Hispanic OR Research Articles

Incidence and Predictors of Diabetes Mellitus after a Diagnosis of Early-Stage Breast Cancer in the Elderly Using Real-World Data.

The incidence and predictors of diabetes (DM) in patients with breast cancer (BC) were evaluated. We compared DM incidence and physician access in BC patients to matched controls. We identified women with stage I-III BC diagnosed from 2005 to 2013 in the SEER-Medicare database, with ≥ 2years of follow-up after diagnosis, without previous DM claims. Incident DM was determined by ≥ 1 DM claims after BC diagnosis. Multivariable analysis was used to identify factors associated with incident DM. Age- and race-matched non-cancer controls were obtained from a 5% random sample and assigned an index date. Physician and PCP visits per-patient-per-year were compared between cases and controls in the two-year period prior to and after the index date. Among 14,506 eligible BC patients, 3234 (22.3%) developed DM versus 16.5% of controls. Among BC patients, factors associated with incident DM included race (Black OR 1.63 95% CI 1.39-1.93, Hispanic OR 3.03 95% CI 1.92-4.81; vs. Caucasians), SES (Quintile 0 vs. Quintile 4 OR 1.55 95% CI 1.33-1.78), and receipt of chemotherapy (vs. none OR 1.19 95% CI 1.08-1.31). Among cases and controls, respectively, median physician visits per-patient-per-year were 19 and 17 prior to the index date, and 46 and 19 after the index date; median PCP visits were 2 for both groups in both periods. About 22% of BC patients developed DM, more than controls in the same period. While there were differences in healthcare access, there weren't differences in PCP access between groups. This represents an opportunity for better comorbidity management in BC patients.

The influence of patient-provider communication on cancer screenings differs among racial and ethnic groups.

Our study aimed to estimate how associations between adults' perceptions of specific domains of PPC quality and their likelihood of receiving cancer screenings differed by race and ethnicity. We analyzed 2011-2015 Medical Expenditure Panel Survey (MEPS) data. Samples included 7337 women ages 50-74 (breast), 13,276 women ages 21-65 (cervical), and 9792 adults ages ≥50years (colorectal). To examine individual domains of PPC quality (independent variables), adults reported how often providers: listened; showed respect; spent enough time; explained things; gave specific instructions; and demonstrated health literate practices (gave clear instructions and asked them to "teach-back" how they will follow instructions). Dependent variables were breast, cervical, and colorectal cancer screenings. Multivariable logistic regression was used to evaluate the odds of receiving cancer screenings using a composite measure of PPC quality and separate domains. Hispanic and non-Hispanic black adults who reported their providers always demonstrated PPC quality had higher odds of receiving colorectal cancer screenings compared to those whose providers did not. Adults' perceptions of whether or not their provider gave them specific instructions increased their odds of receiving breast (Hispanics OR=1.65, 95% CI=1.09, 2.51; non-Hispanic blacks OR=1.54, 95% CI=1.06, 2.24) and colorectal (non-Hispanic whites OR=1.37, 95% CI=1.13, 1.66; Hispanics OR=1.29, 95% CI=1.01, 1.66; non-Hispanic blacks OR=1.92, 95% CI=1.39, 2.65) cancer screenings. Non-Hispanic Asian women who reported their health care providers demonstrated "teach-back" had higher odds (OR=2.25; 95% CI=1.10, 4.62) of receiving cervical cancer screenings. Efforts to improve cancer screenings should focus on training providers to demonstrate health literate practices to improve cancer screenings.

Association of Race with Survival in Intracranial World Health Organization Grade II and III Meningioma in the United States: Systematic Literature Review

Recent literature has shown significant differences in meningioma incidence among different races, but minimal conclusive data exist on the role of race and ethnicity in overall survival for patients with high-grade intracranial meningioma. We conducted a systematic review to investigate the impact of race and ethnicity on survival in patients with high-grade intracranial meningioma. A systematic literature review was conducted for studies using Ovid, PubMed, Cochrane, Embase, and Scopus databases. Databases were queried for the following: Meningioma AND [Ethnic OR Demography, OR African American OR Arab OR Hispanic OR Asian, OR White OR race OR racial] AND [survival OR survival analysis OR survival rate OR treatment outcome OR Survivor OR Outcome]. A literature search yielded a total of 412 abstracts, which were screened according to criteria that were determined a priori, and a total of 129 full-text articles were reviewed. Four articles were included in the final analysis, reporting on a total of 13,424 patients. Three studies saw an overall survival benefit in White non-Hispanics compared with Black non-Hispanics, and 1 reported a survival benefit in White non-Hispanics and Black non-Hispanics among patients who received gross total resection. One study additionally reported an increased likelihood of White patients receiving gross total resection when compared with non-White patients. The limited data available suggest that White patients have improved measures of survival compared with nonw-White patients, for reasons that are likely complex and multifactorial. Further studies are needed to explore these survival differences seen.

ETHNICITY, DEPRESSION, AND FUNCTIONAL OUTCOMES IN OLDER WOMEN

Women continue to have higher prevalence rates of functional impairment and depressive symptoms than men. In addition, women from certain ethnic groups experience disproportionately higher rates of ADL limitation, and are less likely to be screened for depression. The current study examines the association between race/ethnicity and depressive symptoms on functional limitations in Black, White and Hispanic women. We examined prevalence and adjusted odds of ADL limitations by race in n=9,846 women aged 50+ with low (CESD <4) and high (CESD =>4) depressive symptoms from the 2014 wave of the Health and Retirement Study. Overall, Black and Hispanic women had significantly higher rates of depression (p <.001) and ADL limitations (p<.001) than White women. Among those with high depressive symptoms, Black OR 1.98 [1.17, 3.34] and Hispanic OR 2.82 [1.42, 5.6] women have significantly higher rates of ADL limitations as compared to White women.

Predictors of Surgical Approach to Myomectomies by Race

Study Objective To analyze patient and hospital characteristics, stratified by race, among women undergoing minimally invasive and abdominal myomectomies. Design Data was abstracted from the 2010-2014 National Inpatient Sample of women ages 18-50 years undergoing myomectomy for fibroids. We used a multivariate logistic regression to analyze temporal trends in minimally-invasive (laparoscopic and robotic) by patient factors (age, insurance, and income subgroups) and hospital factors (teaching status, for-profit status, size) and stratified by race (White, Black, Hispanic). Setting United States. Patients or Participants 124,880 women ages 18-50 years undergoing inpatient myomectomy for fibroids. Interventions N/A Measurements and Main Results Of the 124,880 women undergoing myomectomy for fibroids, 7% underwent minimally invasive myomectomy (MIM) and 93% underwent abdominal myomectomy. Black women had a total of 55,960 myomectomies performed of which 3,360 (6.0%) were MIM. Black women had lower odds of undergoing MIM at teaching hospitals [OR.79 95%CI.64-.96] and in the highest income bracket [OR.69 95%CI.54-.89]. White women had a total of 39,560 myomectomies performed of which 4,870 (12.3%) were MIM. White women had lower odds of having MIM with private insurance [OR.75 95%CI.60-.93], highest income bracket [OR.71 95%CI.55-.92], at large hospitals [OR.822 95%CI.69-.97], or at teaching hospitals [OR.66 95%CI.56-.79]. Hispanic women had a total of 15,930 myomectomies performed of which 1,140 (7.2%) were MIM. Hispanic women had lower odds of undergoing MIM at for-profit hospitals [OR.62 95%CI.39-.97]. Across all races, women ages 41-50 were more likely to have MIM [White OR 6.5 95%CI 4.73- 8.96, Black OR 2.6 95%CI 1.98-3.44, Hispanic OR 3.73 95%CI 2.28-6.08]. Conclusion Racial disparities exist with access to MIM. Black women undergo the majority of myomectomies, but only 6% are minimally invasive compared to white women (12.3%).

Culture and Diagnosis of MCI in Hispanics: A Literature Review

Abstract Objective Hispanics are a rapidly growing and aging segment of the US population. There is a critical need to accurately and efficiently detect those at risk for dementia, particularly those with Mild Cognitive Impairment (MCI). MCI diagnosis typically relies on neuropsychological tests, although cultural and linguistic factors impact neuropsychological test scores. The current study reviews neuropsychological studies on MCI in Hispanics to evaluate the factors in testing for MCI diagnosis. Participants and Method Studies were identified from a literature search utilizing Web of Science, PubMed, Google Scholar, and Scopus, using search terms “Hispanic OR Mexican American” and “Mild Cognitive Impairment,” and from the reference sections of studies identified through this search. Studies utilizing neuropsychological tests in the diagnosis of MCI for Hispanics living in the US were identified and reviewed. Approaches for sample characterization (e.g., country of origin and of education, literacy, language preference and proficiency), neuropsychological test methods (e.g., test selection and translation, normative data source), and method of MCI diagnosis were reviewed. Results Considerable variability was found across studies with regard to the incorporation – and the method of incorporation – of cultural factors and their consideration in the MCI diagnosis process for Hispanics. For example, several studies did not report their sample’s country of education, source of normative data used for determination of cognitive impairment, or method of test adaptation/translation. Conclusions Diagnosis of MCI in Hispanics has been complicated by a dearth of culturally appropriate neuropsychological assessment tools and normative data, which likely contributes to inconsistency across studies. Future studies are needed to further develop culturally appropriate neuropsychological methods to evaluate MCI in Hispanics in the US and to improve diagnostic accuracy in this population.

Racial disparities and treatment outcomes among patients admitted with a diagnosis of colorectal cancer: Analysis of the 2014 national inpatient sample database.

529 Background: Colorectal cancer is the fourth most common cancer in the United states and the second most common cause of death. Despite universal advocacy for screening colonoscopies and early diagnosis, racial disparities in screening and diagnosis of colorectal cancer exist and affect patients outcomes. In this analysis we determine racial disparities and treatment outcomes for colorectal cancer treatment in the United States. Methods: We performed a retrospective analysis of the National Inpatient Sample 2014 Database (HCUP_NIS) which contains records of all hospital discharges in the United States Patients 18 years and older with a diagnosis of colorectal cancer were identified by their ICD 9 codes along with treatment they had for colorectal cancer. We then used multivariable regression to identify the effect of race on receiving a therapeutic procedure (open surgical, laparoscopic or robotic) during hospitalization and outcomes as it relates to inpatient mortality. We adjusted for patients age, sex, number of comorbidities (elixhauser comorbidity score), insurance type, and hospital level charactertistics (i.e. size, teaching status) and location (urban and rural location). Results: There were 25,749 discharge diagnosis of colorectal cancer in the United States in 2014 of which 19,300 were associated with undergoing a procedure for colorectal cancer treatment. Whites accounted for the majority of colorectal cancer admissions (65%) while blacks 11.4 %, Hispanics 8.0%, Asian/Pacific Islanders 3.2 %, and Native Americans 0.4%. Blacks had the lowest frequency of procedure related admissions and were less likely to undergo a therapeutic procedure relating to colorectal cancer treatment (67.5 vs. 76.6 OR 0.84 CI 0.75 - 0.93) compared to whites. For specific procedures, blacks (OR 0.81, CI 0.72-0.91) and Hispanics (OR 0.85, CI 0.74-0.98) had a significantly lesser odds of undergoing open surgical procedures when compared to whites but were similarly likely (Blacks OR 0.93, CI 0.81-1.05, Hispanics OR 0.84, CI 0.61-1.14) to undergo laparoscopic/robotic surgical procedure. On multivariable analysis, Asian/Pacific Islanders had a significantly higher mortality (OR 1.61 CI 1.01-2.60) for non-procedure related colorectal cancer admissions. However, this increase mortality was not seen in procedure related colorectal cancer admissions. Overall, after adjusting for potential confounders and treatment, there was no significant variation amongst different races for colorectal cancer mortality in patients admitted to the hospital. Conclusions: Among patients with colorectal cancer there was no procedure related mortality differences between various races. However, for some reason Asian/Pacific Islanders had a significantly higher mortality for non-procedure related colorectal cancer admissions. Further studies are warranted to understand the above findings.

Choice of radioactive iodine treatment for thyroid cancer: Results from a population-based survey.

159 Background: For many patients with differentiated thyroid cancer, use of radioactive iodine (RAI) does not improve survival or reduce recurrence risks. Yet, most patients continue to receive RAI suggesting the need for a better understanding of patient perspectives regarding RAI decision making. Methods: All eligible sequentially diagnosed patients with thyroid cancer in 2014-15 from the Georgia and Los Angeles SEER registries were surveyed (N = 2097, current response rate: 63%). Patients with intermediate risk thyroid cancer where selective RAI use is recommended were included in this analysis (N = 1357). Patients were asked whether or not they felt they had a choice to receive RAI (yes/no), how strongly their physician recommended initial RAI treatment (5 point Likert responses: Strongly against RAI--Strongly recommended RAI), whether they received RAI (yes/no), how satisfied they were with their RAI decision (5-pt Likert-type scale), categorized as more (score ≥4) vs. less satisfied. Multivariable logistic regression was used to assess 1) association between patient characteristics and perception of no RAI choice, 2) perception of no RAI choice with receipt of RAI and 3) perception of no RAI choice with decision satisfaction. Results: In this sample,over half (57%) of the respondents perceived they did not have a RAI choice, and the majority of them (76%) received RAI. The odds of perceiving no RAI choice was greater among Hispanic and Asian patients (Hispanic OR: 1.4, 95%CI: 1.0, 1.9, Asian OR: 1.9, 95%CI: 1.2, 2.9), and those whose physician strongly recommended RAI (OR: 1.9, 95%CI: 1.4, 2.6). Patients who perceived they did not have a RAI choice were more likely to receive RAI (Adjusted OR: 3.2, 95%CI: 2.1, 4.9) and report lower decision satisfaction (Adjusted OR: 2.7, 95%CI: 1.9, 3.7). Conclusions: Many patients in whom selective RAI use is recommended, particularly those of more vulnerable groups, did not feel they had a choice about whether or not to receive RAI. Patients who perceived they did not have a RAI choice were more likely to receive RAI and report lower decision satisfaction, suggesting a need for more shared treatment decision making to reduce overtreatment.

2349 - Effects of Ambient Noise on Sleep in New York City

Noise can be harmful to health. One effect of noise is disrupted sleep and poorer daytime cognitive performance. New York City (NYC) adults were surveyed to examine the frequency and sources of ambient noise that cause sleep disturbance, physical (e.g., wearing earplugs) or medical (e.g., using sleep medications) measures taken to reduce noise exposure, and effect on concentration due to poor sleep. The data were obtained from a 2017 automated telephone survey using a Redirected Inbound Call Sampling method. Participants were screened to be 18 years and older and live in a NYC borough. Imputation was used for missing demographic variables and missing or “prefer not to answer” responses of key noise questions. SAS was used to calculate frequencies and perform logistic regression. An estimated 2,650,000 NYC adults reported being disturbed from sleep by noise at least once per week. Of them, 78% were disturbed three or more nights per week. Traffic caused 53% of sleep disturbances of three or more nights per week, with sources consisting of subways (7%), buses (9%), sirens (15%), garbage trucks (11%), and other traffic (12%). 75% of New Yorkers with noise-disrupted sleep three or more nights per week reported difficulty concentrating due to poor sleep at least once per week. Regression analysis showed that significant associations of having noise-disrupted sleep at least once per week were: sleep disturbed by light (OR 2.9, 95% CI 1.9–4.3, p<0.0001), use of physical (OR 7.4, 95% CI 5.2–10.4, p<0.0001) or medical (OR 2.1, 95% CI 1.4–3.1, p=0.0004) interventions to mitigate outside noise, and race/ethnicity when compared to White Non-Hispanic (Hispanic OR 1.9, 95% CI 1.3–2.8, p=0.001; Other OR 1.8, 95% CI 1.1–3.0, p=0.0145). Associations with having difficulty concentrating due to poor sleep at least once per week included having sleep disturbed by light (OR 3.9, 95% CI 2.6–5.8, p<0.0001), sleep disturbed by noise (OR 1.8, 95% CI 1.4–2.4, p<0.0001), and use of physical(OR 2.3, 95% CI 1.6–3.1, p<0.0001) or medical interventions (OR 2.8, 95% CI 1.9–4.2, p<0.0001). Noise pollution, frequently due to traffic, is common in urban environments. It has detrimental effects on sleep, leading to perceived concentration difficulty, even with attempts to reduce it. Additionally, in NYC, there are disparities in noise exposure by race/ethnicity, possibly related to inequities in the concentration of non-white residents in under-resourced neighborhoods. Although NYC has a noise code that sets decibel limits and quiet times, additional ways to reduce noise pollution are needed to complement the regulatory approach.

Improving cancer patient emergency room utilization: A New Jersey state assessment

IntroductionDue to its increasing incidence and its major contribution to healthcare costs, cancer is a major public health problem in the United States. The impact across different services is not well documented and utilization of emergency departments (ED) by cancer patients is not well characterized. The aim of our study was to identify factors that can be addressed to improve the appropriate delivery of quality cancer care thereby reducing ED utilization, decreasing hospitalizations and reducing the related healthcare costs. MethodsThe New Jersey State Inpatient and Emergency Department Databases were used to identify the primary outcome variables; patient disposition and readmission rates. The independent variables were demographics, payer and clinical characteristics. Multivariable unconditional logistic regression models using clinical and demographic data were used to predict hospital admission or emergency department return. ResultsA total of 37,080 emergency department visits were cancer related with the most common diagnosis attributed to lung cancer (30.0%) and the most common presentation was pain. The disposition of patients who visit the ED due to cancer related issues is significantly affected by the factors of race (African American OR=0.6, p value=0.02 and Hispanic OR=0.5, p value=0.02, respectively), age aged 65 to 75years (SNF/ICF OR 2.35, p value=0.00 and Home Healthcare Service OR 5.15, p value=0.01, respectively), number of diagnoses (OR 1.26, p value=0.00), insurance payer (SNF/ICF OR 2.2, p value=0.02 and Home Healthcare Services OR 2.85, p value=0.07, respectively) and type of cancer (breast OR 0.54, p value=0.01, prostate OR 0.56, p value=0.01, uterine OR 0.37, p value=0.02, and other OR 0.62, p value=0.05, respectively). In addition, comorbidities increased the likelihood of death, being transferred to SNF/ICF, or utilization of home healthcare services (OR 1.6, p value=0.00, OR 1.18, p value=0.00, and OR 1.16, p value=0.04, respectively). Readmission is significantly affected by race (American Americans OR 0.41, standard error 0.08, p value=0.001 and Hispanics OR 0.29, standard error 0.11, p value=0.01, respectively), income (Quartile 2 OR 0.98, standard error 0.14, p value 0.01, Quartile 3 OR 1.07, standard error 0.13, p value 0.01, and Quartile 4 OR 0.88, standard error 0.12, p value 0.01, respectively), and type of cancer (prostate OR 0.25, standard error 0.09, p value=0.001). ConclusionWeb based symptom questionnaires, patient navigators, end of life nursing and clinical cancer pathways can identify, guide and prompt early initiation of treat before progression of symptoms in cancer patients most likely to visit the ED. Thus, improving cancer patient satisfaction, outcomes and reduce health care costs.

Racial Disparities in Differentiated Thyroid Cancer: Have We Bridged the Gap?

Racial disparities in the management of differentiated thyroid cancer (DTC) exist in the United States. There is a paucity of data examining their temporal trends. It was hypothesized that racial disparities in care provided to patients with DTC have improved over the past 15 years. Adult patients undergoing surgery for DTC were included from the National Cancer Data Base (1998-2012). Temporal trends in appropriate extent of thyroidectomy and radioactive iodine therapy (RAI) were described for different racial groups. Multivariable logistic regression models were employed to estimate the adjusted association of receipt of appropriate extent of surgery and RAI, specifically under- and over-treatment, among different racial groups. Among 282,043 DTC patients, 80.3% were non-Hispanic white (white), 8.1% Hispanic, 7.2% non-Hispanic black (black), and 4.4% Asian. Black versus white race/ethnicity was associated with lower odds of receiving appropriate surgery (odds ratio [OR] = 0.78 [confidence interval (CI) 0.71-0.87]; p < 0.001). Appropriate RAI treatment was higher in blacks (OR = 1.07 [CI 1.02-1.12]; p = 0.01) and lower for Hispanics (OR = 0.90 [CI 0.86-0.95]; p < 0.001) compared with whites. There was a higher likelihood of RAI under-treatment in minority groups (Hispanic OR = 1.27, black OR = 1.26, Asian OR = 1.25; p < 0.001), and a lower likelihood of RAI over-treatment (Hispanic OR = 0.89, black OR = 0.83, Asian OR = 0.79; p < 0.001) compared with whites. Over time, an increasing proportion of black and white patients underwent appropriate extent of thyroidectomy (1998 vs. 2012: 78% vs. 88% and 81% vs. 91%, respectively). Compared with 1998, fewer patients in 2012 were under-treated with RAI: whites (48% vs. 29%, respectively), blacks (51% vs. 33%), Hispanics (51% vs. 37%), and Asians (55% vs. 39%). The extent of RAI over-treatment increased (1998 vs. 2012): whites (1% vs. 4%), blacks (2% vs. 4%), Hispanics (2% vs. 4%), and Asians (2% vs. 3%), respectively. Appropriate utilization of surgery and RAI for DTC has improved over time. However, the proportion of patients receiving appropriate thyroid surgery is consistently lower for blacks compared with whites. RAI over-treatment increased for all races over the study period. Efforts are needed to standardize DTC care among minority patients.

End-of-Life Racial and Ethnic Disparities Among Patients With Ovarian Cancer.

Purpose To assess disparities in end-of-life care among patients with ovarian cancer. Patients and Methods Using Texas Cancer Registry-Medicare data, we assessed patients with ovarian cancer deceased in 2000 to 2012 with at least 13 months of continuous Medicare coverage before death. Descriptive statistics and multivariate logistic regressions were conducted to evaluate end-of-life care, including chemotherapy in the final 14 days of life, intensive care unit (ICU) admission in the final 30 days of life, more than one emergency room (ER) or hospital admission in the final 30 days of life, invasive or life-extending procedures in the final 30 days of life, enrollment in hospice, enrollment in hospice during the final 3 days of life, and enrollment in hospice while not hospitalized. Results A total of 3,666 patients were assessed: 2,819 (77%) were white, 553 (15%) Hispanic, 256 (7%) black, and 38 (1%) other. A total of 2,642 (72%) enrolled in hospice before death, but only 2,344 (64%) died while enrolled. The median hospice enrollment duration was 20 days. In the final 30 days of life, 381 (10%) had more than one ER visit, 505 (14%) more than one hospital admission, 593 (16%) ICU admission, 848 (23%) invasive care, and 418 (11%) life-extending care. In the final 14 days of life, 357 (10%) received chemotherapy. Several outcomes differed for minorities compared with white patients. Hispanic and black patients were less likely to enroll and die in hospice (black odds ratio [OR], 0.66; 95% CI, 0.50 to 0.88; P = .004; Hispanic OR, 0.76; 95% CI, 0.61 to 0.94; P = .01). Hispanic patients were more likely to be admitted to an ICU (OR, 1.37; 95% CI, 1.05 to 1.78; P = .02), and black patients were more likely to have more than one ER visit (OR, 2.20; 95% CI, 1.53 to 3.16; P < .001) and receive a life-extending procedure (OR, 2.13; 95% CI, 1.49 to 3.04; P < .001). Conclusion We found being a minority was associated with receiving intensive and invasive end-of-life care among patients with ovarian cancer.

Insurance status and race affect treatment and outcome of traumatic brain injury

BackgroundThere is increasing evidence that race and socioeconomic factors affect patient outcomes after traumatic brain injury (TBI). Our goal was to assess the effect of race, ethnicity and insurance status on hospital length of stay, procedures performed, mortality, and discharge disposition after TBI. MethodsThis was a retrospective cohort study using the National Trauma Data Bank (2002-2012) to analyze patients aged 14-89 y with one of five closed head injuries. Univariate regressions identified demographic and injury characteristics that were significant predictors of outcomes. These variables were then included in multivariate regression models. ResultsWe analyzed 187,354 TBI patients. The sample was 78% white, 9% black, 9% Hispanic, 3% Asian, and 1% native American, and included 42% Medicare, 30% private insurance, 12% uninsured, 8% other insurance, and 8% Medicaid. Compared with white patients, black and Hispanic patients were more likely to have a TBI procedure (blacks odds ratio [OR] = 1.19, P < 0.001; Hispanics OR = 1.33, P < 0.001), had longer hospital stays (blacks coeff = 1.02, P < 0.001; Hispanics coeff = 0.61, P < 0.001), were less likely to die in the hospital (blacks OR = 0.90, P = 0.006; Hispanics OR = 0.90, P = 0.007), and more (black OR = 1.09, P = 0.001) or less likely (Hispanic OR = 0.76, P < 0.001) to be discharged to rehabilitation. Compared with the privately insured, the uninsured were less likely to have a TBI procedure (OR = 0.90, P = 0.001), had longer hospital stays (coeff = 0.24, P < 0.001), were more likely to die in the hospital (OR = 1.37, P < 0.001), and less likely to be discharged to rehabilitation (OR = 0.53, P < 0.001). ConclusionsRace/ethnicity and insurance status significantly affect TBI patient outcomes, even after controlling for demographic and injury characteristics.

The Effect of Hospital Characteristics on Racial/Ethnic Variation in Cirrhosis Mortality.

Racial/ethnic disparities in liver disease and cirrhosis are well established. Cirrhosis mortality is improving overall despite vast differences between hospitals. We sought to understand the hospital characteristics where minorities seek care, whether disparities in cirrhosis mortality persist, and determine how hospital differences contribute to these differences. We used data from the Nationwide Inpatient Sample and the American Hospital Association to identify inpatient episodes of care for cirrhosis and structural characteristics at the parent hospital. We used multi-level hierarchical regression models to understand the effect of hospital structural characteristics on racial/ethnic variation in cirrhosis mortality. From 2007 to 2011, 51,260 patients were admitted to the hospital with cirrhosis (White 66.5%, Black 7.6%, Hispanic 19.7%, Asian 2.0%, other 4.2%). The overall adjusted mortality rate was 7.8%, which significantly differed by race/ethnicity. Hospitals varied significantly in resource intensity. Higher mortality hospitals had a lower proportion of White patients and a higher proportion of Black and Hispanic patients compared to average and low mortality hospitals (p<0.0001). Compared to White patients, there was significant racial/ethnic variation in unadjusted odds of mortality (Black OR 1.17; Hispanic OR 0.90; Asian 0.77; other 0.96; all p<0.01). After accounting for hospital and patient differences, there were no racial/ethnic differences in mortality. The increased risk of cirrhosis mortality in Black patients appears to be mediated by facility differences and clinical co-morbidities, suggesting that access to higher quality health services at several points in both the early and late management of liver disease may improve disparate population outcomes.

Reassessing Preemptive Kidney Transplantation in the United States: Are We Making Progress?

Preemptive kidney transplantation (preKT) is associated with higher patient survival, improved quality of life, and lower costs. However, only a minority of patients receives preKT. The aim of this study was to examine changes over the past decade in rates of preKT, focusing on living donor kidney transplantation (LDKT) and specifically recipients who underwent kidney transplantation within 1 year of initiating dialysis. Using United Network of Organ Sharing data, we examined retrospectively all kidney transplant candidates (n = 369 103) and recipients (n = 141 254) from 2003 to 2012 in the United States focusing on LDKT (n = 47 108). Predictors of preKT were examined, and patient and graft survival were compared for preKT, pretransplant dialysis less than 1 year, and pretransplant dialysis recipients of 1 year or longer. PreKT occurred in only 17% of recipients overall and 31% of LDKT recipients. Medicare patients (odds ratio [OR], 0.29; 95% confidence interval [95% CI], 0.28-0.31), diabetics (OR, 0.75; 95% CI, 0.69-0.80), and minorities (Hispanics OR, 0.62; 95% CI, 0.57-0.68 and African Americans OR, 0.58; 95% CI, 0.53-0.63) were less likely to receive preKT. Dialysis recipients for less than 1 year comprised 30% of nonpreemptive LDKT. Dialysis recipients of less than 1 year had similar patient survival to preKT (5 years: preKT, 94%; dialysis < 1 year, 94%; dialysis ≥ 1 year, 89%; P < 0.01), but decreased death-censored graft survival (5 years: preKT, 93%; dialysis < 1 year, 89%; and dialysis ≥ 1 year, 89%; P < 0.01). PreKT remains an unrealized goal for the majority of recipients. Medicare patients, diabetics, and minorities are less likely to receive preKT. Almost one third of nonpreemptive LDKT recipients were dialyzed for less than 1 year, highlighting an important target for improvement.

Patient preferences for provider roles in collaborative breast cancer survivorship care.

184 Background: Prior studies have exploredbarriers to collaborative cancer care and suggest a need for greater clarity about clinician roles. However, little is known about patient’s preferences and expectations for which clinicians handle various aspects of care after primary cancer treatment. Methods: A weighted random sample of newly diagnosed breast cancer patients in the Georgia and Los Angeles SEER registries were surveyed approximately 6 months after diagnosis (expected final N = 2600, 70% current response rate). Patient preferences for which clinician handles the following aspects of care after treatment were ascertained: follow-up mammograms, screening for other cancers, general preventive care, treatment of comorbidities, physical symptoms, emotional symptoms, and reassurance about their breast cancer. Response categories included primary care clinician (PCP), cancer doctors, either or both. The associations between patient demographic and clinical factors with preferences for clinician roles were assessed using multinomial logistic regression. Results: In a preliminary sample (N = 1038), the majority of women preferred to see oncologists for mammograms (63%), other cancer screening (67%) and reassurance about their cancer (75%) and PCPs for general preventive care (80%), comorbid care (85%) and emotional symptoms (67%). Black women (vs. White) were more likely to prefer to see both clinicians for mammograms (OR: 3.7, 95%CI: 2.5, 5.5), screening for other cancers (OR: 2.1, 95%CI: 1.3, 3.2), reassurance about their cancer (OR: 2.1, 95%CI: 1.3, 3.2), and general preventive care (OR: 4.0, 95%CI: 2.1, 7.8). Black and Hispanic women were more likely to prefer to see both for comorbidity care (Black OR: 3.2, 95%CI: 1.6, 6.3; Hispanic OR: 2.6, 95%CI: 1.1, 6.3). Less than a high school education was also associated with a preference for seeing both clinicians for comorbidity care. Conclusions: While patients report clear preferences for which clinicians handle various aspects of their collaborative survivorship care, variation exists by race and education. Targeting these patients to clarify clinician roles may be particularly effective in interventions to improve collaborative cancer care.

Disparities in meeting physical activity guidelines for Asian-Americans in two metropolitan areas in the United States

PurposePhysical activity (PA) levels in Asian-American adults may be lower than other racial or ethnic groups. This analysis tested the hypothesis that Asian-Americans are less likely to meet PA guidelines than other racial or ethnic groups regardless of location of residence. MethodsThe New York City (NYC) Community Health Survey (2010, 2012) and Los Angeles County (LAC) Health Survey (2011) are cross-sectional surveys conducted with similar sampling strategies (NYC: n = 17,462; LAC: n = 8036). Meeting PA guidelines was calculated using self-reported moderate or vigorous minutes per week; multivariable regression models adjusted for demographics, insurance, nativity and language spoken at home. Data were weighted to be representative of their respective geographies. ResultsIn both areas, Asian-Americans had a low prevalence of meeting PA guidelines (NYC: 42.7 [39.2–46.3]; LAC: 55.8 [51.2–60.2]). Other racial or ethnic groups were more likely to meet PA guidelines versus Asian-Americans after adjustment for covariates in NYC (white odds ratio [OR]: 1.35 [1.09–1.68]; black OR: 1.61 [1.28–2.02]; Hispanic OR: 2.14 [1.74–2.62]) and in LAC (white OR: 1.45 [1.13–1.86]; Hispanic OR: 1.71 [1.32–2.22]). ConclusionsAsian-Americans were less likely to meet PA guidelines compared with other racial or ethnic groups in NYC and LAC. Description of cultural and neighborhood-level factors and of types of PA in specific Asian subgroups is needed.

Abstract W MP36: IV tPA Utilization and Outcomes in Asian Americans

Intro: Studies have shown race/ethnic differences in IV tPA utilization and outcomes after acute ischemic stroke (IS). Most studies in the US have examined differences in Black, White, and Hispanic populations. We aimed to examine tPA utilization and outcomes in Asian Americans. Methods: We used administrative claims data on all discharges from nonfederal EDs and acute care hospitals in CA, FL, and NY from 2006 through 2011 (CA and NY) or 2012 (FL). We identified patients with a first-recorded hospitalization for IS using a validated algorithim and included discharge diagnosis of ICH or SAH if treated with tPA to capture cases of hemorrhagic transformation of an infarct. IV tPA was identified by ICD-9-CM procedure code 99.10. We used descriptive statistics to compare rates of IV tPA among different races. We used multiple logistic regression to assess the relationship between race and IV tPA use while adjusting for other demographic characteristics, vascular risk factors, and Elixhauser comorbid conditions. We assessed rates of ICH/SAH and inhospital mortality by race in patients treated with tPA. Results: Among 587,560 IS patients, 63.9% were White, 14.1% Black, 12.5% Hispanic, 4.5% Asian, 0.2% American Indian, and 2.8% other; 2.0% had missing data on race. Mean age was 72 years and 52% were women. Overall 4.8% received IV tPA. tPA use was 5.1% in Whites, 3.9% in Blacks, 3.9% in Hispanics, and 4.7% in Asians. After adjusting for age, gender, insurance status, and comorbidities, tPA use was less likely in non-White patients: Black OR 0.78 (95% CI 0.75-0.81), Hispanic OR 0.78 (95% CI 0.75-0.81), and Asian OR 0.94 (95% CI 0.88-0.995). ICH/SAH after tPA occurred in 16.9% of Asians compared with 11.3% of Whites, 12.2% of Blacks, and 13.6% of Hispanics. In multivariable analysis, Asian race was independently associated with ICH/SAH (OR 1.51; 95% CI 1.29-1.77). In-hospital mortality was also significantly higher in Asians (14.7%) compared to whites (12.6%); OR 1.19 (1.00-1.4). Conclusion: Asian patients less often receive tPA for IS. They also have higher rates of hemorrhage and in-hospital death after tPA. These findings are limited by lack of data on stroke severity, mechanisms, and treatment times. Further studies including these patient characteristics are warranted.

Abstract W P149: Ethnic Disparities In Stroke Related In-Hospital Mortality In Patients With Atrial Fibrillation

Background: Improved strategies are needed to stratify the risk of stroke in atrial fibrillation. While stroke-related mortality is higher in African Americans, it is unclear whether stroke related mortality in patients with atrial fibrillation differs among different ethnicities. We aim to study race/gender disparities in stroke related in-hospital mortality in patients with atrial fibrillation. Method: Data were obtained from the California State Inpatient Database between 2008-2011, using appropriate ICD-9 codes. Frequencies and descriptive analysis adjusting for influence of comorbidities and confounders were utilized. Age and ICD-9 codes for hypertension, diabetes, congestive heart failure and prior stroke were used to calculate the CHADS2 score of patients with atrial fibrillation. A multivariate Cox regression model was used to further explore the relationship. The primary outcome was in-hospital mortality. We hypothesized that higher CHADS2 scores increase the risk of stroke among African Americans due to increased disease burden. Results: Between 2008 and 2011, 18,089 patients with atrial fibrillation had a stroke, 70% were Whites, 5% African Americans, 15% Hispanics and 10% Asians. 57% were females, and 66% of the population were 75 years of age and older. After adjusting for baseline demographics, there was no significant difference in the the odds of in-hospital stroke mortality, with Whites taken as reference (African Americans OR 0.93, 95% CI 0.83-1.05; Hispanics OR 1.02, 95% CI 0.94-1.10; Asians OR 1.07, 95% CI 0.98-1.17). There was no significant difference in the odds of in-hospital stroke mortality between males and females (Males OR 0.97, 95% CI 0.92-1.02). Conclusion: Our results indicate that in a large, statewide database, the in-hospital stroke mortality among the different races with stroke during hospitalization was not significantly different as compared to Whites.

Abstract 24: Race/Ethnic Differences in Microbleed Characteristics and Association of Microbleeds with Poor Outcomes in the ERICH Study

Background: Microbleeds have been reported in up to 60% of patients with primary intracerebral hemorrhage (ICH) and are an important marker of a progressive, small vessel cerebral vasculopathy. The Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study explored the characteristics of microbleeds and their impact on long-term functional outcome. Methods: ERICH is a multi-center prospective study designed to recruit white, black, and Hispanic cases of ICH. At least every 5th ICH patient enrolled undergoes an MRI. All MRIs are interpreted by a core laboratory blinded to clinical data. Results: Among 642 patients with a gradient echo (GRE) sequence, 49% had ≥1 microbleeds (mean 13, median 4). Blacks had the highest rate of microbleeds at 54% compared to 48% for Hispanics, and 42% for whites (overall p=0.046; blacks vs. white p=0.018). There was a significant racial/ethnic difference in the overall rate of microbleeds in lobar locations (79% in whites, 73.5% in blacks, 61% in Hispanics, p&lt;0.0001). A multivariable logistic regression model predicting the presence of microbleeds included hypertension (OR=1.62, p=0.037), severity of white matter disease (12 point scale, 1 point OR=1.36, p&lt;0.0001), elevated white blood cell count (10 3 /μL OR=1.06, p=0.012), and race/ethnicity (overall p value 0.111; compared to white, black OR=1.53, p=0.056; Hispanic OR=1.49, p=0.078). The presence of microbleeds was associated with poor outcome (6 month mRS 4-6, OR=2.21, p=0.001) in a logistic regression analysis that included ICH volume (1 cc OR=1.04, p&lt;0.001), Glasgow Coma Scale score (OR=0.82, p&lt;0.001), intraventricular hemorrhage (OR=1.98, p=0.003), and age (5 year OR=1.21, p&lt;0.001). Conclusions: This study demonstrates substantial differences in microbleed rates across race/ethnicities. This is the first study to report an intermediate microbleed rate among Hispanics relative to white and black ICH cases. In addition to hypertension and leukoaraiosis, our model suggests that inflammation may be an important factor contributing to microbleeds. As a biomarker of progressive vasculopathy and poor outcome, microbleeds may provide a valuable surrogate measure in future studies of therapies targeting optimal approaches to risk factor control.