated with greater morbidity and mortality, little is known about current racial and ethnic disparities in DAMA from the emergency department (ED) nationally. To characterize current patterns of racial and ethnic disparities in rates of ED DAMA. This cross-sectional study used data from the Nationwide Emergency Department Sample on all hospital ED visits made between January to December 2019 in the US. The main outcome was odds of ED DAMA for Black and Hispanic patients compared with White patients nationally and in analysis adjusted for sociodemographic factors. Secondary analysis examined hospital-level variation in DAMA rates for Black, Hispanic, and White patients. The study sample included 33 147 251 visits to 989 hospitals, representing the estimated 143 million ED visits in 2019. The median age of patients was 40 years (IQR, 22-61 years). Overall, 1.6% of ED visits resulted in DAMA. DAMA rates were higher for Black patients (2.1%) compared with Hispanic (1.6%) and White (1.4%) patients, males (1.7%) compared with females (1.5%), those with no insurance (2.8%), those with lower income (<$27 999; 1.9%), and those aged 35 to 49 years (2.2%). DAMA visits were highest at metropolitan teaching hospitals (1.8%) and hospitals that served greater proportions of racial and ethnic minoritized patients (serving ≥57.9%; 2.1%). Odds of DAMA were greater for Black patients (odds ratio [OR], 1.45; 95% CI, 1.31-1.57) and Hispanic patients (OR, 1.16; 95% CI, 1.04-1.29) compared with White patients. After adjusting for sociodemographic characteristics (age, sex, income, and insurance status), the adjusted OR (AOR) for DAMA was lower for Black patients compared with the unadjusted OR (AOR, 1.18; 95% CI, 1.09-1.28) and there was no difference in odds for Hispanic patients (AOR, 1.03; 95% CI, 0.92-1.15) compared with White patients. After additional adjustment for hospital random intercepts, DAMA disparities reversed, with Black and Hispanic patients having lower odds of DAMA compared with White patients (Black patients: AOR, 0.94 [95% CI, 0.90-0.98]; Hispanic patients: AOR, 0.68 [95% CI, 0.63-0.72]). The intraclass correlation in this secondary analysis model was 0.118 (95% CI, 0.104-0.133). This national cross-sectional study found that Black and Hispanic patients had greater odds of ED DAMA than White patients in unadjusted analysis. Disparities were reversed after patient-level and hospital-level risk adjustment, and greater between-hospital than within-hospital variation in DAMA was observed, suggesting that Black and Hispanic patients are more likely to receive care in hospitals with higher DAMA rates. Structural racism may contribute to ED DAMA disparities via unequal allocation of health care resources in hospitals that disproportionately treat racial and ethnic minoritized groups. Monitoring variation in DAMA by race and ethnicity and hospital suggests an opportunity to improve equitable access to health care.

Intracerebral hemorrhage (ICH) is associated with an increased risk of ischemic stroke. Whether there are racial and ethnic disparities in the risk of ischemic stroke after ICH is poorly understood. We therefore aimed to test the hypothesis that non-Hispanic Black and Hispanic ICH patients have a higher risk of ischemic stroke compared with non-Hispanic White ICH patients. We performed a retrospective cohort study using the Healthcare Cost and Utilization Project (HCUP) on all hospitalizations at all nonfederal hospitals in Florida from 2005 to 2018 and New York from 2006 to 2016. Race and ethnicity were coded as a single variable in HCUP. We included patients with an ICH, and without a prior or concomitant diagnosis of ischemic stroke, ascertained using validated International Classification of Diseases-Clinical Modification-9 and 10 diagnosis codes. Using Cox proportional hazard models, we studied the relationship between race and risk of ischemic stroke starting from the time of discharge from ICH hospitalization, after adjustment of demographics and vascular comorbidities. We included 91 342 patients with ICH-62% non-Hispanic White, 18% non-Hispanic Black, and 12% Hispanic patients. Non-Hispanic Black and Hispanic patients were younger and had a higher prevalence of cardiovascular comorbidities; however, atrial fibrillation was more prevalent among non-Hispanic White patients. During a median follow-up period of 4.4 years (interquartile range, 1.5-8.1), an incident ischemic stroke occurred in 3377 (6%) non-Hispanic White, 1323 (8%) non-Hispanic Black, and 844 (8%) Hispanic patients. In adjusted Cox models, the risk of an ischemic stroke was significantly higher among non-Hispanic Black patients (hazard ratio, 1.6 [95% CI, 1.5-1.8]) and Hispanic patients (hazard ratio, 1.4 [95% CI, 1.3-1.5]), compared with non-Hispanic White patients. Similar results were obtained in sensitivity analyses when using death as a competing risk and after excluding patients with atrial fibrillation and valvular heart disease. In a large heterogeneous cohort of patients with ICH, we found that non-Hispanic Black and Hispanic patients had a significantly higher risk of ischemic stroke compared with non-Hispanic White patients.

&lt;div&gt;AbstractBackground:&lt;p&gt;Oral cavity cancer (OCC) and laryngeal cancer are among the most common cancers worldwide. This study investigated survival in non-Hispanic (NH) Black, NH White, Asian, and Hispanic patients with OCC and laryngeal cancer of low, intermediate, and high neighborhood socioeconomic status (nSES).&lt;/p&gt;Methods:&lt;p&gt;We used data from the SEER 18 Census Tract-level SES and Rurality Database of the National Cancer Institute to create cohorts of OCC and laryngeal cancer patients from 2013 to 2018. Univariate survival analysis was performed with Kaplan–Meier curves and log-rank &lt;i&gt;P&lt;/i&gt; values by nSES and then the cross-classification of race, ethnicity, and nSES. We used Cox proportional hazards regression model for multivariable analysis.&lt;/p&gt;Results:&lt;p&gt;Higher nSES was associated with better OCC survival for NH White, NH Black, and Asian patients, and better laryngeal cancer survival for NH White, NH Black, Hispanic, and Asian patients. In the multivariable analyses of both OCC and laryngeal cancer survival, NH Black patients had worse survival than NH White patients in the high nSES tertile. NH Black patients with OCC were at higher risk of death than NH White patients at all nSES levels. Conversely, Asian patients with laryngeal cancer demonstrated better survival than other races within the high nSES.&lt;/p&gt;Conclusions:&lt;p&gt;Overall survival differs between racial and ethnic groups of similar nSESs. These health disparities in patients with OCC and laryngeal cancer reflect broader inequities in the cancer control continuum.&lt;/p&gt;Impact:&lt;p&gt;The cross-classification of race, ethnicity, and nSES revealed disparities in the 5-year overall survival of patients with OCC and laryngeal cancer and highlights the importance of intersectionality in the discussion of health equity.&lt;/p&gt;&lt;/div&gt;

Oral cavity cancer (OCC) and laryngeal cancer are among the most common cancers worldwide. This study investigated survival in non-Hispanic (NH) Black, NH White, Asian, and Hispanic patients with OCC and laryngeal cancer of low, intermediate, and high neighborhood socioeconomic status (nSES). We used data from the SEER 18 Census Tract-level SES and Rurality Database of the National Cancer Institute to create cohorts of OCC and laryngeal cancer patients from 2013 to 2018. Univariate survival analysis was performed with Kaplan-Meier curves and log-rank P values by nSES and then the cross-classification of race, ethnicity, and nSES. We used Cox proportional hazards regression model for multivariable analysis. Higher nSES was associated with better OCC survival for NH White, NH Black, and Asian patients, and better laryngeal cancer survival for NH White, NH Black, Hispanic, and Asian patients. In the multivariable analyses of both OCC and laryngeal cancer survival, NH Black patients had worse survival than NH White patients in the high nSES tertile. NH Black patients with OCC were at higher risk of death than NH White patients at all nSES levels. Conversely, Asian patients with laryngeal cancer demonstrated better survival than other races within the high nSES. Overall survival differs between racial and ethnic groups of similar nSESs. These health disparities in patients with OCC and laryngeal cancer reflect broader inequities in the cancer control continuum. The cross-classification of race, ethnicity, and nSES revealed disparities in the 5-year overall survival of patients with OCC and laryngeal cancer and highlights the importance of intersectionality in the discussion of health equity.