Disparities In Health-related Quality Research Articles

Gender Disparities in Quality of Life Outcomes Among Kidney Stone Formers.

Purpose: This study investigates gender-based disparities in health-related quality of life (HRQOL) outcomes among kidney stone patients and explores potential contributing factors. Methods: A retrospective review of medical records at the University of Rochester Medical Center was conducted on 2199 new urolithiasis patients who completed the Wisconsin Stone Quality of Life Questionnaire (WISQOL) standardized on a 0 to 100 scale. Demographic and clinical data were collected. Statistical analyses included univariate tests, chi-squared tests, and multivariate linear regression. Results: Of the 2199 kidney stone patients, 1085 (49.3%) were women. Women reported significantly lower quality of life (QoL) scores compared with men (71.6 vs 80.7; p < 0.001), and this persisted across all domains, including social impact (80.2 vs 86.9; p < 0.001), emotional impact (67.3 vs 77.1; p < 0.001), disease impact (67.3 vs 77.1; p < 0.001), and impact vitality (62.6 vs 72.9; p < 0.001). Female gender was identified as an independent predictor of diminished QoL scores, along with younger age, symptomatic status, number of surgeries, and presence of a psychosocial comorbidity. Conclusions: Our findings suggest that women with kidney stones experience lower HRQOL compared with men, even accounting for clinical and demographic factors. Although this study provides preliminary insights, additional research is needed to validate these findings in broader and more varied populations.

Military service and health-related quality of life among gay and bisexual prostate cancer survivors: Results from the Restore-2 study

IntroductionThere are notable disparities in health-related quality of life (HRQOL) between gay and bisexual men (GBM) and heterosexual patients with prostate cancer (PCa); however, the role of past military service...

Abstract WP97: Disparities in Health-Related Quality of Life Among Adults With Heart Disease, Stroke, and Both Conditions

Background: Notable racial and ethnic disparities exist in cardiovascular disease (CVD) and stroke epidemiology; however, few studies have assessed the disparate quality of life (QOL) among individuals living with CVD, stroke, or both. This study evaluated the impact of these conditions on health related QOL (HRQOL) and quantified demographic disparities. Methods: Using data from the 2021 National Health Interview Survey (NHIS), we calculated the Health and Activity Limitation Index (HALex)—a generic HRQOL measure comprising perceived health and activity limitations—for 29,482 adults. Stratified analysis and ordinary least-squares regressions were used to adjust for sex, age, income, education, urbanicity, marital status, household size, region of residence, and insurance status. Differences in HRQOL were estimated across racial and ethnic groups with and without CVD, stroke, or both conditions. To test the robustness of study findings, analyses were repeated using the EQ-5D. Results: Adjusted HRQOL was lower for Blacks (-0.014, SE=0.004) and Hispanics (-0.012, SE=0.003) compared to Whites. Compared those with neither CVD nor stroke, individuals with CVD only (-0.21, SE=0.015), stroke only (-0.29, SE=0.028), and both conditions (-0.44, SE=0.040) had 20% to 44% lower HRQOL. Even after for age, income, education, and income, diagnosis with stroke only (-0.19, SE=0.081), CVD only (-0.12, SE=0.051), or both (-0.44, SE=0.040) lowered the HRQOL more for Blacks than Whites, while other racial/ethnic groups showed no statistically significant difference HRQOL. In general, geographic location, sex, and household composition had little impact on HRQOL, but higher age, lower educational attainment, and low/middle income was associated with significant reductions in HRQOL. Conclusion: CVD and stroke were independently associated with significantly low HRQOL, their co-occurrence has a substantially negative impact on HRQOL for all individuals particularly Blacks who had the largest HRQOL impact in all three condition groups. Findings suggest that public health interventions should be aimed at improving HRQOL among individuals diagnosed with these conditions, especially the most vulnerable groups.

Racial and Ethnic Disparities in Health-Related Quality of Life in Older Adults with Non-Hodgkin Lymphoma.

To investigate whether health-related quality of life (HRQOL) disparities exist among different racial and ethnic groups in older patients with Non-Hodgkin Lymphoma (NHL), pre- and post-diagnosis. Using the Surveillance, Epidemiology, and Ends Results-Medicare Health Outcomes Survey (SEER-MHOS) linked database, we included individuals 65 years and older with NHL and reported ethnicities of Whites, Asian, Black, and Hispanic, diagnosed from 1998-2019. HRQOL data within 24 months before and after diagnosis were measured by the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores from the SF-36® and VR-12 instruments. The total combined score (TCS) is reflected by both the PCS and MCS. Multivariate analyses (MVA) adjusted for sex, age, marital status, education, income, year of diagnosis, number of comorbidities, limitations in activities of daily living (ADLs), national region, treatment type (post-diagnosis cohort only), stage, and histology. We identified 2506 patients in the pre-diagnosis and 1903 patients in the post-diagnosis cohorts. In the pre-diagnosis cohort, univariate analysis (UVA) revealed that Whites had higher MCS scores than Asians (53.4 vs 50.2, p = 0.001), Blacks (53.4 vs 48.3, p<0.001), and Hispanics (53.4 vs 49.9, p<0.001). It was also revealed that Whites had higher PCS scores than Blacks (40.5 vs 37.4, p = 0.005), Whites had higher TCS scores than Blacks (93.4 vs 85.1, p<0.0001) and Hispanics (93.4 vs 87.3, p<0.0001), and Asians had higher TCS scores than Blacks (90.5 vs 85.1, p = 0.012). MVA revealed the following: Whites had higher MCS scores than Asians (52.3 vs 50.0, p = 0.038), Blacks (52.3 vs 49.1, p = 0.002), and Hispanics (52.3 vs 49.8, p = 0.005); Whites had higher TCS scores than Blacks (92.5 vs 87.9, p<0.006) and Hispanics (92.5 vs 88.6, p = 0.006); and Asians had higher TCS scores than Blacks (92.6 vs 87.9, p = 0.045). In the post-diagnosis cohort, UVA revealed that Whites had higher PCS scores than Hispanics (36.2 vs 34.1, p = 0.046); Whites had higher MCS scores than Asians (51.3 vs 48.8, p = 0.035), Blacks (51.3 vs 48.7, p = 0.033), and Hispanics (51.3 vs 46.7, p<0.0001); Whites had higher TCS scores than Blacks (87.0 vs 82.3, p = 0.021) and Hispanics (87.0 vs 78.5, p<0.0001); and Asians had higher TCS scores than Hispanics (86.5 vs 78.5, p = 0.001). MVA revealed that Whites had higher MCS scores than Hispanics (47.6 vs 44.0, p = 0.002); Whites had higher TCS scores than Hispanics (83.5 vs 76.5, p<0.0001), and Asians had higher TCS scores than Hispanics (83.7 vs 76.5, p = 0.006). HRQOL disparities exist among different racial and ethnic groups in older patients with NHL. Pre-diagnosis, Whites had better mental HRQOL compared to Asians, Blacks, and Hispanics. Whites also had better overall HRQOL as compared to Blacks and Hispanics, and Asians had better overall HRQOL than Blacks. Post-diagnosis, Whites had better mental and overall HRQOL than Hispanics, and Asians had overall better HRQOL than Hispanics.

Trends in Racial and Ethnicity Disparities in the Health-Related Quality of Life in Older Adults with Breast Cancer: A SEER-MHOS National Database Study

To examine racial and ethnic disparities in Health-Related Quality of Life (HRQOL) in older adults with breast cancer, both pre- and post-diagnosis. Using the Surveillance, Epidemiology and End Results-Medicare Health Outcomes Survey (SEER-MHOS) database, we included patients > 65 years old with breast cancer diagnosed from 1998-2019, who had completed the Health Outcomes Survey within 24 months pre- and post-diagnosis, and who had a reported ethnicity of non-Hispanic White (W), non-Hispanic Asian or Pacific Islander (API), non-Hispanic Black or African American (B), or Hispanic (H). HRQOL data was measured by the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores from the Medical Outcomes Study Short Form-36 and the Veterans RAND 12-Item Health Survey instruments. Univariable (UVA) and multivariable (MVA) linear regression models were fitted for MCS, PCS, and TCS (composite MCS and PCS) as response variables to assess for potential disparities between races and ethnicities. MVA models were adjusted for sex, age, marital status, education, income, number of comorbidities, limitations in activities of daily living, national region, histology, and treatment type (in post-diagnosis cohort only). We identified 1,008 in the pre-diagnosis cohort (56.6% stage I, 29.8% stage II, 9.3% stage III, and 4.3% stage IV) and 991 patients in the post-diagnosis cohort (58.3% stage I, 28.6% stage II, 9.3% stage III, 3.8% stage IV). On UVA, differences in mean scores of TCS, PCS, and MCS, respectively, were found among W, API, B, and H patients in both pre-diagnosis and post-diagnosis cohorts (pre-diagnosis - TCS: 93.4, 93.0, 87.0, 86.3; PCS: 40.3, 40.0, 37.0, 37.5; MCS: 53.1, 52.9, 50.0, 48.7; post-diagnosis - TCS: 90.8, 90.3, 84.3, 83.5; PCS: 38.5, 39.2, 36.8, 34.5; MCS: 52.3, 51.1, 49.8, 46.8; all p < .001). A drop in PCS, MCS, and TCS scores numerically was observed for all groups. Among patients in the pre-diagnosis cohort who would be diagnosed with stage IV breast cancer, race was found to be a predictor of PCS with overall significance (p = 0.04) within MVA linear regression. Specifically, on the local test, compared to B, W had higher pre-diagnosis PCS scores (+13.32, p = 0.03). Race was not found to be a predictor in PCS, MCS, or TCS scores otherwise. Among older patients who would be diagnosed with stage IV breast cancer, W had better physical HRQOL as compared to B patients' pre-diagnosis. The decrease in numerical HRQOL scores of the physical domain in all groups post-diagnosis highlights the potential negative physical impact breast cancer has on patients, demonstrating the need for determining the proper resources and support to improve physical HRQOL following diagnosis.

Racial and Ethnic Disparities in Health-Related Quality of Life for Patients with Colorectal Cancer: Analysis of the SEER-MHOS Linked Data Set

We hypothesized that racial and ethnic disparities exist in health-related quality of life (HRQOL) among older adults with colorectal cancer, both before and after diagnosis. The Surveillance, Epidemiology, and End Results and Medicare Health Outcomes Survey (SEER-MHOS) linked data set was used to identify patients 65 years old and above who were diagnosed with colorectal cancer between 1996 and 2015. Self-reported race/ethnicity, the predictor of interest, was categorized as White (W), Asian/Pacific Islander (API), Black/African American (B), or Hispanic (H). HRQOL data from the 36-Item Short Form Survey and Veterans RAND 12-Item Health Survey were extracted within 24 months pre- and post-diagnosis. HRQOL was measured using the Physical Component Summary (PCS), Mental Component Summary (MCS), and Total Component Summary (TCS, a summation of PCS and MCS), which were the response variables. Associations were assessed via univariable (UVA) and multivariable (MVA) linear regression analysis, adjusting for age, sex, region, marital status, education, income, number of comorbidities, limitations in activities of daily living, stage, and histology. Pairwise comparisons were performed between all racial and ethnic groups. We identified a total of 1,204 evaluable patients, with 815 in the pre-diagnosis cohort and 562 in the post-diagnosis cohort, including 173 patients in both. With unadjusted p-values, pre-diagnosis UVA revealed a higher mean PCS in API patients compared to W, B, and H patients (p<0.001, p<0.001, p = 0.02) as well as in W compared to H patients (p = 0.002); a higher mean MCS in W and API patients compared to B (p<0.001, p = 0.002) and H patients (p<0.001, p = 0.002); and a higher mean TCS in API compared to W, B, and H patients (p = 0.027, p<0.001, p<0.001) as well as in W compared to B and H patients (p<0.001, p = 0.012). Pre-diagnosis MVA revealed a higher mean PCS in API compared to B patients (p = 0.028) and a higher mean MCS in W and B compared to H patients (p = 0.022, p = 0.021). Post-diagnosis UVA showed a higher mean MCS in W compared to B and H patients (p<0.001 for both) as well as in API compared to H patients (p = 0.002), and a higher mean TCS in W and API patients compared to B (p<0.001, p = 0.045) and H patients (p<0.001, p = 0.007). Post-diagnosis MVA showed a higher mean MCS in API compared to H patients (p = 0.035). Compared to pre-diagnosis, post-diagnosis mean TCS was numerically lower for all groups. Among older adults with colorectal cancer, there appear to be racial and ethnic disparities in HRQOL. Before the cancer diagnosis, API patients had better physical HRQOL than B patients, while W and B patients had better mental HRQOL than H patients. After diagnosis, API patients had better mental HRQOL than H patients. For all groups, the cancer diagnosis seemed to have a negative impact on overall HRQOL.

Impact of postoperative sexual function on health-related quality of life after robot-assisted radical prostatectomy.

We investigated potential disparities in health-related quality of life, particularly concerning urinary function, between patients with preserved and those with impaired sexual function after robot-assisted radical prostatectomy (RARP). Between December 2012 and April 2020, 704 men underwent RARP in our hospital. This study included 155 patients with a preoperative 5-item International Index of Erectile Function (IIEF-5) of ≥12 points and an assessable IIEF-5 at 12 months postoperatively. Health-related quality of life was assessed using the 8-item Short-Form Health Survey and Expanded Prostate Cancer Index Composite (EPIC) preoperatively and at 3, 6, and 12 months postoperatively. A logistic regression analysis and Wilcoxon rank sum tests were performed. Patients were grouped according to the median IIEF-5 score 12 months after surgery: those with preserved sexual function (n = 71) and those with impaired sexual function (n = 84). The mental component summary of the 8-item Short-Form Health Survey was better in the group with preserved sexual function at 6 months postoperatively than in the group with impaired sexual function (p < 0.01). In the EPIC, the group with preserved sexual function performed better not only in the sexual domain but also in the urinary domain at all time points compared with the group with impaired sexual function (p < 0.01). In the comparison of the urinary subdomains of the EPIC, there were no significant differences in urinary function or incontinence, but there were significant differences in urinary distress and irritative/obstructive scores (p < 0.01). Patients with preserved postoperative sexual function after RARP showed better urinary function than those with impaired sexual function. Hence, preserved sexual function is closely associated with urinary function.

Disparities in Health-Related Quality of Life among Adults with Ischemic Heart Disease, Stroke, and Both Conditions

Background: Notable disparities exist in ischemic heart disease (IHD) and stroke outcomes. Studies have identified several causal factors that contribute to these disparities, but few have assessed the disparate quality of life (QOL) among individuals living with IHD, stroke, or both. This study evaluated the impact of IHD, stroke, and both conditions on health-related QOL (HRQOL) and quantified existing disparities. Materials and Methods: Using the data from the 2021 National Health Interview Survey, we calculated the health and activities limitation index — a generic HRQOL measure comprising perceived health and activities limitations — for 29,482 adults. Adjusting for sex, age, income, education, urbanicity, marital status, household size, region of residence, and insurance status, the differences in HRQOL between racial and ethnic groups were estimated as well as racial/ethnic differences in the HRQOL of IHD, stroke, or both conditions. Results: Compared to those with neither condition, individuals with IHD (−0.214, Standard Error (SE)=0.015, stroke (−0.291, SE=0.028), and both (−0.438, SE=0.040) had 20% to 44% lower HRQOL. Blacks (−0.014, SE=0.004) and hispanics (−0.012, SE=0.003) had lower HRQOL compared to whites even after sample heterogeneity. Diagnosis with stroke (−0.182, SE=0.082), IHD (−0.137, SE=0.052), or both (−0.208, SE=0.126) lowered the HRQOL more for black individuals compared to white individuals, while other subgroups showed no statistically significant difference in HRQOL. In general, sex, age, and household composition showed little difference in adjusted HRQOL. Conclusion: While IHD and stroke are independently associated with significantly low HRQOL, their co-occurrence has a substantially negative impact on HRQOL, particularly among minoritized racial groups.

Gender disparities in health-related quality of life (HRQoL) in patients with cutaneous T-cell lymphoma.

To investigate potential gender differences in HRQoL for patients with CTCL. We performed a cross-sectional study to assess HRQoL in patients with CTCL by partnering with the Cutaneous Lymphoma Foundation to distribute an electronic survey from February to April 2019. A total of 292 patient responses (66% women, mean age 57 years) were included in the analysis. Most of the cohort had early-stage (IA-IIA) (74%; 162/203) mycosis fungoides (MFs) (87%; 241/279), followed by Sézary syndrome (SS) (12%; 33/279). Women with CTCL experienced significantly worse HRQoL compared with men (Skindex-16: 51±26 vs. 36±26, P ≤ 0.001; FACT-G: 69±21 vs. 77±16, P = 0.005). This gender difference was present even when controlling for stage of disease. Women experienced worse HRQoL in all three of the Skindex-16 subscales (symptoms: β = 14.0, P ≤ 0.001; emotions: β = 15.1, P ≤ 0.001; functioning: β = 11.3, P = 0.006), but only two of the four FACT-G subscales (physical: β =-2.8, P ≤ 0.001; emotional: β = -2.0, P = 0.004). Due to the method of distribution of the survey, we were unable to estimate a participant response rate. Participants' diagnosis and stage were self-reported. In this cohort women with CTCL experienced significantly worse HRQoL when compared to men. Additional studies are necessary to determine what factors contribute to this gender disparity.

Disparities in health-related quality of life among lesbian, gay, and bisexual cancer survivors

Objective This study compared health-related quality of life (HRQOL) among lesbian, gay, and bisexual (LGB) cancer survivors and their heterosexual counterparts in a US population-based sample of cancer survivors. Methods The study utilized data from the All of Us research program. LGB survivors (n = 885) were matched for age, gender identity, marital status, income, education, and cancer site with heterosexual survivors (n = 885) using 1:1 propensity matching. Physical, mental, and social HRQOL were assessed with items from the Patient-Reported Outcomes Measurement Information System (PROMIS). Results Relative to heterosexuals, LGB cancer survivors reported lower HRQOL in mental and social domains, but not in physical HRQOL. Older age was associated with higher HRQOL across domains. LGB survivors identifying as Black/African American were more likely to experience lower social HRQOL than White survivors. Conclusions This study highlights several disparities in HRQOL that exist between LGB and heterosexual cancer survivors.

Socio-demographic disparities in health-related quality of life after hip fracture in China: evidence from the China Health and Retirement Longitudinal Study.

Hip fractures cause high mortality and worsened health-related quality of life (HRQoL). This study aimed to investigate whether socio-demographic-related inequities in post-hip fracture participants' HRQoL exist in China. Data from the China Health and Retirement Longitudinal Study (waves 2013, 2015, and 2018) were used. The measurement of HRQoL in this study focused on 5 health dimensions: depression, body pain, mobility, basic activities of daily living, and instrumental activities of daily living. A difference-in-differences (DID) analysis with multiple time periods was performed to gauge the impact of hip fracture on HRQoL. A multivariate regression approach was used to explore socio-demographic-related factors associated with inequities of HRQoL. A total of 23,622 individuals were included, and 341 participants reported hip fracture events during the survey period. In participants with hip fracture, the presentation rate of body pain increased by 14% (p < 0.01) and the HRQoL of other health dimensions worsened (p ≤ 0.01) after hip fracture. The DID analysis showed that hip fracture had a negative impact on all HRQoL dimensions (p < 0.01). Socioeconomic-related factors of HRQoL inequities included school education level and location of residence. Study participants with hip fracture with greater educational attainment or living in urban areas had higher (p < 0.05) levels of HRQoL. In addition, comorbidities also correlated with a worse HRQoL (p < 0.05). Hip fracture significantly affects people's HRQoL in China, and the impact is more profound for those with lower educational attainment or living in rural areas. Targeted interventions should be designed to narrow this inequity.

Abstract A038: Racial disparities in health-related quality of life among cancer survivors in the United States

Abstract Background: There were an estimated 16.9 million cancer survivors in the United States (U.S.) in 2019. Since this number is projected to increase to over 22 million by 2030 and cancer survivors often face long-term challenges and late effects of treatment, it has become increasingly important to evaluate patients’ health-related quality of life in order to better understand their needs, identify disparities, and develop strategies to improve their overall well-being. Racial/ethnic differences in cancer survivorship have been previously reported, but few have evaluated quality of life among a nationally representative, population-based sample of U.S. patients. Methods: We used self-reported data from the Medical Expenditure Panel Survey (MEPS) as well as its Experience with Cancer Survivorship Supplement questionnaire from 2016-17, which collected information on patient experiences with cancer including quality of life based on the Patient-Reported Outcomes Measurement Information System (PROMIS) measures of physical and mental health. A Global Physical Health (GPH) score using questions related to physical health, physical function, fatigue, and pain and a Global Mental Health (GMH) score using questions related to quality of life, mental health, social support, and emotional problems were calculated where the lower the score indicated the poorer the health. In addition, questions related to whether cancer had a positive impact on patients were considered as well. Multiple logistic regression models with odds ratios (ORs) and 95% confidence intervals (CIs) were used to examine the impact of race on these various quality of life/cancer experience outcomes after considering relevant confounders. Results: A total of 1608 cancer survivors (1225 non-Hispanic Whites, 165 Hispanic Whites, 176 Blacks, 42 Asians) were included. When compared to non-Hispanic Whites, only Blacks were statistically significantly more likely to have a low GPH score (OR=1.95, 95% CI 1.15-3.27) and a low GMH score (OR=1.89, 95% CI 1.24-2.89). However, Blacks and Hispanic Whites were statistically significantly more likely to report their cancer experience leading to positive things in their lives; for example, both racial groups were three times as likely to report that their cancer helped them cope better with life’s challenges relative to non-Hispanic Whites (OR=3.66, 95% CI 2.34-5.73 for Blacks, OR=2.91, 95% CI 1.68-5.03 for Hispanic Whites). Conclusions: There are important racial disparities when it comes to health-related quality of life among cancer survivors. Although Blacks were more likely to see the positive aspects of their cancer diagnosis, they still experienced poorer physical and mental health overall. Future studies should explore the factors that may be contributing to these racial disparities as they could greatly inform targeted strategies to improve the overall survivorship experience of cancer patients. Citation Format: Alice W. Lee, Valerie Poynor, JinKyu Choi. Racial disparities in health-related quality of life among cancer survivors in the United States [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A038.

S987 Racial and Ethnic Disparities in Health-Related Quality of Life in Patients With Inflammatory Bowel Disease: Results From the National Health and Wellness Survey

S987 Racial and Ethnic Disparities in Health-Related Quality of Life in Patients With Inflammatory Bowel Disease: Results From the National Health and Wellness Survey

Symptoms and Comorbidities Differ Based on Race and Weight Status in Persons with HIV in the Northern United States: a Cross-Sectional Study

BackgroundPersons with HIV (PWHIV) on highly active antiretroviral treatments (HAART) may require specialized care based on health and demographic indicators. This study investigated the association of comorbidities, race, weight status, and gastrointestinal (GI) and cardiovascular (CV) symptoms among PWHIV.MethodsThe Symptom Checklist, Co-Morbidity Questionnaire, and Sociodemographic Questionnaire were used to assess weight status and GI and CV symptoms among 283 PWHIV. Data were analyzed using latent class analysis on John’s Macintosh Project 13 Platform.ResultsParticipants were majority Black (50%), 69% male, and 35% AIDS diagnosed. Ages were 25 to 66. Clusters included least symptomatic status, weight gain, and weight loss by Black and non-Black participants. The non-Black weight gain cluster reported a higher incidence of AIDS (70.6% vs 38.2%), nausea (70.6% vs 17.6%), diarrhea (70.6% vs 26.5%), and shortness of breath (58.8% vs 20.6%) compared to the Black weight gain cluster. The Black weight loss cluster reported a higher incidence of CV symptoms such as chest palpitations (42.2% vs 2.7%), chest pain (44.4% vs 8.1%), and shortness of breath (73.3% vs 35.1%). Moreover, the Black weight loss cluster reported a higher incidence of all GI symptoms with the most prominent being diarrhea (71.1% vs 48.6%) compared to the non-Black weight loss cluster.ConclusionsThe existing racial disparities in health-related quality of life for PWHIV may be improved through precision health and nutrition modifications. Continued research is needed investigating differential health outcomes among PWHIV on HAART.Clinical Trial Registration NumberNCT00222716. Registered 22 September 2005. Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT00222716?term=NCT00222716&draw=2&rank=1

Health literacy of ethnic minority in remote China: precise intervention is needed

Health literacy of ethnic minority in remote China: precise intervention is needed

Racial-Ethnic Differences in Health-Related Quality of Life among Adults and Children with Glomerular Disease

Introduction: Disparities in health-related quality of life (HRQOL) have been inadequately studied in patients with glomerular disease. The aim of this study was to identify relationships among race/ethnicity, socioeconomic status, disease severity, and HRQOL in an ethnically and racially diverse cohort of patients with glomerular disease. Methods: Cure Glomerulonephropathy (CureGN) is a multinational cohort study of patients with biopsy-proven glomerular disease. Associations between race/ethnicity and HRQOL were determined by the following: (1) missed school or work due to kidney disease and (2) responses to Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaires. We adjusted for demographics, socioeconomic status, and disease characteristics using multivariable logistic and linear regression. Results: Black and Hispanic participants had worse socioeconomic status and more severe glomerular disease than white or Asian participants. Black adults missed work or school most frequently due to kidney disease (30 vs. 16–23% in the other 3 groups, p = 0.04), and had the worst self-reported global physical health (median score 44.1 vs. 48.0–48.2, p < 0.001) and fatigue (53.8 vs. 48.5–51.1, p = 0.002), compared to other racial/ethnic groups. However, these findings were not statistically significant with adjustment for socioeconomic status and disease severity, both of which were strongly associated with HRQOL in adults. Among children, disease severity but not race/ethnicity or socioeconomic status was associated with HRQOL. Conclusions: Among patients with glomerular disease enrolled in CureGN, the worse HRQOL reported by black adults was attributable to lower socioeconomic status and more severe glomerular disease. No racial/ethnic differences in HRQOL were observed in children.

312 Gender disparities in health-related quality of life (HRQoL) in patients with cutaneous T-cell lymphoma

Patients with cutaneous T-cell lymphoma may experience impaired HRQoL due to pruritus, physical disfigurement, changes in functional status and distress associated with an incurable disease. Existing evidence is conflicting with comparison of HRQoL by gender. We performed a cross-sectional study to assess HRQoL in patients with CTCL by partnering with the Cutaneous Lymphoma Foundation to distribute an electronic survey from February-April 2019. A total of 292 patient responses (66% female, mean age 57y) were included in the analysis. Most of the cohort had early-stage (IA – IIA) (74%; 162/203) mycosis fungoides (MF) (87%; 241/279), followed by Sézary (SS) (12%; 33/279). As assessed by the Skindex-16 and Functional Assessment of Cancer Therapy-General (FACT-G), women with CTCL experience significantly worse HRQoL compared with men (Skindex-16*: 51±26 vs. 36±26, P=<.001; FACT-G: 69±21 vs. 77±16, P=.005). Women experience worse HRQoL in all three of the Skindex-16 subscales (symptoms: β=14.0, P=<.001; emotions: β=15.1, P=<.001; functioning: β=11.3, P=.006) but only two of the four FACT-G subscales (physical: β=-2.8, P=<.001; emotional: β=-2.0, P=.004). Women with CTCL experience a significantly worse HRQoL compared with men. This gender difference was present even when controlling for stage of disease. Further research is needed to disentangle what specific factors contribute to this gender disparity in CTCL. *In Skindex, higher is worse HRQoL; in FACT-G, lower is worse HRQoL.

Patterns of racial/ethnic disparities in baseline health-related quality of life and relationship with overall survival in patients with colorectal cancer.

Racial disparities are evident in colorectal cancer (CRC) prognosis with black patients experiencing worse outcomes than Hispanics and whites, yet mediators of these disparities are not fully known. The aim of this study is to identify variables that contribute to racial/ethnic disparities in health-related quality of life (HR-QoL) and overall survival in CRC. Using SF-12 questionnaires, we assessed HR-QoL in 1132 CRC patients by calculating their physical (PCS) and mental composite summary (MCS) scores. Associations between poor PCS/MCS and sociodemographic factors were estimated and survival differences were identified by race/ethnicity. Hispanic patients who never married were at greater risk of poor PCS (OR 2.69; 95% CI 1.11-6.49; P = 0.028) than were currently married patients. College education was associated with a decreased risk of poor PCS in Hispanic and white, but not black, patients. Gender was significantly associated with poor MCS among white patients only. CRC patients who reported a poor PCS or MCS had poor survival, with differences in median survival times (MSTs) by race. The effect of PCS was strongest in white CRC patients with a difference in overall MST of > 116months between those with favorable versus poor physical HR-QoL. Black patients who reported poor Physical and Mental HR-QoL showed significant risk of a poor outcome. These findings suggest that racial/ethnic disparities in CRC survival may be related to differences in HR-QoL. Identified mediators of HR-QoL could supplement current CRC management strategies to improve patients' survival.

Disparities in health related quality of life among Illinoisans diagnosed with depressive disorder: findings from the 2017 BRFSS

BackgroundThe United States experienced severe mental health budget cuts in many states across the nation during the years of the largest recession since the Great Depression. Illinois had one of the hardest hit mental health budgets in the country. The massive mental health funding cuts in Illinois, combined with the state’s budget impasse, left fewer facilities available to provide treatment and support to those in need. Many of Illinois’s most vulnerable populations either had reduced access, or no access to care. Serious spillover effects were felt by emergency rooms, community hospitals, and the criminal justice system. Therefore, the purpose of this research is to examine disparities in Health Related Quality of Life for those with depression after the funding cuts in Illinois.MethodsData from the 2017 Behavior Risk Factor Surveillance System was analyzed by using multivariate logistic regression models of the Health Related Quality of Life measures for Illinoisans diagnosed with depressive disorders.ResultsAccording to the regression models in this study, disparities exist in HRQOL for Illinoisans with depressive disorders. In all of the HRQOL models, income was associated with a reduction in HRQOL. Additionally, disparities exist in HRQOL for certain age groups and those who are unemployed. Interestingly, the models did not show any racial disparities as anticipated.ConclusionWithout the basic policy-level deficiencies addressed, disparities in Health Related Quality of Life for Illinois’s most vulnerable populations will continue to exist as will costly economic spillover effects.

P.729 Overuse of central nervous system depressants in geriatric patients–characteristics of at-risk patients and disparities in health-related quality of life

Model discrimination identifies a mathematical model that usefully explains and predicts a given system’s behaviour. Researchers will often have several models, i.e. hypotheses, about an underlying system mechanism, but insufficient experimental data to discriminate between the models, i.e. discard inaccurate models. Given rival mathematical models and an initial experimental data set, optimal design of experiments suggests maximally informative experimental observations that maximise a design criterion weighted by prediction uncertainty. The model uncertainty requires gradients, which may not be readily available for black-box models. This paper (i) proposes a new design criterion using the Jensen-Rényi divergence, and (ii) develops a novel method replacing black-box models with Gaussian process surrogates. Using the surrogates, we marginalise out the model parameters with approximate inference. Results show these contributions working well for both classical and new test instances. We also (iii) introduce and discuss GPdoemd, the open-source implementation of the Gaussian process surrogate method.