Highest Income Quartile Research Articles

Primary prescription adherence for obstructive lung disease in a primary care population

BackgroundThe objective of this study was to determine primary prescription adherence for obstructive lung diseases (e.g., asthma, COPD) in an adult primary care patient population over a 3-year period.MethodsA retrospective analysis of electronic medical record and administrative data was performed to determine primary adherence, defined as dispensation of a new prescription within 90 days of the date the prescription was written. Multivariable logistic regression models were used to test predictors of prescription primary adherence.ResultsOf 13,220 prescriptions for obstructive airway disease, 75.9% (N = 10,038) were filled. In multivariate analysis, depression, certain age groups (18–44 years), higher income quartile were associated with reduced prescription adherence. However, 1–2 ER visits in the previous year (compared to no ER visits), number of ambulatory visits in the previous year, and number of hospitalizations in the previous year, did not increase the likelihood of prescription adherence.InterpretationThis study provides important insights about factors associated with prescription nonadherence and is the first study examining primary medication adherence with medications for obstructive lung disease in adults, providing indications of prescription nonadherence patterns among a broad population.

Assessment of dietary intake of bioactive food compounds according to income level in the Brazilian population.

There is an inverse association between bioactive compounds intake and disease risk. The knowledge of its consumption according to socio-economic strata is important, which allows identification of potential intervention targets. Thus, we aimed to investigate bioactive compounds intake according to income level in Brazilian population. Data were obtained from the Brazilian Household Budget Survey, a cross-sectional survey which included data on individual food intake of 34,003 subjects aged 10 years and over collected using two 24-h dietary records. Polyphenol and carotenoid content of foods was identified using published databases. Total polyphenol and carotenoid intake were determined according to per capita income, as well as main food sources. Total polyphenols and flavonoids intake increased with income level, and subjects with lower income showed higher phenolic acids intake than individuals in highest income (p = 0.0001). Total carotenoids and classes intake (with exception to β-cryptoxanthin and zeaxanthin) were higher among subjects in highest income quartile, compared to the lowest quartile (p = 0.0001). Coffee was major source to total polyphenols and phenolic acids intake, and orange juice was main flavonoid provider in individuals from all income levels. In the upper income quartile, total carotenoid was supplied mainly by tomato and kale, and fruits had important contribution to carotenoid intake in the lowest income quartile. There is important influence of income level on diet quality regarding intake of foods with bioactive compounds, and individuals with lower income may experience lower quality diets due to less availability of foods with bioactive compounds.

Seasonal burden of National Emergency Department visits due to hidradenitis suppurativa

Seasonal burden of National Emergency Department visits due to hidradenitis suppurativa

Factors Associated With High Resource Use in Elective Adult Cardiac Surgery From 2005 to 2016

BackgroundLack of consensus remains about factors that may be associated with high resource use (HRU) in adult cardiac surgical patients. This study aimed to identify patient-related, hospital, and perioperative characteristics associated with HRU admissions involving elective cardiac operations. MethodsData from the National Inpatient Sample was used to identify patients who underwent coronary artery bypass graft, valve replacement, and valve repair operations between 2005 and 2016. Admissions with HRU were defined as those in the highest decile for total hospital costs. Multivariable regressions were used to identify factors associated with HRU. ResultsAn estimated 1,750,253 hospitalizations coded for elective cardiac operations. The median hospitalization cost was $34,700 (interquartile range, $26,800– to $47,100), with the HRU (N = 175,025) cutoff at $66,029. Although HRU patients comprised 10% of admissions, they accounted for 25% of cumulative costs. On multivariable regression, patient-related characteristics predictive of HRU included female sex, older age, higher comorbidity burden, non-White race, and highest income quartile. Hospital factors associated with HRU were low-volume hospitals for both coronary artery bypass graft and valvular operations. Among postoperative outcomes, mortality, infectious complications, extracorporeal membrane oxygenation use, and hospitalization for more than 8 days were associated with greater odds of HRU. ConclusionsIn this nationwide study of elective cardiac surgical patients, several important patient-related and hospital factors, including patients’ race, comorbidities, postoperative infectious complications, and low hospital operative volume were identified as predictors of HRU. These highly predictive factors may be used for benchmarking purposes and improvement in surgical planning.

156 Trends in cesarean delivery on maternal request in the United States from 1999 to 2015

The rate of cesarean delivery has increased in the United States over the last several decades. The rate of cesarean delivery on maternal request (CDMR) however remains uncertain. The objectives of this study were to describe the prevalence and temporal trends of CDMR in the United States, and to characterize the population of patients who elect to undergo a CDMR. A retrospective cohort study was conducted using data from The Healthcare Cost and Utilization Project-Nationwide Inpatient Sample from 1999 to 2015. An algorithm based on International Classification of Diseases, Ninth Revision (ICD-9) codes was created to identify patients who delivered by primary elective cesarean section in the absence of fetal or maternal indications. Maternal demographic characteristics between patients who delivered by CDMR and patients who did not were compared. Of the 13,698,836 deliveries included over the study period, 221,310 were identified as potential CDMR. CDMR rates peaked in 2009, and varied from 1% to 1.98% of all live births and 4.53% to 5.88% of all cesarean deliveries over the study period. Overall, the rate of CDMR among all live births increased over the study period, from 1% in 1999 to 1.56% in 2015 (p <0.0001). Patients who elected to deliver by CDMR were more likely to be over the age of 35, in the highest income quartile, and have private insurance, and were less likely to be African American (p <0.0001). Our findings indicate that CDMR accounts for a small proportion of all deliveries in the United States. Furthermore, rates of CDMR have increased only slightly since 1999. CDMR is more prevalent among patients with certain demographic characteristics. These results may indicate that the option of CDMR is more appealing or more frequently offered to a certain population of patients.

Healthcare disparities in cardio oncology: patients receive same level of surveillance regardless of race at a safety net hospital

BackgroundCardiotoxicity remains a dreaded complication for patients undergoing chemotherapy with human epidermal growth factor (HER)-2 receptor antagonists and anthracyclines. Though many studies have looked at racial disparities in heart failure patients, minimal data is present for the cardio-oncology population.MethodsWe queried the echocardiogram database at a safety net hospital, defined by a high proportion of patients with Medicaid or no insurance, for patients who received HER2 receptor antagonists and/or anthracyclines from January 2016 to December 2018. Patient demographics, clinical characteristics, and treatment outcomes were collected. Based on US census data in 2019, home ZIP codes were used to group patients into quartiles based on median annual household income. The primary end point studied was referral rate to cardiology for patients undergoing chemotherapy.ResultsWe identified 149 patients who had echocardiograms and also underwent treatment with HER2 receptor antagonists and/or anthracyclines, of which 70 (47.0%) were referred to the cardio-oncology program at our institution. Basic demographics were similar, but white patients were more likely to live in ZIP codes with higher income quartiles (p < 0.00001). Comparing between racial groups, there was no statistical difference in the percentage of patients that had a reduction in ejection fraction (EF) (p = 0.75). There was no statistical difference between racial groups in the number of cardiology or oncology appointments attended, number of appointments cancelled, average number of echocardiograms received, additional cardiac imaging received. Black patients were more likely to receive ACEI/ARB post chemotherapy (p = 0.047). A logistic regression model was created using race, age, gender, insurance, income quartile by home ZIP code, comorbidities (hypertension, hyperlipidemia, coronary artery disease, arrhythmia, diabetes mellitus, smoking, family history, age > 65), procedures (coronary stents, cardiac surgery), medications pre-chemotherapy, cancer type, cancer stage, and chemotherapy. This model found that there was an increased referral rate among patients from higher income quartiles (p = 0.017 for quartile 3, p = 0.049 for quartile 4), patients with a history of hypertension (p < 0.0001), and patients with breast cancer (p = 0.02).ConclusionsThe results of this study suggest that patients of our cardio-oncology population at a safety net hospital receive the same level of surveillance and treatment, and develop drop in ejection fraction at similar rates regardless of their race. However, patients that reside in ZIP codes associated with higher income quartiles, with hypertension, and with breast cancer, are associated with increased rate of referral.

Explaining the Income and Consumption Effects of COVID in India

The COVID-19 pandemic led to stark reductions in economic activity in India. We employ CMIE's Consumer Pyramids Household Survey to examine the timing, distribution, and mechanism of the impacts from this shock on income and consumption through December 2020. First, we estimate large and heterogeneous drops in income, with ambiguous effects on inequality. While incomes of salaried workers fell 35%; incomes of daily laborers fell 75%. At the same time, we observe that income fell more for individuals from households in the highest income quartile. Second, we document an increase in effort to buffer income shocks by switching occupations. We employ a Roy Model to estimate the gains from occupation churn and find, surprisingly, that reservation wages fell, implying that the risk of COVID did not reduce the value of employment. Third, we find that consumption fell less than income, suggesting households were able to smooth the idiosyncratic components of the COVID shock as well as they did before COVID. Finally, consumption of food and fuel fell less than consumption of durables such as clothing and appliances. Following Costa (2001) and Hamilton (2001), we estimate Engel curves and find that changes in consumption reflect large price shocks (rather than a retreat to subsistence) in sectors other than food and fuel/power. In the food sector, it appear that lockdown successfully distinguished essential and non-essential services, at least to the extent that it did not increase the relative price of food. There is some suggestive evidence that the price shocks outside the food sector were larger in places with greater COVID-19 cases, even during the lockdown.

Factors associated with the inflammatory potential of the Brazilian population's diet.

The aim of the study was to assess the inflammatory potential of the Brazilian population's diet and its association with demographic, socio-economic and anthropometric characteristics. A cross-sectional study was performed with 34003 individuals aged 10 years and older, evaluated by the National Diet and Nutrition Survey from the Consumer Expenditure Survey (POF 2008-2009). The Energy-adjusted Dietary Inflammatory Index (E-DII™) was determined using thirty-four dietary parameters calculated through non-consecutive 2-d dietary records. Positive scores indicate a pro-inflammatory diet, while negative scores indicate an anti-inflammatory diet. A bivariate and multivariate linear regression analysis based on a hierarchical theoretical model was performed to verify the factors associated with the E-DII. The mean of the E-DII was 1·04 (range of -4·77 to +5·98). The highest values of the pro-inflammatory E-DII were found among adolescents (1·42; P < 0·001) and individuals with higher income (1·10; P < 0·001) and level of education (1·18; P < 0·001). In the final model, the E-DII was associated with higher income quartiles and was higher in the Northeast and South regions, in white people, individuals with ≥9 years of education and adults and adolescents age group. The Brazilian population consumes a diet with high inflammatory potential, especially adolescents, white people and those with higher income and level of education. Thus, the index presented uneven distribution among the population, emphasising groups with higher dietary inflammatory potential. The socio-economic risk profile of a diet with higher inflammatory potential in medium-income countries is different from what is observed in high-income nations.

A national analysis of pediatric falls from a building.

Falls remain the leading cause of unintentional pediatric trauma in the United States. Identifying risk factors for pediatric building falls would influence public health policy. We hypothesized that building falls disproportionately affect low income communities. We performed a cross-sectional analysis of the Kids' Inpatient Database for years 2006, 2009, and 2012. We identified cases (age <12 years) of falls from a building using external cause of injury codes. Patient characteristics and injuries were analyzed using ICD-9 codes. National estimates were obtained using case weighting. Multivariable logistic regression was performed to adjust for confounders. There were 2,294 hospitalizations nationally for pediatric falls from a building. The victims were predominately male, in early childhood, non-Hispanic White, in the lowest income quartile, resided in urban settings, and occurred during summer. The mean age was 3.76 years. Logistic regression revealed males were 33% more likely than females, and as compared to non-Hispanic White youth, Black (33%) and Asian or Pacific Islanders (65%) were more likely to experience a fall from a building. Toddlers and those in early childhood were at significantly increased odds than those younger than one year old. Children in the highest income quartile were 29% more likely to experience a building fall. Building falls are a common cause of injury in the U.S. for children under 12 years old. Injury prevention strategies focused on the parents of children aged 1-5 years has the potential to make a significant public health impact.

55EMF Assessing Financial Risk among Uninsured Patients Seeking Care in the Emergency Department

Patients who lack insurance are uniquely reliant on the emergency department (ED) as a safety-net for vital care. Though the number of uninsured Americans initially declined after the Affordable Care Act (ACA) was enacted, the uninsured rate has been on the rise since 2017. Financial risk protection for patients is critically important as nearly two-thirds of bankruptcies are attributable to medical bills, a problem that is likely to worsen as health care costs continue to increase. However, the degree to which ED bills contribute to financial strain among uninsured patients is currently unknown. To address this gap, we aim to conduct the first-known national analysis to estimate and characterize the risk of economic hardship due to ED bills among uninsured patients. The primary data source is the Nationwide Emergency Department Sample, which is the largest publicly-available, all-payer database that captures a nationally-representative sample of U.S. hospital-based ED visits from 2006 to 2017. We obtained each encounter’s insurance status, age, sex, primary diagnosis, zip code income quartile, source file (treat-and-release ED visits versus those hospitalized through the ED), and charge for ED services. The analytic sample was limited to uninsured, treat-and-release ED visits in 2017. Each encounter’s household income was estimated using zip code income quartile data as has been done in prior studies. Following prior work, a catastrophic health expenditure (CHE) was defined as health expenses (ie, the listed ED charge) that exceeded 10% of projected household income. We calculated the percentage of uninsured treat-and-release ED encounters that met criteria for receiving a CHE bill and characterized this risk by income quartile. In 2017, there were an estimated 144.8 million ED visits. Of all ED visits, 86% were treat-and-release encounters with 13% being uninsured among this group. Among the uninsured treat-and-release ED encounters, 51% were male, mean age was 34 years, and the median ED charge was $2090 (mean = $3853, range: $100-$551442). A plurality fell into the lowest income quartile (43%), while 11% were categorized in the highest income quartile. An estimated 23% of all uninsured treat-and-release ED encounters met criteria for receiving a CHE bill, which translates to a weighted estimate of over 3.58 million (95% CI, 3.57 million - 3.59 million) ED encounters in 2017. This at-risk group’s median ED charge was $8710 (mean = $11,476). Those with the lowest income had the highest risk for receiving a CHE bill for ED care (Figure 1). Using a conservative estimate for assessing financial hardship among uninsured ED patients, these findings suggest that nearly 1 in 4 uninsured visits were at risk of receiving a financially catastrophic bill for ED care in 2017. This equates to approximately 3.6 million treat-and-release ED encounters that year. Examining these trends over time will be important in light of historic declines in employment and dynamic changes in insurance coverage that disproportionately burden low-income patients.

Trends in US hospitalizations for anaphylaxis among infants and toddlers: 2006 to 2015

BackgroundAnaphylaxis is a potentially fatal acute allergic reaction. Its overall prevalence appears to be rising, but little is known about US hospitalization trends among infants and toddlers. ObjectiveTo identify the trends and predictors of hospitalization for anaphylaxis among infants and toddlers. MethodsWe used the nationally representative National Inpatient Sample (NIS), from 2006 to 2015, to perform an analysis of trends in US hospitalizations for anaphylaxis among infants and toddlers (age, <3 years) and other children (age, 3-18 years). For internal consistency, we identified patients with anaphylaxis by the International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code and excluded those with the International Classification of Diseases, Tenth Revision, Clinical Modification (late 2015). We calculated trends in anaphylaxis hospitalizations over time by age group and then used multivariable logistic regression to describe anaphylaxis hospitalizations among infants and toddlers. ResultsAmong infants and toddlers, there was no significant change in anaphylaxis hospitalizations during the 10-year study period (Ptrend = .14). Anaphylaxis hospitalization among infants and toddlers was more likely in males, with private insurance, in the highest income quartile, with chronic pulmonary disease, who presented on a weekend day, to an urban teaching hospital, located in the Northeast. In contrast, anaphylaxis hospitalizations among older children (age, 3-<18 years) rose significantly during the study (Ptrend < .001). ConclusionAnaphylaxis hospitalizations among infants and toddlers in the United States were stable from 2006 to 2015, whereas hospitalizations among older children were rising. Future research should focus on the trends in disease prevalence and health care utilization in the understudied population of infants and toddlers.

Role of cumulative biological risk in mediating socioeconomic disparities in cognitive function in the elderly: a mediation analysis

ObjectivesTo evaluate whether allostatic load (AL), a measure of cumulative biological risk, fully or partially mediates observed socioeconomic status (SES) differences in cognitive function in the elderly.DesignCross-sectional mediation analysis.SettingCommunity-dwelling US...

The Association Between Income and Incident Homebound Status Among Older Medicare Beneficiaries.

A large and growing population of older adults with multimorbidity, cognitive impairment, and functional disability live in the community, but many never or rarely leave their homes. Being homebound is associated with decreased access to medical services, poor health outcomes, and increased mortality. Yet, it is unknown what factors, in particular socioeconomic factors, are associated with new onset of homebound status. To evaluate the association between income and risk of becoming homebound. Observational cohort study using 2011 to 2018 data from the National Health and Aging Trends Study, a nationally representative sample of Medicare beneficiaries aged 65 years and older. Population-based study in the United States. A total of 7,042 initially nonhomebound community-dwelling older adults. Total annual household income at baseline (in 2011) measured via self-report. Annual measure of homebound status, defined as leaving home an average of 1 d/wk or less. Over 7 years, 15.81% of older adults in the lowest income quartile (≤$15,003) became homebound, compared with only 4.64% of those in the highest income quartile (>$60,000). In a competing risks analysis accounting for risks of death and nursing home admission, and adjusted for clinical and demographic characteristics, those in the lowest income quartile had a substantially higher subhazard of becoming homebound than those in the highest income quartile (1.65; 95% confidence interval = 1.20-2.29). Moreover, we see evidence of a gradient in risk of homebound status by income quartile. Our work demonstrates that financial resources shape the risk of becoming homebound, which is associated with negative health consequences. In the context of existing income disparities, more support is needed to assist older adults with limited financial resources who wish to remain in the community.

Meal identity as practice - Towards an understanding of business travellers’ meal practices

Business travellers make up a large part of the customer base for the Swedish hospitality industry, accounting for 54% of the occupancy rate of Swedish hotels in 2018. Yet, very little is known about their meal habits while being at the destination of a business trip. This, even though the handling of meals in an environment that is less known to the traveller could add to the complexity of everyday life. Therefore, this study is aimed to explore actions performed by business travellers at the destination of travel as part of their meal practice with the purpose of elucidating the meal habits of this group. The research is theoretically framed within the context of social identity theory and social practice theory. A questionnaire was filled out by 538 Swedish business travellers recruited by means of self-sampling; 77% of the respondents were men, and 77% were above 45 years of age. The majority of the respondents, 67%, travelled over 50 days per annum, and 59% were located in the highest income quartile. The analysis of the data generated a general overview of the actions performed in relation to the meal, while also showing differences in actions taken based on income and gender. Women were significantly more price conscious than men and to a larger extent used technical assistance to find somewhere to eat. When travelling alone they also reported eating faster than at home and bringing back food and eat at the hotel room more often than men did. Men, in contrast, exhibited an inclination towards seeking social contexts to insert themselves in during dinners when travelling alone, as to be able to eat together with other people. The, relatively, lower income group showed more price consciousness as well as used the help of technical assistance to find somewhere to eat.

Lower household income is associated with an increased risk of hospital readmission in patients with decompensated cirrhosis.

The impact of household income, a surrogate of socioeconomic status, on hospital readmission rates for patients with decompensated cirrhosis has not been well characterized. The Nationwide Readmission Database from 2012 to 2014 was used to study the association of lower median household income on 30-, 90-, and 180-day hospital readmission rates for patients with decompensated cirrhosis. From the 42679001 hospital admissions contained in the sample, there were 82598 patients with decompensated cirrhosis who survived a hospital admission in the first 6months of the year. During a uniform 6-month follow-up period, 25914 (31.4%), 39928 (48.3%), and 47496 (57.5%) patients were readmitted at 30, 90, and 180days, respectively. After controlling for demographic and clinical confounders, patients residing in the three lowest income quartiles were significantly more likely to be readmitted at 30days than those in the fourth quartile (first quartile, odds ratio [OR] 1.32 [95% confidence interval, CI, 1.17-1.47, P<0.01]; second quartile, OR 1.25 [95% CI 1.13-1.38, P<0.01]; and third quartile, OR 1.08 [95% CI 0.97-1.20, P=0.07]). The association between lower socioeconomic status and the higher risk of readmissions persisted at 90days (first quartile, OR 1.21 [95% CI 1.14-1.30, P<0.01]) and 180days (first quartile, OR 1.32 [95% CI 1.20-1.44, P<0.01]). Patients with decompensated cirrhosis residing in the lowest income quartile had a 32% higher odds of hospital readmissions at 30, 90, and 180days compared with those in the highest income quartile.

Socio-economic disparities and returning to work following an injury

BackgroundTraumatic injury is one of the main reasons for temporary and permanent occupational disability.The objective of this study was to define the role of socio-economic position on post-injury occupational absenteeism.MethodsThis was a nationwide retrospective cohort study, based on linking The Israeli National Trauma Registry (INTR) and the National Insurance Institute (NII) databases.The study population included 44,740 injured workers (residents of Israel, aged 21–67, hospitalized between 2008 and 2013 and employed prior to injury as salaried workers). Logistic-regression models tested the probability of not returning to work (RTW).ResultsThe majority of the study population (61%) RTW within 1 month following the injury event. Income prior to injury was significantly associated with longer out of work stay, explaining 9% variance. A significant interaction (p value < 0.0001) was found between age and income on out of work stay more than 1 month, 1 year and 2 years. Logistic regression models of out of work stay were conducted separately for all age groups. Lower income was associated with greater chance for out of work stay for more than 1 month; and the gap between the lowest and highest income quartiles was greater among older workers (age 55+), where there was an elevenfold increase in probability of not RTW among casualties from the lowest vs. highest income quartile. In comparison to other population groups, Arabs were at greater odds of longer out of work stay following an injury. Among injured persons recognized by the NII as having occupational injuries, the odds for not RTW within a month, a year and 2 years were respectively 3.9, 2.5 and 2.2 times significantly greater in comparison to employees injured outside the workplace.ConclusionsThis study identified population groups with a high probability of not RTW following an injury requiring hospitalization. Intervention programs for injured employees should promote early rehabilitation and aim to shorten out of work stay. These programs should be ethnically adapted and focus on underprivileged and disadvantaged populations.

Etiologies, trends, and predictors of 30-day pediatric readmissions after hospitalizations for diabetic ketoacidosis in the United States.

To determine the causes, predictors, and trends of 30-day readmissions following hospitalizations for pediatric diabetic ketoacidosis (DKA) in the United States (US) from 2010 to 2014. We used International Classification of Diseases, ninth revision, Clinical Modification codes to identify children with DKA aged 2 to 18 years from the National Readmission Database in the US. Patients who had readmission within 30 days after an index admission for DKA were included in the study. We combined similar diagnoses into clinically important categories to determine the cause of readmission. The primary outcome was all-cause 30-day (AC30) readmissions. Categorical and continuous variables were analyzed using chi-square or student's t-test or Wilcoxon rank sum tests respectively. We performed multivariable logistic regression to identify predictors of 30-day readmission. From 2010 through 2014, a weighted total of 87 815 index DKA-related pediatric hospitalizations were identified of which, 4055 patients (4.6%) had AC30 readmissions and this remained unchanged during the study period. Of all the readmissions, 69% were attributed to DKA. In multivariable regression analysis, the odds of AC30 readmission and 30-day readmission attributed to DKA alone were increased for females, adolescents, patients with depression and psychosis, and discharge against medical advice, while private insurance, the highest income quartile, and admission at teaching hospitals were associated with lower odds of AC30 readmission and 30-day readmission attributed to DKA only. We identified several factors associated with readmission after hospitalization for DKA. Addressing these factors such as depression may help lower readmissions after an admission for DKA.

Income, income inequality and schizophrenia in China: a population-based multilevel analysis

BackgroundPrevious studies have suggested that socio-environmental factors interact with genetic risk in the genesis of schizophrenia. This study aimed to investigate the relationship between income, income inequality and schizophrenia and...

Socioeconomic disparities in the comorbidities and surgical management of pediatric Crohn's disease.

To examine differences in comorbidities and surgical management based on socioeconomics in hospitalized children with Crohn's disease (CD). Using the Kids' Inpatient Database for 2006-2012, we identified patients (<21 years) with a CD diagnosis. Cases were analyzed and stratified by median parental income by zip code. Multivariable logistic regression was performed. Of the 28,337 pediatric CD hospitalizations identified, patients were more likely male (51.1%), non-Hispanic white (71.3%), and had a mean age of 15.9 years. The proportion of minority patients increased as income quartile declined. Higher income quartile patients were more likely to be coded with anxiety and less likely with anemia. The highest income quartile was more likely to have a bowel obstruction, and peritoneal/intestinal abscess and was also 28% more likely to undergo a major surgical procedure. Significant variability exists in the reported comorbidities and surgical interventions associated with CD by income quartile. Lower income quartile patients are more likely to be of minority ethnicity and anemic, but less likely to undergo a major surgical procedure. Further investigation is warranted to determine whether these differences represent disease variability, differences in healthcare resource allocation, or implicit bias in management. There is a disparity in the care of children and young adults with Crohn's disease based on parental income. Links between parental income and the treatment of Crohn's disease in children and young adults has not been assessed in national datasets in the United States. Children in the highest income quartile were more likely to undergo a major surgical procedure. The variations in healthcare for hospitalized children and young adults with CD found in this study may represent variability in patient disease, implicit bias, or a disparity in healthcare delivery across the United States.

Abstract P2-08-04: Bilateral mastectomy in ductal carcinoma in situ: 10-year analysis of national inpatient sample database

Abstract Background: The utilization of bilateral (B/L) mastectomy for ductal carcinoma in situ (DCIS) has been rising within the last two decades. This is occurring despite the lack of convincing evidence to support the positive impact of this approach on disease-specific or overall survival (OS.) Notably, the estimated annual risk of developing a contralateral breast cancer is only 0.1% per year. Method: This is a retrospective cohort analysis of National Inpatient Sample database between the years 2005 and 2014 of adult females who underwent B/L mastectomy. ICD-9-CM procedure codes were used to identify two subpopulations; those who had only DCIS without invasive breast cancer or high risk genetic syndrome (DCIS mastectomy) and all others. The aim of this study is to assess the demographic predictors of undergoing B/L mastectomy for DCIS. Statistical analysis done using STATA. Results: The total number of B/L mastectomies performed within the study period was 144,754, of which 24,766 (17.1%) were performed for DCIS with no invasive cancer and no high risk genetic syndrome. There was no significant difference between the two groups in age (average 52.8 years), length of stay (average 2.34 days) and total charge for hospitalization (average $51,209). Among DCIS mastectomy patients, 56.3% were &amp;gt;50 year-old and only 0.7% were 18-30 year-old, 80.7% were Caucasian and 7.5% were African American, 42% were from highest income quartile neighborhoods and 12.6% were from lowest income quartile neighborhoods and 77.8% had private insurance while 15.9% and 5.2% had Medicare and Medicaid, respectively. Interestingly, 95.6% of B/L mastectomies for DCIS were performed at urban centers, 63.6% in teaching hospitals and 64.2% were in large hospital by bed size. Univariate regression showed no significant predictive value for undergoing B/L mastectomy for DCIS indication by age, race, hospital geographic region, teaching status of hospital or hospital size. The odds of undergoing B/L mastectomy for DCIS was higher for age category for 30-50 year-old compared to 18-30 year-old (OR=2.6, p&amp;lt;0.001), highest income quartile compared to lowest (OR=1.28, p &amp;lt;0.001) and private insurance compared to Medicare (OR=1.3, p&amp;lt;0.001) and was lower for Charlson Comorbidity Index (CCI) ≥3 compared to 0 (OR=0.008, p&amp;lt;0.001). On multivariate analysis, age (OR=1.05, p&amp;lt;0.001), race (OR=1.5 for African American compared to Caucasian, p&amp;lt;0.001), highest income quartile (OR=1.19, p=0.03), higher CCI ≥3 (OR=0.005, p&amp;lt;0.001) and private insurance (OR=1.3, p=0.004) were independent predictors of undergoing B/L mastectomy for the diagnosis of DCIS. This disparity could be explained by the variability in anxiety levels among different groups and access to the financial resources needed to perform these procedures. In addition, we noted a progressive rise in charge of hospitalization for B/L mastectomy over the years (table). Conclusion: A significant proportion of B/L mastectomies are being performed for DCIS. While this approach has not convincingly yielded an OS benefit, it has significant clinical and psychological morbidity along with considerable financial toxicity. We found inequity in populations that receive this procedure by age, race, insurance status, income quartile and urban or rural location of center. Further studies would be helpful to delineate this disparity among patients and assess the utility of B/L mastectomy in the era of molecular prediction and superior therapeutic modalities. YearTotal charge of hospitalization ($)200528,722.3200632,192.5200738,492.2200845,168.5200945,752.2201053,326.5201156,128.0201259,118.7201372,193.6201473,783.9 Citation Format: Sindhu Janarthanam Malapati, Sunny RK Singh, Rohit Kumar, Jason Mouabbi, Ahmed Abdalla, Carrie Dul, Tarik Hadid. Bilateral mastectomy in ductal carcinoma in situ: 10-year analysis of national inpatient sample database [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-08-04.