Health Disparities For Patients Research Articles

The COVID-19 impact on STEMI disparities

ST-segment elevation myocardial infarction (STEMI) is a significant source of morbidity and mortality. Despite guideline-driven management and increased awareness of social determinants of health, there are persistent disparities in diagnosis, management, and outcomes. The coronavirus disease 2019 (COVID-19) pandemic has greatly affected emergency department visitation, conditions and throughput. The aim of this study was to find any potential health disparities in patients who presented with STEMI during the COVID-19 pandemic by reviewing STEMI care data from April to September 2019 (pre-pandemic) and April to September 2020 (during the pandemic) for our hospital system.Patients with STEMI within 12 h of presentation were included in this study, and subdivided by age, gender, and race/ethnicity. We compared the turnaround times between emergency department arrival to intervention (electrocardiogram or catheterization) within the patient subgroups to find any notable differences. No statistically significant changes in turnaround times during either study period were found based on age, gender, or race/ethnicity for the STEMI interventions despite shifts in emergency department resources during the pandemic. This study helped assess the status quo in STEMI intervention for our health system and serves as a baseline for us to monitor gaps in care or areas of improvement. As healthcare systems institute new measures to promote equitable care, such as improving the accuracy of demographic data capture, establishing a baseline is an essential first step in evaluating the impact of these measures.

Is gender dysphoria associated with increased hospital cost per stay among patients hospitalized for depression? Focus on the racial and regional variance in US hospitals

IntroductionIndividuals with gender dysphoria do not identify with their sex assigned at birth and face societal and cultural challenges, leading to increased risk for depression, anxiety, and suicide. Gender dysphoria is a DSM-5 diagnosis but is not necessary for transition therapy. Additionally, individuals with gender dysphoria or who identify as gender diverse/nonconforming may experience “minority stress” from increased discrimination, leading to a greater risk for mental health problems. This study aimed to identify possible health disparities in patients hospitalized for depression with gender dysphoria across the United States. Depression was selected because patients with gender dysphoria are at an increased risk for it. Various patient and hospital-related factors are explored for their association with changes in healthcare utilization for patients hospitalized with depression.MethodsThe National Inpatient Sample was used to identify nationwide patients with depression (n = 378,552, weighted n = 1,892,760) from 2016 to 2019. We then examined the characteristics of the study sample and investigated how individuals’ gender dysphoria was associated with healthcare utilization measured by hospital cost per stay. Multivariate survey regression models were used to identify predictors.ResultsAmong the 1,892,760 total depression inpatient samples, 14,145 (0.7%) patients had gender dysphoria (per ICD-10 codes). Over the study periods, depression inpatients with gender dysphoria increased, but total depression inpatient rates remained stable. Survey regression results suggested that gender dysphoria, minority ethnicity or race, female sex assigned at birth, older ages, and specific hospital regions were associated with higher hospital cost per stay than their reference groups. Sub-group analysis showed that the trend was similar in most racial and regional groups.ConclusionDifferences in hospital cost per stay for depression inpatients with gender dysphoria exemplify how this community has been disproportionally affected by racial and regional biases, insurance denials, and economic disadvantages. Financial concerns can stop individuals from accessing gender-affirming care and risk more significant mental health problems. Increased complexity and comorbidity are associated with hospital cost per stay and add to the cycle.

Choosing to End African American Health Disparities in Patients With Systemic Lupus Erythematosus.

Systemic lupus erythematosus (SLE) is three times more common and its manifestations are more severe in African American women compared to women of other races. It is not clear whether this is due to genetic differences or factors related to the physical or social environments, differences in health care, or a combination of these factors. Health disparities in patients with SLE between African American patients and persons of other races have been reported since the 1960s and are correlated with measures of lower socioeconomic status. Risk factors for these disparities have been demonstrated, but whether their mitigation improves outcomes for African American patients has not been tested except in self-efficacy. In 2002, the first true US population-based study of patients with SLE with death certificate records was conducted, which demonstrated a wide disparity between the number of African American women and White women dying from SLE. Five years ago, another study showed that SLE mortality rates in the United States had improved but that the African American patient mortality disparity persisted. Between 2014 and 2021, one study demonstrated racism's deleterious effects in patients with SLE. Racism may have been the unmeasured confounder, the proverbial "elephant in the room"-unnamed and unstudied. The etymology of "risk factor" has evolved from environmental risk factors to social determinants to now include structural injustice/structural racism. Racism in the United States has a centuries-long existence and is deeply ingrained in US society, making its detection and resolution difficult. However, racism being man made means Man can choose to change the it. Health disparities in patients with SLE should be addressed by viewing health care as a basic human right. We offer a conceptual framework and goals for both individual and national actions.

CORR Insights®: Health Disparities in Patients With Musculoskeletal Injuries: Food Insecurity Is a Common and Clinically Challenging Problem.

CORR Insights®: Health Disparities in Patients With Musculoskeletal Injuries: Food Insecurity Is a Common and Clinically Challenging Problem.

Health Disparities in Patients With Musculoskeletal Injuries: Food Insecurity Is a Common and Clinically Challenging Problem.

Health disparities have important effects on orthopaedic patient populations. Socioeconomic factors and poor nutrition have been shown to be associated with an increased risk of complications such as infection in patients undergoing orthopaedic surgery. Currently, there are limited published data on how food insecurity is associated with medical and surgical complications. We sought to (1) determine the percentage of patients who experience food insecurity in an orthopaedic trauma clinic at a large Level 1 trauma center, (2) identify demographic and clinical factors associated with food insecurity, and (3) identify whether there are differences in the risk of complications and reoperations between patients who experience food insecurity and patients who are food-secure. This was a cross-sectional study using food insecurity screening surveys, which were obtained at an orthopaedic trauma clinic at our Level 1 trauma center. All patients 18 years and older who were seen for an initial evaluation or follow-up for fracture care between November 2022 and February 2023 were considered for inclusion in this study. For inclusion in this study, the patient had to have surgical treatment of their fracture and have completed at least one food insecurity screening survey. Ninety-eight percent (121 of 123) of patients completed the screening survey during the study period. Data for 21 patients were excluded because of nonoperative treatment of their fracture, nonfracture-related care, impending metastatic fracture care, and patients who had treatment at an outside facility and were transferring their care. This led to a study group of 100 patients with orthopaedic trauma. The mean age was 51 years, and 51% (51 of 100) were men. The mean length of follow-up available for patients in the study was 13 months from the initial clinic visit. Patient demographics, hospital admission data, and outcome data were collected from the electronic medical records. Patients were divided into two cohorts: food-secure versus food-insecure. Patients were propensity score matched for adjusted analysis. A total of 37% of the patients in this study (37 of 100) screened positive for food insecurity during the study period. Patients with food insecurity were more likely to have a higher BMI than patients with food security (32 kg/m2 compared with 28 kg/m2; p = 0.009), and they were more likely not to have healthcare insurance or to have Medicaid (62% [23 of 37] compared with 30% [19 of 63]; p = 0.003). After propensity matching for age, gender, ethnicity, current substance use, Charleston comorbidity index, employment status, open fracture, and length of stay, food insecurity was associated with a higher percentage of superficial infections (13% [4 of 31] compared with 0% [0 of 31]; p = 0.047). There were no differences between the groups in the risk of reoperation, deep infection, and nonunion. Food insecurity is common among patients who have experienced orthopaedic trauma, and patients who have it may be at increased risk of superficial infections after surgery. Future research in this area should focus on defining these health disparities further and interventions that could address them. Level III, therapeutic study.

Seasonal variations of arrhythmias and their impact on mortality in cancer patients with health disparities: A propensity score adjusted machine learning analysis of over 100 million hospitalizations across 3 years

Abstract Title Seasonal Variations of Arrhythmias and Their Impact on Mortality in Cancer Patients with Health Disparities: A Propensity Score Adjusted Machine Learning Analysis of over 100 Million Hospitalizations Across 3 Years Background Arrhythmias are observed to increase during high influenza activity seasons (HIA, December to February) with significant clinical impact among high-risk patients, so their outcomes may be optimized through closer monitoring of these populations. It is unknown if cancer is such a risk factor. Methods This is a retrospective analysis of arrhythmia-related mortality and the effect of health disparities in patients with cancer during HIA and non-HIA seasons in a nationally representative database. Machine learning-augmented propensity score adjusted multivariable regression (ML-PSr) was performed using the 2016-2018 National Inpatient Sample (NIS), the United States’ largest all-payer hospitalized dataset. Results A number of 16,795,379 (18.48%) patients presented with arrhythmia of whom 3,214,914 (19.14%) were during HIA. In ML-PSr, HIA did not significantly increase the odds of arrhythmia for cancer patients (OR 1.01, 95%CI 0.99-1.03, p=0.37), but the odds of arrhythmia-related mortality were higher during HIA seasons (OR 1.19, 95%CI 1.12-1.27, p<0.001) compared to non-HIA seasons (OR 1.17, 95%CI 1.13-1.22, p<0.001). Primary malignancies with the highest prevalence of arrhythmias during HIA were that of the lung (19.60%), leukemia (11.49%), non-Hodgkin lymphoma (NHL) (8.24%), prostate (8.15%), and multiple myeloma (MM) (6.21%) (p<0.001). HIA increased arrhythmia-related mortality most for the following primary malignancies by year: gastrointestinal in 2016 (OR 1.15, 95%CI 1.01-1.32, p=0.039), leukemia in 2017 (OR 1.31, 95%CI 1.10-1.54, p=0.002), GI in 2018 (OR 1.14, 95%CI 1.01-1.29, p=0.029), and renal in 2018 (OR 1.54, 95%CI 1.06-2.23, p=0.025). Among patients with active cancer and arrhythmia, African Americans had significantly greater mortality than Caucasians (OR 1.13, 95%CI 1.03-1.23, p=0.013), independent of socioeconomic and clinical confounders. Conclusion This study suggests arrhythmia-related mortality was higher during HIA seasons compared to non-HIA seasons in cancer patients and showed notable disparities by race and worse outcomes by primary malignancy.

Abstract WMP99: A Novel Network Analysis of County- and Individual-Level Factors Associated With Functional Outcomes After Stroke

Background: Social circumstances may contribute to health disparities in patients with stroke through indirect and interdependent mechanisms that are not well understood. Objective: This study used complexity science methodology to examine the interplay between county- and individual-level social and clinical factors influencing stroke functional outcomes. Methods: As part of the Get With the Guidelines-Stroke (GWTG-S) Data Challenge, the GWTG-S Registry was merged with county-level Institute for Health Metrics and Evaluation data. Patients diagnosed with stroke (ischemic, subarachnoid, or intracerebral hemorrhage) were included. Multilayer networks were constructed by estimating mixed graphical models of 32 nodes across four layers, including social (county- and patient-level) and clinical (comorbidities and encounter) factors. Social determinant networks were estimated for patients with less favorable (ie., functional dependence or death, modified Rankin Score [mRS] 3-6) versus favorable outcomes (ie., functional independence, mRS 0-2). Network structure and node centrality were compared between mRS groups using bootstrap permutation analyses. Hub nodes were defined by betweenness centrality and facilitate effects across the network. Results: From 2013-2019, 990 721 (62.3%) stroke patients had mRS of 3-6 and 597 477 (37.6%) had mRS 0-2 at discharge. Compared to the mRS 0-2 group, the mRS 3-6 group’s social determinants network had greater global connectivity (p<0.001), and homelessness (p<0.001) and Black race (p<0.001) were hub nodes. Unique to the mRS 3-6 group, younger patients were more likely to identify as homeless (p=0.031), uninsured (p=0.001), and live in a county with lower per capita income (p<0.001). Conclusions: The effects of social determinants were significantly greater in patients with less favorable functional outcomes. Homelessness and race play critical roles in mediating the impacts of county- and individual-level social determinants on downstream disparities in stroke outcomes. Particularly among younger patients, housing, insurance status, and income may serve as a critical leverage point for county-level interventions to improve function after stroke.

Health Equity and Policy Considerations for Pediatric and Adult Congenital Heart Disease Care among Minoritized Populations in the United States.

Achieving health equity in populations with congenital heart disease (CHD) requires recognizing existing disparities throughout the lifespan that negatively and disproportionately impact specific groups of individuals. These disparities occur at individual, institutional, or system levels and often result in increased morbidity and mortality for marginalized or racially minoritized populations (population subgroups (e.g., ethnic, racial, social, religious) with differential power compared to those deemed to hold the majority power in the population). Creating actionable strategies and solutions to address these health disparities in patients with CHD requires critically examining multilevel factors and health policies that continue to drive health inequities, including varying social determinants of health (SDOH), systemic inequities, and structural racism. In this comprehensive review article, we focus on health equity solutions and health policy considerations for minoritized and marginalized populations with CHD throughout their lifespan in the United States. We review unique challenges that these populations may face and strategies for mitigating disparities in lifelong CHD care. We assess ways to deliver culturally competent CHD care and to help lower-health-literacy populations navigate CHD care. Finally, we review system-level health policies that impact reimbursement and research funding, as well as institutional policies that impact leadership diversity and representation in the workforce.

Global disparities in patients with multiple myeloma: a rapid evidence assessment

There are disparities in outcomes for patients with multiple myeloma (MM). We evaluated the influence of sociodemographic factors on global disparities in outcomes for patients with MM. This rapid evidence assessment (PROSPERO, CRD42021248461) followed PRISMA-P guidelines and used the PICOS framework. PubMed and Embase® were searched for articles in English from 2011 to 2021. The title, abstract, and full text of articles were screened according to inclusion/exclusion criteria. The sociodemographic factors assessed were age, sex, race/ethnicity, socioeconomic status, and geographic location. Outcomes were diagnosis, access to treatment, and patient outcomes. Of 84 articles included, 48 were US-based. Worldwide, increasing age and low socioeconomic status were associated with worse patient outcomes. In the US, men typically had worse outcomes than women, although women had poorer access to treatment, as did Black, Asian, and Hispanic patients. No consistent disparities due to sex were seen outside the US, and for most factors and outcomes, no consistent disparities could be identified globally. Too few studies examined disparities in diagnosis to draw firm conclusions. This first systematic analysis of health disparities in patients with MM identified specific populations affected, highlighting a need for additional research focused on assessing patterns, trends, and underlying drivers of disparities in MM.

0460 Challenges with Administrative Claims Data to Assess Health Disparities in Patients with Obstructive Sleep Apnea

Abstract Introduction Health disparities adversely affect people based on characteristics that are historically linked to discrimination or exclusion. There is limited research on understanding consequences of health disparities in the diagnosis and treatment of obstructive sleep apnea (OSA). This retrospective study sought to investigate health disparities affecting OSA patients using real-world data. Methods A national sample of administrative claims data from OSA patients who had a claim for a sleep test (home sleep test or polysomnography) was used. Gender, insurance payer, race/ethnicity, and 3-digit zip code were characterized from the claims data at the time of the first sleep test to describe differences across patients. Results The sample included about 2 million patients with 44.9% female, an average age 51.0 years, and an insurance payer breakdown of 74% commercial, 18% Medicaid, and 8% Medicare Advantage. There were a number of challenges that made it difficult to draw conclusions about the impact of health disparities in this data. The source of gender data was unknown; therefore, we do not know if it represents identified gender or biological sex. Race/ethnicity data was listed as “unknown” for 89% of commercial patients, 18% of Medicaid patients, and 36% of Medicare Advantage patients. Data reporting did not allow for details on multiple races or separation of race and ethnicity. Using 3-digit zip codes proved to be unreliable for drawing conclusions about a patient’s residence and access to care as 3-digit zip code areas are heterogenous and could cover a small section of a major city, a large rural portion of a state, or both. Lastly, ICD-10 Z codes, which describe social determinants of health (SDOH), appear to be underutilized. Conclusion Currently, using administrative claims as a real-world data source to assess health disparities is difficult due to data incompleteness, lack of adequate data definitions, and data aggregations made to protect patient privacy. Strategies to increase usability of claims data for investigating health disparities may include improvements in payer data reporting, increased utilization of SDOH Z codes, and linking to other more patient-centric data sources. Analyzing large samples of real-world data may help identify disparities and improve care for all patients. Support (if any)

Neighborhood Socioeconomic Status and Racial and Ethnic Survival Disparities in Oral Cavity and Laryngeal Cancer.

Oral cavity cancer (OCC) and laryngeal cancer are among the most common cancers worldwide. This study investigated survival in non-Hispanic (NH) Black, NH White, Asian, and Hispanic patients with OCC and laryngeal cancer of low, intermediate, and high neighborhood socioeconomic status (nSES). We used data from the SEER 18 Census Tract-level SES and Rurality Database of the National Cancer Institute to create cohorts of OCC and laryngeal cancer patients from 2013 to 2018. Univariate survival analysis was performed with Kaplan-Meier curves and log-rank P values by nSES and then the cross-classification of race, ethnicity, and nSES. We used Cox proportional hazards regression model for multivariable analysis. Higher nSES was associated with better OCC survival for NH White, NH Black, and Asian patients, and better laryngeal cancer survival for NH White, NH Black, Hispanic, and Asian patients. In the multivariable analyses of both OCC and laryngeal cancer survival, NH Black patients had worse survival than NH White patients in the high nSES tertile. NH Black patients with OCC were at higher risk of death than NH White patients at all nSES levels. Conversely, Asian patients with laryngeal cancer demonstrated better survival than other races within the high nSES. Overall survival differs between racial and ethnic groups of similar nSESs. These health disparities in patients with OCC and laryngeal cancer reflect broader inequities in the cancer control continuum. The cross-classification of race, ethnicity, and nSES revealed disparities in the 5-year overall survival of patients with OCC and laryngeal cancer and highlights the importance of intersectionality in the discussion of health equity.

Temporal variation of excess deaths from diabetes during the COVID-19 pandemic in the United States

BackgroundAlthough the COVID-19 pandemic has persisted for more than two years with the evident excess mortality from diabetes, few studies have investigated its temporal patterns. This study aims to estimate the excess deaths from diabetes in the United States (US) during the COVID-19 pandemic and evaluate the excess deaths by spatiotemporal pattern, age groups, sex, and race/ethnicity. MethodsDiabetes as one of multiple causes of death or an underlying cause of death were both considered into analyses. The Poisson log-linear regression model was used to estimate weekly expected counts of deaths during the pandemic with adjustments for long-term trend and seasonality. Excess deaths were measured by the difference between observed and expected death counts, including weekly average excess deaths, excess death rate, and excess risk. We calculated the excess estimates by pandemic wave, US state, and demographic characteristic. ResultsFrom March 2020 to March 2022, deaths that diabetes as one of multiple causes of death and an underlying cause of death were about 47.6 % and 18.4 % higher than the expected. The excess deaths of diabetes had evident temporal patterns with two large percentage increases observed during March 2020, to June 2020, and June 2021 to November 2021. The regional heterogeneity and underlying age and racial/ethnic disparities of the excess deaths were also clearly observed. ConclusionsThis study highlighted the increased risks of diabetes mortality, heterogeneous spatiotemporal patterns, and associated demographic disparities during the pandemic. Practical actions are warranted to monitor disease progression, and lessen health disparities in patients with diabetes during the COVID-19 pandemic.

Health Disparities in Patients Seeking Physiological Surgical Treatment for Lymphedema.

Previous studies have demonstrated racial disparities in breast cancer treatment and secondary lymphedema. However, no studies have yet examined the effects of race and socioeconomic status on physiological surgical treatment for lymphedema. The authors aimed to evaluate whether disparities exist within patients seeking physiological surgical lymphedema treatment. A retrospective review was performed of patients presenting for physiological surgical treatment of lymphedema from 2013 to 2019. Data on demographics, medical history, socioeconomic factors, lymphedema, and treatments were collected. A total of 789 patients (712 women and 77 men) seeking physiological surgical treatment of lymphedema were selected. Their mean age was 54.4 ± 13.4 years. A total of 620 patients (78.5%) self-reported as White, 120 (15.2%) as Black, 17 (2.2%) as Asian, five (0.6%) as Hispanic, and eight (2.4%) as multiracial. A total of 566 patients (71.7%) met criteria for surgical candidacy. White race was associated with increased rates of surgical candidacy compared with Black race (46.6% versus 77.2%; P < 0.0001). Compared with White patients, Black patients presented with a longer symptom duration (11.07 versus 6.99 years; P < 0.001), had a higher body mass index (mean, 34.5 versus 28.1; P < 1 × 10 -10 ), had a higher International Society of Lymphology stage ( P < 0.05), and were less likely to have maximized medical treatment for lymphedema (30.8% versus 55.4%; P < 0.01). This study demonstrates racial disparities in patients seeking physiological surgical treatment for lymphedema. Black patients present later with more severe disease, receive less nonsurgical treatment before consultation, and are less likely to meet criteria for physiological surgery. Improved patient and provider education on lymphedema and appropriate diagnosis and nonsurgical treatment is of primary importance to address this disparity.

Inclusion of Social and Structural Determinants of Health to Advance Understanding of their Influence on the Biology of Chronic Disease.

Social Determinants of Health (SDOH) consider social, political, and economic factors that contribute to health disparities in patients and populations. The most common health-related SDOH exposures are food and housing insecurity, financial instability, transportation needs, low levels of education, and psychosocial stress. These domains describe risks that can impact health outcomes more than health care. Epidemiologic and translational research demonstrates that SDOH factors represent exposures that predict harm and impact the health of individuals. International and national guidelines urge health professionals to address SDOH in clinical practice and public health. The further implementation of these recommendations into basic and translational research, however, is lagging. Herein, we consider a precision health framework to describe how SDOH contributes to the exposome and exacerbates physiologic pathways that lead to chronic disease. SDOH factors are associated with various forms of stressors that impact physiological processes through epigenetic, inflammatory, and redox regulation. Many SDOH exposures may add to or potentiate the pathologic effects of additional environmental exposures. This overview aims to inform basic life science and translational researchers about SDOH exposures that can confound associations between classic biomedical determinants of disease and health outcomes. To advance the study of toxicology through either qualitative or quantitative assessment of exposures to chemical and biological substances, a more complete environmental evaluation should include SDOH exposures. We discuss common approaches to measure SDOH factors at individual and population levels and review the associations between SDOH risk factors and physiologic mechanisms that influence chronic disease. We provide clinical and policy-based motivation to encourage researchers to consider the impact of SDOH exposures on study results and data interpretation. With valid measures of SDOH factors incorporated into study design and analyses, future toxicological research may contribute to an evidence base that can better inform prevention and treatment options, to improve equitable clinical care and population health. © 2022 Wiley Periodicals LLC.

971-P: Use of Telemedicine for Type 1 Diabetes Care in the T1D Exchange Quality Improvement Collaborative (T1DX-QI) in 2021

Background: The COVID-pandemic accelerated adoption of telemedicine for diabetes care in 2020. We sought to describe the utilization of telemedicine across the T1DX-QI in 2021. Methods: Twenty four pediatric and nine adult clinics completed a survey about the proportion of televisits performed, center goals and processes in fall of 2021. Results: The majority of clinics reported performing between 11-25% (n=16, 48%) and 0-10% televisits (n=9, 27%) . The majority reported a pre-visit preparation workflow (n=24, 73%) , but most sites reported not having a staff member dedicated to supporting televisits (n=21, 64%) . No major differences in televisit use, goals, and processes were observed between pediatric and adult sites. For diabetes technology data downloads, the majority of clinics integrated data automatically into the EHR (n=25, 73%) . The major barriers to sustaining telemedicine practice across clinics were patient internet access, patient health disparities and access to device data (Figure 1) . Conclusion: More than one year into the pandemic the proportion of televisits performed by the T1DX-QI collaborative is modest. Clinic workflows have been implemented to support telemedicine but insufficient institutional support and technology barriers still represent an obstacle. Disclosure J.M.Lee: Advisory Panel; GoodRx, Consultant; Tandem Diabetes Care, Inc. M.Wilkes: None. A.Neyman: None. F.Vendrame: None. E.L.Ospelt: None. A.Mungmode: None. O.Ebekozien: None. M.Gupta: None. F.Malik: n/a. N.R.Fogel: None. S.Accacha: None. S.Hsieh: None.

The Impact of Socioeconomic, Racial, and Ethnic Disparities on Pulmonary Hypertension Diagnosis and Treatment

Health disparities have a major impact in the quality of life and level of clinical care received in minority populations in the United States. Underrepresented patients with pulmonary arterial hypertension (PAH) may be at risk for worse outcomes. Furthermore, advances in biomedical research have provided extensive knowledge on the genetic role in the pathogenesis of PAH but whether these also impact minorities is incompletely understood. Health disparities in patients with PAH create an enormous barrier in health care delivery. Understanding the contributors to health disparity represent a fundamental step towards personalized medicine and further improvement in PAH care.

Reducing asthma exacerbations in vulnerable children through a medical–legal partnership

Background Asthma health disparities are widely recognized, with worse outcomes in children from low income families. In a Medical-Legal Partnership (MLP), an attorney is embedded in a healthcare setting to address social determinants of health. We studied whether an MLP could impact asthma exacerbation rates in a vulnerable urban population at an academic children’s hospital. Methods The study population comprised children with asthma who were referred to the MLP between 2013 and 2017. We compared healthcare utilization for asthma exacerbations managed in primary care, emergency department and inpatient settings in the year before and year after MLP intervention. Results 98 children with asthma were included in the study. The mean total encounters per person per year decreased from 1.16 to 0.66 (relative reduction 44.2%, p < 0.01). The largest effect was on hospitalizations, with a reduction from 0.33 to 0.10 hospitalizations per patient per year (relative reduction 69.7%, p < 0.01). Encounters for asthma exacerbations in the primary care office and emergency department also decreased but these changes did not meet statistical significance. Conclusion In a pediatric population with asthma, an MLP intervention was associated with a significant reduction in asthma exacerbation encounters and hospitalizations comparing the year before and after MLP intervention. Further studies are needed to better understand which interventions are most effective, and for which patient groups MLP referral would be particularly useful. MLPs may be an important way to reduce health disparities in patients with asthma and other chronic illnesses. KEYWORDS Management/control; pediatrics

Collaborating with pharmacists to advance health equity for patients with diabetes through communication

Health disparities are closely linked with economic, social, or environmental disadvantage and are the differences observed between groups as related to disease morbidity and mortality, injury, or violence. U.S. Food and Drug Administration Office of Minority Health and Health Equity and the American Pharmacists Association are both committed to the advancement of health equity and to increasing education and awareness of diabetes-related health disparity issues. Pharmacists are strategically located within the health care system and have the knowledge and skills to support the reduction of health disparities in patients with diabetes. This article highlights some of the many approaches and resources pharmacists can use in addressing health disparities and describes culturally competent, health literate, and numerate techniques for providing education and communicating with patients who have diabetes.

Health disparities in rheumatoid arthritis.

Rheumatoid arthritis (RA) is an autoimmune disease characterized by joint inflammation that involves symmetric polyarthritis of small and large joints. Autoimmune rheumatic diseases represent a significant socioeconomic burden as they are among the leading causes of death and morbidity due to increased risk of cardiovascular disease. Health disparities in patients with rheumatoid arthritis affect outcomes, prognosis, and management of the disease.

Diversity, Equity, and Inclusion in Hematology and Oncology Fellowship Programs

BackgroundThe National Institutes of Health define African Americans or Blacks, American Indians, Alaska Natives, Hispanics or Latinos, Native Hawaiians, and other Pacific Islanders as being underrepresented in medicine. A number of studies have demonstrated that improving diversity of such underrepresented demographics within the medical profession improves patient outcomes, medical education and reduces health disparities in patients from vulnerable racial or socioeconomic groups. Despite this recognition, significant underrepresentation of various racial, ethnic, and sexual identities still exists within nearly all medical specialties.AimsThe purpose of this study was to a gain a greater understanding of the current state of diversity, equity, and inclusion (DEI) efforts among U.S. hematology and medical oncology fellowship training programs. We explored the perspectives of adult and pediatric fellowship program directors regarding current recruitment strategies and suggestions for improvement to help mitigate the effects of implicit and explicit bias. Here, we present an interim analysis of the data using descriptive statistics.Methods:We convened a multi-institutional collaboration of fellowship program directors, teaching faculty, and staff members of the American Society of Hematology to develop a survey examining perceptions of DEI efforts among hematology and medical oncology fellowship program directors. The survey was pilot tested in a small group of program directors representing 6 different academic programs (5 adult, 1 pediatric). The final online survey was distributed via email to 224 fellowship program directors at U.S. adult and pediatric hematology and medical oncology fellowship programs. The survey included 29 questions regarding perspectives on bias within the fellowship selection process, current DEI initiatives, and current faculty and fellow demographics. Survey respondents were asked to rate the importance of numerous factors in determining which applicants to invite utilizing a scale of 0-10, with 0 and 10 representing lowest and highest importance, respectively. To measure program director perceptions of certain applicant groups, survey respondents were asked to rate applicant demographics as being advantaged/disadvantaged based on survey options ranging from 0-5, with 0 and 5 representing very disadvantaged and very advantaged, respectively.Results:At interim analysis, 41 of 224 program directors completed the survey for an interim response rate of 21%, including 25 adult program directors and 16 pediatric program directors, with representation from university and community programs. Of the program directors surveyed, 28 (68%) reported having access to a dedicated diversity committee or DEI policies in place to improve recruitment of underrepresented applicants. In determining which applicants to invite, respondents placed highest value on the applicant's program director letter (mean score ± standard deviation: 7.44±1.93), caliber of the applicant's residency program (7.28±2.06) and letters of recommendations (7.15±2.23). Survey respondents viewed white and male applicants as representing the most advantaged demographic group, while LGBTQI, age>40, and U.S. citizen and non-citizen international medical graduates were the most disadvantaged (Table 1). Suggestions regarding improving DEI in the fellowship selection process included implementing bias training, identifying potentially disadvantaged applicants in ERAS, increasing faculty diversity, and pairing underrepresented applicants with interviewers based on applicant preference.Conclusion:While the majority of hematology and medical oncology fellowship program directors report having DEI programs or policies to improve recruitment of underrepresented applicants, perceptions of advantaged/disadvantaged groups may extend beyond demographics traditionally viewed as being underrepresented in medicine. As our survey is ongoing, we plan to reanalyze our data when the survey has been finalized with a higher response rate utilizing multivariable regression to identify themes that may further improve DEI efforts within the fellowship selection process. [Display omitted] DisclosuresLaCasce: Bristol-Myers Squibb Company.: Other: Data Safetly and Monitoring. Murphy: North American Thrombosis Foundation: Honoraria. Naik: Rigel: Research Funding. Podoltsev: Pfizer: Honoraria; Blueprint Medicines: Honoraria; Incyte: Honoraria; Novartis: Honoraria; Celgene: Honoraria; PharmaEssentia: Honoraria; Bristol-Myers Squib: Honoraria; CTI BioPharma: Honoraria.