Ethnic Disparities In Mortality Research Articles

Association between social determinants of health and survival among the US cancer survivors population

BackgroundRacial and ethnic disparities in mortality persist among US cancer survivors, with social determinants of health (SDoH) may have a significant impact on these disparities.MethodsA population-based cohort study of a nationally representative sample of adult cancer survivors, who participated in the US National Health and Nutrition Examination Survey from 1999 to 2018 was included. Sociodemographic characteristics and SDoH were self-reported using standardized questionnaires in each survey cycle. The SDoH was examined by race and estimated for associations with primary outcomes, which included all-cause and cancer-specific mortality. Multiple mediation analysis was performed to assess the contribution of each unfavorable SDoH to racial disparities to all-cause and cancer-specific mortality.ResultsAmong 5163 cancer survivors (2724 [57.7%] females and 3580 [69.3%] non-Hispanic White individuals), only 881 (24.9%) did not report an unfavorable SDoH. During the follow-up period of up to 249 months (median 81 months), 1964 deaths were recorded (cancer, 624; cardiovascular, 529; other causes, 811). Disparities in all-cause and cancer-specific mortality were observed between non-Hispanic Black and White cancer survivors. Unemployment, lower economic status, education less than high school, government or no private insurance, renting a home or other arrangements, and social isolation were significantly and independently associated with worse overall survival. Unemployment, lower economic status, and social isolation were significantly associated with cancer-specific mortality. Compared to patients without an unfavorable SDoH, the risk of all-cause mortality was gradually increased in those with a cumulative number of unfavorable SDoHs (1 unfavorable SDoH: hazard ratio [HR] = 1.54, 95% CI 1.25–1.89; 2 unfavorable SDoHs: HR = 1.81, 95% CI 1.46–2.24; 3 unfavorable SDoHs: HR = 2.42, 95% CI 1.97–2.97; 4 unfavorable SDoHs: HR = 3.22, 95% CI 2.48–4.19; 5 unfavorable SDoHs: HR = 3.99, 95% CI 2.99–5.33; 6 unfavorable SDoHs: HR = 6.34 95% CI 4.51–8.90). A similar trend existed for cancer-specific mortality.ConclusionsIn this cohort study of a nationally representative sample of US cancer survivors, a greater number of unfavorable SDoH was associated with increased risks of mortality from all causes and cancer. Unfavorable SDoH levels were critical risk factors for all-cause and cancer-specific mortality, as well as the underlying cause of racial all-cause mortality disparities among US cancer survivors.

Lack of racial and ethnic disparities in mortality in minority patients hospitalised with COVID-19 in a mid-Atlantic healthcare system

IntroductionIn the USA, minoritised communities (racial and ethnic) have suffered disproportionately from COVID-19 compared with non-Hispanic white communities. In a large cohort of patients hospitalised for COVID-19 in a healthcare...

Burden of liver cancer mortality by county, race, and ethnicity in the USA, 2000–19: a systematic analysis of health disparities

Understanding how specific populations are affected by liver cancer is important for identifying priorities, policies, and interventions to mitigate health risks and reduce disparities. This study aims to provide comprehensive analysis of rates and trends in liver cancer mortality for different racial and ethnic populations in the USA nationally and at the county level from 2000 to 2019. We applied small-area estimation methods to death registration data from the US National Vital Statistics System and population data from the US National Center for Health Statistics to estimate liver cancer mortality rates by county, racial and ethnic population, and year (2000-19) in the USA. Race and ethnicity were categorised as non-Latino and non-Hispanic American Indian or Alaska Native (AIAN), non-Latino and non-Hispanic Asian or Pacific Islander (Asian), non-Latino and non-Hispanic Black (Black), Latino or Hispanic (Latino), and non-Latino and non-Hispanic White (White). Estimates were adjusted using published misclassification ratios to correct for inaccuracies in race or ethnicity as recorded on death certificates, and then age-standardised. Mortality rate estimates are presented for all county and racial and ethnic population combinations with a mean annual population greater than 1000. Nationally, the age-standardised liver cancer mortality rate increased between the years 2000 (4·2 deaths per 100 000 population [95% uncertainty interval 4·1-4·3]) and 2016 (6·0 per 100 000 [5·9-6·1]), followed by a stabilisation in rates from 2016 to 2019 (6·1 per 100 000 [6·0-6·2]). Similar trends were observed across the AIAN, Black, Latino, and White populations, whereas the Asian population showed an overall decrease across the 20-year study period. Qualitatively similar trends were observed in most counties; however, the mortality rate and the rate of change varied substantially across counties, both within and across racial and ethnic populations. For the 2016-19 period, mortality continued to increase at a substantial rate in some counties even while it stabilised nationally. Nationally, the White population had the lowest mortality rate in all years, while the racial and ethnic population with the highest rate changed from the Asian population in 2000 to the AIAN population in 2019. Racial and ethnic disparities were substantial: in 2019, mortality was highest in the AIAN population (10·5 deaths per 100 000 [9·1-12·0]), notably lower for the Asian (7·5 per 100 000 [7·1-7·9]), Black (7·6 per 100 000 [7·3-7·8]), and Latino (7·7 per 100 000 [7·5-8·0]) populations, and lowest for the White population (5·5 [5·4-5·6]). These racial and ethnic disparities in mortality were prevalent throughout the country: in 2019, mortality was higher in minoritised racial and ethnic populations than in the White population living in the same county in 408 (87·7%) of 465 counties with unmasked estimates for the AIAN population, 604 (90·6%) of 667 counties for the Asian population, 1207 (81·2%) of 1486 counties for the Black population, and 1073 (73·0%) of 1469 counties for the Latino population. Although the plateau in liver cancer mortality rates in recent years is encouraging, mortality remains too high in many locations throughout the USA, particularly for minoritised racial and ethnic populations. Addressing population-specific risk factors and differences in access to quality health care is essential for decreasing the burden and disparities in liver cancer mortality across racial and ethnic populations and locations. US National Institutes of Health (Intramural Research Program, National Institute on Minority Health and Health Disparities; National Heart, Lung, and Blood Institute; Intramural Research Program, National Cancer Institute; National Institute on Aging; National Institute of Arthritis and Musculoskeletal and Skin Diseases; Office of Disease Prevention; and Office of Behavioral and Social Sciences Research).

Abstract B102: Contribution of comorbid conditions to racial and ethnic disparities in ovarian cancer survival

Abstract Background: Ovarian cancer is the most lethal gynecologic cancer and the fifth leading cause of cancer-related mortality among women in the US. Racial and ethnic disparities in ovarian cancer outcomes exist, wherein non-Hispanic Black (NHB) women are 40% more likely to die compared with non-Hispanic White (NHW) women. Comorbidity burden is differential by race and ethnicity and has the potential to affect treatment and outcomes. Our objective was to evaluate the association between comorbidities, present at the time of diagnosis, and mortality, and to evaluate if comorbidities contributed to racial and ethnic disparities in mortality. Methods: The KP ROCS (Kaiser Permanente Research on Ovarian Cancer Survival) Study includes women diagnosed with invasive ovarian, fallopian, or peritoneal cancer between 2000 and 2018 at KP Northern California, older than 18 years and residing in California at diagnosis. Comorbidities were identified using ICD-9/10 and procedural codes up to five years preceding the ovarian cancer diagnosis. We computed hazard ratios (HRs) and 95% confidence intervals (CIs) associating individual comorbidities and the Charlson Comorbidity Index (CCI) with all-cause mortality, and the racial disparities (Hispanic, non-Hispanic Asian, and NHB vs. NHW) in all-cause mortality by comorbidity, adjusting for age and stage. Results: Of 4,910 ovarian cancer patients in the KP ROCS cohort, 605 (12%) are Hispanic, 672 (13%) are non-Hispanic Asian, 282 (5.5%) are NHB, and 3,321 (74%) are NHW. At diagnosis, NHB and Hispanic ovarian cancer patients were more likely to present with diabetes than non-Hispanic Asian and NHW women (NHB=16%, Hispanic=13% vs non-Hispanic Asian=10%, NHW=8%). Cardiovascular disease was more common among NHB women compared with other racial and ethnic groups (NHB=37% vs. Hispanic=26%, non-Hispanic Asian=19%, NHW=32%). Moreover, the net burden of comorbidities (CCI=3+) was higher among NHB women compared with other racial and ethnic groups (NHB=22% vs non-Hispanic Asian=9%, Hispanic=13%, NHW=13%). In the multivariable-adjusted models, ovarian cancer patients with diabetes (HR=1.16, 95%CI 1.03, 1.31), cardiovascular disease (HR=1.32, 95% CI 1.22, 1.44), hypertension (HR=1.07, 95%CI 0.99, 1.16), or renal disease (HR=1.25, 95%CI, 1.14, 1.38 at the time of their diagnosis were more likely to die than those without the corresponding comorbidity. NHB ovarian cancer patients had an increased hazard of mortality across nearly all comorbid conditions compared with NHW patients, whereas Hispanic women had equivalent mortality rates as NHW patients, and non-Hispanic Asian patients had reduced mortality rates compared with NHW patients across each individual comorbidity. Conclusions: These analyses indicate that the presence of comorbid conditions negatively impacts survival among ovarian cancer patients. Moreover, NHB ovarian cancer patients are more likely to present with comorbidities at the time of their ovarian cancer diagnosis compared with other racial and ethnic groups, which may partially explain the observed disparities. Citation Format: Lindsay J. Collin, Jia Li, Valerie S. Lee, Juraj Kavecansky, Christine Garcia, Carola Sanchez Diaz, Scarlett Lin Gomez, Jennifer A. Doherty, Elisa V. Bandera, Lawrence H. Kushi. Contribution of comorbid conditions to racial and ethnic disparities in ovarian cancer survival [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B102.

Racial and ethnic disparities in early mortality among patients with inborn errors of immunity

Racial and ethnic disparities in life expectancy in the United States have been widely documented. To date, there remains a paucity of similar data in patients with inborn errors of immunity (IEIs). Our aim was to examine racial and ethnic differences in mortality due to an IEI in the United States. We analyzed National Center for Health Statistics national mortality data from 2003 to 2018. We quantified age-adjusted death rate and age-specific death rate as a result of an IEI for each major racial and ethnic group in the United States and examined the association of race and ethnicity with death at a younger age. From 2003 to 2018, IEIs were reported as the underlying or contributing cause of death in 14,970 individuals nationwide. The age-adjusted death rate was highest among Black patients (4.25 per 1,000,000 person years), compared with 2.01, 1.71, 1.50, and 0.92 per 1,000,000 person years for White, American Indian/Alaska Native, Hispanic, and Asian/Pacific Islander patients, respectively. The odds of death before age 65 years were greatest among Black patients (odds ratio [OR]= 5.15 [95% CI= 4.61-5.76]), followed by American Indian/Alaska Native patients (OR= 3.58 [95% CI= 2.30-5.82]), compared with White patients. The odds of death before age 24 years were greater among Hispanic patients than among non-Hispanic patients (OR= 3.60 [95% CI= 3.08-4.18]). Our study highlights racial and ethnic disparities in mortality due to an IEI and the urgent need to further identify and systematically remove barriers in care for historically marginalized patients with IEIs.

Emergency Department Pediatric Readiness and Disparities in Mortality Based on Race and Ethnicity

Presentation to emergency departments (EDs) with high levels of pediatric readiness is associated with improved pediatric survival. However, it is unclear whether children of all races and ethnicities benefit equitably from increased levels of such readiness. To evaluate the association of ED pediatric readiness with in-hospital mortality among children of different races and ethnicities with traumatic injuries or acute medical emergencies. This cohort study of children requiring emergency care in 586 EDs across 11 states was conducted from January 1, 2012, through December 31, 2017. Eligible participants included children younger than 18 years who were hospitalized for an acute medical emergency or traumatic injury. Data analysis was conducted between November 2022 and April 2023. Hospitalization for acute medical emergency or traumatic injury. The primary outcome was in-hospital mortality. ED pediatric readiness was measured through the weighted Pediatric Readiness Score (wPRS) from the 2013 National Pediatric Readiness Project assessment and categorized by quartile. Multivariable, hierarchical, mixed-effects logistic regression was used to evaluate the association of race and ethnicity with in-hospital mortality. The cohort included 633 536 children (median [IQR] age 4 [0-12] years]). There were 557 537 children (98 504 Black [17.7%], 167 838 Hispanic [30.1%], 311 157 White [55.8%], and 147 876 children of other races or ethnicities [26.5%]) who were hospitalized for acute medical emergencies, of whom 5158 (0.9%) died; 75 999 children (12 727 Black [16.7%], 21 604 Hispanic [28.4%], 44 203 White [58.2%]; and 21 609 of other races and ethnicities [27.7%]) were hospitalized for traumatic injuries, of whom 1339 (1.8%) died. Adjusted mortality of Black children with acute medical emergencies was significantly greater than that of Hispanic children, White children, and of children of other races and ethnicities (odds ratio [OR], 1.69; 95% CI, 1.59-1.79) across all quartile levels of ED pediatric readiness; but there were no racial or ethnic disparities in mortality when comparing Black children with traumatic injuries with Hispanic children, White children, and children of other races and ethnicities with traumatic injuries (OR 1.01; 95% CI, 0.89-1.15). When compared with hospitals in the lowest quartile of ED pediatric readiness, children who were treated at hospitals in the highest quartile had significantly lower mortality in both the acute medical emergency cohort (OR 0.24; 95% CI, 0.16-0.36) and traumatic injury cohort (OR, 0.39; 95% CI, 0.25-0.61). The greatest survival advantage associated with high pediatric readiness was experienced for Black children in the acute medical emergency cohort. In this study, racial and ethnic disparities in mortality existed among children treated for acute medical emergencies but not traumatic injuries. Increased ED pediatric readiness was associated with reduced disparities; it was estimated that increasing the ED pediatric readiness levels of hospitals in the 3 lowest quartiles would result in an estimated 3-fold reduction in disparity for pediatric mortality. However, increased pediatric readiness did not eliminate disparities, indicating that organizations and initiatives dedicated to increasing ED pediatric readiness should consider formal integration of health equity into efforts to improve pediatric emergency care.

Social determinants of health and premature death among adults in the USA from 1999 to 2018: a national cohort study

Racial and ethnic disparities in mortality persist in the US population. We studied the contribution of social determinants of health (SDoH) to racial and ethnic disparities in premature death. A nationally representative sample of individuals aged 20-74 years who participated in the US National Health and Nutrition Examination Survey (NHANES) between 1999 and 2018 were included. Self-reported SDoH (employment, family income, food security, education, access to health care, health insurance, housing instability, and being married or living with a partner) were collected in each survey cycle. Participants were categorised into four groups of race and ethnicity: Black, Hispanic, White, and other. Deaths were ascertained from linkage to the National Death Index with follow-up until 2019. Multiple mediation analysis was used to assess simultaneous contributions of each individual SDoH to racial disparities in premature all-cause mortality. We included 48 170 NHANES participants in our analyses, consisting of 10 543 (21·9%) Black participants, 13 211 (27·4%) Hispanic participants, 19 629 (40·7%) White participants, and 4787 (9·9%) participants of other racial and ethnic groups. Mean survey-weighted age was 44·3 years (95% CI 44·0-44·6), 51·3% (50·9-51·8) of participants were women, and 48·7% (48·2-49·1) were men. 3194 deaths before age 75 years were recorded (930 Black participants, 662 Hispanic participants, 1453 White participants, and 149 other participants). Black adults had significantly higher premature mortality than other racial and ethnic groups (p<0·0001): premature death rates per 100 000 person-years were 852 (95% CI 727-1000) for Black adults, 445 (349-574) for Hispanic adults, 546 (474-630) for White adults, and 521 (336-821) for other adults. Unemployment, lower family income, food insecurity, less than high school education, no private health insurance, and not being married nor living with a partner were significantly and independently associated with premature death. Dose-response associations were observed between cumulative number of unfavourable SDoH and premature all-cause mortality: hazard ratios (HRs) were 1·93 (95% CI 1·61-2·31) for those with one unfavourable SDoH, 2·24 (1·87-2·68) for those with two, 3·98 (3·34-4·73) for those with three, 4·78 (3·98-5·74) for those with four, 6·08 (5·06-7·31) for those with five, and 7·82 (6·60-9·26) for those with six or more unfavourable SDoH (p<0·0001 for linear trend). After adjusting for SDoH, HRs for premature all-cause mortality for Black adults compared with White adults decreased from 1·59 (1·44-1·76) to 1·00 (0·91-1·10), suggesting complete mediation of this racial difference in mortality. Unfavourable SDoH are associated with increased rates of premature death and contribute to differences between Black and White racial groups in premature all-cause mortality in the US population. Innovative public health policies and interventions targeting SDoH are needed to reduce premature deaths and health disparities in this population. US National Institutes of Health.

Ethnic disparities in mortality and group-specific risk factors in the UK Biobank.

Despite a substantial overall decrease in mortality, disparities among ethnic minorities in developed countries persist. This study investigated mortality disparities and their associated risk factors for the three largest ethnic groups in the United Kingdom: Asian, Black, and White. Study participants were sampled from the UK Biobank (UKB), a prospective cohort enrolled between 2006 and 2010. Genetics, biological samples, and health information and outcomes data of UKB participants were downloaded and data-fields were prioritized based on participants with death registry records. Kaplan-Meier method was used to evaluate survival differences among ethnic groups; survival random forest feature selection followed by Cox proportional-hazard modeling was used to identify and estimate the effects of shared and ethnic group-specific mortality risk factors. The White ethnic group showed significantly worse survival probability than the Asian and Black groups. In all three ethnic groups, endoscopy and colonoscopy procedures showed significant protective effects on overall mortality. Asian and Black women show lower relative risk of mortality than men, whereas no significant effect of sex was seen for the White group. The strongest ethnic group-specific mortality associations were ischemic heart disease for Asians, COVID-19 for Blacks, and cancers of respiratory/intrathoracic organs for Whites. Mental health-related diagnoses, including substance abuse, anxiety, and depression, were a major risk factor for overall mortality in the Asian group. The effect of mental health on Asian mortality, particularly for digestive cancers, was exacerbated by an observed hesitance to answer mental health questions, possibly related to cultural stigma. C-reactive protein (CRP) serum levels were associated with both overall and cause-specific mortality due to COVID-19 and digestive cancers in the Black group, where elevated CRP has previously been linked to psychosocial stress due to discrimination. Our results point to mortality risk factors that are group-specific and modifiable, supporting targeted interventions towards greater health equity.

Abstract A074: Contribution of neighborhood and clinical factors to differences in early-onset colorectal cancer mortality across different racial and ethnic groups

Abstract Objectives: We investigated racial and ethnic differences in colorectal cancer (CRC) mortality in adults with early onset colorectal cancer (ages &amp;lt;50; EO-CRC) in California and quantified the contribution of sociodemographic, health system, and clinical factors to racial and ethnic disparities in mortality. Methods: California Cancer Registry data were used to estimate CRC-specific mortality for adults ages 18-49 with EO-CRC between 2000-2019 for each racial/ethnic group (non-Hispanic Black [NHB], Hispanic, Asian American, American Indian/Alaska Native [AIAN], Native Hawaiian/Pacific Islander [NHPI]) compared with non-Hispanic White (NHW) adults. Additional disaggregated comparisons were conducted in Asian American ethnic groups: Chinese, Filipino, Japanese, Korean, South Asian, Southeast Asian, Other Asian and NHPI, compared to NHW individuals and separately using Chinese adults as a referent group. Cox proportional hazards models were used to measure association between race/ethnicity and CRC mortality risk, yielding unadjusted hazard ratios (HR) and adjusted hazard ratios (aHR) accounting for sociodemographic, clinical and health system factors, with corresponding 95% confidence intervals (95% CI). Mediation analyses were conducted to measure the percentage of contribution of factors to overall racial/ethnic CRC mortality rates using a sequence of multivariable Cox models. Results: There were 22,997 adults ages 18-49 with an EO-CRC diagnosis between 2000-2019, with 3,544 Asian (1,039 deaths), 6,889 Hispanic (1,998 deaths), 125 AIAN (36 deaths), 1,668 NHB (670 deaths), 10,473 NHW (3,089 deaths), 135 NHPI (51 deaths) and 163 (&amp;lt;5 deaths) unknown race/ethnicity adults. Compared to NHW adults, higher CRC mortality was shown for NHPI adults (HR=1.69; 95% CI: 1.27-2.23; aHR=1.36; 95% CI: 1.03-1.79) and NHB adults (HR=1.53; 95% CI: 1.41-1.66; aHR=1.17; 95% CI: 1.07-1.29). Hispanic adults had an increased risk of CRC mortality in the unadjusted model (HR=1.15, 95% CI: 1.09-1.22) that was attenuated in the adjusted model (aHR=0.99, 95% CI: 0.92-1.04), compared to NHW adults. After disaggregating the Asian American group, Southeast Asian adults had increased CRC mortality risk in the unadjusted (HR=1.29, 95% CI: 1.13-1.46) but not adjusted model (aHR=1.10; 95% CI: 0.97-1.26), compared to NHW adults. In mediation analyses that examined contributors to the association between race/ethnicity and CRC mortality risk, neighborhood socioeconomic status and insurance status were among the top five most influential factors for Hispanic, NHB, and NHPI adults. However, the magnitude of influence differed by racial and ethnic group. Conclusions: Compared to NHWs, NHPI and NHB adults with EO-CRC had increased CRC mortality risk, even after adjusting for clinical and sociodemographic factors. Mediation analyses highlighted variation in the importance of various sociodemographic, clinical, health system and neighborhood factors, underscoring the need to better disentangle factors within racial and ethnic groups that contribute to disparities in CRC-related mortality. Citation Format: Joshua Demb, Scarlett Gomez, Alison Canchola, Alexander Qian, James D. Murphy, Samir Gupta, Maria Elena Martinez. Contribution of neighborhood and clinical factors to differences in early-onset colorectal cancer mortality across different racial and ethnic groups [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A074.

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.

Abstract 12740: Racial and Ethnic Disparities in Mortality in Patients Presenting With STEMI With COVID-19: NACMI Registry

Introduction: COVID-19 infection disproportionally impacts non-Whites with higher morbidity and mortality. However, differences by race and ethnicity in COVID-19 patients with concomitant STEMI have not been previously described. Methods: The North American COVID-19 STEMI (NACMI) registry is a prospective, observational registry enrolling COVID-19 patients with concomitant STEMI from 64 centers in Canada and the United States from March 2020 to December 2021. We compared clinical characteristics, treatment strategies, and in-hospital mortality risks by race/ethnicity. Results: Among 679 STEMI patients with concomitant COVID-19, 54.5% were White, 14.3% Black, 19.4% Hispanic/Latinx, and 11.8% Asian/Indigenous/Other. Blacks had the highest prevalence of current smokers, and Whites had the lowest prevalence of diabetes. The rate of high-risk features including cardiac arrest, cardiogenic shock, and inotropic support was comparable between the groups. Presence of infiltrates and cardiomegaly was higher in Blacks and Hispanic/Latinx; whereas, COVID-19 severity was similar in the groups. Blacks and Hispanic/Latinx and Blacks were more likely to not have coronary angiography performed. Among patients that underwent angiography, Whites and Hispanic/Latinx were more likely to be treated with primary PCI. In-hospital mortality was highest in Hispanic/Latinx (38%) and the Asian/Indigenous/Other group (Table). Conclusions: Despite no difference in high-risk features in patients with COVID-19 and STEMI, there was a significant difference in in-hospital mortality between Whites and non-Whites with highest risk in Hispanic/Latinx and Asian/Indigenous/Other. Further research in needed to explore discrepant outcomes in racial/ethnic minorities in this patient population and the role of discrepant management.

Hispanic ethnicity and mortality among critically ill patients with COVID-19.

BackgroundHispanic persons living in the United States (U.S.) are at higher risk of infection and death from coronavirus disease 2019 (COVID-19) compared with non-Hispanic persons. Whether this disparity exists among critically ill patients with COVID-19 is unknown.ObjectiveTo evaluate ethnic disparities in mortality among critically ill adults with COVID-19 enrolled in the Study of the Treatment and Outcomes in Critically Ill Patients with COVID-19 (STOP-COVID).MethodsMulticenter cohort study of adults with laboratory-confirmed COVID-19 admitted to intensive care units (ICU) at 67 U.S. hospitals from March 4 to May 9, 2020. Multilevel logistic regression was used to evaluate 28-day mortality across racial/ethnic groups.ResultsA total of 2153 patients were included (994 [46.2%] Hispanic and 1159 [53.8%] non-Hispanic White). The median (IQR) age was 62 (51–71) years (non-Hispanic White, 66 [57–74] years; Hispanic, 56 [46–67] years), and 1462 (67.9%) were men. Compared with non-Hispanic White patients, Hispanic patients were younger; were less likely to have hypertension, chronic obstructive pulmonary disease, coronary artery disease, or heart failure; and had longer duration of symptoms prior to ICU admission. During median (IQR) follow-up of 14 (7–24) days, 785 patients (36.5%) died. In analyses adjusted for age, sex, clinical characteristics, and hospital size, Hispanic patients had higher odds of death compared with non-Hispanic White patients (OR, 1.44; 95% CI, 1.12–1.84).ConclusionsAmong critically ill adults with COVID-19, Hispanic patients were more likely to die than non-Hispanic White patients, even though they were younger and had lower comorbidity burden. This finding highlights the need to provide earlier access to care to Hispanic individuals with COVID-19, especially given our finding of longer duration of symptoms prior to ICU admission among Hispanic patients. In addition, there is a critical need to address ongoing disparities in post hospital discharge care for patients with COVID-19.

Ethnic disparities in mortality among overweight or obese adults with newly diagnosed type 2 diabetes: a population-based cohort study

PurposeEthnic variation in risk of type 2 diabetes is well established, but its impact on mortality is less well understood. This study investigated the risk of all-cause and cardiovascular mortality associated with newly diagnosed type 2 diabetes in White, Asian and Black adults who were overweight or obese.MethodsThis population-based cohort study used primary care records from the UK Clinical Practice Research Datalink, linked with secondary care and death registry records. A total of 193,528 obese or overweight adults (BMI of 25 or greater), with ethnicity records and no pre-existing type 2 diabetes were identified between 01 January 1995 and 20 April 2018. Multivariable Cox proportional hazards regression estimated hazards ratios (HR) for incident type 2 diabetes in different ethnic groups. Adjusted hazards ratios for all-cause and cardiovascular mortality were determined in individuals with newly diagnosed type 2 diabetes.ResultsDuring follow-up (median 9.8 years), the overall incidence rate of type 2 diabetes (per 1,000 person-years) was 20.10 (95% CI 19.90–20.30). Compared to Whites, type 2 diabetes risk was 2.2-fold higher in Asians (HR 2.19 (2.07–2.32)) and 30% higher in Blacks (HR 1.34 (1.23–1.46)). In individuals with newly diagnosed type 2 diabetes, the rates (per 1,000 person-years) of all-cause mortality and cardiovascular mortality were 24.34 (23.73–24.92) and 4.78 (4.51–5.06), respectively. Adjusted hazards ratios for mortality were significantly lower in Asians (HR 0.70 (0.55–0.90)) and Blacks (HR 0.71 (0.51–0.98)) compared to Whites, and these differences in mortality risk were not explained by differences in severity of hyperglycaemia.Conclusions/InterpretationType 2 diabetes risk in overweight and obese adults is greater in Asian and Black compared to White ethnic populations, but mortality is significantly higher in the latter. Greater attention to optimising screening, disease and risk management appropriate to all communities with type 2 diabetes is needed.

Disaggregating Asian Race Reveals COVID-19 Disparities Among Asian American Patients at New York City’s Public Hospital System

Data on the health burden of COVID-19 among Asian American people of various ethnic subgroups remain limited. We examined COVID-19 outcomes of people of various Asian ethnic subgroups and other racial and ethnic groups in an urban safety net hospital system. We conducted a retrospective analysis of 85 328 adults aged ≥18 tested for COVID-19 at New York City's public hospital system from March 1 through May 31, 2020. We examined COVID-19 positivity, hospitalization, and mortality, as well as demographic characteristics and comorbidities known to worsen COVID-19 outcomes. We conducted adjusted multivariable regression analyses examining racial and ethnic disparities in mortality. Of 9971 Asian patients (11.7% of patients overall), 48.2% were South Asian, 22.2% were Chinese, and 29.6% were in other Asian ethnic groups. South Asian patients had the highest rates of COVID-19 positivity (30.8%) and hospitalization (51.6%) among Asian patients, second overall only to Hispanic (32.1% and 45.8%, respectively) and non-Hispanic Black (27.5% and 57.5%, respectively) patients. Chinese patients had a mortality rate of 35.7%, highest of all racial and ethnic groups. After adjusting for demographic characteristics and comorbidities, only Chinese patients had significantly higher odds of mortality than non-Hispanic White patients (odds ratio = 1.44; 95% CI, 1.04-2.01). Asian American people, particularly those of South Asian and Chinese descent, bear a substantial and disproportionate health burden of COVID-19. These findings underscore the need for improved data collection and reporting and public health efforts to mitigate disparities in COVID-19 morbidity and mortality among these groups.

Racial and Ethnic Disparities in Hospitalization Outcomes Among Medicare Beneficiaries During the COVID-19 Pandemic

The COVID-19 pandemic has disproportionately affected racial and ethnic minority populations. However, racial and ethnic disparities in hospitalization outcomes during the pandemic-for both COVID-19 and non-COVID-19 hospitalizations-are poorly understood, especially among older populations. To assess racial and ethnic differences in hospitalization outcomes during the COVID-19 pandemic among Medicare beneficiaries. In the 100% traditional Medicare inpatient data, there were 31 771 054 unique beneficiaries in cross-section just before the pandemic (February 2020), among whom 26 225 623 were non-Hispanic White, 2 797 462 were Black, 692 994 were Hispanic, and 2 054 975 belonged to other racial and ethnic minority groups. There were 14 021 285 hospitalizations from January 2019 through February 2021, of which 11 353 581 were among non-Hispanic White beneficiaries, 1 656 856 among Black beneficiaries, 321 090 among Hispanic beneficiaries, and 689 758 among beneficiaries of other racial and ethnic minority groups. Sensitivity analyses tested expanded definitions of mortality and alternative model specifications. Race and ethnicity in Medicare claims from the Social Security Administration. In-hospital mortality and mortality inclusive of discharges to hospice, deaths during 30-day readmissions, and 30-day all-cause mortality. Secondary outcomes included discharges to hospice and discharges to postacute care. The decline in non-COVID-19 and emergence of COVID-19 hospitalizations were qualitatively similar among beneficiaries of different racial and ethnic minority groups through February 2021. In-hospital COVID-19 mortality was not significantly different among Black patients relative to White patients, but was 3.5 percentage points higher among Hispanic patients (95% CI, 2.9-4.1; P < .001) and other racial and ethnic minority patients relative to White counterparts (95% CI, 3.0-4.1; P < .001). For non-COVID-19 hospitalizations, in-hospital mortality among Black patients increased by 0.5 percentage points more than it increased among White patients (95% CI, 0.3-0.6; P < .001), a 17.5% differential increase relative to the prepandemic baseline. This gap was robust to expanded definitions of mortality. Hispanic patients had similar differential increases in expanded definitions of mortality and model specification. Disparities in discharges to hospice and postacute care were evident. In aggregate across COVID-19 and non-COVID-19 hospitalizations, mortality differentially increased among racial and ethnic minority populations during the pandemic. In this cohort study, racial and ethnic disparities in mortality were evident among COVID-19 hospitalizations and widened among non-COVID-19 hospitalizations, motivating greater attention to health equity.

Racial and socioeconomic disparities in congenital heart surgery: A research article.

Though the modern era has proven to be reassuring with the advancement of perioperative care leading to improved survival, congenital heart disease (CHD) continues to underscore its significance in the lives of newborns and families worldwide. Particularly, CHD has disproportionately afflicted vulnerable minorities such as Black and Hispanic populations from the standpoint of ethnic disparities in mortality following heart surgery, increased resource utilization, and longer durations of stay. This study aims to identify and provide insight regarding the relationships between the aforementioned factors to develop targeted strategies of intervention to mitigate the outcomes for patients of these specific populations. Free, current peer-reviewed literature from databases such as the American Heart Association, The European Heart Journal, Science Direct, and PubMed regarding CHD, racial disparities, and socioeconomic variances were accessed. The study was narrowed to a patient population including only infants without chromosomal anomalies or those that passed away before hospital discharge. Having private insurance and maternal education showed positive correlations with positive outcomes of patients post congenital heart surgery. Teaching hospitals were linked with increased mortality and complications. Male infants showed higher rates of complications. Hispanics had increased odds of complications. Black patients had increased risk for failures in being rescued. Race plays a major role in the disparities in CHD, it is imperative to evaluate the socioeconomic contributors, surgical efforts, and provisions in place regarding minority patients. The apparency of these disparities, and willingness to invoke changes in practice has the potential for improvements in outcomes for these patients.

S0067 Trends in Utilization and Analysis of Inpatient Outcomes for Benign Cholangitis: A Nationwide Inpatient Sample Analysis From 2010 to 2017

INTRODUCTION: Cholangitis is a serious clinical syndrome of the hepatobiliary system, which can progress to sepsis, multiorgan failure and death. It can result from various etiologies such as primary autoimmune processes and secondary biliary obstruction (gallstones, benign and malignant stenosis). The aim of this study was to determine trends in patients hospitalized with benign cholangitis and factors associated with its inpatient outcomes. METHODS: The NIS database was used to identify hospitalized adult patients with cholangitis from 2010 to 2017 using ICD codes. Patients with malignancy of the gallbladder, bile duct, ampulla, duodenum or pancreas were excluded. Primary outcomes included the trend of prevalence, interventions, and inpatient outcomes. Secondary outcomes were factors that were independently associated with inpatient outcomes. RESULTS: Between 2010 and 2017, there was an uptrend of total benign cholangitis hospitalizations (33.3–38.1 per 10,000 US adults, P < 0.0001) with an annual prevalence change of 0.972 (P < 0.0001). An uptrend in benign calculous cholangitis was also observed (P < 0.0001). For biliary intervention, there were downtrends in ERCP, percutaneous and open biliary procedures (P < 0.0001). Outcomes in this study also showed downtrends in mortality (P = 0.0002) and length of stay (LOS) (P < 0.0001) with an uptrend in total hospital charges (P < 0.0001). After adjusting for covariates, the mortality was significantly higher among African American patients, >40 years old (especially >70), with Medicaid insurance, high Elixhauser comorbidity index (ECI) and specific comorbid conditions such as acute pancreatitis, HCV infection, bile duct obstruction and septicemia compared to the reference group. Total hospital charges were higher, and LOS was longer among patients with non-Caucasian ethnicities, high ECI and comorbid conditions such as cholecystitis, acute pancreatitis, HIV infection, bile duct obstruction and septicemia. CONCLUSION: Between 2010 and 2017, there was an uptrend of benign cholangitis hospitalizations with an increased proportion of calculous cholangitis and a downtrend in biliary procedures. Overall mortality rates and LOS decreased, while the costs of hospitalization increased during this study period. Further analysis identified ethnic disparities in mortality. High ECI, comorbid pancreatic/biliary conditions, infection and septicemia were independently associated with worse outcomes.Figure 1.: Trends in prevalence, procedures, mortality and cost for benign cholangitis from 2010 to 2017.Table 1.: Trends in selected variables for benign cholangitis from 2010 to 2017.Table 2.: Associations of patient and hospital characteristics with mortality, costs and length of stay.

Racial and ethnic disparities in mortality from gastric and esophageal adenocarcinoma.

BackgroundRacial/ethnic differences in mortality have not been well studied for either non‐cardia gastric cancer (NCGC) or cardia gastric cancer (CGC). The aim of this study was to examine the US mortality rates for these cancer subtypes, as well as esophageal adenocarcinoma (EAC) as a comparator.MethodsWe identified 14 164 individuals who died from NCGC, 5235 from CGC, and 13 982 from EAC in the Surveillance, Epidemiology, and End Results database between 2004 and 2016. Age‐adjusted incidence‐based mortality rates and corresponding annual percent changes (APCs) were calculated. Analyses were stratified by race/ethnicity, age, and stage of disease at diagnosis.ResultsThe mortality rate in NCGC was two‐ to threefold higher in blacks, Hispanics, and Asians/Pacific Islanders (PI) than non‐Hispanic whites, and was significant across all age groups and stages of disease (P < .01). Mortality in CGC was higher in non‐Hispanic whites than blacks and Asians/PI, particularly in individuals in the 50‐64 year age group and those with stage IV disease. Mortality in EAC was two‐ to sixfold higher in non‐Hispanic whites than all other groups across all age groups and stages of disease. From 2004 to 2016, mortality rates were stable across all racial/ethnic groups in NCGC and CGC, and in minority groups with EAC, but have been rising in non‐Hispanic whites with EAC (APC 3.03, 95% CI 0.17‐5.96).ConclusionsThis is the largest study of incidence‐based mortality in CGC and NCGC and demonstrates racial/ethnic differences in mortality between these subtypes. Mortality rates for NCGC are highest in minority groups, and have been stable in recent years despite declining incidence. Mortality rates for CGC are marginally higher in middle‐aged non‐Hispanic whites with advanced disease, though have remained stable. In contrast, mortality in EAC has been rising for non‐Hispanic whites, in parallel to incidence. Further studies are needed to refine prevention strategies for high‐risk individuals dying from these specific cancer subtypes.

Racial and Ethnic Disparities in Mortality in US Veterans Following an Incident Subarachnoid Hemorrhage

Background Blacks and Hispanics have been shown to have higher stroke mortality than Whites. However, few studies have investigated health disparities in post-stroke mortality for specific stroke types, such as subarachnoid hemorrhage (SAH). We analyzed risk of mortality by race/ethnicity after incident SAH in a national sample of stroke patients from the Veteran's Health Administration (VHA). Methods We included 742 patients (98% male, mean age 63±13 years) with a first occurrence of an inpatient SAH in a VHA hospital between 2002-2007. SAH was determined by ICD-9 code 430. We categorized patients as non-Hispanic White, non-Hispanic Black, or Hispanic. Veterans with a prior definite stroke type (including TIA) were excluded. We constructed a piecewise multivariate survival model for post event all-cause mortality, separated according to 1 year post admission follow-up intervals. We then looked at 30-day mortality for vascular and stroke specific deaths. Results The proportion of White, Black, and Hispanic patients was 66%, 23%, and 11% respectively. Total mortality at 30 days, 90 days, 1 year, and end of follow up was 22%, 27%, 33% and 54% respectively. Compared to Whites, Hispanics had higher mortality in the first 30 days post stroke (HR=1.67 95% CI=1.08-2.30), while Blacks and Whites experienced similar mortality (HR=1.02 95% CI=0.68, 1.54). Both Blacks and Hispanics had worse vascular (Black vs White HR=1.59 95% CI=0.95-2.66; Hispanic vs White HR=2.04 95% CI=1.13-3.66) and stroke-specific (Black vs White HR=1.47 95% CI=0.81-2.67; Hispanic vs White HR=2.12 95% CI=1.16-4.22) mortality (“case-fatality”) than Whites in the first 30 days. Conclusion Survivorship following subarachnoid hemorrhage varies in Veterans according to race and ethnicity. Further research into the severity of the stroke as well as risk factor control before and after stroke could help to improve our understanding of these differences.

423-P: Racial and Ethnic Disparities in Mortality and Cardiovascular Disease in Patients with Type 2 Diabetes in a U.S. Integrated Health-Care System

Previous research has documented higher mortality rates and risk of diabetes complications in ethnic minorities in the U.S. While genetic predisposition and lifestyle are potential important factors associated with this disparity, the role of access to care has not been well studied. We examined all-cause mortality and incidence of cardiovascular disease (CVD) by race/ethnicity in a type 2 diabetes (T2DM) population within in a large U.S. integrated healthcare system. We identified adult patients with incident T2DM between 1/1/2003-12/31/2014 using electronic health record (EHR) data and followed them through 6/30/2018. Patient demographics, CVD risk factors, medical history, and medication use were ascertained from the EHR. Age- and sex-adjusted all-cause mortality and incidence rates of myocardial infarction (MI) and heart failure (HF) were estimated by race/ethnicity. Hazard ratios were estimated using multivariable Cox proportional hazards models. We identified 135,199 patients with incident T2DM (mean±SD age: 58±13 years, 48% female, and median follow-up 6 years). 36% were white, 35% Hispanic, 12% Asian, and 12% black. All-cause mortality and incidence of MI and HF were highest among whites followed by blacks (Table). These findings suggest that improving access to quality care may help reduce racial/ethnic health disparities among patients with T2DM. Disclosure J. An: Research Support; Self; Merck &amp; Co., Inc. G.A. Nichols: Research Support; Self; Amarin Corporation, Boehringer Ingelheim Pharmaceuticals, Inc., Janssen Scientific Affairs, LLC., Merck Sharp &amp; Dohme Corp. L. Qian: None. R. Wei: None. T. Harrison: None. M.A. Munis: None. Z. Li: None. T. Weiss: Employee; Self; Merck &amp; Co., Inc. K. Iglay: Employee; Self; Merck &amp; Co., Inc. Stock/Shareholder; Self; Merck &amp; Co., Inc. S. Rajpathak: None. K. Reynolds: Research Support; Self; Amarin Corporation, Amgen Inc., Merck Sharp &amp; Dohme Corp., Novartis AG.