Hispanic OR Research Articles

Food Insufficiency and Coping Resources among Women: Postpandemic Racial, Ethnic, and Household Disparities.

Background: Empirical evidence shows women are more likely to report food hardship (e.g., food insufficiency and food insecurity) compared with men. Coronavirus disease-19 exacerbated these gender disparities; however, the impact of postpandemic social/economic/regulatory changes on women's food sufficiency and coping strategies has not been examined. This study evaluates factors associated with food insufficiency among women postpandemic. Methods: This study used a cross-sectional study design and analyzed data from the U.S. Census Bureau's Household Pulse Survey. Variations in the likelihood of food insufficiency by age, income, household composition, race/ethnicity, region, metropolitan status, and employment status among women were evaluated using logistic regression with state-level response clustering. Among women reporting food insufficiency, associations between these characteristics and likelihood of utilizing food assistance programs and/or donated foods were assessed. Interaction terms accounted for the intersectional nature of these characteristics. Results: Compared with White women, Black (odds ratio [OR] = 1.66, confidence interval [CI] = 1.47, 1.88) and Hispanic (OR = 1.77, CI = 1.52, 2.07) women were more likely to report food insufficiency. These likelihoods were higher in households earning <$100,000 (Black OR = 13.17, CI = 10.82, 16.02; Hispanic OR = 9.32, CI = 7.72, 11.25) and <$35,000 (Black OR = 8.65, CI = 15.31, 22.71; Hispanic OR = 17.86, CI = 3.64, 23.40). Racial/ethnic differences were observed among households with children; no effects appeared in multi-adult households. Food-insufficient Black (OR = 3.74, CI = 2.23, 6.28) and Hispanic (OR = 1.36, CI = 0.79, 2.36) women were more likely to use food assistance programs than Whites. Food-insufficient Hispanic women were more likely to use donated foods (OR = 2.71, CI = 1.84, 3.99). Conclusion: Food insufficiency among low-income Black and Hispanic women, particularly those with children, is likely to have persisted postpandemic, suggesting a high likelihood of dietary deficits in these households. Additional resources should be dedicated to meet the dietary needs of women and children in vulnerable households.

Sociodemographic and Lifestyle Risk Factors Associated with Fragility Hip Fractures: A Systematic Review and Meta-Analysis

Hip fractures inflict heightened morbidity and mortality upon older adults. Although previous studies have explored the impact of individual demographic factors on hip fracture risk, a comprehensive review can help reconcile disparities among these factors. This meta-analysis encompassed 69 studies involving 976,677 participants and 99,298 cases of hip fractures. We found that age ≥ 85 (OR = 1.75), BMI &lt; 18.5 (OR 1.72), female sex (OR = 1.23), history of falls (OR = 1.88), previous fractures (OR = 3.16), menopause (OR 7.21), history of maternal hip fractures (OR = 1.61), single and unmarried status (OR = 1.70), divorced status (OR 1.38), residing in a residential care facility (OR = 5.30), and living alone (OR = 1.47) were significantly associated with an increased incidence of hip fracture. Conversely, BMI ranging from 25 to 30 (OR = 0.59), BMI &gt; 30 (OR = 0.38), parity (OR = 0.79), non-Caucasian descent (overall OR = 0.4, Asian OR 0.36, Black OR = 0.39, and Hispanic OR = 0.45), and rural residence (OR = 0.95) were significantly associated with a diminished risk of hip fracture. Hip fracture patients exhibited significantly lower weight and BMI than the non-fracture group, while their age was significantly higher. However, age at menopause and height did not significantly differ between the two groups.

Experienced Racism and Discrimination and Psychological Distress amid Different Phases of the COVID-19 Pandemic: Evidence from Wisconsin.

The SARS-COV-2 pandemic created an unprecedented crisis and raised concerns about racial discrimination and psychological distress. We assessed trends in COVID-19-related racism and discrimination irrespective of infection status and changes in emotional health and mental well-being outcomes due to experienced racism and discrimination. Using three waves of the Wisconsin COVID-19 Community Impact Survey (2020-2021), we compared demographics of respondents categorized by two mutually exclusive groups: reporting vs. not reporting COVID-19-related racism and discrimination. Using longitudinal logistic-multivariable regressions, we modeled changes in racism and discrimination-induced stress and 4-item patient health questionnaire screening for anxiety and depression (PHQ-4) associated with experiencing racism and discrimination. Prevalence of reported experiencing COVID-19-related racism and discrimination increased among adult Wisconsinites between 2020 and 2021: 6.28% in Wave 1, 11.13% in Wave 2 (Pearson's chi-square Wave 1 vs 2=16.96, p<.001) vs. 10.87% in Wave 3 (chi-square, Wave 1 vs 3=14.99, p<.001). Experiencing COVID-19-related racism and discrimination was associated with a higher likelihood stress (OR=3.15, 95% CI 2.32-4.29) and a higher PHQ-4 score (coeff=0.63, 95% CI 0.32-0.94). Relative to White respondents, racial/ethnic minorities had a higher likelihood of feeling stress: Black OR=7.13, 95% CI 4.68-10.85; Hispanics OR=3.81, 95% CI 2.11-6.89; and other races OR=2.61, 95% CI 1.51-4.53. Estimated associations varied across racial/ethnic groups, age groups, and survey waves. Our study showed that experienced COVID-19-related racism and discrimination increased during the first 2 years of the pandemic and was associated with greater psychological distress among Wisconsinites of all racial/ethnic groups. Public health policies promoting inclusiveness should be implemented to reduce (COVID-19-related) racism and discrimination and its long-term effects on mental health and well-being.

MP54-01 ASSOCIATION BETWEEN SOCIAL NEEDS AND PRIMARY TREATMENT CHOICE FOR LOCALIZED PROSTATE CANCER

You have accessJournal of UrologyCME1 Apr 2023MP54-01 ASSOCIATION BETWEEN SOCIAL NEEDS AND PRIMARY TREATMENT CHOICE FOR LOCALIZED PROSTATE CANCER Jay Rollins, Rutul D. Patel, Kevin Labagnara, and Kara L. Watts Jay RollinsJay Rollins More articles by this author , Rutul D. PatelRutul D. Patel More articles by this author , Kevin LabagnaraKevin Labagnara More articles by this author , and Kara L. WattsKara L. Watts More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003307.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Social Determinants of Health (SDH)–defined as the conditions where people are born, work, live, and age–impact patients’ access to resources and health outcomes in a variety of ways. Additionally, ethnic differences in primary treatment for prostate cancer have been demonstrated. We assessed the relationship between SDH score and primary treatment choice for localized prostate cancer in a diverse, urban patient population. METHODS: Using our institutional registry, we conducted a retrospective study of men diagnosed with prostate cancer between 2003–2022. Primary treatment choice–defined as either radiation therapy (RT) or radical prostatectomy (RP)–was abstracted with clinical variables. A validated SDH questionnaire, distributed over the past 5 years by our institution’s primary care department, provided self-reported demographics and patients’ concerns regarding specific social risks. Multivariable analyses controlling for age, PSA, and Gleason grade group at diagnosis were performed to analyze the association between SDH variables and primary treatment choice for localized prostate cancer. RESULTS: 217 patients completed the SDH questionnaire and met inclusion criteria; 118 (54%) and 99 (46%) received primary RT and RP, respectively. Median age was 64 years. The cohort was primarily non-Hispanic Black (43%) or Hispanic (41%), English-speaking (80%), and insured through Medicare (65%). Table 1 reports the results of binomial logistic regression models assessing the relationship between the variables of interest and primary treatment selection. Compared to White patients, patients of all other races/ethnicities were more likely to undergo prostatectomy (Non-Hispanic Black OR=9.54, p=0.04; Hispanic OR=9.55, p=0.04; Asian/Other OR=13.87, p=0.03). No specific SDH concern endorsed by patients was significantly associated with treatment choice (p>0.05 for all). CONCLUSIONS: Analysis of our cohort indicates that unmet social needs do not influence primary treatment selection for localized prostate cancer. This suggests the presence of other variables that contribute to racial/ethnic differences in treatment choice. Future studies are needed to investigate the social and cultural factors that influence how patients determine primary treatment for localized prostate cancer. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e753 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jay Rollins More articles by this author Rutul D. Patel More articles by this author Kevin Labagnara More articles by this author Kara L. Watts More articles by this author Expand All Advertisement PDF downloadLoading ...

Violent victimization at the intersections of sexual orientation, gender identity, and race: National Crime Victimization Survey, 2017-2019.

Prior research has found that experiences with violence in the U.S. differ across individual demographic characteristics, including race, gender, and sexual orientation. However, peer reviewed studies have yet to examine the relationship between the intersections of race, gender, and sexual orientation, victimization risk, and characteristics of victimization. We use data from three years (2017-2019) of the National Crime Victimization Survey, the primary source of information on criminal victimization in the United States, to examine victimization at the intersection of sexual orientation, gender, and race/ethnicity. We test whether non-Hispanic Black, Hispanic, and non-Hispanic White sexual and gender minority (SGM) persons aged 16 or over are victimized at greater rates than their non-SGM counterparts and assess whether there are differences between sexual minority females and males of each racial group. We further document characteristics of victimization such as reporting to the police by SGM status and race or ethnicity. We find that SGMs are disproportionately more likely to be victims of violent crime than non-SGM people, and these disparities are present across the assessed racial and ethnic groups (non-Hispanic Black odds ratio [OR] = 3.3, 90% CI [CI] = 1.36, 5.16; Hispanic OR = 4.5, CI = 2.25, 6.71; non-Hispanic White OR = 4.8, CI = 2.25, 6.71). However, sexual orientation disparities are statistically distinguishable for lesbian or bisexual (LB) non-Hispanic White and Hispanic females but not for non-Hispanic Black LB females. Among LB females, the overall differences in victimization were primarily driven by bisexual respondents. We further find racial and ethnic differences among SGM victims in the likelihood of having the victimization reported to the police, in the utilization of community (non-police) resources, and in other aspects of victimization experiences, such as whether arrests occurred or in the suspicion that the violent incident was a hate crime. Our findings raise indicate a complex picture of how sexual orientation, gender identity, sex, and race and ethnicity interact in victimizations and their characteristics that should be further explored.

Racial/Ethnic Disparities in Physical Therapy Utilization After Total Knee Arthroplasty.

Total knee arthroplasty (TKA) is a common orthopaedic procedure, after which many patients benefit from physical therapy (PT). However, such services may not be uniformly accessible and used. To that end, disparities in access to care such as PT after interventions may be a factor for those of varying race/ethnicities. TKAs were abstracted from the 2014 to 2016 Standard Analytic Files PearlDiver data set-a large national health administrative data set containing information on more than 60 million Medicare patients. Occurrences of home or outpatient PT within 90 days after TKA were identified. Patient demographic factors were extracted, including age, sex, Elixhauser Comorbidity Index, estimated average household income of patient based on zip code (low average household income [<75k/year] or high average household income [>75k/year]), and patient race/ethnicity (White, Hispanic, Asian, Native American, Black, or Other). Predictive factors for PT utilization were determined and compared with univariate and multivariate analyses. Of 23,953 TKA patients identified, PT within 90 days after TKA was used by 18,837 (78.8%). Patients self-identified as White (21,824 [91.1%]), Black (1,250 [5.2%]), Hispanic (268 [1.1%]), Asian (241 [1.0%]), Native American (90 [0.4%]), or "Other" (280 [1.2%]) and were of low household income (19,957 [83.3%]) or high household income (3,994 [16.7%]). When controlling for age, sex, and ECI, PT was less likely to be received by those of low household income (relative to high household income OR 0.79) or by those of defined race/ethnicity (relative to White or Black OR 0.81, Native American OR 0.58, Asian OR 0.50, or Hispanic OR 0.44) ( P < 0.05 for each). In a large Medicare data set, disparities in utilization of PT after TKA were identified based on patient's estimated household income and race/ethnicity. Identification of such factors may help facilitate the expansion of care to meet the needs of all groups adequately. Level III.

PREDICTORS OF PARTICIPATION IN A TELEPHONE-BASED SOCIAL CONNECTEDNESS INTERVENTION FOR OLDER ADULTS

Abstract Background Social isolation is a well-documented contributor to poor mental and physical health, and interventions promoting social connectedness have been shown to be protective. This study examined predictors of participating in a telephone-based social connectedness intervention for socially isolated older adults. Methods Data was obtained from a social connectedness intervention that paired students with older adults. Eligible participants included Houston area older adults, 65 years or older, enrolled in Medicare Advantage plans. Eligible participants were contacted telephonically and asked to complete the 3-item UCLA Loneliness Scale. Those who screened positive for loneliness were invited to participate in the social connectedness intervention. Logistic regression models, that accounted for sociodemographic, clinical and functional indices, were used to identify predictors of participation. Results Females (OR: 1.23, 95% CI: 1.04-1.45), and racial/ethnic minorities (African American OR: 1.39, 95%CI: 1.16-1.68; Hispanic OR: 1.43, 95%CI: 1.04-1.99) were more likely to participate in a telephone-based social connectedness intervention. Older adults with a disability (OR: 2.37, 95%CI: 1.96-2.87), higher CMS Hierarchical Condition Category risk scores (OR: 1.15, 95%CI: 1.06-1.25) and those who reported having 1+ social needs (OR: 1.38, 95%CI: 1.14-1.66) were more likely to participate. Of all Charlson Comorbidity Index flags examined, diabetes was the single strongest predictor of participation (OR=2.49, p=0.02). Older adults who reported functional comorbidities for anxiety and depression were also more likely to participate. Conclusion Telephone-based social connectedness interventions can reach vulnerable older adults with clinical and social needs, and can be useful in addressing racial/ethnic health equity gaps in socially isolated older adults.

175 National Trends in Chemical Restraint for Pediatric Behavioral Health Patients in the Emergency Department

175 National Trends in Chemical Restraint for Pediatric Behavioral Health Patients in the Emergency Department

P4. INCREASED COST OF UNPLANNED HOSPITALIZATIONS FOR RACIAL MINORITIES AFTER COMMON PLASTIC SURGERY PROCEDURES

PURPOSE: The association of systems-level inequities with surgical outcomes resulting in racial disparities has been identified in the literature. Nonetheless, the effect for patients in the postoperative period is not well understood. We aimed to identify the effect of race on the rate and cost of unplanned hospitalizations after reconstructive plastic surgery. METHODS: An analysis of the Healthcare Cost and Utilization Project (HCUP) from 2006 to 2015 was used to identify adult patients undergoing autologous and implant-based breast reconstruction and abdominoplasty. Multivariable analyses were performed to determine the association of race with readmission rate and costs. RESULTS: Five percent of the 17,739 patients included in our sample experienced a readmission. There was no significant difference in the readmission rate for Black and Hispanic patients compared to White patients (Black patients OR:0.87, 95% CI:0.70-1.09, Hispanic patients OR:1.10, 95% CI:0.86-1.40). However, Black (OR:1.28, 95% CI:1.05-1.56) and Hispanic patients (OR:1.27, 95% CI:1.03-1.58) had increased odds of incurring greater cost compared to White patients, despite controlling for income and comorbidities. CONCLUSION: Racial minorities bear a substantially higher cost for readmission for breast and abdominoplasty procedures, resulting in discrepancies in access and care provision. Systems-level issues may influence access to care which can lead to delayed diagnoses. Future research is needed to examine the role of different payment models on inequities and identify solutions to foster more equitable care.

Abstract EP62: Impact Of Smoking On In-hospital Mortality Following Type 2 Myocardial Infarction- A Nationwide Population-based Analysis

Background: Smoking has been linked to coronary artery vasoconstriction and increased myocardial oxygen demand. However, its impact on the outcomes of type 2 myocardial infarction (T2MI) remains unknown. Methods: We analyzed odds and predictors of in-hospital mortality in smokers vs. non-smokers from National Inpatient Sample (2018) T2MI hospitalizations after excluding secondary diagnoses of Type 1 MI. Results: Of 33155 T2MI admissions, 55.4% (n=14780) were smokers and 44.6% non-smokers (n=18375). Smokers were often younger (median 68 vs 74 yrs) and males (57.7% vs. 44.9%) than non-smokers. Unadjusted (OR 0.67, 95CI 0.50-0.91 (p=0.01) and demographically adjusted (OR 0.71, 95CI 0.52-0.98 (p=0.034) regression analyses revealed “smokers’ paradox” for in-hospital mortality. However, when additionally adjusted for comorbidities, the lower risk of all-cause mortality in smokers vs non-smokers failed to reach a statistical significance (OR 0.81, 95CI 0.56-1.16, p=0.253) [Table 1a] . Smokers had a higher rate of substance abuse, depression, and prior MI/PCI/CABG/stroke (p&lt;0.05). Higher risk of all-cause mortality was found in patients with advanced age (OR 1.05), males (vs female OR 1.92) whereas whites (vs blacks OR 0.61, Hispanics OR 0.70), patients from higher-income quartile (76-100th vs. 0-25th OR 0.37) had a lower risk of mortality. CHF (OR 27.20), sepsis (OR 8.83), fluid-electrolyte disorders (OR 4.72), metastatic cancers (OR 3.29), coagulopathy (OR 2.16), prior VTE (OR 2.66) and CKD (OR 1.41) raised the odds of mortality in smokers whereas hypertension, hyperlipidemia, past cancer, prior PCI and prior TIA/Stroke showed lower odds of mortality (all p&lt;0.05) [Table 1b] . Conclusion: In-hospital mortality associated with T2MI in unadjusted and sociodemographically adjusted models showed "Smoker's Paradox" but when controlled for comorbidities the lower odds failed to reach a statistical significance. The predictors of T2MI related mortality in smokers may help clinicians to identify high-risk patients.

Explanatory role of sociodemographic, clinical, behavioral, and social factors on cognitive decline in older adults with diabetes

BackgroundThe aim of the study was to examine the explanatory role of sociodemographic, clinical, behavioral, and social factors on racial/ethnic differences in cognitive decline among adults with diabetes.MethodsAdults aged 50+ years with diabetes from the Health and Retirement Survey were assessed for cognitive function (normal, mild cognitive impairment [MCI], and dementia). Generalized estimating equation (GEE) logistic regression models were used to account for repeating measures over time. Models were adjusted for sociodemographic (gender, age, education, household income and assets), behavioral (smoking), clinical (ie. comorbidities, body mass index), and social (social support, loneliness, social participation, perceived constraints and perceived mastery on personal control) factors.ResultsUnadjusted models showed non-Hispanic Blacks (NHB) and Hispanics were significantly more likely to progress from normal cognition to dementia (NHB OR: 2.99, 95%CI 2.35–3.81; Hispanic OR: 3.55, 95%CI 2.77–4.56), and normal cognition to MCI (NHB OR = 2.45, 95%CI 2.14–2.82; Hispanic OR = 2.49, 95%CI 2.13–2.90) compared to non-Hispanic Whites (NHW). Unadjusted models for the transition from mild cognitive decline to dementia showed Hispanics were more likely than NHW to progress (OR = 1.43, 95%CI 1.11–1.84).After adjusting for sociodemographic, clinical/behavioral, and social measures, NHB were 3.75 times more likely (95%CI 2.52–5.56) than NHW to reach dementia from normal cognition. NHB were 2.87 times more likely (95%CI 2.37–3.48) than NHW to reach MCI from normal. Hispanics were 1.72 times more likely (95%CI 1.17–2.52) than NHW to reach dementia from MCI.ConclusionClinical/behavioral and social factors did not explain racial/ethnic disparities. Racial/ethnic disparities are less evident from MCI to dementia, emphasizing preventative measures/interventions before cognitive impairment onset are important.

Disparities in esophageal cancer care based on race: a National Cancer Database analysis

Esophageal cancer is one of the most common cancer killers in our country. The effects of racial disparities on care for esophageal cancer patients are incompletely understood. Using the National Cancer Database, we investigated racial disparities in treatment and outcome of esophageal cancer patients. The National Cancer Database was queried from 2004 to 2017. Logistic regression and survival analysis were used to determine racial differences in access, treatment and outcome. A total of 127,098 patients were included. All minority groups were more likely to be diagnosed at advanced stages versus Caucasians after adjusting for covariates (African American OR-1.64 [95% confidence interval 1.53-1.76], Hispanic OR-1.19 [1.08-1.32], Asian OR-1.78 [1.55-2.06]). After adjustment, all minorities were less likely at every stage to receive surgery. Despite these disparities, Hispanics and Asians had improved survival compared with Caucasians. African Americans had worse survival. Racial disparities for receiving surgery were present in both academic and community institutions, and at high-volume and low-volume institutions. Surgery partially mediated the survival difference between African Americans and Caucasians (HR-1.13 [1.10-1.16] and HR-1.04 [1.02-1.07], without and with adjustment of surgery).There are racial disparities in the treatment of esophageal cancer. Despite these disparities, Hispanics and Asians have improved overall survival versus Caucasians. African Americans have the worst overall survival. Racial disparities likely affect outcome in esophageal cancer. But other factors, such as epigenetics and tumor biology, may correlate more strongly with outcome for patients with esophageal cancer.

S413 The Interaction Effect of Gender and Socio-Economic Status on the Incidence of COVID-19 in Patients With Gastroesophageal Reflux Disease: A Population-Based Study

Introduction: Reports on COVID-19 have shown gender and racial differences in health outcomes. Our aim was to examine the relationship between social determinants of health and risk of COVID-19 in patients with gastroesophageal reflux disease (GERD). Methods: We analyzed medical records from a large population database (Explorys, IBM) pooled from 26 major healthcare systems across US. Only adult patients with diagnosis of GERD from January 1999-May 2021 and COVID-19 from December 2019-May 2021 were included. Data on gender, race/ethnicity, insurance status and PPI use were collected. Univariable and multivariable analyses were used for statistical analysis. Model was stratified by gender. Effect modification by PPI use was examined. Results: We identified 6215670 GERD patients of which 4057825 (65%) used PPI, 2409175 (59%) were females and 1648650 (41%) were males. A total of 3605950 (58%) were uninsured. Cumulative incidence of COVID-19 among PPI users and non-users was 0.11% vs 0.04% (P< 0.001). In univariate analysis, odds (OR) of COVID-19 was highest among whites 3.35 [3.11-3.6, P< 0.05], African Americans OR 2.9 [2.7-3.12, P< 0.05] and Hispanics OR 2.8 [2.6-3.0, P< 0.05]. Risk of COVID-19 was modified across all races if they were PPI users: whites OR 2.83 [2.6-3.14, P< 0.001], African Americans OR 3.11 [2.8-3.5, P< 0.05] and Hispanics OR 1.9 [1.4-2.5, p< 0.05]. Lack of insurance was significantly associated with COVID-19 diagnosis OR 3.1 [2.9-3.3, P < 0.001]. In the multivariate model, after adjusting for covariates, African American race was the strongest independent risk factor for COVID-19 OR 4.8 [4.3-5.2], P< 0.001) followed by PPI use OR 2.9 [2.7-3.1, P< 0.001]. There was no clear association between Hispanic or white race and COVID-19 OR 0.99 [0.87-1.1, P=0.6] and OR 0.94 [0.86-1.0, P=0.2], respectively. When the model was stratified by gender, being female reduced the risk of COVID-19 in Hispanics OR 0.55 [0.2-0.7, P< 0.001]. Female gender did not modify COVID-19 risk in African Americans (OR 1.2 [1.0-1.4, P=0.53] or whites OR 1.2 [1.0-1.4, P=0.9]. Patients with GERD who had public insurance such as Medicare OR 0.3 [0.2-0.31, P < 0.001] or Medicaid OR 0.4 [0.4-0.48, P< 0.001] had reduced risk of COVID-19 diagnosis compared to the uninsured. Conclusion: In GERD patients, COVID-19 diagnosis was highest among African Americans and PPI users. Female Hispanics were least likely to be diagnosed with COVID-19. Insurance status may indirectly influence susceptibility to COVID-19.Figure 1.: Multivariable regression analysis. A forest plot of gender differences for odds of COVID-19 diagnosis in patients with gastroesophageal reflux disease (GERD) based on race/ethnicity and public insurance type. Abbreviation: PPI, proton pump inhibitors.Table 1.: Baseline Characteristics of Patients with Gastroesophageal Reflux Disease (GERD) Included in the Study. Abbreviations: PPI, proton pump inhibitors; CI, confidence interval.

Association of mental health diagnosis with race and all-cause mortality after a cancer diagnosis: Large-scale analysis of electronic health record data.

Disparity in mental health care among cancer patients remains understudied. A large, retrospective, single tertiary-care institution cohort study was conducted based on deidentified electronic health record data of 54,852 adult cancer patients without prior mental health diagnosis (MHD) diagnosed at the University of California, San Francisco between January 2012 and September 2019. The exposure of interest was early-onset MHD with or without psychotropic medication (PM) within 12 months of cancer diagnosis and primary outcome was all-cause mortality. There were 8.2% of patients who received a new MHD at a median of 197 days (interquartile range, 61-553) after incident cancer diagnosis; 31.0% received a PM prescription; and 3.7% a mental health-related visit (MHRV). There were 62.6% of patients who were non-Hispanic White (NHW), 10.8% were Asian, 9.8% were Hispanic, and 3.8% were Black. Compared with NHWs, minority cancer patients had reduced adjusted odds of MHDs, PM prescriptions, and MHRVs, particularly for generalized anxiety (Asian odds ratio [OR], 0.66, 95% CI, 0.55-0.78; Black OR, 0.60, 95% CI, 0.45-0.79; Hispanic OR, 0.72, 95% CI, 0.61-0.85) and selective serotonin-reuptake inhibitors (Asian OR, 0.43, 95% CI, 0.37-0.50; Black OR, 0.51, 95% CI, 0.40-0.61; Hispanic OR, 0.79, 95% CI, 0.70-0.89). New early MHD with PM was associated with elevated all-cause mortality (12-24 months: hazard ratio [HR], 1.43, 95% CI, 1.25-1.64) that waned by 24 to 36 months (HR, 1.18, 95% CI, 0.95-1.45). New mental health diagnosis with PM was a marker of early mortality among cancer patients. Minority cancer patients were less likely to receive documentation of MHDs or treatment, which may represent missed opportunities to identify and treat cancer-related mental health conditions.

The Impact of Race/Ethnicity on the Outcomes of Burn Patients: A Systematic Review of the Literature.

Racial and ethnic disparities are endemic to the United States and are only beginning to attract the attention of researchers. With an increasingly diverse population, focused and tailored medicine to provide more equitable care is needed. For surgical trauma populations, this topic is a small but expanding field and still rarely mentioned in burn medicine. Disparities in prevention, treatment, and recovery outcomes between different racial and ethnic minorities who are burned are rarely discussed. The purpose of this study is to determine the current status of identified disparities of care in the burn population literature and areas of future research. A systematic review was conducted of literature utilizing PubMed for articles published between 2000 and 2020. Searches were used to identify articles that crossed the burn term (burn patient OR burn recovery OR burn survivor OR burn care) and a race/ethnicity and insurance status-related term (race/ethnicity OR African-American OR Black OR Asian OR Hispanic OR Latino OR Native American OR Indigenous OR Mixed race OR 2 or more races OR socioeconomic status OR insurance status). Inclusion criteria were English studies in the United States that discussed disparities in burn injury outcomes or risk factors associated with race/ethnicity. One thousand one hundred and sixty-nine papers were populated, 55 were reviewed, and 36 articles met inclusion criteria. Most studies showed minorities had poorer inpatient and outpatient outcomes. While this is a concerning trend, there is a paucity of literature in this field and more research is needed to create culturally tailored medical care and address the needs of disadvantaged burn survivors.

Disentangling Racial, Ethnic, and Socioeconomic Disparities in Treatment for Colorectal Cancer.

Colorectal cancer is curable if diagnosed early and treated properly. Black and Hispanic patients with colorectal cancer are more likely to experience treatment delays and/or receive lower standards of care. Socioeconomic deprivation may contribute to these disparities, but this has not been extensively quantified. We studied the interrelationship between patient race/ethnicity and neighborhood socioeconomic status (nSES) on receipt of timely appropriate treatment among patients with colorectal cancer in California. White, Black, and Hispanic patients (26,870) diagnosed with stage I-III colorectal cancer (2009-2013) in the California Cancer Registry were included. Logistic regression models were used to examine the association of race/ethnicity and nSES with three outcomes: undertreatment, >60-day treatment delay, and >90-day treatment delay. Joint effect models and mediation analysis were used to explore the interrelationships between race/ethnicity and nSES. Hispanics and Blacks were at increased risk for undertreatment [Black OR = 1.39; 95% confidence interval (CI) = 1.23-1.57; Hispanic OR = 1.17; 95% CI = 1.08-1.27] and treatment delay (Black/60-day OR = 1.78; 95% CI = 1.57-2.02; Hispanic/60-day OR = 1.50; 95% CI = 1.38-1.64) compared with Whites. Of the total effect (OR = 1.15; 95% CI = 1.07-1.24) of non-white race on undertreatment, 45.71% was explained by nSES. Lower nSES patients of any race were at substantially higher risk for undertreatment and treatment delay, and racial/ethnic disparities are reduced or eliminated among non-white patients living in the highest SES neighborhoods. Racial and ethnic disparities persisted after accounting for neighborhood socioeconomic status, and between the two, race/ethnicity explained a larger portion of the total effects. This research improves our understanding of how socioeconomic deprivation contributes to racial/ethnic disparities in colorectal cancer.

Promoción del antígeno prostático específico para el cáncer de próstata en hombres de Estados Unidos

Objective: To analyze the association between races/ethnicity and the use of PSA to detect prostate cancer in the US. Method: Observational cross-sectional study. The data used comes from the 2018 Behavioral Risk Surveillance System. Inclusion Criteria: male population residing in the US from Caucasian, African American, and Hispanic race/ethnicity. Exclusion criteria: Men with missing data regarding the variables. Independent variable: race/ethnicity. Dependent variable: Use of the PSA. Confounding Variables: Socioeconomic situation, access to health, information received (advantages, disadvantages, recommendations) about the PSA test by health workers. An adjusted and unadjusted logistic regression was performed calculating odds ratios and a 95% confidence interval. Results: No association was found between race/ethnicity and PSA, OR for Caucasians 1.02 (95% CI 0.95, 1.12), and for Hispanics OR 1.02 (95% CI 0.90, 1.14). The use of the PSA compared to the information received on the advantages of this exam had an OR of 0.19 (95% CI 0.18, 0.20); on disadvantages an OR of 1.06 (95% CI 1.00, 1.13); on recommendations an OR of 0.05 (0.04; 0.05). Access to health and income level had an OR of 0.50 (95% CI 0.46, 0.56) and OR of 1.43 (95% CI 1,36, 1,49), respectively. Conclusions: There was an association between the information provided by health professionals and the use of the PSA, this could encourage the creation of promotional campaigns for the population.

594 Racial and Ethnic Disparities in Burn Patient Outcomes: A Review of the Literature

Abstract Introduction Racial and ethnic disparities in outcomes for surgical trauma populations has been an expanding field in recent years. Despite this, disparities in prevention, treatment, and recovery outcomes for burn patients of racial and ethnic minority backgrounds have not been well-studied. Our study aims to review the literature regarding risk factors and burn outcomes among racial and ethnic minority populations to develop culturally-tailored burn care for minority burn patients. Methods A systematic review of literature utilizing PubMed was conducted for articles published between 2000–2020. Searches were used to identify articles that crossed the burn term (burn patient OR burn recovery OR burn survivor OR burn care) and a race/ethnicity and insurance status-related term (race/ethnicity OR African-American OR Asian OR Hispanic OR Latino OR Native American OR Mixed race OR 2 or more races OR socioeconomic status OR insurance status). Inclusion criteria were English studies in the U.S. that discussed disparities in burn injury outcomes or burn injury risk factors associated with race/ethnicity. Results 1,031 papers were populated, and 38 articles were reviewed. 26 met inclusion criteria (17 for adult patients, 9 for pediatric patients). All but 4 of the included papers were written in the last 10 years. 17 of the 26 articles describe differences in outcomes or risk factors for Black Americans, 8 discuss Latinx, 5 discuss Native Americans, 3 discuss Asian Americans, and 1 referred to “Non-White” minorities, collectively. Majority of studies showed that racial and ethnic minorities (vs. Whites) exhibited poorer burn injury outcomes such as higher mortality rates, greater scar complications, and longer duration for length of stay. Conclusions Few studies exist on outcomes for minority burn populations. Interestingly, most have been published in the last 10 years, which may indicate a trend in increased awareness. There is also a discrepancy in which minorities are included in each study with the least amount of data collected on Asian, Latinx, and Native American communities. More research with a larger base of minority populations will help further investigate this problem and develop better culturally-appropriate burn treatment.

Risk Factors for Malignancy after Orthotopic Heart Transplant: An Analysis of the UNOS Registry

PurposeFor patients with end stage heart failure, orthotopic heart transplant (OHT) remains the definitive management. Advances in immunosuppression have led to improved long-term survival. Malignancy is an important cause of long-term morbidity and mortality with a reported rate of occurrence between 20-40% within 10 years of transplant. To date, significant evidence into mechanisms and risk profiles for post OHT malignancy is lacking. The purpose of this study is to identify patient and donor related factors associated with post OHT malignancy.MethodsWe performed a retrospective analysis of 51,218 OHT recipients captured in the United Network for Organ Sharing (UNOS) registry. Included in this analysis were adults 18 years and older who received a heart transplant between 1987 and 2019. The patients were categorized by the presence of post OHT malignancy (“yes”, “no”). Baseline characteristics were compared using chi-squared analysis for categorical variables and Mann-Whitney test for continuous variables. Logistic regressions were applied to evaluate the association between post OHT malignancy and the risk factors.ResultsWithin the study period (1987-2019), 13,060 OHT recipients (25.5%) developed a malignancy. Denovo solid tumors comprised 82% of all malignancy types. OHT recipients with malignancy were older (56 vs 50.9 years, p= <0.001), had higher proportion that were male (85% vs. 73%, p=<0.001), and White (90% vs. 68%, p= <0.001). Recipient factors associated with post OHT malignancy included older age (OR 1.05, CI 1.05-1.06, p= <0.001), White race (Asian OR 0.22, CI 0.16-0.30, p= <0.0001; Black OR 0.34, CI 0.30-0.38, p= 0.038; Hispanic OR 0.32, CI 0.27-0.39, p= 0.02), and treatment for rejection (OR 2.17, CI 1.04-4.52, p= 0.038).ConclusionIn this study, we reported the prevalence of post OHT malignancy as well as recipient and donor factors associated with post OHT malignancy. Further analysis based on malignancy subtype should be performed to aid in risk stratification and surveillance. For patients with end stage heart failure, orthotopic heart transplant (OHT) remains the definitive management. Advances in immunosuppression have led to improved long-term survival. Malignancy is an important cause of long-term morbidity and mortality with a reported rate of occurrence between 20-40% within 10 years of transplant. To date, significant evidence into mechanisms and risk profiles for post OHT malignancy is lacking. The purpose of this study is to identify patient and donor related factors associated with post OHT malignancy. We performed a retrospective analysis of 51,218 OHT recipients captured in the United Network for Organ Sharing (UNOS) registry. Included in this analysis were adults 18 years and older who received a heart transplant between 1987 and 2019. The patients were categorized by the presence of post OHT malignancy (“yes”, “no”). Baseline characteristics were compared using chi-squared analysis for categorical variables and Mann-Whitney test for continuous variables. Logistic regressions were applied to evaluate the association between post OHT malignancy and the risk factors. Within the study period (1987-2019), 13,060 OHT recipients (25.5%) developed a malignancy. Denovo solid tumors comprised 82% of all malignancy types. OHT recipients with malignancy were older (56 vs 50.9 years, p= <0.001), had higher proportion that were male (85% vs. 73%, p=<0.001), and White (90% vs. 68%, p= <0.001). Recipient factors associated with post OHT malignancy included older age (OR 1.05, CI 1.05-1.06, p= <0.001), White race (Asian OR 0.22, CI 0.16-0.30, p= <0.0001; Black OR 0.34, CI 0.30-0.38, p= 0.038; Hispanic OR 0.32, CI 0.27-0.39, p= 0.02), and treatment for rejection (OR 2.17, CI 1.04-4.52, p= 0.038). In this study, we reported the prevalence of post OHT malignancy as well as recipient and donor factors associated with post OHT malignancy. Further analysis based on malignancy subtype should be performed to aid in risk stratification and surveillance.

Relationship of socio-demographics, comorbidities, symptoms and healthcare access with early COVID-19 presentation and disease severity

BackgroundCOVID-19 studies are primarily from the inpatient setting, skewing towards severe disease. Race and comorbidities predict hospitalization, however, ambulatory presentation of milder COVID-19 disease and characteristics associated with progression to severe disease is not well-understood.MethodsWe conducted a retrospective chart review including all COVID-19 positive cases from Stanford Health Care (SHC) in March 2020 to assess demographics, comorbidities and symptoms in relationship to: 1) their access point of testing (outpatient, inpatient, and emergency room (ER)) and 2) development of severe disease.ResultsTwo hundred fifty-seven patients tested positive: 127 (49%), 96 (37%), and 34 (13%) at outpatient, ER and inpatient, respectively. Overall, 61% were age < 55; age > 75 was rarer in outpatient setting (11%) than ER (14%) or inpatient (24%). Most patients presented with cough (86%), fever/chills (76%), or fatigue (63%). 65% of inpatients reported shortness of breath compared to 30–32% of outpatients and ER patients. Ethnic/minority patients had a significantly higher risk of developing severe disease (Asian OR = 4.8 [1.6–14.2], Hispanic OR = 3.6 [1.1–11.9]). Medicare-insured patients were marginally more likely (OR = 4.0 [0.9–17.8]). Other factors associated with developing severe disease included kidney disease (OR = 6.1 [1.0–38.1]), cardiovascular disease (OR = 4.7 [1.0–22.1], shortness of breath (OR = 5.4 [2.3–12.6]) and GI symptoms (OR = 3.3 [1.4–7.7]; hypertension without concomitant CVD or kidney disease was marginally significant (OR = 2.3 [0.8–6.5]).ConclusionsEarly widespread symptomatic testing for COVID-19 in Silicon Valley included many less severely ill patients. Thorough manual review of symptomatology reconfirms the heterogeneity of COVID-19 symptoms, and challenges in using clinical characteristics to predict decline. We re-demonstrate that socio-demographics are consistently associated with severity.