Asian And Pacific Islander Research Articles

1103-P: Prediabetes and Associated Characteristics among Asian/Pacific Islander Adolescents with Obesity

Background: There are limited data regarding modifiable lifestyle behaviors and prediabetes among US Asian/Pacific Islander (API) children. This study characterizes the association of obesogenic behaviors and weight with prediabetes among API adolescents with obesity receiving pediatric care. Methods: We used retrospective data from 3,233 API adolescents aged 13-17 years in a US healthcare system who had well child visits in 2016-2019, provided well-check information on health behaviors, had BMI ≥95th percentile, and HbA1c level (within 1 year). Age, sex, self-reported daily obesogenic behaviors (eating <5 servings of fruits/vegetables, drinking ≥12 oz juice/soda, exercising for <60 minutes, >2 hours screen time), obesity level (Class I,2,3) and neighborhood deprivation index (NDI) were examined. Prediabetes was defined as HbA1c 5.7-6.4%; those with HbA1c ≥6.5% or diabetes diagnosis were excluded. Multivariable logistic regression was used to examine the association of these factors and prediabetes. Results: Among 3,233 API adolescents (mean age 14.6 ± 1.4 y; 63.8% male) with obesity, 22.4% had prediabetes (84.4% had HbA1c 5.7-5.9%). Prediabetes did not differ by age or sex but increased with obesity level (20.1%, 25.2%, 33.2% for Class 1, 2, 3 obesity, respectively). In unadjusted analyses, low exercise was marginally associated with prediabetes (p=0.07) but not diet or screen time. In fully adjusted multivariable analyses, obesity severity (OR 1.98 [95% CI 1.47-2.64] for class 3, OR 1.34 [1.10-1.63] for class 2 vs 1), and low exercise (OR 1.20 [1.01-1.44]) were associated with increased odds of prediabetes, whereas other modifiable behaviors were not. Conclusion: About 1 in 5 API adolescents with obesity had prediabetes, associated with obesity severity and low exercise. These findings support efforts that address obesity and promote physical activity in API children to reduce the risk of diabetes. Further studies should examine potential differences by ethnic group. Disclosure C.Chu: None. L.A.Rodriguez: None. M.Chandra: None. L.Greenspan: None. A.M.Bacong: None. J.C.Lo: None. Funding Kaiser Permanente Northern California

422 Healthcare disparities in atopic dermatitis: insights from TARGET-DERM registry

Abstract Atopic dermatitis disproportionately affects diverse patient populations. Furthermore, complex factors may influence the burden of disease and access to treatment amongst different racial and ethnic groups. The aim of this study is to evaluate health disparities and real-world management patterns in distinct populations treated for AD in routine clinical practice. The study included patients with AD (≥age 6) enrolled in TARGET-DERM, an observational, longitudinal study of over 2500 participants across 43 US academic/community centers. Participants were classified in four race/ethnicity categories as reported in enrollment forms and/or patient self-reported: non-Hispanic (NH) White, Black, Asian/Pacific Islander (API) and Hispanic. Patient characteristics analysed included demographics, clinical characteristics, investigator-assessed and patient-reported outcomes, and treatment history. A total of 1928 patients (mean age 34 years; 58% female; 60% enrolled at community-based centers) were included, encompassing 251 NH-Black (13%), 271 NH-API (14%), 288 Hispanic (15%) and 1118 NH-White (58%) participants. Most (71%) had a medical comorbid condition with 30% having ≥3 conditions. Private insurance was highest among NH-APIs (82%) and NH-Whites (70%), Medicaid was highest among Hispanics (46%) and NH-Blacks (27%), and uninsured was highest among NH-Blacks (18%) and NH-Whites (12%). At enrollment, clinical disease severity assessments [vIGA-AD, TBSA and vIGA-ADxTBSA (VxT)] varied by race/ethnicity, also suggesting healthcare disparities. Lowest severity was among NH-Whites (25.9% vIGA-AD clear/almost clear, 26.7% VxT clear/almost clear and median TBSA 5%), followed by Hispanics (21.7%, 18.2% and 7%), NH-Blacks (15.7%, 15.3% and 10%), and NH-APIs (10.7%, 13.8% and 8%). No differences were identified in the distribution of traditional systemic therapies across groups. However, in multivariable analysis (adjusted for age, sex, insurance status, comorbidities, vIGA and treatment status), NH-Blacks and Hispanics were less likely to be treated with advanced systemic therapies than NH-Whites [odds ratio (OR) of 0.67 and 0.70, respectively; P < 0.01]. Similarly, NH-APIs were more likely to have higher vIGA-AD scores than NH-Whites (OR = 1.57; P < 0.01). Non-Hispanic Blacks also had higher vIGA-AD scores than NH-Whites (OR = 1.42; P < 0.05) when controlling for all covariates other than treatment type (P < 0.05), adjustment for which renders the estimated black–white disparity nonsignificant. (OR = 1.32, P = 0.11). Descriptively comparing patient-reported outcome distributions identified no significant differences (P > 0.12). Despite presenting with more severe disease, Blacks and Hispanics have significantly lower odds of using advanced systemic therapy relative to NH-Whites, suggestive of an access disparity leading to disparities in disease control. These disadvantages persist after adjusting for an array of demographic, socioeconomic and medical history characteristics. The results highlight real-world evidence of racial and ethnic disparities among patients with AD.

125-OR: Disparities in Access to Sodium–Glucose Cotransporter-2 Inhibitors (SGLT2i)

SGLT2i are shown to improve diabetes control and delay the onset of diabetes-related complications. However, socioeconomic (SES) factors may influence access to SGLT2i. We assessed trends and differences in SGLT2i prescription rates by race, ethnicity, and insurance type at a large academic medical center (AMC). Data were extracted from the electronic health records at a large AMC from January 2014 to December 2021. The study outcome was SGLT2i prescription rates over time. Race and ethnicity were classified as Non-Hispanic White (NHW), NH Black (NHB), Hispanics, and Asian/Pacific Islanders (API), and insurance type as Private, Medicare, and Medicaid. Negative binomial regressions were used to estimate the prescription rates by year. Between 2014-2021, 30,030 type 2 diabetes patients received an SGLT2i prescription, and the prescription rates increased significantly from 0.25% to 11.47%, with the rates increasing fastest in Medicare patients. Privately-insured and Medicare patients were more likely to be prescribed SGLT2i than Medicaid patients (p<0.001). NHB, and Hispanic patients were less likely to be prescribed SGLT2i than NHW and API patients (p<0.001). Although SGLT2i prescription rates increased after FDA approval, substantial variations by race, ethnicity, and insurance type exist. Future studies are needed to explore how SES factors drive observed differences in access to SGLT2i. Disclosure D.S.Zhang: None. A.Rajan: None. S.Islam: None. D.M.Charytan: Advisory Panel; Merck & Co., Inc., CSL Behring, GlaxoSmithKline plc., Consultant; Novo Nordisk, Gilead Sciences, Inc., AstraZeneca, Other Relationship; Boehringer Ingelheim and Eli Lilly Alliance, zogenix, medtronic, Research Support; Amgen Inc. A.M.Jacobson: None. J.Divers: None. Funding Doucette Innovation Fund

1242-P: Obesity Disparities in a Multiracial Sample of Asian American and Pacific Islander (API) Adults

Background: Asians have higher diabetes rates than Non-Hispanic white (NHW) people, despite having lower BMI. Studies on Asians often present monoracial groups. We examined obesity rates among mono- and multiracial APIs. Methods: We examined obesity and other factors by self-reported race using case-control data from two integrated healthcare systems with large API populations. Results: Obesity varied by race, ranging from 8.5% (Chinese) to 53.5% (Other Pacific Islander) (Table 1). Obesity was high for multiracial API. Demographic, behavioral, and clinical factors explained some, but not all the differences in obesity rates (Table 2). Conclusion: Multiracial API people had higher obesity rates than monoracial API and NHW people. Robust data on multiracial people are needed to understand health disparities among this group. Disclosure A.M.Bacong: None. S.L.Gibbs: None. T.B.Frankland: Research Support; Pfizer Inc., Stock/Shareholder; AbbVie Inc., Pfizer Inc., CVS Health Corp, Regeneron Pharmaceuticals Inc. J.Li: None. Y.G.Daida: Research Support; GlaxoSmithKline plc. S.P.Fortmann: Research Support; Pfizer Inc. L.Palaniappan: None. Funding National Heart, Lung, and Blood Institute (R01HL126172)

ASO Visual Abstract: Colon Cancer Disparities in Stage at Presentation and Time to Surgery for Asian Americans, Native Hawaiians, and Pacific Islanders: A Study with Disaggregated Ethnic Groups.

ASO Visual Abstract: Colon Cancer Disparities in Stage at Presentation and Time to Surgery for Asian Americans, Native Hawaiians, and Pacific Islanders: A Study with Disaggregated Ethnic Groups.

“More than a song and dance”: Exploration of patient perspectives and educational quality of gynecologic cancer content on TikTok

ObjectiveTo investigate themes, quality, and reliability of gynecologic cancer-related content on the social media application TikTok. MethodsTikTok was systematically searched for the 100 most popular posts for ovarian cancer (OC), endometrial cancer (EC), cervical cancer (CC), vulvar cancer (VC), and gestational trophoblastic disease (GTD) in August 2022. Data was collected for demographics, tone, and themes. Educational videos were rated for quality and reliability utilizing the modified DISCERN scale. Relationships between content demographics, disease sites, and themes were assessed. ResultsAs of August 2022, the top five hashtags for each gynecologic cancer on TikTok had 466.7 million views. 430 of the top 500 posts were eligible for inclusion (OC: n = 86, CC: n = 93, EC: n = 98, GTD: n = 63, VC: n = 90). The majority of creators (n = 323, 75.1%) were White, 33 (7.7%) were Black, 20 (4.6%) were Asian/Pacific Islander (API), 10 (2.3%) were South Asian, 20 (4.7%) were Hispanic/Latino/a, 24 (5.5%) were unable to determine. Eleven central themes were identified, with significant differences when analyzed by disease site and race. The median DISCERN score for all posts was 1.0, indicating poor educational quality and reliability. When compared by race, South Asian/API posters received the highest scores (3, IQR 2.5) versus Black (2: IQR 3), Hispanic/Latino/a (2: IQR 0), and White posters (1, IQR 2) (p = 0.0013). Conclusion(s)Gynecologic cancer-related content on TikTok is of poor educational quality, and racial disparities in gynecologic cancer extend to social media. Opportunities exist to create more diverse content to support racial and cultural experiences in gynecologic cancer treatment.

Associations Between Insurance, Race and Ethnicity, and COVID-19 Hospitalization Beyond Underlying Health Conditions: A Retrospective Cohort Study

: People of lower socioeconomic position (SEP) and people of color (POC) experience higher risks of severe COVID-19, but understanding of these associations beyond the effect of underlying health conditions (UHCs) is limited. Moreover, few studies have focused on young adults, who have had the highest incidence of COVID-19 during much of the pandemic. : We conducted a retrospective cohort study using electronic health record data from the University of Washington Medicine healthcare system. Our study population included individuals aged 18-39 years who tested positive for SARS-CoV-2 from February 2020 to March 2021. Using regression modeling, we estimated adjusted risk ratios (aRRs) and differences (aRDs) of COVID-19 hospitalization by SEP (using health insurance as a proxy) and race and ethnicity. We adjusted for any UHC to examine these associations beyond the effect of UHCs. Results: Among 3,101 individuals, the uninsured/publicly insured had a 1.9-fold higher risk of hospitalization (aRR [95% CI]=1.9 [1.0, 3.6]) and 9 additional hospitalizations per 1,000 SARS-CoV-2 positive persons (aRD [95% CI]=9 [-1, 20]) compared to the privately insured. Hispanic or Latine, non-Hispanic (NH) Asian, NH Black, and NH Native Hawaiian or Pacific Islander patients had a 1.5-, 2.7-, 1.4-, and 2.1-fold-higher risk of hospitalization (aRR [95% CI]=1.5 [0.7, 3.1]; 2.7 [1.1, 6.5]; 1.4 [0.6, 3.3]; 2.1 [0.5, 9.1]), respectively, compared to NH White patients. Conclusions: Though they should be interpreted with caution given low precision, our findings suggest the increased risk of COVID-19 hospitalization among young adults of lower SEP and young adults of color may be driven by forces other than UHCs, including social determinants of health.

Asian Americans and Pacific Islanders’ preferences in recruitment strategies/messaging for participation in a research recruitment registry for Alzheimer’s disease and related dementias, aging, and caregiving research: A discrete choice experiment survey

AbstractBackgroundUnderrepresentation of Asian Americans and Pacific Islanders (AAPIs) in research requires urgent attention. The Collaborative Approach for AAPIs Research and Education (CARE) registry aims to increase AAPIs’ representation in research. We report results from a multilingual discrete choice experiment (DCE), an innovative method to determine older AAPIs’ preferences for tailored recruitment strategies and messaging.MethodsInitial DCE recruitment strategy/messaging attributes and attribute levels were selected based on feedback from CARE focus groups. A pilot study (16 participants from 7 AAPI cultural groups) refined attribute wording and levels. The final DCE survey was translated into Simplified and Traditional Chinese, Korean, and Vietnamese. CARE academic and community partners recruited participants (AAPIs aged ≥50 years) for the survey, asking them to select their preference in each of 12 pairs of recruitment strategies (randomly selected from 48 different combinations) of three attributes: (1) from whom they would like to learn about CARE; (2) what would motivate them to join CARE; and (3) how they would prefer hearing about CARE. A custom Qualtrics survey displayed image pairs of randomly selected messaging combinations. Analyses utilized conditional logistic regression models to estimate odds ratios with 95% confidence intervals.ResultsA total of 356 (mean age = 65.0; range: 50‐93) participants from 7 AAPI cultural groups (Asian Indian, Chinese, Filipino, Japanese, Korean, Samoan, and Vietnamese) completed the survey. Overall, participants had similar preferences for learning about CARE between community organizations and the healthcare community, however, participants preferred learning about CARE from the healthcare community (e.g., doctors, clinics) relative to community champions and faith‐based organizations. Participants were more motivated to join CARE to help advance research relative to sharing personal experiences; and preferred to hear about CARE via social media and instant messaging relative to a flyer or workshop/seminar. Importantly, preferences varied by age, cultural group, survey completion language, and whether the participant received assistance with the survey.ConclusionsTo our knowledge, this is the first study using a DCE approach to elicit preferences for registry recruitment strategies among AAPIs. Findings will inform appropriate tailoring of recruitment strategies/messaging to successfully engage AAPI participants in a registry for ADRD research.aging after age 90.

Increasing Asian Americans’ and Pacific Islanders’ representation in research: Updates from the CARE research recruitment registry

AbstractBackgroundThe underrepresentation of Asian Americans and Pacific Islanders (AAPIs) in Alzheimer’s disease and related dementias (ADRD) research is a significant concern given that they are the fastest growing racial group in the US. The Collaborative Approach for AAPIs Research and Education (CARE) research recruitment registry is a collaboration among multiple academic and community partners aimed at creating a sustainable research recruitment source.MethodsBetween October 15, 2020 and January 17, 2022, 7,455 AAPIs enrolled in the CARE registry. The enrollment survey and outreach materials are available in 7 languages: English, Chinese (Simplified/Traditional), Hindi, Korean, Samoan, and Vietnamese. With input from CARE’s community advisory board, CARE was strategically promoted with a focus on health research across the lifespan, including ADRD. Participants can enroll online, by phone, or in‐person. A protocol for CARE‐supported recruitment requests was developed and was presented at four Brain Trust Meetings to promote CARE to the research community.ResultsThe mean age of participants is 53.4 years, including 2,130 middle‐aged (50‐64 years old) and 2,373 older (≥65 years old) participants who may be targeted groups for ADRD research. Overall, 11% (n = 819) reported having ADRD (mean age = 62.8; SD = 15.2). Among the 810 caregivers (mean age = 51.2; SD = 14.6), 37% were ADRD caregivers. Most participants who had self‐reported ADRD (96.2%) and caregivers (78%) were foreign‐born. Most participants with ADRD were Vietnamese (83.6%), followed by Chinese (12.5%). The major cultural groups among ADRD caregivers were Chinese (47.7%), Vietnamese (29%), Korean (10%), Asian Indian (7.7%), and Japanese (7%). Participants from several AAPI cultural groups were smaller in numbers (e.g., Filipino, Native Hawaiians and Pacific Islanders), however, we anticipate they will grow following targeted outreach efforts. Of the 32 recruitment referral requests, 21 were aging‐related, including 18 ADRD or ADRD‐caregiving studies. 798 CARE participants had been referred to participate in 20 requesting studies.ConclusionsCARE has successfully recruited over 7,400 participants despite limitations to conduct in‐person outreach during the COVID‐19 pandemic. The registry is poised to be a valuable recruitment source and a resource for fostering meaningful engagement of AAPIs in ADRD‐related research.

Disparities in pancreatic cancer among Asian-Pacific Islander and American Indian-Alaskan Native populations.

e16275 Background: Pancreatic cancer (PanCan) is the third deadliest cancer in the United States, causing 8.2% of all U.S. cancer deaths. A steady rise in incidence rates has been observed nationally, with striking variation by geographic region and across race/ethnicity. Several studies have demonstrated a disproportionate burden of PanCan incidence on non-Hispanic Black (NHB) as compared to non-Hispanic White (NHW) populations. Yet little attention has been given to the burden of disease on Asian-Pacific Islander (API) and American Indian-Alaskan Native (AI/AN) populations. Additionally, there are limited data on disparities in PanCan incidence by U.S. geographical region. This study investigates age-adjusted incidence rates and annual percent change in PanCan incidence over a 20-year period, emphasizing burden of disease among API and AI/AN persons as well as by U.S. geographic region. Methods: The National Cancer Institute’s Surveillance, Epidemiology, and End-Results (SEER) database of 22 registries was used to study newly diagnosed pancreatic cancer cases (ICD-O-3/WHO 2008) for the period 2000-2019. Incidence rates and annual percent change were age-adjusted to the 2000 U.S. standard population and calculated per 100,000 persons using SEER*Stat software. Results: The overall age-adjusted PanCan incidence rates, from lowest to highest, for AI/AN, API, NHW and NHB populations were 6.6, 9.6, 12.5 and 15.3, respectively (per 100,000 persons). When examining each registry separately, two notable outliers were observed in the state of Hawaii where API and AI/AN persons had incidence rates of 13.4 and 24.5 per 100,000 persons, respectively. For all racial/ethnic groups, except AI/AN, the annual percent change in PanCan incidence significantly rose from 2000-2019, with increases of 0.9, 0.6 and 0.3 percent per year for NHW, API and NHB persons, respectively (p < 0.05). Conclusions: A striking observation in this study was the unusually high PanCan incidence rates among API and AI/AN persons in the state of Hawaii, as compared to national rates. Moreover, a significant increase in annual percent change in PanCan incidence was observed over the study period for all racial/ethnic groups, except AI/AN. A key strength of this analysis is the examination of a large, population-based database over an extended time period. The SEER regions examined cover approximately 48% of the U.S. population and intentionally balance on racial/ethnic composition of the U.S. However, the database does not capture cancer incidence data from all U.S. states. Furthermore, this study did not examine sub-categories of API and AI/AN persons, which are groupings that may be heterogeneous with respect to disease burden over time and across U.S. regions. Future efforts will include refining the analysis into more granular racial/ethnic groups and exploring incidence rates among API and AI/AN subgroups in Hawaii.

Racial/ethnic differences in 21-gene recurrence score and survival among estrogen receptor-positive breast cancer patients.

511 Background: Despite studies on racial/ethnic disparities in breast cancer patients, there is limited literature evaluating association of racial/ethnic differences with 21-gene recurrence score (RS) and survival differences stratified by RS risk categories. We performed an observational cohort study to evaluate such disparities in context of RS. Methods: The National Cancer Database (NCDB) was queried for patients with ER-positive, pT1-3N0-1aM0 breast cancer who received surgery followed by adjuvant endocrine therapy with available RS from 2006 to 2018. Racial/ethnic groups were stratified by non-Hispanic White (NHW), Hispanic White (HW), Black, and Asian/Pacific Islander (API). Our primary endpoint was overall survival (OS). Logistic multivariable analysis (MVA) was built upon baseline patient and tumor characteristics to evaluate variables associated with RS > 25. Cox MVA was used to evaluate OS. Interaction term analysis was used to identify heterogeneous association of racial/ethnic groups and RS; if significant, subgroup analyses compared magnitude of racial/ethnic differences stratified by RS. To address immortal time bias, Cox MVA analyses were repeated after excluding patients with post-diagnosis survival < 6 months. P values were two-sided. Bonferroni correction was used for multiple comparisons (NHW vs HW women, NHW vs Black women, and NHW vs API women) with p values less than 0.017 being statistically significant. Results: A total of 140,133 women (median [interquartile range (IQR)] age, 60 [52-67] years) were included for analysis. 115,651 (82.5%), 8,213 (5.9%), 10,814 (7.7%), and 5,455 (3.9%) were NHW, Hispanic, Black, and API women respectively. Median (IQR) follow up was 66.2 mo. (48.0-89.8). Logistic MVA showed compared to NHW women, Black women were associated with higher RS (26 or higher vs < 26: adjusted odds ratio [aOR] 1.19, 95% confidence interval [CI] 1.12-1.26, p < 0.001), while HW (aOR 0.93, 95% CI 0.86-1.00, p = 0.04) and API (aOR 1.03, 95% CI 0.95-1.13, p = 0.45) were not. Cox MVA showed compared to NHW, Black women were associated with worse OS (adjusted hazards ratio [aHR] 1.10, 95% CI 1.02-1.19, p = 0.012) while HW (aHR 0.85, 95% CI 0.77-0.94, p = 0.001) and API (aHR 0.66, 95% CI 0.56-0.77, p < 0.001) were not. There was significant interaction between race/ethnicity and RS (interaction p = 0.006). Subgroup analysis found similarities in those with RS < 26, while only API women were associated with improved OS among those with RS ≥ 26. After excluding those with post-diagnosis survival < 6 mo., our findings remained comparable. Conclusions: To our knowledge, this is the largest nationwide oncology database study to suggest that Black women are associated with higher RS, while HW and API are not. It also suggests that Black women are associated with worse OS among those with RS < 26, while API are associated with improved OS regardless of RS compared to NHW women.

Racial and ethnic disparities in survival among persons with subsequent primary cancer.

12093 Background: Racial and ethnic disparities in survival after first primary cancer diagnoses have been well documented. Yet comprehensive data for disparities after subsequent primary cancer (SPC) are lacking despite the growing burden of SPCs. Methods: This study included 230,370 persons diagnosed with one of the 13 common SPCs at ages≥20 years during 2000-2013 in 18 Surveillance, Epidemiology, and End Results registries. Cause-specific proportional hazards models were used to estimate HR (hazard ratio), overall and stratified by SPC types, comparing the risk of cancer or cardiovascular death in Hispanic, non-Hispanic Asian or Pacific Islander (API), or non-Hispanic Black (Black) persons to that in non-Hispanic White (White) persons. HRs were adjusted for sex, first primary cancer type and stage, age and year of SPC diagnosis (base model); and additionally household income, urbanicity, SPC stage, subtype, and treatment receipt (surgery, radiotherapy, chemotherapy) (final model). Results: During 54 months of median follow-up, 109,757 cancer deaths and 18,283 cardiovascular deaths occurred among persons with SPCs. Overall, HRs for cancer death were higher among Black (HR = 1.21, 95% CI = 1.18-1.23) and Hispanic (HR = 1.10, 95% CI = 1.07-1.13) persons compared with White persons, but lower among API persons (HR = 0.93, 95% CI = 0.90-0.96) in the base model. When stratified by SPC types, the increased HRs were evident for 10 of 13 cancers among Black persons with the greatest HR among those with uterine corpus cancer (HR = 1.87, 95%CI = 1.63-2.15) and for 7 of 13 cancers among Hispanic persons with the highest HR among those with melanoma (HR = 1.46, 95%CI = 1.21-1.76). For cardiovascular death, compared with White persons, the overall HR was higher among Black (HR = 1.42, 95% CI = 1.35-1.49) persons but lower among API (HR = 0.75, 95%CI = 0.69-0.81) and Hispanic (HR = 0.90, 95% CI = 0.84-0.96) persons. The risk of cardiovascular death was higher for 11 of 13 cancers among Black persons with the greatest HR among those with pancreatic (HR = 1.80, 95%CI = 1.17-2.75), thyroid (HR = 1.70, 95%CI = 1.12-2.57), and kidney (HR = 1.63, 95%CI = 1.38-1.93) cancers. Additional adjustments in the final model reduced the elevated HRs substantially especially for cancer death among Black or Hispanic persons, although the associations remained statistically significant for most cancers. Conclusions: Among persons with SPCs, Black persons had a higher risk of death from both cancer and cardiovascular disease, whereas Hispanic persons had a higher risk of death from cancer. Adjusting for differences in potentially modifiable factors attenuated the associations substantially, highlighting opportunities for interventions toward health equities among cancer survivors.

Association of molecular profiles of head and neck squamous cell carcinoma with heterogeneity across racial/ethnic groups in the United States.

e18036 Background: Significant disparities exist across the head and neck cancer (HNC) care continuum in presentation, treatment, and survival. Along with demographic factors such as race or ethnicity, tumor-specific molecular signatures may play a role in these differences. In the United States, the current body of literature mainly highlights molecular contrasts between Black and White patients. Here, we further investigate the molecular profiles of Black and White patients with HNC and add to the literature by comparing additional racial/ethnic groups in a large, real-world cohort. Methods: De-identified records of patients with a primary diagnosis of HNC who underwent Tempus xT testing (Tempus Labs, Chicago, IL) were selected from the Tempus Database. Those with squamous cell histology and self-reported race were selected for retrospective analysis. Briefly, Tempus xT is a targeted, tumor/normal-matched panel that detects single-nucleotide variants, insertions and/or deletions, and copy number variants in 648 genes, as well as chromosomal rearrangements in 22 genes with high sensitivity and specificity. Tumor mutational burden (TMB) was calculated by dividing the number of nonsynonymous mutations by the megabase size of the panel. Results: Among the 749 patients included, most identified as Non-Hispanic/Latino (NHL) White (n = 570), while 62 identified as NHL Black, 44 as NHL Asian/Pacific Islander (API), 21 as NHL of other races, and 52 as Hispanic/Latino of any race. Age at diagnosis differed between races ( P= 0.009). Oral cavity was the most common subsite in our cohort (N = 306, 41%). TMB also differed among races ( P= 0.018), with Black patients demonstrating the highest TMB (median = 4.6 mut/Mb [3.0-6.2]) and API the lowest (median = 2.3 mut/Mb [1.5-4.2]). Black patients had higher proportions of TP53 (76%), KMT2D (24%), and CTTN (15%) alterations (not significant across races). There were differences in the frequencies of OR4G11P (q = 0.031) and OR4F5 (q = 0.014) aberrations between races, with Black patients showing the highest frequencies (16% and 15%, respectively). The API population demonstrated higher frequencies of RASA1 (16%), MTAP (11%), CDKN2B (32%), and ERCC3 (11%) mutations (not significant across races). Additionally, there were differences in TERT mutations between races (q = 0.01), with API harboring the highest proportion of TERT co-mutations (52%). Conclusions: Overall, these results demonstrate that molecular profiles are heterogeneous across multiple racial/ethnic groups. Many of the alterations described here have been previously associated with outcomes in HNC. Accordingly, future investigations should aim to understand the effects of the activated pathways for clinical utility and investigate biomarkers to drive individualized treatment plans that result in equitable care.

The association of race and curative-intent treatment with mortality outcomes among early-stage NSCLC.

e20563 Background: Racial disparities in early-stage non-small cell lung cancer (NSCLC) survival have persisted between blacks and whites in the past few decades. The role of receipt of curative-intent surgery and/or stereotactic body radiation therapy (SBRT) in this disparity is unclear. We examined the associations of race/ethnicity and curative-intent treatment (surgery and/or SRBT) with mortality outcomes among early-stage NSCLC patients, using population-based data from Florida, the third largest state in the US and the second state in the number of cancer cases diagnosed annually. Methods: Florida Cancer Data System (FCDS) data were used to estimate cancer-specific mortality for all patients diagnosed in the state between 2007 to 2018 for each racial/ethnic group: non-Hispanic black (NHB), Hispanic, and Asian/Pacific Islander (API)) and non-Hispanic whites (NHW). FCDS were further individually linked to population-based discharge data (94% match rate) containing patient-level comorbidities and treatment-specific information. Multivariable Cox proportional hazards regression models were applied to study the association of race/ethnicity and curative-intent treatment with lung cancer-specific mortality (LCSM). Competing risk analysis (deaths by other causes) for LCSM was performed. Results: We identified 63,872 early-stage NSCLC patients; 83.2% NHW, 6.6% NHB, 8.7% Hispanic, 0.77% API, and 0.79% other races; 72.2% of patients received curative-intent treatment (surgery and/or SRBT). The median lung cancer-specific survival time for all patients was 5.43 years (95% CI, 5.30-5.56). After inclusion of all clinical and sociodemographic factors including stage at diagnosis and comorbidities, race/ethnicity (NHB vs NHW: hazard ratio [HR], 1.06; 95% CI, 1.00-1.11) and curative-intent treatment (SBRT vs curative-intent surgery: HR, 1.87; 95% CI, 1.78-1.97;) were both independently associated with LCSM. Nevertheless, after combining the effect of race/ethnicity and curative-intent treatment in the same fully adjusted model, NHB patients who received curative-intent treatment experienced nearly identical survival as their NHW counterparts (HR, 0.95; 95% CI, 0.87-1.03). Similar findings were observed in competing risk analysis (subdistribution hazard ratio [sHR], 0.97; 95% CI: 0.89-1.02). Conclusions: In this racially diverse population, receipt of curative-intent treatment revealed comparable survival between NHB and NHW patients. The results underscore the importance of considering receipt of (specifically) curative-intent treatment rather than receipt of any form of surgery or radiotherapy in racial/ethnic survival disparities. The uptake of curative-intent surgery and SBRT, which currently stands at 56.5% and 9.4% respectively, should be increased to improve survival outcomes for early-stage NSCLC for all.

Meaningful Community-Engaged Partnerships: Lessons Learned from Implementing a Community Health Needs Survey among Asian American and Pacific Islander Subgroups.

Community-based needs assessments are instrumental to address gaps in data collection and reporting, as well as to guide research, policy, and practice decisions to address health disparities in under-resourced communities. The New York University Center for the Study of Asian American Health collaboratively developed and administered a large-scale health needs assessment in diverse, low-income Asian American and Pacific Islander communities in New York City and three U.S. regional areas using an in-person or web-based, community-engaged approach. Community-engaged processes were modified over the course of three survey rounds, and findings were shared back to communities of interest using community preferred channels and modalities. Sustaining multiyear, on-the-ground engagement to drive community research efforts requires active bidirectional communication and delivery of tangible support to maintain trust between partners. Findings to facilitate community health programming and initiatives were built from lessons learned and informed by new and existing community-based partners.

Gatekeepers to the community college presidency for leaders of color

AbstractResearch has identified a clear underrepresentation of race and gender diversity in the community college presidency and scant progress in diversification. This phenomenological study used critical race theory (CRT) and glass ceiling theory (GCT) lenses to examine the lived experiences of minority community college presidents, including those who identified as African American, Asian Pacific Islander, and Latino/Hispanic and spanned 12 states and every region of the U.S. The counter‐narratives of the participants were examined using a modified interpretative phenomenological approach concept model with cultural domain analysis (CDA) for validation. Participants were categorized by generational definitions and their associated community college development leadership styles. Findings include evidence of a leaky pipeline, a flawed hiring process with gatekeepers along the hiring continuum, and biases and stereotypes encountered, illustrating leaders’ perceptions of underrepresentation of minorities serving in presidential roles in community colleges. The study identified numerous deficiencies impacting this underrepresentation and offered recommendations to improve practice.

Disparities in intensity of care at the end-of-life for patients with gastrointestinal cancer.

6558 Background: Racial/ethnic minority patients experience disparities along the cancer continuum. Studies show that racial/ethnic minorities with cancer have higher rates of intensity of care at the end-of-life (EOL) compared to non-Hispanic Whites (NHW). Less is known whether disparities in intensity of care at EOL exist among racial/ethnic minority patients with a gastrointestinal (GI) cancer. Methods: Using the California Cancer Registry linked to hospital discharge data, we conducted a retrospective study of patients ≥18yrs with upper GI, pancreatic, or colorectal cancer who died from 2005-2018. We evaluated if race/ethnicity was associated with EOL intensity of care defined as hospital/ED visit or death, ICU, intubation, CPR & dialysis within 14-days of death. We used logistic regressions to calculate odds ratios adjusting for age, socioeconomic status (SES), insurance, geography, stage, comorbidities, and NCI-designated centers. Results: 189,837 patients with GI cancer died: 41,389 (21.8%) with upper GI, 46,554 (24.5%) with pancreatic & 101,894 (53.7%) with colorectal cancer. 118,995 (62.7%) were NHW, 14,146 (7.5%) Black, 33,802 (17.8%) Hispanic & 22,894 (12.1%) Asian/Pacific Islander (API). Median age was 74.6 yrs, 54.1% male, 85.9% lived in urban areas, 48.9% had Medicare, 16.1% had low SES & 35.7% had Stage 4. Black, Hispanic, and API patients compared to NHW had higher odds of intensity of care at EOL (Table). Conclusions: This study shows disparities in intensity of care at the EOL among racial/ethnic minorities with GI cancers. Solutions are urgently needed to reduce such disparities in care. [Table: see text]

Improving Asian Americans’ awareness and interest in clinical research: Examining the role of culturally tailored messaging

AbstractBackgroundAsian Americans and Pacific Islanders (AAPI) are one of the fastest‐growing populations in the United States, yet these communities comprise less than one percent of participants in NIH’s Alzheimer’s disease and Alzheimer’s disease related dementias (AD/ADRD) clinical research. This underrepresentation is due to numerous barriers well‐documented in the literature, with a key deterrent being a lack of culturally and linguistically appropriate outreach materials. This abstract presents findings from focus groups conducted by the National Institute on Aging (NIA) to identify culturally and linguistically appropriate message concepts that raise awareness, address barriers and motivate Asian American and Pacific Islanders to consider participation in AD/ADRD research studies.MethodEighteen virtual focus groups (N = 103 individuals) were conducted with Chinese Americans, Filipino Americans, and Indian Americans who are at‐risk for AD/ADRD or are caregivers to people living with dementia. Focus groups were conducted in Chinese, Hindi, Tagalog and English. The sessions tested multiple audience‐tailored message concepts designed to increase interest and encourage participation in AD/ADRD clinical research. These discussions also examined participants’ preferred language, terminology and communication approaches.ResultOverall, message concepts that 1) emphasized the value of caring for family members; 2) offered a sense of hope; 3) communicated a clear call to action; and 4) provided opportunities to learn more information about clinical research resonated across all groups. Between participant audiences, there were some important differences, including around terminology preferences. For example, Chinese‐American participants expressed concern about the term “caregiver” as it implied that taking care of a loved one was a burden or a professional job, rather than a familial responsibility. Concept visuals will be presented.ConclusionThis research conducted by NIA improves our understanding of messaging concepts that do and do not resonate with AAPI, providing valuable insight into themes that should be leveraged to effectively promote awareness about AD/ADRD clinical research with these communities. The finding from this study were used to develop, finalize and make available to the research community a suite of culturally and linguistically appropriate materials to increase awareness and interest in AD/ADRD clinical research among AAPI communities.

Patient-level factors associated with the use of active surveillance: The talking about prostate cancer cohort.

10565 Background: Talking About Prostate Cancer is a population-based cohort study on multilevel determinants of active surveillance (AS) and patient reported outcomes in a racially and ethnically diverse population of men with low-risk prostate cancer. The study includes qualitative one-on-one interviews with patients and physicians, and quantitative cross-sectional provider and longitudinal (baseline and 12-month follow-up) patient surveys to address gaps in the literature regarding patient-level factors associated with AS, particularly among understudied populations including Asian American and Hispanic patients, we assessed socio-demographic characteristics associated with receipt of AS. Methods: Men aged 40-79 diagnosed with low-risk prostate cancer from May 2018 through March 2022 were identified within 12 months of diagnosis from the population-based Greater Bay Area Cancer Registry. To expand recruitment, men were also identified from the cancer registries covering the rest of California. To ensure sufficient representation of diverse racial and ethnic groups, 20% of non-Hispanic White men were sampled, while all Asian American and Pacific Islander, Black, and Hispanic men were invited to participate. Univariable and multivariable logistic regression were used to estimate the odds ratios (OR), adjusted odds ratios (aOR), and 95% confidence intervals (CI), of receiving AS. Potential predictors included year of diagnosis, age, health insurance, usual source of care, race and ethnicity, educational attainment, employment, nativity, and language preference. Results: Among 500 men with low-risk prostate cancer, 27% went on AS, 30% underwent surgery, radiation, hormonal treatment, cryotherapy, and/or high-intensity focused ultrasound, and 43% had not yet made a treatment decision at baseline. Among those who had made a treatment decision at baseline (N = 287), 27% of Hispanic men received AS, which was the lowest proportion among the racial and ethnic groups (Black 28%; Asian 47%; White 59%). A higher proportion of coupled men (29%) received AS compared to single men (15%). Less than half of men with less than a high school education received AS. Compared to men with a high school education or less, men with a bachelor’s degree had an aOR of 2.91 (95% CI 1.10 – 8.42) and men with a graduate degree had an aOR of 4.37 (95% CI 1.50-12.76) of receiving AS. A significantly lower odds of AS was identified among Black (aOR 0.26; 95% CI 0.11-0.64) and Hispanic men (aOR 0.35; 95% CI 0.15 – 0.81) compared to non-Hispanic White men. Conclusions: We identified several significant socio-demographic differences between patients who received definitive treatment versus AS in this cohort, including race and ethnicity and educational attainment. Further study of these domains in larger, diverse samples will elucidate the strength of these associations within racial and ethnic groups.

Burden and predictors of subsequent/recurrent stroke, associated sex/racial disparities and in-hospital outcomes in elderly patients with obstructive sleep apnea and prior stroke/TIA

Abstract Funding Acknowledgements Type of funding sources: None. Background Obstructive Sleep Apnea (OSA) increases the risk of cardiovascular events and stroke. However, limited data on burden and impact of OSA on recurrent/subsequent stroke and associated hospitalization outcomes in geriatric patients (G-OSA) with prior stroke/TIA prompted us to perform this analysis. Methods The National Inpatient Sample (2019) was used to identify patients with G-OSA and prior stroke/TIA. We compared the rate of SS by sex and racial subgroups. We subdivided the G-OSA with and without subsequent stroke (SS+ vs SS-) and compared demographics and comorbidities. Primary outcomes included prevalence of SS, subsequentin-hospital all-cause mortality and multivariate predictors of SS in G-OSA patients with prior stroke/TIA. Secondary outcomes included healthcare resource utilization between SS+ vs SS- cohorts. Results Of 133,545 patients admitted with G-OSA and prior history of stroke/TIA, 4.9% (6520) had subsequent strokes including 3.7% of acute ischemic stroke (AIS). SS+ cohort comprised mainly of Males, Asian-Pacific Islander cvs. SS- cohort. On subgroup analysis based on Racial and gender distribution, the rate of SS was highest in Asian/Pacific islander (6%), and Native Americans (5.6%) followed by white, blacks and Hispanics, (4.9%, 4.6% & 4.1%), and Males had higher prevalence vs females (5.2% vs 4.4%; p<0.001). In addition, despite similar median age of admission, SS+ cohort had higher burden of uncomplicated hypertension (42.7% vs 29.7%), diabetes without chronic complications (17.9% vs 12.8%), hyperlipidemia (76.5% vs 71.7%) and alcohol abuse (2.8% vs 1.6%) (all p<0.001). Furthermore, a higher all-cause in-hospital mortality was noticed in in SS+ cohort (5.1% vs 1.6%; p<0.001), which was prominently highger in Hispanics compared to whites and blacks (10.6% vs 4.9% vs 4.4%; p<0.001) respectively with no gender disparity noticed. Significant clinical predictors of SS in G-OSA patients on multivariable regression analysis were found to be complicated and uncomplicated hypertension (aOR 2.17 [95CI 1.78-2.64; 3.18 [2.58-3.92]), diabetes with chronic complications (aOR 1.28 [95CI 1.08-1.51]), hyperlipidemia (aOR 1.24 [95CI 1.08-1.43]) and thyroid disorders (aOR 1.69 [95CI 1.14-2.49]). However, we noticed lower odds of SS in patient with obesity (0.86 [0.76-0.98]), prior MI (aOR 1.27 [95CI 1.22-1.33]) and chronic pulmonary disease (aOR 0.54[95CI 0.47-0.62]) [Table 1]. The SS+ cohort had fewer routine discharges and higher healthcare cost. Conclusion Nearly 5% of G-OSA patients with prior stroke/TIA history were hospitalized with a subsequent stroke which showed significantly higher mortality rate compared to patients with no subsequent stroke and had considerably higher healthcare resource utilization. Comorbidities including hypertension, diabetes, dyslipidemia and admissions in rural hospitals were independent predictors of having SS and warrant preventive strides for secondary prevention of stroke.