Blacks Research Articles

The Safety of Outpatient Health Care : Review of Electronic Health Records.

Despite considerable emphasis on delivering safe care, substantial patient harm occurs. Although most care occurs in the outpatient setting, knowledge of outpatient adverse events (AEs) remains limited. To measure AEs in the outpatient setting. Retrospective review of the electronic health record (EHR). 11 outpatient sites in Massachusetts in 2018. 3103 patients who received outpatient care. Using a trigger method, nurse reviewers identified possible AEs and physicians adjudicated them, ranked severity, and assessed preventability. Generalized estimating equations were used to assess the association of having at least 1 AE with age, sex, race, and primary insurance. Variation in AE rates was analyzed across sites. The 3103 patients (mean age, 52 years) were more often female (59.8%), White (75.1%), English speakers (90.8%), and privately insured (70.4%) and had a mean of 4 outpatient encounters in 2018. Overall, 7.0% (95% CI, 4.6% to 9.3%) of patients had at least 1 AE (8.6 events per 100 patients annually). Adverse drug events were the most common AE (63.8%), followed by health care-associated infections (14.8%) and surgical or procedural events (14.2%). Severity was serious in 17.4% of AEs, life-threatening in 2.1%, and never fatal. Overall, 23.2% of AEs were preventable. Having at least 1 AE was less often associated with ages 18 to 44 years than with ages 65 to 84 years (standardized risk difference, -0.05 [CI, -0.09 to -0.02]) and more often associated with Black race than with Asian race (standardized risk difference, 0.09 [CI, 0.01 to 0.17]). Across study sites, 1.8% to 23.6% of patients had at least 1 AE and clinical category of AEs varied substantially. Retrospective EHR review may miss AEs. Outpatient harm was relatively common and often serious. Adverse drug events were most frequent. Rates were higher among older adults. Interventions to curtail outpatient harm are urgently needed. Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions.

HIV Screening Among Young Black Men Who Have Sex with Women in New Orleans, LA.

There are significant disparities in HIV acquisition, with Black individuals facing disproportionately more new diagnoses. Per Centers for Disease Control and Prevention (CDC), all people aged 13-64 should be tested at least once in their lifetime, and men at increased risk (e.g., those who have male sexual contact, multiple partners, have partners with multiple partners, or share drug injection equipment) should be tested annually. The study included young Black men who have sex with women (MSW), aged 15-26, and who live in New Orleans, LA. Survey data was used to elicit the frequency and factors associated with three self-reported outcomes: (1) history of ever HIV testing, (2) HIV screening in the last year among those who were recommended per CDC, and (3) HIV positivity. Of the 1321 men included, 694/1321 men (52.5%) reported ever having been HIV tested. There were 708/1321 (54.2%) men who met the recommendation for annual screening and 321/708 (45.3%) of these eligible men reported being tested in the previous year. Of those ever tested, 44/694 (6.3%) self-reported testing positive. In logistic regression analysis, older age (OR: 1.27, p < 0.001), prior STI testing (OR: 6.45, p < 0.001), and prior incarceration (OR:1.70, p = 0.006) were positively associated with having ever received an HIV test, and ever having a male partner (OR: 3.63, p = 0.014) was associated with HIV positivity. Initiatives to improve HIV testing rates among young Black men who have sex with women are needed to reduce the burden of HIV and help the End the Epidemic initiative.

Exploring ethnic differences in the distribution of blood test results in healthy adult populations to inform earlier cancer detection: a systematic review.

In primary care, health professionals use blood tests to investigate nonspecific presentations to inform referral decisions. Reference ranges for the commonly used blood tests in western countries were developed in predominately White populations, and so may perform differently when applied to non-White populations. Knowledge of ethnic variation in blood test results in healthy/general populations could help address ethnic inequalities in cancer referral for diagnosis and outcomes. This systematic review explored evidence of ethnic differences in the distribution of selected blood test results among healthy/general populations to inform future research aimed at addressing inequalities in cancer diagnosis. We searched PubMed and EMBASE to identify studies reporting measures of haemoglobin, MCV, calcium, albumin, platelet count, and CRP in nondiseased adults from at least 2 different ethnic groups. Two reviewers independently screened studies, completed data extraction and quality assessment using an adapted Newcastle-Ottawa scale. Participants were stratified into White, Black, Asian, Mixed, and Other groups. Data were synthesised narratively and meta-analyses were conducted where possible. A total of 47 papers were included. Black men and women have lower average values of haemoglobin, MCV, and albumin, and higher average values of CRP relative to their White counterparts. Additionally, Black men have lower average haemoglobin than Asian men, whereas Asian women have lower average CRP values when compared with White women. There is evidence of ethnic differences in average values of haemoglobin, MCV, CRP, and albumin in healthy/general populations. Further research is needed to explore the reasons for these differences. Systematic review registration: CRD42021274580.

Acceptable dark skinned women and egotistical light skinned women: black women speak on colorism and colorist microaggressions within the black community on campus

ABSTRACT This study focuses on Black undergraduate women’s perspectives and experiences with colorism and colorist microaggressions in Black communities at a Historically Predominantly White University (HPWI). Previous studies demonstrate that Black undergraduate women’s experiences are shaped by their race and gender together. Our study highlights how their skin tone, colorism, and colorist microaggressions also shape their college experiences. Twenty-five Black undergraduate women were interviewed about their experiences with discrimination on campus. The perspectives on colorism from dark and light skinned Black women show that colorist ideals are present within the campus’ Black Community and impact Black student interactions. Colorist microaggressions experienced by light-skinned Black women were rooted in objectification and fetishization; whereas the colorist microaggressions endured by dark-skinned Black women were enmeshed in anti-Black constructions of darkness with masculinity and deviance. This study demonstrates the importance of centering skin tone when exploring and analyzing Black undergraduate women’s experiences with discrimination.

Racial and Ethnic Disparities in All-Cause and Cause-Specific Mortality Among US Youth.

Mortality rates in US youth have increased in recent years. An understanding of the role of racial and ethnic disparities in these increases is lacking. To compare all-cause and cause-specific mortality trends and rates among youth with Hispanic ethnicity and non-Hispanic American Indian or Alaska Native, Asian or Pacific Islander, Black, and White race. This cross-sectional study conducted temporal analysis (1999-2020) and comparison of aggregate mortality rates (2016-2020) for youth aged 1 to 19 years using US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database. Data were analyzed from June 30, 2023, to January 17, 2024. Pooled, all-cause, and cause-specific mortality rates per 100 000 youth (hereinafter, per 100 000) for leading underlying causes of death were compared. Injuries were classified by mechanism and intent. Between 1999 and 2020, there were 491 680 deaths among US youth, including 8894 (1.8%) American Indian or Alaska Native, 14 507 (3.0%) Asian or Pacific Islander, 110 154 (22.4%) Black, 89 251 (18.2%) Hispanic, and 267 452 (54.4%) White youth. Between 2016 and 2020, pooled all-cause mortality rates were 48.79 per 100 000 (95% CI, 46.58-51.00) in American Indian or Alaska Native youth, 15.25 per 100 000 (95% CI, 14.75-15.76) in Asian or Pacific Islander youth, 42.33 per 100 000 (95% CI, 41.81-42.86) in Black youth, 21.48 per 100 000 (95% CI, 21.19-21.77) in Hispanic youth, and 24.07 per 100 000 (95% CI, 23.86-24.28) in White youth. All-cause mortality ratios compared with White youth were 2.03 (95% CI, 1.93-2.12) among American Indian or Alaska Native youth, 0.63 (95% CI, 0.61-0.66) among Asian or Pacific Islander youth, 1.76 (95% CI, 1.73-1.79) among Black youth, and 0.89 (95% CI, 0.88-0.91) among Hispanic youth. From 2016 to 2020, the homicide rate in Black youth was 12.81 (95% CI, 12.52-13.10) per 100 000, which was 10.20 (95% CI, 9.75-10.66) times that of White youth. The suicide rate for American Indian or Alaska Native youth was 11.37 (95% CI, 10.30-12.43) per 100 000, which was 2.60 (95% CI, 2.35-2.86) times that of White youth. The firearm mortality rate for Black youth was 12.88 (95% CI, 12.59-13.17) per 100 000, which was 4.14 (95% CI, 4.00-4.28) times that of White youth. American Indian or Alaska Native youth had a firearm mortality rate of 6.67 (95% CI, 5.85-7.49) per 100 000, which was 2.14 (95% CI, 1.88- 2.43) times that of White youth. Black youth had an asthma mortality rate of 1.10 (95% CI, 1.01-1.18) per 100 000, which was 7.80 (95% CI, 6.78-8.99) times that of White youth. In this study, racial and ethnic disparities were observed for almost all leading causes of injury and disease that were associated with recent increases in youth mortality rates. Addressing the increasing disparities affecting American Indian or Alaska Native and Black youth will require efforts to prevent homicide and suicide, especially those events involving firearms.

Police killings of unarmed Black persons and suicides among Black youth in the US: A national time-series analysis.

Suicide deaths among Black youth in the US have increased rapidly over the past decade. Direct or vicarious racial trauma experienced through exposure to police brutality may underlie these concerning trends. We obtained nationally aggregated monthly counts of suicides for non-Hispanic Black and White youth (age ≤ 24 years) and adults (age > 24 years) from the National Mortality Vital Statistics restricted-use data files provided by the Centers for Disease Control and Prevention, from 2013 to 2019. Monthly counts of Black youth suicides constituted our main outcome. We defined our exposure as the monthly counts of police killings of unarmed Black persons over 84 months (2013 to 2019), retrieved from the Mapping Police Violence database. We used ARIMA (AutoRegressive Integrated Moving Average) time-series analyses to examine whether Black youth suicides increased within 0 to 3 months following police killings of unarmed Black persons, controlling for autocorrelation and corresponding series of White youth suicides. Suicides among Black youth increase by ~1 count three months following an increase in police killings of unarmed Black persons (exposure lag 0 coefficient = 0.16, p >0.05; exposure lag 1 coefficient = -0.70, p >0.05; exposure lag 2 coefficient = -0.54, p > 0.05; exposure lag 3 coefficient = 0.95, p< 0.05). The observed increase in suicides concentrates among Black male youth (exposure lag 3 coefficient = 0.88, p< 0.05).

Black Crip Superpowers

This article contains some language that readers may find offensive. Black people have never been human. White heteropatriarchal paradigms in the United States depend upon the abjection of blackness, excluding us from the realm of human identities. It is this exclusion that generates the problem of unintelligibility; this lack of grammar in turn renders black bodies invisible and more vulnerable to violence. The article attends to the black disabled body as a source of new grammars , short-circuiting the separation of blackness from other modes of difference. These new grammars, or what the article articulates as crip superpowers , theorize new ways of thinking, knowing, and being beyond abjection. By building on the labor of black feminist, crip/queer, and disability scholars, this intervention into disability studies analyzes how marginalized bodies engage with issues of erasure and disability within the black community. The article offers a transtemporal reading of Essex Hemphill’s Ceremonies (1992) and Danez Smith’s Don’t Call Us Dead (2017) to examine how black disabled subjects have developed these new grammars across time and space. Through this affective connection between the past and our contemporary moment, we can, as it were, go home ; we can imagine, that is, alternative worlds, where we can be whole and free.

Elite schools and slavery in the UK – capital, violence and extractivism

ABSTRACT Elite schools in the UK are bound to the history of British colonialism. This paper examines the material ties between these schools and the transatlantic slave trade. We combine multiple sources to examine which schools and their alumni accrued substantial economic capital derived from the enslavement of Black people. We find two principal connections: first, in donations and foundations of schools from those who made their fortune in the slave trade; and second, through income of boys attending these schools. Drawing on the Legacies of British Slavery dataset, we show that schools with alumni benefitting from the slave trade include the most prestigious British private schools. Moreover, this paper traces the histories of several secondary schools founded by, or in receipt of, substantial donations from slave-owning families. We argue that extractive, violent forms of colonial capital accumulation have been central to, the formation and maintenance of these elite educational institutions.

Exploring the Association Between Structural Racism and Mental Health: Geospatial and Machine Learning Analysis.

Structural racism produces mental health disparities. While studies have examined the impact of individual factors such as poverty and education, the collective contribution of these elements, as manifestations of structural racism, has been less explored. Milwaukee County, Wisconsin, with its racial and socioeconomic diversity, provides a unique context for this multifactorial investigation. This research aimed to delineate the association between structural racism and mental health disparities in Milwaukee County, using a combination of geospatial and deep learning techniques. We used secondary data sets where all data were aggregated and anonymized before being released by federal agencies. We compiled 217 georeferenced explanatory variables across domains, initially deliberately excluding race-based factors to focus on nonracial determinants. This approach was designed to reveal the underlying patterns of risk factors contributing to poor mental health, subsequently reintegrating race to assess the effects of racism quantitatively. The variable selection combined tree-based methods (random forest) and conventional techniques, supported by variance inflation factor and Pearson correlation analysis for multicollinearity mitigation. The geographically weighted random forest model was used to investigate spatial heterogeneity and dependence. Self-organizing maps, combined with K-means clustering, were used to analyze data from Milwaukee communities, focusing on quantifying the impact of structural racism on the prevalence of poor mental health. While 12 influential factors collectively accounted for 95.11% of the variability in mental health across communities, the top 6 factors-smoking, poverty, insufficient sleep, lack of health insurance, employment, and age-were particularly impactful. Predominantly, African American neighborhoods were disproportionately affected, which is 2.23 times more likely to encounter high-risk clusters for poor mental health. The findings demonstrate that structural racism shapes mental health disparities, with Black community members disproportionately impacted. The multifaceted methodological approach underscores the value of integrating geospatial analysis and deep learning to understand complex social determinants of mental health. These insights highlight the need for targeted interventions, addressing both individual and systemic factors to mitigate mental health disparities rooted in structural racism.

Intersectional Disadvantage

ABSTRACT When people simultaneously occupy multiple social identities, ascriptions of disadvantage and advantage, as well as our reasoning with them, need to be handled with care. For instance, as various US-American courts have come to acknowledge, we cannot in general reason from the premise that someone has neither been discriminated against as a woman nor as a Black person to the conclusion that they have not been discriminated against as a Black woman. In this article, I show how, by systematising such qualified ascriptions of disadvantage (and advantage), as well as the patterns of reasoning involving them, we can articulate and defend central theses of intersectionality theory in remarkably general terms, and without having to commit to a particular metaphysics of intersectional identity.

Widespread Misperceptions Among U.S. Adults About Tobacco Company Engagement in Black and African American Communities.

Menthol cigarettes and flavored cigars (MC/FC) bring profits to U.S. tobacco companies at the cost of Black/African American (B/AA) lives. This exploratory cross-sectional study describes perceptions of tobacco company engagement and activities in B/AA communities related to MC/FC. Among 2307 U.S. adults aged 18-45 surveyed in 2022, six items addressed beliefs about tobacco company funding of B/AA community organizations, payment of B/AA lobbyists to oppose public health policies, support of health equity efforts in B/AA communities, and targeted marketing of MC/FC in B/AA communities. Adjusted proportions were calculated for each belief overall and by race and cigarette smoking status. Among all adults, 37% believed that tobacco companies deny the harms of MC/FCs, 20% believed they pay Black lobbyists to oppose health policies, and 12% believed they fund Black community organizations. Compared with non-B/AA adults, a higher proportion of B/AA adults believed that tobacco companies target Black communities with MC/FC marketing (62% vs. 46%). More adult smokers (ie, menthol or non-MC) than nonsmokers thought that tobacco companies support health equity efforts and did not target Black communities with MC/FC marketing nor deny the harms of MC/FCs to B/AA communities. Few B/AAs and adult smokers believed that tobacco companies used B/AA organizations and lobbyists to oppose MC/FC policies in the B/AA community as well as reject MC/FC's harmfulness. Culturally tailored and community-engaged communication efforts are needed to correct disinformation about MC/FC tobacco companies' engagement and activities in B/AA communities among B/AA and menthol cigarette smokers. Tobacco companies have a history of predatory marketing that promotes flavored tobacco products to Black/African American (B/AA) individuals and more recently has spread disinformation to dissuade policy support for menthol cigarette/flavored cigar (MC/FC) bans. It is unclear what are the perceptions of tobacco company engagement and activities in B/AA communities related to MC/FC. Our study shows that B/AA adults and current cigarette smokers hold misperceptions about tobacco companies' role in spreading disinformation about MC/FC. This study identified beliefs about the industry's role in funding B/AA organizations and lobbyists who oppose policy, as well as the industry's denial of menthol cigarette and flavored cigar harms as potential messaging targets for communication efforts designed to correct disinformation about MC/FC policies among B/AA and those who currently smoke MC.

Abstract PO5-09-06: Outcomes of breast cancer in a minority-enriched population treated at a large safety-net system: Is site of care a predictor of poor outcomes?

Abstract Background: Breast cancer outcomes in the United States continue to improve, but sociodemographic disparities remain prevalent and impact care delivery and outcomes in vulnerable populations. Safety-net health systems are intended to address inequities by providing access to care for the uninsured/underinsured. Care delivery in a safety-net setting is often inherently complicated by limited resources at these institutions. Here, we present the overall survival (OS) data of breast cancer patients treated at a large safety-net system, compared to the national average. Methods: Parkland Health (PH) is the safety-net system for Dallas County and is affiliated with the University of Texas Southwestern Harold C. Simmons Comprehensive Cancer Center (NCI-CCC). Electronic medical records of patients diagnosed with invasive breast cancer between 2018 to 2020 at PH were reviewed and data on demographics, treatment, and outcomes were collected. Categorical data was summarized with counts and percentages and continuous data was summarized with median and interquartile range. Statistical comparisons used Chi-square test for categorical data and rank sum test for continuous data with a significance level of 0.05. Survival data was analyzed using Cox proportional hazard model. Data from the National Cancer Database (NCDB) for the same period was used for comparison. Results: Of the 657 patients included in the study, the majority (82.5%) belonged to racial and ethnic minorities (Hispanic 50.2%; Black 32.3%). Compared to the NCDB, PH patients were more often uninsured (67% vs 1.6%) or enrolled on Medicaid (14.5% vs 6.9%), and less often on Medicare (8.5% v. 43%) (p&amp;lt; 0.01). Triple negative breast cancer (TNBC) phenotype and late-stage diagnosis (stage III/IV) rates were higher at PH compared to NCDB (TNBC 22.8% vs 10.7%, p&amp;lt; 0.01; late stage 30.6% vs 13.2%, p&amp;lt; 0.01). At a median follow up of 33 (range 24-43) months in PH and 28 (range 21-36) months in NCDB, the unadjusted OS for the PH population was 86.3% vs 92.6% for the NCDB population (p &amp;lt; 0.01). Within the PH population, Black race, higher stage, and TNBC were associated with decreased OS. There was a significant interaction between Black race and TNBC. When combining all patients (PH+NCDB), site of care (PH) was associated with a higher risk of death from breast cancer (HR 1.467, 95% CI 1.192-1.805, p&amp;lt; 0.0005), however, multivariate analysis did not show a significant difference based on site of care. Factors associated with a significantly increased risk of death in this multivariate analysis (corrected for interaction between Black race and TNBC phenotype) included age, late-stage diagnosis, TNBC, Black race, and uninsured status (Table 1). Conclusions: Breast cancer patients treated at PH were more likely to have adverse disease characteristics compared to the NCDB population. When accounting for these risk factors in multivariate analysis, patients treated at PH had similar outcomes compared to the national average. Our findings reinforce the critical role of safety-net systems in promoting health equity and eliminating disparities. Table 1 Citation Format: Sarah Kashanian, Shifa Kanjwal, L. Steven Brown, Andrea Semlow, Mary Hodges, Robyn Cobb, Brad Walsh, Umber Dickerson, Navid Sadeghi. Outcomes of breast cancer in a minority-enriched population treated at a large safety-net system: Is site of care a predictor of poor outcomes? [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-09-06.

Abstract PO3-03-10: Race and neoadjuvant treatment of triple negative breast cancer (TNBC) in the US community oncology setting

Abstract Background: TNBC is an aggressive subtype of breast cancer with limited targeted therapies. Black women have twice the incidence of TNBC compared to White women and within TNBC, Black women have worse outcomes than White women. Differences in both tumor biology of TNBC and social determinants of health (SDOH) play a role in observed disparities. The focus of this study is to evaluate SDOH factors associated to differences in the use of neoadjuvant chemotherapy (NC) in Black and White women in the US community oncology setting. Methods: This study was a retrospective, observational, cross-sectional design and used iKnowMed SM EHR data from the The US Oncology Network. Patients diagnosed with TNBC between 03/31/2017 and 09/30/2021 with stages II-III disease of tumor size ≥ 2cm (T2 or higher) were included. The index date was date of TNBC diagnosis and records were assessed from 6 months pre- to 6 months post-diagnosis for NC initiation. Univariable and multivariable logistic regression was conducted to evaluate impact of self-reported race on NC. Age, stage, BMI, insurance, area deprivation index (ADI), size of practice represented by physician count and geographical region, were studied in their mediating and moderating effects1 on the relationship between race and NC treatment. Results: Of the 3321 patients with TNBC identified in this study, 1969 self-reported white and 494 self-reported black (80% and 20% respectively). In multivariable regression accounting for all variables, Black race (OR = 1.57, 95% CI [ 1.02, 2.44], p=0.04), younger age, more advanced stage, obesity, non-Medicaid insurance, and West region, were all found to be positively associated with use of NC. Higher physician count was nominally associated, (p = 0.07). ADI was not found to be associated to NC. Mediator and moderator analysis for the relationship between race and NC showed that only stage and ADI variable inclusion in the model are required for the positive association between black race and NC. This is driven by a significant interaction between ADI and stage (p = 0.027) which differed for Black and White women. Mainly, for Black women ADI is positively associated to NC treatment in stage IIA, but negatively associated in all other stages (interaction term, p = 0.033). For White women, ADI is negatively associated to NC treatment in all stages. Only Black women with stage IIA tend to be treated more instead of less with NC in areas of greater deprivation (greater ADI). BMI presents nominal interactions with both race and stage, where obesity was more strongly associated with NC treatment in Black women (p = 0.088) and in stage IIA (p = 0.086). All other variables presented association to NC treatment without mediation or moderation of the race effect and without detectable differences across stages. Conclusions: Black women with stage IIA appear to be a special subgroup of TNBC patients for whom treatment with NC increases with ADI. Increased ADI generally results in less standard of care treatment; this is observed in this study for White women overall and for Black women in stages &amp;gt; IIA. Black women in areas of greater deprivation with stage IIA disease, may be perceived to be presenting with more aggressive disease and thus offered NC preferentially. This result lends support to the hypothesis that young black women present with a distinct, more aggressive subtype of TNBC in the early stages. Mediator and moderator analyses are important tools in elucidating the relationships between factors underlying racial disparities in both care and outcomes. 1. Hayes AF, Rockwood NJ. Regression-based statistical mediation and moderation analysis in clinical research: Observations, recommendations, and implementation. Behav Res Ther. 2017 Nov;98:39-57. Odds ratios for multivariable analysis –insert figure image– Race, stage and ADI –insert figure image– Race and BMI in stage IIA –insert figure image– Citation Format: Paola Raska, Joseph Dye, Nicholas J Robert, Angel Kidd, Michael Danso. Race and neoadjuvant treatment of triple negative breast cancer (TNBC) in the US community oncology setting [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-03-10.

Abstract PO1-17-10: Impact of COVID19 on neoadjuvant endocrine therapy use in breast cancer: A National Cancer Database analysis

Abstract Background: Neoadjuvant endocrine therapy (NET) is associated with similar response rates as neoadjuvant chemotherapy in hormone receptor positive (HR+) breast cancer (BC), with less toxicity. While gene expression assays such as the 21-gene recurrence score (RS) have led to decreased chemotherapy use in early HR+/HER2- BC, NET is often underutilized. In 2020, the COVID19 pandemic led to disruption in oncologic care, including cancellation of surgeries. Guidelines for BC management during the pandemic recommended NET for HR+/HER2- BC patients unable to obtain surgery due to pandemic restrictions. We evaluated NET use in 2020, compared to NET use in prior years. Methods: Female pts with nonmetastatic HR+/HER2- BC diagnosed between 2016 and 2020 were identified from the 2004-2020 National Cancer Database (NCDB). Annual number of pts receiving NET, and duration of use, were compared between years, and characteristics of pts treated with and without NET were evaluated within and across years, using Chi-squared test for categorical variables and Wilcoxon rank-sum test or Kruskal-Wallis test for continuous variables. Results: 554,733 pts met inclusion criteria; 84.50% white, 9.19% Black, 4.06% Asian; 5.88% Hispanic. 25,553 (4.61%) pts received NET. Annual NET use increased slightly between 2016 and 2018 [3.25% vs 3.49% (p=0.021) vs 3.89% (p &amp;lt; 0.0001)], remained stable in 2019 (3.98%), and then increased to 8.67% in 2020 (p &amp;lt; 0.0001). Median duration of NET remained relatively stable between 2016 and 2019 [74 days (d), 68d, 73d and 61d, 2016-2019] but declined in 2020 (56d, p&amp;lt; 0.0001 for 2020 vs 2016, 2017, 2018, and 2019). Older age and greater comorbidities were associated with NET use in all years (p &amp;lt; 0.0001). No racial association with NET use was seen in 2016-2018, but Black race was associated with greater NET use in 2019 (p=0.0122) and 2020 (p &amp;lt; 0.0001). Lobular histology, moderate grade, larger tumor size, and node involvement were associated with increased NET use in all years (p &amp;lt; 0.0001). Progesterone receptor positivity (PR+) and lower Ki67 were associated with NET use in 2020 (p=0.0007 and p&amp;lt; 0.0001), but not prior. Median tumor size for pts receiving NET was smaller in 2020 (16mm) compared with prior years (22, 23, 22, and 21mm for 2016-2019, p&amp;lt; 0.0001). Annual RS use increased for all pts between 2016 (34.59%) and 2020 (43.47%). RS use in NET pts was stable in 2016 (27.79%) and 2017 (27.54%), with modest increase in 2018 (29.56%; p 0.094, 2016 vs 2018, p=0.045, 2017 vs 2018), and then increased annually in 2019 (33.28%, p=0.0001) and 2020 (40.64%, p&amp;lt; 0.0001). Median RS was higher in pts receiving NET than in pts who did not in 2016-2019 (p=0.0078, 0.0003, 0.0271, and &amp;lt; 0.0001), but was similar in 2020 (RS=16; IQR 11, 22). Conclusions: Frequency of NET administration more than doubled in 2020, but duration was shorter than in prior years, possibly due to use of NET as “bridging therapy” due to COVID19 restrictions. Black race was associated with receipt of NET in 2020, possibly reflecting disparate impact of COVID19 on Black communities. NET use in 2020 was also associated with smaller tumor size, lower Ki67, and greater likelihood of PR+ disease than in prior years. Use of RS to guide NET increased annually, beginning in 2018. Association of NET with older age, greater comorbidities, higher stage, moderate grade, and lobular histology were seen in all years. Citation Format: Della Makower, Jaeun Choi, Susan Fineberg. Impact of COVID19 on neoadjuvant endocrine therapy use in breast cancer: A National Cancer Database analysis [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-17-10.

"It's like we are seen as animals": The relationship between Black people's encounters with the police, metadehumanization, and perceptions of police legitimacy.

Across two studies, we explored the relationship between Black civilians' encounters with the police, their attitudes toward the police, perceptions of police legitimacy, and metadehumanization perceptions. We predicted the more negative Black individuals' encounters with the police, the more unfavorable their views of police would be (attitudes and perceived legitimacy) and the more likely they would believe police believe Black people are less than human. We further hypothesized that the relationships between Black Americans negative counters with the police and their views of the police would be mediated by metadehumanization. Black Americans (N = 522, Mage = 35.85) were either asked about the quality of their interactions with police (Study 1) or randomly assigned to write about a positive, negative, or neutral encounter with police (Study 2). They completed attitudes toward the police and police legitimacy and metadehumanization measures. Study 1 found the more negative Black individuals' encounters with the police were, the more negative their views were toward police and the more they believed police saw them as less than human. This relationship was partially mediated by metadehumanization. Study 2 demonstrated a causal relationship between negative police encounters and negative perceptions of the police; however, metadehumanization only partially mediated this relationship. Negative encounters with the police may have lasting negative implications on Black citizens' perceptions of legitimacy but more research is necessary regarding the role of metadehumanization perceptions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Abstract PO5-16-09: Associations of age, body mass index, diabetes and hypertension with relative dose intensity among women receiving anthracycline- and/or taxane-based chemotherapy for invasive breast cancer

Abstract Research suggests that medical comorbidity is associated with reduced relative dose intensity (RDI) in patients receiving chemotherapy for treatment of breast cancer. We aimed to determine factors associated with RDI of specific chemotherapy drugs in anthracycline- and/or taxane-based regimens. Women with a diagnosis of lymph node positive, invasive breast cancer who received neoadjuvant or adjuvant chemotherapy with either doxorubicin (DOX) + paclitaxel (PAC) or docetaxel (DOCE)-containing regimens at a single centerfrom2012 to2019 were included in this retrospective study. Age, race, comorbidities, height, weight, and chemotherapy regimen and dose were abstracted from the electronic health record. BMI was calculated using height and weight measured in clinic at the time initial chemotherapy orders were written and categorized according to US national guidelines (18.5 to &amp;lt; 25, 25 to &amp;lt; 30, and &amp;gt;30kg/m2). Presence of diabetes (DM) and hypertension (HTN) at time of diagnosis were determined by chart review. The oncologists’ initial chemotherapy orders (dose and duration) were used as the basis for RDI calculations. Cumulative actual dose received and duration of treatment were compared to planned dose and duration for individual chemotherapy drug and by regimen (DOX+PAC vs. DOCE). Associations between patient characteristics and RDI were evaluated in bivariate and multivariable analyses. A total of 230 women met the inclusion criteria, with 125 receiving a DOX+PAC regimen and 105 receiving a DOCE-based regimen. A higher percentage of women on DOX+PAC received &amp;gt;85% RDI compared to women receiving DOCE (80.8% vs 67.6%). Women aged 65+ years had lower median RDI [IQR] for DOCE than younger women (0.83 [0.67 - 0.98] vs 0.94 [0.84 - 1.00], p = 0.04), and a lower percentage in the older group received &amp;gt;85% RDI (35.3% vs 73.9%, p&amp;lt; 0.01). Median RDIs of PAC and DOX+PAC were lower for Black women than for White and Asian women (PAC: 0.91 [0.75 - 1.00] vs 1.00 [0.89 - 1.00], p = 0.02, DOX+PAC: 0.92[0.87-0.99] vs. 0.97 [0.91-1.00], p = 0.03), and the percent of Black women receiving &amp;gt;85% RDI of PAC was also lower (55.3% vs 77.6%, p = 0.01). BMI category was associated with median RDI for PAC (p= 0.03) and DOX+PAC (p = 0.01), with women in the &amp;gt;30kg/m2 category having the lowest median RDIs and PAC RDI &amp;gt;85% (p &amp;lt; 0.01). Median RDI of DOX+PAC was lower for women with DM (0.89 [0.84-0.92] vs. 0.96 [0.88-1:00], p = 0.03), and a lower percentage of women with DM received DOX RDI &amp;gt;85% compared to women without DM (66.7% vs 91.6%, p &amp;lt; 0.01). Median RDI was lower among women with HTN compared to women without for PAC (0.85 [0.73 - 1.00] vs 0.98 [0.83 - 1.00], p = 0.01) and DOX+PAC (0.91 [0.84 - 0.97] vs 0.97 [0.90 - 1.00], p = 0.01), and a lower percentage of women with HTN received &amp;gt;85% RDI for PAC (50.0% vs 73.3%, p = 0.01). Multiple logistic regression models adjusted for age (continuous), race, BMI (continuous), DM, and HTN had modestly improved predictive value compared to null models (McFadden’s R2 = 0.10 to 0.19); each year of increased age was associated with lower odds of RDI &amp;gt; 85% for DOX (OR [95% confidence interval] 0.91 [0.84-0.97], p = &amp;lt; 0.01), DOX+PAC (0.95 [0.90-0.99], p = 0.02), and DOCE (0.93 [0.88-0.97], p &amp;lt; 0.01), and DM with lower odds for DOX (0.26 [0.07-0.95], p = 0.04). Our findings of associations between increasing age, Black race, BMI, DM, and HTN and reduced RDI are consistent with prior research and present new data regarding associations between medical comorbidities and individual components of chemotherapy regimens. Citation Format: Heather Wopat, Annette Aldous, Adam Ciarleglio, Kendall Anderson, Kim Robien. Associations of age, body mass index, diabetes and hypertension with relative dose intensity among women receiving anthracycline- and/or taxane-based chemotherapy for invasive breast cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-16-09.

Abstract PO3-10-04: Palliative Care, Healthcare Utilization, and Disparities in Deceased Breast Cancer Patients in U.S. Hospitals: Analysis of National Inpatient Sample

Abstract Objective: This study aims to explore the characteristics of receiving palliative care and the patterns of utilization among breast cancer patients using a large-scale representative population-based sample. Methods: A retrospective analysis was performed on hospitalization data obtained from the National Inpatient Sample (NIS) covering the period from January 2016 to December 2019. The objective of the study was to investigate the characteristics and disparities associated with the provision of palliative care to breast cancer patients who had passed away, and to evaluate its impact on healthcare utilization as indicated by discounted hospital charges and length of stay (LOS). To achieve this, multivariate linear and logistic regression analyses were conducted, with the data stratified according to age, race, Charlson comorbidity index, insurance status, patient's zip code, and hospital characteristics. The classification and identification of the study population were performed using ICD-10 codes. Results: In the study, a total of 6,325 deceased breast cancer patients were identified from hospitalization records. Among them, 59.16% (n=3,742) received palliative care during their hospital stay. Multivariate linear regression analysis revealed that patients who received palliative care experienced a significant reduction in LOS by an average of 0.67 days (-1.246 to -0.898, p = 0.02) compared to those who did not receive palliative care. Furthermore, the palliative care group exhibited lower total charges, with a mean decrease of $21,392 (-28205 to -14578, p=0.00) compared to the non-palliative care group. Multivariate logistic regression analysis indicated that patients with black race had lower odds of receiving palliative care, while those with higher household income and patients admitted to larger hospitals had higher odds of receiving palliative care. Additionally, patients with private insurance had a higher probability of receiving palliative care compared to other insurance groups. Conclusion: Palliative care has demonstrated its benefits in reducing healthcare utilization costs and length of stay for breast cancer patients. However, disparities exist in access to palliative care, particularly among Black patients and those with lower household income. Larger hospitals and patients with private insurance show higher rates of palliative care utilization. Addressing these disparities is crucial to ensure equitable access, optimize patient outcomes, and improve resource allocation. Integrating palliative care into breast cancer hospitalizations requires targeted interventions. Further research and implementation efforts are needed to enhance the availability and delivery of palliative care services for all patients, regardless of their demographics or socioeconomic backgrounds. Health policymakers should consider these findings in their resource allocation decisions as palliative care plays an increasingly important role in cancer treatment. Odds of Receiving Palliative care among deceased breast cancer patients XX XX Length Of Stay and Total Charges XX XX Citation Format: Rushin Patel, Zalak Patel, Mrunal Patel, Darshil Patel, Afoma Onyechi, Akshit Chitkara, Femina Patel. Palliative Care, Healthcare Utilization, and Disparities in Deceased Breast Cancer Patients in U.S. Hospitals: Analysis of National Inpatient Sample [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-10-04.

Abstract PO5-26-12: Optimizing Treatment Decisions in Microinvasive Ductal Carcinoma in Situ: Evaluating the Need for Surgical Axillary Staging

Abstract Background: Surgical axillary staging is often debated in patients with microinvasive ductal carcinoma in situ (T1mi) due to the low occurrence of nodal metastasis. Axillary surgery (ASx) is associated with risks like seroma, wound complications, lymphedema, and sensory deficits. This study aims to assess the utility of surgical axillary staging in clinically node-negative (cN0) T1mi breast cancer patients and provide insights for optimizing high value surgical treatment and subsequent decision-making. Methods: This retrospective cohort study analyzed data from the National Cancer Database (NCDB) to investigate axillary status of patients with cT1mi breast cancer between 2012 and 2019. Patient demographics, clinical characteristics, treatment methods and pathologic findings were collected. Comparisons were made between those who did and did not undergo ASx, and of those who did, between patients who were pathologically node-positive (pN+) vs. node-negative (pN-). Results: Of 10,843 patients analyzed, 9,220 (85.0%) underwent ASx while 1,623 (15.0%) did not. Mean age of patients undergoing ASx and those who did not was 59.2±11.2 and 66.3±12.8 years, respectively (p&amp;lt; 0.001). On univariate analysis, other factors associated with undergoing ASx were having private insurance, fewer medical comorbidities, having a HER2+ or triple negative phenotype, higher grade, presence of lymphovascular invasion and undergoing mastectomy (all p&amp;lt; 0.05). Sentinel lymphadenectomy was performed in 83% of patients while axillary lymph node dissection (ALND) was performed in 17% of patients. Final pathology demonstrated an upgrade to a true invasive cancer (T1 or greater) in 29.3% of cases. Of 9,069 patients who underwent ASx with known pathologic nodal status, 8,512 (93.9%) were pN- and 557 (6.1%) were pN+. Factors independently associated with increased odds of having positive nodes were younger age (OR 1.02, 95% CI 1.01-1.03, p&amp;lt; 0.001), Black race (OR 1.51, 95% CI 1.12-2.10, p=0.007), lymphovascular invasion (OR 13.72, 95% CI 10.25-18.36, p&amp;lt; 0.001), and undergoing mastectomy (OR 1.98, 95% CI 1.57-2.51, p&amp;lt; 0.001). Among the pN+ patients, only 64 (0.7%) had ≥3 total positive nodes and would require ALND. On subset analysis of the 4,190 patients undergoing mastectomy, 244 (5.8%) did not undergo ASx, while 3,946 (94.2%) did, of whom 373 (9%) were pN+. Regarding adjuvant treatments in this group, more patients who underwent ASx received chemotherapy (12% v. 8%, p&amp;lt; 0.001), and among those who did undergo surgery those who were pN+ were much more likely to receive chemotherapy (58% v. 12%, p&amp;lt; 0.001). However, similar proportions of patients who did and did not undergo ASx received adjuvant radiation (5% v. 4%, p=0.65), while, as expected, among those undergoing ASx, a higher proportion who were pN+ underwent radiation (32% v. 5%, p&amp;lt; 0.001). Conclusion: Surgical axillary staging for T1mi breast cancer is common, but many patients are node-negative. More patients are undergoing ALND than necessary based on pathology. Nodal status influences adjuvant therapy decisions. Identifying factors linked to upgrade and higher pN+ probabilities can enable personalized surgical treatments, reducing morbidity for most patients. Citation Format: Christian Lava, Karen Li, Lauren Berger, Daisy Spoer, Lindy Rosal, Austin Williams, Monika Masanam, Ian Greenwalt, Jennifer Son, Lucy De La Cruz. Optimizing Treatment Decisions in Microinvasive Ductal Carcinoma in Situ: Evaluating the Need for Surgical Axillary Staging [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-26-12.

Abstract PO5-16-02: Investigating survivin as a novel target for immunotherapy in diverse breast cancer patients

Abstract Background: The BIRC5 gene encodes survivin, a tumor-specific antigen associated with aggressive tumor features, Black race and poor prognosis in breast cancer (BC). Recent studies have shown that anti-survivin vaccines stimulate a strong anti-tumor immune response in multiple tumor types. However, the relationship between BIRC5/survivin and immune response in BC is poorly understood, particularly among diverse patients. In this analysis, we sought to investigate the relationship between BIRC5/survivin and the BC immune microenvironment across clinical tumor features and RNA-based risk scores for genomic instability. Methods: We leveraged the Carolina Breast Cancer Study (CBCS), a large population-based study that oversampled young (≤50 years) and Black women with invasive BC. NanoString mRNA expression profiling was used to evaluate breast tumor expression for 10 major immune cell types, adaptive and innate immune response, TP53 and homologous recombination deficiency (HRD) pathways, and BIRC5/survivin from 1952 BC patients, including 1,030 (53%) Black and 922 (47%) non-Black women from the CBCS, with additional comparison in The Cancer genome Atlas (TCGA) (n=1,095 breast tumors). BIRC5 was evaluated both as a continuous and categorical variable, using the third expression quartile as a cut point for BIRC5-high, with the lower three quartiles categorized as BIRC5-low. We used generalized linear models to estimate beta values and adjusted p-values as the measure of association between BIRC5 status and immune-related expression in strata defined by estrogen receptor (ER) status, tumor stage, TP53 and HRD status. All analyses were adjusted for multiple comparisons with the Benjamini-Hochberg procedure. Results: In an analysis of continuous BIRC5 expression and global classes of immune response, BIRC5 mRNA expression was highest among tumors with an adaptive-enriched immune class (p&amp;lt; 0.001) in both CBCS and TCGA. However, when investigating immune gene expression according to BIRC5 status (i.e., BIRC5-high relative to BIRC5-low), multivariate differential expression analysis revealed significantly decreased immune cell-related expression scores among BIRC5-high tumors relative to BIRC5-low, and this relationship persisted in analysis stratified on stage (I/II vs III/IV), ER status, TP53 and HRD status. Across all strata, the strongest relationship between BIRC5-high and the immune microenvironment was observed for adaptive immune response (Beta: -0.14; p=0.005), with decreased immune gene expression related to B cells (Beta: -0.16; p=0.01), T cells (Beta: -0.14; p=0.007), Cytotoxic cells (Beta: -0.14; p=0.005), and PD-L1 (Beta: -0.15; p=0.005), relative to BIRC5-low. Conclusion: High BIRC5/survivin expression is associated with decreased immune-related gene expression in both ER-positive and ER-negative disease, and across all tumor stages. Anti-survivin therapies may be beneficial for boosting immune response in breast tumors with low immunogenicity, offering promise for BC subtypes previously ineligible for immunotherapy. Citation Format: Alina Hamilton, Qichen Wang, Sarah Soppe, Melissa Troester, Yara Abdou. Investigating survivin as a novel target for immunotherapy in diverse breast cancer patients [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-16-02.

Resources

AbstractIn this conclusion, we provide resources that offer implications for practice for Black men in college navigating mental health. This includes resources from community‐based organizations, professional associations, and other support outlets that support the needs of Black men in college. These resources will be useful to graduate students, faculty, and institutional leaders seeking information on how to aid the needs of Black men in college contending with mental health challenges.