Ethnic Differences In Survival Research Articles

Ethnic Differences in Survival among Brazilian Modern-era Olympic Medalists from 1920 to 1992: A Cohort Study.

Disparities in health outcomes among racial groups warrant investigation, even among elite athletes. Therefore, understanding the impact of race upon post-medal survival in Brazilian Olympians becomes essential. To compare post-medal survival between white and non-white Brazilian Olympic medalists from 1920 to 1992. This study used publicly available data for a retrospective cohort study on all Brazilian Olympic medalists from 1920 to 1992 (males only). Athletes were classified into white and non-white groups using structured ethnicity determination. Kaplan-Meier analyses computed the restricted mean survival time (RMST) for each ethnic group. A Cox proportional hazards analysis assessed ethnicity-based survival differences, adjusting for medal-winning age and birth year (p<0.05). Among 123 athletes (73.9% white), the mean age of medal achievement was 25.03±4.8 years. During the study, 18.7% of white and 37.5% of non-white athletes died (p=0.031). White athletes had a mean age at death of 75.10±18.01 years, while non-white athletes had an age of 67.13±14.90 years (p=0.109). The RMST for white athletes was 51.59 (95% CI 49.79-53.39) years, while for non-white athletes, it was 45.026 (95% CI 41.31-48.74) years, resulting in a ΔRMST of 6.56 (95% CI 2.43-10.70; p=0.0018). Multivariate analysis showed that non-white athletes had a higher mortality risk than did white athletes (HR 5.58; 95% CI, 2.18-14.31). Following their first medal, white Brazilian Olympians typically enjoy a six-year longer lifespan than their non-white counterparts, illustrating a marked mortality gap and health disparities among healthy individuals in Brazil.

The Health Inequality Impact of Liquid Biopsy to Inform First-Line Treatment of Advanced Non–Small Cell Lung Cancer: A Distributional Cost-Effectiveness Analysis

ObjectivesTo perform a distributional cost-effectiveness analysis of liquid biopsy (LB) followed by, if needed, tissue biopsy (TB) (LB-first strategy) relative to a TB-only strategy to inform first-line treatment of advanced non–small cell lung cancer (aNSCLC) from a US payer perspective by which we quantify the impact of LB-first on population health inequality according to race and ethnicity. MethodsWith a health economic model, quality-adjusted life-years (QALYs) and costs per patient were estimated for each subgroup. Given the lifetime risk of aNSCLC, and assuming equally distributed opportunity costs, the incremental net health benefits of LB-first were calculated, which were used to estimate general population quality-adjusted life expectancy at birth (QALE) by race and ethnicity with and without LB-first. The degree of QALYs and QALE differences with the strategies was expressed with inequality indices. Their differences were defined as the inequality impact of LB-first. ResultsLB-first resulted in an additional 0.21 (95% uncertainty interval: 0.07-0.39) QALYs among treated patients, with the greatest gain observed among Asian patients (0.31 QALYs [0.09-0.61]). LB-first resulted in an increase in relative inequality in QALYs among patients, but a minor decrease in relative inequality in QALE. ConclusionsLB-first to inform first-line aNSCLC therapy can improve health outcomes. With current diagnostic performance, the benefit is the greatest among Asian patients, thereby potentially widening racial and ethnic differences in survival among patients with aNSCLC. Assuming equally distributed opportunity costs and access, LB-first does not worsen and, in fact, may reduce inequality in general population health according to race and ethnicity.

Response to Treatment, Racial and Ethnic Disparity, and Survival in Patients With Breast Cancer Undergoing Neoadjuvant Chemotherapy in the US

With the increasing delivery of neoadjuvant chemotherapy (NACT) for patients with breast cancer in the US, it is important to know whether there is differential response to NACT by race and ethnicity and the potential long-term outcomes. To examine whether there were any racial and ethnic differences in pathologic complete response (pCR) rate following NACT and, if so, whether they varied by molecular subtype and were associated with survival. A retrospective cohort study was conducted including patients with stage I to III breast cancer diagnosed between January 2010 and December 2017 who underwent surgery and received NACT; median follow-up was 5.8 years, and data analysis was conducted from August 2021 to January 2023. Data were obtained from the National Cancer Data Base, a nationwide, facility-based, oncology data set that captures approximately 70% of all newly diagnosed cases of breast cancer in the US. Pathologic complete response, defined as ypT0/Tis ypN0, was modeled using logistic regression. Racial and ethnic differences in survival were analyzed using a Weibull accelerated failure time model. Mediation analysis was conducted to measure whether racial and ethnic differences in the pCR rate affect survival. The study included 107 207 patients (106 587 [99.4%] women), with a mean (SD) age of 53.4 (12.1) years. A total of 5009 patients were Asian or Pacific Islander, 18 417 were non-Hispanic Black, 9724 were Hispanic, and 74 057 were non-Hispanic White. There were significant racial and ethnic differences in pCR rates, but the differences were subtype-specific. In hormone receptor-negative (HR-)/erb-b2 receptor tyrosine kinase 2 (ERBB2; formerly HER2 or HER2/neu)-positive (ERBB2+) subtype, Asian and Pacific Islander patients achieved the highest pCR rate (56.8%), followed by Hispanic (55.2%) and non-Hispanic White (52.3%) patients with the lowest pCR rate seen in Black patients (44.8%). In triple-negative breast cancer, Black patients had a lower pCR rate (27.3%) than other racial and ethnic groups (all >30%). In HR+/ERBB2- subtype, Black patients had a higher pCR rate (11.3%) than other racial/ethnic groups (all ≤10%). In mediation analysis, racial and ethnic differences in achieving pCR after NACT could explain approximately 20% to 53% of the subtype-specific survival differences across racial and ethnic groups. In this cohort study of patients with breast cancer receiving NACT, Black patients had a lower pCR rate for triple-negative and HR-/ERBB2+ breast cancer but a higher pCR rate for HR+/ERBB2- diseases, whereas Asian and Pacific Islander patients had a higher pCR rate for HR-/ERBB2+ diseases. Tumor grade and ERBB2 copy number could account for some of these within-subtype disparities, but further studies are warranted. Inability to achieve a pCR can mediate in part, but not entirely, the worse survival outcomes experienced by Black patients.

Racial and ethnic disparities in mortality among breast cancer survivors after a second malignancy.

Racial and ethnic differences in survival after a first cancer are well established but have not been examined after a second primary cancer (SPC) despite the increasing incidence among survivors. We examined 39 029 female breast cancer survivors who developed an SPC between 2000 and 2014 in the Surveillance, Epidemiology, and End Results 18 database. Multivariable Cox proportional hazards regression for competing risks data was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for cancer and cardiovascular disease mortality after SPCs comparing Hispanic, Non-Hispanic Asian, and Non-Hispanic Black survivors with Non-Hispanic White survivors. Models were adjusted for sociodemographics, tumor characteristics, and treatments of the first and second cancer. Analyses were stratified by SPC type. During 17 years of follow-up, there were 15 117 deaths after SPCs. The risk of cancer death was 12% higher among Non-Hispanic Black survivors (HR = 1.12, 95% CI = 1.05 to 1.19) and 8% higher among Hispanic survivors (HR = 1.08, 95% CI = 1.00 to 1.16) compared with Non-Hispanic White survivors. In subgroup analyses, the strongest associations were observed among Non-Hispanic Black survivors with a second breast or uterine cancer and among Hispanic survivors with a second breast cancer. Non-Hispanic Black survivors also experienced a 44% higher risk of cardiovascular disease death after SPC diagnosis than Non-Hispanic White survivors (HR = 1.44, 95% CI = 1.20 to 1.74). Higher cancer mortality among Non-Hispanic Black and Hispanic survivors and higher cardiovascular mortality among Non-Hispanic Black survivors exist among women who survive a first breast cancer to develop an SPC. Studies focused on identifying the contributors to these disparities are needed to enable implementation of effective mitigation strategies.

Ethnic and socioeconomic disparities in survival of children and adolescents with CNS tumors in Southern Israel.

This study sought to evaluate survival of pediatric and adolescent patients with central nervous system (CNS) cancer in southern Israel, outline disparities between ethnic and socioeconomic groups (Bedouin Arabs compared to Jews) and evaluate the role of socioeconomic status (SES) in ethnic disparities. A retrospective study was conducted among 91 patients aged one to 20 years, who were diagnosed with CNS tumors between 2001 and 2017, and followed-up through 2020. Ethnic differences in survival were measured by age, sex, stage, histology and SES. One and 3-year survival rates were calculated. Multivariable regression analysis was used to estimate adjusted ethnic differences in survival rates. Ethnic differences in survival existed within all studied variables. All Bedouin patients lived in low SES settlements (All Bedouin settlement in Southern Israel are ranked in lower socioeconomic deciles). Twenty-eight patients had medulloblastoma. Seven (25%) presented with leptomeningeal disease or distant metastases. Medulloblastoma molecular subgroups were not assessed for logistic reasons. Three-year overall survival of Bedouins was 50% compared to 92.3% for Jews. Adjusted risk of death at 3 years was significantly higher for Bedouin patients (aHR 3.36, 95% CI 1.41-7.98, P = .006). We conclude that Bedouin children with CNS tumors have significantly lower survival rates compared to Jewish children, and SES seems to play a major part in these disparities. Factors influencing these disparities should be addressed and public health interventions to eliminate these disparities should be developed.

Racial and ethnic differences in all-cause mortality among Hispanics diagnosed with follicular lymphoma and chronic lymphocytic leukemia in the Bronx, NY.

Research suggests better survival among Hispanics with diffuse large B-cell lymphoma (DLBCL) compared to non-Hispanic Whites (NHW); however, less is known about racial/ethnic survival differences in follicular lymphoma (FL) and chronic lymphocytic leukemia (CLL). We identified incident FL and CLL cases diagnosed between 2005 and 2016 at Montefiore Medical Center in the Bronx, NY. Cox proportional hazards regression assessed the association between race/ethnicity and all-cause mortality among FL and CLL separately. Of the 201 FL patients, 39.3% were NHW, 19.4% non-Hispanic Black (NHB), and 41.3% Hispanic, with a similar distribution among CLL patients. After adjusting for International Prognostic Index factors, sex, and chemotherapy, Hispanics with FL had lower all-cause mortality compared to NHWs (HR = 0.22; 95% CI 0.08-0.63), similar to prior DLBCL findings. All-cause mortality did not differ between NHBs and NHWs for FL or by any race/ethnicity for CLL. In our diverse, urban population, we found that Hispanic diagnosed with FL had lower all-cause mortality compared to NHWs. We found no significant difference in all-cause mortality between Hispanics and NHWs diagnosed with CLL. Our study adds to the growing literature on racial and ethnic differences in survival among Hispanics with hematologic malignancies.

Ethnic Differences in Survival Among Lung Cancer Patients: A Systematic Review.

BackgroundDespite a substantially worse risk factor profile, Hispanics in the United States experience lower incidence of many diseases and longer survival than non-Hispanic Whites (NHWs), an epidemiological phenomenon known as the Hispanic Health Paradox (HHP). This systematic review evaluated the published longitudinal literature to address whether this pattern extends to lung cancer survival.MethodsSearches of Medline, PubMed, Embase, Web of Science, and the Cochrane Library were conducted for publications dated from January 1, 2000, to July 18, 2018. Records were restricted to articles written in English, employing a longitudinal design, and reporting a direct survival comparison (overall survival [OS], cancer-specific survival [CSS]) between NHW and Hispanic lung cancer patients.ResultsA final sample of 29 full-text articles were included, with 28 fully adjusted models of OS and 21 of CSS included. Overall, 26 (92.9%) OS models and 20 (95.2%) CSS models documented either no difference (OS = 16, CSS = 11) or a Hispanic survival advantage (OS = 10, CSS = 9). Both larger studies and those including foreign-born Hispanics were more likely to show a Hispanic survival advantage, and 2 studies of exclusively no-smokers showed a survival disadvantage. A number of reporting gaps were identified including Hispanic background and sociodemographic characteristics.ConclusionsHispanics exhibit similar or better survival in the context of lung cancer relative to NHWs despite a considerably worse risk factor profile. These findings support the HHP in the context of lung cancer. Further research is needed to understand the potential mechanisms of the HHP as it relates to lung cancer.

Clinical presentation of multiple myeloma by race/ethnicity and Asian subgroup in an integrated healthcare system.

e20012 Background: Several US studies have evaluated ethnic differences in patients with multiple myeloma (MM), but few have focused on populations other than non-Hispanic Whites and Blacks. We examined ethnic differences in a contemporary cohort of MM patients and their presenting laboratory findings in a large, insured, community-based population, including findings across Asian American subgroups. Methods: Using the Kaiser Permanente Northern California (KPNC) Cancer Registry, we identified all new cases of MM from 2010-2018 and obtained data on age, sex, race/ethnicity, Asian subgroup, and presenting hemoglobin, calcium, and estimated renal function (eGFR derived from serum creatinine) from health plan databases. Moderate to severe anemia was defined by hemoglobin &lt;10 g/dL, hypercalcemia by calcium &gt;11 mg/dL, and chronic kidney disease (CKD) by eGFR: stage 3 (eGFR 30-59) and stages 4-5 (eGFR &lt;30). MM incidence was estimated using membership denominators. Results: There were 2224 new MM cases (mean age 68y, 60% male) in 2010-2018, with an annual MM incidence of 7.9-9.8/100,000. Table 1 compares presentation by race/ethnicity. Non-Whites (45%) were more likely to present at age &lt;65 than non-Hispanic Whites (30%, p&lt;0.01). Black (43%) and Asian (39%) adults were more likely to present with hemoglobin &lt;10 g/dL than non-Hispanic Whites (27%, p&lt;0.01); Black adults were more likely to present with hemoglobin &lt;10 g/dL than Hispanic adults (31%, p=0.02). Among the primary Asian subgroups, proportions with hemoglobin &lt;10 g/dL were 38% (East Asian), 43% (Filipino), and 45% (South Asian). Blacks were more likely to present with CKD stage 4-5 (19.5%) than other races/ethnicities (p=0.04); differences between White vs non-White or Asian vs non-Asian were not significant. In Asians, 12.7% (South Asian) and 19.0% (Filipino, East Asian) presented with CKD 4-5. Asians were least likely to present with hypercalcemia (6.7%, p=0.03), and this was similar for Asian subgroups. Conclusions: We observed ethnic differences in MM presentation in a large integrated healthcare system. Blacks were more likely to have CKD stage 4-5 and hemoglobin &lt;10 g/dL than non-Hispanic Whites. Asians were more likely to have CKD stage 4-5 than non-Hispanic Whites but least likely to have hypercalcemia. This is one of the first studies to identify Asian subgroups and examine variation across East Asians, Filipinos, and South Asians. Analyses examining ethnic differences in survival among MM patients are in progress.[Table: see text]

Diversity, Equity, and Inclusion: A strategic priority for the American Pediatric Surgical Association

Diversity, Equity, and Inclusion: A strategic priority for the American Pediatric Surgical Association

Racial and ethnic differences in survival of pediatric patients with brain and central nervous system cancer in the United States.

Brain and central nervous system (CNS) cancer is the leading cause of cancer death among children and adolescents in the United States. Data from earlier studies suggested racial and ethnic differences in survival among pediatric patients with brain tumor. This study examined racial/ethnic difference in survival using national data and considered the effects of demographic and clinical factors. Using National Program of Cancer Registries data, 1-, 3-, and 5-year relative survival (cancer survival in the absence of other causes of death) was calculated for patients with brain and CNS cancer aged<20 years diagnosed during 2001-2008 and followed up through 2013. Racial and ethnic differences in survival were measured by sex, age, economic status, stage, anatomic location, and histology. Adjusted racial and ethnic difference in 5-year cancer specific survival was estimated using multivariable Cox regression analysis. Using data from 11 302 patients, 5-year relative survival was 77.6% for non-Hispanic white patients, 69.8% for non-Hispanic black patients, and 72.9% for Hispanic patients. Differences in relative survival by race/ethnicity existed within all demographic groups. Based on multivariable analysis, non-Hispanic black patients had a higher risk of death at 5 years after diagnosis compared to non-Hispanic white patients (adjusted hazard ratio=1.2, 95% confidence interval, 1.1-1.4). Pediatric brain and CNS cancer survival differed by race/ethnicity, with non-Hispanic black patients having a higher risk of death than non-Hispanic white patients. Future investigation of access to care, social and economic barriers, and host genetic factors might identify reasons for disparities in survival.

Abstract IA41: Standard of care and clinical disparities in epithelial ovarian cancer

Abstract Ovarian cancer afflicts approximately 204,000 women worldwide, with ∼125,000/year deaths. In the United States more than 22,000 new cases of ovarian cancer diagnosed with over 14,000 disease-related deaths.[1] The standard of care in ovarian cancer includes expedient access to the health care system, consultation with a gynecologic oncologist, surgical intervention, and multiagent platinum-based chemotherapy. Prognostic factors for improved survival in women with ovarian cancer include younger age; early stage; low-grade and serous histology; good performance status; disease biology (BRCA1 and 2 mutation carriers have a better prognosis); and low volume of residual disease at the time of cytoreductive surgery. In contrast, African-American race, low socioeconomic status (SES), geographic location, and insurance status have been associated with worse survival and increased probability of not receiving appropriate standard of care treatment.[2-7] These differences in ovarian cancer outcomes linked to race, social, and economic factors indicate that health care disparities exist in the treatment of this gynecologic cancer. In this presentation, we will (1) review the standard of care for epithelial ovarian cancer treatment, (2) discuss the variables affecting the outcome for patients with epithelial ovarian cancer, (3) describe the factors contributing to healthcare disparities, and (4) discuss the evidence for clinical disparities in epithelial ovarian cancer care and outcomes. Causes of healthcare disparities are complex and include differences in race/ethnicity, SES, insurance status, education level, geographic location, culture, healthcare system factors (adherence to treatment guidelines, and access to care), and disease biology.[2-7] The following are highlighted in this presentation: Population-based studies have demonstrated that African-American women are at increased risk of ovarian cancer death compared to non-Hispanic Caucasian women.Population-based studies have demonstrated that African-American women are less likely to undergo site-specific surgery or surgical staging for ovarian cancer compared to Caucasian women.African-American women were less likely to seek care at high-volume hospitals or be operated on by high-volume surgeons.African-American women and those with Medicaid/Medicare payer status are less likely to receive standard of care therapy based on National Comprehensive Cancer Network (NCCN) guidelines.Geographic location away from a high-volume hospital is associated with increased risk of non-adherent ovarian cancer care.Geographic barriers to standard treatment disproportionately affect racial minorities and women of low-SES.In contrast to population-based studies, retrospective single academic institution studies and ancillary analysis of large cooperative group phase III trials in advanced ovarian cancer have demonstrated no difference in overall survival in women of African-American and Caucasian descent. The reported research in ovarian cancer indicates that unequal delivery of quality care, obstacles to the delivery of recommended care, and limited access to expert care may account for the disparities seen in ovarian cancer care. The U.S. Department of Health and Human Services has targeted disparities in access to health care as the centerpiece of the Healthy People 2020 campaign and the Department of Health and Human Services (HHS) has unveiled an action plan to reduce racial and ethnic Health disparities.[8, 9] The 5 goals of the HHS Disparities Action Plan are: (1) transform health care; (2) strengthen the nation's Health and Human Services infrastructure and workforce; (3) advance the health, safety, and well-being of the American people; (4) advance scientific knowledge and innovation; and (5) increase the efficiency, transparency, and accountability of HHS programs. The HHS Disparities initiative will specifically target programs to increase knowledge of, access to, and utilization of biomedical and behavioral procedures to reduce cancer disparities.[9] Listed below are future research objectives that will reduce and potentially eliminate health care disparities in ovarian cancer in the United States: Improve our knowledge of the interaction between race, ethnicity, SES, geographic location and ovarian cancer health care disparities across the United States to harmonize existing data and identify opportunities for intervention.Improve our knowledge regarding cultural barriers to care.Promote community-based participatory research to increase ovarian cancer awareness and review standards of care.Develop interventions to provide expedient access to expert care by trained specialists in Gynecology Oncology, cytoreductive surgery, and administration of multiagent platinum-based chemotherapy in order to increase the likelihood of NCCN adherent standard of care therapy.

Cancer survival differences between South Asians and non-South Asians of England in 1986-2004, accounting for age at diagnosis and deprivation.

Background:South Asian migrants show lower cancer incidence than their host population in England for most major cancers. We seek to study the ethnic differences in survival from cancer.Methods:We described and modelled the effect of ethnicity, time, age and deprivation on survival for the five most incident cancers in each sex in South Asians in England between 1986 and 2004 using national cancer registry data. South Asian ethnicity was flagged using the validated name-recognition algorithm SANGRA (South Asian Names and Group Recognition Algorithm).Results:We observed survival advantage in South Asians in earlier periods. This ethnic gap either remained constant or narrowed over time. By 2004, age-standardised net survival was comparable for all cancers except three in men, where South Asians had higher survival 5 years after diagnosis: colorectal (58.9% vs 53.6%), liver (15.0% vs 9.4%) and lung (15.9% vs 9.3%). Compared with non-South Asians, South Asians experienced a slower increase in breast and prostate cancer survival, both cancers associated with either a screening programme or an early diagnosis test. We did not find differential patterns in survival by deprivation between both ethnicities.Conclusions:Considering recent survival trends, appropriate action is required to avoid deficits in cancer survival among South Asians in the near future.

Ethnic differences in survival of elderly chronic myeloid leukemia patients in pre- and post-imatinib era in the United States.

7063 Background: Survival of chronic myeloid leukemia (CML) has improved since FDA approval of imatinib in May 2001. However, there is limited data on survival pattern of elderly patients. We condu...

Neurological, Functional, and Cognitive Stroke Outcomes in Mexican Americans

Our objective was to compare neurological, functional, and cognitive stroke outcomes in Mexican Americans (MAs) and non-Hispanic whites using data from a population-based study. Ischemic strokes (2008-2012) were identified from the Brain Attack Surveillance in Corpus Christi (BASIC) Project. Data were collected from patient or proxy interviews (conducted at baseline and 90 days poststroke) and medical records. Ethnic differences in neurological (National Institutes of Health Stroke Scale: range, 0-44; higher scores worse), functional (activities of daily living/instrumental activities of daily living score: range, 1-4; higher scores worse), and cognitive (Modified Mini-Mental State Examination: range, 0-100; lower scores worse) outcomes were assessed with Tobit or linear regression adjusted for demographics and clinical factors. A total of 513, 510, and 415 subjects had complete data for neurological, functional, and cognitive outcomes and covariates, respectively. Median age was 66 (interquartile range, 57-78); 64% were MAs. In MAs, median National Institutes of Health Stroke Scale, activities of daily living/instrumental activities of daily living, and Modified Mini-Mental State Examination score were 3 (interquartile range, 1-6), 2.5 (interquartile range, 1.6-3.5), and 88 (interquartile range, 76-94), respectively. MAs scored 48% worse (95% CI, 23%-78%) on National Institutes of Health Stroke Scale, 0.36 points worse (95% CI, 0.16-0.57) on activities of daily living/instrumental activities of daily living score, and 3.39 points worse (95% CI, 0.35-6.43) on Modified Mini-Mental State Examination than non-Hispanic whites after multivariable adjustment. MAs scored worse than non-Hispanic whites on all outcomes after adjustment for confounding factors; differences were only partially explained by ethnic differences in survival. These findings in combination with the increased stroke risk in MAs suggest that the public health burden of stroke in this growing population is substantial.

Differences in psychosocial factors among diverse women enrolled in a phase III cooperative group metastatic breast cancer trial (CALGB 40502/Alliance).

9581 Background: Previous metastatic breast cancer trials have shown lower overall survival among African American (AA) women. Studies have also shown links between higher comorbidities and lower levels of social support and survival. Whether these factors differ by race and ethnicity is not known. Methods: Breast cancer patients enrolling in a phase III cooperative group metastatic breast cancer trial completed a self-administered survey measuring psychosocial and socio-demographic factors and comorbidities. Results were analyzed by self-identified race/ethnicity and evaluated by other measured variables. Results: 703 out of 799 patients completed the survey (88%). Questions were answered by greater than 95% of participants. The table shows differences broken down by Race/Ethnicity. AA and Hispanic (H) patients were more likely to have trouble paying for medications and have incomes less than 15K per year. AA were less likely to be married, and had lower levels of social support. Differences in income did not mediate these social support differences. Marital status did not mediate lower social support for AA (p=0.79) but did so for whites (p&lt;0.001) Conclusions: Compliance with the questionnaire was quite high. Differences in social support by race were apparent and were mediated by different factors according to race. Future efforts will analyze the impact of these factors on survival and as mediators for potential racial and ethnic differences in survival. [Table: see text]

A Population-Based Analysis of Ethnic Differences in Admission to the Intensive Care Unit after Stroke

Mexican-Americans (MAs) have shown lower post-stroke mortality compared to non-hispanic whites (NHWs). Limited evidence suggests race/ethnic differences exist in intensive care unit (ICU) admissions following stroke. Our objective was to investigate the association of ethnicity with admission to the ICU following stroke. Cases of intracerebral hemorrhage and acute ischemic stroke were prospectively ascertained as part of the Brain Attack Surveillance in Corpus Christi (BASIC) project for the period of January 2000 through December 2009. Logistic regression models fitted within the generalized additive model framework were used to test associations between ethnicity and ICU admission and potential confounders. An interaction term between age and ethnicity was investigated in the final model. A total 1,464 cases were included in analysis. MAs were younger, more likely to have diabetes, and less likely to have atrial fibrillation, health insurance, or high school diploma than NHWs. On unadjusted analysis, there was a trend toward MAs being more likely to be admitted to ICU than NHWs (34.6 vs 30.3 %; OR = 1.22; 95 % CI 0.98-1.52; p = 0.08). However, on adjusted analysis, no overall association between MA ethnicity and ICU admission (OR = 1.13; 95 % CI 0.85-1.50) was found. When an interaction term for age and ethnicity was added to this model, there was only borderline evidence for effect modification by age of the ethnicity/ICU relationship (p = 0.16). No overall association between ethnicity and ICU admission was observed in this community. ICU utilization alone does not likely explain ethnic differences in survival following stroke between MAs and NHWs.

Patient factors, health care factors and survival from lung cancer according to ethnic group in the south of London, UK

International and UK data suggest that there are ethnic differences in survival for some malignancies. The aim of the present study was to identify any health inequalities related to lung cancer and ethnicity. Data on 423 patients with a diagnosis of lung cancer treated at a large specialist cancer hospital in London UK were analysed. Data on stage of disease at diagnosis, co-morbidities, socio-economic status, treatments received and survival were collected and examined for differences by ethnic group. There was a significant difference between black and minority ethnic (BME) patients and White-European patients in socio-economic status (Chi-square test P-value < 0.001). BME patients were over-represented in the most deprived socio-economic groups and under-represented in the most affluent. There were no significant differences in histology, stage of disease, co-morbidities and performance status or treatments received between the different ethnic groups. Ethnicity was not associated with survival. Significant prognostic factors for overall survival were performance status (P < 0.001), stage of disease (P = 0.001) and gender (P = 0.003). Our findings suggest that patients from BME groups are over-represented in more deprived socio-economic groups; however, this did not impact on significant prognostic factors or the treatments that they received. Importantly ethnicity did not influence survival.

Abstract 2653: Racial and ethnic differences in survival after cancer diagnosis

Abstract Introduction: Racial differences in cancer survival have been well established based on national and independent cancer registries. Multiple extrinsic factors including stage, socioeconomic status (SES) and treatment have been postulated as causative, questioning whether race is a significant independent predictor of cancer survival. The purpose of this study was to evaluate racial differences in overall cancer survival rates in a diverse NY population. Methods: Study population included 18,556 patients (28% White, 31% African American (AA), 27% Hispanic) diagnosed and/or treated for primary cancer from 1/1/2000 through 1/1/2007 at Montefiore Medical Center (MMC), identified through MMC's Cancer Registry. Demographics, clinical information and survival were obtained through the Cancer Registry. SES was determined using census tract data. Kaplan-Meier survival curves and Cox proportional hazards regression were used to compare overall survival by race. Results: White patients were older (67.6 vs. 60.9 &amp; 58.7) and of higher SES than AA and Hispanic patients, with similar rates of stage III/IV cancer and surgical treatment. Unadjusted analysis revealed that Whites had a significantly higher risk of death compared to all other patients (HR 1.29, 95%CI 1.23-1.35). Adjusting for age, sex, stage at diagnosis, surgical treatment and SES in all cancer types combined, revealed a significantly higher risk of death compared to all other patients (HR 1.14, 95%CI 1.06-1.21). However, race was no longer a significant predictor of cancer survival in multivariate models stratified by cancer type. Conclusion: Contrary to published literature, White patients had significantly lower survival rates than AA and Hispanic patients in unadjusted models. Racial differences in cancer survival diminished in adjusted models, and were absent when stratifying by cancer type. These results suggest that racial disparities in cancer survival may be better explained by variables such as age, stage at presentation, SES, treatment. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 2653. doi:1538-7445.AM2012-2653

Ethnic Differences in Survival after Breast Cancer in South East Asia

BackgroundThe burden of breast cancer in Asia is escalating. We evaluated the impact of ethnicity on survival after breast cancer in the multi-ethnic region of South East Asia.Methodology/Principal FindingsUsing the Singapore-Malaysia hospital-based breast cancer registry, we analyzed the association between ethnicity and mortality following breast cancer in 5,264 patients diagnosed between 1990 and 2007 (Chinese: 71.6%, Malay: 18.4%, Indian: 10.0%). We compared survival rates between ethnic groups and calculated adjusted hazard ratios (HR) to estimate the independent effect of ethnicity on survival. Malays (n = 968) presented at a significantly younger age, with larger tumors, and at later stages than the Chinese and Indians. Malays were also more likely to have axillary lymph node metastasis at similar tumor sizes and to have hormone receptor negative and poorly differentiated tumors. Five year overall survival was highest in the Chinese women (75.8%; 95%CI: 74.4%–77.3%) followed by Indians (68.0%; 95%CI: 63.8%–72.2%), and Malays (58.5%; 95%CI: 55.2%–61.7%). Compared to the Chinese, Malay ethnicity was associated with significantly higher risk of all-cause mortality (HR: 1.34; 95%CI: 1.19–1.51), independent of age, stage, tumor characteristics and treatment. Indian ethnicity was not significantly associated with risk of mortality after breast cancer compared to the Chinese (HR: 1.14; 95%CI: 0.98–1.34).ConclusionIn South East Asia, Malay ethnicity is independently associated with poorer survival after breast cancer. Research into underlying reasons, potentially including variations in tumor biology, psychosocial factors, treatment responsiveness and lifestyle after diagnosis, is warranted.

The role of psychosocial factors in ethnic differences in survival on dialysis in the Netherlands

Ethnic minority patients on dialysis are reported to have better survival rates relative to Caucasians. The reasons for this finding are not fully understood and European studies are scarce. This study examined whether ethnic differences in survival could be explained by patient characteristics, including psychosocial factors. We analysed data of the Netherlands Cooperative Study on the Adequacy of Dialysis study, an observational prospective cohort study of patients who started dialysis between 1997 and 2007 in the Netherlands. Ethnicity was classified as Caucasian, Black or Asian, assessed by local nurses. Data collected at the start of dialysis treatment included demographic, clinical and psychosocial characteristics. Psychosocial characteristics included data on health-related quality of life (HRQoL), mental health status and general health perception. Cox proportional hazards analysis was used to explore ethnic survival differences. One thousand seven hundred and ninety-one patients were Caucasian, 45 Black and 108 Asian. The ethnic groups differed significantly in age, residual glomerular filtration rate, diabetes mellitus, erythropoietin use, plasma calcium, parathormone and creatinine, marital status and general health perception. No ethnic differences were found in HRQoL and mental health status. Crude hazard ratios (HRs) for mortality for Caucasians compared to Blacks and Asians were 3.1 [95% confidence interval (CI) 1.6-5.9] and 1.1 (95% CI 0.9-1.5), respectively. After adjustment for a range of potential explanatory variables, including psychosocial factors, the HRs were 2.5 (95% CI 1.2-4.9) compared with Blacks and 1.2 (95% CI 0.9-1.6) compared with Asians. Although patient numbers were rather small, this study demonstrates, with 95% confidence, better survival for Black compared to Caucasian dialysis patients and equal survival for Asian compared to Caucasian dialysis patients in the Netherlands. This could not be explained by patient characteristics, including psychosocial factors.