Disparities In Clinical Outcomes Research Articles

Impact of environmental temperature on the survival outcomes of breast cancer: A SEER-based study.

Experimental evidence in tumor-bearing mouse models shows that exposure to cool, that is, sub-thermoneutral environmental temperature is associated with a higher tumor growth rate and an immunosuppressive tumor immune microenvironment than seen at thermoneutral temperatures. However, the translational significance of these findings in humans is unclear. We hypothesized that breast cancer patients living in warmer climates will have better survival outcomes than patients living in colder climates. A retrospective population-based analysis was conducted on 270,496 stage I-III breast cancer patients, who were retrieved from the Surveillance, Epidemiology and End Results (SEER) over the period from 1996 to 2017. The average annual temperature (AAT) was calculated based on city level data from the National Centers for Environmental Information. A total of 270, 496 patients were analyzed. Temperature as assessed in quartiles. After adjusting for potential confounders, patients who lived in the 3rd and 4th quartile temperature regions with AAT 56.7-62.5°F (3rd quartile) and > 62.5°F (4th quartile) had a 7% increase in the OS compared to patients living at AAT < 48.5°F (1st quartile) (HR 0.93, 95% CI 0.90-0.95 and HR 0.93, 95% CI 0.91-0.96, respectively). For DSS, When comparing AAT quartiles, patients living with AAT in the range of 56.7-62.5°F and > 62.5°F demonstrated a 7% increase each in DSS after adjustment (HR 0.93, 95% CI 0.90-0.96 and HR 0.93, 95% CI 0.90-0.96). Higher environmental temperatures are associated with significantly better OS and DSS in breast cancer patients. Future research is warranted to confirm this observation using large datasets to elucidate the underlying mechanisms and investigate novel therapeutic strategies to minimize this geographic disparity in clinical outcomes.

Abstract PO4-09-12: Academic-community partnership bridges disparities in African American patient representation in accelerated partial breast irradiation clinical trials

Abstract Purpose/Objectives: Clinical outcomes in African American (AA) patients diagnosed with breast cancer continue to lag behind other racial groups. Thus, AA women are 41% more likely to die from breast cancer than White women despite lower incidence of breast cancer in AA women. Some of these disparities are related to barriers in access to standard-of-care treatments such as radiation therapy (RT). The prolonged nature of radiation treatments confers disproportionate higher burden (due to lost wages, transportation costs etc.) on economically disadvantaged groups such as AA women. Accelerated partial breast irradiation (ABPI), which dramatically reduces treatment time in appropriately selected patients, has the potential to mitigate financial toxicity, and improve access and treatment compliance for AA. However, underrepresentation of AA patients in APBI trials may pose a barrier to wide adoption of APBI treatments in this patient population. At our institution, we have established a unique partnership between our University Hospital and a county hospital that serves as a safety-net hospital for many economically disadvantaged groups and treats a large proportion of AA patients. The goal of this study is to determine if our unique academic-community partnership improves disparities in representation of AA patients in APBI trials. Methods: We performed a PUBMED search to identify 197 clinical trials involving ABPI. After excluding international trials and multiple reports from the same trials, we identified 80 unique studies that were based in the United States. A total of 20 studies investigating APBI provided demographics data, comprising 1735 total patients. AA enrollment rate in these trials was compared to APBI trials completed at our institution in partnership with our county hospital partner. Results: Out of 1785 patients enrolled in APBI trials in the United States where demographic information was available, 1488 patients were White (85.7%), 124 were Black (7.1%), 67 were Hispanic (3.9%), and 46 were Asian (2.7%), and 10 patients were classified as multiple or unknown (0.6%). We compared these results to two APBI trials conducted at our institution investigating 5-fraction and single fraction APBI regimens. Out of a total of 104 patients treated, 17 patients (16.3%) were Black. This difference in proportion of AA patient enrollment between our institution (16.3%) versus those reported in APBI trials across the United States (7.1%) was statistically significant (p &amp;lt; 0.05). Conclusion: Reporting and representation of AA patients in APBI trials remains low, which may lead to lower adoption of APBI treatments in AA patients. This may lead to underutilization of APBI, a convenient treatment with lower financial toxicity, among AA patients. Our study shows that effective academic-community partnerships can bridge such disparities in AA patient representation in APBI trials. Expansion of such academic-community partnerships across the country may bridge systemic disparities in AA patient representation in oncology clinical trials. Future studies are needed to determine if improved access to novel and convenient treatments such APBI will bridge existing disparities in clinical outcomes in patients diagnosed with breast cancer. Citation Format: Ev Kakadiaris, Brian Lue, Young Suk Kwon, Prasanna Alluri, D Nathan Kim, Ann Sprangler, Mona Arbab, Robert Timmerman, Asal Rahimi. Academic-community partnership bridges disparities in African American patient representation in accelerated partial breast irradiation clinical trials [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 PO4-09-12.

Abstract 4834: Racial disparities in pain and psychiatric medication use in patients with metastatic colorectal cancer

Abstract Background: In the United States, colorectal cancer (CRC) is a public health concern, as it is the second leading cause of cancer-related death, accounting for over 50,000 deaths annually. In addition to its high mortality, CRC is associated with significant comorbidities including pain and psychiatric symptoms, particularly in late-stage disease. Supportive care medications (SCM) are frequently used for symptom management and improving health-related Quality of Life (HRQoL). Racial disparities in clinical outcomes including HRQoL have been reported in CRC. While racial disparities have been described in the use of SCM for some cancer types, no investigation of SCM use in late-stage CRC have been performed. The purpose of our study was to explore the relationship between SCM use and race/ethnicity in patients with metastatic CRC. Methods: We used the National Cancer Institute Surveillance Epidemiology and End Results (NCI SEER)- Medicare-linked database to analyze all patients with a CRC diagnosis and a newly initiated outpatient prescription claim for an SCM of interest from 2009-2018. Patients on SCM before cancer diagnosis or who had non-metastatic CRC at diagnosis were excluded. We assessed six SCM classes: opioids, non-opioid analgesics, skeletal muscle relaxants, antidepressants, anxiolytics, and antipsychotics. Results: After application of inclusion/exclusion criteria, 28, 212 patients were included in the final analysis (White: 72.8%, Black: 12.7%, Hispanic: 9.5%, Asian: 4.6%, Native American: 0.4%). After controlling for socioeconomic factors and compared to non-Hispanic White patients, there were significant differences across multiple SCM drug classes. When considering pain medications, these differences were bi-directional. Black patients were less likely to receive opioids (adjusted Odds Ratio [aOR] 0.86, 95% CI: 0.80-0.93), while Hispanic patients were more likely to receive opioids (aOR: 1.12, 95% CI: 1.03-1.22) and non-opioid analgesics (aOR 1.22, 95% CI: 1.06-1.40). Asian patients were more likely to receive non-opioid analgesics (aOR 1.71, 95% CI: 1.45-2.03), but less likely to receive skeletal muscle relaxants (aOR 0.60, 95% CI: 0.43-0.82). When considering psychiatric medications, decreased use among all racial groups was noted for antidepressants (Black: aOR 0.53, 95% CI: 0.50-0.60; Hispanic: aOR 0.82, 95% CI: 0.75-0.90; Asian: aOR 0.48, 95% CI: 0.42-0.56), and anxiolytics (Black: aOR 0.43, 95% CI: 0.38-0.49; Hispanic: aOR 0.76, 95% CI: 0.67-0.85; Asian: aOR 0.45, 95% CI: 0.37-0.55). Among antipsychotics, only Asian patients had less use compared to non-Hispanic White patients. Conclusion: Racial disparities in the use of pain and psychiatric medications among patients with late-stage CRC were present, even after controlling for multiple confounders. Further investigation is needed to understand drivers and their impact on HRQoL outcomes. Citation Format: John M. Allen, Olga M. Trejos Kweyete, Yi Guo, Sherise C. Rogers, Lisa Scarton, David L. DeRemer, Chardae Whitner, Diana J. Wilkie. Racial disparities in pain and psychiatric medication use in patients with metastatic colorectal cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4834.

Trends in pediatric firearm-related injuries and disparities in acute outcomes.

Firearm-related injuries (FRI) are an increasing cause of death and injury in children. The etiology for this rise is multifactorial and includes socioeconomic factors. Despite its prevalence and documented increase over COVID-19, there is a paucity of research on disparities and the influence of social determinants of health (SDH) in pediatric FRI. This study aims to explore the epidemiology of this vulnerable population in Atlanta, trends over time and relevant dates such as COVID-19 and a state firearm law, and disparities in clinical outcomes. Retrospective cohort of patients with FRI (0-20 years-old, x̄=9.8, Median = 11) presenting to our hospital EDs from January 2014 to April 2023 (N = 701) and eligible for the Trauma Registry. This period includes two major events, namely the COVID-19 pandemic (March 2020), and passage of state law Constitutional Carry Act (SB 319) (April 2022), allowing for permit-less concealed firearm carry. Single series interrupted time series (ITS) models were run and clinical outcome differences between race and insurance groups were calculated unadjusted and adjusted for confounders using inverse propensity treatment weights (IPTW). The primary outcome was mortality; secondary are admission and discharge. Majority of FRI involved patients who were male (76.7%), Black (74.9%), publicly insured (82.6%), ≤12 years-old (61.8%), and injured by unintentional shootings (45.6%) or assault (43.7%). During COVID-19, there was a sustained increase in FRI rate by 0.42 patients per 1,000 trauma visits per month (95% CI 0.02-0.82, p = 0.042); post-SB 319 it was 2.3 patients per 1,000 trauma visits per month (95% CI 0.23-4.31, p = 0.029). Publicly insured patients had 58% lower odds of mortality than privately insured patients (OR 0.42, 95% CI 0.18-0.99, p = 0.047). When controlled for race and mechanism of injury, among other confounding factors, this association was not significant (p = 0.652). Pediatric FRI are increasing over time, with disproportionate burdens on Black patients, at our hospitals. Disparities in mortality based on insurance necessitate further study. As social and economic repercussions of COVID-19 are still present, and state firearm law SB 319 is still in effect, assessment of ongoing trends is warranted to inform preventative strategies.

Gender disparities and predictors of in-hospital mortality with Takotsubo cardiomyopathy

BackgroundTakotsubo cardiomyopathy (TCM) is classically associated with significant gender disparities, such that it is more prevalent in females, but the clinical outcomes are worse for male patients. The goal of this study was to assess contemporary gender disparities in clinical outcomes of TCM hospitalizations and to determine predictors of male in-hospital mortality. MethodsThis was a retrospective analysis involving adult hospitalizations for TCM in the U.S between 2016 and 2020. Multivariable Logistic regression was used to estimate Odds Ratio (OR) for in-hospital mortality between the two genders. Univariable Cox regression was performed to identify predictors associated with in-hospital mortality for male hospitalizations. All factors from the univariable analysis with p < 0.20 were included in a multivariable Cox regression model. ResultsA total of 199,920 patients with TCM were identified. Female patients with TCM had 50% lower risk of in-hospital mortality compared to male patients (Adjusted OR 0.50, 95% CI 0.46–0.55, p < 0.001). Older age, higher Charlson comorbidity index, history of intracranial hemorrhage, cardiac arrest, need for vasopressor agents, mechanical intubation, and cardiogenic shock without the use of temporary mechanical circulatory support (MCS) were associated with higher in-hospital male mortality. ConclusionsAlthough TCM is more prevalent among females, gender disparities exist in the clinical outcomes of TCM patients. Cardiac arrest and cardiogenic shock without the use of temporary MCS were found to be the most significant predictors of male in-hospital mortality. Cardiogenic shock with use of temporary MCS did not lead to higher male in-hospital mortality.

Spatial and temporal analysis of HIV clinical outcomes in Florida reveals counties with persistent racial and ethnic disparities during 2012-2019

BackgroundRacial/ethnic disparities in the HIV care continuum have been well documented in the US, with especially striking inequalities in viral suppression rates between White and Black persons with HIV (PWH). The South is considered an epicenter of the HIV epidemic in the US, with the largest population of PWH living in Florida. It is unclear whether any disparities in viral suppression or immune reconstitution—a clinical outcome highly correlated with overall prognosis—have changed over time or are homogenous geographically. In this analysis, we 1) investigate longitudinal trends in viral suppression and immune reconstitution among PWH in Florida, 2) examine the impact of socio-ecological factors on the association between race/ethnicity and clinical outcomes, 3) explore spatial and temporal variations in disparities in clinical outcomes.MethodsData were obtained from the Florida Department of Health for 42,369 PWH enrolled in the Ryan White program during 2008-2020. We linked the data to county-level socio-ecological variables available from County Health Rankings. GEE models were fit to assess the effect of race/ethnicity on immune reconstitution and viral suppression longitudinally. Poisson Bayesian hierarchical models were fit to analyze geographic variations in racial/ethnic disparities while adjusting for socio-ecological factors.ResultsProportions of PWH who experienced viral suppression and immune reconstitution rose by 60% and 45%, respectively, from 2008-2020. Odds of immune reconstitution and viral suppression were significantly higher among White [odds ratio =2.34, 95% credible interval=2.14-2.56; 1.95 (1.85-2.05)], and Hispanic [1.70 (1.54-1.87); 2.18(2.07-2.31)] PWH, compared with Black PWH. These findings remained unchanged after accounting for socio-ecological factors. Rural and urban counties in north-central Florida saw the largest racial/ethnic disparities.ConclusionsThere is persistent, spatially heterogeneous, racial/ethnic disparity in HIV clinical outcomes in Florida. This disparity could not be explained by socio-ecological factors, suggesting that further research on modifiable factors that can improve HIV outcomes among Black and Hispanic PWH in Florida is needed.

Sex-Specific Disparities in Clinical Outcomes After Transcatheter Aortic Valve Replacement Among Different Racial Populations

BackgroundSex-related disparities in clinical outcomes following transcatheter aortic valve replacement (TAVR) and the impact of sex on clinical outcomes after TAVR among different racial groups are undetermined. ObjectivesThis study assessed whether sex-specific differences in baseline clinical and anatomical characteristics affect clinical outcomes after TAVR and investigated the impact of sex on clinical outcomes among different racial groups. MethodsThe TP-TAVR (Trans-Pacific TAVR) registry is a multinational cohort study of patients with severe aortic stenosis who underwent TAVR at 2 major centers in the United States and 1 major center in South Korea. The primary outcome was a composite of death from any cause, stroke, or rehospitalization after 1 year. ResultsThe incidence of the primary composite outcome was not significantly different between sexes (27.9% in men vs 28% in women; adjusted HR: 0.97; 95% CI: 0.79-1.20). This pattern was consistent in Asian (23.5% vs 23.3%; adjusted HR: 0.99; 95% CI: 0.69-1.41) and non-Asian (30.8% vs 31.6%; adjusted HR: 0.95; 95% CI: 0.72-1.24) cohorts, without a significant interaction between sex and racial group (P for interaction = 0.74). The adjusted risk for all-cause mortality was similar between sexes, regardless of racial group. However, the adjusted risk of stroke was significantly lower in male patients than in female patients, which was more prominent in the non-Asian cohort. ConclusionsDespite significantly different baseline and procedural characteristics, there were no sex-specific differences in the adjusted 1-year rates of primary composite outcomes and all-cause mortality, regardless of different racial groups. (Transpacific TAVR registry [TP-TAVR]; NCT03826264)

THE IMPORTANCE OF PATIENT ENGAGEMENT IN THE MANAGEMENT OF INFLAMMATORY BOWEL DISEASE (IBD)

Abstract BACKGROUND IBD constitutes a diverse and progressive spectrum of chronic illnesses, presenting formidable management challenges for both patients and healthcare providers. Due to the inherent unpredictability of disease progression, proactive monitoring strategies are crucial for optimal IBD management. The linchpin of proactive monitoring in IBD is patient engagement, which is necessary for continuous monitoring of disease activity. GI practices using SonarMD, a technology-driven care coordination company specializing in IBD, have consistently maintained an enrollment and engagement rate exceeding 80%. This study demonstrates the disparity in clinical outcomes between an engaged patient population utilizing SonarMD’s platform and an unengaged cohort within a single large gastrointestinal (GI) practice under a value-based agreement with a major health plan. METHODS The study cohort was composed of a population of 1173 patients attributed by the heallth plan on the basis of ICD-10 Codes who had a diagnosis of Crohn's Disease (K50) or ulcerative colitis (K51). 939 (80%) enrolled in the program and 234 (20%) remaining unenrolled. Demographic and clinical characteristics of the patient groups are detailed in Table 1. The enrolled and unenrolled groups exhibited similar metrics with regard to: age, gender, average risk score (AVG), disease type, stricturing/fistulizing disease, and history of behavioral health diagnoses. The enrolled group did demonstrate a 10% higher utilization of biologics. The SonarMD platform was only deployed into the enrolled group. Claims data (including pharma claims) from a single health plan, which insured all cohort patients, was the source for the utilization data analysis. The study period was the calendar year 2022 with a claim runoff period of 3 additional months. RESULTS The IBD specific Inpatient hospitalization rate and ED Visit rate for each group is shown in table 2. There is a 10X statistically significant difference in both hospital inpatient admission rate and ED visit rate between the engaged and unengaged populations. (p = 0.02). Two thirds of the INPT/ED admissions for the entire attributed population were driven by the unenrolled group. CONCLUSIONS This study highlights the influential role of proactive patient engagement in the management of IBD, exemplified by the utilization difference for inpatient care and ED usage and its potential to optimize clinical outcomes. Proactive patient engagement is critical in population management of symptomatic chronic disease. An unengaged population represents a significant risk for unnecessary morbidity and healthcare cost. Provider-payer-industry partnerships can help build the infrastructure necessary to accomplish high rates of engagement. You can’t manage the patient you don’t engage.

Comparison of the effectiveness of zero-profile device and plate cage construct in the treatment of one-level cervical disc degenerative disease combined with moderate to severe paraspinal muscle degeneration.

Recent evidence indicates that cervical paraspinal muscle degeneration (PMD) is a prevalent and age-related condition in patients with cervical disc degenerative disease (CDDD). However, the relationship between surgery selection and post-operative outcomes in this population remains unclear. Consequently, this study aims to investigate the disparities in clinical outcomes, radiological findings, and complications between two frequently utilized anterior cervical surgical procedures. The objective is to offer guidance for the management of PMD in conjunction with CDDD. A total of 140 patients who underwent single-level anterior cervical discectomy and fusion (ACDF) at our department were included in this study. The patients were divided into three groups based on the severity of PMD: mild (n=40), moderate (n=54), and severe (n=46), as determined by Goutalier fat infiltration grade. The subjects of interest were those with moderate-severe PMD, and their clinical outcomes, radiological parameters, and complications were compared between those who received a stand-alone zero-profile anchored cage (PREVAIL) and those who received a plate-cage construct (PCC). The JOA, NDI, and VAS scores exhibited significant improvement at all postoperative intervals when compared to baseline, and there were no discernible differences in clinical outcomes between the two groups. While the PCC group demonstrated more pronounced enhancements and maintenance of several sagittal alignment parameters, such as the C2-7 angle, FSU angle, C2-7 SVA, and T1 slope, there were no statistically significant differences between the two groups. The incidence of dysphagia in the zero-profile group was 22.41% at one week, which subsequently decreased to 13.79% at three months and 3.45% at the final follow-up. In contrast, the plate cage group exhibited a higher incidence of dysphagia, with rates of 47.62% at one week, 33.33% at three months, and 11.90% at the final follow-up. Notably, there were significant differences in the incidence of dysphagia between the two groups within the first three months. However, the fusion rate, occurrence of implant subsidence, and adjacent segment degeneration (ASD) were comparable at the final follow-up. For patients with one-level cervical disc degenerative disease combined with paraspinal muscle degeneration, both the zero-profile technique and PCC have demonstrated efficacy in ameliorating clinical symptoms and maintaining the postoperative sagittal balance. Although no significant disparities were observed between these two technologies in terms of complications such as adjacent segment degeneration and implant subsidence, the zero-profile technique exhibited superior performance over PCC in relation to dysphagia during the early stages of postoperative recovery. To validate these findings, studies with longer follow-up periods and evaluations of multilevel cervical muscles are warranted.

Abstract B026: Exploring differences in supportive care medication use among racial and ethnic minorities with pancreatic and colorectal cancers

Abstract Background: Pancreatic (PC) and colorectal cancer (CRC) are both cancers of the digestive system, with similar symptom profiles. Neurologic and psychiatric symptoms are commonly seen in multiple types of cancer including PC and CRC. Supportive care medications (SCM) are central to symptom management and improving health-related Quality of Life (HRQoL). Examples of SCM used to manage these symptoms include opioid analgesics, non-opioid analgesics, antidepressants, anxiolytics, and antipsychotics. Racial disparities in clinical outcomes including HRQoL have been reported in PC and CRC, respectively. While racial disparities have been separately described in the use of SCM for PC and CRC, no comparisons of SCM use based on cancer type in racial and ethnic minorities has been performed. The purpose of our study was to explore differences in SCM use among racial and ethnic minorities with PC and CRC, respectively. Methods: We used the National Cancer Institute Surveillance Epidemiology and End Results (NCI SEER)- Medicare-linked database to analyze all patients with a PC or CRC diagnosis and a newly initiated outpatient prescription claim for an SCM of interest from 2009-2018. Patients on SCM before cancer diagnosis or were not a member of racial or ethnic group were excluded from the analysis. We assessed five SCM classes, including opioids, non-opioid analgesics, antidepressants, anxiolytics, and antipsychotics. Prescription claims were specific to patients diagnosed with PC or CRC, and compared by cancer type. Our objective was to characterize the relationship between cancer type and receipt of SCM in racial and ethnic minorities. Results: After assessment of our inclusion/exclusion criteria, 45,502 patients were included in the analysis (PC- 44.9%; CRC- 55.1%). Racial demographics were as follows: Black/African American: 51.5%, Hispanic- 23.6%, Asian- 23.5%, American Indian/Alaska Native: 1.3%. When comparing cancer types, patients with PC were more likely to receive multiple classes of SCM including opioids (Odds Ratio [OR] 2.17, 95%CI: 2.09-2.25), non-opioid analgesics (OR 1.29, 95%CI: 1.22-1.37), antidepressants (OR 1.19, 95%CI: 1.14-1.24), and anxiolytics (OR 1.45, 95%CI:1.37- 1.54). PC patients were less likely to receive antipsychotics (OR 0.77, 95%CI: 0.72- 0.83). Differences were similar when disaggregated by specific race and ethnicity. Conclusion: Among racial and ethnic minorities, patients with PC were more likely to be prescribed multiple classes of SCM used to treat neurologic and psychiatric symptoms, including opioids, non-opioid analgesics, antidepressants, and anxiolytics. The observed results suggests a heavier overall symptom burden for PC in this population. Citation Format: John M. Allen, MegCholack Awunti, Yi Guo, Sherise C. Rogers, Lisa Scarton, Chardaé Whitner, Diana J. Wilkie. Exploring differences in supportive care medication use among racial and ethnic minorities with pancreatic and colorectal cancers [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B026.

S133 Disparities in Clinical Outcomes Between Younger and Older UC Patients With Respect to Insurance Status: An Analysis of the National Inpatient Sample 2016-2020

S133 Disparities in Clinical Outcomes Between Younger and Older UC Patients With Respect to Insurance Status: An Analysis of the National Inpatient Sample 2016-2020

S30 Disparities in Clinical Outcomes Between Younger and Older IBD Patients With Respect to Insurance Status: An Analysis of the National Inpatient Sample 2016-2020

S30 Disparities in Clinical Outcomes Between Younger and Older IBD Patients With Respect to Insurance Status: An Analysis of the National Inpatient Sample 2016-2020

Gender disparities in clinical outcomes of urothelial carcinoma linked to X chromosome gene KDM6A mutation

ObjectiveKDM6A, a representative tumour suppressor gene with sex bias, is frequently altered in urothelial carcinoma (UC). The specific impacts of KDM6A mutations on gender-based clinical outcomes in UC remain poorly...

Disparities in Clinical Outcomes of B-Lymphoblastic Lymphoma: A National Cancer Database Study with Focus on Hispanic Populations in the United States

BACKGROUND Lymphoblastic lymphoma, a rare non-Hodgkin's lymphoma subtype, exhibits striking cytological and histological parallels with acute lymphoblastic leukemia (ALL). Such similarities have led to its classification as precursor B and T lymphoblastic lymphoma/leukemia by the World Health Organization. Exhibiting a modest global incidence of 1 to 5 cases per 100,000 population, it is notable that two-thirds of cases of ALL cases are of B-cell phenotype (PMID 15698386). To deepen our comprehension of this rare disease, it becomes essential to understand its behavior across various demographics, particularly among Hispanic (HI) and Non-Hispanic (NH) populations in the United States (US). To bridge this knowledge gap, this pioneering nationwide study endeavors to unravel how demographic, clinical, and survival outcomes vary between HI and NH patients with this disease. METHODS: Data were analyzed on B-Lymphoblastic lymphoma patients in the US reported to the National Cancer Database (NCDB) between 2004 and 2019. Demographic and treatment characteristics were compared between ethnic groups. Kaplan-Meier and Cox regression analyses were used to compare OS between Hispanic and Non-Hispanic populations. Multivariate analysis and propensity score matching was performed with adjustment for age, stage, co-morbidity score, and insurance status, type of facility and great circle distance. RESULTS Of 989 B-Lymphoblastic Lymphoma patients, 16 were HI, and 81% NH. 53% of HI were male, compared to 57% of NH. At diagnosis, HI patients were younger (40 years vs. 56 years) (p=&amp;lt;0.001); the majority of HI 84% and NH 68% were diagnosed in the age bracket of &amp;lt; 65 (p=&amp;lt;0.001). With respect to race, most of both HI and NH were whites (87% vs 85%), followed by blacks (1% vs 10%). Examining the stage, most of both HI 45% and NH 47% were stage IV (p= 0.260). When looking at insurance type; private insurance was the most prevalent type in HI vs NH (42% vs 51%), followed by government-sponsored (40% vs 44%). The most uninsured group was HI 16% vs NH 3%. Considering Census Median Income (2008-2012), the most prevalent bracket for HI was Less than $38,000 (29%) and NH was $63,000+ (34%). When it comes to median income of less than $38,000, HI were 29% vs NH 16%. As for Charlson-Deyo Score (comorbidities score), HI had 10% =/&amp;gt; 2 scores, vs NH 8%. In terms of Academic/Research Programs, including NCI-designated comprehensive cancer centers, it was the most prevalent type of facility providing care for both HI 55% and NH 50%. Regarding the median distance in miles between the patient's residence and the hospital that reported the case (Great Circle Distance), HI lived at a median of 9.3 miles, vs NH at a median of 12.4 miles. On survival analysis; the survival probability at 2, 5, and 10 years of HI vs NH were (0.624 vs 0.552), (0.516 vs 0.435), and (0.458 vs 0.362), respectively. The median survival time (MS) was 10.0 years for HI, vs 3.1 years for NH; and there was an overall survival (OS) difference favoring HI with (p=0.017). On multivariate analysis, there were no independent variables associated with better or worse OS; however, the propensity matched analysis showed a striking MS difference between HI vs NH (3.02 y vs. 1.43 y). CONCLUSION This groundbreaking study provides crucial insights into the distinct demographic and clinical characteristics of HI and NH patients with B-Lymphoblastic Lymphoma in the US. Importantly, we found that HI patients were significantly younger at diagnosis, and despite having a higher percentage of uninsured individuals and lower median income, showed better survival outcomes compared to NH. These findings highlight the critical role ethnicity plays in disease presentation and prognosis, thus emphasizing the importance of culturally sensitive, tailored healthcare approaches. This study underscores the urgent need for further research to understand intrinsic biologic factors contributing to these disparities and enhance health equity in lymphoma care.

Socioeconomic, Racial, and Insurance Disparities in Clinical Outcomes After Surgery Among Patients With Idiopathic Scoliosis.

Socioeconomic status (SES), race, and insurance type correlate with initial curve severity for patients with idiopathic scoliosis, but less is known regarding how these variables impact surgical outcomes. The objectives of this study were to determine the influence of SES, race, and insurance on preoperative appointment attendance, likelihood of obtaining a preoperative second opinion, brace prescription, missed 6 or 12-month postsurgical appointments, incidence of emergency department visits 0 to 90 days after surgery, and major complications within a year of surgery. A review of 421 patients diagnosed with idiopathic scoliosis who underwent surgery at a single high-volume pediatric spinal deformity institution between May 2015 and October 2021 was conducted. Area Deprivation Index, a quantitative measure of SES, was collected. Scores were stratified by quartile; higher scores indicated a lower SES. χ 2 tests for correlation were performed to determine whether clinical outcomes were dependent upon Area Deprivation Index, race, or insurance type; P ≤0.05 was significant. The sample was 313 Caucasian (74%), 69 (16%) black, and 39 (9.3%) other patients. More patients had private versus public insurance (80% vs 20%) and were of higher SES. The likelihood of missing preoperative appointments was higher for black patients ( P = 0.037). Those with lower SES missed more postoperative appointments and received less bracing and second opinions ( P = 0.038, P = 0.017, P = 0.008, respectively). Being black and publicly insured correlated with fewer brace prescriptions ( P < 0.001, P = 0.050) and decreased rates of obtaining second opinions ( P = 0.004, P = 0.001). Patients with idiopathic scoliosis surgery who were Caucasian, privately insured, and of higher SES were more likely to seek preoperative second opinions, be prescribed a brace, and attend postoperative appointments. Recognition of the inherent health care disparities prevalent within each pediatric spine surgery referral region is imperative to better inform local and national institutional level programs to educate and assist patients and families most at risk for disparate access to scoliosis care. Level III; retrospective case-control study.

Racial Disparities in Clinical Outcomes of Emergency Colectomies for Diverticulitis.

The literature suggests that there are ongoing racial disparities in healthcare outcomes between patients in White and non-White populations. As such, we examined the outcomes of patients who underwent an emergency colectomy for diverticulitis. We identified 4841 White and 590 non-White patients, which include Black/African American and Asian patients, using the 2016-2019 American College of Surgeons National Surgical Quality Improvement Program databases. We compared Black/African American and Asian patients with White patients for differences in surgical outcomes. Non-White patients had more comorbidities than White patients (P < 0.05). These patients underwent longer operations, developed more postoperative complications, and were more likely to have lengths of stay >30 days. When controlling for all of the covariates in multivariate logistic regression models, White race was independently associated with a 22.14% lower odds of a hospital stay >30 days compared with non-White patients (P = 0.001). In this study, non-White patients developed more complications than did White patients and had longer hospitalizations. These disparities represent a more complex societal issue that cannot be managed perioperatively alone.

Navigating Unequal Paths: Racial Disparities in the Infertility Journey.

Infertility is one of the most emotionally devastating conditions experienced during the reproductive window. Although not life-threatening, it significantly erodes quality of life for those with the diagnosis. Disturbingly, data demonstrate the existence of profound racial disparities that persist along the entire journey of infertility. Though most of the scientific literature emphasizes disparities in clinical outcomes after infertility treatment, it is important to recognize that these inequities are the downstream effect of a series of distinct challenges encountered by historically marginalized people on their path to parenthood. In this review, we explore the current state of knowledge concerning the inequities at each "step" in the path to overcome infertility challenges and propose solutions to create a future in which reproductive medicine is truly equitable, accessible, and supportive for everyone.

Post-operative Opioid Reduction Protocol Reduces Racial Disparity in Clinical Outcomes in Children

IntroductionRacial disparities in health outcomes continue to exist for children requiring surgery. Previous investigations suggest that clinical protocols may reduce racial disparities. A post-operative opioid reduction protocol was implemented in children undergoing abdominal surgery who were less than 1 years old at a tertiary level hospital. The purpose of this investigation was to determine if the clinical protocol was associated with a reduction in racial disparity in post-operative opioid prescribing patterns and associated clinical outcomes. MethodsA post-operative opioid reduction protocol based on standing intravenous acetaminophen, educational sessions with nursing staff, and standardized post-operative sign-out between the surgical and NICU teams was implemented in children under 1 year old in 2016. A time series and before and after analysis was conducted using a historical pre-intervention cohort (Jan 2011–Dec 2015) and prospectively collected post-intervention cohort (Jan 2016–Jan 2021). Primary outcomes included post-operative opioid use and post-operative pain scores stratified by race. Secondary outcomes included associated clinical outcomes also stratified by race. ResultsA total of 249 children were included in the investigation, 117 in the pre-intervention group and 132 in the post intervention group. The majority of patients in both cohorts were either White or Black. The two cohorts were equally matched in terms of pre-operative clinical variables. In the pre-intervention cohort, the median post-operative morphine equivalents in White children was 2.1 mg/kg (IQR 0.2, 11.1) while in Black children it was 13.1 mg/kg (IQR 2.4, 65.3), p-value = 0.0352. In the post-intervention cohort, the median value for White children and Black children was statistically identical (0.05 mg/kg (IQR 0, 0.5) and 0.0 mg/kg (IQR 0, 0.3), respectively, p-value = 0.237). This pattern was also demonstrated in clinical variables including length of stay, intubation length and total parenteral nutrition use. In the pre-intervention cohort, the total length of stay for white children was 16 days while for black children it was 45 days (p = 0.007). In the postintervention cohort the length of stay for both White and Black children were identical at 8 days (p = 0.748). ConclusionThe use of a clinical opioid reduction protocol implemented at a tertiary medical center was associated with a reduction in racial disparity in opioid prescribing habits in children. Prior to the protocol, there was a racial disparity in clinical variables associated with prolonged opioid use including length of stay, TPN use, and intubation length. The clinical protocol reduced variability in opioid prescribing patterns in all racial groups which was associated with a reduction in variability in associated clinical variables. Level of EvidenceLevel III.

Enhanced antitumour immunity following neoadjuvant chemoradiotherapy mediates a favourable prognosis in women with resected pancreatic cancer

BackgroundThis study investigates sex disparities in clinical outcomes and tumour immune profiles in patients with pancreatic ductal adenocarcinoma (PDAC) who underwent upfront resection or resection preceded by gemcitabine-based neoadjuvant chemoradiotherapy...

Sex differences in neurologic presentation and outcome of SARS-CoV-2, especially cerebrovascular manifestations

Neurological manifestations of COVID-19 and their impact have not been well characterized. Neurological involvement may be caused directly by the effects of the virus infecting the brain or indirectly by the local and systemic immune responses against the virus. Acute cerebrovascular disease, particularly ischemic stroke, has emerged as a serious complication of infection by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The arrival of COVID-19 represented a unique occasion to study sex difference, and accentuated the need for further study to elucidate the mechanisms that differentiate clinical outcomes among male and female patients. Recent pandemics has a clear sex disparity in clinical outcomes, and morbidity and mortality from COVID-19 are higher among men. Interestingly, the previous decade, there was sparse literature evaluating the impact of sex differences on outcomes in infectious diseases, especially on neurologic complications. Ongoing advances in scientific research have demonstrated sex differences in the neurological complications of neuroinfectious diseases, and sex and disparities in health care are frequently encountered. The evidence for potential sex differences and gender inequalities, including socioeconomic status and occupational exposure in the COVID-19 pandemic is continuing to emerge. In summary, sex is increasingly recognized as a critical determinant of health and disease, particularly relevant to the topical COVID-19 pandemic. Morbidity and mortality from COVID-19 are greater for males, however, the mechanisms for this difference are unclear. Understanding the differences in outcomes between males and females improve the effectiveness of health interventions. However, outcomes of the neurologic complications of infectious disease may be partially explained by sex differences in immune responses. With this narrative, we intend to provide the reader with a comprehensive coverage of where we currently stand regarding sex differences specific, especially on outcomes critical neurologic manifestations of the SARS-CoV-2 infection.