Afro-Latin American Research Articles

Race/Ethnic Differences, Skin Tone, and Memory Among Older Latinos in the United States.

U.S. Latino populations are diverse. Research on racial identity, skin tone, and Latino health is imperative for understanding and combating racism and colorism. We examined differences in memory performance: among non-Latinos and Latinos who identified as Black, other, and White in the United States and then among Puerto Ricans in Boston whose skin tones ranged from dark, medium, light to "white." We used 2010 Health and Retirement Study and 2004 Boston Puerto Rican Health Survey data, respectively, to examine racial and color differences in memory performance among 50 and older adults in the United States and Puerto Rican older adults in Boston. We applied ordinary least squares regression to immediate and delayed word recall test scores and adjusted for education, health conditions, and health behaviors. In adjusted models, White non-Latinos had better memory performance than White Latinos. Black Latinos, other Latinos, and Black non-Latinos had lower delayed word recall scores than White Latinos. Black Latinos and Black non-Latinos had similar scores. Intra-Latino racial disparities endured despite the inclusion of education and other covariates. Among Puerto Ricans in Boston, medium-toned individuals had higher scores than "white"-toned individuals. Findings support the importance of examining self-identified race and skin tone in Latino aging research. Further investigation is needed to understand the stubborn intra-Latino racial disparities in memory performance and surprising adverse cognitive performance among "white"-toned relative to darker-toned Puerto Ricans in Boston.

Association of the Timing of Postpartum Intrauterine Device Insertion and Breastfeeding With Risks of Intrauterine Device Expulsion

Intrauterine device (IUD) expulsion increases the risk of unintended pregnancy; how timing of postpartum IUD insertion and breastfeeding are associated with risk of expulsion is relevant to the benefit-risk profile. To evaluate the association of postpartum timing of IUD insertion and breastfeeding status with incidence and risk of IUD expulsion. The Association of Perforation and Expulsion of Intrauterine Devices (APEX-IUD) cohort study included women aged 50 years or younger with an IUD insertion between 2001 and 2018. The breastfeeding analysis focused on a subcohort of women at 52 or fewer weeks post partum with known breastfeeding status. The study was conducted using data from electronic health records (EHRs) at 4 research sites with access to EHR: 3 Kaiser Permanente sites (Northern California, Southern California, Washington) and the Regenstrief Institute (Indiana). Data analysis was conducted from June to November 2019. Timing of IUD insertion post partum was categorized into discrete time periods: 0 to 3 days, 4 days to 6 or fewer weeks, more than 6 weeks to 14 or fewer weeks, more than 14 weeks to 52 or fewer weeks, and non-post partum (>52 weeks or no evidence of delivery). Breastfeeding status at the time of insertion was determined from clinical records, diagnostic codes, or questionnaires from well-baby visits. Incidence rates and adjusted hazard ratios (aHRs) were estimated using propensity scores to adjust for confounding. The full cohort included 326 658 women (mean [SD] age, 32.0 [8.3] years; 38 911 [11.9%] Asian or Pacific Islander; 696 [0.2%] Hispanic Black; 56 180 [17.2%] Hispanic other; 42 501 [13.0%] Hispanic White; 28 323 [8.7%] non-Hispanic Black; 137 102 [42.0%] non-Hispanic White), and the subcohort included 94 817 women. Most IUDs were levonorgestrel-releasing (259 234 [79.4%]). There were 8943 expulsions. The 5-year cumulative incidence of IUD expulsion was highest for insertions 0 to 3 days post partum (10.73%; 95% CI, 9.12%-12.61%) and lowest for insertions more than 6 weeks to 14 or fewer weeks post partum (3.18%; 95% CI, 2.95%-3.42%). Adjusted HRs using women with non-post partum IUD insertion as the referent were 5.34 (95% CI, 4.47-6.39) for those with postpartum insertion at 0 to 3 days; 1.22 (95% CI, 1.05-1.41) for those with postpartum insertion at 4 days to 6 or fewer weeks; 1.06 (95% CI, 0.95-1.18) for those with postpartum insertion at more than 6 to 14 or fewer weeks; and 1.43 (95% CI, 1.29-1.60) for those with postpartum insertion at more than 14 to 52 or fewer weeks. In the subcohort, 5-year cumulative incidence was 3.49% (95% CI, 3.25%-3.73%) for breastfeeding women and 4.57% (95% CI, 4.22%-4.95%) for nonbreastfeeding women; the adjusted HR for breastfeeding vs not breastfeeding was 0.71 (95% CI, 0.64-0.78). In this study of real-world data, IUD expulsion was rare but more common with immediate postpartum insertion. Breastfeeding was associated with lower expulsion risk.

A quantitative synthesis of disparities in the inclusion of racial/ethnic minorities and older adults in prostate cancer clinical trials over the last three decades.

26 Background: The underrepresentation of minority populations in clinical trials negatively impacts cancer and widens inequities. We aimed to quantify the enrollment disparities in prostate cancer (PC) clinical trials over the last three decades. Methods: MEDLINE and Embase were searched to identify primary reports of prostate cancer RCTs (1989-2020). Data for trial characteristics, the proportion of trials reporting race, ethnicity and age, and the proportion of patients by race, ethnicity and age enrolled in trials were summarized using descriptive statistics. Enrollment incidence ratios (EIR), which compare trial enrollment against global estimates of incidence in age-related subgroups (acquired from the Global Burden of Disease database) and U.S. population-based estimates of racial/ethnic subgroups (acquired from the SEER 18 incidence database) were calculated. Individual trial EIRs were pooled using random-effects meta-analyses to account for the substantial heterogeneity between trials. Multivariable meta-regression was used to explore associations between key trial characteristics and EIR. Annual percentage changes (APC) over the last three decades in enrollment disparities were analyzed using the Joinpoint Regression Analysis. Results: 281 trials from 1989 to 2020 with 99,588 patients were included in this analysis. 107 trials reported race (38%), of which only 25 trials (9%) reported data on all 5 U.S. racial categories (Black, White, Asian, Pacific Islander and Native American. 255 (91%) trials reported mean or median but only 71 trials (25%) specifically reported the enrollment proportion of older adults (age > 65 years). Clinical outcomes by race and age were reported in 9 (8%) and 37 (14%) trials, respectively. Results from meta-analyses showed that Black patients (summary EIR: 0.42 [95% CI: 0.35 - 0.51]), Hispanics (summary EIR: 0.50 [95% CI: 0.37 - 0.68]) and older adults (summary EIR: 0.95 [95% CI: 0.91 - 0.99]) were underrepresented in trials relative to their population estimates. Significantly fewer Black participants (EIR for Black patients = 0.42, EIR for White patients = 0.99; p < 0.0001), Hispanic participants (EIR for Hispanics = 0.50, EIR for non-Hispanics = 1.00; p = 0.001) and older adults (EIR for older adults = 0.95, EIR for younger adults = 1.06; p = 0.037) were enrolled. Representation of Black patients decreased significantly from 1989-2019 (APC: -4.25), while Hispanic representation increased significantly from 2000-2020 (APC: 5.89). Meta-regression showed Black patients were particularly underrepresented in larger-size trials (p < 0.0001). Conclusions: Black representation in PC clinical trials is less than 50% of their expected share based on cancer incidence and it has consistently decreased over last three decades, contributing to the disparities experienced by the population.

Abstract P3-13-05: Comprehensive analysis of global genetic ancestry and socioeconomic status on breast cancer outcomes

Abstract Purpose: Disparities in breast cancer outcomes have been a long-standing and persistent challenge. Earlier onset, advanced stage at diagnosis, aggressive tumor subtypes [triple negative breast cancer (TNBC)], and worse overall survival (OS) are some of the characteristic features of breast cancer in non-Hispanic Black (NHB) women compared to their non-Hispanic White (NHW) counterparts, denoting one of the most significant examples of racial/ethnic differences in oncology. Given our location in South Florida, gateway to Latin America and the Caribbean, we discovered that these disparities in tumor characteristics and outcomes among NHB and NHW also extend to Hispanic Blacks (HB) compared to Hispanic Whites (HW). Since Hispanics are the second largest ethnic group in the US and have a rich genetic architecture with contributions from European (EU), West African (WA), and Native American (NA) populations, we sought to investigate genomic associations between observed inter and intra-racial/ethnic differences and breast cancer characteristics and outcomes. Methods: Patients with stage I-IV breast cancer were included. Patient socioeconomnic status (SES), tumor and treatment characteristics, and follow-up data were collected for each patient. Genomic analysis was performed on the peripheral blood from a cohort of 309 patients with breast cancer. This breast cancer cohort was comprised of 192 self-reported HW, 12 HB, 46 NHW, 47 NHB, and 12 unknown (declined to report) patients. Leukocyte DNA from each patient was genotyped, generating whole genome single nucleotide polymorphism (SNP) profiles. Global ancestral estimates, using >100,000 SNPs, were calculated against reference samples from EU, WA, NA, and East Asian (EA) ancestral populations. A genomic diversity space was generated via principal component analysis and ADMIXTURE was used to estimate the ancestral proportions among the patients. Results: The genetic structure of individual patient sample revealed a diverse ancestral admixture where average EU, WA, NA, and EA ancestries were 64.5%, 21.8%, 11.2%, and 2.5%, respectively. Multinomial logistic regression revealed a significant association between increasing WA ancestry and aggressive tumor subtypes (ER-/HER2+ and TNBC), p=0.009 and p=0.031, respectively. These findings remained significant when correcting for patient age and tumor stage; however, when adjusting for income, the association between WA ancestry and ER-/HER2+ and TNBC was no longer significant. Kaplan Meier survival curves showed a significant difference in 5-year OS for patients with >70% WA ancestry compared to those with <70% WA ancestry, p=0.023. Conclusions: In this first integrative approach studying genetic ancestry and SES on breast cancer characteristics and outcomes, we found a significant association between increasing WA ancestry and aggressive breast cancer subtypes, even after adjusting for known covariates. More striking, this association was negated when adjusting for income, suggesting potential gene-environment interactions not accounted for by genetic race. We also discovered that Hispanics have a more complex genetic architecture than non-Hispanic patients, which may in-turn drive genetically-associated survival patterns of resiliency with improved survival in HW compared to NHB patients. Furthermore, the OS differences based on quantitative genetic ancestry cut-offs may serve as a future tool in patient prognosis. Collectively, our results show that genetic ancestry and SES influence breast cancer subtypes and survival. This lays a foundation for future studies to investigate complex genomic relationships between race/ethnicity, SES, and breast cancer characteristics and outcomes through the lens of gene-environment interactions. Citation Format: Daniel A Rodriguez, Sina Yadegarynia, J. William Harbour, Nipun B. Merchant, Erin N. Kobetz, Neha Goel. Comprehensive analysis of global genetic ancestry and socioeconomic status on breast cancer outcomes [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-13-05.

Abstract WP70: Racial-ethnic Differences In Reintegrating To Normal Living Among Stroke Survivors

Background: In the continuum of care for stroke survivors, racial-ethnic disparities are most prominent during post-stroke rehabilitation. This includes reintegration of stroke survivors to normal living, an important component in stroke rehabilitation and predicts stroke survivors’ participation in typical daily activities and post-stroke depression. We assessed the association between racial-ethnic factors and ability of survivors to reintegrate to normal living at one-year post stroke. Methods: Using data from the DESERVE (Discharge Educational Strategies for Reduction of Vascular Events) trial, we assessed reintegration to normal living (RNL) using the RNL index of 335 participants with acute stroke. Race and ethnicity were asked at baseline and the survivors’ RNL index was assessed at one-year follow-up. The RNL index was calculated from 11 questions rating survivor’s reintegration from 0-10 (no to complete integration). We used linear regression to assess variations in race-ethnicity on RNL index adjusting for intervention, age, sex, education, living arrangement, stroke history, and severity of recent stroke. Results: At baseline, 27.8% identified as Non-Hispanic (NH) white, 31.6% identified as NH black, 34.9% identified as Hispanic and 5.7% identified as NH other. Crude mean RNL index was greater in the intervention arm than the usual care arm for Hispanics and NH blacks (Figure). In adjusted models, NH whites (5.88, CI: -2.9,14.8) and NH Blacks (6.63, CI: -1.1,14.3) had higher RNL index compared to Hispanics. Conclusion: Racial-ethnic differences may play a clinically important role in reintegrating stroke survivors to normal living. Future interventions must be aimed at understanding fundamental causes of disparities that may lead to inequities in stroke survivors’ rehabilitation to better implement preventative strategies well before stroke incidence.

Abstract PO-154: Clinical and prognostic significance of tumor infiltrating lymphocytes of triple negative breast cancer in Colombian women

Abstract Background: Triple negative breast cancer (TNBC) is the most aggressive breast cancer subtype, represents 10%-20% of all breast cancers and occurs more frequently in young Non- Hispanic Black and Latina women. TNBC is highly immunogenic due to the relatively high levels of tumor infiltrating lymphocytes (TILs) which in turn has been associated with long term survival as well as a risk reduction of death and recurrence. Little is known about TILs and its prognostic value in TNBCs from Latinas such as Colombian women. The goal of this study was to evaluate the differences in the clinic-pathological variables according to TILs levels. Also, to evaluate if TILs are an independent prognostic factor in TNBC from Colombian patients. Methods: We included 130 TNBC patients diagnosed between 2008-2016 at the Colombian National Cancer Institute. Analysis of TILs was performed on a single full-face hematoxylin and eosin (H&E) stained pre-treatment sections. TILs score was estimated as a proportion of intratumoral TILs (iTILs) and stromal TILs (sTILs) on tumoral area and was classified using a cut-off of 10% for sTILs and 1% for iTILs. Additionally, immunohistochemistry for PD-L1 (n=92), CD4 (n=40) and CD8 (n=40) was evaluated on three different fields of vision. Chi-squared test and ANOVA were used to test differences in clinic-pathological variables and Kaplan Meier analysis and long-rank test was used to explore differences in survival according to TILs. Results: High sTILs (≥10%) was observed in 36.4% of the patients. We observed that patients in the high sTILs group were usually diagnosed at early stages and with smaller tumors (<2cm) compared to patients with low sTILs (48.9% vs 23.2%, p<0.01 and 27.3% vs. 5.3%, p<0.01). Regarding treatment, a lower number of patients with high sTILs received neoadjuvant chemotherapy (46.8% vs. 74.4%, p<0.01 and mastectomy (53.2% vs. 74.4%, p=0.02) but had clinical complete response (cCR) (30% vs. 6.2%, p=0.053) compared to patients with low sTILs. Similar results were found for cCR in the iTILs positive group compared to iTILs negative group (13.8% vs. 0%, p<0.01). Differences in overall survival was observed according to sTILs (p<0.01). Cox regression analysis in a model adjusted by AJCC stage found low sTILs (<10%) as a prognostic factor associated with higher risk of death (HR: 1.65, 95% CI 0.99 – 2.77, p=0.05). Stromal and intratumoral CD4 and CD8 were evaluated, and patients were categorized according to the median of expression. For low iCD4 we observed a higher percentage of patients with node involvement (88.9% vs. 52.6%, p=0.04) and for the low iCD8 group we observed larger tumors (>5cm) (47.4% vs. 31.2%, p=0.03). Finally, PD-L1 expression was positive in 21.7% of the patients and was associated with high level of sTILs (p=0.02). Conclusions: Our results suggests that higher levels of sTILs in the TNBC are associated with a better prognosis. Further work is needed to explore the level of CD4, CD8 and PD-L1 expression in our patients to assess its clinical impact. Citation Format: Carlos A. Huertas, Mayra A. Ramirez, Henry J. Gonzalez, Juan C. Mejía, Laura Fejerman, Jovanny Zabaleta, María C. Sanabria, Silvia J. Serrano. Clinical and prognostic significance of tumor infiltrating lymphocytes of triple negative breast cancer in Colombian women [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-154.

Editorial Commentary

Editorial Commentary

Applying Intersectionality Framework to Explore the Development of Frailty in Older Adults

Dementia disproportionately impacts the health and financial security of women and certain minority groups. Long-standing inequities create distrust of the medical system, fewer treatment options, and reduced access to care. Research predicts that from 2020 to 2060, the number of African Americans and Latinx living with dementia will grow by nearly 200 percent and 440 percent, respectively, while prevalence among non-Hispanic Whites will increase by 69 percent. As the prevalence of dementia rises, so will the costs associated with dementia care. African Americans bear 1/3 of the costs associated with dementia. And the costs for Latinx living with Alzheimer’s disease are expected to exceed $100 billion by 2060. To mitigate these growing health and economic concerns, efforts to improve dementia care must put equity front and center. This presentation highlights five actionable recommendations to build health equity by reducing disparities in dementia prevention, detection, diagnosis, and care. These recommendations center around two overarching themes: (1) Strengthening the infrastructure among health-care, long-term care, and community-based organizations to achieve greater health equity for people living with dementia and their caregivers and (2) Expanding dementia-friendly networks and workplaces in racially and ethnically diverse communities. The recommendations discussed in this presentation will offer guidance for policymakers, health services researchers, businesses, health systems, and communities to reduce the inequitable impact of dementia on African Americans and Latinx, which is even more vital amid demographic trends showing a population growing older and more racially and ethnically diverse.

Socioeconomic status across the life course and smoking trajectories of older adult smokers in the U.S.

The objective of this study is to assess how SES over the life course impacts smoking cessation among older adult smokers in the U.S. 6,058 current smokers 50 years and older were identified from the 1998-2018 Waves of the Health and Retirement Study (HRS). The outcome of interest was smoking cessation. The main independent predictor was lifetime SES, categorized as low child and low adult SES (persistent low); low child, high adult SES; high child, low adult SES; and high child, high adult SES (persistent high). Multilevel mixed-effect logistic model was used to examine how lifetime SES predicts smoking cessation at age 65 and over time, adjusted by health and smoking covariates. The majority of older smokers had persistent high lifetime SES (60.3%), followed by high child/low adult SES (18.7%), persistent low SES (15.5%) and low child/high adult SES (5.6%). Compared to those with persistent high SES, those with persistent low SES were more likely to be Hispanic (25.9% vs. 3.0%, p<0.001) or non-Hispanic Black (22.7% vs. 8.7%, p<0.001), respectively. The adjusted results showed that at age 65, compared to those with persistent high SES, those with persistent low SES, low child/high adult SES, and low adult/high child SES were less likely to quit (OR: 0.42, 95%CI:0[.31-0.56]; OR:0.37, [0.24-0.55]; OR:0.53, [0.40-0.70], respectively). Similar results were observed over time for those with persistent low SES and low adult/high child SES. However, there was no significant difference for those with low child/high adult SES.

Abstract 11123: Racial and Ethnic Disparities Exist in Economic Stability and Healthcare Access and Utilization Among U.S. Children with Heart Conditions, National Survey of Children’s Health 2016-2019

Racial disparities exist in mortality among children with heart conditions, but less is known about disparities in upstream determinants of health. Our objective was to assess differences in economic stability, access to care, and healthcare utilization by race/ethnicity among children with heart conditions. Using caregiver-reported data on 0- to 17-year-olds from the 2016-2019 National Survey of Children’s Health, we calculated prevalence estimates for family economic stability (caregiver educational attainment and work status), child’s healthcare access (insurance type, usual place of care, and problems paying for child’s care), and child’s healthcare utilization (receipt of preventive care, specialty care, and 1 and ≥2 emergency room (ER) visits in the past 12 months) by race/ethnicity (Hispanic, non-Hispanic (NH) Black, and NH White), accounting for complex sampling and weighted to produce national estimates. We used the predicted marginal approach to multivariable logistic regression to generate adjusted prevalence ratios (aPRs) controlling for child’s age and sex. Of 2,596 children with heart conditions, 65.5% were NH White and 52.2% were male. Compared to NH White children, Hispanic and NH Black children, respectively, were 0.9 to 0.8 times less likely to have caregivers who were employed or had more than a high school education. Hispanic and NH Black children were more likely to have public insurance (respective aPRs 1.8, 2.1) and less likely to have a usual place of care (aPRs 0.9, 0.8). Hispanic children were less likely than NH White children to have visited the ER once in the past 12 months, whereas NH Black children were more likely to have visited the ER once (aPR 1.4) and twice or more (aPR 2.5). Among U.S. children with heart conditions, racial/ethnic disparities were seen in indicators of economic stability, access to care, and healthcare utilization.

El asedio a la libertad: Abolición y posabolición de la esclavitud en el Cono Sur

El asedio a la libertad: Abolición y posabolición de la esclavitud en el Cono Sur

Treatment delays in older women with nonmetastatic breast cancer treated at minority-serving hospitals.

122 Background: Almost 60% of breast cancer in the U.S. occur in women aged &gt;65, but these women are less likely to receive guideline-concordant care. Given existing treatment disparities by race/ethnicity, older minority women may be especially prone to potential gaps in breast cancer care. Hospitals serving higher proportions of minority patients are at risk to deliver suboptimal care, but how site of care impacts aging patients with breast cancer is not well defined. We sought to evaluate the association between race/ethnicity and breast cancer treatment delays in older women treated at minority-serving hospitals (MSH) vs non-MSHs. Methods: Women &gt;65 years old with non-metastatic breast cancer diagnosed from 2010-2017 were identified in the National Cancer Database using data from Commission on Cancer (CoC)-accredited hospitals. Treatment delay was defined as &gt;90 days from diagnosis to first treatment (surgery, chemotherapy, endocrine therapy). MSHs were defined as the top decile of hospitals serving predominantly Black or Hispanic patients. Multivariable logistic regression models adjusted for patient, disease, and hospital characteristics were used to determine the odds of treatment delay for women at MSHs vs non-MSHs across racial/ethnic groups. Results: 529,128 women (84.5% non-Hispanic White, 3.3% Hispanic White, 9.6% non-Hispanic Black, 0.1% Hispanic Black, 0.2% Native American, 2.5% Asian/Pacific Islander) were identified among 41 MSHs and 1,146 non-MSHs. Overall, time to treatment was &lt;90 days in &gt;95% of women (mean 33.4 days; standard deviation 26.4 days). Older women regardless of race at MSHs were more likely to suffer treatment delays than those at non-MSHs (odds ratio 1.31; 95% confidence interval 1.22-1.41). Compared to non-Hispanic White women, all minority groups had a higher likelihood of treatment delay regardless of MSH status (Table). Conclusions: Although most older women with non-metastatic breast cancer treated at CoC hospitals received care in a timely fashion, minorities and those treated at MSHs were more likely to experience treatment delays. Effective interventions addressing barriers to timely care at MSHs and among racial/ethnic minorities are needed. [Table: see text]

Endometrial Cancer Type 2 Incidence and Survival Disparities Within Subsets of the US Black Population.

IntroductionEndometrial cancer type 2 (EC2) carries a worse prognosis compared to EC type 1. EC2 disproportionately affects Black women among whom incidence is higher and survival is poorer compared to Whites. Here we assessed EC2 incidence and survival patterns among US Black ethnic groups: US-born Blacks (UBB), Caribbean-born Blacks (CBB), and Black Hispanics (BH).MethodsWe analyzed population-based data (n=24,387) for the entire states of Florida and New York (2005–2016). Hysterectomy-corrected EC2 incidence rates were computed by racial-ethnic group, and survival disparities were examined using Cox regression adjusting for tumor characteristics, poverty level, and insurance status.ResultsEC2 incidence rates were highest among UBB (24.4 per 100,000), followed by CBB (18.2), Whites (11.1), and Hispanics of all races (10.1). Compared to Whites, the age-adjusted cause-specific survival was worse for non-Hispanic Blacks (aHR: 1.61; 95%CI 1.52–1.71) and Hispanics of all races (aHR:1.09; 95% CI:1.01–1.18). In relation to Whites, survival was worse for non-Hispanic Blacks: UBB (aHR:1.62; 95%CI 1.52–1.74) and CBB (aHR:1.59; 95% CI:1.44–1.76) than for BH (aHR:1.30; 95% CI:1.05–1.61). Surgical resection was associated with a lower risk of death, while carcinosarcoma subtype and advanced stage at diagnosis were associated with a greater risk.ConclusionsAlthough higher EC2 incidence and lower survival are observed among all African-descent groups, there are significant intra-racial differences among UBB, CBB, and BH. This heterogeneity in EC2 patterns among Black populations suggests an interplay between genetic and socioenvironmental factors.

Hispanic Ethnicity and Breast Cancer: Disaggregating Surgical Management and Mortality by Race.

Breast cancer is the leading cause of cancer death among Hispanic women. Unfortunately, few studies disaggregate Hispanic patients by race to understand its implications on treatment and clinical outcomes such as mortality. The aim of this study is to examine surgical management and overall mortality among different subgroups of women who self-identify as Hispanic. Hispanic female patients, ages 18-90, stages I-III, diagnosed with breast cancer between 2010 and 2015 from the National Cancer Data Base were identified. The study cohort was divided into three ethnoracial categories: (1) Hispanic White (HW), 2) Hispanic Black (HB), and 3) Hispanic Other (HO). Descriptive statistics and multivariate models were constructed to determine the relationship between sociodemographic factors, clinical variables, surgical management, and mortality when disaggregated by race. There were 56,675 Hispanic women who met the study criteria. Most where HW (n=50,599, 89.3%) and the rest were HB (n=1,334, 2.4%) and HO (n=4,742, 8.3%). There was no difference between the three groups on receipt of breast conservation therapy (P=0.12). HB (48.5%) and HO (46.6%) women were more likely to undergo reconstruction than those who identified as HW (38.7%) (P<0.001). Additionally, HB (38.3%) women were more likely to undergo tissue-based reconstruction than HW (29.0%) and HO women (30%) (P=0.0008). There was no difference between the groups in the utilization of contralateral prophylactic mastectomy (CPM) (P=0.078). On multivariable analysis, there was no difference in mortality between HB and HW patients (HR 1.18, 95%CI 0.92-1.51; Ref HW). However, HO women had a 24% relative risk reduction in mortality (HR 0.76, 95% CI 0.63-0.92; HW ref). Findings from this study suggest there are ethnoracial disparities in reconstruction utilization and mortality among Hispanic women. Future studies should examine how culture, language, healthcare access, and patient preferences contribute to these disparities.

Skin Tone, Discrimination, and Allostatic Load in Middle-Aged and Older Puerto Ricans.

A growing body of research suggests that skin tone may be a health risk indicator for Hispanics. Black and darker-skinned Hispanics have worse mental and physical outcomes than White and lighter-skinned Hispanics. Discrimination exposure has been implicated as a risk factor that may explain the association between skin tone and health. However, there is scant research examining the interrelationship between skin tone, discrimination, and health, particularly among Puerto Ricans. We examine the interrelationships between two measures of skin tone, two measures of discrimination, and allostatic load (AL) among Puerto Rican adults. Using cross-sectional data from wave 3 of the Boston Puerto Rican Health Study (n = 882), we examined the indirect association (IA) of skin tone on physiological dysregulated systems, also known as AL, through major discrimination and everyday discrimination. We tested these associations using two distinct measures of skin tone: interviewer-ascribed skin tone and spectrophotometer-measured skin tone. Interviewer-ascribed skin tone was indirectly associated with AL through major discrimination (IA = 0.03, 95% confidence interval = 0.004 to 0.06). However, there was no evidence of an IA of interviewer-ascribed skin tone on AL through everyday discrimination (IA = -0.01, 95% confidence interval = -0.03 to 0.01). In addition, there was no evidence that spectrophotometer-measured skin tone was indirectly associated with AL through major discrimination or everyday discrimination. The sociocultural significance of skin tone may affect how Puerto Ricans are perceived and treated by others, which can, in turn, have physiological health consequences. Future research is needed to replicate these findings and examine the interrelationship between skin tone, discrimination, and other health outcomes.

Contributors

Contributors

Racial and Ethnic Disparities in Breast Cancer Survival: Emergence of a Clinically Distinct Hispanic Black Population.

To understand the impact of Black race on breast cancer (BC) presentation, treatment, and survival among Hispanics. It is well-documented that non-Hispanic Blacks (NHB) present with late-stage disease, are less likely to complete treatment, and have worse survival compared to their non-Hispanic White (NHW) counterparts. However, no data evaluates whether this disparity extends to Hispanic Blacks (HB) and Hispanic Whites (HW). Given our location in Miami, gateway to Latin America and the Caribbean, we have the diversity to evaluate BC outcomes in HB and HW. Retrospective cohort study of stage I-IV BC patients treated at our institution from 2005-2017. Kaplan-Meier survival curves were generated and compared using the log-rank test. Multivariable survival models were computed using Cox proportional hazards regression. Race/ethnicity distribution of 5951 patients: 28% NHW, 51% HW, 3% HB, and 18% NHB. HB were more economically disadvantaged, had more aggressive disease, and less treatment compliant compared to HW. 5-year OS by race/ethnicity was: 85% NHW, 84.8% HW, 79.4% HB, and 72.7% NHB (P < 0.001). After adjusting for covariates, NHB was an independent predictor of worse OS [hazard ratio:1.25 (95% confidence interval: 1.01-1.52), P < 0.041)]. In this first comprehensive analysis of HB and HW, HB have worse OS compared to HW, suggesting that race/ethnicity is a complex variable acting as a proxy for tumor and host biology, as well as individual and neighborhood-level factors impacted by structural racism. This study identifies markers of vulnerability associated with Black race and markers of resiliency associated with Hispanic ethnicity to narrow a persistent BC survival gap.

Soldier and Scholar: Abdias Nascimento and the Origins of Afro-Latin American Studies

Abdias Nascimento shaped Brazil and the lives of Afro-Brazilians as an activist, as a politician, as an internationally recognized scholar, and through the arts as a playwright, a director, a poet, and painter. Through a scholarly career that spanned much of the 20th century and continued into the 21st, his ideas preceded and served as a model for the recent growth of Afro-Latin American studies as a discipline. This article draws on Nascimento’s writing to shed light on the less studied period when he was enrolled in the Brazilian army in São Paulo from 1930 to 1936, as well as the two related periods during which he was incarcerated between 1936 and 1938. This essay argues that—much like Afro-descendant soldiers globally who fought in conflicts from the American Wars of Independence through the World Wars of the 20th century—military service and his subsequent captivity deeply inpacted Abdias Nascimento. His relations with the Brazilian military and its penal institutions guided his concept of race, citizenship, and nation, his activism and scholarship, and subsequently helped mold the contemporary field of Afro-Latin American studies, directly and indirectly.

536-P: Resilience in Real Time: Parents of Youth with Type 1 Diabetes (T1D) Summer 2020 Psychosocial Experiences

Objective: The COVID-19 pandemic disproportionately impacts parents, people with health risks like diabetes, and those with fewer financial resources. Minorities face particularly negative outcomes of the pandemic, and racial tensions after George Floyd’s murder may have worsened effects. We examined group differences by race/ethnicity and socio-economic status (SES) in depressive symptoms and protective factors in parents of children with T1D in summer 2020. Methods: Participants were n=100 parents (98% mothers) of youth with T1D (60% female, M age=6.7±1.6 yrs, M T1D duration = 2.9±.5 yrs), who completed a behavioral RCT ≥6 months prior. In July/July 2020, parents self-reported on awareness of how to obtain housing/financial/food resources (Protective Factor Survey Concrete Support [PFS-CS] subscale) and depressive symptoms (Center for Epidemiological Studies -Depression [CES-D]). Race/ethnicity (66% non-Hispanic white, 12% non-Hispanic Black, 11% Hispanic, 11% other) and health insurance (33% public, 67% private) were reported at RCT enrollment. We ran ANOVAs and Pearson correlations to compare CES-D and PFS-CS by demographic groups. Results: PFS-CS scores differed significantly by race/ethnicity and insurance status, both p&amp;lt;.01. Hispanic (M=1.6±0.5) and non-Hispanic Black (M=1.6±0.6) parents had higher CS than non-Hispanic white parents (M = 1.3±0.3). Those with public insurance (M = 1.6±0.5) had higher CS than those with private insurance (M = 1.3±0.3). Higher CS correlated with lower CES-D, r = -.26, p = .05. CES-D did not differ across groups. Conclusion: Racially/ethnically diverse and lower SES parents of children with T1D reported more knowledge about how to access useful resources. This may have buffered against elevated mood symptoms during co-occurring major societal and public health stressors in 2020. Highlighting sources of support and resilience may be a useful strategy in strength-based interventions for parents of children with T1D. Disclosure J. N. Jones: None. S. A. Carreon: None. K. Rooney: None. C. H. Wang: None. C. Tully: None. M. Monaghan: None. R. Streisand: None. M. E. Hilliard: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (1R01DK102561)

Trends in breast cancer survival by race-ethnicity in Florida.

e18556 Background: Considerable efforts to improve disparities in breast cancer outcomes for underserved women have occurred over the past 3 decades. This study was conducted to evaluate trends in survival, by race-ethnicity, for women diagnosed with breast cancer in Florida over a 26-year period to assess potential improvement in racial-ethnic disparities. Methods: This was a retrospective cohort study of women diagnosed with invasive breast cancer in Florida between 1990-2015. Data were obtained from the Florida Cancer Data System. Women in the study were categorized according to race (white/black) and Hispanic ethnicity (yes/no) as non-Hispanic white (NHW), non-Hispanic black (NHB), Hispanic white (HW), and Hispanic black (HB). Cumulative incidence estimates of 5- and 10-year breast cancer death with 95% confidence intervals (CI) were obtained by race-ethnicity, according to diagnosis year. Subdistribution hazard models were used to obtain subdistribution hazard ratios (sHR) for the relative rate of breast cancer death accounting for competing causes. Results: Compared to NHW women, minority women were more likely to be younger, be uninsured or have Medicaid as health insurance, live in high poverty neighborhoods, have more advanced disease at diagnosis, have high grade tumors, have hormone receptor negative tumors, and receive chemotherapy as treatment. Minority women were less likely to receive surgery. Over the course of the study, breast cancer mortality decreased for all racial-ethnic groups, and racial-ethnic minorities had greater absolute and relative improvement in breast cancer survival for nearly all metrics compared to non-Hispanic white (NHW) women. However, for the most recent time period (2010-2015), black women still experienced significant survival disparities with non-Hispanic black (NHB) women having twice the rate of 5-year (sHR = 2.04: 95% CI; 1.91-2.19) and 10-year (sHR = 2.02: 95% CI; 1.89-2.16) breast cancer death. Conclusions: Despite efforts to improve disparities in breast cancer outcomes for underserved women in Florida, additional targeted approaches are needed to reduce the poorer survival in black (especially NHB) women. Our next step is to conduct a mediation analysis of the most important factors driving racial/ethnic disparities in breast cancer outcomes for women in Florida.