Ethnic Differences In Treatment Research Articles

Abstract B128: Underlying factors influencing kidney cancer surgical treatment disparities: Patients, non-patient community members and urologists’ perspectives

Abstract Background: Racial and ethnic minority patients often delay or forgo kidney cancer (KCa) surgical treatment and have an invasive surgical treatment. This study aimed to understand the underlying factors of KCa surgical treatment disparities through interviews with KCa patients and non-patients from racial and ethnic minority communities in Arizona and online surveys with urologists who practice in the U.S. Methods: We conducted phone interviews with KCa patients (n=13) and interviews at health events with community members without KCa (n=61). Online surveys were conducted with urologists (n=54). Results: Many interview participants had healthcare access issues with 22% reporting not having a primary care doctor and 12% reporting that there was a time when they could not see a doctor because of cost. Almost 50% reported that they had delayed care because they could not get an appointment soon enough. Among 10 patients who responded to a question about diagnosis delay, 4 answered that they waited over a year to see their doctor when they had health issues before their diagnosis. A quarter of community participants (25%) and about a third of patients (31%) reported that cultural values or religious beliefs influenced their choice of treatment. When community participants were asked what they knew about KCa symptoms and treatments, many did not provide relevant or correct information. Only 51% of non-patients reported that they trusted their doctor’s judgements about their medical care, but 92% of patients reported that they trusted their doctor’s judgement. About 30% of urologists reported that patients from racial and ethnic minority backgrounds often have healthcare access challenges, but only 9% responded that NHW patients often have challenges. They did not report that racial and ethnic differences in treatment exist. About 10% of urologists reported socioeconomic backgrounds of patients affect treatment decision and timeliness often or all the time. Only 46% reported that they refer patients to necessary services all the time, when patients express concerns of finance and healthcare access challenges. Many urologists strongly or slightly agreed that treatment decisions should be made by the treating clinicians (82%) and based on clinical information (87%). Many also strongly or slightly agreed that patients and their family members should contribute to decision-making (98%), while 46% strongly or slightly agreed that patients’ cultural and religious backgrounds often affect their treatment choices. In open-ended questions, urologists responded that work and family obligations, healthcare access, and health literacy rather than race and ethnicity are factors influencing treatment, while mistrust was identified as one of factors influencing treatment delay. Conclusions: Barriers to healthcare access, lack of knowledge, and mistrust before diagnosis may be underlying factors among patients, while urologists view healthcare access, social and economic factors, and mistrust influence KCa surgical treatment decision and delay. Citation Format: Ken Batai, Alex Cruz, Juan Adrover, Daphne Larose, D'Andre Gomez, Francine C. Gachupin, Jacquanette R. Slowtalker, Benjamin R. Lee, Juan Chipollini. Underlying factors influencing kidney cancer surgical treatment disparities: Patients, non-patient community members and urologists’ perspectives [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B128.

Racial and Ethnic Differences in Initiation and Discontinuation of Antiarrhythmic Medications in Management of Atrial Fibrillation.

Atrial fibrillation (AF) is associated with considerable morbidity and mortality. Timely management and treatment are critical in alleviating AF disease burden. There is significant heterogeneity in patterns of AF care. It is unclear whether there are racial and ethnic differences in treatment of AF following antiarrhythmic drug (AAD) prescription. Using the Optum Clinformatics Data Mart-Socioeconomic Status database from January, 2009, through March, 2022, multivariable logistic regression techniques were used to examine the impact of race and ethnicity on rate of AAD initiation, as well as receipt of catheter ablation within two years of initiation. We compared AAD discontinuation rate by race and ethnicity groups using Cox regression models. Log-rank analyses were used to examine the rate of AF-related hospitalization. Among 143,281 patients identified with newly diagnosed AF, 30,019 patients (21%) were initiated on an AAD within 90 days. Patients identified as Non-Hispanic Black (NHB) were significantly less likely to receive an AAD compared to Non-Hispanic White patients (NHW) (Odds Ratio [OR] 0.90, 95% confidence interval [CI] 0.85-0.94). Compared to NHW, Hispanic (Hazard Ratio [HR] 1.08, 95% CI 1.02-1.14) and Asian patients (HR 1.17, 95% CI 1.06-1.29) have a higher rate of AAD discontinuation. Following AAD initiation, NHB patients were significantly more likely to have an AF-related hospitalization (p < 0.01). However, NHB patients were significantly less likely to receive ablation compared to NHW (HR 0.83, 95% CI 0.70-0.97), and less likely to change AAD (p < 0.01). Patients identified as NHB are 10% less likely to receive an AAD for treatment of newly diagnosed AF. Compared to NHW, Hispanic and Asian patients were more likely to discontinue AAD treatment. Once initiated on an AAD, NHB patients were significantly more likely to have an AF -related hospitalization, but were 17% less likely to receive ablation compared to NHW patients. The etiology of, and interventions to reduce, these disparities require further investigation.

Changes over time in POLST use and content by race and ethnicity among California nursing home residents.

Physician Orders for Life-Sustaining Treatment (POLST) are commonly used for nursing home (NH) residents. Treatment orders differ across race and ethnicity, presumably related to cultural and socioeconomic variation and levels of access to care and trust. Because national efforts focus on addressing the underpinnings of racial and ethnic differences in treatment (i.e., access to care and trust), we describe POLST use and content by race and ethnicity. California requires NHs to document POLST completion and content in the Minimum Data Set. We describe POLST completion and content for all California NH residents from 2011 to 2016 (N = 1,120,376). Adjusting for resident characteristics, we compared changes in completion rate and differences by race and ethnicity in POLST content-orders for cardiopulmonary resuscitation (CPR), do not resuscitate (DNR), CPR with full treatment, DNR with selective treatment or comfort orders, and if unsigned. POLST completion increased across all racial and ethnic groups from 2011 to 2016; by 2016, NH residents had a POLST two-thirds or more of the time. In 2011, Black residents had a POLST with a CPR order 30.4% of the time, Hispanic residents 25.6%, and White residents 19.7%. By 2016, this grew to 42.5%, 38.2%, and 28.1%, respectively, with Black and Hispanic residents demonstrating larger increases than White residents (p < 0.001). Increases over time in POLST with CPR and full treatment were greater for Black and Hispanic residents compared to White residents. The increase in POLST with DNR and DNR with Selective treatment and Comfort orders was greater for White compared to Black patients (p < 0.001). Unsigned POLST with CPR and DNR orders decreased across all racial and ethnic groups. Racial and ethnic differences in POLST intensity of care orders increased between 2011 and 2016 suggesting that efforts to mitigate factors underlying differences were ineffective. Studies of newer POLST data are imperative.

Neoadjuvant Chemotherapy in Ovarian Cancer: Are There Racial Disparities in Use and Survival?

We investigated racial and ethnic disparities in treatment sequence [i.e., neoadjuvant chemotherapy (NACT) plus interval debulking surgery (IDS) versus primary debulking surgery (PDS) plus adjuvant chemotherapy] among patients with ovarian cancer and its contribution to disparities in mortality. Study included 37,566 women ages ≥18 years, diagnosed with stage III/IV ovarian cancer from the National Cancer Database (2004-2017). Logistic regression was used to compute ORs and 95% confidence intervals (CI) for racial and ethnic disparities in treatment sequence. Cox proportional hazards regression was used to estimate HRs and 95% CI for racial and ethnic disparities in all-cause mortality. Non-Hispanic Black (NHB) and Asian women were more likely to receive NACT plus IDS relative to PDS plus adjuvant chemotherapy than non-Hispanic White (NHW) women (OR: 1.12; 95% CI: 1.02-1.22 and OR: 1.12; 95% CI: 0.99-1.28, respectively). Compared with NHW women, NHB women had increased hazard of all-cause mortality (HR: 1.14; 95% CI: 1.09-1.20), whereas Asian and Hispanic women had a lower hazard of all-cause mortality (HR: 0.81; 95% CI: 0.74-0.88 and HR: 0.83; 95% CI: 0.77-0.88, respectively), which did not change after accounting for treatment sequence. NHB women were more likely to receive NACT plus IDS and experience a higher all-cause mortality rates than NHW women. Differences in treatment sequence did not explain racial disparities in all-cause mortality. Further evaluation of racial and ethnic differences in treatment and survival in a cohort of patients with detailed treatment information is warranted.

Treatment and survival following in-hospital cardiac arrest: does patient ethnicity matter?

Previous research on racial/ethnic disparities in relation to cardiac arrest has mainly focused on black vs. white disparities in the USA. The great majority of these studies concerns out-of-hospital cardiac arrest (OHCA). The current nationwide registry study aims to explore whether there are ethnic differences in treatment and survival following in-hospital cardiac arrest (IHCA), examining possible disparities towards Middle Eastern and African minorities in a European context. In this retrospective registry study, 24 217 patients from the IHCA part of the Swedish Registry of Cardiopulmonary Resuscitation were included. Data on patient ethnicity were obtained from Statistics Sweden. Regression analysis was performed to assess the impact of ethnicity on cardiopulmonary resuscitation (CPR) delay, CPR duration, survival immediately after CPR, and the medical team's reported satisfaction with the treatment. Middle Eastern and African patients were not treated significantly different compared to Nordic patients when controlling for hospital, year, age, sex, socioeconomic status, comorbidity, aetiology, and initial heart rhythm. Interestingly, we find that Middle Eastern patients were more likely to survive than Nordic patients (odds ratio = 1.52). Overall, hospital staff do not appear to treat IHCA patients differently based on their ethnicity. Nevertheless, Middle Eastern patients are more likely to survive IHCA.

Abstract 16133: Racial and Ethnic Differences in Treatment and Outcomes of Left Atrial Appendage Occlusion in Patients With Atrial Fibrillation

Introduction: Non-white patients have been reported to face barriers to left atrial appendage occlusion (LAAO). Hypothesis: We hypothesized that white vs. non-white patients would have disparate wait times for and post-procedural treatment course after LAAO. Methods: We identified consecutive patients undergoing LAAO (Watchman TM ) at our institution between November 2015 - March 2020. In white vs. non-white patients, we compared patient characteristics, indications for LAAO, procedural wait time from index event (IE) and cardiology encounter to LAAO procedure, complications, post-procedure anticoagulation regimen, and adherence to 45-day post-procedural transesophageal echocardiogram (TEE). Results: Of 109 consecutive patients receiving LAAO implants, 45% were white (n = 49). White patients were less likely to have prior cerebral vascular accident (14% vs. 43%, p=0.001), heart failure (18% vs. 48%, p=0.001), and end stage renal disease (0% vs. 20%, p&lt;0.001). White patients also had lower CHADS2VASc and HAS-BLED scores (4 vs. 4.8, p=0.006 and 3.5 vs. 4.2, p&lt;0.001, respectively). The majority of both white and non-white patients underwent LAAO due to prior gastrointestinal bleed (66% vs. 76%, p=0.9). Non-white patients were more likely to be in poverty (55% vs. 15% p&lt;0.001). There was no difference in median time from IE or initial cardiology encounter to LAAO procedure in whites vs. non-whites (10.5 vs. 13.7 months, p=0.9 and 1.9 vs 1.8 months p=0.6, respectively), and there was no significant difference in procedural complications, all of which were non-fatal pericardial effusions (4% vs. 5%, p=0.33). After adjusting for CHADS2VASc score, whites may have been more likely to be discharged on oral anticoagulation vs. dual anti-platelet therapy (OR 2.4, 95%CI [0.94-6] p=0.07). Adherence to post-procedural TEE was similar between groups (92% vs 90%, p=0.7). Conclusions: Whites and non-whites had similar indications for LAAO, procedural wait time, risk of procedural complications, and adherence to post-procedural TEE, despite a higher burden of co-morbidities. White patients may be more likely to be discharged on oral anticoagulation.

Demographic trends and in-hospital mortality data in patients with hepatocellular carcinoma.

e16648 Background: Hepatocellular carcinoma (HCC) remains the 4th leading cause of cancer related mortality in the US. The incidence of HCC in the US appears to be increasing in specific demographic subgroups (Caucasian males, Hispanics and in the Southern US). Older studies identified substantial racial and ethnic differences in treatment and survival in HCC. There is a lack of large scale studies exploring the mortality patterns in patients hospitalized with HCC. Methods: The National Inpatient Sample was used to extract admissions for HCC using the ICD-9 code 155.0 from the years 2010 to 2014. The sample was weighted to approximate the full inpatient population of the U.S. over the 5-year interval. Univariate analysis was performed to determine the frequency distribution and bivariate analysis was performed using Chi Square test to determine the in-hospital mortality percentage. Results: A total of 52,868 (weighted = 262845) admissions were extracted from the years 2010 to 2014. While the number of patients admitted with HCC steadily increased over the 5-year study period, the overall in-hospital mortality decreased significantly from 9.35% to 7.68% (p &lt; 0.0001). The mortality was highest for patients with African American ethnicity at 11.2% and for uninsured patients at 13%. The mortality rate among patients in the low income group (0-25th percentile) was 10.2 %, significantly higher (p = 0.0005) than other income groups. Conclusions: Even though the incidence of in-hospital mortality in HCC patients is decreasing, there appears to be a disparity in mortality data among patients of low socioeconomic status, self-pay or uninsured status and among African Americans. Our study further confirms the persistence of racial,economic and social disparities and highlights the need for additional equity research to understand the reasons for these differences and to improve outcomes for these subgroups of patients.

To the Future of Ethnogeriatric Research and Publication.

The reinstatement of the Journal of the American Geriatrics Society Section on Ethnogeriatrics coincides with more rapid growth in older populations that are classified as ethnic and racial minorities in the United States than those classified as non-Hispanic white. By 2060, 40% of older Americans are predicted to belong to a minority. Important needs for ethnogeriatric research and publication include: making sure research populations are meaningful and precise rather than using categories that include many unrelated groups; and increasing research among smaller ethnic populations of older adults. Topics in need of attention include epidemiology of common geriatric illness among the smaller populations, and social determinants for those in which disparities have been established; the extent and effectiveness of use of Culturally and Linguistically Appropriate Services Standards in geriatric care; examination of communication strategies used in provider/patient interaction, especially use of interpreters; ethnic differences in treatment of older patients; and models of use of community health workers from older patients' own cultural communities. Stresses related to caregiving in cultures emphasizing the importance of family care are important to understand acceptable models of long-term care for diverse families. The new Ethnogeriatric Section opens the opportunity for geriatric researchers, especially those from diverse backgrounds, to explore important issues in cross-cultural geriatric care; their findings can then form the basis of expanded ethnogeriatric curriculum for training future providers for the growing population of diverse older Americans.

Ethnic differences in colon cancer care in the Netherlands: a nationwide registry-based study

BackgroundEthnic differences in colon cancer (CC) care were shown in the United States, but results are not directly applicable to European countries due to fundamental healthcare system differences. This is the first study addressing ethnic differences in treatment and survival for CC in the Netherlands.MethodsData of 101,882 patients diagnosed with CC in 1996–2011 were selected from the Netherlands Cancer Registry and linked to databases from Statistics Netherlands. Ethnic differences in lymph node (LN) evaluation, anastomotic leakage and adjuvant chemotherapy were analysed using stepwise logistic regression models. Stepwise Cox regression was used to examine the influence of ethnic differences in adjuvant chemotherapy on 5-year all-cause and colorectal cancer-specific survival.ResultsAdequate LN evaluation was significantly more likely for patients from ‘other Western’ countries than for the Dutch (OR 1.09; 95% CI 1.01–1.16). ‘Other Western’ patients had a significantly higher risk of anastomotic leakage after resection (OR 1.24; 95% CI 1.05–1.47). Patients of Moroccan origin were significantly less likely to receive adjuvant chemotherapy (OR 0.27; 95% CI 0.13–0.59). Ethnic differences were not fully explained by differences in socioeconomic and hospital-related characteristics. The higher 5-year all-cause mortality of Moroccan patients (HR 1.64; 95% CI 1.03–2.61) was statistically explained by differences in adjuvant chemotherapy receipt.ConclusionThese results suggest the presence of ethnic inequalities in CC care in the Netherlands. We recommend further analysis of the role of comorbidity, communication in patient-provider interaction and patients’ health literacy when looking at ethnic differences in treatment for CC.

Racial and ethnic differences in treatment and survival among women with invasive squamous cell carcinoma of the vulva in the United States

Racial and ethnic differences in treatment and survival among women with invasive squamous cell carcinoma of the vulva in the United States

Racial and Ethnic Differences in Substance Abuse Service Needs, Utilization, and Outcomes in California

Racial and Ethnic Differences in Substance Abuse Service Needs, Utilization, and Outcomes in California

Ethnic differences in the treatment of depression in patients with ischemic heart disease

The aim of this study is to examine ethnic differences in depressive symptoms and antidepressant treatment in a cohort of patients undergoing diagnostic coronary angiography. Coronary heart disease (CHD) is the leading cause of mortality in the United States, with an excess of mortality in African Americans. Traditional risk factors occur more frequently among African Americans but do not fully account for this increased risk. Elevated depressive symptoms have been shown to be associated with higher morbidity and mortality in patients with CHD. A consecutive series of 864 patients (727 whites, 137 African Americans) completed the Beck Depression Inventory to assess depressive symptoms. Data describing cardiovascular risk factors and type of medications including antidepressants were obtained from chart review at the time of study enrollment. There was no difference in the severity of depressive symptoms between whites (P = .50); the prevalence of elevated depressive symptoms also was similar for African Americans (35%) and whites (27%) (P = .20). However, the rate of antidepressant use was 21% for whites but only 11.7% for African Americans (P = .016). The odds ratio for ethnicity (African American vs whites) in predicting antidepressant use was 0.43 (95% confidence interval 0.24-0.76, P = .004) after adjustment for Beck Depression Inventory scores. African Americans with CHD are less likely to be treated with antidepressant medications compared with whites despite having similar levels of depression. The ethnic differences in the psychopharmacological management of depression suggests that more careful assessment of depression, especially in African Americans, is necessary to optimize care of patients with CHD.

Service Utilization Differences for Axis I Psychiatric and Substance Use Disorders Between White and Black Adults

Service Utilization Differences for Axis I Psychiatric and Substance Use Disorders Between White and Black Adults

Racial and ethnic differences in treatment and survival among adults with primary extremity soft‐tissue sarcoma

Limb preservation is preferred to amputation for patients with extremity soft tissue sarcoma (ESTS). Disparities in the treatment and outcomes of several malignancies have been reported, but not for ESTS. The authors assessed racial/ethnic differences in patient- and tumor-specific characteristics, treatment, and disease-specific survival in a population of adults with ESTS. The Surveillance, Epidemiology, and End Results (SEER) database was used to identify 6406 adult patients with ESTS who were diagnosed and treated between 1988 and 2003. Patients were categorized into 1 of 4 racial/ethnic groups: whites, blacks, Hispanics, and Asians. Comparisons of treatment and disease-specific survival were conducted with regression models that adjusted for patient age, sex, SEER geographic region, extent of disease, tumor grade, tumor size, and histology. Relative to whites, blacks received lower rates of adjuvant radiation with surgery (odds ratio [OR], 0.77; 95% confidence interval [95% CI], 0.66-0.90). Hispanics received significantly lower rates of limb-sparing surgery (OR, 0.76; 95% CI, 0.59-0.97). In a multivariate analysis controlling for patient age, sex, SEER geographic region, extent of disease, tumor grade, tumor size, and histology, blacks displayed a worse disease-specific survival (hazard ratio [HR] 1.39; 95% CI, 1.13-1.70), whereas Asians demonstrated superior disease-specific survival (HR, 0.67; 95% CI, 0.46-0.97). There were significant racial/ethnic differences in treatment and survival among adults with ESTS. Compared with whites, survival was poorer for blacks but better for Asians. These disparities were not explained by differences in patient or tumor characteristics.

Treatment Needs and Completion of Community-Based Aftercare Among Substance-Abusing Women Offenders

Women offenders with substance abuse problems typically have many treatment needs on reentry to the community from prison. This paper explores the correlates of treatment needs among a sample of women offenders with substance-abuse problems (n = 1,404), and the relationship between their treatment needs and other background characteristics with completion of community-based treatment after parole. Treatment needs were assessed at admission into prison-based substance abuse treatment; participants were admitted into community-based treatment upon parole. Descriptive statistics and multiple regression were used to examine their treatment needs; logistic regression analysis was used to determine the factors related to completion of the aftercare program. Analysis of variance was used to examine ethnic differences in treatment needs. Greater treatment needs were associated with unstable housing before incarceration, a history of sexual or physical abuse, mental health problems, alcohol or drug dependence, and first arrest at age <19; lower treatment needs were associated with having been mandated to prison-based treatment (versus volunteering). Mental health problems and earlier age at first arrest predicted treatment noncompletion. Drug dependence was associated with higher treatment needs and a greater likelihood of treatment completion, whereas African American and Hispanic ethnicity were both associated with lower treatment needs (compared with Whites) and a lower likelihood of treatment completion. Interventions are needed to engage substance-abusing women offenders in community treatment after parole to address their treatment needs, improve their retention in treatment, and reduce the likelihood of recidivism.

Fighting Unequal Treatment

Ensuring that all Americans have access to quality health care is one of the major goals of The Robert Wood Johnson Foundation (RWJF), as is improving the quality of health care for people with chronic conditions. Working toward this goal means that we must eliminate the embarrassing and unacceptable gaps in health care experienced by racial and ethnic minorities. Research indicates that Americans do not receive half of the care that experts recommend,1 but the evidence also indicates that these quality gaps are even worse for racial and ethnic minorities.2 Disparities in treatment exist across a wide range of chronic conditions, and the evidence of differential treatment is particularly strong with regard to treatment for cardiovascular conditions such as myocardial infarction and congestive heart failure.3 Even though disparities in care have not been conclusively linked to disparities in health outcomes, many experts believe that persistent patterns of lower-quality care for minority Americans do contribute to worse health outcomes, which could explain in part the disproportionate impact of heart disease on minority Americans. Mortality rates from cardiovascular disease are higher among blacks than whites,4 and one study found that heart disease accounted for nearly one third of the overall mortality difference between black and white patients.5 For all of these reasons, efforts to reduce disparities in cardiovascular care are likely to be particularly important in closing gaps in care and will be a high priority for RWJF in the next half decade. This editorial describes the foundation’s approach to reducing racial and ethnic disparities in health care and the underlying rationale for the strategy. For RWJF, developing a new targeted strategy for funding work to reduce racial and ethnic disparities in care required an immediate emphasis on discovering or helping to develop replicable solutions. We believe …