African American Patients Research Articles

Social determinants of health and financial burden among patients with pancreatic cancer at a tertiary cancer center.

678 Background: Financial toxicity (FT) represents a challenge for cancer patients that impacts treatment decisions, patient satisfaction, and quality of life. Social determinants of health (SDoH) screening may predict who is at risk of FT and could potentially benefit from financial interventions. Methods: This is a retrospective study of all cancer patients presenting to Mayo Clinic sites between Sept 2023 – Jun 2024. Patients completed SDoH questionnaires and were given risk scores of Low Risk, Medium Risk, and High Risk for SDoH categories: Financial Strain Risk, Transportation Risk, and Food Insecurity Risk. Patient financial data including active debt amounts, insurance coverage, and financial aid were collected. Patients with pancreatic ductal adenocarcinoma (PDAC) were compared to those with pancreatic neuroendocrine tumors (PNET) and patients with other cancers (Others). Categorical variables were compared with Pearson's Chi-squared test, continuous variables with Kruskal-Wallis rank sum test. P values < 0.05 were considered significant. Results: Data was obtained from 88,039 patients, 2,607 of whom had PDAC and 449 had PNET. Compared to PDAC patients, PNET patients and Others were more likely to have Medium/High risk scores for Financial Strain Risk (6% vs 6.5% and 8.5%, respectively) and Food Insecurity (1.7% vs 3.8% and 3.2%) (Table). There was no statistically significant difference in median medical debt and need of financial assistance between the groups. Among PDAC patients, there were differences in distributions among race, primary language spoken, and patient electronic record access depending on Financial Risk categories. African American patients had the greatest proportion of Medium/High risk (12.9%) compared to Asian (4.4%) and White (5.8%) patients (P<0.001). Among patients with English as their primary language, 64.9% had Low Risk scores compared to 27.7% with other primary languages (P<0.001). Patients with electronic record access were more likely to report High Risk scores (6.9%) compared to those without access (1.6%). Conclusions: Per patient responses collected, PDAC patients presenting to our center have lower risk of financial strain and similar medical debt levels compared to the remainder of cancer patients. Among PDAC patients, higher financial strain was experienced by non-whites (7.9% vs 5.8%). Diagnosis PDAC (N=2607) PNET (N=449) Other (N=84983) p value Current Financial Risk (Grouped) < 0.001 - Low Risk 1662 (63.8%) 304 (67.7%) 59298 (69.8%) - Medium/High Risk 157 (6.0%) 29 (6.5%) 7209 (8.5%) - Unknown/Missing 788 (30.2%) 116 (25.8%) 18476 (21.7%) Food Insecurity Risk < 0.001 - Low Risk 1764 (67.7%) 308 (68.6%) 63235 (74.4%) - Medium Risk 45 (1.7%) 17 (3.8%) 2703 (3.2%) - Unknown/Missing 798 (30.6%) 124 (27.6%) 19045 (22.4%) Median Active Debt in USD 1102.230 1020.010 1141.135 0.593

Racial disparities in secondary metastasis in patients with hepatocellular carcinoma: A 5-year National Inpatient Sample study.

523 Background: Hepatocellular carcinoma (HCC), a primary liver malignancy, is one of the leading causes of cancer-related mortality worldwide. The incidence and outcomes of HCC vary significantly across racial groups. Secondary metastasis, a key factor in disease progression and prognosis, also appears to differ by race, though these disparities remain poorly understood. This study aims to explore how race influences the metastatic progression of HCC, providing valuable insights into potential racial differences in disease outcomes. Methods: A retrospective analysis of National Inpatient Sample (NIS) data from 2016 to 2020 was conducted, identifying adults with HCC using International Classification of Diseases, Tenth Revision (ICD-10) codes, and categorizing them based on the presence of metastasis. The primary outcome was racial differences in organ metastasis. Multivariable logistic regression models were used to adjust for potential confounders and to evaluate the impact of race on all metastatic patterns, with Caucasians as the reference category. Statistical significance was defined as p-values ≤ 0.05. Results: The study cohort included 236,985 adult patients with HCC, of whom 34,875 had secondary metastasis. The cohort was predominantly male (77.37%), with 22.63% female. The racial distribution was 52.61% Caucasian, 19.08% African American, 15.04% Hispanic, and 13.27% from other racial groups. After adjusting for confounders, African American patients had significantly higher odds of lung (aOR 1.42, P<0.001), bone (aOR 1.51, P<0.001), and brain metastasis (aOR 1.47, P=0.02), but lower odds of adrenal gland metastasis (aOR 0.74, P=0.003) compared to Caucasians. Asian/Pacific Islander patients demonstrated increased odds of lung (aOR 2.00, P<0.001) and brain metastasis (aOR 1.95, P=0.02). In contrast, Hispanic patients had lower odds of abdominal lymph node (aOR 0.69, P=0.008) and bone metastasis (aOR 0.83, P=0.007). Conclusions: This study highlights significant racial disparities in the metastatic patterns of hepatocellular carcinoma, emphasizing the need to consider these differences in clinical management and treatment strategies for HCC patients. Further research is required to investigate the underlying causes of these disparities and their impact on long-term survival.

Multi-target stool DNA test adherence in average-risk African Americans from 2017-2024.

99 Background: Colorectal cancer (CRC) stands as the second most common cause of cancer-related mortality in the United States, while being the third most common cancer in the country. African Americans (AA) are disproportionately affected with CRC (incidence and mortality), yet the disease can be prevented through screening and early detection. Data reveals that only 59% of AA between ages 45-75 were up to date with CRC screening as of 2021. Broad availability of the navigation-supported, at home multi-target stool DNA (mt-sDNA) test may help mitigate barriers to screening adherence in this population. We examined multi-target stool-DNA (mt-sDNA) test adherence rates in a nationally representative AA population. Methods: Using a national claims database of over 165 million individuals linked with Exact Sciences Laboratories data, mt-sDNA orders for AA patients were retrospectively identified from 2016 to 2024. Average CRC risk individuals aged ≥45 years, and new to mt-sDNA, were included in this analysis. Primary outcome of interest was adherence, defined as mt-sDNA kit return rate within 365-days from shipment. Time to test return was examined as the secondary outcome. Demographics were age, sex, ordering provider, residential geography, payor, and outreach preference. Covariates on adherence were examined using logistic regression. Results: Among 434,951 mt-sDNA orders from 2017-2024, the overall adherence rate was 62%, and the average time to test return was 27.6 days. The cohort included higher percentages of women (61.7%), ages 50-64 years (57.8%), located in Southern US (51.4%), and metro areas (90.9%). Most patients were also commercially insured (56.1%) and received their mt-sDNA order from their primary care provider (65.4%). Digital SMS was the most preferred outreach option (47%). Patients ages ≥76 years demonstrated the highest adherence (70.3%), with all age categories near or above 60% (45-49 yrs [59.4%]; 50-64 yrs [60.8%], 65-75 yrs [64.3%]). Across payors, patients with Medicare had the highest adherence rates (66.5%). Across outreach, highest adherence was among those who preferred ‘Digital SMS + Email’ outreach (64.3%). Men were quicker to return their test than women (26.8 days vs 28 days, p<0.001). Those ages ≥76 years and with tests ordered by GIs had the shortest time to test return (21.3 and 22.2 days, respectively). Adjusted analyses revealed multiple factors were associated with increased odds of adherence, including older age (≥76 years; OR=1.54; p<0.001), ‘Digital SMS + Email’ outreach (OR=1.25; p<0.001), rural residence (OR=1.23; p<0.001), and males (OR=1.05; p<0.001). Conclusions: Mt-sDNA adherence was higher for AA patients in this large, national cohort as compared to previously reported overall CRC screening adherence data for this population group. Findings suggest mt-sDNA utilization, with its included patient navigation, may help reduce screening disparities among AA patients.

Use of Body Armor by EMS Clinicians, Workplace Violence, and Racial and Ethnic Disparities in Care

There is a clear benefit to body armor against firearms; however, it remains unclear how these vests may influence day-to-day patient encounters when worn by emergency medical services (EMS). To determine the association of ballistic vests worn by EMS clinicians with workplace violence (WPV) and disparities in care among racial and/or ethnic minority patients. Prospective cohort study of a volunteer-based sample of EMS clinicians at a large, multistate EMS agency encompassing 15 ground sites across the Midwest from April 1, 2023, to March 31, 2024. Data were analyzed from May to June 2024. External ballistic armor being used by a group of self-selected clinicians on every run. Prevalence and characteristics associated with WPV and with declines of treatment and/or transport compared between crews with 1 or more vested vs no vested members. A total of 156 of 415 staff (37.6%) opted in to wear the vests, including 77 male participants (49.4%). Prevalence of WPV was higher for vested crews (1.11 vs 0.85 cases per 100 runs; adjusted risk ratio [aRR], 1.28; 95% CI, 1.10 to 1.50; P = .001) and was due to higher rates of verbal abuse. The presence of 1 or more vested crew members increased the likelihood of all patients declining EMS treatment and/or transport; however, effect size was highest among patients with an unknown race and/or ethnicity (2234 [21.1%] vs 2134 [16.5%] patients; aRR, 1.19; 95% CI, 1.10 to 1.27; P < .001), followed by racial and/or ethnic minority patients (708 [16.7%] vs 399 [13.8%] patients; aRR, 1.18; 95% CI, 1.05 to 1.33; P = .01). Analyses of individual minority groups revealed a significant increase only in Black or African American patients declining treatment and/or transport by vested crews (461 [17.6%] vs 223 [13.7%] patients; RR, 1.28; 95% CI, 1.10 to 1.49; P = .002). In this cohort study, vested crews experienced increased prevalence of WPV compared with nonvested crews. Use of vests increased the frequency of all patients declining EMS treatment and/or transport. Among minority groups, there was a significant increase in Black or African American patients declining treatment and/or transport. Agencies should consider benefits and unintended consequences of EMS clinicians wearing body armor.

Interleukin-23 versus Interleukin-17 Inhibitors in Preventing Incidental Psoriatic Arthritis in Patients with Psoriasis: A Real-World Comparison From the TriNetX US Collaborative Network.

Psoriatic arthritis (PsA) is a common comorbidity in patients with psoriasis (PsO) that leads to significant disease burden. Biologic therapies targeting the interleukin (IL)-23/IL-17 axis have been widely used for PsO, but their comparative effectiveness in preventing PsA remains unclear. The study objective was to compare the occurrence of developing incidental PsA among PsO patients treated with interleukin-23 inhibitors (IL23is) or interleukin-17 inhibitors (IL17is). A retrospective cohort study was conducted using real-world data from the TriNetX US Collaborative Network, including 53 healthcare organizations. Adult PsO patients treated with IL23is or IL17is between January 2019 and June 2022 were identified. Cox regression analysis was used to assess the risk of PsA incidence, with hazard ratios (HRs) and 95% confidence intervals (CIs) reported. Subgroup analyses were performed based on age, sex, and ethnicity. Sensitivity analyses included comparisons with tumor necrosis factor (TNF) inhibitors (TNFis) to ensure robustness. A total of 4,580 PsO patients were included in the study, with 2,273 receiving IL23is and 2,307 receiving IL17is. Treatment with IL23is was associated with a significantly lower incidence of PsA compared to IL17is (HR = 0.60, 95% CI 0.44-0.82, P = 0.001). This reduction in risk was particularly notable in the 41- to 65-year age group (HR = 0.42, 95% CI 0.27-0.64, P < 0.001) and among females (HR = 0.57, 95% CI 0.38-0.86, P = 0.007). Subgroup analyses based on ethnicity revealed varying outcomes, with White patients showing a significant risk reduction (HR = 0.55, 95% CI 0.38-0.79, P = 0.001) but no significant risk reduction was observed in Black or African American patients (HR = 1.37, 95% CI 0.37-5.13, P = 0.637). Sensitivity analyses comparing IL23is and TNFis confirmed the robustness of the findings. IL23is are associated with a lower risk of PsA incidence compared to IL17is in PsO patients, particularly in specific age, sex, and ethnic groups. These findings suggest that IL23is may be more suitable for PsO patients at high risk of PsA and could inform potential updates to treatment guidelines. Further research should focus on refining therapeutic strategies by incorporating patient-specific factors such as comorbidities, ethnicity, and genetic predispositions, which could optimize biologic selection and enhance PsA prevention efforts in clinical practice.

P-1453. Disparities in PrEP utilization

Abstract Background In October 2023, the CDC released data regarding PrEP uptake in the United States. The data indicated that in 2022, for the first time, more than one-third of individuals who could benefit from PrEP had been prescribed it. While this advancement is certainly significant, as PrEP coverage is one of the cornerstones in ending the HIV epidemic, the report also highlighted substantial disparities. According to the report, while 94% of White individuals who could benefit from PrEP had been prescribed it, only 13% of Black and 24% of Hispanic/Latino individuals who could benefit had received prescriptions for PrEP. Another notable disparity was observed regarding sex at birth, with 40% of males who could benefit from PrEP being prescribed it, compared to only 15% of females. Methods We aimed to determine if such a magnitude of disparity existed within our patient population receiving care at the infectious disease clinic. We identified 99 patients who had been prescribed PrEP at the ID clinic. These individuals were categorized based on their self-identified race/ethnicity and sex assigned at birth. Results Of the 99 individuals prescribed PrEP, 86 were males, while only 13 were females. Regarding race/ethnicity, there were 65 White or Caucasian patients, 24 Black or African American patients, 5 Hispanic or Latino patients, and 5 others. Conclusion Compared to national data published by the CDC, our data shows similar disparities. While the PrEP-to-need ratio would be a better indicator of the true disparity, our data still highlights the trend in racial and sex-based differences among users of PrEP prescriptions. Disclosures All Authors: No reported disclosures

Sleeve Gastrectomy Versus Semaglutide for Weight Loss in a Severely Obese Minority Cohort: A Propensity-Matched Study.

The rising obesity rates in the USA have led to a surge in various weight loss treatments. Glucagon-like peptide-1 (GLP-1) analogues have shown promise in reducing weight but primarily studied in Caucasian populations. Sleeve gastrectomy (SG) has already proven successful weight loss outcomes. This study aimed to compare the weight loss outcomes between semaglutide and SG in a minority population over a 12-month period. Two separate cohorts of patients were identified through a retrospective review of electronic medical records. The first cohort consisted of patients prescribed semaglutide from January to December 2022, and the second one included patients who underwent SG during the same period. Weight loss was the primary outcome of interest, measured at 3-, 6-, and 12-month post-intervention. Propensity score matching was used to ensure balanced characteristics between the two groups. A total of 206 patients were included; 103 (50%) in the semaglutide group and 103 (50%) in the SG group. The entire cohort consisted mostly in African Americans (67%) and Hispanics (21%). The mean BMI was 55kg/m2 and 56kg/m2 for the SG and semaglutide groups, respectively. The SG group consistently outperformed semaglutide regarding weight loss at all follow-up periods, with the largest difference observed at 12-month post-intervention (total weight loss 32% vs. 2%, p < 0.001). SG led to significantly more weight loss than semaglutide over a 12-month period. Our findings suggesting that GLP-1 agonists might be less effective for weight loss in African American and Hispanic patients with severe obesity warrants further research.

Impact of Race on Transplantation in Autosomal Dominant Polycystic Kidney Disease.

Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic cause of end-stage kidney disease (ESKD) and occurs without racial predilection. In general, non-White ESKD patients have less access to transplantation, especially living donor transplantation. We examined long-term outcomes of ADPKD-ESKD patients by self-reported race, with attention to the trajectory of Estimated Post-Transplant Survival (EPTS) scores over time. United Network for Organ Sharing Standard Transplant Analysis and Research files were used to identify 32,611 ADPKD transplant recipients between 1/2000-12/2022. EPTS scores were calculated from the date of waitlisting until transplantation occurred. Cumulative incidences of living and deceased transplantation were calculated and plotted. Cox models were made for graft failure and death, and a sub-distribution hazards model for graft failure accounted for death as a competing outcome, with adjustment for patient, donor, and transplant factors. Compared to White ADPKD patients, all other groups had more dialysis years, more delayed graft function, and fewer living and pre-emptive transplants; mean EPTS scores were lower in African American (AA) and Hispanic patients at each timepoint on the waitlist. However, EPTS scores at the time of transplant was less likely to be <20% in AA and Hispanic patients, due to longer waiting time. AA patients had a significantly higher risk of graft failure with death as competing risk compared to White patients. Asian and Hispanic patients had similar graft survivals but better patient survival compared to White patients. Waitlist experience, allograft quality, and post-transplant outcomes of patients with ADPKD are influenced by patient race.

Prevalence of Comorbidities and Racial Disparities in Anterior Uveitis Risk Among Ankylosing Spondylitis Patients

Introduction: Ankylosing spondylitis (AS) is a chronic inflammatory condition primarily affecting the axial spine, commonly associated with extra-articular manifestations such as anterior uveitis (AU). Racial disparities have been observed in the prevalence of AU among AS patients, with African American individuals often experiencing higher frequencies compared to their white counterparts. Moreover, AS is linked with various comorbidities, contributing to increased morbidity and mortality. This study aims to investigate the prevalence of AU and associated comorbidities among AS patients, with a focus on racial differences. Methods: This retrospective study utilised data from the 2020 National Inpatient Sample (NIS) database, identifying adult patients with AS admitted to hospitals in the United States. Descriptive statistics were employed to analyse demographic characteristics and comorbidity prevalence. Multivariate analysis assessed the association between AU, race, comorbidities, and inpatient outcomes. Results: Our analysis revealed significant racial disparities in the prevalence of AU among AS patients. Patients with AU tended to be younger, with a mean age of 48 years versus a mean age of 60 in patients with AS without AU. Among patients with AS without AU, 82% were Caucasians and African Americans represented 6%. Among patients with AS with AU, Caucasians represented 71% and African Americans represented 18%. In terms of outcomes, patients with a history of AU exhibited similar inpatient mortality rates (less than 1%) compared to those without (3%). Acute kidney injury (AKI) was more prevalent among patients with AU (24%) versus those without (16%) but was not statistically significant. The comorbidities commonly associated with AS include hypertension, both complicated (23%) and uncomplicated (40%), along with diabetes presenting with and without chronic complications at rates of 17% and 11%, respectively. Conclusion: Our study underscores the need for further research to elucidate the relationships between AS, AU, and comorbidities, particularly in the context of racial disparities. Improved risk assessment and early detection strategies tailored to the African American population are crucial for facilitating timely diagnosis and targeted treatment interventions for AS. Addressing these disparities and advocating for proactive management approaches can help mitigate healthcare inequities and enhance overall health outcomes for African American AS patients.

Proteomic profiling identifies upregulation of aurora kinases causing resistance to taxane-type chemotherapy in triple negative breast cancer

Nowadays, chemotherapy and immunotherapy remain the major treatment strategies for Triple-Negative Breast Cancer (TNBC). Identifying biomarkers to pre-select and subclassify TNBC patients with distinct chemotherapy responses is essential. In the current study, we performed an unbiased Reverse Phase Protein Array (RPPA) on TNBC cells treated with chemotherapy compounds and found a leading significant increase of phosphor-AURKA/B/C, AURKA, AURKB, and PLK1, which fall into the mitotic kinase group. The increase of AURKA and AURKB protein was majorly due to a post-transcription level regulation, and Paclitaxel treatment induced Aurora Kinases protein phosphorylation on AURKA(T288)/AURKB(T232) sites and their protein stability. In our UAB TNBC cohort, the expression of AURKA and AURKB was significantly higher in TNBC tumors compared to normal adjacent tissues, and AURKB was found to be highly expressed in African American TNBC patients compared to European Americans. Moreover, Aurora Kinases overexpression in TNBC cells renders resistance to Paclitaxel treatment and attenuates the apoptosis effect triggered by chemotherapy treatment, suggesting Aurora Kinases could mediate the chemo-resistance in TNBC. Hence, a combination of Aurora kinase inhibitors or PROTAC degrader and taxane-type chemotherapy significantly enhanced the chemotherapy effect. In summary, we revealed that Aurora Kinases upregulation after treatment with chemotherapy could confer chemotherapy resistance to TNBC cells, and AURKB could serve as preselection markers for stratifying patients’ response to neoadjuvant chemotherapy.

CRYβB2 alters cell adhesion to promote invasion in a triple-negative breast cancer cell line

ObjectiveAfrican American women with breast cancer experience disproportionately poor survival outcomes, primarily due to the high prevalence of the deadliest subtype; triple-negative breast cancer (TNBC). The CRYβB2 gene is upregulated in tumors from African American patients across all breast cancer subtypes, including TNBC, and is associated with worse survival rates. This study investigated the effect of CRYβB2 on the invasion of TNBC cells and the underlying mechanisms contributing to this phenotype.ResultsWe utilized the SUM159 cells with stable CRYβB2 overexpression in a 3D-culture tumor spheroids model in our investigation. A quantitative 3D invasion assay demonstrated that CRYβB2 overexpression significantly enhanced invasion (median invasion %; SUM159 = 0.14 and SUM159 + CRYβB2 = 0.33). RNA sequencing analysis indicated that CRYβB2 overexpression modulated cell-cell adhesion and extracellular matrix organization pathways, which are critical to invasion of cancer cells. Specifically, CRYβB2 suppressed the expression of key cell-cell adhesion genes known as clustered protocadherins and promoted the expression of PCDH7, a nonclustered protocadherin with known oncogenic roles in various cancers. Notably, the knockout of PCDH7 diminished the invasive capacity induced by CRYβB2 (median invasion %; SUM159 = 0.093, SUM159 + CRYβB2 = 0.184 and SUM159 + CRYβB2/PCDH7−/−=0.082). These findings provide a novel link between a previously identified differentially expressed gene, CRYβB2, in driving breast cancer phenotypes by modulating a class of adhesion proteins.

Real world effectiveness, persistence, tolerability, and safety of ofatumumab in clinical practice.

To describe the 12-month effectiveness, persistence, tolerability, and safety of ofatumumab (OMB), a highly effective disease-modifying therapy (DMT) for relapsing multiple sclerosis (MS), in a real-world MS population. Electronic medical records of patients starting OMB from October 2020 to August 2022 at two comprehensive MS centers were reviewed. Demographics and disease characteristics and 6- and 12-month clinical, patient-reported, and radiologic outcome measures were analyzed. A total of 175 patients started OMB with mean age 44.9 (SD 10.4) and disease duration 13.6 (SD 9.6) years. The cohort was 74% female, included 81% White and 13% Black American patients, and consisted of 80% relapsing-remitting MS or clinically isolated syndrome. Most (87%) had prior DMT exposure with 38% switching from high efficacy DMT. Over 12 months, 9.7% discontinued OMB (mean 117 days, SD 99.2), with tolerability issues being the most common reason. Thirty-nine (22%) had relapses in the year before starting OMB. By 12 months, only 1 relapse had occurred after approximately 4 months post-treatment initiation. This real-world study demonstrated that OMB is highly effective with robust persistence and good safety and tolerability by 12-month follow-up. Further analyses are planned to examine longer-term outcomes.

Disparities in Patient Demographics at a Student-Run Free Clinic: Comparing Clinic Utilization to City, State, and National Trends.

With 8.4% of Americans uninsured, free clinics serve as essential safety nets for underserved populations. This study compared the demographics of the patients of a student-run free to Toledo, Ohio, and national census data to evaluate health needs, barriers to care, and the characteristics of the underserved population. A retrospective review of 1,338 visits across five clinic sites was conducted from February 2023 to February 2024. Demographic variables, including race, insurance, education, sex, and primary language, were analyzed and compared to 2020 Census data from Toledo, Ohio, and the United States. Compared to Toledo, the clinic served 22.63% fewer White patients, 17.27% more Hispanic/Latino patients, and 5.62% fewer African American patients. Among clinic patients under 65 years, 61.91% were uninsured, compared to 8.3% in Toledo and 10.2% nationally. Non-English speakers were overrepresented (33.4% vs. 6.8% in Toledo and 9.5% nationally), with Spanish speakers making up 21.72% of clinic patients compared to 3.2% in Toledo. Educational attainment differed slightly, with fewer high school graduates (82.97% vs. 87.10% in Toledo) but more individuals with higher education degrees (27.10% vs. 19.6% in Toledo and 25.6% nationally). This study underscores the demographic differences between CCC patients and city, state, and national populations, offering insight into the populations most reliant on free clinics. Policymakers and public health agencies must consider these disparities to tailor interventions addressing healthcare access and social determinants of health.

Prevalence of Pulmonary Embolism in COVID-19 Positive Critically Ill Children.

To investigate the prevalence of pulmonary embolism (PE) in children admitted to critical care diagnosed with COVID-19 infection. Retrospective database study. Data reported to the Virtual Pediatric Systems, 2018-2021. Patients 28 days to younger than 18 years old, admitted to a PICU with either PE or COVID-19 diagnoses. None. Among the PE-positive subgroups, from January 2020 to December 2021, 78 patients (14%) had an acute COVID-19 infection. The prevalence of PE pre-pandemic period (2018-2019) was 0.19% and for pandemic period (2020-2021) was 0.26% (p < 0.001). During the pandemic period, the prevalence of PE for COVID-negative patients was 0.21% and for COVID-positive patients was 1.01% (p < 0.001). The result shows that the chance to develop PE for COVID-positive patients is 4.8 times that for COVID-negative patients during the pandemic. In the subgroup of the PE-positive patients, 55.1% were Black or African American in the COVID-positive group and 19% in the COVID-negative group (p < 0.001). A multivariable logistic regression showed that race was an independent risk factor for COVID in PE-positive patients. Our study demonstrates a significant increase in the prevalence of PE among pediatric patients admitted to PICUs during the COVID-19 pandemic compared with pre-pandemic. Our study indicates that COVID-positive patients are 4.8 times more likely to develop PE than COVID-negative patients. Additionally, the study highlights substantial racial disparities in the prevalence of PE, with Black or African American patients being disproportionately affected.

Clinical expression of radiographic axial spondyloarthritis and its association with HLA-B27 in European and Ibero-American populations.

To compare the clinical and sociodemographic characteristics of Ibero-American patients with radiographic axial spondyloarthritis (r-axSpA) to those of European patients, with a particular focus on the influence of HLA-B27. This was an observational, cross-sectional, and multicentre study of patients who fulfilled the European Spondyloarthropathy Study Group (ESSG) criteria for SpA from the REGISPONSER and RESPONDIA registries. Univariate and multivariate analyses between European and Ibero-American populations stratified by HLA-B27 status were conducted. Race stratification (White, Black American, and Indian American) was also performed to evaluate clinical differences according to HLA-B27. A total of 2592 patients with a clinical diagnosis of r-axSpA were included in the analysis: 1083 (41.8%) Ibero-American patients and 1509 (58.2%) European patients. Among the HLA-B27-positive patients, Ibero-American status was independently associated with conventional synthetic disease-modifying antirheumatic drugs (csDMARD) intake (OR: 4.21), arthritis (OR: 2.36), enthesitis (OR: 6.01), dactylitis (OR: 6.10), severe structural damage (BASRI) (OR: 1.12) and poor functionality (BASFI) (OR: 1.40). Multivariate analysis of HLAB27-negative patients revealed that Ibero-American status was independently associated with enthesitis (OR: 11.67), csDMARDs (OR: 15.51) and total BASRI (OR: 1.34). Clinical manifestations also varied across racial groups, with differences noted in the prevalence of peripheral joint manifestations such as more arthritis and enthesitis in American Indian patients than in White and Black American patients. Ibero-American r-axSpA patients in our study exhibit more peripheral manifestations, more structural damage, and worse functionality than European patients, regardless of the presence of HLA-B27.

Patient-reported outcome trajectories the first 24 months after surgery for cervical spondylotic myelopathy: a Quality Outcomes Database study.

Cervical spondylotic myelopathy (CSM) shows varying levels of improvement after surgical treatment. While some patients improve soon after surgery, others may take months to years to show any signs of improvement. The goal of this study was to evaluate postoperative improvement, patient-reported outcomes, and patient satisfaction up to 2 years after surgical treatment for CSM, which will help optimize the current treatment strategies and effectively manage patient expectations. This was a retrospective study of prospectively collected data using the Quality Outcomes Database. The primary outcomes of interest were achievement of the minimal clinically important difference (MCID) for the numeric rating scale for neck and arm pain, modified Japanese Orthopaedic Association, Neck Disability Index, and EQ-5D scores and postoperative satisfaction (North American Spine Society scale). Early and sustained improvement was defined as MCID achievement in at least one patient-reported outcome measure (PROM) at the 3-, 12-, and 24-month follow-ups. Transient improvement was defined as MCID achievement only at the 3-month and/or 12-month follow-up but not at the 24-month follow-up. Late improvement was defined as MCID achievement in at least one PROM only at the 24-month follow-up. There were 630 patients included in the comparative analysis. A total of 463 (73.5%) patients achieved early and sustained improvement, 105 (16.7%) patients experienced transient improvement with subsequent decline, 25 (4.0%) patients reported late improvement, and 37 (5.9%) patients did not report any clinically meaningful improvement after surgery. Patients with an anterior approach were more likely to be in the early and sustained improvement group. African American patients (OR 2.98, 95% CI 1.14-7.76; p = 0.03) were more likely to report late improvement when compared with White patients. The overall satisfaction rate at the 24-month follow-up was 87.8%. These findings indicate that 73.5% of patients achieve early and sustained improvement, and 87.8% of patients are satisfied with surgery 24 months postoperatively.

Depression and Distress Screening in Oncology Patients: A Descriptive Analysis.

This retrospective study aimed to describe the characteristics of cancer patients undergoing depression and distress screening at the Sidney Kimmel Cancer Center and to assess factors associated with their screening results. Data were retrieved from electronic medical records of adult Sidney Kimmel Cancer Center patients with at least one oncology encounter between January 2021 and June 2022, who underwent both depression and distress screening using the Patient Health Questionnaire-2/9 for depression and the National Comprehensive Cancer Network distress thermometer for distress during the encounter. Demographics, clinical factors, and screening results were analyzed using descriptive statistics and binary logistic regression. A total of 1954 cancer patients were screened for psychological needs. Of these, 110 (5.6%) screened positive for depression and 830 (42.5%) screened positive for distress. About 69.1% of patients who screened positive for depression also screened positive for distress. Conversely, 9.2% of patients who screened positive for distress also screened positive for depression. Cancer patients >65 years old were found significantly less likely to screen positive for both distress and depression, while males were found significantly less likely to screen positive for distress. African American patients were found to be significantly more likely than White patients to screen positive for both distress and depression (odds ratio: 2.58; confidence interval: 1:53-4.34). In this study, a higher proportion of cancer patients were found to be distressed than depressed, suggesting that the National Comprehensive Cancer Network distress thermometer may be a more useful tool in identifying psychosocial concerns in this population. Differences in depression and distress scores were significantly associated with age, sex, and race. These findings highlight the need for the implementation of effective screening strategies to better address the psychosocial needs of cancer patients. Further research is warranted to validate these findings and assess the impact of distress screening on patient outcomes across various oncology settings.

Understanding the Role of Trust in Healthcare and Intentions to Pursue Live Donor Kidney Transplant Among African American End Stage Kidney Disease Patients.

African Americans (AAs) with end-stage kidney disease (ESKD) experience significant barriers to accessing living donor kidney transplantation (LDKT), largely due to individual and systemic factors, including a lack of trust in healthcare systems resulting from a legacy of and continued experiences with medical racism. This cross-sectional study analyzed survey data from 416 AA patients with ESKD undergoing transplant evaluation in 2019-2023 at two kidney transplant centers in the Southeast United States, examining whether trust (specifically trust in kidney doctors, hospitals, and healthcare) modifies the relationship between attitudes towards LDKT and behavioral intentions to discuss LDKT with family and friends. Multivariable analyses revealed significant interactions. The regression model including attitudes and trust in kidney doctors was statistically significant (R2 = 0.114, F(7, 368) = 6.779, p ≤ 0.001). It was found that attitudes toward LDKT (β = 0.297, p ≤ 0.001) and trust in kidney doctors (β = 0.132, p = 0.008) were significantly associated with behavioral intentions to discuss LDKT with a family member or friend. Trust in hospitals, trust in the healthcare system, nor the interactions between attitudes and trust variables were significantly associated with behavioral intentions. Our findings support positive relationships between attitudes, trust in one's kidney doctor, and behavioral intentions to pursue LDKT, which have important implications for interventions that seek to improve access to LDKT among AA patients with ESKD.

Non-Caucasian Race/Ethnicity Predisposes to Unfavorable Stage and Grade at Upper Tract Urothelial Carcinoma Diagnosis.

To test whether race/ethnicity affects stage or grade distribution at upper tract urothelial carcinoma (UTUC) diagnosis. Within the Surveillance, Epidemiology, and End Results (SEER) database 2004-2020, UTUC patients were identified. Multivariable logistic regression models tested for the association between race/ethnicity and stage as well as grade at diagnosis according to renal pelvis vs. ureteral origin. Stage at presentation was defined as (i) metastatic stage (TanyNanyM1) and (ii) advanced stage (locoregional or metastatic (T3-4N0-2M0-1)). Of 14,384 UTUC patients, 8926 (62%) were renal pelvis. Of renal pelvis UTUC patients, 7064 (79%) were Caucasian, 797 (9%) Hispanic, 623 (7%) Asian Pacific Islander (API), and 442 (5%) African American (AA). Relative to Caucasians, API (odd ratio (OR) 1.85, 95% confidence interval (CI) 1.44-2.37, p < 0.001) and AA (OR 1.37, 95% CI 1.02-1.83, p = 0.03) patients more frequently harbored metastatic stage. APIs also more frequently harbored advanced (OR 1.33, 95% CI 1.11-1.60, p = 0.002) stage and high (OR 1.33, 95% CI 1.07-1.67, p = 0.01) grade. Of 5458 (38%) ureteral UTUC patients, 4360 (80%) were Caucasian, 362 (7%) Hispanic, 509 (9%) API, and 227 (4%) AA. Relative to Caucasians, Hispanic (OR 1.45, 95% CI 1.01-2.05, p = 0.03) patients more frequently harbored metastatic stage. APIs also more frequently harbored advanced stage (OR 1.22, 95% CI 1.02-1.47, p = 0.03) and high (OR 1.94, 95% CI 1.49-2.55, p < 0.001) grade. Race/ethnicity other than Caucasian, such as API and Hispanic, may predispose to higher odds of metastatic (TanyNanyM1) or advanced (T3-4N0-2M0-1) stages as well as to higher grade at initial diagnosis.

Predictors of Health Care Disparities in Fuchs Dystrophy Treatment Using the IRIS Registry.

To evaluate associations between sociodemographic factors and surgical management in patients with Fuchs Endothelial Corneal Dystrophy (FECD). Patients >40 years old with FECD diagnosis and subsequent corneal edema between 2007 and 2020 were identified from the American Academy of Ophthalmology IRIS Registry (Intelligent Research in Sight). Multivariable Cox proportional hazards models were fit to examine the relationships between sociodemographic variables and time from FECD diagnosis to penetrating keratoplasty (PK) and endothelial keratoplasty (EK)/PK. A total of 20,366 patients with FECD diagnosis and subsequent corneal edema were identified. Of the 4313 patients who underwent either EK or PK (any surgery), 374 patients underwent PK, 4037 underwent EK, and 98 received both interventions. After controlling for age, sex, and insurance status, Black or African American patients were 1.48 times as likely (hazard ratio 1.48, 95% confidence intervals (CI), 1.06-2.07) to undergo PK as compared with White patients and were less likely to receive any surgery (HR 0.83, 95% CI, 0.74-0.94). Asian patients were less likely (HR: 0.57, 95% CI, 0.43-0.75) to undergo any surgery. Female patients were more likely to undergo PK and less likely to undergo any surgery than male patients, and older patients were less likely to undergo any surgery with each increasing decade of life. There were no significant differences when stratified by insurance type. Age, sex, race and ethnicity, and insurance type are associated with varying rates of different surgical interventions for FECD.