Disparities In Treatment Research Articles

Disparities in management of symptomatic osteoporotic vertebral compression fractures: a nationwide multidisciplinary survey

SummaryThis nationwide multidisciplinary survey found dissatisfaction among physicians with current osteoporotic vertebral compression fracture care, revealing significant disparities in diagnosis, treatment, and follow-up practices. Issues include poor communication and differing guidelines. Improving interdisciplinary collaboration and standardized care strategies is essential for better patient outcomes.PurposeThis survey aims to assess current preferred care practices for symptomatic osteoporotic vertebral compression fractures (OVCF) in the Netherlands, focusing on guideline adherence, identifying knowledge gaps, and clarifying consensus and collaboration across medical disciplines in OVCF treatment.MethodsThis cross-sectional study was conducted via Qualtrics (Provo, UT) using a self-administered online survey distributed to 238 general practitioners and physicians in orthopedics, traumatology, internal medicine, rheumatology, and geriatrics working at 51 hospitals in the Netherlands. The survey, conducted in Dutch, included 36 multiple-choice and two open questions and was accessible via an anonymous email link or QR code. General practitioners received additional questions specific to their role. Data was anonymized, stored securely, and analyzed using descriptive statistics in Microsoft Excel and SPSS (Version 24). Open-ended responses were coded and categorized. The survey was conducted prior to the publication of the updated Federation of Medical Specialists guidelines in 2024.ResultsPhysicians across various disciplines uniformly expressed dissatisfaction with current OVCF care. The survey highlighted significant disparities in diagnosis, treatment, and follow-up practices. A lack of communication between primary and secondary care providers and differing guidelines further complicate OVCF management. These issues point to considerable variation in clinical practice and gaps in interdisciplinary collaboration.ConclusionAddressing the identified issues requires fostering interdisciplinary collaboration and creating cohesive care strategies. Ensuring access to diagnostic resources in both primary and secondary care and establishing coordinated care models promises more structured and standardized treatment. These steps are crucial for enhancing patient outcomes in OVCF management.

Comparing Black and White Patients in Treatment of Advanced Prostate Cancer and Survival in an Equal Access Health System.

Racial disparities in prostate cancer treatment and survival in the U.S. have been attributed to differences in access to care and medical insurance. We aimed to compare treatment and survival of advanced prostate cancers between White and Black men in the equal access Military Health System (MHS). We accessed the MilCanEpi database to study a cohort of non-Hispanic White and Black men diagnosed with stage III or IV prostate cancer between 1998 and 2014 in the MHS. The racial groups were compared in receiving curative treatment of radical prostatectomy (RP) only, RP with (neo)adjuvant radiation or hormone therapy, radiation only, or combination radiation and hormone therapy; and overall survival using multivariable regression models. The study included 1476 White and 531 Black men. Overall, there was no racial difference in receiving any curative treatment (AOR = 0.85, 95% CI = 0.67, 1.08 for Black vs. White). By treatment type, Black men were statistically as likely to receive RP only (AOR = 0.87, 95% CI = 0.67, 1.14), radiation only (AOR = 0.81, 95% CI = 0.49, 1.34), or combination radiation and hormone therapy (AOR = 1.12, 95% CI = 0.71, 1.78) but statistically less likely to receive RP with (neo)adjuvant treatment (AOR = 0.56, 95% CI = 0.37, 0.86) relative to no curative treatment compared to White men. The difference in RP with (neo)adjuvant treatment was also statistically significant among patients with stage III tumors, but not stage IV. Survival was similar overall (AHR = 1.12, 95% CI = 0.88, 1.42 for Black vs. White) and when evaluated by tumor stage. In the MHS, the overall likelihood to receive any treatment for advanced prostate cancers and survival was similar between races, which might result from universal health care. Racial differences in receipt of RP with (neo)adjuvant treatment, especially for patients with stage III prostate cancer, may be related to factors other than access to care and warrants further research.

Representation of women and racial minorities in SGLT2 inhibitors and heart failure clinical trials

BackgroundInadequate representation of women and racial minorities in heart failure (HF) clinical trials continues to limit the generalizability of the results. This could create a disparity in treatment for future heart failure therapies and devices. The study aims to assess the representation of women and racial minorities in recent heart failure studies involving sodium-glucose cotransporter-2 (SGLT-2) inhibitors. MethodsPubMed was used to search randomized controlled trials (RCTs) looking at SGLT-2 inhibitors and heart failure, which were published from inception to August 2024. ResultsA total of 43 RCTs with 27,703 participants were identified. The studies were published between 2018 and 2024. Seven studies (41 %) were multi-country, with 45 countries represented. The overall proportion of women enrolled in the studies was 35.6 %. The proportion of women was 24.06 % in studies that recruited only patients with HFrEF, 44.33 % in those that recruited only patients with HFpEF, and 41.4 % in those that recruited both HFrEF and HFpEF. Data on race was partially reported in 25 studies (58 %). 76 % of the pharmaceutical industry-funded studies reported race data. However, only 33.3 % of the unfunded or non-industry-funded studies reported race data. In the studies that reported race data, 72.91 % were Caucasians, 15.48 % were Asians, 5.62 % were African-American and 4.1 % were mixed race or others.In the bivariate analysis, race was more likely to be reported in studies done in the US (p < 0.001), multi-country studies (p = 0.013), and studies sponsored by pharmaceutical companies. More than a third of the study participants were more likely to be women in more recently published studies than older studies (p < 0.001). Additionally, more than a third of the study participants were more likely to be women in studies done in the US (p = 0.055). The multivariate analysis showed an increased odds of having more than a third of the study participants being women in more recently published studies (OR 1.83, 95 % CI 1.06–3.17, p = 0.031) and in studies done in the US (OR 7.69, 95 % CI 1.53–38.59, p = 0.013). ConclusionOur study found that women and racial minority individuals have remained underrepresented in recent heart failure studies. Although some progress has been made over the years, more work is needed to improve data reporting and address barriers to enrollment for women and racial minority individuals in clinical trials.

AS ENTRELINHAS DO CONTRATO BANCÁRIO: UMA ANÁLISE DOS RISCOS DE TAXAS ABUSIVAS

This study aimed to analyze, through a bibliographic review, the legislative framework ruling banking contracts in Brazil, highlighting the inconsistencies stemming from abusive fees and onerous clauses in banking operations. In Brazil, the definitions of abusive clauses in contracts are determined by the Civil Code and the Consumer Defense Code, under which agencies such as the Central Bank of Brazil (BCB), the Delegacia do Consumidor and PROCON operate to uphold the principle of good faith. It was concluded that the imposition of a series of contractual parameters inaccessible to borrowers by financial institutions generates inequities and disparities in treatment that are incompatible with the economic order. The research might provide preventive and protective precautions to consumers confronted with banking contracts, this way assisting at the divulgation of secure economic practices and avoiding the overcrowding of the Judiciary with processes entailed by leonine clauses and abusive fees.

Comparing ‘fair’ machine learning models for detecting at-risk online gamblers

ABSTRACT Researchers have worked to develop machine learning models that detect at-risk online gamblers, enabling personalized harm prevention tools. However, existing research has not evaluated these models’ potential to reinforce or amplify sociodemographic biases leading to treatment disparity, a recognized issue in the machine learning field. We sought to develop and compare three examples of potentially fair models using online gambling data. In two large samples of transaction data from a provincially owned Canadian gambling website (N1 = 9,145, N2 = 10,716), we developed three machine learning models based on competing concepts of fairness: fairness via unawareness, classification parity, and outcome calibration. We hypothesized that significant relationships existed between reporting a high risk of past-year gambling problems (the dependent variable) and participants’ age and sex. Further, we hypothesized that the three ‘fair’ models would show differing levels of classification performance both in aggregate and within sociodemographic groups. Significant age and sex effects were found, refuting the fairness via unawareness modeling strategy. Superiority across all performance metrics was not present for either of the remaining models. For the fairest practices in any jurisdiction, classification parity and outcome calibration models should be tested in situ, and incorporate the perspectives and preferences of end users who will be affected.

Sociodemographic Influence on the Management of Orofacial Cleft in Urban and Rural Indonesia.

To explore the social experiences of orofacial cleft patients and contextualize sociodemographic influence on management disparities in rural and urban areas of Indonesia. This study explores patients' lives in two demographical settings in South Sulawesi Province, Makassar and Selayar Islands Regency. It employs ethnography, including open-ended interviews and observations of patients, their neighborhoods, schools, and workplaces. Secondary data from the two regencies and South Sulawesi province are employed to demonstrate demographic disparities in patient care between urban and rural areas. Thematic content analysis was performed according to socio-demographical differences and networks involved in the management. This study engaged a diverse group of participants, including patients, family caregivers, medical team members, and patient peers (n = 40), primarily from middle to low-income families. Parents in both regions had limited knowledge about treatment modalities, which resulted in concerns regarding the safety of surgical procedures and the postponement of mandatory surgeries. In rural areas, patients faced significant financial burdens when referred to Makassar. In contrast to parents in Selayar, parents in Makassar prioritized more social interaction to ensure that their children attended school, college, and work. Patients in both settings reported facing various obstacles at different stages of their lives. Sociodemographic conditions contribute to disparities in treatment, social positioning, and self-perception. Promoting education about the safety of medical and rural surgical procedures is vital. Involving patients in public activities and providing support from family caregivers is paramount to nurturing patients' optimistic outlooks.

Treatment and Survival Disparities in Asian Americans With Hepatocellular Carcinoma

Background: Hepatocellular carcinoma (HCC) is one of the leading causes of cancer death in the United States and globally. The Asian American, Native Hawaiian, and Pacific Islander (AANHPI) population has often been studied as one homogenous cohort despite its heterogeneity. We aim to understand differences in treatment modality and mortality among AANHPI patients with early-stage HCC. Methods: The National Cancer Database was queried between 2004 and 2019. Patients with early-stage HCC eligible for liver transplantation (LT) were included. AANHPI patients were further disaggregated into subgroups, and non-Hispanic White (NHW) patients were included as reference. χ2 was used for categorical variables and the Student t test was used for continuous variables. Survival curves were generated using Kaplan-Meier estimates. Results: A total of 3039 (8.5%) AANHPI and 32,845 (91.5%) NHW were included. Among the AANHPI, 1368 (45.0%) were East Asian (EA), 1229 (40.4%) were Southeast Asian (SEA), 302 (9.9%) were South Asian (SA), and 140 (4.6%) were Native Hawaiian and other Pacific Islander (NHPI). Compared with NHW, AANHPI patients were less likely to undergo LT but had lower mortality. When disaggregated, SA patients were more likely to receive LT (HR: 2.70), and SEA (HR: 1.43) and NHPI (HR: 1.90) patients had higher mortality when compared with EA, all P&lt;0.01. Conclusions: AANHPI with early-stage HCC had better survival as a cohort. However, when disaggregated, there were notable disparities among different subgroups. AANHPI represents an incredibly diverse group of individuals, and it is imperative for physicians, researchers, and policy makers to appreciate the true heterogeneity of this population.

Revealing the impact of social circumstances on the selection of cancer therapy through natural language processing of social work notes.

We aimed to investigate the impact of social circumstances on cancer therapy selection using natural language processing to derive insights from social worker documentation. We developed and employed a Bidirectional Encoder Representations from Transformers (BERT) based approach, using a hierarchical multi-step BERT model (BERT-MS), to predict the prescription of targeted cancer therapy to patients based solely on documentation by clinical social workers. Our corpus included free-text clinical social work notes, combined with medication prescription information, for all patients treated for breast cancer at UCSF between 2012 and 2021. We conducted a feature importance analysis to identify the specific social circumstances that impact cancer therapy regimen. Using only social work notes, we consistently predicted the administration of targeted therapies, suggesting systematic differences in treatment selection exist due to non-clinical factors. The findings were confirmed by several language models, with GatorTron achieving the best performance with an area under the receiver operating characteristic curve (AUROC) of 0.721 and a Macro F1 score of 0.616. The UCSF BERT-MS model, capable of leveraging multiple pieces of notes, surpassed the UCSF-BERT model in both AUROC and Macro-F1. Our feature importance analysis identified several clinically intuitive social determinants of health that potentially contribute to disparities in treatment. Leveraging social work notes can be instrumental in identifying disparities in clinical decision-making. Hypotheses generated in an automated way could be used to guide patient-specific quality improvement interventions. Further validation with diverse clinical outcomes and prospective studies is essential. Our findings indicate that significant disparities exist among breast cancer patients receiving different types of therapies based on social determinants of health. Social work reports play a crucial role in understanding these disparities in clinical decision-making.

Dismantling Racism in Research Methods and Practices

Dismantling racism in American psychology has recently emerged as a critical goal of the field accompanied by actionable steps being developed in training, research, and practice. To contribute to this significant undertaking, we offer an exploration of the impact of racism on psychological research methods and practices using the ABC model. First, antecedents to the present manifestation of the problem are identified as an advancement of research topics that supported a hereditary hierarchy based on race, the normalization of White participants as standard in comparative studies, and the use of biased measures to investigate various constructs, particularly as it relates to psychological testing. Second, sampling bias is discussed as a systemic behavior that produces racism in psychological research methods; specifically, issues of omission and commission are described along with the use of WEIRD samples and the role of implicit bias in the limited production of knowledge on people of color. Third, the antecedents and behaviors give way to consequences that include threats to cultural validity, unequal treatment and health disparities, and epistemic oppression in the field. We end with recommendations for avoiding a continuation of the field’s racist legacy in present-day psychology.

Standardization through education of molecular pathology: a spotlight on the European Masters in Molecular Pathology.

Despite advancements in precision medicine, many cancer patients globally, particularly those in resource-constrained environments, face significant challenges in accessing high-quality molecular testing and targeted therapies. The considerable heterogeneity in molecular testing highlights the urgent need to harmonize practices across Europe and beyond, establishing a more standardized and consistent approach in MP laboratories. Professionals, especially molecular pathologists, must move beyond traditional education to cope with this heterogeneity. This perspective addresses critical issues in molecular pathology (MP), such as limited access to high-quality molecular testing, leading to disparities in cancer treatment, and the consequences of inconsistent practices. Recognizing the necessity for a standardized framework for education to address these issues, educational programs play a pivotal role in updating professionals' skills to achieve standardization in MP. European experts from the Steering Committee, the Pathology Section of the European Union of Medical Specialists, and the European Society of Pathology have proposed creating a comprehensive Master's degree program called the "European Masters in Molecular Pathology" (EMMP). This program emerges as a strategic response to the demand for a specialized and standardized framework for education in MP, catering to professionals who concurrently work and study. The program's design aligns with evidence-based education methods, ensuring effective learning and engagement while integrating computational pathology to analyze complex molecular data, enhance diagnostic accuracy, and improve treatment outcomes. EMMP's structured curriculum, strategic partnerships, and regular updates underscore its significance in standardizing MP practices. Exploring future developments, this perspective delves into technology integration and interdisciplinary collaboration, anticipating ongoing advances and harmonization. Challenges and future directions in MP education are discussed, emphasizing the necessity for dynamic curriculum updates, seamless technology integration, and interdisciplinary cooperation. This perspective underscores EMMP's pivotal role in preparing pathologists for this dynamic field, advocating continuous advancements in education and training to uphold excellence in MP practices and maintain the highest patient care standards.

A-271 Expansion of sample viability for self-collected urine specimens containing CT/NG &amp; TV/MG utilizing the Roche cobas® 6800 System

Abstract Background The CDC estimates that 1 in 5 Americans have an STI. Home collection for STIs could help mitigate the stigma, cost, and accessibility, which contribute to low diagnosis rates and disparities in diagnosis and treatment. Home self-collected specimens occasionally arrive in the lab with volumes higher or lower than what is required by the assay manufacturer’s specifications for self-collection. This study demonstrates that sample stability is retained after temperature fluctuation via shipping - even when the correct ratio of buffer to sample has been disturbed, a precise and accurate measurement persists. Our goal is to improve accessibility to discreet, patient collected STI tests. Methods Positive samples were prepared by spiking negative urine with organisms near the manufacturer’s limit of detection (LoD). Properly collected samples were aliquoted into tubes with 5mL volumes as per manufacturer specifications. Improperly collected samples were either overfilled (9mL for CT/NG, 7mL for TV/MG) or underfilled (1mL for CT/NG, 2mL for TV/MG). Samples underwent temperature cycling to mimic summer or winter shipping conditions. Ambient temperature studies were conducted on over/underfilled specimens. All samples were baseline tested and compared qualitatively to the manufacturer's claimed LoD using the Roche c6800 and the IVD assays for CT/NG &amp; TV/MG. Results Improperly filled samples were stable at ambient temperature for 63 days for CT/NG, and 59 days for TV/MG. See chart for temperature cycling results. All samples (n=164) showed 100% qualitative agreement with their baseline result after summer and winter shipping challenges. Conclusions Urine samples that fail to satisfy the manufacturer’s self-collection specifications or have endured temperature fluctuations still yield accurate CT/NG &amp; TV/MG results. These results indicate the potential to enhance sample viability and patient accessibility utilizing validated IVD assays.

Racial and Ethnic Disparities in Hepatitis C Care in Reproductive-Aged Women With Opioid Use Disorder.

In the United States, hepatitis C virus (HCV) diagnoses among reproductive-aged women are increasing amidst the ongoing opioid and drug overdose epidemic. While previous studies document racial and ethnic disparities in HCV testing and treatment in largely male populations, to our knowledge no national studies analyze these outcomes in reproductive-aged women with opioid use disorder (OUD). We analyzed data from a cohort of reproductive-aged women (aged 15-44 years) with diagnosed OUD captured in the TriNetX Research Network, a network of electronic health records from across the United States. Using a log-binomial model, we assessed differences in achieving HCV cascade of care stages (HCV antibody testing, HCV infection [positive HCV RNA test result], linkage to care, and HCV treatment) by race and ethnicity. From 2014 to 2022, 44.6% of the cohort were tested for HCV antibody. Asian and black/African American individuals had a lower probability of having an HCV antibody test than white individuals (risk ratio, 0.77 [95% confidence interval, .62-.96] and 0.76 [.63-.92], respectively). Among those with HCV infection, only 9.1% were treated with direct-acting antivirals. Hispanic/Latinx individuals had a higher probability of treatment than non-Hispanic/Latinx individuals (risk ratio, 1.63 [95% confidence interval, 1.01-2.61]). Few reproductive-aged women with OUD are tested or treated for HCV. Disparities by race and ethnicity in HCV testing further exacerbate the risk of perinatal transmission and disease progression among minoritized communities. Interventions are needed to improve overall rates of and equity in HCV screening and treatment for reproductive-aged women.

Racial Disparities in Cancer Guideline-Concordant Treatment Using Surveillance, Epidemiology, and End Results Data for Patients With NSCLC

IntroductionDespite efforts to achieve health care equality, racial/ethnic disparities persist in lung cancer survival in the United States, with non-Hispanic Black patients experiencing higher mortality compared with non-Hispanic Whites. Previous research often focused on single treatments, overlooking the broad range of options available. We aimed to highlight disparities in survival and receipt of comprehensive lung cancer treatment by developing a guideline-concordant initial treatment (GCIT) indicator based on disease stage and recommended treatment. MethodsUsing data of the Surveillance, Epidemiology, and End Results on 377,370 patients with NSCLC, we derived a GCIT indicator based on National Comprehensive Cancer Network guidelines. Observed probabilities and logistic regression models adjusted for age, disease stage, and race were used to assess racial disparities in treatment and survival, with the Kaplan-Meier method evaluating survival rates. Racial/ethnic groups analyzed included non-Hispanic White, non-Hispanic Black, Asian/Pacific Islander, Hispanic, and American Indian/Alaska Native. ResultsNon-Hispanic Black patients had lower odds of receiving GCIT (OR = 0.80; 95% confidence interval [CI]: 0.78–0.82) and surviving 2 years after diagnosis (OR = 0.80; 95% CI: 0.78–0.82). Non-Hispanic Asians had the highest odds of receiving GCIT (OR = 1.02; 95% CI: 0.99–1.05). Patients receiving GCIT had improved survival, with early stage patients experiencing median survival of 67 to 102 months, compared with 11 to 17 months for those without GCIT. ConclusionReceiving GCIT significantly improves survival across all races, though disparities in receipt are observed. Interventions are needed to ensure equitable access to guideline-concordant care and reduce survival disparities for patients.

Racial and Ethnic Disparities in Pediatric Atopic Dermatitis.

Atopic dermatitis (AD) is one of the most common chronic childhood conditions. Disparities in treatment and access to care can result in poor disease control and decreased quality of life. The aim of this study was to determine whether race and ethnicity affect treatment and healthcare utilization for pediatric atopic dermatitis in central Florida. This study of 4008 children with AD compared healthcare utilization and management using the numbers of AD-related healthcare visits, prescriptions, testing, and subspecialty referrals. Multivariable models were used to compare racial and ethnic groups (Black, Hispanic, Asian, and Other) with the reference group of non-Hispanic White, while adjusting for common confounders. The mean number of urgent care visits for the Hispanic group was 1.61 times that of the non-Hispanic White group, and the mean number of emergency department visits was 3.71 (P < 0.001) times the reference group. Black or African American patients had a mean number of emergency department visits that was 1.52 times that of non-Hispanic White patients (P = 0.021). The mean count of primary care visits was lower among Hispanic patients and higher among Asian patients (P = 0.012). Visits to subspecialty clinics and hospitalizations did not differ significantly. There were no consistent patterns in differences of AD-related prescriptions, testing, or subspecialty referrals. This study indicates that racial and ethnic disparities exist in healthcare utilization in pediatric AD. The underlying factors contributing to these disparities need to be further studied and addressed to reach health equity within pediatric AD.

Evaluation of guideline recommended treatment utilization among Black and White men with metastatic prostate cancer.

103 Background: Prostate cancer is the second leading cause of cancer death among men with a disproportionate burden on Black men. 1 Black men are twice as likely to die from prostate cancer compared to White counterparts. 2 Racial disparities in care delivery for early-stage disease are well documented and may contribute to disparate outcomes, 3–6 but less is known about racial gaps in advanced prostate cancer care, a stage where effective therapies can prolong life for years. 7 We sought to evaluate if treatment disparities were evident among Black and White men with metastatic prostate cancer. Methods: We performed a retrospective cohort study of patients with metastatic prostate cancer receiving treatment at a large public tertiary care health system between 2015 and 2020. Demographic, clinical, treatment, and medication prescribing data were extracted from the electronic health record. We excluded patients without ICD codes indicating metastatic disease, those without any documented medication data in our health system, and those who did not identify as Black or White race. We estimated the prevalence ratio (PR) of being prescribed each of the recommended treatment options for metastatic prostate cancer per National Comprehensive Care Network guidelines, including androgen deprivation therapy (ADT), novel anti-androgens, chemotherapy, and bone protection comparing Black men to White men using log-binomial regression. Results: We identified 1,594 patients with metastatic prostate cancer; 485 (30%) were Black. Black patients were younger and had higher Charlson scores compared to White men. Both groups were highly insured, Medicaid was more common for Black men (7.2% vs 2.2%). Prescribing of systemic treatments was similar by race (Table). Combination ADT and novel antiandrogen prescribing was also similar by race (PR 1.04 95% CI:(0.91 - 1.17), p=0.6). About 30% of both Black and White patients interacted with our Patient Navigation team, a group of oncology nurses focused on ensuring patients receive recommended care. Conclusions: In a large public tertiary care health system, we did not observe racial disparities in receipt of guideline recommended therapies for metastatic prostate cancer. High rates of insurance, a robust patient navigation program, and a well-developed pharmacy assistance program may have helped mitigate racial disparities in care. Ongoing analyses are evaluating prescribing patterns among patients with de novo metastatic disease. Future studies should explore delivery of prostate cancer therapies across health systems and the influence of patient navigation and pharmacy assistance programs on medication receipt. Prevalence ratios of treatment by race. Medication PR (95% CI) for Black v White men p-value ADT 1.04 (0.98-1.11) 0.19 Novel Antiandrogen 1.05 (0.95-1.16) 0.31 Bone protection 0.89 (0.76-1.04) 0.13 Chemotherapy 1.09 (0.85-1.39) 0.51

Racial/ethnic disparities in curative-intent treatment for early-stage non-small cell lung cancer patients among heterogeneous Black populations: US-born Black, Afro-Haitian, West Indian Black, and Hispanic Black.

Heterogeneous Black populations encounter significant obstacles in accessing cancer care, yet research on lung cancer treatment disparities remains limited. This study investigates whether the disparity in receiving curative-intent treatment (curative-intent surgery and/or stereotactic body radiation therapy [SBRT]) for early-stage non-small cell lung cancer (NSCLC) between non-Hispanic Whites (NHWs) and total Blacks extends to diverse Black populations, including US-born, Afro-Haitian, West Indian Black, and Hispanic Black individuals. This cross-sectional study included all Florida cancer registry early-stage NSCLC cases 2005-2017, linked to individual-level discharge data containing comorbidity and specific treatment details (surgery and/or SBRT). Multivariable logistic regression assessed the association between race/ethnicity and the receipt of curative-intent treatment, while accounting for sociodemographic factors (poverty, age, insurance, and smoking status) and clinical variables. Among 55,655 early-stage NSCLC patients, 71.1% received curative-intent treatment: 72.1% NHW and 59.7% Black (non-Hispanic and Hispanic)individuals. Black patients had 35% lower odds (ORadj, 0.65; 95% CI, 0.59-0.70) of receiving curative-intent treatment compared to NHW patients. ORs varied from 0.57 (95% CI, 0.59-0.70) for Hispanic Black to 0.76 (95% CI, 0.56-1.02) for West Indian Black. Remarkably, Black-White disparities persisted despite the availability of curative treatment options (SBRT) for both high Charlson Comorbidity Index (CCI) observed among US-born Blacks and surgery for low CCI patients among all other Black subgroups. Pronounced disparities in accessing curative-intent treatments for early-stage NSCLC were evident across all Black subgroups, regardless of treatment availability and comorbidity profile. These findings underscore the need to address Black heterogeneity and prompt further research to rectify treatment disparities in early-stage NSCLC.

Bridging the Gap: Tackling Racial and Ethnic Disparities in Hypertension Management.

Hypertension is a prevalent health concern with significant implications for cardiovascular disease risk, affecting diverse populations worldwide and imposing substantial health system burdens. This review article explores racial and ethnic disparities in hypertension prevalence, treatment, and management, highlighting the disproportionate impact on minority populations. Certain racial and ethnic groups in the United States exhibit higher prevalence rates of hypertension and related complications due to a confluence of genetic, social, and economic factors. Despite comparable treatment rates, blood pressure control is often less effective among these groups, partly due to less intensive treatment and systemic barriers to care. Different populations encounter unique challenges, with prevalence and control rates influenced by dietary habits, socioeconomic status, and healthcare disparities. This review summarizes current management practices and highlights the necessity for tailored approaches that consider ethnic-specific treatment responses. It underscores the importance of addressing socioeconomic and cultural barriers while incorporating both pharmacological and nonpharmacological treatments. Future research should focus on developing culturally relevant assessment tools, enhancing data collection, and evaluating interventions designed to mitigate these disparities. To promote health equity and optimize the management of hypertension in a variety of populations, it is imperative to address these inequities using individualized, evidence-based strategies.

Possible sex and racial disparities in myasthenia gravis care.

Given the importance of early diagnosis and treatment of myasthenia gravis (MG), it is critical to understand disparities in MG care. We aimed to determine if there are any differences in testing, treatment, and/or access to neurologists for patients of varying sex and race/ethnicity with MG. We used a nationally representative healthcare claims database of privately insured individuals (2001-2018) to identify incident cases of MG using a validated definition. Diagnostic testing, steroid-sparing agents, intravenous immunoglobulin (IVIG), plasma exchange (PLEX), and thymectomy were defined using drug names or CPT codes. Steroid use was defined using AHFS class codes. We also determined whether an individual had a visit to a neurologist and the time between primary care and neurologist visits. Logistic regression determined associations between sex and race/ethnicity and testing, treatments, and access to neurologists. Female patients were less likely to get a computed tomography (CT) chest (odds ratio (OR) 0.73, 95% confidence interval (CI): 0.64-0.83), receive steroids (OR: 0.85, 95% CI: 0.75-0.97), steroid-sparing agents (OR: 0.84, 95% CI: 0.72-0.97), and IVIG or PLEX (OR: 0.80, 95% CI: 0.67-0.95). Black patients were less likely to receive steroids (OR: 0.78, 95% CI: 0.63-0.96). No significant disparities were seen in access to neurologists. We found healthcare disparities in MG treatment with female and Black patients receiving less treatment than men and those of other races/ethnicities. Further research and detailed assessments accounting for individual patient factors are needed to confirm these apparent disparities.

Racial disparities in hepatocellular carcinoma (HCC) treatment and survival: A SEER-Medicare analysis.

144 Background: Between 2017-2022, approved systemic therapies for HCC increased from 1 to 10. Studies have shown racial disparities in overall survival (OS), but no studies have evaluated disparities in new systemic treatments. Methods: We identified patients in SEER-Medicare data diagnosed with HCC in 2014-2019 with claims through 2020. We identified demographics, liver disease type, cirrhosis complications (e.g, jaundice), diagnosis stage, receipt of local therapies (e.g, resection) and receipt of systemic therapies (e.g, sorafenib). We described cohort characteristics by race. OS and receipt of treatment were analyzed using Cox and logistical regression models adjusted for the above covariates. Results: The study included 8,257 patients (77.7% White, 11.9% Asian, 9.1% Black, 0.9% American Indian). Median OS for all patients was 9.1 months. Compared to White patients, Black patients had worse OS (hazard ratio [HR] 1.36, p= &lt;.0001). Black patients receiving no treatment (HR 1.24, p=0.002) and local therapy first (HR 1.29, p=0.003) also had worse survival, while Black patients receiving systemic therapy first had similar OS (HR 1.08, p=0.62) to White patients. Black patients were less likely than White patients to receive any treatment (odds ratio [OR]: 0.64, p=&lt;.0001) or curative treatment if they had early stage-HCC (OR 0.49, p=0.013), but had no difference in receipt of a new systemic therapy if receiving any systemic therapy (OR 0.72, p=0.19) (Table). Compared to White patients, Asian patients had better OS among all patients (HR 0.91, p=0.04) and among patients receiving local therapy first (HR 0.89), but similar OS among patients receiving no treatment (HR 0.90, p=0.13) or systemic therapy first (HR 1.07, p=0.60). Asian patients were as likely as White patients to receive any treatment (OR 1.07, p=0.43), curative treatment for early-stage HCC (OR 0.94, p=0.70) and novel therapies if receiving systemic therapy (OR 1.10, p=0.70). Conclusions: As new HCC therapies emerged, there were racial disparities in OS and receipt of any treatment or local therapies, but not in receipt of new systemic treatments. Targeted interventions are essential to address these disparities and ensure equitable access to care. Treatment and survival disparities, by race. All PatientsN=8,218 White N=6412 Black N=747 Asian or Pacific Islander N=983 American Indian/Alaskan Native* N=76 Median Overall survival, months 9.1 9.5 5.6 10.1 8.3 No treatment, n (%) 3213 (39.1) 2510 (39.2) 348 (46.6) 330 (33.6) 25 (32.9) Systemic first, n (%) 894 (10.9) 693 (10.8) 85 (11.4) 103 (10.5) 13 (17.1) Local first, n (%) 4111 (50.0) 3209 (50.0) 314 (42.0) 550 (56.0) 38 (50.0) Of patients with early-stage HCC, those who received curative treatment, n (%) 749 (41.7) &gt;542 (&gt;41.5) 43 (29.3) 147 (45.2) &lt;11 (&lt;40.0) Of patients receiving systemic therapy, those who got a novel therapy, n (%) 763 (44.3) &gt;581 (&gt;43.9) 63 (40.9) 103 (46.0) &lt;11 (&lt;50.0)

Gender Differences in Outcomes of Ambulatory and Hospitalized Patients With Obesity Hypoventilation Syndrome

Obesity hypoventilation syndrome (OHS) is associated with high morbidity and mortality. There are few data on whether there are gender differences in outcomes. Is female gender associated with worse outcomes in ambulatory and hospitalized patients with OHS? Post hoc analyses were performed on 2 separate OHS cohorts: (1) stable ambulatory patients from the 2 Pickwick randomized controlled trials; and (2) hospitalized patients with acute-on-chronic hypercapnic respiratory failure from a retrospective international cohort. We first conducted bivariate analyses of baseline characteristics and therapeutics between genders. Variables of interest from these analyses were then grouped into linear mixed effects models, Cox proportional hazards models, or logistic regression models to assess the association of gender on various clinical outcomes. The ambulatory prospective cohort included 300 patients (64%female), and the hospitalized retrospective cohort included 1,162 patients (58%female). For both cohorts, women were significantly older and more obese than men. Compared with men, baseline Paco2 was similar in ambulatory patients but higher in hospitalized women. In the ambulatory cohort, in unadjusted analysis, women had increased risk of emergency department visits. However, gender was not associated with the composite outcome of emergency department visit, hospitalization, or all-cause mortality in the fully adjusted model. In the hospitalized cohort, prescription of positive airway pressure was less prevalent in women at discharge. In unadjusted analysis, hospitalized women had a higher mortality at 3, 6, and 12months following hospital discharge compared with men. However, after adjusting for age, gender was not associated with mortality. Although the diagnosis of OHS is established at a more advanced age in women, gender is not independently associated with worse clinical outcomes after adjusting for age. Future studies are needed to examine gender-related health disparities in diagnosis and treatment of OHS.