Blacks Research Articles

Abstract 21: At least 1 in 4 Stroke Survivors do Not Achieve Adequate BP Control

Introduction: For stroke survivors, blood pressure (BP) reduction significantly lowers the risk of recurrence; a 10mmHg decrease in systolic BP is associated with a 20% risk reduction. Despite the magnitude of this benefit, existing data quantifying post-stroke BP control is limited to small cohorts, national surveys relying on self-report of stroke, and cross-sectional surveys from closed health systems. We aim to determine rates of post-stroke BP control from a broader population within the first year of stroke from multiple cohorts of patients, including from a large US fee-for-service health system, TriNetX (global data source), and two randomized control trials. Methods: We analyzed rates of uncontrolled BP ( > 140/90 mmHg) after stroke in 4 cohorts of individuals 18 years or older: 1) patients in the Yale New Haven Health System (YNHHS) between 2015-2020 at 6 months after stroke (both ischemic and hemorrhagic) hospitalization, 2) patients in TriNetX from 01/01/20 to 07/20/2024 with hypertension (ICD-10 code I10) and a hospital diagnosis of ischemic stroke (ICD-10 code I63), 3) participants with ischemic stroke in the Insulin Resistance Intervention after Stroke (IRIS) trial, and 4) the control arm of the blood-pressure targets in patients with recent lacunar stroke: the SPS3 randomized trial. For TriNetX, IRIS, and SPS3, BP was evaluated at one year after hospitalization. Results: Among YNHHS patients with stroke [n=3,339; mean age 67, 21% Black race, 10% Hispanic ethnicity, 49% male], the rate of uncontrolled BP was 31%. Ischemic strokes accounted for 83.2% of population, while hemorrhagic strokes accounted for 16.8%. In TriNetX [n= 495,474; mean age 69, 17.7% Black race, 5.9% Hispanic ethnicity, 48.6% male], the rate of uncontrolled BP was 33.4%. In the IRIS trial [n=3,135; mean age was 63, 11% Black race, 4% Hispanic ethnicity, and 67% male], 29% of participants were classified with uncontrolled BP. In the SPS3 trial [n=1,519; mean age was 63, 17% Black race, 31% Hispanic ethnicity, 65% male], 40.1% of participants were classified as uncontrolled BP. Conclusion: Among individuals with stroke in clinical trial and real-world cohorts, the rate of uncontrolled BP post-stroke ranged from 29 to 41%. These results support the tremendous need for improved BP management strategies for stroke survivors.

Risk factors for mortality and financial burdens in patients with colon cancer.

300 Background: Colon cancer remains one of the most common cancers of the digestive system and continues to rank high among the leading causes of cancer-related deaths, despite the increased prevalence of screening. In this study, we aimed to investigate risk factors for mortality and health care costs in hospitalized patients diagnosed with colon cancer. Methods: Patients admitted to the hospital in 2019 and 2020 were identified using the Nationwide Inpatient Sample database and categorized into two groups based on the presence of colon cancer (with relevant ICD-10 codes). To account for confounding factors, multivariate regression analysis was applied to calculate mortality. Statistical analyses were conducted to assess mortality rates, length of stay, and hospital charges. Results: A total of 169,805 patients were admitted with a primary diagnosis of colon cancer, with a mean age of 67.6 years. The majority were White (69.9%), and 50.2% were male. Age over 60 (OR: 1.67, p < 0.001) and sepsis (OR: 16.01, p < 0.001) were associated with increased in-hospital mortality among colon cancer patients, while higher household income (76th to 100th percentile, OR: 0.71, p = 0.011) and treatment at an urban teaching facility (OR: 0.54, p < 0.001) were linked to a lower risk of in-hospital mortality. Female gender (OR: 0.88, p = 0.080) and having inflammatory bowel disease (OR: 0.67, p = 0.055) did not significantly affect in-hospital mortality, nor did Black race (OR: 1.1, p = 0.348) or Hispanic race (OR: 1.15, p = 0.287) compared to White patients. Sepsis (+11.8 days, p<0.001; +$192,699, p< 0.001), age over 60 (+0.99 days, p<0.001; +$6,134, p<0.001), and care at urban teaching hospitals (+0.54 days, p< 0.001; +$32,230, p< 0.001) were associated with longer hospital stays and higher total charges. Conversely, female gender (-0.21 days, p=0.001; -$5,529, p<0.001) and higher income (-0.69 days, p<0.001; -$1,565, p=0.466) were linked to shorter hospital stays and lower total charges. Conclusions: Early recognition of sepsis in colon cancer patients could potentially reduce in-hospital mortality rates, as well as significantly decrease costs and length of stay. The higher mortality rates observed in patients with sepsis may be attributed to the immunocompromised state associated with cancer. Implementing targeted interventions to address the higher risks in older patients and those with sepsis could improve outcomes and reduce the overall burden of colon cancer-related hospitalizations. Impact of patient demographics, socioeconomic factors, and clinical conditions on mortality, length of hospital stay, and total hospital charges. Data Mortality Length of Hospital stay Total Charge Age>60 1.67 (p< 0.001) 0.99 days, p<0.001 $6428, p< 0.001 Race (Hispanic compared to White race) 1.15 (p=0.287) 0.38 days, p= 0.004 $14,127, p<0.001 Race (Black compared to White race) 1.1 (p=0.348) 1.4 days, p< 0.001 $5370, p=0.002 Female gender 0.88 (p=0.08) -0.21 days, p= 0.001 -$5529, p< 0.001 High house hold income 0.71 (p= 0.011) -0.69 days, p<0.001 -$1565, p= 0.466 Treatment at urban teaching facility 0.54 (p<0.001 0.54 days, p<0.001 $32230, p< 0.001 Sepsis 16.01 (p<0.001) 11.8 days, p<0.001 $192699, p< 0.001 IBD 1.05 (p=0.888) 0.67 days, p=0.055 $5348, p=0.293

Mortality and other outcomes of hospitalizations due to pancreatic cancer.

780 Background: Pancreatic cancer continues to be a highly fatal malignancy of the digestive system and imposes a significant financial strain on healthcare systems. Although it is often diagnosed incidentally, several risk factors have been identified, including smoking, family history, age, race, gender, and alcohol use. In this study, we aimed to examine inpatient outcomes and the healthcare burden of patients hospitalized with pancreatic cancer. Methods: Patients admitted to the hospital in 2019 and 2020 were identified using the Nationwide Inpatient Sample database and categorized into two groups based on the presence of a pancreatic cancer diagnosis (with relevant ICD-10 codes). To account for confounding factors, multivariate regression analysis was applied when calculating mortality. Statistical analyses were conducted to assess mortality rates, length of stay and hospital charges. Results: : A total of 74,584 patients met the inclusion criteria, with a mean age of 68.5 years. The majority were white (69%), while black patients made up 13% of the study population, and 49% were female (36,570 patients). Thrombosis (OR: 2.08, p < 0.001), age over 60 (OR: 1.22, p = 0.042), and being of black race (compared to white race, OR: 1.45, p = 0.001) were linked to higher mortality rates. Thrombosis was also associated with longer hospital stays (+1.9 days, p<0.001) and increased costs (+$16,003, p= 0.001). However, age over 60 (+0.26 days, p = 0.088; +$589, p = 0.833) and black race (+1.01 days, p< 0.001; +$1,493.7, p = 0.649) showed trends toward longer stays and higher costs, these were not statistically significant. On the other hand, pancreatic conditions such as chronic pancreatitis, pancreatic cysts, pseudocysts, or exocrine pancreatic insufficiency (OR: 0.589, p < 0.001), female gender (OR: 0.78, p = 0.002), and care at urban teaching facilities (OR: 0.37, p < 0.001) were associated with lower mortality. While female gender (+0.06 days, p=0.603; -$1699, p=0.448) did not significantly impact hospital length of stay or costs, pancreatic disease (+0.33 days, p = 0.031; +$10,826, p < 0.001) and being treated at urban teaching facilities (+1.8 days, p < 0.001; +$57,106, p < 0.001) were linked to longer stays and higher costs. Conclusions: Although some unmodifiable risk factors significantly increase mortality, thrombosis contributes not only to higher mortality but also to increased healthcare costs and longer hospital stays. However, it may be preventable with anticoagulation therapy. The inverse relationship between pancreatic disease and mortality could potentially be explained by more frequent imaging and earlier detection of malignancies in these patients. Analysis of factors influencing in-hospital mortality, length of hospital stay, and total charges in hospitalized patients. Data Mortality Length of hospital stay Total Charge Age>60 1.22(p=0.042) +0.26 days, p=0.088 $589, p=0.833 Race (black compared to white race) 1.45 (p=0.001) +1.01 days, p< 0.001 $1493.7, p=0.649 Female gender 0.78 (p=0.002) +0.06 days, p=0.603 -$1699, p=0.448 Treatment at urban teaching facility 0.37(p<0.001) +1.8 days, p<0.001 $57,106, p<0.001 Thrombosis 2.08(p<0.001) +1.9 days, p< 0.001 $16,003, p= 0.001 Pancreatic conditions 0.589(p<0.001) +0.33 days, p= 0.031 $10,826, p<0.001

ACUTE KIDNEY INJURY FOLLOWING ACUTE CHOLANGITIS: A RISK MULTIPLIER FOR ADVERSE OUTCOMES AND HEALTHCARE UTILIZATION.

Background: Acute kidney injury (AKI) is a common, fatal complication of acute cholangitis (AC). The link between AC and AKI is poorly understood. Aims: To delineate the incidence trends, clinical outcomes and healthcare utilization of inpatients with AKI following AC and to explore the risk factors for AKI following AC. Methods: This population-based retrospective study used the National Inpatient Sample database from 2010 to 2018 to compare the demographics, complications, in-hospital mortality and healthcare utilization between AC patients with and without AKI. Predictors of AKI and the prognostic impact of AKI on in-hospital outcomes were defined using multivariate logistic regression. Results: The overall incidence of AKI was 24.06% among AC patients. Its trend generally increased annually. AKI was associated with more complications, greater invasive therapy requirements, longer hospital stays, costlier total hospital charges, and higher in-hospital mortality. The risk factors for AKI following AC were advanced age, Black race, multiple comorbidities, large hospitals, teaching hospitals, urban hospitals, hospitals in the southern and western United States, choledocholithiasis/cholelithiasis, surgery, percutaneous transhepatic biliary drainage, deficiency anemia, congestive heart failure, coagulopathy, diabetes, hypertension, chronic liver disease, obesity, chronic kidney disease excluding end-stage renal disease, weight loss, acute pancreatitis, and severe sepsis. Female sex, private insurance, elective admission, and endoscopic retrograde cholangiopancreatography were protective factors against AKI in AC patients. Conclusion: AKI often follows AC and is strongly associated with poor prognosis and increased healthcare utilization. Healthcare professionals should make more efforts to identify patients with AC at risk of AKI and start management promptly to limit adverse outcomes.

Differential outcomes and treatment in non-traumatic carotid versus vertebral cervical artery dissection: A national inpatient sample study.

Cervical artery dissection (CAD) involves the carotid or vertebral artery. However, limited studies have compared their clinical features and outcomes. We examined non-traumatic CAD patients from the National Inpatient Sample (2005-2019). Those diagnosed with both carotid and vertebral artery dissections were excluded. The evaluation included patient demographics, comorbidities, and treatment. Differences between carotid and vertebral dissections were assessed using survey-weighted stepwise backward logistic regression, followed by adjusted multivariable regressions for the primary outcomes of in-hospital mortality and routine discharge (to home or self-care). From 2005 to 2019, we included 123,224 non-traumatic CAD admissions without concurrent vertebral and carotid dissections. There were more carotid dissections than vertebral dissections (67,533 vs. 55,691). Compared to vertebral dissection, carotid dissection was associated with older age (54 [44-66] years vs. 49 [37-62] years, P<0.001), Black race (12.6% vs. 8.8%, P<0.001), White race (73.5% vs. 72.0%, P = 0.024), atrial fibrillation (10.8% vs. 6.3%, P<0.001), aortic dissection (7.7% vs. 0.3%, P<0.001), and fewer concurrent acute ischemic strokes (AIS) (47.8% vs. 56.7%, P<0.001).Within the concurrent AIS group, carotid CAD patients exhibited higher NIHSS (8 [2-17] vs. 2 [0-5], P<0.001), an increased utilization of intravenous thrombolysis (6.7% vs. 2.7% P<0.001), endovascular therapy (13.3% vs. 3.3%, P<0.001), and angioplasties (9.8% vs. 0.3%, P<0.001). Overall, carotid CAD was associated with more inpatient deaths (aOR 1.30, 95% CI 1.04-1.62, P=0.023) and less routine discharges (aOR 0.88, 95% CI 0.79-0.97, P=0.014) than vertebral CAD. Our study underscores distinct comorbidity profiles and treatment patterns between non-traumatic carotid dissection and vertebral dissection groups. These findings advocate for tailored treatment strategies based on dissection type to optimize patient outcomes.

Patient and clinical characteristics associated with pain during cesarean delivery: a prospective single-center patient-reported outcome study.

There are multiple variables known to be associated with pain during cesarean delivery (PDCD), including patient-related factors, obstetrical and surgical factors, and anesthetic technique. The primary aim of this prospective patient-reported outcome study was to evaluate patient-related factors, including expectations and anxiety, and clinical variables associated with PDCD. Patients undergoing cesarean delivery from December 1, 2023 to March 31, 2024 were enrolled 24 to 72hours postoperatively. They completed the STAI-6 anxiety survey, a 13-item catastrophizing survey, a question about expected PDCD, and reported PDCD on a 0-100mm visual analog scale (VAS). We defined PDCD as a VAS score ≥30mm. Demographic, physical, and clinical data were retrieved from the electronic medical record. There were 110 recruited patients with 40 (36%) reporting PDCD. Patients who had PDCD differed in race, surgical duration, and administration of supplemental systemic analgesic medication. A multivariate logistic regression identified that surgical duration, history of anxiety, intrapartum activation of epidural (versus spinal or combined spinal epidural) and Black race (versus White) were associated with PDCD. There were 33 (30%), 48 (44%), 14 (13%), 7 (6%), and 7 (6%) patients who reported no pain, pain less than expected, pain that was expected, more pain than expected, and much more pain than expected during their cesarean delivery, respectively. In our cohort with a high reported PDCD rate, potentially modifiable variables associated with PDCD were initial anesthetic technique and surgical duration. A concerning finding was that most patients reported some level of PDCD.

Trajectories of premorbid healthcare contact days in veterans with pancreatic cancer.

706 Background: Early detection of pancreatic cancer is a key clinical priority. Although prior work has evaluated machine learning models to identify at-risk patients for pancreatic cancer screening, this is limited by complexity and cost. "Contact days’’— days spent receiving healthcare outside the home for any reason or length of time—have previously been used to measure the ‘’time toxicity’’ of cancer care post-diagnosis. We sought to characterize trajectories of premorbid contact days, alongside standardized risk scores and healthcare costs to explore their use as potential markers for early pancreatic cancer diagnosis. Methods: We identified decedents with pancreatic adenocarcinoma diagnosed between 2012 and 2022 who had at least one primary care visit in the Veterans Affairs (VA) system in each of the two years prior to diagnosis using the VA Clinical Cancer Registry (VACCR) and the Corporate Data Warehouse (CDW). We grouped patients into two cohorts: (1) surgical (receipt of curative intent surgery), and (2) non-surgical and collected sociodemographic and clinical characteristics. During a 2-year premorbid period we calculated monthly contact days (24 data points) and plotted them as percentages (e.g., 3 contact days in a month=10%) and visualized their trajectory using cubic smoothing splines. We plotted trajectories for each sociodemographic and clinical subgroup and visually evaluated differences. We similarly plotted monthly Care Assessment Need (CAN) scores, a validated VA risk score identifying patients at high risk of hospitalization/death, and monthly VA healthcare costs. Results: We included 8,654 patients (649 surgical - median age 69 years, 74% white, 78% stage 1-2 and 8,005 non-surgical - median age 71 years, 72% white, 21% stage 1-2). For both groups, trajectories of contact days were similar. Baseline contact days (-24 to -12 months) were 7-8% (≈2 days/month). Contact days started to rise on average 9 months prior to diagnosis at an approximate rate of 1% per month, reaching 15-20% at diagnosis (≈5-6 days/month). In the surgical group, patients with a Charlson comorbidity score of ≥2, urban residence, and Black race had higher baseline contact days. Those &lt;65 years and rural residence had a steeper slope of rise in contact days. CAN score trajectories closely mirrored contact day trajectories in both groups. Cost trajectories were similar in both groups (≈$1000/month at baseline), rose gradually to ≈$2000/month by -3 months, and then rose sharply to &gt;$6000/month 2 months before diagnosis. Conclusions: In this decade-long national study of Veterans diagnosed with pancreatic cancer, we found that contact days and CAN scores, but not costs, start to rise 9 months prior to diagnosis. These data provide the first evidence supporting their further evaluation in pancreatic cancer risk models which may aid early diagnosis. The similar trajectories in patients who go on to receive curative-intent surgery or not may imply they may be markers for pancreas cancer diagnosis but perhaps not outcomes.

Survival disparities in small intestine carcinoid tumors: A SEER-based analysis.

653 Background: Small intestine carcinoid tumors (SI-carcinoids) are rare neuroendocrine neoplasms with variable survival outcomes. This study examines the impact of age, sex, race, income, and geographic location on overall survival (OS) in patients with SI-carcinoid tumors. Methods: A retrospective cohort study was conducted using the Surveillance, Epidemiology, and End Results (SEER) registry 22 to identify patients aged 20 and above with SI-carcinoid tumors from 2000 to 2021. Kaplan-Meier survival analysis and log-rank tests were used to assess differences in survival. Cox proportional hazards models estimated hazard ratios (HR) for Overall Survival (OS). Results: 20,777 patients were included, with 7,029 deaths recorded. Median OS varied significantly by age, sex, race, income, and tumor site. Patients aged 60-85 had a median OS of 10 months (95% CI: 9.75-10.42), while those over 85 had 2.92 months (95% CI: 2.67-3.33). Females had better OS (13.92 months; 95% CI: 13.42-14.42) than males (12.83 months; 95% CI: 12.42-13.25). Non-Hispanic Black patients had worse OS (12.33 months; 95% CI: 11.50-13.33) compared to Non-Hispanic Whites (13.25 months; 95% CI: 12.92-13.67). Patients earning less than $50,000 had worse OS (11.42 months; 95% CI: 10.67-12.42) than those earning $100,000–$120,000 (15.42 months; 95% CI: 14.25-17.83). Geographic disparities were noted, with nonmetropolitan areas showing worse OS (11.42 months; 95% CI: 10.83-12.92) compared to large metropolitan areas (14.00 months; 95% CI: 13.50-14.42). Cox models confirmed age (HR for 85+ years: 21.99; 95% CI: 17.40-27.81), male sex (HR: 1.12; 95% CI: 1.07-1.17), and Black race (HR: 1.29; 95% CI: 1.18-1.42) were linked to worse OS. Tumor site also affected OS, with ileal tumors showing better survival compared to duodenal tumors (HR: 0.89; 95% CI: 0.84-0.94). Conclusions: Age, sex, race, income, and geographic location significantly affect OS in patients with small intestine carcinoid tumors, highlighting the need for tailored interventions for vulnerable groups.

Association of a Liver Allocation Policy Change With Domestic Travel for Liver Transplantation.

In 2020, liver allocation policy in the United States was changed to allow for broader organ sharing, which was hypothesized to reduce patient incentives to travel for transplant. Our objective was to describe patterns of travel for domestic liver transplant pre- and post-acuity circle (AC) implementation. Incident adult liver transplant listings between August 16, 2016, and February 3, 2020 (pre-AC) or June 13, 2020, and December 3, 2023 (post-AC) were obtained from the Scientific Registry of Transplant Recipients. We used previously defined geographic catchment areas to classify patients as (1) no travel, (2) travel to a neighboring region, and (3) travel beyond a neighboring region. We used multinomial logistic regression to identify characteristics associated with travel and cause-specific hazards modeling to estimate the association between travel and time to deceased donor transplant, stratified by model for end-stage liver disease (MELD) score and AC era. Among 83 033 liver candidates, 76% were listed in their home region. Black race, lower educational attainment, increased neighborhood social deprivation, and Medicaid were significantly associated with decreased odds of traveling beyond a neighboring region. After AC, traveling beyond a neighboring region was associated with an increased hazard of transplant for patients with a MELD score <15 (cause-specific hazard ratio [csHR]: 1.25; 95% confidence interval [CI], 1.11-1.40), MELD score 15-24 (csHR: 1.19; 95% CI, 1.07-1.31), and MELD score 25-34 (csHR: 1.15; 95% CI, 1.01-1.32). Travel frequency, geographic patterns of travel, and characteristics associated with travel were largely unchanged after AC. Changes to allocation policy alone may not equalize patient means or desire to travel for transplant care.

Effect of marital status and race on survival of patients with well differentiated neuroendocrine tumors (NETs).

654 Background: Socioeconomic status factors (SES) such as marital status, income, and race can influence and enhance disparities in cancer incidence and outcomes. Marriage has documented positive impacts on overall survival of numerous cancer types. Consequences of divorce have been less explored. The unique indolent, secretory nature of NETs may be differentially affected by SES factors. This study identifies implications of marital status and sex on 5-year survival rates of different racial groups diagnosed with NETs within the Surveillance, Epidemiology, and End Results (SEER) database between 2000-2020 while controlling broadly for the type of treatment received. Methods: Within the SEER data base patients with reported sex, race, marital status and treatment who were diagnosed with well differentiated NETs were selected excluding carcinomas. Relative and disease specific 5-year survival analyses were calculated with 95% confidence intervals and age standardized. Three groupings were analyzed single, separated/divorced/widowed and domestic-partner/married. Results: For all races and sexes, relative survival for individuals in a union was higher than those who were single, or separated, divorced/widowed [86.9% (CI 86.1% - 87.7%); 79.3% (77% to 81.3%); and 79.2% (78% to 80.3%) respectively]. When individuals of each marital status group were compared by matching sex and race, there were no significant differences in relative survival. But males of any race who left a union had lower chances of survival than corresponding females [72.4% (69.7% to 74.9%) vs 81.6% (80.3% to 82.8%)]. As expected, all groupings who received surgical treatment had a higher relative survival than those who did not. Those who received surgical treatment while in a partnership had a higher relative survival then those who were separated [94.5% (93.6% to 95.3%) vs 88.7% (87.3% to 89.9%)]. All marital groupings who underwent surgery or did not, had comparable relative survival between races; except, black individuals in a partnership had improved outcomes compared to the white population. More specifically, when accounting for race, sex, marital status and treatment received, black men who did not undergo surgery had a higher relative survival compared to white men [69.9% (62.2% to 76.3%) vs 59.4% (56.6% to 62.1%)]. All the same conclusions were statistically significant for disease specific survival. Conclusions: Due to NETs slow growing nature SES factors play a major role in the care of patients living with them. Our findings demonstrate generally, irrespective of race, sex, or surgical treatment, being involved in a union is advantageous, showing a protective effect on patient survival, while parting from a union could be deleterious as it is tied to less favorable outcomes. These findings underscore the importance of considering these factors in treatment and care strategies.

Do White and Black People Truly View the Police Differently? Findings from a Study of Crime Hot Spots in Baltimore, Maryland

Do White and Black People Truly View the Police Differently? Findings from a Study of Crime Hot Spots in Baltimore, Maryland

Racism and Postpartum Blood Pressure in a Multiethnic Prospective Cohort.

Postpartum hypertension is a key factor in racial-ethnic inequities in maternal mortality. Emerging evidence suggests that experiences of racism, both structural and interpersonal, may contribute to disparities. We examined associations between gendered racial microaggressions (GRMs) during obstetric care with postpartum blood pressure (BP). We conducted a prospective postpartum cohort of 373 Asian, Black, and Hispanic people in New York City and Philadelphia. At delivery, we administered the GRM in obstetrics scale. We measured BP for 3 months using text-based monitoring. We estimated place-based structural racism with the Structural Racism Effect Index. We used mixed models to estimate associations between GRM and mean postpartum systolic BP and diastolic BP. We adjusted for race-ethnicity, education, body mass index, chronic hypertension (diagnosed at <20 weeks of gestation), age, and the Structural Racism Effect Index. We examined effect modification by hypertensive disorder of pregnancy and place-based structural racism. A total of 4.6% of participants had chronic hypertension, 20.9% had pregnancy hypertension, and 13.4% had preeclampsia, comprising a hypertensive disorder of pregnancy subgroup (n=117). A total of 37.5% of participants experienced ≥1 GRM. Participants who experienced ≥1 GRM versus none had 1.88 mm Hg higher systolic BP from days 1 to 10 (95% CI, -0.19 to 3.95) and 2.19 mm Hg higher systolic BP from days 11 to 85 (95% CI, 0.17-4.22). Associations followed a similar pattern for diastolic BP and were stronger among the hypertensive disorder of pregnancy subgroup. Participants experiencing GRM and a high Structural Racism Effect Index had systolic BP 7.55 mm Hg (95% CI, 3.41-11.69) and diastolic BP 6.03 mm Hg (95% CI, 2.66-9.41) higher than those with neither. Structural racism and interpersonal racism are associated with increased postpartum BP, potentially contributing to inequities in postpartum morbidity and mortality and lifecourse cardiovascular disease.

Racial disparities in intrapartum care experiences and birth hospital characteristics.

Policymakers and researchers have posited intrapartum care as a potential mediator of racial inequities in perinatal outcomes. However, few studies have measured patient-centered quality of intrapartum care or explored differences by race. To address this gap, we developed a survey supplement using cognitive interviewing and administered it to a probability-based race-stratified random sample of people who recently gave birth in Wisconsin in 2020, including oversamples of non-Hispanic Black and Indigenous birthing people. We estimate overall and race-specific prevalences of intrapartum care experiences and use survey-weighted mixed effects ordinal and logistic regression to estimate differences in intrapartum care experiences by race/ethnicity and hospital characteristics. We find significant racial differences in the population prevalence of negative experiences of intrapartum care providers, including disrespect, lack of responsiveness, inclusion in decision-making about care, and pressure to use epidural analgesia. In unadjusted models, both non-Hispanic Indigenous (American Indian/Alaska Native) and non-Hispanic Black respondents had higher odds (than non-Hispanic White birthing people) of reporting several negative intrapartum experiences, including feeling disrespected by providers and experiencing a lower level of care team responsiveness. In adjusted models, Indigenous respondents had significantly higher odds of reporting that intrapartum care providers withheld information, showed disrespect, and were less responsive. Giving birth at a low birth-volume hospital was associated with higher odds of reporting greater participation in decision-making. CONCLUSION: While all birthing people are entitled to respectful and person-centered care, in practice, Indigenous and Black birthing persons are more likely than their white counterparts to endure negative intrapartum experiences including disrespect and lack of responsiveness to their needs. Equitable implementation of person-centered care principles will require concerted efforts to institutionalize practices that preserve patient dignity and autonomy.

Infant birth weight in Brazil: A cross-sectional historical approach.

In 1888, Brazil became the last country in the Americas to abolish slavery. Historians have outlined the racialized health disparities of people of African descent in the post-abolition period. Epidemiologists have shown that twenty-first-century health disparities continue to mirror patterns from over a century ago. This cross-sectional analysis quantifies health disparities in a post-abolition maternity hospital using infant birth weight. It relies on hospital records on infants delivered between 1922 and 1926 (n=2845) at the Maternidade Laranjeiras in the city of Rio de Janeiro, Brazil to run linear models assessing differences in infant birth weight by maternal skin color, age, number of pregnancies (parity), and nationality. African ancestry was correlated with lower birth weights. Infants born to Afro-descendant women had birth weights estimated to be 84g lighter (p-value=0.002 [95% CI -137, -32]) than infants born to Euro-descendant women. Among Afro-descendant women, infants born to Black (preta) women had birth weights estimated to be 100g lighter (p-value=0.001 [95% CI -160, -39]) and infants born to mixed-race (parda) women had birth weights estimated to be 70g lighter (p-value=0.022 [95% CI -130, -10]) than infants born to White women. The findings were likely the consequence of slavery's legacy, particularly race-based socioeconomic inequality - including more strenuous work schedules, poorer nutrition, and less sanitary living environments for people of African descent. The findings are consistent with current-day research on racialized health disparities in Brazil and demonstrate the importance of historical findings to public health research.

Abstract TMP107: Midlife Vascular Risk Factors are Associated with Late-life Depression in the ARIC Study

Objective: Late-life vascular health and cerebrovascular disease have been identified as potential risk factors for late-life depression (LLD). However, the impact of midlife vascular health, which is strongly linked with other aspects of brain function, on LLD is less understood. This study examined associations of midlife vascular risk factors (VRFs), and the cumulative burden of these factors, with LLD. Methods: Individuals from the Atherosclerosis Risk in Communities (ARIC) Study were evaluated for VRFs (smoking, hypertension, diabetes, hypercholesterolemia, and obesity) at midlife (ages 44-66). To assess cumulative vascular risk burden, the number of VRFs were counted and categorized as 0, 1, 2, or ≥3. Approximately 20 years later, LLD was assessed at late-life (ages 66-90) as a Center for Epidemiological Studies Depression Scale (CES-D) score ≥9. The association between VRFs and LLD was examined using logistic regression models adjusted for age, race-center, sex, education, and APOEε4 carrier status. Models were stratified by race; interaction terms were evaluated to assess effect modification. Results: Among 6,198 participants, the mean age was 52 years, 58.7% were female, and 22.2% were of self-reported Black race. At midlife, 20.2% had 0 VRFs, 41.3% had 1 VRF, 27.2% had 2 VRFs, and 11.3% had 3 or more VRFs. In the overall sample, smoking (OR: 1.68, 95% CI: 1.32-2.12), diabetes (1.41, 95% CI: 1.00-1.98), hypertension (OR: 1.29, 95% CI: 1.02-1.61), and obesity (OR: 1.51, 95% CI: 0.79-1.20) were associated with LLD when combined in one model; hypercholesterolemia was not. Compared to individuals with 0 VRFs in midlife, individuals with 2 VRFs had greater odds of LLD (OR: 1.69, 95% CI: 1.21-2.38), and individuals with 3 or more VRFs had even greater odds of LLD (OR: 2.34, 95% CI: 1.62-3.41). There was effect modification by race: midlife diabetes was associated with LLD in White individuals (OR: 2.18, 95% CI: 1.42-3.25) but not Black individuals (OR: 0.69, 95% CI: 0.36-1.25, p-interaction: 0.0005). Further, having 3 or more VRFs was associated with LLD in White individuals (OR: 3.57, 95% CI: 2.31-5.56), but not in Black individuals (OR: 1.46, 95% CI: 0.75-3.03, p-interaction: 0.01). Conclusion: Midlife vascular risk factors, and the cumulative burden of these factors, were associated with late-life depression (LLD), especially among White individuals. Further studies should evaluate mechanisms for these associations.

Trends in surgery and overall survival in non-metastatic anal cancer: A population-based analysis.

3 Background: The incidence of anal cancer has recently exceeded &gt; 10,000 patients/year in the United States. For non-metastatic squamous cell carcinoma of the anal canal (SCCA), concurrent chemoradiotherapy (CRT) followed by abdominoperineal resection (APR) as salvage surgery for non-responders is a key treatment approach. Over the past two decades, findings from phase III trials (RTOG 98-11 and ACT II) have increased our knowledge about appropriate treatment approaches. ACT II indicated that delayed assessment of tumor response and consideration of APR up until 26 weeks is appropriate, as many patients demonstrate delayed response to treatment. Our analysis examines whether current evidence has influenced real-world clinical practice by analyzing trends in rates of primary APR and overall survival (OS) outcomes. Methods: We conducted a retrospective cohort study using data from the Surveillance, Epidemiology, and End Results (SEER) registry, including patients diagnosed with non-metastatic SCCA between 2004 and 2020. Patients with T0 or T1N0 stage disease were excluded. Descriptive statistics were generated, and chi-square tests were used to compare characteristics between patients who underwent surgery and those who did not. Temporal trends in surgery and radiation therapy were analyzed using the Cochrane-Armitage trend test. Multivariable logistic regression was employed to identify factors associated with surgery uptake, while OS trends were analyzed using Kaplan-Meier and Cox proportional hazard models. Results: A total of 16,718 patients were included, with 33.1% requiring salvage APR following CRT. The proportion of patients requiring surgery significantly declined from 46.6% in 2004 to 31.1% in 2020 (p &lt; 0.001). Factors associated with surgery included younger age, male gender, and non-Hispanic Black race (p &lt; 0.001). Kaplan-Meier analysis revealed significant improvements in OS over the study period (log-rank p = 0.0002), with more recent years (2016-2020) associated with significantly better OS compared to earlier periods (2004-2007, HR = 0.77, p &lt; 0.001). Conclusions: The significant decrease in rates of salvage APR for non-metastatic SCCA likely reflects the global impact of recent phase III trials. Meanwhile, OS rates have been steadily improving. These findings suggest improved overall knowledge regarding treatment strategies and highlight the real-world impact of clinical investigation in non-metastatic squamous cell carcinoma of the anal canal.

Gender and ethnic disparities in hepatocellular carcinoma: Trends in incidence rates across U.S. populations from 2000 to 2021.

524 Background: Hepatocellular carcinoma (HCC) is a primary malignancy of the liver strongly associated with liver cirrhosis and the etiologies producing cirrhosis. As such, racial and ethnic factors might affect incidence rates of HCC resulting in disparities. While disparities have been reported, the effect of gender within certain populations, particularly Hispanic and non-Hispanic White ancestry, have not been fully explored. This study looks at the changing incidence rates of HCC in the US amongst different populations with a particular focus on the impact of gender on incidence. Methods: Incidence rates of HCC between 2000 and 2021 among different sexes within racial and ethnic groups in the United States were analyzed utilizing delay-adjusted data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program. Annual percent change (APC) was calculated by using Joinpoint Regression software. Results: Overall, HCC incidence rates since 2014 to 2021 show a slight decrease (APC, -0.06). While Hispanic men HCC incidence rates declined from 2012 to 2021 (APC, -0.44), Hispanic women incidence have had a steady increase since 2000 (APC, +2.52). Non-Hispanic Black men (APC, -3.07) rates vastly declined from 2015 to 2021 while non-Hispanic black women interestingly experienced a slight decrease in incidence from 2013 to 2021 (APC, -0.34). Non-Hispanic White men experienced stagnant rates of HCC since 2014 (APC, -0.05) while non-hispanic white women (APC, +3.59) showed increasing trends in HCC incidence since 2003. For comparison, non-Hispanic Asian/Pacific Islander men (APC, -2.19) and women (APC, -2.36), which both experienced a decline since 2007. This analysis was repeated without significant change. Further corroborations are necessary to validate these findings. Conclusions: These findings show that while the incidence rates of HCC overall have decreased, this benefit appears to be largely driven in male populations. In contrast, in women, and particularly Hispanic and Non-Hispanic White women, incidence rates have been increasing. This phenomenon likely reflects the changes in etiologies of cirrhosis and HCC. Surveillance strategies and screening might need to be optimized to reflect these trends.

Discrepancies in Temporal Artery Biopsy Positivity Rate Among White and Black Patients Suspected of Having Giant Cell Arteritis.

Our hypothesis is that biopsy-positive giant cell arteritis (GCA) is infrequent among Black patients. To evaluate this, we compared the temporal artery biopsy (TAB) positivity rates among White and Black patients. This is a case-control study review from all patients who underwent TAB at our institution from 2012 until 2021. The main study outcome was the TAB positivity rate. The main independent variable was race/ethnicity. Clinical and demographic features of patients undergoing TAB were compared between those with positive and negative biopsies with t tests, Wilcoxon rank sum test, χ2 test, or Fisher exact test where appropriate. A multiple logistic regression with Firth correction was performed with factors found to be significant in bivariate analysis to evaluate for independent associations with a positive biopsy. Three hundred eighty-five patients who underwent TAB for suspected GCA were included (290 White, 95 Black). Mean sedimentation rate was higher in Black patients, but otherwise, both groups had similar demographic and clinical characteristics. Positivity rate of TAB in White patients was 20.3% and 8.4% in Black patients. White race was associated with higher likelihood of TAB positivity compared with Black race (odds ratio, 3.47). Patients with positive TAB were more likely to have jaw claudication, constitutional symptoms, and higher inflammatory markers. Other factors significant in the logistic regression model included age, and inversely with decreased visual acuity. Our study results support the hypothesis that there is a discrepancy in the frequency of biopsy-confirmed GCA in patients referred for TAB, with Black patients having lower rates than their White counterparts.

‘We were there’: how black nurses used friendship to navigate hierarchy within the NHS from 1960 to 1983

ABSTRACT To fill post-war labour shortages in the National Health Service (NHS), the British government recruited thousands of nurses from the Commonwealth. This article examines the experiences of Black nurses, many of whom were recent migrants from the Commonwealth, within the racially-informed hierarchical structure of the NHS from 1960 to 1983. Although this period saw significant changes in British immigration legislation, NHS bureaucracy and the politicisation of Black people across Britain, Black nurses’ position at the lowest levels of the NHS hierarchy, and the ways they navigated the hierarchy, remained largely the same. We analyse oral histories alongside the archival record to examine how Black nurses found strategies to navigate these hierarchies, with a focus on friendship.

2830 A systematic review of the association between ethnicity and frailty prevalence, incidence, trajectories and risks

Abstract Background Ethnic variations in frailty are poorly understood. This systematic review examined ethnic variations in frailty prevalence, incidence and trajectories; associations between frailty and sociodemographic/lifestyle risk-factors; and health-related outcomes of pre-frailty and frailty. Methods We searched four electronic databases from 2000 to April 2023 using terms for ethnicity and frailty. Inclusion criteria: observational studies assessing frailty in adults ≥18 years from community-based settings, including care homes; ethnicity defined by race, country of birth, language, ancestry, or culture. We supplemented searches with manual citation and reference list searches. Primary outcomes: prevalence, incidence, and transitions of frailty. Secondary outcomes: factors associated with frailty and health-related outcomes (e.g. falls, hospital admissions, mortality). Two reviewers independently screened all articles; conflicts were resolved by a third reviewer. Results We included 80 studies, representing data from 13 countries plus two multi-national samples from 15 European and 10 Asian countries, respectively. Across settings, frailty prevalence was higher in minority groups (including Black or Hispanic people in USA, South Asian or Black people in UK, Moroccan or Surinamese in the Netherlands, ‘non-white’ groups in South America, Māori in New Zealand, and non-Han groups in China) compared to majority groups (White in most settings, or Han in studies in China). Ethnic differences appear sensitive to methods used to measure frailty. Two US-based studies found that ethnic differences were independent of sociodemographic differences. Six studies from USA or UK showed that Black and South-Asian people, respectively, had higher frailty incidence or more rapid frailty progression. There were no significant differences in mortality risk of frailty between ethnic groups. Conclusion Ethnic variation in frailty prevalence and dynamics persist across multiple settings, with minority groups adversely impacted. Future research should seek to explain ethnic differences in frailty measurement. Interventions targeting frailty need to take account of structural inequalities faced by minority groups.