Disparities In Adverse Outcomes Research Articles

Risk of adverse perinatal outcomes among African-born Black women in California, 2011-2020.

African-born women have a lower risk of preterm birth and small for gestational age (SGA) birth compared to United States (US)-born Black women, however variation by country of origin is overlooked. Additionally, the extent that nativity disparities in adverse perinatal outcomes to Black women are explained by individual-level factors remains unclear. We conducted a population-based study of non-anomalous singleton live births to US- and African-born Black women in California from 2011-2020 (n=194,320). We used age-adjusted Poisson regression models to estimate risk of preterm birth and SGA, and reported risk ratios (RR) and 95% confidence intervals (CI). Decomposition using Monte Carlo integration of the g-formula computed the percentage of disparities in adverse outcomes between US- and African-born women explained by individual-level factors. Eritrean women (RR 0.4; 95%CI: 0.3, 0.5) had the largest differences in risk of preterm birth and Cameroonian women (RR 0.5; 95% CI: 0.3, 0.6) in SGA birth, compared to US-born Black women. Ghanaian women had smaller differences in risk of preterm birth (RR 0.8; 95%CI: 0.7, 1.0) and SGA (RR 0.9; 95% CI 0.8, 1.1) compared to US-born women. Overall, we estimate that absolute differences in socio-demographic and clinical factors contributed to 32% of nativity-based disparities in the risk of preterm birth and 26% of disparities in SGA. We observed heterogeneity in risk of adverse perinatal outcomes for African- compared to US-born Black women, suggesting that nativity disparities in adverse perinatal outcomes were not fully explained by differences in individual-level factors.

Sex disparities in adverse outcomes after surgically managed isolated traumatic spinal injury

BackgroundTraumatic spinal injury (TSI) encompasses a wide range of injuries affecting the spinal cord, nerve roots, bones, and soft tissues that result in pain, impaired mobility, paralysis, and death. There is some evidence suggesting that women may have different physiological responses to traumatic injury compared to men; therefore, this study aimed to investigate if there are any associations between sex and adverse outcomes following surgically managed isolated TSI.MethodsUsing the 2013–2019 TQIP database, all adult patients with isolated TSI, defined as a spine AIS ≥ 2 with an AIS ≤ 1 in all other body regions, resulting from blunt force trauma requiring spinal surgery, were eligible for inclusion in the study. The association between the sex and in-hospital mortality as well as cardiopulmonary and venothromboembolic complications was determined by calculating the risk ratio (RR) after adjusting for potential confounding using inverse probability weighting.ResultsA total of 43,756 patients were included. After adjusting for potential confounders, female sex was associated with a 37% lower risk of in-hospital mortality [adjusted RR (95% CI): 0.63 (0.57–0.69), p < 0.001], a 27% lower risk of myocardial infarction [adjusted RR (95% CI): 0.73 (0.56–0.95), p = 0.021], a 37% lower risk of cardiac arrest [adjusted RR (95% CI): 0.63 (0.55–0.72), p < 0.001], a 34% lower risk of deep vein thrombosis [adjusted RR (95% CI): 0.66 (0.59–0.74), p < 0.001], a 45% lower risk of pulmonary embolism [adjusted RR (95% CI): 0.55 (0.46–0.65), p < 0.001], a 36% lower risk of acute respiratory distress syndrome [adjusted RR (95% CI): 0.64 (0.54–0.76), p < 0.001], a 34% lower risk of pneumonia [adjusted RR (95% CI): 0.66 (0.60–0.72), p < 0.001], and a 22% lower risk of surgical site infection [adjusted RR (95% CI): 0.78 (0.62–0.98), p < 0.032], compared to male sex.ConclusionFemale sex is associated with a significantly decreased risk of in-hospital mortality as well as cardiopulmonary and venothromboembolic complications following surgical management of traumatic spinal injuries. Further studies are needed to elucidate the cause of these differences.

MP07-16 RACIAL DISPARITIES IN COMPLICATIONS AFTER SURGICAL TREATMENT OF PELVIC ORGAN PROLAPSE

You have accessJournal of UrologyCME1 Apr 2023MP07-16 RACIAL DISPARITIES IN COMPLICATIONS AFTER SURGICAL TREATMENT OF PELVIC ORGAN PROLAPSE Arshia Aalami Harandi, Anjali Kapur, and Jason Kim Arshia Aalami HarandiArshia Aalami Harandi More articles by this author , Anjali KapurAnjali Kapur More articles by this author , and Jason KimJason Kim More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003222.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Pelvic organ prolapse (POP) is a common condition with a 12.5% risk of surgical treatment by age 80. Prior studies have shown racial differences in outcomes of surgical treatment of POP in the US. Our study investigates whether there are racial disparities in adverse outcomes following surgical treatment of POP in the American College of Surgeons National Surgical Quality Improvement Program (NSPIQ) database. METHODS: Patients were collected from the NSPIQ database between 2011-2020 with current procedural terminology codes for minimally invasive and open sacrocolpopexy, vaginal vault suspension, anterior colporrhaphy, vaginal repair, enterocele/rectocele repair, and obliterative surgery. Reported complications were aggregated into composite Clavien-Dindo I-II and III-IV classifications. Multivariate logistic regression was utilized to calculate adjusted odds ratios (aOR) for complications. Age, BMI, past medical history, smoking history, surgical treatment, and ASA score were included as covariates in the regression model. RESULTS: Within Clavien Dindo III-IV complications, African Americans had a 35% increased risk (aOR: 1.35, p<.01), while Asians and Hispanics had a 42% (aOR: 0.58, p<.01) and 23% (aOR: 0.77, p<.01) decreased risk, respectively. Asian race was associated with a 19% decreased risk of Clavien-Dindo I-II complications (aOR: 0.81, p<.05) compared to White patients, with all other ethnicities bearing similar risk. Age >65 was associated with a 14% decreased risk of Clavien-Dindo I-II complications (aOR: 0.86, p<.01) and 15% decreased risk of Clavien-Dindo III-IV complications (aOR: 0.85, p<.01). Comorbidities of dyspnea, severe COPD, ascites, CHF, disseminated cancer, open wound/infection, steroids/immunosuppression, smoking history, and BMI >30 were significantly associated with higher odds of Clavien-Dindo III-IV complications (p<.05) (Table 1). CONCLUSIONS: African American women receiving surgical treatment for POP have increased risk of high-grade complications even when adjusted for age, past medical history, smoking status, and type of surgery. Further research is needed to elucidate implicit biases or disparities in healthcare that may contribute to adverse outcomes. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e91 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Arshia Aalami Harandi More articles by this author Anjali Kapur More articles by this author Jason Kim More articles by this author Expand All Advertisement PDF downloadLoading ...

Impact of Pre-operative Opioid Use on Racial Disparities in Adverse Outcomes Post Total Knee and Hip Arthroplasty.

The growing opioid epidemic in the USA has underlying racial disparities dimensions. Also, studies have shown that patients from minority racial groups are at higher risk of adverse events following major orthopedic surgery. The aim of our study was to determine whether pre-operative opioid-use disorders (OUDs) impacted racial disparities in the likelihood of patients experiencing adverse post-operative outcomes following TKA and THA. Data about patients undergoing TKA and THA were collected from the 2005-2014 National Inpatient Sample databases. Regression modeling was used to assess the impact of OUDs on odds of adverse outcomes comparing racial groups. The adverse outcomes included any in-hospital post-surgical complications, prolonged length of stay (LOS), and nonhome discharge. In our fully adjusted regression models using White patients as the reference group, we found that OUDs were associated with racial disparities in prolonged LOS and nonhome discharge. In the non-OUD group, Black patients had significantly higher odds of longer LOS (OR: 1.35, 95% CI: 1.26-1.46, p-value: < 0.0001), whereas those with history of OUD had non-significantly lower odds of longer LOS (OR: 0.94, 95% CI: 0.69-1.29, p-value: 0.71). Similarly, for the outcome of nonhome discharges, Black patients in the non-OUD group had significantly higher odds (OR: 1.31, 95% CI: 1.21-1.43, p-value: < 0.0001) and those with a history of OUD had non-significantly lower odds (OR: 0.91, 95% CI: 0.64-1.29, p-value: 0.59). Significant racial disparities are present in adverse events among patients in the non-OUD group, but those disparities attenuated in the OUD group.

Disparities in chemical exposures among pregnant women and neonates by socioeconomic and demographic characteristics: A nontargeted approach

BackgroundExposure to environmental chemicals during pregnancy adversely affects maternal and infant health, and identifying socio-demographic differences in exposures can inform contributions to health inequities. MethodsWe recruited 294 demographically diverse pregnant participants in San Francisco from the Mission Bay/Moffit Long (MB/ML) hospitals, which serve a primarily higher income population, and Zuckerberg San Francisco General Hospital (ZSFGH), which serves a lower income population. We collected maternal and cord sera, which we screened for 2420 unique formulas and their isomers using high-resolution mass spectrometry using LC-QTOF/MS. We assessed differences in chemical abundances across socioeconomic and demographic groups using linear regression adjusting for false discovery rate. ResultsOur participants were racially diverse (31% Latinx, 16% Asian/Pacific Islander, 5% Black, 5% other or multi-race, and 43% white). A substantial portion experienced financial strain (28%) and food insecurity (20%) during pregnancy. We observed significant abundance differences in maternal (9 chemicals) and cord sera (39 chemicals) between participants who delivered at the MB/ML hospitals versus ZSFGH. Of the 39 chemical features differentially detected in cord blood, 18 were present in pesticides, one per- or poly-fluoroalkyl substance (PFAS), 21 in plasticizers, 24 in cosmetics, and 17 in pharmaceuticals; 4 chemical features had unknown sources. A chemical feature annotated as 2,4-dichlorophenol had higher abundances among Latinx compared to white participants, those delivering at ZSFGH compared to MB/ML, those with food insecurity, and those with financial strain. Post-hoc QTOF analyses indicated the chemical feature was either 2,4-dichlorophenol or 2,5-dichlorophenol, both of which have potential endocrine-disrupting effects. ConclusionsChemical exposures differed between delivery hospitals, likely due to underlying social conditions faced by populations served. Differential exposures to 2,4-dichlorophenol or 2,5-dichlorophenol may contribute to disparities in adverse outcomes.

Predictors of Initial Hydroxychloroquine Receipt Among Medicaid Beneficiaries With Incident Systemic Lupus Erythematosus.

Although hydroxychloroquine/chloroquine (HCQ/CQ) form the cornerstone of systemic lupus erythematosus (SLE) treatment, not all patients receive this, which may contribute to disparities in outcomes. The present study was undertaken to investigate factors associated with first dispensing of HCQ/CQ. Using Medicaid insurance claims from 2000 to 2010, we identified individuals ages 18-65 years with incident SLE (≥3 SLE International Classification of Diseases, Ninth Revision codes separated by ≥30 days without prior SLE codes or HCQ/CQ use for 24 months). The primary outcome was first dispensing of HCQ/CQ within 24 months of the first SLE code. We used Cox proportional hazards regression models to examine the association between sociodemographic factors, comorbidities, health care utilization, and medication use and HCQ/CQ dispensing within 24 months of diagnosis. We identified 9,560 Medicaid beneficiaries with incident SLE; 41% received HCQ (n = 3,949) or CQ (n = 14) within 24 months of diagnosis. Younger patients were more likely to receive HCQ/CQ. Black, Asian, Hispanic, and American Indian/Alaska Native individuals were more likely to receive HCQ/CQ than White individuals. Alcohol and nicotine use, chronic pain, diabetes mellitus, and end-stage renal disease were associated with lower dispensing. Appointments and preventive care services were associated with higher rates, and more hospitalizations with lower rates. Only 41% of Medicaid beneficiaries with SLE received HCQ/CQ within 24 months of diagnosis. Greater outpatient and preventive care increased receipt. All non-White race/ethnicities had higher rates of first dispensing. Time to initial HCQ/CQ dispensing may not explain racial/ethnic disparities in adverse outcomes, highlighting the need to consider other care quality-related issues and medication adherence challenges.

220 Trends in racial disparities in adverse outcomes in influenza in pregnancy

Non-Hispanic Black (NHB) pregnant women experience higher rates of maternal morbidity compared to their non-Hispanic White (NHW) peers, regardless of influenza. Whether NHB experience worse outcomes with influenza remains to be defined. Our objective was to assess whether NHB women with influenza during pregnancy are at increased risk of severe maternal morbidity (SMM). An analysis of delivery hospitalizations with influenza during pregnancy was conducted using the 2000-2015 National Inpatient Sample. Maternal race was assessed for women of NHW, NHB, and Hispanic race. Outcomes were SMM excluding transfusion (defined by the Centers for Disease Control and Prevention), and complications of influenza, sepsis/shock, acute respiratory distress syndrome (ARDS), and mechanical ventilation/tracheostomy. Trend analysis was conducted presenting the average annual percent change (AAPC). The association between maternal race and outcomes were calculated using log linear models, adjusted for demographic, hospital, and clinical variables. Between 2000-2015, 182,228 (0.3%) deliveries were complicated by influenza and 15.7% of women were NHB. Overall, 2.1% had SMM, 4.8% sepsis/shock, 23.4% ARDS, and 4.2% mechanical ventilation/tracheostomy. The rate of SMM was higher among NHB compared to NHW patients with an AAPC 5.6% (95% CI: 0.7%, 10.7%) versus 5.1% (95% CI: 1.2%, 9.3%) (Figure). NHB women with influenza were at higher risk of SMM compared to their NHW peers (3.5% vs. 2.0%, aRR 1.64, 95% CI: 1.48, 1.81) and similarly elevated with mechanical ventilation and sepsis/shock (Table). Non-Hispanic Black women with influenza during pregnancy experience higher rates of maternal morbidity compared to their non-Hispanic White peers. Addressing racial disparities in adverse outcomes for pregnant women with influenza should be a public health priority, including improving influenza vaccination rates in minority populations.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

942: How much is too much? Adverse pregnancy outcomes associated with estradiol level at embryo transfer

To delineate the relationship between estradiol level at the time of embryo transfer and the development of obstetric complications. This study is a retrospective cohort of 99 patients who underwent IVF, with delivery of a singleton greater than 24 weeks at a single institution from 2012-2018. Data were analyzed in relation to the patient’s cycle type, fresh (n=54) v frozen (n=45) embryo transfer, and the estradiol level at the time of transfer. The primary outcome was placental-related composite morbidity (abnormal placentation, hypertension, gestational diabetes, oligohydramnios, and SGA). There was a significantly higher composite morbidity in the fresh, compared to the frozen group (69% v 44%, p=0.01). Neonates in the fresh group were 194g smaller, and significantly more likely to be SGA (15% v 2%, p=0.02). There was a higher frequency of LGA neonates in the frozen group (18% v 6%, p=0.05), despite a similar rate of diabetes. Estradiol levels were significantly higher in the fresh versus frozen group (524 v 2640pg/mL, p< 0.001). When assessed by low, medium, and high categories of estradiol level, a parabolic relationship was observed, such that the highest rate of complications occurred in the medium group. One potential explanation for the disparity in adverse outcomes is hyperestrogenic-induced vascular remodeling resulting from ovarian stimulation in the fresh group. We sought to elucidate the relationship between placental-related morbidity and estradiol level at the time of transfer. The highest frequency of adverse outcomes was noted in the medium group (estradiol 750-2000pg/mL), demonstrating a parabolic relationship in which lower frequencies were noted in the low and high categories. This likely represent a dose-dependent response which reaches saturation of estrogen receptor signaling, with down-regulation of the receptor at higher estrogen concentrations. These results provide further evidence for the benefit of frozen embryo transfer, and may help to stratify which patients may benefit from frozen cycle transfer based on estradiol level.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Rural-urban disparities in health care costs and health service utilization following pediatric mild traumatic brain injury.

To compare health care costs and service utilization associated with mild traumatic brain injury (mTBI) in rural and urban commercially insured children. MarketScan Commercial Claims and Encounters Data, 2007-2011. We compared health care costs and outpatient encounters for physical/occupational therapy, speech therapy, and psychiatry/psychology encounters 180days after mTBI among rural versus urban children (<18years). A total of 387846 children had mTBI, with 13 percent residing in rural areas. Adjusted mean total health care costs in the 180days after mTBI were $2778 (95% CI: 2660-2897) among rural children, compared to $2499 (95% CI: 2471-2528) among urban children (adjusted cost ratio 1.11, 95% CI 1.06-1.16). Rural-urban differences in utilization for specific services were also found. Total health care costs were higher for rural compared to urban children despite lower utilization of certain services. Differences in health service utilization may exacerbate geographic disparities in adverse outcomes associated with mTBI.

Status of Childhood Asthma in the United States, 1980–2007

Centers for Disease Control and Prevention data were used to describe 1980-2007 trends among children 0 to 17 years of age and recent patterns according to gender, race, and age. Asthma period prevalence increased by 4.6% per year from 1980 to 1996. New measures introduced in 1997 show a plateau at historically high levels; 9.1% of US children (6.7 million) currently had asthma in 2007. Ambulatory care visit rates fluctuated during the 1990 s, whereas emergency department visits and hospitalization rates decreased slightly. Asthma-related death rates increased through the middle 1990 s but decreased after 1999. Recent data showed higher prevalence among older children (11-17 years), but the highest rates of asthma-related health care use were among the youngest children (0-4 years). After controlling for racial differences in prevalence, disparities in adverse outcomes remained; among children with asthma, non-Hispanic black children had greater risks for emergency department visits and death, compared with non-Hispanic white children. For hospitalizations, for which Hispanic ethnicity data were not available, black children had greater risk than white children. However, nonemergency ambulatory care use was lower for non-Hispanic black children. Although the large increases in childhood asthma prevalence have abated, the burden remains large. Potentially avoidable adverse outcomes and racial disparities continue to present challenges. These findings suggest the need for sustained asthma prevention and control efforts for children.