African American Patients Research Articles

Metabolic Dysfunction and Alzheimer’s Disease Risks in African Americans

AbstractBackgroundMetabolic diseases like chronic Type 2 Diabetes Mellitus (T2DM) are now a serious global health concern In the United States. African Americans (AA) are being affected at a disproportionate rate with the condition compared to other ethnic groups, yet there are relatively few studies that have specifically focused on this group. Our previous findings have suggested that AA patients with T2DM had gene expression signals associated with Alzheimer’s Disease (AD). The current pilot study aimed to examine the amyloidogenic processing pathways (APP) and cholesterol biosynthesis‐related marker genes in the circulation of clinically identified T2DM AA patients in the Washington DC area.MethodA total of 12 confirmed T2DM AA patients and matched healthy controls were recruited from a regional hospital's outpatient departments, with sociodemographic and medical details obtained for analysis. Whole blood was collected in DNA/RNA Shield™ Blood Collection Tube for RNA extraction and isolation. The APP and cholesterol biosynthesis‐related gene expression patterns were examined using profiler array gene expression (qRT‐PCR). The affected pathways were identified using Ingenuity Pathway Analysis (IPA).ResultWe identified Amyloid Processing, Neuroinflammation Signaling, ERB4 Signaling, Interleukin signaling, and nNos signaling as the top canonical pathways. The top diseases and their functions were Metabolic disease, Neurological disease, Organismal Injury and Abnormalities, Psychological disorders, and cardiovascular diseases. APP, CDK5R1, PSENEN, and MAPT were the key genes that were differentially expressed (≥2‐fold change at p <0.05) in APP pathways, with PHLPP2, IL33, APP, CRP, & TAC1 as the top upstream regulators.ConclusionThe results suggest that T2DM may influence the risk of developing AD in AA patients. Further studies on larger multi‐ethnic populations would be of interest to validate and extend these findings. Information from such biochemical and genetic studies will be crucial to the development of therapeutic targets to assess future AD risks.

Association of Race and Ethnicity with Prescriptions for Continuous Glucose Monitoring Systems Among a National Sample of Veterans with Diabetes on Insulin Therapy.

Introduction and Objective: Continuous glucose monitoring (CGM) can improve glycemic control in people with diabetes on insulin therapy. We assessed rates of prescriptions for CGM in a national sample of Veterans across subgroups defined by race and ethnicity. Methods: This cross-sectional analysis of data from the U.S. Veterans Health Administration included adults with type 1 or type 2 diabetes on insulin therapy. Main exposures included self-reported race and ethnicity, and primary outcome was the percentage of patients with at least one CGM prescription between January 1, 2020, and December 31, 2021. Association of race and ethnicity categories with CGM prescription was examined using multilevel, multivariable mixed-effects models. Results: Among 368,794 patients on insulin (mean age, 68.5 years; 96% male; 96.8% type 2 diabetes; 0.8% American Indian or Alaska Native, 0.7% Asian, 18.9% Black or African American, 0.9% Native Hawaiian or other Pacific Islander, 70.2% White, 2.8% multiracial, 5.7% with unknown race, and 7.0% Hispanic or Latino ethnicity), 11.2% were prescribed CGM. CGM was prescribed for 10.4% American Indian or Alaska Native, 9.7% Asian, 9.2% Black or African American, 9.3% Native Hawaiian or other Pacific Islander, 11.8% White, 11.8% multiracial, and 10.1% patients with unknown race. CGM was prescribed for 8.3% Hispanic or Latino, 11.4% non-Hispanic, and 11.5% of patients with unknown ethnicity. After accounting for patient-, clinical-, and system-level factors, Black or African American patients had significantly lower odds of CGM prescription compared with White patients (adjusted odds ratio [aOR] 0.62, 95% confidence interval [CI] 0.59-0.64), whereas Hispanic or Latino patients had significantly lower odds compared with non-Hispanic patients (aOR 0.79, 95% CI 0.74-0.84). Findings were consistent across subgroups with clinical indications for CGM use. Conclusions: Among Veterans with diabetes on insulin therapy, there were significant disparities in prescribing of CGM technology by race and ethnicity, which require further study and intervention.

Post‐COVID Cognitive impairment in a large hospital‐based multi‐ethnic sample during the COVID‐19 pandemic

AbstractBackgroundCOVID‐19 has been associated with developing cognitive impairment. Individuals with cognitive impairment have a higher likelihood of progressing into dementia. Furthermore, studies have suggested that COVID‐19 is associated with an increased risk of developing Alzheimer’s disease (HR 2.03). Despite the increasing number of individuals developing post‐COVID cognitive impairment, the risk factors remain unclear.MethodWe used the electronic health record data on 32,018 patients with at least one COVID‐19 infection from 2020‐2022. We defined cognitive events based on ICD 10 for memory loss, mild cognitive impairment, dementia, or any neurocognitive disorders. We looked at the temporal relation between these events and the COVID‐19 events and classified patients as either with or without cognitive impairment and whether it was an incident (i.e. only after COVID without any pre‐COVID cognitive impairment or pre‐existing cognitive impairment). We then explored potential correlates with COVID‐related cognitive impairments. We also evaluated the effect of race and sex on the possible risk factors for developing post‐COVID cognitive impairment. We used Multivariable logistic regression to determine the significance of associations.ResultIn this study of 32018 patients with a COVID infection, and a mean age of 60, we found that the prevalence and incidence of post‐COVID cognitive impairment were higher in African American patients vs. White patients (prevalence 25% vs 23% incidence: 15% vs 13%) and male vs. female 39% vs. 33% patients. We also found a greater risk for post‐COVID cognitive impairment to be associated with delirium, recurrent COVID infection, kidney disease, and cardiovascular disorders, OR increased by 4.7, 2.4, 2.1 & 2.3 respectively (all P<0.0001). In contrast, we found that obesity, Remdesivir use, and prevalent psychiatric, and respiratory disorders decreased the odds of having post‐COVID cognitive impairment (OR 0.84, 0.83, 0.64, and 0.86 respectively) (all P<0.0001). The risk of cognitive diagnosis post‐COVID significantly differed by race with AA males having the highest risk. (all P<0.0001).ConclusionOur study shows post‐COVID cognitive impairment is common with the top risk factors being AA race, recurrent COVID infections, and cardiovascular disorders. Future studies should investigate the role these risk factors play and their contribution to the mechanisms underlying post‐COVID cognitive impairment.

The Unbefriended Patient, Their Professional Guardians, and Clinical Liaison Psychiatry: The Challenging Ethics of Changing Goals of Care.

AbstractUnbefriended patients are those with decisional impairments who lack family or friends to serve as healthcare surrogates. When such patients cannot make decisions, the court typically appoints a professional guardian to make choices aligned with the patient's values and preferences. However, this case report illustrates ethical challenges that can arise when professional guardians disregard the patient's authentic wishes. In this case study, the 38-year-old unbefriended African American male patient expressed fears about traumatic resuscitation efforts and ultimately desired de-escalation of care, which the guardian was hesitant to honor despite confirmed decision-making capacity. The guardian quickly reversed a new do-not-resuscitate order when the patient later changed his mind. Decisions about aggressive interventions like a colostomy were significantly delayed while awaiting final judgments involving the guardian's supervisors and the judicial system. The case highlights pitfalls with guardians defaulting to treatment escalation without sufficiently engaging with ethical standards or eliciting the patient's narrative identity, leading to inconsistent surrogate decisions. We propose that more robust reforms are needed, including enhanced training of guardians in ethical decision-making, and we present other means to facilitate best practices in proxy decision-making.

S33 Clinical Outcomes of African American Patients With Crohn’s Disease: A Population-Based Study

S33 Clinical Outcomes of African American Patients With Crohn’s Disease: A Population-Based Study

Sex-stratified association of variants in the Serotonin 1A receptor gene with acute crisis pain among African American sickle cell disease patients

Patients with sickle cell disease (SCD) suffer from pain in their daily lives. Both the acute and chronic pain phenotypes of this disease exhibit high variability, making pain management a challenge. The underlying reasons for the phenotypic variability are poorly understood. Given the importance of serotonergic neurotransmission in pain signaling, we aimed to explore the role of variants in the 5-HT1A receptor gene (HTR1A) on pain variability in SCD. Four variants (rs6449693, rs878567, rs6294, and rs10042486) in HTR1A were genotyped in a cohort of 131 African Americans with SCD. Acute and chronic pain were measured by the acute care utilization and the McGill Pain Questionnaire, respectively. Association analyses were performed for three genetic models (additive, dominant, and recessive). Three variants (rs6449693, rs6294, and rs10042486) in HTR1A showed significant association with crisis pain in both the additive and dominant models. While the G allele of rs6449693 and the C allele of rs10042486 associated with lower acute crisis pain, the T allele of rs6294 associated with increased acute crisis pain. Sex-stratified analyses revealed that the associations of these three variants with acute pain were significant only in males, and not in females. Furthermore, the A allele rs878567 that did not reach statistical significance in the overall cohort, showed a significant association with lower crisis pain in males. As the first study to explore the role of HTR1A variants in sickle cell pain, we identified that four variants across the gene are associated with acute crisis pain in SCD in a sex-stratified manner.

Trends and Symptoms Among Increasing Proportion of African Americans with Early-Onset Colorectal Cancer over a 60-Year Period.

The proportion of early onset colorectal cancer (EOCRC) is alarming in adults, including in African Americans (AA). To investigate differences between EOCRC compared to late-onset colorectal cancer (LOCRC) among AA patients. This retrospective study reviewed demographic, clinical presentations, colonoscopy, and pathology reports of patients at Howard University Hospital from 1959 to 2023. The study included 176 EOCRC cases (< 45years) and 2034 LOCRC cases (> 45years). Both EOCRC and LOCRC groups were predominantly AA (> 80%) with slightly more females (53%) than males. The mean age was 38years for EOCRC and 66years for LOCRC cases. EOCRC cases increased as a proportion of total detected CRC cases since 2010 (over 13%) after several decades of just above 6%. Family history of CRC in first degree relatives was higher among EOCRC (15.5% vs.3.4% in LOCRC patients, p < 0.01). Symptoms at presentation were prevalent in both EOCRC (93.8%) and LOCRC (92.6%). EOCRC patients exhibited higher incidence of abdominal pain (23.3% vs. 17.2%, p = 0.05) and changes in bowel habits (24.4% vs. 14%, p < 0.01) compared to LOCRC patients. Other symptoms such as melena, hematochezia, and weight loss were less prevalent in EOCRC patients. Comorbidities like hypertension (HTN), diabetes mellitus (DM), and inflammatory bowel disease (IBD) were less frequent among EOCRC patients. EOCRC was primarily observed in the sigmoid and rectosigmoid regions (p = 0.02). Metastasis at index colonoscopy was more prevalent with EOCRC compared to LOCRC (p = 0.04), with a higher proportion of patients at stage 3 cancer (p < 0.05). Significant differences were noted in the timeline for undergoing surgery after the diagnosis of colorectal cancer, with EOCRC patients taking longer than LOCRC patients (p = 0.03). Presentation of EOCRC over LOCRC increased proportionally in our cohort since 2010 and is associated with family history, and symptoms such as abdominal pain and change in bowel habits. Likely because of age at presentation, there are less comorbidities among EOCRC patients who predominantly present in the outpatient setting, and more likely diagnosed with advanced stage lesions that are predominantly sigmoid or rectosigmoid. These findings are similar to observations seen in the general population with EOCRC, albeit African American patients have commonly had earlier age presentation of CRC than White American patients.

Does race and insurance status play a role in high-grade renal trauma in the pediatric population? - An analysis from the traumatic renal injury collaborative in kids (TRICK) consortium.

We sought to examine the potential role of race and insurance status on the presentation, management, and outcomes of high-grade renal trauma (HGRT) in a large trauma registry. A retrospective cohort study of a large, multi-center registry of high-grade pediatric renal trauma was performed. Patients < 18 years of age with HGRT (grades III, IV, and V) from 2007 to 2020 were included. Patient demographics, presenting characteristics, hospital courses, outcomes, and follow-ups were extracted and compared. A total of 341 patients were initially identified, 32 were excluded. 66.3% were Caucasian(C), 27.5% were African American(AA), and 6.2% were Other races(O). 43.7% had public insurance,49.8% had private insurance and 6.5% were self-pay. Association of Race: AA patients had a higher rate of penetrating trauma (9% AA vs. 4% C, 0% Others, p = 0.002). Those with O and AA races presented at a younger age (9.5 yo O vs. 12.5 yo AA vs. 14 yo C, p = 0.001). However, no differences were found between race groups in the hospital course or outcome. Association of Insurance status: Those with public insurance presented with higher rates of bowel injury and blood transfusion, no differences were found in hospital course or outcome. Private insurance had higher Urology follow up rates (49% Private vs. 34.6% Public vs. 35% Self pay, p = 0.041). Race and insurance status was associated with differences found on the mechanism of injury, transfusion rate and urology follow-up rate; however, they do not influence rates of surgical intervention, post-injury complications or mortality.

Racial and Socioeconomic Disparities in Traumatic Brain Injury Outcomes: Insights From a Nationwide Analysis

BACKGROUND AND OBJECTIVES: To examine the effects of racial and socioeconomic disparities on clinical outcomes: in-hospital mortality, discharge dispositions, and hospital length of stay (LOS) among patients with traumatic brain injury (TBI) stratified by race and socioeconomic status (SES). METHODS: We conducted a retrospective analysis by analyzing the 1995-2015 Nationwide Inpatient Sample database. Adjusted logistic regressions and multinomial logistic regression models with and without propensity score matching were applied to investigate the effects of disparities on clinical outcomes. RESULTS: African American and Hispanic patients with TBI had a lower risk of in-hospital mortality, longer hospital LOS, and lower likelihood of being discharged to rehabilitation compared with White patients. The TBI patients with poor SES (pSES) had lower in-hospital mortality and were more likely to leave against medical advice compared with non-pSES TBI patients. CONCLUSION: Racial and socioeconomic disparities had significant influences on in-hospital mortality, discharge dispositions, and hospital LOS among the TBI population. Our study observed pSES TBI patients had a lower likelihood of in-hospital mortality than non-pSES patients, which may be partially attributed to the fact that most of the pSES TBI patients were hospitalized in urban teaching hospitals and hospitals with large bed size. In effect, our data suggest that the Social Safety Net of the United States is effective in preventing mortality in patients with TBI.

Abstract B037: Expression of MRTFA facilitates an immunosuppressive tumor microenvironment via upregulation of VSIR

Abstract Breast cancer, the second highest cause of cancer-related deaths in women, accounts for 31% of female cancer diagnoses. African American women have lower survival rates than White American women, influenced by both biological factors (age, family history, genetic factors, tumor biology) and social determinants (socio-economic status, insurance status, health care access). However, precise biological determinants remain unclear. The primary reason for breast cancer mortality is metastasis to organs like the lung, liver, and brain, with transcription factors playing a key role in this process. Myocardin related transcription factor A/B (MRTFA/B) are co-activators of serum-response factor (SRF), and the MRTF-SRF complex promotes breast cancer cell migration, invasion, and metastasis by regulating genes involved in actin cytoskeleton remodeling. MRTFA also supports tumor growth by modulating cancer-associated fibroblasts (CAFs) and remodeling the extracellular matrix (ECM) in the tumor microenvironment. While the pro-metastatic role of MRTFA/B is established in vitro and in mice, their impact on human cancer progression and metastasis requires further investigation. Therefore, understanding MRTFA's role in breast cancer metastasis is crucial for improving patient outcomes, making it essential to investigate MRTFA/B expression patterns in both tumor cells and the tumor microenvironment (TME). To explore the clinical, demographic, tumor-intrinsic, and tumor microenvironmental patterns of MRTFA/B’s expression and activation, we utilized multiplex imaging methods on multiple racially diverse tissue microarrays (TMA) and bioinformatics analyses of The Cancer Genome Atlas (TCGA), Molecular Taxonomy of Breast Cancer International Consortium (METABRIC), and available single-cell RNA sequencing datasets. Strikingly, MRTFA expression levels were higher in African American patients than in White American patients. Next, we investigated MRTFA expression patterns in the TME by using single-cell sequencing databases and found more abundant MRTFA expression in dendritic cells (DCs) within the TME compared to any other cell subtype. Moreover, our multiplex-imaging of tumor microarray (TMA) samples showed prominent MRTFA expression in HLA-DRA+CD45+ cells, indicative of antigen-presenting cells (APC). Notably, public single-cell RNA sequencing data indicated that breast cancer DCs strongly express the V-set immunoregulatory receptor (VSIR), an immune checkpoint protein, implying the immunosuppressive nature of the TME and we found that this increased VSIR expression is mediated by the MRTF-SRF complex. These findings suggest that DCs expressing MRTFA in breast cancer microenvironment contribute to creating the immunosuppressive TME via upregulation of VSIR expression, resulting in racial breast cancer disparities. Citation Format: Kihak Lee, Stephanie M. Wilk, Alexa M. Gajda, Mohamed Haloul, Virgilia Macias, Elizabeth L. Wiley, Zhengjia Chen, Xinyi Liu, Xiaowei Wang, Maria Sverdlov, Kent F. Hoskins, Ekrem Emrah Er. Expression of MRTFA facilitates an immunosuppressive tumor microenvironment via upregulation of VSIR [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Tumor-body Interactions: The Roles of Micro- and Macroenvironment in Cancer; 2024 Nov 17-20; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84(22_Suppl):Abstract nr B037.

Abstract 4125334: Disparities In Clinical And Demographic Outcomes Of Non-Acute Myocardial Infarction-Associated Cardiogenic Shock In African American Vs. Non-African American Patients: An Analysis From The National Inpatient Sample Database

Background: Limited knowledge exists regarding non-acute myocardial infarction-associated cardiogenic shock (nACS-CS) and its associated outcomes within the African American population. Aim: This investigation aimed to examine the clinical outcomes of nACS-CS in the African American population compared to the non-African-American population in the United States. Methods: The National Inpatient Sample (NIS) database was employed to identify hospitalizations with nACS-CS from 2018 to 2020. Patients were categorized as either African Americans or non-African Americans. Statistical analyses, including Chi-square and t-tests, were conducted using STATA version 18. Results: Out of 8,607 nACS-CS hospitalizations, 1,325 (15.4%) involved African Americans between 2018 and 2020 (Figure 1a). African American patients with nACS-CS tended to be younger (60.9±16.6 vs. 65.8±16.7 years; p &lt; 0.05). Moreover, the length of stay for this cohort was notably longer (16.2±0.75 vs. 14.8±0.32 days; p &lt; 0.05). The demographic age group affected by cardiogenic shock exhibited a decreasing trend as time progressed up to 2020 (p-trend&lt;0.05; Figure 1b). The mean hospital charges were also higher for the African American cohort (p&lt;0.05). In-hospital mortality also showed a progressive increase among African Americans over time (p&lt;0.05). Conclusion: Among African American patients with nACS-CS, there is an escalating burden on healthcare, evidenced by a progressively younger demographic being affected over time, coupled with worsening rates of in-hospital mortality. Furthermore, there is a higher mean cost of hospitalization and a prolonged length of stay compared to their non-African American counterparts.

Abstract 4140149: Differences in Interventional Treatment Outcomes of Peripheral Arterial Disease between African American Females, African American Males, and Caucasian Females

Introduction: Several recent publications demonstrated worse outcomes of interventional treatment of peripheral arterial disease (PAD) in patients of African American (AA) descent compared to Caucasians (C), and in female patients compared to male patients. However, studies addressing sex differences in outcomes, included predominantly white female patients. To our knowledge, there are no published studies specifically addressing outcomes of interventional treatment of PAD in female patients of African American descent. Aims: 1. To determine if the outcomes of interventional treatment of PAD in female patients of African American (FAA) descent differ from male African American patients (MAA), and Caucasian female patients (FC). If such differences exist, to identify factors associated with it. Methods: This study has a cross-sectional design with systematically retrospective data collection by the National Vascular Quality Initiative. Included in this study was data on patients treated with endovascular and open surgical options for symptomatic PAD. Statistical analysis was done using IBM Statistic SPSS V25. Results: 447,263 unique cases containing required data were available in the VQI database. Among them, 171,250 were female patients, of which 32,966 were FAA, 126,519 FC, and 39,461 MAA. This race and gender distribution is not significantly different from the US population structure (US Census Bureau 2023). 1 However, female to male ratio was higher in AA (0.83) compared to C (0.58, p&lt;0.0001). FAA were younger (65.143+/-9.59) compared to FC (69.16+/-10.32, P&lt;0.00001). Comparison of comorbidities, smoking rates, pre-interventional medications and post-interventional outcomes are listed in Table 1. Multivariate analysis confirmed higher amputation rate among FAA compared to FC and to MAA and showed no significant difference in mortality. Conclusions: FAA patients who require interventional treatment for PAD have significantly higher rate of hypertension and diabetes compared to FC and MAA patients and have higher amputation rates. It appears that differences in clinical outcomes of PAD treatment in FAA are related mostly if not entirely to poorly managed comorbidities existed prior to intervention.

Gene expression-based modeling of overall survival in Black or African American patients with lung adenocarcinoma.

Lung cancer is a leading cause of cancer-related deaths worldwide. Black/African American (B/AA) populations, in particular, exhibit the highest incidence and mortality rates of lung adenocarcinoma (LUAD) in the United States. This study aims to explore gene expression patterns linked to LUAD in B/AA and case-matched white patients, with the goal of developing predictive models for prognosis. Leveraging RNA sequencing data from The Cancer Genome Atlas (TCGA) database, genes and pathways associated with overall survival (OS) were identified. The OS-associated genes in B/AA patients were distinct from those in white patients, showing predominant enrichment in immune-related pathways. Furthermore, mRNA co-expression network analysis revealed that OS-associated genes in B/AA patients had higher levels of interaction with various pathways, including those related to immunity, cell-ECM interaction, and specific intracellular signaling pathways. Notably, a potential B/AA-specific biomarker, C9orf64, demonstrated significant correlations with genes involved in immune response. Unsupervised machine learning algorithms stratified B/AA patients into groups with distinct survival outcomes, while supervised algorithms demonstrated a higher accuracy in predicting survival for B/AA LUAD patients compared to white patients. In total, this study explored OS-associated genes and pathways specific for B/AA LUAD patients. Further validation and clinical application of these findings are warranted to address disparities and improve outcomes in diverse patient populations.

Studying the Role of Novel Carbon Nano Tubes as a Therapeutic Agent to Treat Triple Negative Breast Cancer (TNBC) - an In Vitro and In Vivo Study.

Triple Negative Breast Cancer (TNBC) is a malignant cancer with a very high mortality rate around the world. African American(AA) women are 28% more likely to die from triple-negative breast cancer (TNBC) than white women with the same diagnosis. AA patients are also more likely to be diagnosed at a later stage of the disease and have the lowest survival rates for any stage of diagnosis; There are very few existing anti TNBC drugs with therapeutic efficacy hence newer anti TNBC drug design and investigation is needed. Carbon Nano Tubes(CNT) in recent years have shown effective anti-cancer properties in various types of cancers as reported in peer reviewed journals. Henceforth, we did an investigation to study the anticancer properties of a novel CNT in both in vitro and in vivo models of TNBC. We tested the CNT drug in vitro cytotoxicity studies on TNBC model MDA-MB-231 VIM RFP cell lines and Spheroid forming assays on the same cancer cells; we also did an in vivo study on TNBC model mice to study the therapeutic efficacy of this CNT drug in reducing the tumor load. Our initial studies showed increased cell death and reduction in spheroid numbers in the CNT treated cancer cells in comparison to control and a significant reduction in the tumor volume in the TNBC model mice than in untreated animals. Thus our initial studies have shown significant therapeutic efficacy of the novel CNT as an anti TNBC agent. Additional mechanistic studies need to be done to find out the cell death mechanisms, core canonical pathways involved, pharmacokinetic studies before translational research for this novel nanoparticle as a therapeutic agent from bench to bedside.

Racial Disparities in Inpatient Hospital Outcomes of Primary Sclerosing Cholangitis in United States: Nationwide Analysis.

Background: Primary sclerosing cholangitis (PSC) is an idiopathic cholestatic liver disease that may lead to biliary strictures and destruction. It is associated with p-ANCA positivity and inflammatory bowel disease, typically ulcerative colitis. The aim of this study is to investigate the trends of inpatient healthcare utilization and mortality from 2008 to 2017 in the United States. Methods: The Nationwide Inpatient Sample (NIS) was examined to identify adult patients diagnosed with PSC between 2008 and 2017. Data on patient demographics, resource utilization, mortality, and PSC-related complications were collected. STATA version 16.0 was employed to perform forward stepwise multivariate regression analysis, generating adjusted odds ratios for both primary and secondary outcomes. Primary outcomes included the inpatient mortality rate and healthcare resource utilization (length of stay, total charges, and trends over the study period). Secondary outcomes focused on trends in associated comorbidities and malignancies in patients with PSC. Results: The average total charge increased by 32.2% ± 2.12 from USD 61,873 ± 2567 in 2008 to USD 91,262 ± 2961 in 2017. Concurrently, the average length of stay declined from 8.07 ± 0.18 days in 2008 to 7.27 ± 0.13 days in 2017. The APR-DRG severity of illness and risk of death significantly increased (major or extreme) during the study period (2008 to 2017), with severity rising from 73.6% to 82.7% (coefficient: 0.21, 95% CI: 0.13-0.28) and risk of death from 45.3% to 60.9% (coefficient: 0.15, 95% CI: 0.08-0.23). The proportion of patients with HCC increased from 1.3% to 7.9% (coefficient: 2.13, 95% CI: 1.9-2.8). Conversely, the percentage of patients with cholangiocarcinoma (CCA) decreased from 5.1% to 2.8% (coefficient: -0.36, 95% CI: -0.25 to -0.46). Conclusions: There was rising mortality and healthcare resource utilization among patients with PSC from the years 2008 to 2017. These trends were paralleled by increasing rates of decompensated cirrhosis, HCC, and liver transplants. However, the incidence of CCA decreased during this time period. African American patients with PSC had worse inpatient mortality outcomes and healthcare utilization as compared to white patients. Further studies are warranted to investigate a possible causal link amongst these trends.

Identification of Risk Factors for Myeloma Progression in African American Patients

Identification of Risk Factors for Myeloma Progression in African American Patients

Mass Spectrometry (MS)-Based Exent® Solution Reveals High Prevalence of Multiple M-Proteins in African American Patients with Multiple Myeloma (MM) and Precursor Conditions

Mass Spectrometry (MS)-Based Exent® Solution Reveals High Prevalence of Multiple M-Proteins in African American Patients with Multiple Myeloma (MM) and Precursor Conditions

Metformin Use and Risk of Non-Melanoma Skin Cancer: A Propensity-Matched Case-Control Study.

There is literature that suggests metformin may play a protective role against the development of non-melanoma skin cancers. Given the significant burden of disease non-melanoma skin cancers represent, the possibility of a widely available and generally well-tolerated medication such as metformin as part of the prevention and treatment ladder warrants further research. This study aims to evaluate the potential of metformin in reducing the risk of non-melanoma skin cancers, specifically squamous cell carcinoma and basal cell carcinoma, using the All of Us research database. A retrospective case-control analysis was conducted using the All of Us database. Propensity score matching and multivariable regression analyses were performed to evaluate the impact of metformin on the incidence of squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) while controlling for confounding variables. Our results indicate a reduced risk of non-melanoma skin cancer following exposure to metformin in individuals diagnosed with both SCC and BCC. Subgroup analyses revealed that metformin exposure was associated with a decreased risk of BCC across all sex and ethnicity groups. Metformin use was also associated with a significantly lower risk of SCC, with univariable and multivariable ORs consistently showing reduced odds. However, metformin exposure was not significantly associated with decreased SCC risk in African American patients. Our study's findings indicate a potential protective effect of metformin against skin cancer, particularly in patients with skin of color. Further prospective research is necessary to substantiate metformin's role in skin cancer chemoprevention within these populations.J Drugs Dermatol. 2024;23(12):1089-1095. doi:10.36849/JDD.8249.

Dupilumab reduces psychiatric and sleep disorder risk in atopic dermatitis: a population-based cohort study

BackgroundPatients with atopic dermatitis (AD) have a higher risk of developing psychiatric and sleep disorders. ObjectiveTo compare the risk of psychiatric and sleep disorders in AD patients treated with dupilumab versus those on conventional drugs (systemic corticosteroids, methotrexate, cyclosporin, azathioprine). MethodsThis retrospective cohort study used the TriNetX Global Collaborative Network and included adult AD patients newly prescribed dupilumab (DUPI-cohort) or conventional drugs without prior dupilumab exposure (CONV-cohort). Propensity score matching was performed for age, sex, race, comorbidities, and laboratory measures. Risks of various psychiatric disorders, such as anxiety, depressive disorders, adjustment disorders, and attention deficit hyperactivity disorder (ADHD), as well as sleep disorders, were compared between cohorts, with hazard ratios (HRs) determined using Cox regression. ResultsAfter matching, both the DUPI- and CONV-cohorts included 6,114 patients each, with an average age of 44 years and 53% female. The racial distribution in both cohorts was roughly 49% White, 15% Black or African American, and 12% Asian. During the 3-year follow-up, the DUPI-cohort had reduced risks of anxiety (HR 0.76, 95% CI 0.64-0.89), depressive disorders (0.70, 0.58-0.86), adjustment disorders (0.535, 0.37-0.78), and sleep disorders (0.78, 0.65-0.94), while the risk of ADHD was not significantly affected (0.92, 0.61-1.38). These findings were consistent across age groups, sexes, races, and atopic comorbidities, with a more pronounced effect in Black or African American patients. ConclusionAD patients prescribed dupilumab exhibited a lower risk of psychiatric and sleep disorders, with the effect being more evident within the Black or African American subgroup.

Nursing strategies to address health disparities in genomics-informed care: a scoping review.

The objective of this review was to map the available global evidence on strategies that nurses can use to facilitate genomics-informed health care to address health disparities to inform the development of a research and action agenda. The integration of genomics into health care is improving patient outcomes through better prevention, diagnostics, and treatment; however, scholars have noted concerns with widening health disparities. Nurses work across the health system and can address health disparities from a clinical, research, education, policy, and leadership perspective. To do this, a comprehensive understanding of existing genomics-informed strategies is required. Published (qualitative, quantitative, mixed methods studies, systematic and literature reviews and text and opinion papers) and unpublished (gray) literature that focuses on genomics-informed nursing strategies to address health disparities over the last 10 years were included. No limitations were placed on language. The review was conducted in accordance with the JBI methodology for scoping reviews. A search was undertaken on May 25, 2023, across 5 databases: MEDLINE (Ovid), Embase, Cochrane Library (Ovid), APA PsycINFO (EBSCOhost), and CINAHL (EBSCOhost). Gray literature was searched through websites, including the International Society of Nurses in Genetics and the Global Genomics Nursing Alliance. Abstracts, titles, and full texts were screened by 2 or more independent reviewers. Data were extracted using a data extraction tool. The coded data were analyzed by 2 or more independent reviewers using conventional content analysis and the summarized results are presented using descriptive statistics and evidence tables. In total, we screened 818 records and 31 were included in the review. The majority of papers were published in either 2019 (n=5, 16%), 2020 (n=5, 16%), or 2021 (n=5, 16%). Most papers came from the United States (n=25, 81%) followed by the Netherlands (n=3, 10%), United Kingdom (n=1, 3%), Tanzania (n=1, 3%) and written from a global perspective (n=1, 3%). Nearly half the papers discussed cancer-related conditions (n=14, 45%) and most of the others did not specify a disease or condition (n=12, 30%). In terms of population, nurse clinicians were mentioned the most frequently (n=16, 52%) followed by nurse researchers, scholars, or scientists (n=8, 26%). The patient population varied, with African American patients or communities (n=7, 23%) and racial or ethnic minorities (n=6, 19%) discussed most frequently. The majority of equity issues focused on inequitable access to genetic and genomics health services amongst ethnic and racial groups (n=14, 45%), individuals with lower educational attainment or health literacy (n=6, 19%), individuals with lower socioeconomic status (n=3, 10%), migrants (n=3, 10%), individuals with lack of insurance coverage (n=2, 6%), individuals living in rural or remote areas (n=1, 3%) individuals of older age (n=1, 3%). Root causes contributing to health disparity issues varied at the patient, provider, and system levels. Strategies were grouped into 2 categories: those to prepare the nursing workforce and those nurses can implement in practice. We further categorized the strategies by domains of practice, including clinical practice, education, research, policy advocacy, and leadership. Papers that mentioned strategies focused on preparing the nursing workforce were largely related to the education domain (n=16, 52%), while papers that mentioned strategies that nurses can implement were mostly related to clinical practice (n=19, 61%). Nurses in all domains of practice can draw on the identified strategies to address health disparities related to genomics in health care. We found a notable lack of intervention and evaluation studies exploring the impact on health and equity outcomes. Additional research informed by implementation science and that measures health outcomes is needed to identify best practices. A French-language version of the abstract of this review is available as Supplemental Digital Content [ http://links.lww.com/SRX/A65 ].