Evaluate Health Disparities Research Articles

Non-Linkage to Care and Non-Viral Suppression among Hispanic/Latino Persons by Birthplace and Social Vulnerability-United States, 2021.

Assessing individual- and community-level factors may help to explain differences among Hispanic/Latino adults with diagnosed HIV not linked to care and without viral suppression in the United States. We analyzed CDC's National HIV Surveillance System data among Hispanic/Latino persons aged ≥ 18years with HIV diagnosed during 2021 in 47 states and the District of Columbia and linked cases via census tracts to the CDC/ATSDR's Social Vulnerability Index (SVI). Adjusted prevalence ratios and 95% confidence intervals for non-linkage to care and non-viral suppression were estimated using Poisson regression model. Among 5,056 Hispanic/Latino adults with HIV diagnosed in 2021, 51.5% were born in the United States, 17.3% in Mexico, 9.2% in Central America, 11.1% in South America, 1.8% in Puerto Rico, 6.8% in Cuba, and 2.4% in the Caribbean. Compared with U.S.-born Hispanic/Latino adults, those born in Mexico and South America had a lower prevalence of non-linkage to care. Hispanic/Latino adults born in Mexico, South America, and the Caribbean (excluding Puerto Rico and Cuba) had a lower prevalence of non-viral suppression, compared with those born in the United States. No significant differences were observed among SVI quartiles for either care outcome. This study aimed to challenge the narrow perspective on HIV care outcomes by examining the impact of birthplace and social vulnerability among Hispanic/Latino adults. To increase HIV care and prevention among Hispanic/Latino persons, research must evaluate health disparities within the group, and efforts are needed to better understand and tailor interventions within the diverse Hispanic/Latino population.

ENCoDE - a skin tone and clinical dataset from a prospective trial on acute care patients.

Although hypothesized to be the root cause of the pulse oximetry disparities, skin tone and its use for improving medical therapies have yet to be extensively studied. Studies previously used self-reported race as a proxy variable for skin tone. However, this approach cannot account for skin tone variability within race groups and also risks the potential to be confounded by other non-biological factors when modeling data. Therefore, to better evaluate health disparities associated with pulse oximetry, this study aimed to create a unique baseline dataset that included skin tone and electronic health record (EHR) data. Patients admitted to Duke University Hospital were eligible if they had at least one pulse oximetry value recorded within 5 minutes before an arterial blood gas (ABG) value. We collected skin tone data at 16 different body locations using multiple devices, including administered visual scales, colorimetric, spectrophotometric, and photography via mobile phone cameras. All patients' data were linked in Duke's Protected Analytics Computational Environment (PACE), converted into a common data model, and then de-identified before publication in PhysioNet. Skin tone data were collected from 128 patients. We assessed 167 features per skin location on each patient. We also collected over 2000 images from mobile phones measured in the same controlled environment. Skin tone data are linked with patients' EHR data, such as laboratory data, vital sign recordings, and demographic information. Measuring different aspects of skin tone for each of the sixteen body locations and linking them with patients' EHR data could assist in the development of a more equitable AI model to combat disparities in healthcare associated with skin tone. A common data model format enables easy data federation with similar data from other sources, facilitating multicenter research on skin tone in healthcare. A prospectively collected EHR-linked skin tone measurements database in a common data model with emphasis on pulse oximetry disparities.

Abstract C096: Disparities in incidence rates of pediatric neuroblastoma in the United States: A Surveillance, Epidemiology, and End Results (SEER) Program Study using HD*Calc

Abstract Even though racial, rural-urban and socioeconomic disparities have been identified in pediatric neuroblastoma incidence rates, the exact measurement of the disparities is rarely done. The study was conducted to generate summary measures to evaluate health disparities in the age-adjusted incidence rates of neuroblastoma. We used Surveillance, Epidemiology, & End Results (SEER) 17 registries data from 2000 to 2020 to identify pediatric neuroblastoma cases, race and ethnicity, area of residence, and median income and to calculate age-adjusted incidence rates. We then used HD*Calc software to calculate the trends of range difference (RD), range ratio (RR), and a pairwise comparison of RD and RR based on racial, rural-urban, and median household income. Out of 3592 patients identified, 57% were Non-Hispanic Whites, 90% lived in metropolitan counties, 54% were male, and 56% had income less than $75,000. The absolute RD for race and ethnicity from 2000 to 2020 calculated by comparing the incidence rate of less-advantaged race/ethnicity to more-advantaged race/ethnicity was fluctuating and peaked in the year 2017 with an RD of 1.886, indicating a huge gap which then decreased gradually. Pairwise comparison showed that Non-Hispanic Whites and Non-Hispanic Blacks had RD greater than 0 and RR greater than 1 compared to Hispanics, indicating a higher incidence rate in both Non-Hispanic Whites and Non-Hispanic Blacks compared to Hispanics. While comparing rurality, metropolitan counties had higher age-adjusted incidence rates than non-metropolitan counties. The RD was less than 0 except in 2006, 2011, 2013, and 2014 when comparing metropolitans to non-metropolitans. Pairwise RR also showed similar results with RR less than 1 except in the above-mentioned years. Comparing based on median household income, those with higher income ($75,000+) had positive RD till 2016 than those with lower income (<75,000) which then changed to negative from 2017 to 2020, which indicates an increase in incidence rates in the lower income group in the past few years. The pairwise ratio comparison also aligned, with a ratio above 1 most years which then turned to less than one after 2017. Racial rural-urban and socioeconomic disparities in incidence rates were evident in our study. Disparities have an impact on the incidence of pediatric neuroblastoma. Further exploration of the factors that lead to pediatric neuroblastoma disparities is required to reduce the gap. Citation Format: Krishtee Napit, Emma Hymel, Josiane Kabayundo, Shinobu Watanabe-Galloway. Disparities in incidence rates of pediatric neuroblastoma in the United States: A Surveillance, Epidemiology, and End Results (SEER) Program Study using HD*Calc [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 C096.

Health Disparities in Lapses in Diabetic Retinopathy Care

To develop a novel methodology to identify lapses in diabetic retinopathy care in electronic health records (EHRs) and evaluate health disparities by race and ethnicity. Retrospective cohort study. Adult patients with diabetes mellitus who were evaluated at the Wilmer Eye Institute from January 1, 2013 to April 2,2022. The methodology to identify lapses in care first identified diabetic retinopathy screening or treatment visits and then compared the providers' recommended follow-up timeframe with the patient's actual time to next encounter. The association of race and ethnicity with odds of lapses in care was evaluated using a mixed-effects logistic regression model controlling for age, sex, insurance, severity of diabetic retinopathy, presence of other retinal disorders, and glaucoma. Lapses in diabetic retinopathy care. The methodology to identify diabetic retinopathy-related visits had a 95.0% (95% confidence interval, 93.0-96.6) sensitivity and 98.8% (98.1-99.3) specificity as compared with a gold standard grader. The methodology resulted in a 97.3% (96.2-98.4) sensitivity and 98.1% (97.3-98.9) specificity for detecting a follow-up recommendation, with an average error of-0.05 (-0.31 to 0.21) weeks in extracting the precise timeframe. A total of 39 561 patients with 91 104 office visits were included in the analysis. The average age was 61.4 years. More than 3 (77.6%) in 4 patients had a lapse in care. In multivariable analysis, non-Hispanic Black patients had 1.24 (1.19-1.30) odds and Hispanic patients had 1.26 (1.13-1.40) odds of ever having a lapse in care compared with non-Hispanic White patients (P < 0.001, respectively). We have developed a reliable methodology for identifying lapses in diabetic retinopathy care that is tailored to a provider's recommended follow-up. Using this approach, we find that 3 in 4 patients experience a lapse in diabetic retinopathy care and that these rates are higher among non-Hispanic Black and Hispanic patients. Deploying this methodology in the EHR is one potential means by which to identify and mitigate lapses in critical ophthalmic care in patients with diabetes. Proprietary or commercial disclosure may be found after the references.

Evaluating Health Disparities in Radiology Practices in New Jersey: Exploring Radiologist Geographical Distribution.

This study aimed to determine if a disproportionate number of radiologists practice in high-income versus low-income counties in New Jersey (NJ), identify which vulnerable populations are most in need of more radiologists, and discuss how these relative differences can ultimately influence health outcomes. The NJ Health Care Profile, a database overseen and maintained by the Division of Consumer Affairs, was queried for all actively practicing radiologists within the state of NJ. These results were grouped into diagnostic and interventional radiologists followed by further stratification of physicians based on the counties where they currently practice. The median household income and population size of each county for 2021 were obtained from the US Census database. The ratio of the population size of each county over the number of radiologists in that county was used as a surrogate marker for disparities in patient care within the state and was compared between counties grouped by levels of income. Of the 1,186 board-certified radiologists actively practicing within the state of NJ, 86% are solely diagnostic radiologists and 14% are interventional radiologists. About 44% of radiologists practice within counties that are within the top one-third of median household income in NJ, 25% practice within counties in the middle one-third, and 31% practice within counties in the bottom one-third. There is a disproportionate number of radiologists practicing in high-income counties as opposed to lower-income counties. A contradiction to this trend was noted in three low-income counties: Essex, Camden, and Atlantic County, all of which exhibited low numbers of individuals per radiologist that rivaled those of higher-income counties. This finding is a concrete measure of successful radiologist recruitment efforts within these counties during the past few years to combat the increased prevalence of disease and associated complications that historically marginalized communities tend to disproportionately exhibit. Other low-income counties should look to what Essex, Camden, and Atlantic County have done to increase radiologist recruitment to levels that rival those of high-income areas.

422 Healthcare disparities in atopic dermatitis: insights from TARGET-DERM registry

Abstract Atopic dermatitis disproportionately affects diverse patient populations. Furthermore, complex factors may influence the burden of disease and access to treatment amongst different racial and ethnic groups. The aim of this study is to evaluate health disparities and real-world management patterns in distinct populations treated for AD in routine clinical practice. The study included patients with AD (≥age 6) enrolled in TARGET-DERM, an observational, longitudinal study of over 2500 participants across 43 US academic/community centers. Participants were classified in four race/ethnicity categories as reported in enrollment forms and/or patient self-reported: non-Hispanic (NH) White, Black, Asian/Pacific Islander (API) and Hispanic. Patient characteristics analysed included demographics, clinical characteristics, investigator-assessed and patient-reported outcomes, and treatment history. A total of 1928 patients (mean age 34 years; 58% female; 60% enrolled at community-based centers) were included, encompassing 251 NH-Black (13%), 271 NH-API (14%), 288 Hispanic (15%) and 1118 NH-White (58%) participants. Most (71%) had a medical comorbid condition with 30% having ≥3 conditions. Private insurance was highest among NH-APIs (82%) and NH-Whites (70%), Medicaid was highest among Hispanics (46%) and NH-Blacks (27%), and uninsured was highest among NH-Blacks (18%) and NH-Whites (12%). At enrollment, clinical disease severity assessments [vIGA-AD, TBSA and vIGA-ADxTBSA (VxT)] varied by race/ethnicity, also suggesting healthcare disparities. Lowest severity was among NH-Whites (25.9% vIGA-AD clear/almost clear, 26.7% VxT clear/almost clear and median TBSA 5%), followed by Hispanics (21.7%, 18.2% and 7%), NH-Blacks (15.7%, 15.3% and 10%), and NH-APIs (10.7%, 13.8% and 8%). No differences were identified in the distribution of traditional systemic therapies across groups. However, in multivariable analysis (adjusted for age, sex, insurance status, comorbidities, vIGA and treatment status), NH-Blacks and Hispanics were less likely to be treated with advanced systemic therapies than NH-Whites [odds ratio (OR) of 0.67 and 0.70, respectively; P &amp;lt; 0.01]. Similarly, NH-APIs were more likely to have higher vIGA-AD scores than NH-Whites (OR = 1.57; P &amp;lt; 0.01). Non-Hispanic Blacks also had higher vIGA-AD scores than NH-Whites (OR = 1.42; P &amp;lt; 0.05) when controlling for all covariates other than treatment type (P &amp;lt; 0.05), adjustment for which renders the estimated black–white disparity nonsignificant. (OR = 1.32, P = 0.11). Descriptively comparing patient-reported outcome distributions identified no significant differences (P &amp;gt; 0.12). Despite presenting with more severe disease, Blacks and Hispanics have significantly lower odds of using advanced systemic therapy relative to NH-Whites, suggestive of an access disparity leading to disparities in disease control. These disadvantages persist after adjusting for an array of demographic, socioeconomic and medical history characteristics. The results highlight real-world evidence of racial and ethnic disparities among patients with AD.

Evaluating Health Disparities in a Pediatric Population With Type 1 Diabetes

We sought to determine the association between SES and glycemic control in children with type 1 diabetes (T1D) followed at the Montreal Children’s Hospital (MCH), and whether insulin pump use, processes of care and depression modified the association. Using MCH’s Pediatric Diabetes Database, we conducted a retrospective cohort study of children ages 0 to 18 years diagnosed with T1D for at least a year with a visit between November 2019 and October 2020. Our outcome was mean glycated hemoglobin (HbA1c) in the following year.

Data Sources for Evaluating Health Disparities in Ophthalmology: Where We Are and Where We Need to Go

Data provide an opportunity to discover disparities and inequities that may otherwise be unrecognized. Within the American Academy of Ophthalmology (AAO) Task Force on Disparities in Eye Care, the Leveraging Data Sub-task Force was charged with identifying data sources to study health disparities in eye care and to leverage data to advance health equity. We evaluated large data sources to determine their strengths, deficiencies, and relative accessibility in relation to the likelihood of identifying eye care disparities. We highlight the current challenges with these data sources and review key recommendations for improving future sources for studying health disparities in eye care.

482 Evaluating the Effects and Contributing Factors to the “Hidden Curriculum” in Medical School

OBJECTIVES/GOALS: The “hidden curriculum” is a set of unofficial rules outside of the formal curriculum that allows medical students to succeed. It is often not accessible to those who are first-generation in medicine. This study created a novel survey tool to directly evaluate the hidden curriculum, its contributing factors, and its effects on students. METHODS/STUDY POPULATION: Using available literature as a guide, a novel survey tool to evaluate different aspects of the hidden curriculum was created. This survey consists of 17 Likert scale questions on topics varying from sense of belongingness to dress code, self-guided studying, mentorship, and confidence in knowing how to succeed. This survey tool was embedded into a larger survey evaluating health disparities and diversity, inclusion, accessibility, and justice (DEIAJ) in the curricular and extracurricular spaces. This survey packet was administered to all medical students at a large U.S. medical school. RESULTS/ANTICIPATED RESULTS: 166 medical students from all years responded to this survey. 70% were female, 27% male, and 3% non-binary or prefer not to say. 67% of respondents agreed or strongly agreed that there is a hidden curriculum accessible to only those who have family members in medicine. 57% agreed or strongly agreed that the medical school gave them the adequate training and resources to succeed. 48% agreed or strongly agreed that they would perform better academically if they had more money with 11% stating they often feel embarrassed in a professional setting due to lack of money. Fellow classmen, faculty members, and upperclassmen were identified as the most useful resources to learn how to succeed in medical school. Students on average reported feeling like they knew what to do to succeed in medical school half of the time. DISCUSSION/SIGNIFICANCE: This data strongly supports the existence of a hidden curriculum and gives insight into the importance of financial support for low-income students and peer support groups for those who do not have family members in medicine. This data will be used to inform future interventions to address the hidden curriculum.

Abstract P197: Heart Failure In A Universally Insured Working Age Population: The Military Community Experience

Background: Heart disease is the leading cause of death in the United States (US) and deaths due to heart failure (HF) are increasing, while disparities are widening. The military community is pertinent to the study of the epidemiology of HF for several reasons: the 9.6 million individuals receiving care through the Military Health System (MHS) are representative of the working age US population and the MHS is the closest model to universal healthcare in the US. Hence, this environment is conducive to evaluate health disparities as access to care is uncoupled from race, sex, and ethnicity. Further, persons who serve have numerous risk factors (hypertension, smoking, PTSD, anxiety), HF is a leading cause of death among veterans and for those on active duty presents challenges to military readiness. Methods: We conducted a cross-sectional study of MHS beneficiaries aged 18 to 64 years to measure the prevalence of HF in 2018-19 overall and by sex, race, and other sociodemographic characteristics. HF was defined by International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. Results: Among 6,375,086 MHS beneficiaries aged 18 to 64 years, 142,201 (2.23%) were diagnosed with HF. Beneficiaries with HF were mainly men (60%), age 50 to 59 (41%), retired from military service (52%), with a Senior Enlisted rank (proxy for lower socio-economic status based on salary) (79%) and serving in the US Army (39%). In logistic regression, male sex, older age, Black race, and lower rank were associated with higher relative odds of HF. After multivariable adjustment, Black race and lower rank were independently associated with large increases in prevalent HF (Table). Conclusion: Among MHS beneficiaries of working age, the prevalence of HF is high and substantial disparities exist. The large excess odds of HF among Black beneficiaries and among lower rank individuals underscores the urgent need to understand and address the determinants of these disparities.

Evaluating health disparities in access to genomic testing for metastatic non-small cell lung cancer patients.

113 Background: Over the past decade, genomic testing has become standard of care for metastatic non-small cell lung cancer (NSCLC). These tests qualify patients for additional anti-cancer therapies and should be performed in all patients. Small scale studies at the institutional level have revealed that there may be disparities in genomic testing in NSCLC and not all patients may have similar access to care. In this study, we use the IBM Explorys Electronic Health Record (EHR) database to conduct a nationwide retrospective, observational study to understand how gender, race, insurance type, and spoken language impacts the rate of genomic testing in metastatic NSCLC patients. Methods: From Jan 1st, 2015 to Dec 31st, 2020, the IBM Explorys EHR database comprised 128,119 lung cancer patients using the SNOMED-CT concept of Primary Malignant Neoplasm of the Lung (CID 93880001). As structured staging information was not available, metastatic NSCLC patients were imputed by removing patients who received thoracic surgeries (presumably stage I or II) and those who received radiation therapy (presumably stage III). Following imputation, 120,470 patients with metastatic NSCLC were queried for testing for EGFR, ALK, ROS1, and/or RET. Odds ratios and chi-squared tests were computed for gender, race, insurance type, and spoken language comparing patients that received genomics testing to those who did not. Results: Genomic testing was taken significantly more by male patients (OR: 1.35, p&lt;0.0001), and by Caucasian patients (OR: 1.39, p&lt;0.0001). Compared to the public insurance plans, the genomic testing was significantly more in patients with private insurance plans (OR: 2.48, p&lt;0.0001) and self-pay patients (OR: 2.84, p&lt;0.0001). Patients speaking English as their first language significantly less likely took genomic testing (OR: 0.81, p&lt;0.05). Conclusions: This study aims to identify gaps in health disparities in gender, race/ethnicity, and insurance type for genomic testing that should be standard practice. Future investigation and attention to this issue appears necessary to begin moving from documenting disparities, to understanding them, and ultimately to reducing them.[Table: see text]

Use of Geographic Information System Technology to Evaluate Health Disparities in Smoking Cessation Class Accessibility for Patients in Louisiana Public Hospitals.

Research has shown cigarette smoking is a major risk factors for many type of cancer or cancer prognosis. Tobacco related health disparities were addressed continually in cancer screening, diagnosis, treatment, prevention and control. The present study evaluated the health disparities in attendance of smoking cessation counseling classes for 4,826 patients scheduled to attend between 2005 and 2007. Of 3,781 (78.4%) patients with records to calculate the distance from their home domicile to counseling sites using Geographic Information System technology, 1,435 (38%) of smokers who attended counseling had shorter travel distances to counseling sites (11.6 miles, SD = 11.29) compared to non-attendees (13.4 miles, SD = 16.72). When the travel distance was >20 miles, the estimated odds of attending decreased with greater travel distance. Smokers who actually attended were more likely to be older, female, White, living in urban areas, and receiving free healthcare. After controlling for other socio-demographic factors, shorter distances were associated with greater class attendance, and individuals more likely to attend included those that lived closer to the counseling site and in urban settings, were female, White, commercially insured, and older than their counterparts. These findings have the potential to provide important insights for reducing health disparities for cancer prevention and control, and to improve shared decision making between providers and smokers.

U.S. hospital performance methodologies: a scoping review to identify opportunities for crossing the quality chasm

BackgroundHospital performance quality assessments inform patients, providers, payers, and purchasers in making healthcare decisions. These assessments have been developed by government, private and non-profit organizations, and academic institutions. Given the number and variability in available assessments, a knowledge gap exists regarding what assessments are available and how each assessment measures quality to identify top performing hospitals. This study aims to: (a) comprehensively identify current hospital performance assessments, (b) compare quality measures from each methodology in the context of the Institute of Medicine’s (IOM) six domains of STEEEP (safety, timeliness, effectiveness, efficiency, equitable, and patient-centeredness), and (c) formulate policy recommendations that improve value-based, patient-centered care to address identified gaps.MethodsA scoping review was conducted using a systematic search of MEDLINE and the grey literature along with handsearching to identify studies that provide assessments of US-based hospital performance whereby the study cohort examined a minimum of 250 hospitals in the last two years (2017–2019).ResultsFrom 3058 unique records screened, 19 hospital performance assessments met inclusion criteria. Methodologies were analyzed across each assessment and measures were mapped to STEEEP. While safety and effectiveness were commonly identified measures across assessments, efficiency, and patient-centeredness were less frequently represented. Equity measures were also limited to risk- and severity-adjustment methods to balance patient characteristics across populations, rather than stand-alone indicators to evaluate health disparities that may contribute to community-level inequities.ConclusionsTo further improve health and healthcare value-based decision-making, there remains a need for methodological transparency across assessments and the standardization of consensus-based measures that reflect the IOM’s quality framework. Additionally, a large opportunity exists to improve the assessment of health equity in the communities that hospitals serve.

Breast Cancer Survival Disparities in Mexican Women Under a Comprehensive Health Reform

PURPOSE One of the goals of Seguro Popular, Mexico’s landmark healthcare reform, was bridging the existing disparities in access to health care and health status. In 2007, this program began reimbursement of breast cancer treatment of previously uninsured Mexican women. We evaluated geographic disparities in breast cancer survival in women treated under this program and explored potential sources of heterogeneity. METHODS We classified women who were treated between 2007 and 2016 as having early (stages 0-IIA), locally advanced (stages IIB-IIIC), or metastatic (stage IV) disease. We categorized women based on a widely used marginalization index that considers education, household characteristics, rural population, and poverty levels in Mexican municipalities (low, moderate, high, and very high marginalization). We cross-linked reimbursement data with a national death registry and estimated 5-year overall survival according to clinical stage, marginalization levels, and state where women received treated. RESULTS Among 53,990 women treated for breast cancer the mean age was 52.9 years (± SD 12.4). Most patients had locally advanced disease (57.4%, n = 30,996). Early disease was more common in women with very low marginalization levels compared with women with very high levels (34% v 19%). Survival was 89.4% (95% CI: 88.8 to 89.9) for early disease, 69.8% (95% CI: 69.2 to 70.4) for locally advanced disease, and 36.1% (95% CI: 34.6 to 37.6) for metastatic disease. The least marginalized state experienced the highest survival for locally-advanced disease [76.0% (95% CI: 71.4 to 80.0)] whereas the most marginalized state experienced the lowest survival [50.2% (95% CI: 45.5 to 54.7)]. Survival in women from very highly marginalized communities was 68.7% (95% CI: 64.7 to 72.4), whereas survival in women from low marginalized communities was 74.8% (95% CI: 74.1 to 75.5). CONCLUSION In the face of a new wave of healthcare reform, Mexico will need to monitor and evaluate health disparities to achieve universal care for women with breast cancer.

Effect of online courses on US college students’ knowledge about health disparities

Objective: To describe faculty efforts to deliver and evaluate health disparities–related education in US online undergraduate and graduate public health courses. Design: A pre- and post-survey was given to a cohort of 46 US college students in three public health courses taught asynchronously online over an 8-week period in 2017. This study took place at a mid-sized, public, rural, midwestern US university. Method: Faculty received professional development and online training and were assigned to develop courses for a new public health programme. Following the receipt of ethical approval, students completed anonymous, online pre- and post-surveys to assess effect of intentional instructional approaches on their knowledge and attitudes about health disparities. Curricula incorporated various assessment methods and teaching strategies. Descriptive statistics were used to compare pre- and post-survey scores and analyse demographic data. Paired t-tests and one-way analysis of variance were used to analyse pre- and post-survey test scores. Results: At post-survey, students demonstrated a positive change in mean scores for several items, including for ability to discuss the role of theory in understanding health behaviour and disparities in health status (3.20 vs 4.06; p &lt; .001) and ability to discuss strategies health promotion programmes can use to reduce health disparities (3.47 vs 4.40; p &lt; .001). Post-survey response rate was 87%. Conclusion: Results suggest an effective way to increase health disparities knowledge among online college students. Additional research is encouraged to expand upon these findings.

The Importance of Evaluating Health Disparities Research.

Health disparity populations are socially disadvantaged, and the multiple levels of discrimination they often experience mean that their characteristics and attributes differ from those of the mainstream. Programs and policies targeted at reducing health disparities or improving minority health must consider these differences. Despite the importance of evaluating health disparities research to produce high-quality data that can guide decision-making, it is not yet a customary practice. Although health disparities evaluations incorporate the same scientific methods as all evaluations, they have unique components such as population characteristics, sociocultural context, and the lack of health disparity common indicators and metrics that must be considered in every phase of the research. This article describes evaluation strategies grouped into 3 components: formative (needs assessments and process), design and methodology (multilevel designs used in real-world settings), and summative (outcomes, impacts, and cost). Each section will describe the standards for each component, discuss the unique health disparity aspects, and provide strategies from the National Institute on Minority Health and Health Disparities Metrics and Measures Visioning Workshop (April 2016) to advance the evaluation of health disparities research.

Uveitis and health disparities: results from the National Inpatient Sample

PurposeHealth disparities exist when the prevalence or outcome of the disease are influenced by age, race, sex or income. Health disparities are prevalent in autoimmune diseases. However, there is a...

Healthcare disparities in outcomes of patients with resectable pancreatic cancer

BackgroundThe aim of this study was to evaluate health disparities in the outcomes of patients with resectable pancreatic adenocarcinoma. MethodsWe retrospectively analyzed 280,935 patients from the National Cancer Data Base (NCDB), from 1998 to 2012 to compare the differences in patient characteristics, refusal of offered surgical treatment and overall survival after pancreatic adenocarcinoma resection between white vs. black patients. ResultsBlack patients did not undergo and refused offered surgical treatment more frequently. Race and insurance were the most important factors independently associated with not receiving the offered resection. Having private insurance, Hispanic ethnic background, geographic location, higher income, residing in urban/metropolitan area and systemic treatment were independently associated with improved survival. Race was associated with overall worse survival in an unadjusted model but not in multivariable analysis. The association between race and survival was removed when adjusting for facility location, income, education, tumor size, tumor stage or systemic treatment. ConclusionDisparities exist at various levels in resectable pancreatic cancers. These findings help developing targeted interventions and quality improvement initiatives.

Abstract A03: Evaluating health disparities in prostate cancer: A neighborhood-wide association study (NWAS) in African Americans

Abstract Background: African American (AA) men are more than twice as likely to be diagnosed with and die of prostate cancer (PCa) compared to White men. Risk factors from social influences to biology could be contributing to these disparities. However, empiric methods to assess the role of social or neighborhood factors in PCa are limited. In a previous study, we developed a neighborhood-wide association study (NWAS) approach, which is analogous to a genome-wide association study (GWAS), and empirically identified neighborhood characteristics from the U.S. Census associated with PCa in White men. In this study, we conducted an NWAS in AA men and preliminarily compared neighborhood and PCa effects by race. Methods: Pennsylvania State Cancer Registry data from 1995-2005 were linked to the 2000 U.S. Census data. In a successively more stringent multiphase approach, we evaluated the association between neighborhood exposures (n = 14,663, standard deviation adjusted census variables) and prostate cancer aggressiveness (n = 911 aggressive Stage&amp;gt;3/Gleason grade &amp;gt;7 cases vs. n = 8632 non-aggressive Stage&amp;lt;3/Gleason grade&amp;lt;7 controls) in AA men. Specifically, we used generalized estimating equations in Phase 1 and Bayesian mixed effects models in Phase 2 to calculate odds ratios (OR) and credible intervals (CI), adjusting for age, year of diagnosis, spatial correlation, and multiple testing. Variables meeting statistically significant thresholds were identified and used in subsequent phases. In Phase 3, principal components analysis grouped together correlated variables, and the most significant variable within each component was identified as the study top hit. Results: Seven variables were most significantly associated with prostate cancer aggressiveness in AA men. The top hit related to crowding in renter-occupied housing units (OR = 1.10; CI = 1.001-1.12). In White men, 17 variables were significant, and the top hit related to workers' mode of transportation (OR = 1.05; CI = 1.001-1.09). Similar to the NWAS in White men, significant associations were seen between PCa and neighborhood employment and transportation, but the specific variables used to represent these domains differed by race. Further, neighborhood education was significant in the AA analysis, but not in White men. Conclusions: These preliminary findings suggest that associations between neighborhood circumstances and aggressive PCa may differ by race. Although further testing is needed, NWAS is a novel, empiric approach that could provide new insights into health disparities research. Citation Format: Shannon M. Lynch, Elizabeth Handorf, Craig Newcomb, Charnita Zeigler-Johnson, Timothy R. Rebbeck. Evaluating health disparities in prostate cancer: A neighborhood-wide association study (NWAS) in African Americans [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr A03.

An assessment of the impact of pharmacogenomics on health disparities: a systematic literature review.

This review assessed evidence of disparities in benefits of pharmacogenomics related to 'model performance' in subgroups of patients and studies which reported impact on health inequalities. 'Model performance' refers to the ability of algorithms including clinical, environmental and genetic information to guide treatment. A total of 4978 abstracts were screened by one reviewer and 30% (1494) were double screened by a second independent reviewer, after which data extraction was performed. Additional forward and backward citation searching of reference lists was conducted. Investigators independently double rated study quality and applicability of included studies. Only five individual studies were identified which met our inclusion criteria, but were contradictory in their conclusions. While three studies of genotype-guided dosing of warfarin reported that ethnic disparities in healthcare may widen, two other studies (one reporting on warfarin and reporting on clopidogrel) suggested that disparities in healthcare may reduce. There is a paucity of studies which evaluates the impact of pharmacogenomics on health disparities. Further work is required not only to evaluate health disparities between ethnic groups and countries but also within ethnic groups in the same country and solutions need to be identified to overcome these disparities.