Differences In Testing Rates Research Articles

Evaluating reflexive NGS and testing rates in community oncology.

e23302 Background: In oncology, NGS allows for the identification of DNA sequence variations within a cancer. The goal of testing is to identify/define therapeutic targets & improve patient outcomes, employing specific therapies directed at those targets. In breast cancer, reflex tumor testing (ER/PR/Her2neu) has been performed for > 20 yrs. In CRC, as published by ASCO, guideline-adherent biomarker testing rates for RAS, BRAF, & MSI/MMR-d were 41%, 43%, and 51%, respectively1. In lung cancer, recent data has shown overall testing rates minimally better at 58%2. Methods: The study was conducted on historical data of lung, colorectal, and breast cancer patients seen in Verdi community oncology clinics between 4/1/2022-7/31/2023. Clinical & social health data were collected & abstracted from patient medical history (Doctor’s notes, Pathology studies, NGS results). The database contains demographic & clinical data features for each patient. Results: 153 lung cancer patients were identified, median age 71(44 – 96). 82 F, 71 M. 85% of patients were smokers (130 smokers, 22 non-smokers, 1 unknown). Self-identified race: Asian 1, Black 22, white 106, 24 patients declined to identify. 61.9% (65) of later stage (≥IIB) patients had NGS testing. Of 258 colon/rectal cancer patients (anal cancer was excluded), median age 67(29-96), 122 M,146 F. Self-identified race: Asian 3, Black 26, 181 white, 34 patients declined to identify, 14 were unknown. Overall, 34.5% (89) of patients had NGS testing, and 76.2% (34) of Stage IV patients. There were 511 breast cancer patients, median age 63(25-85), 506 F, 5 M. Self-identified race: Asian/HPI 2, Black 137, white 299, 56 patients declined to identify, 17 were unknown. 100% had NGS, with minimum testing of ER/PR/Her2neu status. In the lung & colorectal patients, statistically significant differences in rates of testing were seen in males (p < 0.0001), older age (p < 0.0001), and non-whites (p = 0.002). Conclusions: Testing at Verdi clinics were higher than reported testing. We propose that to improve testing rates, NGS should be reflexively ordered in other tumor types, as is the standard of care in breast cancer. This would eliminate many issues, including waiting time patients must undergo when testing is not ordered until the patient is seen by the medical oncologist. Proactive testing allows potential targeted treatments to be delivered in real-time and thus improve patient outcomes. 1Genomic Profiling for KRAS, NRAS, BRAF, Microsatellite Instability, and Mismatch Repair Deficiency Among Patients With Metastatic Colon Cancer. JCO Precision Oncology (2019)3(3). 2Improving biomarker testing in advanced non-small cell lung cancer and metastatic colorectal cancer: experience from a large community oncology network in the USA. Future Oncology (2023)19(20),1397-1414.

Practice- and provider-level inequities in next-generation sequencing (NGS) testing by race/ethnicity for patients (pts) with advanced non-small cell lung cancer (aNSCLC) treated in the community setting.

6508 Background: Inequities in NGS testing in pts with aNSCLC are well documented. Here, we examined elements of total inequity in NGS testing for pts with aNSCLC treated in the US community setting, in terms of within and between inequities at the practice and provider level. Methods: Using the nationwide, deidentified, electronic health record–derived Flatiron Health database, we studied pts with aNSCLC diagnosed in April 2018 or later and treated in the community setting. Testing quality was defined as an NGS result reported ≤60 days after advanced diagnosis. Total-practice inequity was the average percentage-point (pp) difference in the rate of testing quality for non-Latinx Black or Latinx pts compared with non-Latinx white pts. Within-practice inequity was the average pp difference in testing rates at a practice weighted by overall practice enrollment. Between-practice inequity was the covariance between a practice's overall testing rate and the extent of practice-level racial/ethnic underrepresentation. We estimated these inequities at the practice and provider levels using a Bayesian approach. Results: Our study included a total of 12,045 pts (9,981 non-Latinx white, 1,528 non-Latinx Black, and 536 Latinx pts). Both within- and between-practice inequities contributed to total inequity in NGS testing for non-Latinx Black and Latinx pts compared with non-Latinx white pts (Table). For non-Latinx Black pts, between-practice inequities were estimated as 57% (3.77 pp/6.56 pp) of the total inequity in NGS testing; for Latinx pts, the contribution of between-practice inequity was 39% (3.13 pp/8.01 pp). At the provider level, between-provider inequities were the dominant contributor to total inequity in NGS testing for both non-Latinx Black and Latinx pts, accounting for 86% (5.88 pp/6.87 pp) of total provider-level inequity for non-Latinx Black pts and 64% (5.36 pp/8.43 pp) for Latinx pts. Conclusions: Inequities within and between practices, as well as between providers, are meaningful contributors to total inequity in NGS testing. Additional healthcare equity initiatives are needed to identify potential causes for lagging practices/providers to address inequities in NGS testing. [Table: see text]

Did the UK's public health shielding policy protect the clinically extremely vulnerable during the COVID-19 pandemic in Wales? Results of EVITE Immunity, a linked data retrospective study

IntroductionThe UK shielding policy intended to protect people at the highest risk of harm from COVID-19 infection. We aimed to describe intervention effects in Wales at 1 year. MethodsRetrospective comparison of linked demographic and clinical data for cohorts comprising people identified for shielding from 23 March to 21 May 2020; and the rest of the population. Health records were extracted with event dates between 23 March 2020 and 22 March 2021 for the comparator cohort and from the date of inclusion until 1 year later for the shielded cohort. ResultsThe shielded cohort included 117,415 people, with 3,086,385 in the comparator cohort. The largest clinical categories in the shielded cohort were severe respiratory condition (35.5%), immunosuppressive therapy (25.9%) and cancer (18.6%). People in the shielded cohort were more likely to be female, aged ≥50 years, living in relatively deprived areas, care home residents and frail. The proportion of people tested for COVID-19 was higher in the shielded cohort (odds ratio [OR] 1.616; 95% confidence interval [CI] 1.597–1.637), with lower positivity rate incident rate ratios 0.716 (95% CI 0.697–0.736). The known infection rate was higher in the shielded cohort (5.9% vs 5.7%). People in the shielded cohort were more likely to die (OR 3.683; 95% CI: 3.583–3.786), have a critical care admission (OR 3.339; 95% CI: 3.111–3.583), hospital emergency admission (OR 2.883; 95% CI: 2.837–2.930), emergency department attendance (OR 1.893; 95% CI: 1.867–1.919) and common mental disorder (OR 1.762; 95% CI: 1.735–1.789). ConclusionDeaths and healthcare utilisation were higher amongst shielded people than the general population, as would be expected in the sicker population. Differences in testing rates, deprivation and pre-existing health are potential confounders; however, lack of clear impact on infection rates raises questions about the success of shielding and indicates that further research is required to fully evaluate this national policy intervention.

Uptake in genetic testing in patients with pancreatic cancer with oncologist-driven testing protocol.

33 Background: The objective was to compare the uptake of genetic testing in patients with pancreatic adenocarcinoma (PDAC) seen at a single center (1) before the 2019 NCCN recommendation of universal screening for genetic mutations in all new PDAC diagnoses, (2) after this change in guideline, and (3) after transitioning to an oncologist-driven genetic testing protocol. Methods: A retrospective review of patient records seen for a new PDAC diagnosis at BIDMC between May 2018-May 2022 was performed. Patients were categorized into three groups by date of visit: pre-guideline change (5/2018-4/2019), post-guideline change (5/2019-12/ 2020), and after implementation of an oncologist-driven testing protocol (12/ 2020-5/2022). The primary outcome was the differences in rates of testing between each time period. Results: An increase in rates of genetic testing occurred between each successive time period. Pre-guideline change, 22% of patients had testing sent, and this increased to 32% post-guideline. With the oncologist-driven testing, this increased to 73%. There was an increase in referrals for genetic testing from the pre- to post-guideline change time periods (42% to 61%). However, in both groups, the number of patients who completed testing was approximately half of those who were referred (23% and 34%, respectively). Conclusions: Our cancer center moved to oncologist-driven testing to increase uptake in the wake of a guideline change recommending universal testing of all PDAC patients. By this protocol, germ-line testing is sent by the medical oncologist at the initial multidisciplinary clinic visit, rather than following a consultation with our genetic counseling team. With this change, there was a dramatic increase in genetic testing (32% to 73%), thereby capturing approximately 10 additional patients with actionable pathogenic variants. However, this change necessitated additional resources in the multidisciplinary clinic and time from the oncologist to consent for testing. In addition, the expertise of cancer genetics counselors was not provided to all patients. We attempted to address the latter via selective referral after positive results. Despite these trade-offs, oncologist-driven testing successfully met the goal of increasing our adherence with guideline-based genetic testing of all PDAC patients.[Table: see text]

An Intervention to Improve Chlamydia and Gonorrhea Testing Among Adolescents in Primary Care.

Rates of chlamydia and gonorrhea among adolescents continue to rise. We aimed to evaluate if a universal testing program for chlamydia and gonorrhea improved testing rates in an urban general pediatric clinic and an urban family medicine clinic within a system of federally qualified health care centers and evaluated the feasibility, cost, and logistic challenges of expanding implementation across 28 primary care clinics within a federally qualified health care centers system. A universal testing quality improvement program for male and female patient 14 to 18 years old was implemented in a general pediatrics and family medicine clinic in Denver, Colorado. The intervention was evaluated by using a controlled pre-post quasi-experimental design. The difference in testing rates due to the intervention was assessed by using a difference-in-differences regression model weighted with the inverse probability of treatment. In total, 15 541 pediatric encounters and 5420 family medicine encounters were included in the analyses. In pediatrics, the unadjusted testing rates increased from 32.0% to 66.7% in the intervention group and from 20.9% to 28.9% in the comparison group. For family medicine, the rates increased from 38.5% to 49.9% in the intervention group and decreased from 26.3% to 24.8% in the comparison group. The intervention resulted in an adjusted increase in screening rates of 25.2% (P < .01) in pediatrics and 11.8% (P < .01) in family medicine. The intervention was well received and cost neutral to the clinic. Universal testing for chlamydia and gonorrhea in primary care pediatrics and family medicine is a feasible approach to improving testing rates .

Geographic and demographic heterogeneity of SARS-CoV-2 diagnostic testing in Illinois, USA, March to December 2020

BackgroundAvailability of SARS-CoV-2 testing in the United States (U.S.) has fluctuated through the course of the COVID-19 pandemic, including in the U.S. state of Illinois. Despite substantial ramp-up in test volume, access to SARS-CoV-2 testing remains limited, heterogeneous, and insufficient to control spread.MethodsWe compared SARS-CoV-2 testing rates across geographic regions, over time, and by demographic characteristics (i.e., age and racial/ethnic groups) in Illinois during March through December 2020. We compared age-matched case fatality ratios and infection fatality ratios through time to estimate the fraction of SARS-CoV-2 infections that have been detected through diagnostic testing.ResultsBy the end of 2020, initial geographic differences in testing rates had closed substantially. Case fatality ratios were higher in non-Hispanic Black and Hispanic/Latino populations in Illinois relative to non-Hispanic White populations, suggesting that tests were insufficient to accurately capture the true burden of COVID-19 disease in the minority populations during the initial epidemic wave. While testing disparities decreased during 2020, Hispanic/Latino populations consistently remained the least tested at 1.87 tests per 1000 population per day compared with 2.58 and 2.87 for non-Hispanic Black and non-Hispanic White populations, respectively, at the end of 2020. Despite a large expansion in testing since the beginning of the first wave of the epidemic, we estimated that over half (50–80%) of all SARS-CoV-2 infections were not detected by diagnostic testing and continued to evade surveillance.ConclusionsSystematic methods for identifying relatively under-tested geographic regions and demographic groups may enable policymakers to regularly monitor and evaluate the shifting landscape of diagnostic testing, allowing officials to prioritize allocation of testing resources to reduce disparities in COVID-19 burden and eventually reduce SARS-CoV-2 transmission.

Investigating tumor molecular profiling as a possible contributor to racial/ethnic disparities in pancreatic cancer.

6522 Background: A variety of biologic, socioeconomic, and treatment-related factors may contribute to the racial/ethnic disparities observed in pancreatic ductal adenocarcinoma (PDAC) outcomes. As tumor molecular profiling (TMP) is now recommended for patients (pts) with advanced PDAC to inform treatment selection, we hypothesized that rates of TMP, detection of actionable alterations (AA), and use of molecularly-targeted treatments differ across different racial/ethnic groups and may contribute to disparate outcomes. Methods: This retrospective analysis included all Non-Hispanic White (NWH), Asian, Hispanic/Latinx (H/L), and Black/African American (B/AfrAm) pts with PDAC who underwent TMP at UCSF over a 4-yr period. Medical records were reviewed for demographic and disease-specific data. Alterations classified as ‘pathogenic’ or ‘likely pathogenic’ in TMP clinical reports were included, and were categorized as ‘actionable’ if there was clinical or preclinical evidence of benefit from targeted therapy in any cancer. Associations between NHW and other groups were tested with Fishers exact test. Results: Between 1/2016-1/2020, 159/727 (22%) pts underwent PDAC TMP. 60 AA were detected in 54 pts. Rates of TMP or AA detection were not associated with racial/ethnic group (Table). Most AA (33/60, 55%) were associated with the Homologous Recombination DNA Damage Repair (HR-DDR) pathway ( ARID1A n = 15 , ATM n = 7 , and BRCA1 n = 5). Other common AA included PIK3CA alterations (n = 6), CDK4/6 amplifications (n = 5), AKT2 amplifications (n = 4) and KRAS G12C mutation (n = 4). Molecular targets differed between groups (HR-DDR genes comprised 55% AA in NHW vs 100% in H/L, p = 0.03). Regarding treatment, rates of platinum chemotherapy for HR-DDR gene-altered PDAC differed significantly between groups. Three NHW pts with HR-DDR alterations received a PARP-inhibitor +/- ATR inhibitor. Conclusions: To our knowledge, this is the first study to report PDAC TMP rates and therapeutic implications across racial/ethnic groups. Acknowledging the limitations of sample size and what defines AA, we observed no significant differences in rates of testing nor AA detection. Further study is needed to evaluate whether rates of molecularly-informed treatment selection contribute to racial/ethnic disparities in clinical outcomes. As therapeutic advances increase the likelihood of identifying AA, equitable access to both TMP and targeted treatments must be ensured for all pts with PDAC.[Table: see text]

Underutilization of germline BRCA testing in commercially-insured women diagnosed with ovarian cancer.

5539 Background: Germline BRCA (gBRCA) testing has prognostic, therapeutic, and familial implications for patients with ovarian cancer. Since 2010, national guidelines have recommended universal genetic testing, but few data are available about rates and timeliness of testing or factors associated with testing. Methods: We examined rates of gBRCA testing and the time from index procedure to testing among commercially-insured women aged 18 to 64 with claims for ovarian, fallopian tube, or primary peritoneal cancers cancer who received cytoreductive surgery and chemotherapy between 2008-2018. We used logistic regression to assess patient-, clinician-, and practice-level characteristics associated with testing. Results: Overall, the rate of g BRCA testing was 33.9%, increasing from 14.7% in 2008 to 46.4% in 2018; the median time to testing decreased from 280.0 to 72.5 days. Patients who were tested were younger than those who were not (mean [SD] 54.7 [9.9] years vs. 58.1 [11.8] years, P&lt;.001) and had fewer comorbidities (Charlson score ≥2: 3.7% vs. 9.5%, P=0.01). There were no differences in testing rates by US region, rurality of practice location, or medical vs. gynecologic oncology providers. However, testing rates were higher in academic and NCI-designated cancer centers (36.2% and 32.5%, respectively), compared with community practices (25.5%; P&lt;0.001) (Table). In adjusted analyses, lower test rates were associated with older age (aOR=0.97, 95%CI=0.96-0.98), more medical comorbidities (Charlson score ≥2: aOR=0.77, 95%CI=0.61-0.97), and community practices vs. NCI cancer centers (aOR=0.64, 95%CI=0.46-0.88). Conclusions: While the rates and time to testing for gBRCA in patients with new diagnoses of ovarian cancer have improved over time, testing remains underutilized, even among well-insured populations. Future studies should examine barriers to timely genetic testing and identify scalable strategies for increasing testing in women with ovarian cancer, particularly for women treated in community practices.[Table: see text]

Prostate-specific antigen testing among young men: an opportunity to improve value.

IntroductionProstate cancer screening using prostate‐specific antigen (PSA) testing remains widespread. The prevalence of PSA testing in young men is unknown and may be an appropriate target for improving health care by decreasing low‐value testing in this age group. The purpose of this study was to determine PSA testing rates in men younger than current guidelines support.Materials and MethodsHealth Informational National Trends Surveys (HINTS) from 2011 to 2014 and 2017 were analyzed to establish the prevalence of PSA testing in young men and to evaluate the differences in testing rates based on race.ResultsThe combined survey data included 5178 men, with 2393 reporting previous PSA screening. Of men ages 18–39, 7% recalled receipt of PSA testing. Twenty‐two percent of men between the ages of 40 and 44 had been tested. Among men under age 40, PSA testing was more common among black men (14%) compared to white men (7%), Hispanics (6%), and men of Asian descent (8%). Logistic regression modeling demonstrates that black men under the age of 40 were more likely to undergo PSA testing than other racial or ethnic groups (odds ratio 2.14; 95% CI 1.17, 3.93).ConclusionsCurrent guidelines do not recommend routine PSA testing in average‐risk men under the age of 40. This study found that a significant number of young men are exposed to testing, with the greatest risk among black men. This suggests that there is an opportunity to improve the value of PSA testing by decreasing testing in young men.

Does BMI predict the early spatial variation and intensity of Covid-19 in developing countries? Evidence from India

This paper studies BMI as a correlate of the early spatial distribution and intensity of Covid-19 across the districts of India and finds that conditional on a range of individual, household and regional characteristics, adult BMI significantly predicts the likelihood that the district is a hotspot, the natural log of the confirmed number of cases, the case fatality rate, and the propensity that the district is a red zone. Controlling for air-pollution, rainfall, temperature, demographic factors that measure population density, the proportion of the elderly, and health infrastructure including per capita health spending and the proportion of respiratory cases, does not diminish the predictive power of BMI in influencing the spatial incidence and spread of the virus. The association between adult BMI and measures of spatial outcomes is especially pronounced among educated populations in urban settings, and impervious to conditioning on differences in testing rates across states. We find that among women, BMI proxies for a range of comorbidities (hemoglobin, high blood pressure and high glucose levels) that affects the severity of the virus while among men, these health indicators are also important, as is exposure to risk of contracting the virus as measured by work propensities. We conduct sensitivity checks and control for differences that may arise due to variations in timing of onset. Our results provide a readily available health marker that may be used to identify and protect especially at-risk populations in developing countries like India.

Determinants of HIV Testing Uptake among Women (aged 15-49 years) in the Philippines, Myanmar, and Cambodia

Background:Many countries have been trying to eliminate Mother-to-Child transmission of the Human Immunodeficiency Virus (HIV) and achieve the 90-90-90 target goals. The targets mean that 90% of People Living with HIV (PLWHIV) know their HIV status, 90% of those who are infected receive Antiretroviral treatment (ART), and 90% of those achieve viral suppression. Despite some progress, the goals have not been met in the Philippines, Myanmar, and Cambodia, countries with relatively high or growing HIV prevalence. This study identifies the sociodemographic determinants of testing among women in these countries so that better health education and stigma reduction strategies can be developed.Methods:Descriptive and multivariable analyses were conducted using Demographic and Health Survey data conducted in the Philippines (2017), Myanmar (2015/2016), and Cambodia (2014). The outcome variable was having ever been tested for HIV. Independent variables included knowledge and attitudes about HIV and social determinants of health.Results:A significant difference in testing rates among women was observed (the Philippines: 5%, Myanmar: 19%, Cambodia: 42%). In Myanmar and Cambodia, women who had more HIV knowledge and less stigma towards PLWHIV were more likely to get tested for HIV than those who did not. Marital status, education, wealth were strong predictors for HIV testing among women. Younger women aged 15-19 and those who live in the rural areas were less likely to get HIV tested than older and those living in urban areas. Employed women were less likely to seek an HIV test than the unemployed in Myanmar and Cambodia, whereas, in the Philippines, the opposite relationship was found.Conclusion and Global Health Implications:Women with less education and those less familiar with HIV should be targeted for HIV testing interventions. Stigma reduction and different testing strategies could facilitate early screening leading to improved HIV testing among women.

Safety and efficacy of routine diagnostic test reduction interventions in patients admitted to the intensive care unit: A systematic review and meta-analysis.

Reducing unnecessary routine diagnostic testing has been identified as a strategy to curb wasteful healthcare. However, the safety and efficacy of targeted diagnostic testing strategies are uncertain. The aim of this study was to systematically review interventions designed to reduce pathology and chest radiograph testing in patients admitted to the intensive care unit (ICU). A predetermined protocol and search strategy included OVID MEDLINE, OVID EMBASE and the Cochrane Central Register of Controlled Trials from inception until 20 November 2019. Eligible publications included interventional studies of patients admitted to an ICU. There were no language restrictions. The primary outcomes were in-hospital mortality and test reduction. Key secondary outcomes included ICU mortality, length of stay, costs and adverse events. This systematic review analysed 26 studies (with more than 44,00 patients) reporting an intervention to reduce one or more diagnostic tests. No studies were at low risk of bias. In-hospital mortality, reported in seven studies, was not significantly different in the post-implementation group (829 of 9815 patients, 8.4%) compared with the pre-intervention group (1007 of 9848 patients, 10.2%), (relative risk 0.89, 95% confidence intervals 0.79 to 1.01, P = 0.06, I2 39%). Of the 18 studies reporting a difference in testing rates, all reported a decrease associated with targeted testing (range 6%-72%), with 14 (82%) studies reporting >20% reduction in one or more tests. Studies of ICU targeted test interventions are generally of low quality. The majority report substantial decreases in testing without evidence of a significant difference in hospital mortality.

Exploring the percentage of COVID-19 cases reported in the community in Canada and associated case fatality ratios.

While surveillance can identify changes in COVID-19 transmission patterns over time and space, sections of the population at risk, and the efficacy of public health measures, reported cases of COVID-19 are generally understood to only capture a subset of the actual number of cases. Our primary objective was to estimate the percentage of cases reported in the general community, considered as those that occurred outside of long-term care facilities (LTCFs), in specific provinces and Canada as a whole. We applied a methodology using the delay-adjusted case fatality ratio (CFR) to all cases and deaths, as well as those representing the general community. Our second objective was to assess whether the assumed CFR (mean = 1.38%) was appropriate for calculating underestimation of cases in Canada. Estimates were developed for the period from March 11th, 2020 to September 16th, 2020. Estimates of the percentage of cases reported (PrCR) and CFR varied spatially and temporally across Canada. For the majority of provinces, and for Canada as a whole, the PrCR increased through the early stages of the pandemic. The estimated PrCR in general community settings for all of Canada increased from 18.1% to 69.0% throughout the entire study period. Estimates were greater when considering only those data from outside of LTCFs. The estimated upper bound CFR in general community settings for all of Canada decreased from 9.07% on March 11th, 2020 to 2.00% on September 16th, 2020. Therefore, the true CFR in the general community in Canada was likely less than 2% on September 16th. According to our analysis, some provinces, such as Alberta, Manitoba, Newfoundland and Labrador, Nova Scotia, and Saskatchewan reported a greater percentage of cases as of September 16th, compared to British Columbia, Ontario, and Québec. This could be due to differences in testing rates and criteria, demographics, socioeconomic factors, race, and access to healthcare among the provinces. Further investigation into these factors could reveal differences among provinces that could partially explain the variation in estimates of PrCR and CFR identified in our study. The estimates provide context to the summative state of the pandemic in Canada, and can be improved as knowledge of COVID-19 reporting rates and disease characteristics are advanced.

No standarisation or harmonisation in anti-doping testing frequency

The use of performance-enhancing drugs (PEDs) has undermined the credibility of sports for many years, with cycling and athletics, especially badly hit. The World Anti-Doping Agency has been tasked with...

An examination of radon awareness, risk communication, and radon risk reduction in a Hispanic community

Purpose: Radiation risk communication is a critical component of radiation protection and the public’s understanding of radiation risks and benefits. Risk communication becomes even more complicated when considering cultural and language differences. In the US, many diverse communities face risk communication challenges. We obtained radon testing data to evaluate patterns of radon testing in Allentown, the third largest city in Pennsylvania. Radon exposure is the second leading cause of lung cancer after smoking and is associated with over 21,000 lung cancer deaths in the US annually. It is estimated that 1 in every 15 homes in the US has elevated radon levels above the recommended action level set by the US Environmental Protection Agency. Allentown has some of the highest reported levels of indoor radon in the country, yet only a small portion of the population has tested their homes. This is true particularly among self-identified Hispanics, who make up nearly half of the city’s population. This study seeks to (1) characterize the difference in testing rates between self-identified Hispanics and non-Hispanics in Allentown, (2) quantify the level of radon awareness and knowledge, (3) identify potential obstacles to radon testing among the Allentown population that self-identifies as Hispanic, and (4) determine whether more effective risk communication is needed.Method: Radon test results in Allentown were analyzed to better understand the nature of radon testing. To evaluate radon awareness and knowledge, a cross-sectional study was conducted using a face-to-face survey. This data was informative in assessing testing and mitigation practices, ethnicity, income level, age, education level, homeowner status, zip code and primary language.Results: Ethnicity was an independent predictor of radon awareness and knowledge. Statistically significant differences were found between the number of self-identified Hispanics (39%) and non-Hispanics (84%) who indicated that they had ever heard of radon; 13% of Hispanics and 49% of non-Hispanics knew that they lived in an area with typically high radon levels. There was a statistically significant association between self-reported ethnicity and radon testing with non-Hispanics (43%) more likely to test their homes for radon than Hispanics (32%).Conclusion: Individual and community understanding of the risks of exposure to radiation sources such as radon is dependent upon communication that informs and spurs appropriate action. This study demonstrates the need for culturally appropriate radon risk communication strategies targeted to a Hispanic population. Successful communication will raise awareness and knowledge that can lead to better public health protection.

Assessing real-world biomarker testing rates in metastatic colon cancer.

209 Background: Despite national guideline recommendations for universal biomarker testing (KRAS, NRAS, BRAF, and mismatch repair/microsatellite instability [MMR/MSI]) in all patients with metastatic colorectal cancer (mCRC), little is known regarding adherence to these recommendations in the community. Methods: We evaluated 20,333 patients aged &gt;18 years with mCRC diagnosed between 1/1/2013-12/27/18 from the nationwide de-identified Flatiron Health electronic health record-derived database. Changes in rates of biomarker testing based upon chart abstraction according to date of mCRC diagnosis were assessed in patients with ≥ 6 months of follow-up using Cochran-Armitage trend tests. We also assessed whether testing differed by patient characteristics using chi-square tests. Results: Biomarker testing rates increased between 2013 and 2018 (15.3 to 65.7% for NRAS, 23.9 to 56.6% for BRAF, and 34 to 76.6% for MMR, all p &lt; 0.0001). There was no change in rate of KRAS testing (63.8 to 68.3% p= 0.1695) over this period of time. Univariate analysis showed that patients with, worse performance status, and Medicare/Medicaid insurance were less likely to be tested (for all variables, p &lt;0.0001). There were no meaningful differences in testing rates by tumor sidedness, race, gender, or initial stage. Conclusions: In mCRC, adoption of guideline-driven recommendations for NRAS, BRAF and MMR/MSI testing increased significantly between 2013-2018. Adoption of BRAF and NRAS testing has neared the rate of KRAS testing. Interpretation of overall testing rates must recognize potential for missing biomarker test information for care not captured within the Flatiron network. Further study is required to characterize the magnitude of and reasons for absent biomarker testing among patients with metastatic colorectal cancer.

Mainstreamed genetic testing of breast cancer patients in two hospitals in South Eastern Norway

Studies have shown that a significant number of eligible breast cancer patients are not offered genetic testing or referral to genetic counseling. To increase access to genetic testing in South Eastern Norway, testing has since 2014 been offered directly to breast cancer patients by surgeons and oncologists. This practice is termed “mainstreamed genetic testing”. The aim of this study was to investigate to what extent patients in South Eastern Norway are offered testing. Three hundred and sixty one patients diagnosed in 2016 and 2017 at one regional and one university hospital in South Eastern Norway were included. Data on whether the patients fulfilled the criteria, whether they had been offered testing and if they were tested were collected. In total, 26.6% (96/361) fulfilled the criteria for testing. Seventy five percent (69/92) of these were offered testing, and 71.7% (66/92) were tested. At the university hospital, 90.2% (37/41) of eligible patients were offered testing, and at the regional hospital 62.7% (32/51). Fifty two percent (12/23) of eligible patient not offered testing were younger than 50 years at time of diagnosis. As many as 95.4% (125/131) of all patients who were offered testing, wanted to be tested. The majority of patients who fulfilled the criteria were offered testing, supporting the practice of mainstreamed genetic testing. There were nevertheless differences in rates of testing between the hospitals that affected all groups of patients, indicating that genetic testing may not be equally accessible to all patients. We suggest that efforts should be made to increase awareness and improve routines for genetic testing of breast cancer patients in Norway.

Does BMI Predict the Early Spatial Variation and Intensity of Covid-19 in Developing Countries? Evidence from India

This paper studies BMI as a correlate of the early spatial distribution and intensity of Covid-19 across the districts of India and finds that conditional on a range of individual, household, and regional characteristics, adult BMI significantly predicts the likelihood that the district is a hotspot, the natural log of the confirmed number of cases, the case fatality rate, and the propensity that the district is a red zone. Controlling for air-pollution, rainfall, temperature, demographic factors that measure population density, the proportion of the elderly, and health infrastructure including per capita health spending, the proportion of respiratory cases, and the number of viral disease outbreaks in the recent past, does not diminish the predictive power of BMI in influencing the spatial incidence and spread of the virus. The association between adult BMI and measures of spatial outcomes is especially pronounced among educated populations in urban settings, and impervious to conditioning on differences in testing rates across states. We find that among women, BMI proxies for a range of comorbidities (hemoglobin, high blood pressure and high glucose levels) that affects the severity of the virus while among men, these health indicators are less important and exposure to risk of contracting the virus as measured by work propensities is explanatory. We conduct heterogeneity and sensitivity checks and control for differences that may arise due to variations in timing of onset. Our results provide a readily available health marker that may be used to identify especially at-risk populations in developing countries like India.

Diagnostic Testing Patterns and Concordance with World Health Organization (WHO) Criteria for Patients (Pts) with Newly Diagnosed (ND) Myelodysplastic Syndromes (MDS) in the Connect® MDS/AML Registry

Diagnostic Testing Patterns and Concordance with World Health Organization (WHO) Criteria for Patients (Pts) with Newly Diagnosed (ND) Myelodysplastic Syndromes (MDS) in the Connect® MDS/AML Registry

C. difficile Infection in Inflammatory Bowel Disease: A Nursing-Based Quality Improvement Strategy

Introduction: Patients with IBD not only have a higher prevalence of C. difficile infection (CDI), but also significantly worse outcomes. Numerous IBD treatment guidelines include ruling out CDI for all patients who present with a flare. Recent research has highlighted the inconsistent, and occasionally inappropriate, care that is provided to IBD patients. At our institution, the baseline C. difficile testing rate for patients admitted to our gastrointestinal unit with exacerbation of IBD was 41%. The present quality improvement intervention sought to increase the rate of testing for C. difficile for IBD inpatients with a flare. Methods: Fifty-three patients admitted to our gastrointestinal unit under medical (n=27) or surgical (n=26) specialties from December 1, 2014 to June 1, 2014 with a primary diagnosis of IBD and with symptoms and laboratory findings suggestive of flare were eligible for the study. If a patient did not have a C. difficile test ordered, the admitting floor nurse collected stool and alerted the primary provider to order the test. Monthly educational meetings were held with nursing to maintain study objectives. The primary outcome was percent of eligible patients receiving a C. difficile test. Secondary outcomes included rate of CDI, length of hospital stay, colectomy rate, readmission rate within 6 months, and mortality. Chi-square analysis was used to determine statistical significance. Results: There was a significant increase in percent of eligible patients receiving a C. difficile test such that by the end of the study period, greater than 65% of all patients received a test (p<0.001). This increased to nearly 100% for patients admitted to medical subspecialty services. There was a significant difference in testing rates between subspecialties with patients admitted to surgical services less likely to receive a test (p<0.001), and this remained unchanged throughout the study period. In addition, patients who received a C. difficile test were more likely to have CDI (p<0.001), shorter hospital stays (p=0.02), and fewer readmissions within 6 months (p=0.01). Conclusion: IBD is a heterogeneous disease with patients often cared for by a multidisciplinary team. Despite known guidelines for CDI in IBD, the rate of testing remains suboptimal. The present study utilized the nursing admission workflow to increase rate of testing. This strategy was widely successful for patients admitted to a medical service, but failed to improve testing rates for patients admitted to a surgical service. More work is needed to understand barriers to C. difficile testing in surgical patients. Future studies should further characterize inconsistencies in IBD care and implement universal quality improvements aimed at reducing this harmful disparity.