African American Patient Population Research Articles

Outcomes of slow coagulation transscleral cyclophotocoagulation in a predominantly African American glaucoma population

PurposeTo evaluate outcomes of slow coagulation transscleral cyclophotocoagulation (SC-TSCPC) in a primarily African American patient population with glaucoma. MethodsA retrospective chart review was performed for 104 consecutive cases of SC-TSCPC by a single surgeon between November 6, 2019–September 7, 2023. Power ranged from 1150 to 1500 mW, duration was 4 s, and number of spots ranged from 10 to 25. Exclusion criteria were diagnosis of neovascular glaucoma, prior CPC, visual acuity (VA) of no light perception or unable to be assessed due to patient's mental status, aphakia, or follow-up <3 months. The primary outcome measure was surgical success defined as an intraocular pressure (IOP) of 6–21 mmHg with a ≥20 % reduction from baseline, no glaucoma re-operation, and no loss of light-perception. Secondary outcome measures included VA, glaucoma medication use, and post-surgical complications. Analysis was also stratified by lens status as literature suggests a greater IOP-lowering effect in pseudophakic eyes after CPC. ResultsThere were 28 eligible patients (6 phakic, 22 pseudophakic) included in this analysis. Mean follow-up was 11.6 ± 8.3 months, and 14 patients had postoperative year 1 data available. The mean age was 75.2 ± 13.9 years, 42.9 % were female, and 92.9 % were African American, reflective of the demographics of the local community. The cumulative success rate was 68.5 % at 1 year and did not differ significantly between phakic and pseudophakic patients. Mean VA worsened from 20/600 preoperatively to 20/1050 at last follow-up (P = 0.04) and was marginally worse in the phakic group (P = 0.15). Mean IOP decreased from 31.1 ± 13.2 mmHg on 4.0 ± 1.5 medications preoperatively to 13.8 ± 7.1 mmHg on 2.6 ± 1.5 medications at last follow-up (P < 0.001; P < 0.01), with a more pronounced effect among pseudophakic patients. 85.7 % of patients had prolonged anterior chamber (AC) inflammation beyond 1 month, which persisted in 10.7 % at last follow-up. The cystoid macular edema (CME) rate was 21.4 %, with 10.7 % persistent at last follow-up. ConclusionsSC-TSCPC is an effective, non-incisional IOP-lowering procedure in phakic and pseudophakic eyes that may not otherwise be ideal candidates for incisional glaucoma surgery. Pseudophakic eyes may experience larger reductions in IOP, however, laser settings can be titrated on a case-by-case basis depending on individual patients’ goals. There was a higher incidence of prolonged AC inflammation and CME in our cohort compared to similar studies which report rates of 12.7 % and 2.7 %, respectively. Although the significance of such complications may differ based on the visual potential of each patient, these findings support existing literature that African American patients can have greater incidence of inflammation and subsequent sequalae after ocular surgery.

Is it Safe to Omit the One-week Postoperative Examination after Uncomplicated Phacoemulsification?

The incidence of cataract surgery is increasing, accounting for a large percentage of eye care expenses. Scientific evidence supporting the medical necessity of the traditional postoperative schedule is lacking. Further studies are needed to optimize postoperative care to reduce the burden on patients and medical providers. To study the rate of complication one week after uncomplicated phacoemulsification to determine if the one-week postoperative examination can be safely omitted. A retrospective record review was conducted on all consecutive patients who had uncomplicated phacoemulsification between February 1, 2019, and February 1, 2020, at a clinic in an urban setting with a predominantly black and African American patient population. Subjects were included if they had no complications during the one-day postoperative examination. Complications at the one-week and one-month postoperative examination were recorded and analyzed. Omitting the one-week postoperative examination would result in missed complications in 4.48%-15.97% of patients and failure to make unexpected management changes in 1.78% to 13.84% of patients. The results of this study do not support omitting the one-week postoperative examination after uncomplicated phacoemulsification. Further studies are needed to determine whether telemedicine can be safely substituted for postoperative examinations.

Assessment of multi-population polygenic risk scores for lipid traits in African Americans.

Polygenic risk scores (PRS) based on genome-wide discoveries are promising predictors or classifiers of disease development, severity, and/or progression for common clinical outcomes. A major limitation of most risk scores is the paucity of genome-wide discoveries in diverse populations, prompting an emphasis to generate these needed data for trans-population and population-specific PRS construction. Given diverse genome-wide discoveries are just now being completed, there has been little opportunity for PRS to be evaluated in diverse populations independent from the discovery efforts. To fill this gap, we leverage here summary data from a recent genome-wide discovery study of lipid traits (HDL-C, LDL-C, triglycerides, and total cholesterol) conducted in diverse populations represented by African Americans, Hispanics, Asians, Native Hawaiians, Native Americans, and others by the Population Architecture using Genomics and Epidemiology (PAGE) Study. We constructed lipid trait PRS using PAGE Study published genetic variants and weights in an independent African American adult patient population linked to de-identified electronic health records and genotypes from the Illumina Metabochip (n=3,254). Using multi-population lipid trait PRS, we assessed levels of association for their respective lipid traits, clinical outcomes (cardiovascular disease and type 2 diabetes), and common clinical labs. While none of the multi-population PRS were strongly associated with the tested trait or outcome, PRSLDL-Cwas nominally associated with cardiovascular disease. These data demonstrate the complexity in applying PRS to real-world clinical data even when data from multiple populations are available.

Impact of in-hospital statin use on mortality in COVID-19 patients from a majority African American population

BackgroundThe COVID-19 pandemic has claimed over 6.4 million lives globally. Finding effective medications to reduce mortality in hospitalized COVID-19 patients remains critical. No previous study has been published on the effects of statin use in a majority African American COVID-19 patient population. ObjectiveThis study aims to assess the relationship between in-hospital statin use and mortality in this population. MethodsA retrospective chart review of patients diagnosed with COVID-19 from March 2020 to June 2020 admitted to the Phoebe Putney Health System in Albany, Georgia, an early epicenter of the COVID-19 pandemic, was conducted. The outcomes of 735 hospitalized COVID-19 positive patients from over 40 counties in Georgia were analyzed. The primary outcome of interest was all-cause mortality, with secondary outcomes of interest of ICU care, length of ICU stay, need for mechanical ventilator, duration of intubation, and need for dialysis. Multivariate logistic regression and Cox proportional hazards analysis were conducted to examine the effect of in-hospital statin use and mortality. Results186 of 735 total patients were prescribed statins in-hospital. 83.8% were African American. Multivariate logistic regression found in-hospital statin use was not significantly associated with the primary outcome – all-cause mortality (p=0.23). Similar findings were seen in need for ICU care, length of ICU stay, need for mechanical ventilator, duration of intubation, and need for dialysis (p>0.05). Additionally, results from a Cox proportional hazards model found in-hospital statin use was not associated with survival time. Sensitivity analysis conducted on only African American patients validated that in-hospital statin use was not associated with all-cause mortality in these patients. Of note, immunosuppression and severe disease presentation were associated with a six-fold increase in risk of mortality and the largest decreases in survival time. ConclusionIt is possible statins have no mortality benefit for this patient population, but further research beyond this association study would need to be conducted to determine this conclusively. From this study, the best clinical recommendation would be to continue statins for COVID-19 patients with pre-hospital statin use and to launch a randomized clinical trial to definitively determine the efficacy of statins in the treatment of hospitalized COVID-19 patients.

Age-Dependent Occurrence of Prostate Cancer in an African-American Patient Population of Predominantly West Indian Origins

In a prior study of the occurrence of prostate cancer in a unique population of African American patients many of whom have West Indian ancestry, we found that seventy percent of patients screened for prostate were found to have this disease and that, of the seventy percent diagnosed with prostate cancer, 70 percent were found to have high-grade (Gleason score ≥ 7) disease. Overall, therefore, high-grade prostate cancer was found in over 50 percent of all cancers diagnosed, a rate of occurrence that was significantly higher than the corresponding ones for other demographic populations. Since the average age for screening was 65, the same as in other demographic groups, we conjectured that earlier screening of our patients might eliminate many of these high-grade tumors. To validate this hypothesis, we have now examined the rates of occurrence of high-grade prostate cancers in successive age groups, i.e., 40-&lt;50, 50-&lt;60, 60-&lt;70, 70-&lt;80 and &gt;80. Surprisingly, we found that, already in the 50-&lt;60 age group, the frequency of occurrence of high-grade cancers is &gt;50%. (The number of patients in the 40-&lt;50, i.e.,12 and &gt;80, i.e., 6, were too small to be accurately evaluated.) Since the high rate of high-grade cancer occurs in the 50-&lt;60-year group, we conclude that screening for prostate cancer should be performed on our patients at significantly earlier ages such as 40-&lt;50. Also, in view of the expectation that high-grade tumors would increase with increasing age, a second unexpected finding was that the percentage of high-grade tumors was statistically the same at &gt;50 percent in the 50-&lt;60, 60-&lt;70 and 70-&lt;80 age groups. This result could be explained if there was a concurrent increase in low-grade tumors occurring in older patients suggesting that continued, persistent screening is necessary even in advanced age groups. We further found that the mean Gleason score of the 50-&lt;60 and 60-&lt;70 age groups is statistically the same, suggesting that the high-grade tumors are "stable". However, there is a statistically significant increase in Gleason scores between the 70-&lt;80 age group and the two lower age groups which is associated with a large increase in Gleason 9 cancers in the 70-&lt;80 age group and a concurrent, marked decrease in Gleason 7 cancers, suggesting significant recurrent progression of high-grade tumors in this age group.

Evaluating factors contributing to low rates of breast cancer clinical trial accrual in a diverse patient population.

100 Background: In an ideal world, the populations studied in cancer clinical trials (CCT) would be representative of the patients seen in clinic. Unfortunately, significant disparities exist in trial enrollment. Patients who are white, male, insured, or of high socioeconomic status (SES) are overrepresented in NCI-sponsored CCT. Despite data indicating equal willingness for participation in CCT across all racial groups, lack of access, cultural barriers, and social determinants of health contribute to poor accrual rates among racial and ethnic minority patients. The Dan L. Duncan Comprehensive Cancer Center (DLDCCC) provides equal access to breast CCT at Smith Clinic (SC) within the safety-net Harris Health system and Baylor St. Luke’s Medical Center (BSLMC). The patient populations differ greatly at these two sites, with BSLMC serving &gt; 95% insured, largely Caucasian patients, and SC serving 60% uninsured, mostly low SES patients, with &gt; 80% racial and ethnic minorities. Despite equal access, patients at SC have a significantly higher CCT refusal rate. Methods: We performed a retrospective review of a prospectively maintained database of new patients seen at DLDCCC dating from 5/2015 to 9/2021, which included 3043 patients screened for breast CCT. 366 patients were found to be eligible for CCT. Some patients were eligible for multiple CCT, so there were 431 total offers of CCT. We performed logistic regression to evaluate whether differences in age, clinic, race, trial type, and primary language may be underlying the observed differences in CCT enrollment rates. Results: In the BSLMC cohort, 61% (116/204) of eligible patients enrolled in a CCT, while in the SC cohort only 39% (74/227) of eligible patients elected to enroll in CCT. This difference was significant on univariate but not multivariate analysis. There were significant differences when comparing race and trial type in the overall patient set. On univariate analysis, SC patients, African American (AA) patients, Hispanic/Latino patients, and Spanish speaking patients were significantly more likely to decline CCT participation. However, on multivariate analysis, only the AA patient category was associated with enrollment refusal (odds ratio 0.261, 95% CI 0.116-0.563, p &lt; 0.001). On both univariate and multivariate analyses, patients were significantly more likely to accept biobanking trials (multivariate: odds ratio 12.799, 95% CI 3.777-61.403, p &lt; 0.001). Conclusions: Based on these findings, it is likely an oversimplification to assume that equal access will lead to a complete elimination of CCT disparities. Our AA patients were significantly less likely to agree to participate in clinical trials, challenging the commonly held view that lack of access is a major barrier. We are exploring interventions designed to improve our AA patient population’s views of trial enrollment.

S262 Impact of Younger Age Inclusion on Adenoma Detection Rate in an African American Predominant Screening Population

Introduction: Recent guidelines have lowered the age for initiation of colorectal cancer (CRC) screening to 45. The current benchmark for adenoma detection rate (ADR) for screening colonoscopy in men and women 50 years and older are 30% and 20%, respectively. It is unclear if the adenoma detection rate (ADR) will need to be lowered to accommodate for a younger patient population with a presumably lower adenoma burden. Our study’s objective was to evaluate the ADR in a largely African American population comparing 45–49-year-old men and women to those 50 and older Methods: We performed a retrospective review of our endoscopy database for all patients ages 45-73 who underwent average-risk screening colonoscopy at our institution. All average-risk screening colonoscopies for patients 50 years and older in the year 2017 and colonoscopies for patients younger than 50 from 2017 to 2021. We analyzed patients’ race, age, pathologic findings, and bowel preparation. Colonoscopies were excluded if the cecum was not reached, or the bowel preparation was inadequate. Statistical analysis was performed utilizing Chi-square testing with significance set at a P < 0.05 Results: A total of 1267 average-risk colonoscopies were performed for patients between 45-73 years. After applying our exclusion criteria, 1152 colonoscopies were analyzed, Table. The overall ADR was 35.4%, with a statistically significant difference between patients ≥50 years and < 50 years (38.4% vs 28.7%, p=0.002). ADR correlated with age, Figure. ADR for males was higher than females (41.4% vs 30.4%, p< 0.001). There was no statistically significant difference in ADR between African Americans and non-African Americans (35.2% vs 35.6%, p=0.822) Conclusion: In our predominantly African American patient population undergoing average-risk screening colonoscopy, we found an increase in ADR with age. Despite the inclusion of patients 45-49 years of age with a lower adenoma burden, ADR thresholds recommended by the GI societies were still attainable in this patient population. Endoscopists with a large young patient panel should expect a lower ADR but should not expect a drop in the ADR below the 25% benchmarkFigure 1.: Adenoma Detection Rate Correlation with Age Table 1. - Patient characteristics in patients with or without adenomas. (N=1152) Patient characteristic (N, %) Adenoma: N (%) No Adenoma: N (%) P-value Gender Female (626, 54.3) Male (526, 45.7) 190 (30.4)218 (41.4) 436 (69.6)308 (58.6) < 0.001 Race African American (952, 82.6%) Non-African American (160, 13.9) Unknown (40, 3.5) 335 (35.2)57 (35.6)16 (40.0) 617 (64.8)103 (64.4)24 (60.0) 0.822 Age, Years < 50 (349, 30.3) ≥50 (803, 69.7) 100 (28.7)308 (38.4) 249 (71.3)495 (61.6) 0.002

Obesity and COVID-19 Outcomes in a Primarily Black Population

Background: Studies have noted higher COVID-19 mortality with more severe obesity in populations that included a small percentage of Black patients. Methods: We retrospectively analyzed COVID-19 outcomes associated with obesity in our largely African American patient population. A total of 1101 symptomatic patients with a positive COVID-19 laboratory test March 5 to June 3, 2020, were categorized into weight groups based on body mass index (BMI). Of these patients, 679 (61.7%) were Black. A total of 355 (32.2%) patients had overweight and 516 (46.9%) had obesity. Results: BMI was an independent risk factor for intubation and an independent predictor for ICU length of stay and intubation days. An unexpected observation was favorable outcomes in mild obesity compared with normal weight and more severe obesity, likely a result of older age and higher Charlson comorbidity index in patients with normal BMI compared with patients with mild obesity. Conclusions: In a diverse primarily Black population, comorbidities were a concern for adverse COVID-19 outcomes and COVID-19 outcomes were significantly worse with moderate and severe obesity.

Can COVID-19 worsen racial disparities in breast cancer screening and diagnosis?

BackgroundHealth disparities among minority groups, especially African Americans, can limit their access to quality medical care and lead to disproportionate medical management and disease outcomes. The aim of this study was to compare the COVID-19-related change in mammogram volumes and cancer detection at two affiliated academic breast centers, one that serves a predominantly African American patient population and one that serves a predominantly non-African American patient population.Materials and methodsFor the purpose of anonymity, racial demographics were collected and the center with a higher African American patient population was designated as institution A, while the center with a higher non-African American patient population was designated as institution B. Careful selection of the two breast centers was instituted in order to limit the impact of potential confounders other than race.An Institutional Review Board (IRB) exemption was obtained and two Mammography Quality Standards Act (MQSA) reports were generated; one for March 2020 through September 2020, during the height of the COVID-19 pandemic, and one for March 2019 through September 2019 to serve as the pre-pandemic control group. The i2b2 Query Analysis Tool® was used to obtain racial demographic data and compare the percent change in screening and diagnostic mammograms, image-guided biopsies, total cancers diagnosed by imaging, and percent of minimal cancers for both institutions.ResultsScreening mammograms and breast cancer detection decreased in 2020 compared to 2019 at both institutions. However, the percent change from 2019 to 2020 was greater at institution A than at institution B. Percent minimal cancers, an indicator of early-stage breast cancer also decreased more drastically at institution A than at institution B. Interestingly, the total number of diagnostic exams and image-guided biopsies increased in 2020 at institution B, whereas both decreased at institution A.ConclusionThe COVID-19 pandemic may lead to worsening racial disparities in breast cancer screening. In an effort to narrow future disparity, it is crucial for radiologists and other health care providers to be aware of this inequality and educate all women on the importance of obtaining routine screening mammography. More studies are needed.

Evaluating patient risk factors associated with low rates of breast cancer clinical trial accrual.

e18547 Background: In an ideal world, the populations studied in cancer clinical trials (CCT) would be representative of the patients seen in clinic. Unfortunately, significant disparities exist in trial enrollment. Patients who are white, male, insured, or of high socioeconomic status (SES) are overrepresented in NCI-sponsored CCT. Despite data indicating equal willingness for participation in CCT across all racial groups, lack of access, cultural barriers, and social determinants of health contribute to poor accrual rates among racial and ethnic minority patients. The Dan L. Duncan Comprehensive Cancer Center (DLDCCC) notably provides equal access to breast CCT at Smith Clinic (SC) within the Harris Health system and Baylor St. Luke’s Medical Center (BSLMC). The patient populations differ greatly at these two sites, with BSLMC serving &gt; 95% insured, largely Caucasian patients, and SC serving 60% uninsured, mostly low SES patients, with &gt; 80% racial and ethnic minorities. Despite equal access, patients at SC have a significantly higher CCT refusal rate. This retrospective cohort study aims to identify predictors of CCT refusal. Methods: We performed a retrospective review of a prospectively maintained database of new patients seen at DLDCCC dating from 5/2015 to 9/2021, which included 3043 patients screened for breast CCT. 366 patients were found to be eligible for CCT. Some patients were eligible for multiple CCT, so there were 431 total offers of CCT. We performed logistic regression to evaluate whether differences in age, clinic, race, trial type, and primary language may be underlying the observed differences in CCT enrollment rates. Results: In the BSLMC cohort, 61% (116/204) of eligible patients enrolled in a CCT, while in the SC cohort only 39% (74/227) of eligible patients elected to enroll in CCT. This difference was significant on univariate but not multivariate analysis. There were significant differences when comparing race and trial type in the overall patient set. On univariate analysis, SC patients, African American (AA) patients, Hispanic/Latino patients, and Spanish speaking patients were significantly more likely to decline CCT participation. However, on multivariate analysis, only the AA patient category was associated with enrollment refusal (odds ratio 0.261, 95% CI 0.116-0.563, p &lt; 0.001). On both univariate and multivariate analyses, patients were significantly more likely to accept biobanking trials (multivariate: odds ratio 12.799, 95% CI 3.777-61.403, p &lt; 0.001). Conclusions: Based on these findings, it is likely an oversimplification to assume that equal access will lead to a complete elimination of CCT disparities. Our AA patients were significantly less likely to agree to participate in clinical trials, challenging the commonly held view that lack of access is a major barrier. We are exploring interventions designed to improve our AA patient population’s views of trial enrollment.

Pharmacist hypertension management using an electronic health record-based approach.

To evaluate the impact of the chronic medication optimization pharmacist (CMOP) program on blood pressure (BP) control and time to goal compared with usual care in the ambulatory care setting. This was a retrospective cohort study that included patients from June 2018 to June 2020 who were seen in an ambulatory care clinic for hypertension management. Patients aged 18 to 80 years were divided into 2 cohorts based on hypertension management by usual care or the CMOP program. Patients were enrolled in the CMOP program either by referral or identification via a data analytics tool. The primary outcome assessed the proportion of patients within BP goal (< 140/90 mm Hg) at 3 months. Secondary outcomes assessed the proportion of patients within goal at 6 months, time and number of visits to goal, and adherence (CMOP cohort only). The primary end point demonstrated a greater proportion of patients within goal in the CMOP cohort compared with usual care (69.4% vs 42.3%; P < .001). The CMOP cohort also displayed a greater proportion of patients achieving goal within 6 months (75.7% vs 60.4%; P = .014) and faster time to goal (42.99 vs 63.12 days; P = .002), but more visits (1.67 vs 1.18; P = .001). Lastly, adherence improved from 50.4% to 72.1% in the patients with a documented adherence assessment in the pharmacist group (P = .03). The pharmacist intervention improved BP control in a primarily African American patient population compared with usual care. Future studies should assess the sustainability of this intervention.

COVID-19 among African Americans and Hispanics: Does gastrointestinal symptoms impact the outcome?

BACKGROUNDThe coronavirus disease 2019 (COVID-19) disproportionately affected African Americans (AA) and Hispanics (HSP). AIMTo analyze the significant effectors of outcome in African American patient population and make special emphasis on gastrointestinal (GI) symptoms, laboratory values and comorbiditiesMETHODSWe retrospectively evaluated the medical records of 386 COVID-19 positive patients admitted at Howard University Hospital between March and May 2020. We assessed the symptoms, including the GI manifestations, comorbidities, and mortality, using logistic regression analysis.RESULTSOf these 386 COVID-19 positive patients, 257 (63.7%) were AAs, 102 (25.3%) HSP, and 26 (6.45%) Whites. There were 257 (63.7%) AA, 102 (25.3%) HSP, 26 (6.45%) Whites. The mean age was 55.6 years (SD = 18.5). However, the mean age of HSP was the lowest (43.7 years vs 61.2 for Whites vs 60 for AAs). The mortality rate was highest among the AAs (20.6%) and lowest among HSP (6.9%). Patients with shortness of breath (SOB) (OR2 = 3.64, CI = 1.73-7.65) and elevated AST (OR2 = 8.01, CI = 3.79-16.9) elevated Procalcitonin (OR2 = 8.27, CI = 3.95-17.3), AST (OR2 = 8.01, CI = 3.79-16.9), ferritin (OR2 = 2.69, CI = 1.24-5.82), and Lymphopenia (OR2 = 2.77, CI = 1.41-5.45) had a high mortality rate. Cough and fever were common but unrelated to the outcome. Hypertension and diabetes mellitus were the most common comorbidities. Glucocorticoid treatment was associated with higher mortality (OR2 = 5.40, CI = 2.72-10.7). Diarrhea was prevalent (18.8%), and GI symptoms did not affect the outcome.CONCLUSIONAfrican Americans in our study had the highest mortality as they consisted of an older population and comorbidities. Age is the most important factor along with SOB in determining the mortality rate. Overall, elevated liver enzymes, ferritin, procalcitonin and C-reactive protein were associated with poor prognosis. GI symptoms did not affect the outcome. Glucocorticoids should be used judiciously, considering the poor outcomes associated with it. Attention should also be paid to monitor liver function during COVID-19, especially in AA and HSP patients with higher disease severity

S3452 Clinical and Endoscopic Variations Among Gastric Cancer Types in African American Patient Population: Findings From a Tertiary Care Academic Medical Center

S3452 Clinical and Endoscopic Variations Among Gastric Cancer Types in African American Patient Population: Findings From a Tertiary Care Academic Medical Center

Prevalence of Vitamin D Deficiency in a Predominantly African-American Hemodialysis Patient Population

Prevalence of Vitamin D Deficiency in a Predominantly African-American Hemodialysis Patient Population

S3405 Utility of FibroScan to Identify Patients With Cirrhosis in a Predominantly African American Patient Population With Chronic HCV

S3405 Utility of FibroScan to Identify Patients With Cirrhosis in a Predominantly African American Patient Population With Chronic HCV

Comparison of clinical and echocardiographic features of first and second waves of COVID-19 at a large, tertiary medical center serving a predominantly African American patient population

As clinicians have gained experience in treating patients with the novel SARS-CoV-2 (COVID-19) virus, mortality rates for patients with acute COVID-19 infection have decreased. The Centers for Disease Control (CDC) has identified the African American population as having increased risk of COVID-19 associated mortality, however little is known about echocardiographic markers associated with increased mortality in this patient population. We aimed to compare the clinical and echocardiographic features of a predominantly African American patient cohort hospitalized with acute COVID-19 infection during the first (March–June 2020) and second (September–December 2020) waves of the COVID-19 pandemic, and to investigate which parameters are most strongly associated with composite all-cause mortality. We performed consecutive transthoracic echocardiograms (TTEs) on 105 patients admitted with acute COVID-19 infection during the first wave and 129 patients admitted during the second wave. TTE parameters including left ventricular ejection fraction (LVEF), left ventricular global longitudinal strain (LVGLS), right ventricular global longitudinal strain (RVGLS), right ventricular free-wall strain (RVFWS), and right ventricular basal diameter (RVBD) were compared between the two groups. Clinical and demographic characteristics including underlying co-morbidities, biomarkers, in-hospital treatment regimens, and outcomes were collected and analyzed. Univariable and multivariable analyses were performed to determine variables associated with all-cause mortality. There were no significant differences between the two waves in terms of age, gender, BMI, or race. Overall all-cause mortality was 35.2% for the first wave compared to 14.7% for the second wave (p < 0.001). Previous medical conditions were similar between the two waves with the exception of underlying lung disease (41.9% vs. 29.5%, p = 0.047). Echocardiographic parameters were significantly more abnormal in the first wave compared to the second: LVGLS (− 17.1 ± 5.0 vs. − 18.9 ± 4.8, p = 0.02), RVGLS (− 15.7 ± 5.9% vs. − 19.0 ± 5.9%, p < 0.001), RVFWS (− 19.5 ± 6.8% vs. − 23.2 ± 6.9%, p = 0.001), and RVBD (4.5 ± 0.8 vs. 3.9 ± 0.7 cm, p < 0.001). Stepwise multivariable logistic analysis showed mechanical ventilation, RVFWS, and RVGLS to be independently associated with mortality. In a predominantly African American patient population on the south side of Chicago, the clinical and echocardiographic features of patients hospitalized with acute COVID-19 infection demonstrated marked improvement from the first to the second wave of the pandemic, with a significant decrease in all-cause mortality. Possible explanations include implementation of evidence-based therapies, changes in echocardiographic practices, and behavioral changes in our patient population. Mechanical ventilation and right-sided strain-based markers were independently associated with mortality.

Role of Bowel Preparation in Adenoma Detection Rate and Follow-up Recommendations in African American Dominant Patient Population.

Introduction: Bowel preparation quality in colonoscopy is one of the most essential components of quality assessment. According to the latest guidelines, inadequate bowel preparation warrants repeat colonoscopy in less than a year. Our aim was to investigate the role of bowel preparation in adenoma detection rate (ADR), its relationship with patients' demographics, and compliance with subsequent surveillance recommendations with guidelines.Methods: This is a retrospective chart review study. Bowel preparation quality was divided into three categories: high, intermediate, and low. ADR and polyp detection rates (PDR) were calculated as the number of patients with adenoma or polyp divided by the total number of patients.Results: Among 1,062 patients (934 African American and 128 non-African American) 81%, 11%, and 8% had high, intermediate, and low-quality bowel preparations, respectively. Race, gender, age, type of endoscopist, and body mass index did not play any role in bowel preparation quality. ADR and PDR were significantly higher in African Americans as compared to non-African Americans. ADR was significantly lower in the low-quality as compared to the high- and intermediate-quality bowel preparations (OR=2.13; p=0.0032). Bowel preparation quality was not correlated with subsequent follow-up recommendations. Academic gastroenterologists and surgeons had the highest and lowest compliance with surveillance guidelines, respectively.Conclusions: Racial and gender disparity appears to have no meaningful effect on the quality of bowel preparation. Only two categories (adequate [high/intermediate] or inadequate [low-quality]) may be used for follow-up recommendations. Non-compliance with surveillance guidelines is concerning and may inadvertently increase the interval risk of colorectal cancer.

Comparative Analysis of Clinical Trial Outcomes between African American and White Patients Treated with Lenalidomide and Dexamethasone for Multiple Myeloma (MM)

Background: Race/ethnicity are associated with varied outcomes in MM (Ailawadhi S, et al. Br J Haematol. 2012;158:91-98). Because many previous MM clinical trials had predominantly white (W) participants, the reported clinical effects of therapeutic interventions for MM may not be generalizable to patients of other races/ethnicities. Prior data has suggested that racial/ethnic minorities may not have adequate access to novel anti-MM therapies (Kirtane K, Lee S. Blood . 2017 Jul 19 [Epub]). Few prospective studies, and none in the setting of novel agents, eg, IMiD compounds, have explored the effect of race/ethnicity on MM outcomes. This subgroup analysis of the MM-009 phase 3 clinical trial compared the progression-free survival (PFS) benefit experienced by African American (AA) vs W patients treated with lenalidomide (LEN). Safety was also evaluated.Methods: In the MM-009 trial, 353 patients from the United States and Canada who had received ≥ 1 previous therapy for MM but still experienced disease progression were randomized to treatment with either LEN plus dexamethasone (LEN-D; n = 177) or placebo plus dexamethasone (PBO-D; n = 176). LEN 25 mg or PBO was given on days 1-21 of a 28-day cycle. Both treatment groups received D 40 mg on days 1-4, 9-12, and 17-20 of the first 4 cycles, then days 1-4 for cycle 5 and beyond. The median follow-up time for surviving patients was 26.2 months in the LEN-D group and 12.9 months in the PBO-D group. In this analysis, the baseline characteristics and outcomes of 42 AA and 289 W patients were compared. Data from 22 patients (11 from each treatment arm) were excluded because race was reported as other than W or AA.Results: Patients were analyzed in 4 groups, by treatment and by race: LEN-D-AA (n = 25), PBO-D-AA (n = 17), LEN-D-W (n = 141), and PBO-D-W (n = 148). Baseline characteristics were similar across the AA and W groups, except for sex (P < .0001) and baseline creatinine (P= .0172). Male patients represented 63.7% and 28.6% of the W and AA patient populations, respectively. A greater proportion of patients in the AA (14.3%) than the W group (4.8%) had baseline creatinine > 2 mg/dL. Detailed baseline characteristics are listed in the table. LEN treatment decreased risk of disease progression or death in both the AA (HR, 0.20 [95% CI, 0.09-0.42]; P < .0001) and the W (HR, 0.32 [95% CI, 0.24-0.44]; P <.0001) groups compared with PBO (Figure). Median PFS was 9.2, 3.7, 13.1, and 4.6 months in the LEN-D-AA, PBO-D-AA, LEN-D-W, and PBO-D-W groups, respectively. The most common hematologic treatment-emergent adverse event (TEAE) was neutropenia, which occurred in 52.0% of patients in the LEN-D-AA group, 11.8% of patients in the PBO-D-AA group, 46.1% of patients in the LEN-D-W group, and 6.8% of patients in the PBO-D-W group. Fatigue was the most common nonhematologic TEAE, occurring in 52.0%, 23.5%, 51.8%, and 52.0% of patients in the LEN-D-AA, PBO-D-AA, LEN-D-W, and PBO-D-W groups, respectively.Conclusions: The data presented here indicate that LEN administration for the treatment of RRMM results in a similar PFS benefit in AA patients as in W patients. It is imperative to provide adequate access of novel anti-MM agents to racial minorities. [Display omitted] DisclosuresAilawadhi:Amgen: Consultancy, Honoraria; Takeda: Consultancy, Honoraria; Novartis: Consultancy, Honoraria; Pharmacyclics: Research Funding. Larkins:Celgene: Employment. Chung:Celgene Corporation: Employment, Equity Ownership. Srinivasan:Celgene: Employment. Agarwal:Celgene Corporation: Employment.

Analysis of Real-World Data to Investigate the Impact of Race and Ethnicity on Response to Programmed Cell Death-1 and Programmed Cell Death-Ligand 1 Inhibitors in Advanced Non-Small Cell Lung Cancers.

BackgroundRacial disparities among clinical trial participants present a challenge to assess whether trial results can be generalized into patients representing diverse races and ethnicities. The objective of this study was to evaluate the impact of race and ethnicity on treatment response in patients with advanced non‐small cell lung cancer (aNSCLC) treated with programmed cell death‐1 (PD‐1) or programmed cell death‐ligand 1 (PD‐L1) inhibitors through analysis of real‐world data (RWD).Materials and MethodsA retrospective cohort study of 11,138 patients with lung cancer treated at hospitals within the Mount Sinai Health System was performed. Patients with confirmed aNSCLC who received anti‐PD‐1/PD‐L1 treatment were analyzed for clinical outcomes. Our cohort included 249 patients with aNSCLC who began nivolumab, pembrolizumab, or atezolizumab treatment between November 2014 and December 2018. Time‐to‐treatment discontinuation (TTD) and overall survival (OS) were the analyzed clinical endpoints.ResultsAfter a median follow‐up of 14.8 months, median TTD was 7.8 months (95% confidence interval, 5.4–not estimable [NE]) in 75 African American patients versus 4.6 (2.4–7.2) in 110 White patients (hazard ratio [HR], 0.63). Median OS was not reached (18.4–NE) in African American patients versus 11.6 months (9.7–NE) in White patients (HR, 0.58). Multivariable Cox regression conducted with potential confounders confirmed longer TTD (adjusted HR, 0.65) and OS (adjusted HR, 0.60) in African American versus White patients. Similar real‐world response rate (42.6% vs. 43.5%) and disease control rate (59.6% vs. 56.5%) were observed in the African American and White patient populations. Further investigation revealed the African American patient group had lower incidence (14.7%) of putative hyperprogressive diseases (HPD) upon anti‐PD‐1/PD‐L1 treatment than the White patient group (24.5%).ConclusionAnalysis of RWD showed longer TTD and OS in African American patients with aNSCLC treated with anti‐PD‐1/PD‐L1 inhibitors. Lower incidence of putative HPD is a possible reason for the favorable outcomes in this patient population.Implications for PracticeThere is a significant underrepresentation of minority patients in randomized clinical trials, and this study demonstrates that real‐world data can be used to investigate the impact of race and ethnicity on treatment response. In retrospective analysis of patients with advanced non‐small cell lung cancer treated with programmed cell death‐1 or programmed cell death‐ligand 1 inhibitors, African American patients had significantly longer time‐to‐treatment discontinuation and longer overall survival. Analysis of real‐world data can yield clinical insights and establish a more complete picture of medical interventions in routine clinical practice.

Ten-Year Single Institutional Analysis of Geographic and Demographic Characteristics of Patients Treated With Stereotactic Body Radiation Therapy for Localized Prostate Cancer

ObjectivesStereotactic Body Radiation Therapy (SBRT) offers definitive treatment for localized prostate cancer with comparable efficacy and toxicity to conventionally fractionated radiotherapy. Decreasing the number of treatment visits from over 40 to five may ease treatment burden and increase accessibility for logistically challenged patients. Travel distance is one factor that affects a patient’s access to treatment and is often related to geographic location and socioeconomic status. In this study, we review the demographic and geographic factors of patients treated with SBRT for prostate cancer for a single institution with over a decade of experience.MethodsPatient zip codes from one thousand and thirty-five patients were derived from a large, prospectively maintained quality of life database for patients treated for prostate cancer with SBRT from 2008 to 2017. The geospatial distance between the centroid of each zip code to our institution was calculated using the R package Geosphere. Characteristics for seven hundred and twenty-one patients were evaluated at the time of analysis including: race, age, and insurance status. To assess the geographic reach of our institution, we evaluated the demographic features of each zip code using US Census data. Statistical comparisons for these features and their relation to distance traveled for treatment was performed using the Mann-Whitney U test. Finally, an unsupervised learning algorithm was performed to identify distinct clusters of patients with respect to median income, racial makeup, educational level, and rural residency.ResultsPatients traveled from 246 distinct zip codes at a median distance of 11.35 miles. Forty percent of patients were African American, 6.9% resided in a rural region, and 22% were over the age of 75. Using K-means cluster analysis, four distinct patient zip-code groups were identified based on the aforementioned demographic features: Suburban/high-income (45%), Urban (30%), Suburban/low-income (17%), and Rural (8%). For each of the clusters, the average travel distance for SBRT was significantly different at 11.17, 9.26, 11.75, and 40.2 miles, respectively (p-value: <0.001).ConclusionsDistinct demographic features are related to travel distance for prostate SBRT. In our large cohort, travel distance did not prevent uptake of prostate SBRT in African American, elderly or rural patient populations. Prostate SBRT offers a diverse population modern treatment for their localized prostate cancer and particularly for those who live significant distances from a treatment center.