Higher Median Household Income Research Articles

Outpatient Physical Therapy Attendance by Older Adults After Emergency Department Discharge was a Predictor for Lower 30-Day Revisits-But Demographic Factors Affected Attendance.

Given the high risk of functional loss and revisits among older adults presenting to the emergency department (ED), there is a need to understand how post-ED discharge outpatient physical therapy affects outcomes. This study sought to examine patient demographics and their association with outpatient physical therapy utilization after ED discharge and physical therapy attendance with 30-day ED revisits among older adults discharged to home. In this retrospective cohort study, we analyzed data from 1395 older adults (65years old and older) who had a referral to outpatient physical therapy upon discharge from 15 EDs between January 2021 and December 2022. Descriptive statistics and multivariate logistic regression were used to evaluate the likelihood of attending outpatient physical therapy and the odds of a 30-day ED revisit. Of the sample, 39.3% attended outpatient physical therapy. Older adults in the first and second neighborhood income quintile had a 51% lower odds of attending outpatient physical therapy than those in the fourth quintile. Patients with a diagnosis of vertigo had a 67% higher odds of attending outpatient physical therapy (OR = 1.67; 95% CI = 1.21-2.29) than those with back pain. Older adults who did not attend outpatient physical therapy within 30days of ED visit had a 88% higher odds of returning to the ED than those who did attend (OR = 1.88; 95% CI = 1.34-2.64). Older adults in the first and second income quintile had a 66% higher odds of revisiting the ED than those in the fourth quintile. Outpatient physical therapy attendance after ED discharge was a predictor of revisit within 30days. Patient diagnosis of vertigo and higher median household income were predictors of higher outpatient physical therapy attendance. However, a diagnosis of falls or mobility concerns and a lower household income status were associated with lower attendance. Physical therapy after ED discharge has the potential to reduce 30-day ED revisit but requires strategies to improve access equity across diagnostic groups and household income levels.

Impact of household income on survival in solid malignancies with synchronous brain metastases: A population-based study.

142 Background: Solid malignancies presenting with brain metastasis at the initial diagnosis usually carry a poor prognosis. Increased incidence of brain metastasis can be attributed to the advancements in neuroimaging techniques and improvements in the treatment of solid malignancies. The role of socioeconomic factors in cancer survival is being increasingly recognized. In this study, we analyzed the effect of median household income on survival outcomes in patients diagnosed with brain metastasis at the time of diagnosis of primary malignancies from 2010 to 2020. Methods: We analyzed the Surveillance, Epidemiology, and End Results (SEER) Program 17 registry (November 2022 submission) database for four primary sites of cancers based on their high propensity to develop brain metastases- Lung and/or Bronchus, Breast, Kidney and/or Renal Pelvis, and Melanoma. Patients with a median household income (MHHI) greater than 75,000 per year were classified as a high-income group, whereas those less than 75,000 per year were low-income. Patients diagnosed with malignancy during autopsy or via death certificate and with incomplete data were excluded. Kaplan-Meier method was used for 2-year survival rates and overall survival analyses. Cox regression analysis was used to calculate hazard ratios (HR). Results: A total of 66493 patients were identified across the four primary sites of tumors. Lung and/or bronchus tumors comprised most of the cases (n = 58,324). 25337 patients were in the high-income group, and 41156 patients comprised the low-income group. Median survival in the low-income group was 4 months, and in the high-income group was 5 months, with a 2-year survival rate of 11% and 18% respectively. Patients in the high-income group had better survival outcomes than the low-income [HR:0.88, 95% CI:0.86-0.90, p<0.001]. Additionally, the high-income group had 19% higher odds of receiving chemotherapy [OR:1.19, 95% CI:1.16-1.23, p<0.0001]. Amongst the cancer subgroups, household income did not have a significant effect on survival in patients with kidney and/or renal pelvis tumors [HR:0.97, 95% CI:0.88-1.06, p=0.5]. The 2-year survival rates are outlined (Table). Conclusions: Our analysis highlights a modest improvement in survival in the patient population with higher median household income. This difference could be attributed to the greater accessibility to treatment modalities and other resources for patients with higher household incomes. Further studies are needed to address socioeconomic disparities in survival for patients with solid malignancies having synchronous brain metastases. 2-year survival rates (95% CI). Cancer Groups Low-income High-income Combined Cancers 11% (11-12%) 18% (18-19%) Lung and/or Bronchus 10% (10-11%) 17% (17-18%) Breast 27% (25-29%) 34% (31-37%) Melanoma 19% (17-21%) 23% (20-25%) Kidney and/or Renal Pelvis 15% (13-17%) 18% (15-21%)

Abstract A054 Liver cancer mortality by structural disadvantage and race: An analysis of U.S. area-level factors

Abstract Introduction: Racial/ethnic and sex disparities in liver cancer (LC) mortality are well established; yet little is known about the contributions of county-level social risks on these disparities. Methods: We used U.S. national death certificate data from the National Center for Health Statistics (2018-2022) for LC mortality. County-level estimates of income inequality (ratio of household income at the 80th and 20th percentile), and median household income were obtained using the American Community Survey. Severe housing problems (percentage of households with 1 of 4 housing problems: overcrowding, high housing costs, lack of kitchen facilities, or lack of plumbing facilities) were abstracted from the U.S. Department of Housing and Urban Development (HUD) and U.S. Census Bureau. We estimated age-adjusted mortality rates (MR) and MR rate ratios (aRR) across metrics of county-level social risk grouped in quartiles overall and by race/ethnicity. Results: There were 101,088 liver cancer (LC) deaths from 2018-2022 (MR=6.16 per 100,000). Areas of highest county-level income inequality had 31% higher LC mortality compared to areas within the lowest quartile (aRR=1.31). LC MRs were 45% higher in counties with the lowest vs. highest median household income (aRR=1.45). Men and women in the highest quartile of severe housing problems had 29% and 22% higher LC MR (aRR=1.29 and 1.22, respectively), than those in the lowest quartiles. Men and women in the lowest quartile of median household income had 43% and 49% higher LC mortality than those in the highest median income quartiles (aRR=1.43 and 1.49, respectively). Within the highest quartile of income inequality, American Indian/Alaskan Native (AI/AN) persons had the highest LC mortality rates (MR=7.07), followed by Hispanic (MR=6.75), Black (MR=6.48), and Asian (MR=5.83) individuals. Similarly, in the highest quartile of severe housing problems, AI/AN persons had the highest LC mortality rate (MR 7.74), while Hispanic persons had 58% higher MR (MR 7.01), followed by Black (MR=6.19), Asian (MR=5.85) and White (MR=4.07) individuals. In the lowest median household income quartile, compared to White persons (MR=5.91), AI/AN persons had the highest MR (MR=8.86), and Hispanic persons had a 70% increase in mortality (MR=8.48). Among counties with the highest income inequality, compared to White persons (aRR=1.15), Black persons had an 80% increase in mortality (aRR=1.43). For those in the most concentrated quartile of severe housing problems, compared to White persons (aRR=1.07), AI/AN persons had an 80% increase in mortality (MR=1.34).Conclusion: All county-level indicators of highest social risk were associated with greater liver cancer mortality, but do not appear to fully account for racial and ethnic disparities in mortality. Therefore, place- based interventions are needed to address the role of county-level economic attributes in liver cancer mortality disparities. Citation Format: Jennifer K. McGee-Avila, Wayne R. Lawrence, Natalie Joe, Cameron B. Haas, Meredith S Shiels. Liver cancer mortality by structural disadvantage and race: An analysis of U.S. area-level factors [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A054.

Comparative prognosis analysis of ovarian squamous cell carcinoma versus serous carcinoma: Insights from the SEER database.

The aim of this study was to identify survival rates and potential prognostic factors of ovarian squamous cell carcinoma (OSCC), offering valuable insights for clinical decision making. Leveraging the Surveillance, Epidemiology, and End Results (SEER) database, we selected 11 078 serous carcinoma (SC) patients and 198 OSCC patients based on predetermined criteria diagnosed from 2000 to 2020. We compared the overall survival (OS) and cancer-specific survival (CSS) before and after propensity score matching (PSM) in two groups. Prognostic differences were also compared between OSCC and SC groups at different stages. Univariate and multivariate Cox regression analyses were performed to investigate the impact of clinical and pathologic variables on the survival of patients with OSCC. Finally, we developed and validated a nomogram predictive model. OSCC tumors exhibited distinct characteristics, being relatively larger, more frequently unilateral, and better differentiated than SC tumors. After PSM, Kaplan-Meier analysis revealed significantly lower survival rates for OSCC patients in Stages IIB-IV, while Stages IA-IC displayed comparable survival. Independent risk factors for OSCC patients included advanced age, single marital status, higher tumor stage, and increased tumor size. Conversely, higher median household income and chemotherapy emerged as independent protective factors. Our predictive model and nomogram accurately forecasted patient survival rates in both SEER and internal validation datasets. OSCC patients face significantly poorer prognosis than their SC counterparts, except in the very early stages. Higher median household income was associated with better OSCC survival.

Components of Residential Neighborhood Deprivation and Their Impact on the Likelihood of Live-Donor and Preemptive Kidney Transplantation.

Adults residing in deprived neighborhoods face various socioeconomic stressors, hindering their likelihood of receiving live-donor kidney transplantation (LDKT) and preemptive kidney transplantation (KT). We quantified the association between residential neighborhood deprivation index (NDI) and the likelihood of LDKT/preemptive KT, testing for a differential impact by race and ethnicity. We studied 403937 adults (age ≥ 18) KT candidates (national transplant registry; 2006-2021). NDI and its 10 components were averaged at the ZIP-code level. Cause-specific hazards models were used to quantify the adjusted hazard ratio (aHR) of LDKT and preemptive KT across tertiles of NDI and its 10 components. Candidates residing in high-deprivation neighborhoods were more likely to be female (40.1%vs. 36.2%) and Black (41.9%vs. 17.7%), and were less likely to receive both LDKT (aHR=0.66, 95% confidence interval [CI]: 0.64-0.67) and preemptive KT (aHR=0.60, 95% CI: 0.59-0.62) than those in low-deprivation neighborhoods. These associations differedby race and ethnicity (Black: aHRLDKT=0.58, 95% CI: 0.55-0.62; aHRpreemptive KT=0.68, 95% CI: 0.63-0.73; Pinteractions: LDKT<0.001; Preemptive KT=0.002). All deprivation components were associated with the likelihood of both LDKT and preemptive KT (except median home value): for example, higher median household income (LDKT: aHR=1.08, 95% CI: 1.07-1.09; Preemptive KT: aHR=1.10, 95% CI: 1.08-1.11) and educational attainments (≥high school [LDKT: aHR=1.17, 95% CI: 1.15-1.18; Preemptive KT: aHR=1.23, 95% CI: 1.21-1.25]). Residence in socioeconomically deprived neighborhoods is associated with a lower likelihood of LDKT and preemptive KT, differentially impacting minority candidates. Identifying and understanding which neighborhood-level socioeconomic status contributes to these racial disparities can be instrumental in tailoring interventions to achieve health equity in LDKT and preemptive KT.

Social Determinants of Health and Other Predictors in Initiation of Treatment with CDK4/6 Inhibitors for HR+/HER2- Metastatic Breast Cancer.

In hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-) metastatic breast cancer (MBC), cyclin-dependent kinase 4/6 inhibitors (CDK4/6is) have replaced endocrine therapy alone as the standard of care; however, several barriers to treatment initiation still exist. We assessed social determinants of health (SDOH) and other factors associated with the initiation of CDK4/6i for HR+/HER2- MBC in the Medicare population. Using a retrospective cohort design, patients aged ≥65 years and diagnosed during 2015-2017 were selected from the SEER-Medicare database. Time from MBC diagnosis to first CDK4/6i initiation was the study outcome. The effect of SDOH measures and other predictors on the outcome was assessed using the multivariable Fine and Gray hazard modeling. Of 752 eligible women, 352 (46.8%) initiated CDK4/6i after MBC diagnosis (median time to initiation: 27.9 months). In adjusted analysis, SDOH factors significantly associated with CDK4/6i initiation included high versus low median household income (HHI) (hazard ratio [HR] = 1.70; 95% CI = 1.03-2.81) and the percentage of population with high versus low Medicare-only coverage (HR = 1.54; 95% CI = 1.04-2.27). In summary, older Medicare patients with HR+/HER2- MBC residing in areas with high median HHI and a high proportion of Medicare-only coverage had higher rates of initiating CDK4/6i, suggesting inequitable access to these novel, effective treatments and a need for policy intervention.

Association of characteristics of cancer, patient, and county with telemedicine services use: Impact of the waiver of reimbursement restrictions on telemedicine.

11058 Background: Telemedicine services have great potential to improve access to care of cancer patients who are vulnerable in health status and may experience financial hardship due to the cost of their care. However, very little is known about how the Centers for Medicare and Medicaid Services’ waiver of reimbursement restrictions on telemedicine and characteristics of cancer affected their use of telemedicine services. We examined the changes in frequency of telemedicine use before and after the waiver and, after the waiver, the determinants of telemedicine use across medical provider types. Methods: We used the 5% Surveillance, Epidemiology and End Results registry file linked to Medicare data among patients who had a newly diagnosed cancer in 2019 and were enrolled in Medicare Parts A and B during 2019-2020, and Area Health Resources File. Our outcomes were binary variables of telemedicine services use in outpatient (OP), office-based clinics (OB), and emergency department (ED), respectively, and for detailed provider types in OB. Primary independent variables included the ten most frequently observed cancer sites (reference: all other sites), sequence of cancer, stage of diagnosis, and quarter of diagnosis in 2019. Analysis was by a multilevel mixed effects logistic regression model, adjusting characteristics of cancer, patient and county. Results: Among eligible patients (n = 14,226), telemedicine services use for all provider types increased from 4.3% in pre-waiver period to 40.3% (5.2% in OP, 39.3% in OB, and 0.2% in ED) in post-waiver period. Telemedicine services use varied by primary cancer site, but was higher for those with a cancer recurrence (odds ratio [OR] 1.36, 95% confidence interval [CI] 1.16-1.60) and advanced cancer stage (OR 1.24, 95% CI 1.03-1.48). For visits to oncologists, cancer characteristics such as recurrence (OR 1.67, 95% CI 1.34-2.08), advanced stage (OR 5.52, 95% CI 4.12-7.40) and diagnosis in the last quarter in 2019 (OR 1.39, 95% CI 1.20-1.61) were associated with greater use of telemedicine. Patients of older age and minority race/ethnicity and in non-Northeast regions were less likely to use telemedicine, while women, patients with dual eligibility for Medicaid, and those living in a county with high median household income and high availability of hospital beds were more likely to use telemedicine. Conclusions: Cancer patients used telemedicine services more frequently after the waiver and their cancer characteristics were most strongly associated with that use, implying their greater need for, and benefit from, telemedicine. Disparities in telemedicine use related to individual and county-level socio-demographics and medical supply suggest health policy changes to improve equitable access to telemedicine and efficient cancer care planning.

Gender disparity in chimeric antigen receptor T-cell therapy utilization and outcomes in the United States.

2556 Background: Chimeric antigen receptor T-cell [CART] therapy has marked a new era in the treatment of relapsed/refractory hematological malignancies since its approval in 2017. Racial disparity was studies previously but not gender. Current study aimed to evaluate gender disparity in CART therapy utilization and outcomes. Methods: This cross sectional study was done using National Inpatient Sample [NIS], the largest database available in the US. Inpatient admissions of adults who received CART therapy for various indications during year 2020 were included. Results: A total of 6915 patients were admitted to hospital for CART therapy in 2020 with an overall inpatient mortality rate of 1%. Mean age of the patients was 57yr. Majority were White [64%], with a higher median household income, admitted to urban and large sized hospitals and predominantly covered by Medicare or private insurance [~80%]. Study population was divided into males and females and outcomes were compared. Females were significantly younger with lower Charlson comorbidity index and higher utilization of CART therapy [81% vs 19%] compared to males. Females had 86% lesser odds of mortality compared to males (Odds Ratio [OR] 0.14; 95% confidence interval [CI] 0.04-0.47; p value 0.001). Females had significantly lesser hospitalization charges [mean decrease $471,193; p value 0.000] and length of stay [mean decrease 8 days; p value 0.000] compared to males after adjusting for confounders. Racial differences in outcome were compared after multiple imputation was used to correct for 4% missing data in the race category in NIS 2020. There was no statistically significant difference in mortality, length of stay or hospitalization charges between Whites, Blacks and Hispanic races similar to previous studies. Conclusions: Eligibility criteria for CART therapy includes patients with good performance status and organ function with less comorbidities. Our study found that females were younger, healthier and therefore qualified better for CART therapy compared to males. Hence they had significantly higher utilization of CART therapy. In addition, among the population receiving CART therapy, females had better outcomes compared to males in terms of mortality, length of stay and hospitalization charges. In general, males have higher incidence and mortality with poorer outcomes in most hematological malignancies where CART therapy is a treatment option. Measures at modifying and improvising CART therapy to cater to more male subjects will not only reduce gender disparity but also improve overall survival and reduce disease burden. [Table: see text]

Systematic disparities in reporting on community firearm violence on local television news in Philadelphia, PA, USA

ObjectiveTo better understand how community firearm violence (CFV) is communicated to the public, we aimed to identify systematic differences between the characteristics of shooting victims and events covered on television news and all shootings in Philadelphia, PA, a city with escalating CFV incidence. MethodsWe compiled a stratified sample of local television news clips covering shootings that occurred in Philadelphia aired on two randomly selected days per month from January-June 2021 (n = 154 clips). We coded the clips to determine demographic and geographic information about the shooting victims and events and then matched coded shootings with corresponding shootings in the Philadelphia police database. We compared characteristics of shooting victims and shooting event locations depicted in television clips (n = 62) with overall characteristics of shootings in Philadelphia during the study period (n = 1082). ResultsCompared to all individuals shot, victims whose shootings were covered on local television news more likely to be children and more likely to be shot in a mass shooting. The average median household income of shooting locations featured on television was significantly higher than the median household income across all shooting locations ($60,302 for television shootings vs. $41,233 for all shootings; p = 0.002). Shootings featured on television occurred in areas with lower rates of income inequality and racialized economic segregation compared to all shooting locations. ConclusionsTelevision news outlets in Philadelphia systematically over-reported shootings of children, mass shootings, and shootings that occurred in neighborhoods with higher median household income, less socioeconomic inequality, and lower rates of racialized economic segregation.

Abstract 2243: A multi-ethnic population-based pilot study of multiple myeloma disparities

Abstract To understand multiple myeloma (MM) disparities we established the Precision MEDicine, EqUity and Disparities Research in MultipLe MyeLomA (MEDULLA) study, a population-based study in California. Our study contacted, via the Cancer Registry of Greater California (CRGC), 100 adult MM patients from four racial/ethnic groups: Non-Hispanic Black (NHB), Non-Hispanic White (NHW), Latinos, and Asians. Data collection included variables reported to the CRGC, a self-administered survey, and biospecimen saliva collection. The survey focused on demographics, risk factors, cancer treatment, family history, quality of life, and social determinants of health. Of the 400 MM patients, we had 95 patients who responded to the survey, giving a response rate of 24%. 44% of those who responded were NHW, 21% NHB, 19% Latinos, and 16% Asians. Those that provided a response tend to be living in a census tract location with lower proportions of poverty (p=0.0004), higher proportion of adults ages 25 years or over with a college degree (p=0.0011), higher median household income (p=0.0048), lower proportion of adults ages 25 years or over without a high school diploma (p&amp;lt;0.0001), and a lower proportion of individuals ages 16 or over who are unemployed (p&amp;lt;0.006). All respondents also have a lower comorbidity count and expressed being in good health. For minorities, we identified a trend where a higher response rate is seen if they live in an area where median household income is higher (p=0.0108). For every 1% increase in poverty rates, NHW living in such neighborhoods were 3% less likely to respond to the survey (p=0.04). For every 10% increase in the proportion of individuals having a college degree, response rate increased by 1.17 for minorities in that neighborhood (p=0.07). Minorities living in neighborhoods with high proportions of adults without a high school diploma and high unemployment rates are less likely to respond (p=0.02 and p=0.047, respectively). In conclusion, we found significantly lower participation rates among minority groups, with socio-economic factors affecting response rates. Our findings, therefore, suggest that future studies must develop improved community-focused and culturally tailored strategies to engage and meaningfully understand MM etiology and survivorship in such populations. Citation Format: Angelica M. Rolon, April P. Vang, J. Elizabeth Quino, Ana Estrada, Eric Stewart, Rosemary D. Cress, Luis Carvajal-Carmona, Alexa Morales Arana. A multi-ethnic population-based pilot study of multiple myeloma disparities [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2243.

Abstract 1006: Revitalizing the accrual of women and minorities: Unique drivers of therapeutic clinical trial enrollment for underrepresented patients with diffuse glioma

Abstract Introduction: Despite the enactment of the 1993 NIH Revitalization Act to improve accrual of women and minorities in clinical trials, these groups remain underrepresented. This study aims to uncover drivers of therapeutic clinical trial enrollment that are unique to women and minority patients with low- and high-grade glioma. Methods: Adult glioma patients who received care from the UCSF Brain Tumor Center between 1997-2017 were identified in a prospective registry. Dividing the cohort into subgroups by gender and NIH-designated minority status, factors associated with therapeutic clinical trial enrollment on univariate logistic regression (p&amp;lt;0.2) were selected for multivariate logistic regression. Results: There were 351 trial participants (41% women, 12% minority) and 627 non-trial participants (44% women, 17% minority). Among women only, seizure at presentation (OR 2.10, p=0.008) was associated with increased odds of trial enrollment. In contrast, among men only, higher median household income (OR 1.09 per $10,000 increase, p=0.006), higher WHO tumor grade (OR 1.89, p=0.045), and occupational status according to the International Standard Classification of Occupations [professionals (e.g., physicians) vs managers (e.g., supervisory positions), OR 2.87, p=0.043] were associated with increased odds of trial enrollment. Among both women and men, lack of insurance (women: OR 0.49, p=0.02; men: OR 0.55, p=0.031) and no treatment with chemotherapy (women: OR 0.18, p=0.001; men: OR 0.34, p=0.002) were associated with decreased odds of clinical trial enrollment, whereas higher KPS (women: 90 vs &amp;lt;80, OR 3.16, p=0.003; men: 90 vs &amp;lt;80, OR 3.15, p=0.002) was associated with increased odds of trial enrollment. Among NIH-designated minority patients, older age (OR 0.66 per 10-year increase, p=0.033) and non-English preferred language (OR: 0.30, p=0.035) were associated with decreased odds of trial enrollment on univariate analysis, but not on multivariate analysis. Among non-minority patients, lack of insurance (OR 0.58, p=0.008) and no chemotherapy treatment (OR 0.25, p&amp;lt;0.001) were associated with decreased odds of trial enrollment, whereas seizure at presentation (OR 1.80, p=0.001), higher neighborhood household income (OR 1.07 per $10,000 increase, p=0.004), higher WHO grade (4 vs 2-3, OR 1.86, p=0.015), higher KPS (90 vs &amp;lt;80, OR 3.21, p&amp;lt;0.0001), and lower extent of tumor resection (80-89% vs 100%, OR 2.16, p=0.047) were associated with increased odds of trial enrollment. Conclusion: Drivers of trial enrollment differed for women and minority patients with glioma. Non-English-speaking minority patients may face additional barriers to trial enrollment requiring targeted interventions. Our findings can revitalize and tailor efforts to recruit women and minority patients to therapeutic clinical trials in neuro-oncology. Citation Format: Mulki Mehari, Gayathri Warrier, Sheantel Reihl, Abraham Dada, Aymen Kabir, Mikias Negussie, Cesar Nava Gonzales, Ugonma Chukwueke, Alyx Porter, Shawn Hervey-Jumper. Revitalizing the accrual of women and minorities: Unique drivers of therapeutic clinical trial enrollment for underrepresented patients with diffuse glioma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1006.

Low Household Income Increases Hospital Length of Stay and Decreases Home Discharge Rates in Lumbar Fusion.

Retrospective Matched Cohort Study. Low median household income (MHI) has been correlated with worsened surgical outcomes, but few studies have rigorously controlled for demographic and medical factors at the patient level. This study isolates the relationship between MHI and surgical outcomes in a lumbar fusion cohort using coarsened exact matching. Patients undergoing single-level, posterior lumbar fusion at a single institution were consecutively enrolled and retrospectively analyzed (n = 4263). Zip code was cross-referenced to census data to derive MHI. Univariate regression correlated MHI to outcomes. Patients with low MHI were matched to those with high MHI based on demographic and medical factors. Outcomes evaluated included complications, length of stay, discharge disposition, 30- and 90day readmissions, emergency department (ED) visits, reoperations, and mortality. By univariate analysis, MHI was significantly associated with 30- and 90day readmission, ED visits, reoperation, and non-home discharge, but not mortality. After exact matching (n = 270), low-income patients had higher odds of non-home discharge (OR = 2.5, P = .016) and higher length of stay (mean 100.2 vs 92.6, P = .02). There were no differences in surgical complications, ED visits, readmissions, or reoperations between matched groups. Low MHI was significantly associated with adverse short-term outcomes from lumbar fusion. A matched analysis controlling for confounding variables uncovered longer lengths of stay and higher rates of discharge to post-acute care (vs home) in lower MHI patients. Socioeconomic disparities affect health beyond access to care, worsen surgical outcomes, and impose costs on healthcare systems. Targeted interventions must be implemented to mitigate these disparities.

SOCIOECONOMIC DISPARITIES IN HOSPITALIZATION AND OUTCOMES OF EOSINOPHILIC COLITIS: A FIVE-YEAR NATIONAL ANALYSIS

Abstract BACKGROUND Eosinophilic colitis (EoC) is a rare gastrointestinal inflammation of the colon due to an altered hypersensitivity reaction characterized by eosinophilic infiltration into the colonic wall. Patients usually present with abdominal pain, diarrhea, and weight loss. METHODS We used the National Inpatient Sample (NIS) database to conduct a retrospective study of hospitalized adult patients with eosinophilic colitis using the validated ICD-10 diagnosis codes between January 1, 2016, and December 31, 2020. RESULTS We identified 4353 cases of eosinophilic colitis using the NIS database. There were 748, 776, 889, 934, and 1,006 eosinophilic colitis cases diagnosed in 2016, 2017, 2018, 2019, and 2020 respectively. Males were more likely to be hospitalized due to eosinophilic colitis than females (51.8% vs. 48.2%). Moreover, there was a significantly higher prevalence of eosinophilic colitis among the white population, with 81.7% in Whites, 8.1% in Blacks, 6.3% in Hispanics, and 1.3% in Asians. 26.5% of those patients had Medicare, 15.7% had Medicaid, and 50.6% had private/HMO insurance. About 20.7% of patients had a median household income of $45,999 or less, 23.6% had $46,000-58,999, and 55.6% had $59,000 or more. Based on hospital location, 30.3% of the cases were in the South, 27.5% in the Midwest, 23.4% in the West, and 18.8% in the Northeast. The majority of patients admitted for eosinophilic colitis were recorded in urban teaching hospitals (77.8%) compared to 17.6% in urban nonteaching hospitals and 4.6% in rural areas. Only 16.5% of the patients with eosinophilic colitis had a Charlson Comorbidity Index of 3 or higher. CONCLUSION Based on the national inpatient sample over 5 years, males and whites are more likely to be hospitalized with eosinophilic. The report suggests that eosinophilic colitis is common among patients with high median household income and has a better prognosis.

Association of Neighborhood Socioeconomic Status With Withdrawal of Life-Sustaining Therapies After Intracerebral Hemorrhage.

Mortality after intracerebral hemorrhage (ICH) is common. Neighborhood socioeconomic status (nSES) is an important social determinant of health (SDoH) that can affect clinical outcome. We hypothesize that SDoH, including nSES, contribute to differences in withdrawal of life-sustaining therapies (WLSTs) and mortality in patients with ICH. We performed a retrospective study of patients with ICH at 3 tertiary care hospitals between January 2017 and December 2022 identified through the Get with the Guidelines Database. We collected data on age, clinical severity, race/ethnicity, median household income, insurance, marital status, religion, mortality before discharge, and WLST from the electronic medical record. We assessed for associations between SDoH and WLST, mortality, and poor discharge mRS using Mann-Whitney U tests and χ2 tests. We performed multivariable analysis using backward stepwise logistic regression. We identified 868 patients (median age 67 [interquartile range (IQR) 55-78] years; 43% female) with ICH. Of them, 16% were Black non-Hispanic, 17% were Asian, and 15% were of Hispanic ethnicity; 50% were on Medicare and 22% on Medicaid, and the median (IQR) household income was $81,857 ($58,669-$122,078). Mortality occurred in 17% of patients, and of them, 84% of patients had WLST. Patients from zip codes with higher median household incomes had higher incidence of WLST and mortality (p < 0.01). Black non-Hispanic race was associated with lower WLST and discharge mortality (p ≤ 0.01 for both). In multivariable analysis adjusting for age and clinical severity scores, patients who lived in zip codes with high-income levels were more likely to have WLST (adjusted odds ratio [aOR] 1.88; 95% CI 1.29-2.74) and mortality before discharge (aOR 1.5; 95% CI 1.06-2.13). SDoH, including nSES, are associated with WLST after ICH. This has important implications for the care and management of patients with ICH.

Socioeconomic determinants of the biology and outcomes of acute lymphoblastic leukemia in adults

AbstractVarious socioeconomic and biologic factors affect cancer health disparities and differences in health outcomes. To better characterize the socioeconomic vs biologic determinants of acute lymphoblastic leukemia (ALL) outcomes, we conducted a single-institution, retrospective analysis of adult patients with ALL treated at the University of Chicago (UChicago) from 2010 to 2022 and compared our outcomes with the US national data (the Surveillance, Epidemiology, and End Results [SEER] database). Among 221 adult patients with ALL treated at UChicago, BCR::ABL1 was more frequent in patients with higher body mass index (BMI; odds ratio [OR], 7.64; 95% confidence interval [CI], 1.17-49.9) and non-Hispanic Black (NHB) ancestry (59% vs 24% in non-Hispanic White (NHW) and 20% in Hispanic patients; P = .001). In a multivariable analysis, age (hazard ratio [HR], 6.93; 95% CI, 2.27-21.1) and higher BMI at diagnosis (HR, 10.3; 95% CI, 2.56-41.5) were independent predictors of poor overall survival (OS). In contrast, race or income were not predictors of OS in the UChicago cohort. Analysis of the national SEER database (2010-2020) demonstrated worse survival outcomes in Hispanic and NHB patients than in NHW patients among adolescent and young adults (AYAs) but not in older adults (aged >40 years). Both AYA and older adult patients with higher median household income had better OS than those with lower income. Therefore, multidisciplinary medical care coupled with essential supportive care services offered at centers experienced in ALL care may alleviate the socioeconomic disparities in ALL outcomes in the United States.

Modeling Spatio-Temporal Dynamics of BMPs Adoption for Stormwater Management in Urban Areas

Nonpoint source (NPS) pollution is a severe problem in the U.S. and worldwide. Best management practices (BMPs) have been widely used to control stormwater and reduce NPS pollution. Previous research has shown that socio-economic factors affect households’ adoption of BMPs, but few studies have quantitatively analyzed the spatio-temporal dynamics of household BMP adoption under different socio-economic conditions. In this paper, diverse regression approaches (linear, LASSO, support vector, random forest) were used on the ten-year data of household BMP adoption in socio-economically diverse areas of Washington, D.C., to model BMP adoption behaviors. The model with the best performance (random forest regression, R2 = 0.67, PBIAS = 7.2) was used to simulate spatio-temporal patterns of household BMP adoption in two nearby watersheds (Watts Branch watershed between Washington, D.C., and Maryland; Watershed 263 in Baltimore), each of which are characterized by different socio-economic (population density, median household income, renter rate, average area per household, etc.) and physical attributes (total area, percentage of canopy in residential area, average distance to nearest BMPs, etc.). The BMP adoption rate was considerably higher at the Watts Branch watershed (14 BMPs per 1000 housing units) than at Watershed 263 (4 BMPs per 1000 housing units) due to distinct differences in the watershed characteristics (lower renter rate and poverty rate; higher median household income, education level, and canopy rate in residential areas). This research shows that adoption behavior tends to cluster in urban areas across socio-economic boundaries and that targeted, community-specific social interventions are needed to reach the NPS control goal.

County characteristics associated with refusing breast cancer surgery: Evidence from the Surveillance, Epidemiology, and End Results program

BackgroundIndividuals’ communities impact cancer disparities and are intimately related to social determinants of health. Studies show that personal factors affect treatment refusals for a potentially curable cancer, but few studies have investigated whether community-based characteristics affect the receipt of surgery. MethodsWe used Surveillance Epidemiology and End Results Program registries from 2010 to 2015 to examine differences in rates of surgery refusal among non-Hispanic White, non-Hispanic Black, and Hispanic women diagnosed with nonmetastatic breast cancer. The community factor measures were based on county-level factors. Sociodemographic and community differences were analyzed using Pearson’s χ2 tests and analysis of variance. Multivariate logistic regression of predictors of surgery refusal and the Cox proportional hazard model of disease-specific mortality were performed. ResultsSurgery refusers among non-Hispanic Black and Hispanic all races lived in counties with lower rates of educational attainment, median family and household income, and higher rates of poverty, unemployment, foreign-born, language isolation, urban population, and women more than 40 years old having mammography in last 2 years. Multivariate analysis shows surgery refusal rates increased in counties having a high percentage of urban population and declined in counties with an increased percentage of less than high school level education, unemployment, and median household income. Breast cancer-specific mortality increased significantly with surgery refusal. ConclusionResidence in counties with the lowest socioeconomic status and disproportionately populated by racial and ethnic minorities is associated with surgery refusal. Given the high mortality associated with refusing surgery, culturally sensitive education on the benefits of care may be appropriate.

Ancillary Treatment Referrals and Visits After Breast Cancer Surgery in a Sociodemographically Diverse Population.

Ancillary therapies with rehabilitative, palliative, and survivorship specialists mitigate adverse effects of breast cancer surgery. Existing data suggest that patients from disadvantaged backgrounds may be less likely to receive these services. This study aimed to assess variations in ancillary provider referrals and patient visits at a high-volume urban cancer center. Electronic health records of breast cancer surgical patients at the Yale-New Haven Health System between 2010 and 2017 were reviewed. The primary end points were postoperative referral to ancillary service providers and patient use of ancillary services (defined as attending ≥ 1 consultation). Associations between end points and demographic/disease variables were identified in uni- and multivariable logistic regression analyses. The study identified 5496 patients: 2288 patients (41.6%) referred to ancillary services and 1572 patients (28.6%) who attended one or more consultations. Referrals were highest among the patients with Hispanic (57.5%) or black (54.9%) ancestry, no health insurance (57.6%), lowest percentage of high school degrees for the zip code area (50.5%), and poorest median income bracket (50.7%). Associations remained significant in the multivariable analysis (p < 0.05). Minority race remained associated with referrals in analyses of each ancillary service individually. Visits to ancillary specialists were greatest among the patients with private insurance (70.7%), highest percentage of high school degrees (72.8%), highest median household income (72.2%), and Hispanic ethnicity (73.5%). Highest median household income (odds ratio [OR] 1.45; p = 0.02) and Hispanic ethnicity (OR, 1.50; p = 0.05) remained associated in the multivariable analysis. In a well-resourced health system serving a demographically diverse population, traditional markers of poor health care access were associated with referral for ancillary treatment after breast cancer surgery but not with utilization of ancillary treatment. Health care access remains a critical barrier to adjunctive therapies that target postoperative morbidity and elevate quality of life.

Complex implementation factors demonstrated when evaluating cost-effectiveness and monitoring racial disparities associated with [18F]DCFPyL PET/CT in prostate cancer men

Prostate cancer (PC) staging with conventional imaging often includes multiparametric magnetic resonance (MR) of the prostate, computed tomography (CT) of the chest, abdomen, and pelvis, and whole-body bone scintigraphy. The recent development of highly sensitive and specific prostate specific membrane antigen (PSMA) positron emission tomography (PET) has suggested that prior imaging techniques may be insufficiently sensitive or specific, particularly when evaluating small pathologic lesions. As PSMA PET/CT is considered to be superior for multiple clinical indications, it is being deployed as the new multidisciplinary standard-of-care. Given this, we performed a cost-effectiveness analysis of [18F]DCFPyL PSMA PET/CT imaging in the evaluation of PC relative to conventional imaging and anti-3-[18F]FACBC (18F-Fluciclovine) PET/CT. We also conducted a single institution review of PSMA PET/CT scans performed primarily for research indications from January 2018 to October 2021. Our snapshot of this period of time in our catchment demonstrated that PSMA PET/CT imaging was disproportionately accessed by men of European ancestry (EA) and those residing in zip codes associated with a higher median household income. The cost-effectiveness analysis demonstrated that [18F]DCFPyL PET/CT should be considered as an alternative to anti-3-[18F]FACBC PET/CT and standard of care imaging for prostate cancer staging. [18F]DCFPyL PET/CT is a new imaging modality to evaluate PC patients with higher sensitivity and specificity in detecting disease than other prostate specific imaging studies. Despite this, access may be inequitable. This discrepancy will need to be addressed proactively as the distribution network of the radiotracer includes both academic and non-academic sites nationwide.

Area-based comparison of risk factors and testing rates to improve sexual health care access: cross-sectional population-based study in a Dutch multicultural area

ObjectivesAreas with high sexually transmitted infection (STI) testing rates may not require additional strategies to improve testing. However, it may be necessary to intervene in areas with elevated STI risk,...