Blacks Research Articles

Association Between Health Care Discrimination and Medical Mistrust Among Black Assigned Female at Birth Adults with Minoritized Sexual and Gender Identities in the United States.

Purpose: Black sexually and gender minoritized (SGM) people who were assigned female at birth (AFAB) experience compounding health care inequities, barriers to equitable care, and disproportionately adverse health outcomes. Given prior literature indicating that both experienced and/or anticipated reported health care discrimination and medical mistrust may shape these health care experiences of Black SGM AFAB people, we sought to investigate the specific interplay between these two factors to bolster understanding of their relationship. Methods: In January and February 2023, we conducted a cross-sectional online survey of 156 Black SGM AFAB adults in the United States (U.S.) assessing their reported lifetime experiences of all-cause and gender-, race/ethnicity-, and weight-based discrimination in health care settings, in addition to their ratings of medical mistrust on the Medical Mistrust Index (MMI). Univariate statistics, analysis of variance, post hoc pairwise tests, and multivariable linear regression were conducted to assess measures of health care discrimination, medical mistrust, and covariates and their associations among the analytic sample (n = 130). Results: Most participants reported prior experiences of health care discrimination. Adjusting for demographic, socioeconomic, and health care factors, we identified an association between experiencing any-cause-, race/ethnicity-, or weight-based discrimination and significantly higher MMI scores. The association for gender-based discrimination was not statistically significant. Conclusion: Black SGM AFAB people who experience any-cause-, race/ethnicity-, or weight-based discrimination may be more likely to experience higher levels of medical mistrust. Identifying interventions and pathways to tackle health care discrimination and the systemic and structural drivers of medical mistrust will be critical to augmenting health care outcomes and experiences of Black SGM communities.

Creating the ‘Suspect’: New Works on Policing France

Critiques of police brutality and dire warnings about public safety are a seemingly inescapable topic of controversy today, saturating headlines and political campaigns all over the world. In 2020, the murder of George Floyd in Minneapolis prompted huge protests across the United States, with activists denouncing yet another episode of excessive police violence against a Black man. As Covid-19 lockdowns kept people tethered to their homes, protests echoed globally, affirming solidarity in the value of Black lives and critiques of police violence. In Europe, marchers filled the streets everywhere from the United Kingdom to Poland, and, notably for this essay, in France. France, of course, did not need an American example to reckon with police misconduct. Since at least the 1970s, French activists have been calling attention to the way that police violence is directed disproportionately at economically marginalised banlieues and socially marginalised immigrant populations. In 2018, French citizens witnessed the brutal policing of the gilets jaunes, a populist movement that criticised economic inequality and President Macron's neoliberal policies. With horror, they read stories of protestors battered by police batons, grenades, and tear gas, losing hands and eyes in the fray. More recently, in June 2023, the police murder of Nahel Merzouk in Nanterre, following a routine traffic stop, reopened old wounds. ‘Who, exactly, do the police serve?’, protestors asked. Certainly not Nahel.

Call, Response, and Compromisso: Ethical Practice in Capoeira of Backland Bahia, Brazil

Abstract In the Afro-Brazilian music-movement form capoeira, call and response saturates all interactions in live performance events (rodas). In addition to call-and-response song structures, music calls bodies into movement, bodies call to one another, and movements invoke responses from instrumentalists. Yet call and response does more than organize the roda. Demonstrating how antiphony organizes group sociality, the article argues that the music and movement also summon members to assume a range of responsibilities within the group and their lives. These include showing up for trainings and rodas, maintaining instruments, preparing for annual events, and teaching capoeira to younger generations in Bahia's underserved communities. Practitioners frame their ethical commitments to capoeira as compromisso, a concept that implies broad, long-term dedication. Grounding the study in my ethnographic research conducted in Brazil, I bridge Black music scholarship with ethical Africana philosophy to argue that capoeira practitioners use knowledge generated in their music-movement practice to conceive an ethics of compromisso. While the literature on Black musics across the Americas widely acknowledges call and response as a foundational musical mechanism, few ethnographic studies have delved more deeply into the social, ethical, and political potentials of antiphony. The article thus contributes to understandings of how Black music-dance practices generate ethical knowledge and practice through their sounds and movements. As capoeira's antiphony transcends the roda's space-time, it calls practitioners to assume an unending compromisso, making commitments that span generations to continually leverage capoeira's lessons to improve lives in Black communities of backland Bahia.

Disparities in cocaine use disorder among Alabama Medicaid recipients

ABSTRACT Objective To examine racial and sex disparities in Cocaine Use Disorder (CoUD) use among rural and urban Medicaid recipients in the state of Alabama between 2016 and 2020. Methods Alabama Medicaid administrative claims were extracted for the period between January 1 2016, and December 31 2020. Our dataset included 100% of claims for the study period. We examined trends in CoUD rates, and disparities in county-level CoUD rates by sex, race, and rurality. Results Results showed a greater decrease in CoUD rate in urban areas than rural. Among racial groups, there were no changes among Black females, Black males, nor White females, but only among White males. Conclusion Findings provide understanding of racial and sex differences in CoUD among rural and urban Medicaid recipients.

The Effects of MyChoices and LYNX Mobile Apps on HIV Testing and Pre-Exposure Prophylaxis Use by Young US Sexual Minority Men: Results From a National Randomized Controlled Trial.

Young sexual minority men have among the highest rates of HIV in the United States; yet, the use of evidence-based prevention strategies, including routine HIV testing and pre-exposure prophylaxis (PrEP), remains low. Mobile apps have enormous potential to increase HIV testing and PrEP use among young sexual minority men. This study aims to assess the efficacy of 2 theory- and community-informed mobile apps-LYNX (APT Mobility) and MyChoices (Keymind)-to improve HIV testing and PrEP initiation among young sexual minority men. Between October 2019 and May 2022, we implemented a 3-arm, parallel randomized controlled trial in 9 US cities to test the efficacy of the LYNX and MyChoices apps against standard of care (SOC) among young sexual minority men (aged 15-29 years) reporting anal sex with cisgender male or transgender female in the last 12 months. Randomization was 1:1:1 and was stratified by site and participant age; there was no masking. The co-primary outcomes were self-reported HIV testing and PrEP initiation over 6 months of follow-up. A total of 381 young sexual minority men were randomized. The mean age was 22 (SD 3.2) years. Nearly one-fifth were Black, non-Hispanic (n=67, 18%), Hispanic or Latino men (n=67, 18%), and 60% identified as gay (n=228). In total, 200 (53%) participants resided in the Southern United States. At baseline, participants self-reported the following: 29% (n=110) had never had an HIV test and 85% (n=324) had never used PrEP. Sociodemographic and behavioral characteristics did not differ by study arm. Compared to SOC (n=72, 59%), participants randomized to MyChoices (n=87, 74%; P=.01) were more likely to have received at least 1 HIV test over 6 months of follow-up; those randomized to LYNX also had a higher proportion of testing (n=80, 70%) but it did not reach the a priori threshold for statistical significance (P=.08). Participants in both MyChoices (n=23, 21%) and LYNX (n=21, 20%) arms had higher rates of starting PrEP compared to SOC (n=19, 16%), yet these differences were not statistically significant (P=.52). In addition to facilitating earlier treatment among those who become aware of their HIV status, given the ubiquity of mobile apps and modest resources required to scale this intervention, a 25% relative increase in HIV testing among young sexual minority men, as seen in this study, could meaningfully reduce HIV incidence in the United States. ClinicalTrials.gov NCT03965221; https://clinicaltrials.gov/study/NCT03965221.

“More Than a Workshop”: Perspectives from First-Generation and Low-Income Men of Color Participating in a Community College Men of Color Initiative

ABSTRACT This study examined the experiences of first-generation and low-income men of color involved with a community college men of color initiative, focusing on the students’ perspective. The research was guided by two main questions: (a) What factors contribute to the participation of first-generation and low-income men of color with a community college men of color initiative? (b) How do community college men of color initiatives activate the assets of first-generation and low-income men of color to support their vertical transfer aspirations? A qualitative case study approach was employed, involving interviews with 10 Black and Latino men participating in the initiative. After the interviews were transcribed, they were analyzed using an in-vivo and higher-level coding process, using the participants’ words to identify themes. Students described how programming, active coaching and mentorship, and the relationships formed within the initiative significantly enriched their community college experiences and aspirations for vertical transfer. The initiative’s opportunities established a multilevel support system for students, which activated aspects of their community cultural wealth. The findings uncovered valuable insights into effectively engaging first-generation and low-income men of color in community college. They also shed light on the programmatic and individual practices that validate students’ experiences. These findings underscore the necessity for more community colleges to embrace similar practices to enhance the support provided to first-generation and low-income men of color on campus and strengthen their community college to four-year university vertical transfer pathways.

Balancing Sustainability and Social Equity

Urban rezoning policies are increasingly designed to promote environmental sustainability, yet they often inadvertently exacerbate social inequalities. This paper examines the unintended consequences of New York City’s 2023 “City of Yes for Carbon Neutrality” initiative, which, while addressing climate change, risks accelerating gentrification and displacing low-income Black communities. Drawing from the works of Joseph Stiglitz, Po Chu-I, and urban policy scholars, this study explores the broader ethical and socioeconomic tensions between green development and social equity. Findings indicate that urban sustainability initiatives frequently drive up property values, disproportionately benefiting affluent stakeholders while marginalizing vulnerable populations. This paper further evaluates potential solutions, including Community Land Trusts (CLTs), inclusive zoning policies, and Community Benefit Agreements (CBAs), assessing their effectiveness in mitigating displacement. The research underscores the urgent need for comprehensive policy approaches that balance environmental goals with social justice to create equitable and sustainable urban development.

Development of a machine learning model related to explore the association between heavy metal exposure and alveolar bone loss among US adults utilizing SHAP: a study based on NHANES 2015–2018

BackgroundAlveolar bone loss (ABL) is common in modern society. Heavy metal exposure is usually considered to be a risk factor for ABL. Some studies revealed a positive trend found between urinary heavy metals and periodontitis using multiple logistic regression and Bayesian kernel machine regression. Overfitting using kernel function, long calculation period, the definition of prior distribution and lack of rank of heavy metal will affect the performance of the statistical model. Optimal model on this topic still remains controversy. This study aimed: (1) to develop an algorithm for exploring the association between heavy metal exposure and ABL; (2) filter the actual causal variables and investigate how heavy metals were associated with ABL; and (3) identify the potential risk factors for ABL.MethodsData were collected from National Health and Nutrition Examination Survey (NHANES) between 2015 and 2018 to develop a machine learning (ML) model. Feature selection was performed using the Least Absolute Shrinkage and Selection Operator (LASSO) regression with 10-fold cross-validation. The selected data were balanced using the Synthetic Minority Oversampling Technique (SMOTE) and divided into a training set and testing set at a 3:1 ratio. Logistic Regression (LR), Support Vector Machines (SVM), Random Forest (RF), K-Nearest Neighbor (KNN), Decision Tree (DT), and XGboost were used to construct the ML model. Accuracy, Area Under the Receiver Operating Characteristic Curve (AUC), Precision, Recall, and F1 score were used to select the optimal model for further analysis. The contribution of the variables to the ML model was explained using the Shapley Additive Explanations (SHAP) method.ResultsRF showed the best performance in exploring the association between heavy metal exposure and ABL, with an AUC (0.88), accuracy (0.78), precision (0.76), recall (0.83), and F1 score (0.79). Age was the most important factor in the ML model (mean| SHAP value| = 0.09), and Cd was the primary contributor. Sex had little effect on the ML model contribution.ConclusionIn this study, RF showed superior performance compared with the other five algorithms. Among the 12 heavy metals, Cd was the most important factor in the ML model. The relationship of Co & Pb and ABL are weaker than that of Cd. Among all the independent variables, age was considered the most important factor for this model. As for PIR, low-income participants present association with ABL. Mexican American and Non-Hispanic White show low association with ABL compared to Non-Hispanic Black and other races. Gender feature demonstrates a weak association with ABL. In the future, more advanced algorithms should be developed to validate these results and related parameters can be tuned to improve the accuracy of the model.Clinical trial numbernot applicable.

PRÁTICAS PEDAGÓGICAS, MEMÓRIA E ANCESTRALIDADE ÉTNICO-RACIAL NO TERRITÓRIO: EDUCAÇÃO E DIREITOS HUMANOS NO SÍTIO LEITE, JUAZEIRO DO NORTE, CEARÁ

This paper aims to discuss how certain pedagogical practices in non-formal contexts can promote the preservation of the memory and ancestry of the black/indigenous community of the Sítio Leite territory, in Serra do Catolé, Juazeiro do Norte-CE. This is a qualitative study that involved field research with semi-structured interviews with the community's residents and intervention actions with the screening of short films and, later, discussion groups. The results obtained through the meetings with the community pointed to a greater awareness of their rights as black and indigenous people. In addition, the discussions allowed for greater knowledge of their history, as well as the appreciation of black and indigenous memory and ancestry evidenced by the sharing of stories and perceptions about the collective cultural identity of the community. It is concluded that the pedagogical practices used in non-formal spaces can contribute more effectively to human rights education with an emphasis on ethnic-racial relations, with positive implications for strengthening ethnic identity in the territory. Educating about human rights is an essential task for valuing the memory and ancestry of several black and indigenous communities that have long been marginalized. The Sítio Leite community has faced this type of social marginalization and lack of access to essential rights. In this context, pedagogical practices have contributed to the political strengthening of the community and to their understanding as subjects of knowledge and rights.

Long-Term Survival in Children Following Heart Transplantation.

Short-term outcomes following heart transplantation in children have improved, but comparable improvements in long-term survival continues to have barriers. We sought to investigate long-term outcomes following heart transplantation and to identify protective and risk factors associated with long-term survival in children. The Pediatric Heart Transplant Society (PHTS) database was queried for heart transplant recipients from 1993 to 2010 who were ≤ 10 years of age at time of transplant. Patients with conditional graft survival > 3 years and at ≥ 10 years were analyzed. Survival and time-to-event were compared using the Kaplan-Meier method with a log-rank test for significance. Factors associated with graft loss were identified using Cox proportional hazard modeling. There were 1610 patients ≤ 10 year of age who were transplanted between 1993 and 2010 with conditional survival to 3 years post-transplant. Of those patients, there were 1170 with conditional survival to 10 years post-transplant. Patients < 1 year at transplant had improved survival compared to other age groups. Risk factors for graft loss after 3 years post-transplant were malignancy, rejection, cardiac allograft vasculopathy (CAV), age, congenital heart disease, female sex, and Black race (p value for all < 0.05). Heart transplantation remains an effective therapy in children with a growing number of long-term survivors. Risk factors for mortality in patients ≤ 10 years of age at transplant with conditional survival to 3 years post-transplant include CAV, rejection, malignancy, female sex, and Black race. Further studies are needed to understand the social and biologic causes of racial and sex disparities in pediatric transplant patients.

From Gene to Clinic: The Role of APOL1 in Focal Segmental Glomerulosclerosis

Apolipoprotein L1 (APOL1) genetic variations, notably the G1 and G2 alleles, have important roles in the pathophysiology of focal segmental glomerulosclerosis (FSGS) and other kidney problems, especially in people of African descent. This review summarizes current understanding about the genetic, molecular, and clinical features of APOL1-associated FSGS and investigates new therapeutic options. It reveals how APOL1 mutations generate kidney injury through mechanisms such as podocyte dysfunction, mitochondrial impairment, and dysregulated inflammatory networks. Recent treatment developments, such as small-molecule inhibitors like inaxaplin, antisense oligonucleotides, and novel interventions targeting lipid metabolism and inflammatory pathways, are being assessed for their capacity to address the specific issues presented by APOL1-associated nephropathy. We also address gaps in knowledge, such as the function of environmental triggers and the systemic consequences of APOL1 mutations, emphasizing the significance of targeted research.

Gender and ethnoracial disparities in Veterans’ trauma exposure prevalence across differing life phases

BackgroundVeterans show increased vulnerability to trauma exposure. Yet, there is limited research examining Veterans’ prevalence of experiencing different trauma exposure types by race, gender, and ethnicity and across unique phases of life (i.e., pre-military service, during service, and post-service). This study compares trauma exposure prevalence across women and men Veterans of differing ethnoracial identities (i.e., white, Black, Hispanic) within three life phases (i.e., pre-military service, during military service, post-military service).MethodsThis study examined survey data from 3,544 Veterans (1,781 women; 1,686 men) across six discrete data collection points (between August 2018 to March 2022). Surveys were mailed nationally and oversampled for women (51.6%) and Veterans living in high crime areas (67.6%). Veterans reported on their exposure to various trauma types (e.g., sexual assault, physical assault, community violence, captivity, serious accident, witnessing violent death) at each wave of data collection using items from a modified Life Events Checklist. Veterans also reported on demographic information (e.g., gender, race, ethnicity). Chi-square analyses were conducted to compare prevalence of reported exposure to each trauma type within each life phase across gender and ethnoracial groups.ResultsThere were significant differences in trauma exposure prevalence across: (1) men vs. women Veterans; (2) white vs. Black vs. Hispanic Veterans; (3) Black vs. Hispanic vs. white women Veterans; and (4) Black vs. Hispanic, vs. white men Veterans. For example, in this study, Black men Veterans reported higher prevalence of intimate partner physical assault exposure pre-service (14.8%) and post-service (27.1%) than White men Veterans (9.0% and 13.8%; prevalence ratios = 1.64, 95% CI = 1.17, 2.32 and 1.96, 95% CI = 1.53, 2.51). White women Veterans were less likely to witness a violent death pre-service (11.5%) than Black (21.1%; prevalence ratio = 1.83, 95% CI = 1.42, 2.37) or Hispanic (18.1%) women Veterans.ConclusionsFindings help uncover disparities within Veteran subgroups. They inform mental health treatment and prevention services to better meet the needs of all Veterans across differing life phases.

Racial and gender inequities in the control of arterial hypertension in ELSA-Brasil: An intersectional approach.

This study investigated the association of the intersectional categories of gender-race/color with inadequate blood pressure (BP) control in Brazilian adults using antihypertensive drugs to treat hypertension. This is a cross-sectional analysis conducted with 4448 participants living with hypertension from visit 2 (2012-2014) of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) undergoing pharmacological treatment. The association of the intersectional categories - White woman, Brown woman, Black woman, White man, Brown man, Black man - with inadequate BP control (systolic BP levels ≥140mmHg and/or diastolic BP levels ≥90mmH) was estimated by the prevalence ratio (PR) and 95% confidence interval (95% CI) obtained by generalized linear models with Poisson distribution, adjusted covariates. The age-standardized prevalence of inadequate BP control ranged from 18.9% (White women) to 35.6% (Black men). After adjusting for sociodemographic characteristics, health-related behavior, health conditions, and the class number of antihypertensive medications, compared to White women, Black men (PR: 1.49 95% CI: 1.26-1.75), Brown men (PR: 1.42 95% CI: 1.18-1.72), Black women (PR: 1.36 95% CI: 1.12-1.65), and White men (PR: 1.32 95% CI: 1.09-1.60) showed poorer BP control. Results corroborate a higher prevalence of inadequate BP control in Black and Brown men. Furthermore, this intersectional approach evidenced that the prevalence of inadequate BP control in Black women is higher than that in White men, when compared to White women. Findings highlight that, for the development of more equitable BP control strategies, one must consider the specificities of socially marginalized intersectional groups, especially Black men and women.

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 ( &gt; 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.

Sociodemographic landscape of suspected prostate cancer referrals and diagnoses across North East London

AbstractObjectivesThe objective of this study is to identify healthcare inequities in referrals and diagnoses of suspected prostate cancer (PCa) in an ethnically diverse and socially deprived large urban region.MethodsRetrospective cohort study of 2‐Week Wait (2WW) suspected PCa patients (n = 12 947) referred to two acute NHS Trusts in North East London (NEL) from February 2019 to August 2023. Sociodemographics, diagnosis and pretreatment staging data were collected from patient records. We examined referral and diagnosis statistics, age at referral, radiological T‐stage at diagnosis, levels of deprivation by ethnicity and the impact of COVID‐19 pandemic lockdowns on proportion of referrals and diagnoses by ethnicity and T‐stage at diagnosis. Uni‐ and multivariable logistic regression was performed to identify predictors of locally advanced (T‐stage ≥T3) disease.ResultsOf all referrals, 22% were diagnosed with PCa. There were no statistically significant differences in referrals, diagnoses or T‐stage of PCa by ethnicity during COVID lockdown versus non‐lockdown periods (p &gt; 0.05). Compared to men from any other ethnicity, Black men (from Black British, Black African and Black Caribbean ethnic groups) were diagnosed at a younger age (mean = 65 years), had the highest age‐adjusted PCa incidence rate of 149 per 100 000 person‐years, were from the most deprived backgrounds, and were diagnosed with the highest proportion of localised PCa (74%). Multivariable analysis of a patient subgroup revealed age bands 71–80 years (OR 2.01, 95% CI 1.31–3.07) and &gt;80 (OR 4.27, 95% CI 2.25–8.08) as independent positive predictors of locally advanced PCa, and Black ethnicity as an independent predictor of localised disease (OR 0.66, 95% CI 0.43–1.00). Limitations of this study include the exclusion of PCa cases diagnosed outside the 2WW pathway, as well as missing data on Prostate‐Specific Antigen (PSA) levels, distant radiological staging and histopathological findings.ConclusionWe identify disparities in PCa incidence, stage and age at presentation, as well as socio‐economic deprivation among Black men in NEL. Targeted efforts are needed to mitigate these healthcare inequities.

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 &lt; 0.001) and sepsis (OR: 16.01, p &lt; 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 &lt; 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&lt;0.001; +$192,699, p&lt; 0.001), age over 60 (+0.99 days, p&lt;0.001; +$6,134, p&lt;0.001), and care at urban teaching hospitals (+0.54 days, p&lt; 0.001; +$32,230, p&lt; 0.001) were associated with longer hospital stays and higher total charges. Conversely, female gender (-0.21 days, p=0.001; -$5,529, p&lt;0.001) and higher income (-0.69 days, p&lt;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&gt;60 1.67 (p&lt; 0.001) 0.99 days, p&lt;0.001 $6428, p&lt; 0.001 Race (Hispanic compared to White race) 1.15 (p=0.287) 0.38 days, p= 0.004 $14,127, p&lt;0.001 Race (Black compared to White race) 1.1 (p=0.348) 1.4 days, p&lt; 0.001 $5370, p=0.002 Female gender 0.88 (p=0.08) -0.21 days, p= 0.001 -$5529, p&lt; 0.001 High house hold income 0.71 (p= 0.011) -0.69 days, p&lt;0.001 -$1565, p= 0.466 Treatment at urban teaching facility 0.54 (p&lt;0.001 0.54 days, p&lt;0.001 $32230, p&lt; 0.001 Sepsis 16.01 (p&lt;0.001) 11.8 days, p&lt;0.001 $192699, p&lt; 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 &lt; 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&lt;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&lt; 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 &lt; 0.001), female gender (OR: 0.78, p = 0.002), and care at urban teaching facilities (OR: 0.37, p &lt; 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 &lt; 0.001) and being treated at urban teaching facilities (+1.8 days, p &lt; 0.001; +$57,106, p &lt; 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&gt;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&lt; 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&lt;0.001) +1.8 days, p&lt;0.001 $57,106, p&lt;0.001 Thrombosis 2.08(p&lt;0.001) +1.9 days, p&lt; 0.001 $16,003, p= 0.001 Pancreatic conditions 0.589(p&lt;0.001) +0.33 days, p= 0.031 $10,826, p&lt;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.