Hispanic Research Articles

Stroke Death Rates Among Adults Ages 45-64 by Region and Race and Hispanic Origin: United States, 2002-2022.

This Data Brief presents trends in stroke death rates among people ages 45-64, in total and by sex, for 2002 to 2022. Trends are also presented for men and women by region (Northeast, Midwest, South, and West) from 2002 to 2022. For 2022, stroke death rates are presented for men and women by race and Hispanic origin within each region. Mortality data for 2002-2017 are from the National Center for Health Statistics' 1999-2020 Underlying Cause of Death by Bridged-Race Categories and data for 2018-2022 are from the 2018-2022 Underlying Cause of Death by Single-Race Categories. Stroke deaths are for people ages 45-64 and are identified by International Classification of Diseases, 10th Revision underlying cause-of-death codes I60-I69. The four regions of the United States are: Northeast, Midwest, South, and West. The four race and Hispanic-origin groups in this report are: Asian non-Hispanic; Black non-Hispanic; White non-Hispanic, and Hispanic. These groups had at least 20 stroke deaths among men and women in all regions to compute reliable rates. Line trends were evaluated using the National Cancer Institute's Joinpoint Regression Program. Pairwise comparisons were tested using the z test statistic at p < 0.05. After declines between 2002 and 2012, stroke death rates for adults ages 45-64 increased 7% between 2012 (20.2 per 100,000) and 2019 (21.7) and an additional 12% through 2021 (24.4). Throughout the period, the highest stroke death rates for both men and women were in the South and the lowest were in the Northeast. In each region, differences in stroke death rates by race and Hispanic origin were seen, as Black men and women had rates that were at least twice those of all other groups.

CDC: Many teens say they don't receive emotional support, but parents say they do

According to the federal National Health Interview Survey and National Health Interview Survey–Teen, there's a big gap between the emotional support parents think their adolescent children are getting, and the support the teens say they're getting. In 2021–2022, 58.5% of teenagers reported always or usually receiving the social and emotional support they needed. Differences were seen by several demographic characteristics including sex, race and Hispanic origin, sexual or gender minority status, highest parental education level, and family income level. Teenagers who always or usually received support were less likely to report poor or fair health, anxiety or depression symptoms, very low life satisfaction, and poor sleep quality. Parents consistently reported higher perceived levels of their teenager's social and emotional support compared with the teenager's self‐report.

Engaging Students in a Bilingual Service-Learning Health Promotion Project.

Introduction: This service-learning, health promotion project used Leininger's Culture Care Theory to engage Baccalaureate Nursing students in a health promotion initiative specific to Hispanic community members. Methods: Thirty-seven students examined population health data, surveyed Hispanic community members to identify health priorities, and developed a population-specific intervention on diet and risk factors for diabetes. Students created a 5-min script focused on healthy eating plans with recognition of traditional foods associated with the Hispanic culture. Students delivered the script to community members attending an annual Hispanic Heritage Festival. Results: Seventy-six percent of the 488 community participants reported increased knowledge about diabetes risk factors and healthy eating habits. Each student completed a self-reflection on how the project impacted their transcultural skills and reported increased confidence related to engagement and communication with the Hispanic community. Discussion/Significance: Incorporating community-based service-learning into the undergraduate curricula is a powerful educational approach that can enhance students' ability to provide culturally congruent nursing care.

Depression and Diet Quality, US Adolescents and Young Adults: National Health and Nutrition Examination Survey, 2015-March 2020

BackgroundDepression is a common mental health disorder. ObjectiveThe objective of this study was to explore the association between diet quality, as measured by the Healthy Eating Index 2020 (HEI-2020), and depression symptoms among US adolescents and young adults aged 12 to 29 years. DesignThe study design was a cross-sectional secondary data analysis. ParticipantsData from the first 24-hour dietary recall for adolescents and young adults aged 12 to 29 years in the National Health and Nutrition Examination Survey from 2015 to March 2020 (n = 4750) were analyzed. Main outcome measureDepression was defined as a score ≥10 on the Patient Health Questionnaire, reflecting moderate or severe symptoms in the previous 2 weeks. Statistical analyses performedHEI-2020 total (range, 0-100) and component scores were calculated for those with and without depression. Predicted HEI-2020 scores were estimated from linear regression models, adjusting for age, gender, race and Hispanic origin, family income, and seeing a mental health professional in the past year. Statistical analyses accounted for the complex sample design. ResultsThe prevalence of depression among adolescents and young adults was 7.8% (95% CI 6.3% to 9.5%). Total HEI-2020 score was 45.9 (95% CI 45.0 to 46.7) out of 100 on a given day during 2015 to March 2020. Among young people with depression, total HEI-2020 score was lower than among those without depression (41.7 vs 46.2; P < .001). After adjustment for covariates, the difference was attenuated, but remained significant. In adjusted analyses, HEI-2020 component scores were lower for those with depression compared with those without depression for the adequacy components: total fruits (1.4 vs 1.7; P = .03), whole fruits (1.2 vs 1.7; P < .01), total vegetables (2.1 vs 2.6; P < .01), greens and beans (0.8 vs 1.2; P < .01), and total protein foods (3.6 vs 4.0; P = .02) out of a maximum score of 5. There were no statistically significant differences observed for whole grains, dairy, seafood and plant proteins, fatty acids, saturated fats, refined grains, sodium, or added sugars. ConclusionsOverall diet quality is low among young people. Diet quality, especially consumption of fruits, vegetables, and protein foods was lower among young people with depression compared with those without depression.

Understanding Health Care Disparities Based on Medicare Use for Inflammatory and Infectious Eye Diseases.

Inflammatory and infectious eye diseases are an important cause of visual impairment in patients older than 65 years of age. Health care disparities for eye care are present for general eye care. However, there is lack of national data on health disparities regarding eye care use for inflammatory and infectious eye diseases. Our study examines the effect of gender and race on eye care in patients with inflammatory and infectious eye diseases who are equal or greater than 65 years of age. We have used Medicare data to examine the effect gender and race on use of eye care services in patients with inflammatory and infectious eye diseases for 2014 to 2018. Medicare is a national insurance program administered by the government of United States to insure people age 65 years or older. Owing to its high enrollment, those in Medicare are representative of the U.S. population aged 65 and older. We found that females have higher use for Medicare for inflammatory and infectious eye diseases across all races from 2014 to 2018. On examining the effect of race, African Americans have lower use as compared with Whites. People of Asian descent have the highest use, followed by Hispanic people. Health care disparities exist for eye care use for inflammatory and infectious eye diseases for patients 65 years of age and older. Future studies are required to address these disparities to provide equitable eye care. Identification of eye care disparities is the first step to addressing these disparities.

Experiences in Recruitment for Hispanic, Non-Hispanic Black, and Other Non-White Cancer Survivors Through Community Outreach and Other Targeted Approaches

ObjectivesRecruitment of racial/ethnic underserved populations in oncology research is essential to address health disparities. This article presents strategies and lessons learned from community outreach and other approaches for recruiting non-Hispanic Black, Hispanic, and other non-White survivors of cancer into a pilot study that investigated biopsychosocial determinants of health behaviors. MethodsWe critically examined the participant recruitment approaches to explore challenges and successful strategies and develop recommendations for future studies. Direct recruitment strategies included engaging with research staff members’ personal community contacts/liaisons and participating in community outreach events (eg, farmers’ markets, block parties, library events, cancer awareness events). Indirect recruitment strategies included posting and distribution of study flyers in community centers (eg, LIVESTRONG® at the YMCA, churches, libraries), online platforms (eg, FORCE, Survivor Journey website), and invitation letters sent to individuals identified as eligible through a single state cancer registry. ResultsBetween April 2022 and May 2023, among the 64 individuals recruited, 36 were non-Hispanic Black, 25 were Hispanic, and three were American Indian/Alaska Native people. The use of a state cancer registry (64.1%), snowballing/word of mouth (7.8%), and advertisement through an established cancer support organization (ie, FORCE) website (7.8%) were the most effective strategies in this study. ConclusionRecruitment of non-Hispanic Black, Hispanic, and other non-White people into biobehavioral studies through community-engaged research is challenging and requires long-term commitment and engagement with partners from target communities and affiliated organizations. Implication for Nursing PracticeRegistries and community outreach events can build trust for successful enrollment. Using multiple strategies can provide the best opportunities to reach diverse populations and enroll them in cancer-related research studies.

An Empirical Analysis of Avoidable Medicare Payments and Medicare Payment Variations

This study investigates the determinants of average Medicare payments, focusing on the impact of secondary diagnoses, demographic factors, and regional disparities. Our model reveals that major complications and comorbidities (MCCs) significantly increase average Medicare payments compared to less severe complications (CCs), with coefficients of 7674.13 and 1542.67, respectively. Higher percentages of the elderly living in poverty correlate with increased payments, highlighting the influence of social determinants on healthcare costs. Demographic analysis shows that counties with higher populations of Black, Hispanic, Asian, or other races receive higher Medicare payments, indicating potential racial disparities in healthcare access and quality. Political affiliation also plays a role, with Democrat-voting counties incurring higher Medicare costs. Surprisingly, larger populations served correlate with decreased payments, possibly due to cost-containment programs like Medicare’s Competitive Bidding. State-level analysis reveals significant regional variations, with states like Oregon and Wyoming showing higher payments, while Mississippi and Georgia have the lowest. Our findings underscore the complexity of Medicare funding and the need for targeted policy interventions to address health disparities and ensure sustainable healthcare delivery.

Infant Mortality in the United States, 2022: Data From the Period Linked Birth/Infant Death File.

This report presents final 2022 infant mortality statistics by age at death, maternal race and Hispanic origin, maternal age, gestational age, leading causes of death, and maternal state of residence. Trends in infant mortality are also examined. Descriptive tabulations of data are presented and interpreted for infant deaths and infant mortality rates using the 2022 period linked birth/infant death file. The linked birth/infant death file is based on birth and death certificates registered in all 50 states and the District of Columbia. A total of 20,577 infant deaths were reported in the United States in 2022, up 3% from 2021. The U.S. infant mortality rate was 5.61 infant deaths per 1,000 live births, a 3% increase from the rate of 5.44 in 2021. The neonatal mortality rate increased 3% from 3.49 in 2021 to 3.59 in 2022, and the postneonatal mortality rate increased 4% from 1.95 to 2.02. The overall infant mortality rate increased for infants of American Indian and Alaska Native non-Hispanic, White non-Hispanic, and Dominican women in 2022 compared with 2021; changes in rates for the other race and Hispanic-origin groups were not significant. Infants of Black non-Hispanic women had the highest mortality rate (10.90) in 2022, followed by infants of American Indian and Alaska Native non-Hispanic and Native Hawaiian or Other Pacific Islander non-Hispanic (9.06 and 8.50, respectively), Hispanic (4.89), White non-Hispanic (4.52), and Asian non-Hispanic (3.51) women. Mortality rates increased from 2021 to 2022 among preterm (less than 37 weeks of gestation) infants (33.59 to 34.78) and for infants born term (37 to 41 weeks of gestation) (2.08 to 2.18). The five leading causes of infant death in 2022 were the same as in 2021. Infant mortality rates by state for 2022 ranged from a low of 3.32 in Massachusetts to a high of 9.11 in Mississippi.

Changes in First and Second Births to U.S. Teenagers From 2000 to 2022.

This study examines trends in the numbers, percentages, and rates of first and second and higher-order births to teenagers younger than age 20 and for those ages 15-17 and 18-19 by race and Hispanic origin. Data for this analysis are from the National Vital Statistics System birth data files from 2000 and 2022. Analyses are limited to births to females younger than age 20. Changes in the numbers, percentages, and rates of total, first, and second and higher-order teen births from 2000 to 2022 were calculated for all teenagers and for non-Hispanic American Indian and Alaska Native, non-Hispanic Black, non-Hispanic White, and Hispanic teenagers. The number of first teen births declined 67% and the number of second and higher-order teen births declined 79%, while the population of female teenagers increased 7% from 2000 to 2022. The declines were greater for younger teenagers compared with older teenagers. First and second and higher-order teen birth rates declined 69% and 80%, respectively. Similar declines were found for each race and Hispanic-origin group. In 2000 and 2022, first and second and higher-order birth rates were lowest among White teenagers. First birth rates were highest among Hispanic teenagers in 2000 and for Hispanic and non-Hispanic American Indian and Alaska Native teenagers in 2022. In 2000, second and higher-order birth rates were highest for non-Hispanic Black and Hispanic teenagers; second and higher-order birth rates were more similar by race and Hispanic-origin group in 2022.

Telehealth Uptake Among Hispanic People During COVID-19: Retrospective Observational Study.

The Hispanic community represents a sizeable community that experiences inequities in the US health care system. As the system has moved toward digital health platforms, evaluating the potential impact on Hispanic communities is critical. The study aimed to investigate demographic, socioeconomic, and behavioral factors contributing to low telehealth use in Hispanic communities. We used a retrospective observation study design to examine the study objectives. The COVID-19 Research Database Consortium provided the Analytics IQ PeopleCore consumer data and Office Alley claims data. The study period was from March 2020 to April 2021. Multiple logistic regression was used to determine the odds of using telehealth services. We examined 3,478,287 unique Hispanic patients, 16.6% (577,396) of whom used telehealth. Results suggested that patients aged between 18 and 44 years were more likely to use telehealth (odds ratio [OR] 1.07, 95% CI 1.05-1.1; P<.001) than patients aged older than 65 years. Across all age groups, patients with high incomes were at least 20% more likely to use telehealth than patients with lower incomes (P<.001); patients who had a primary care physician (P=.01), exhibited high medical usage (P<.001), or were interested in exercise (P=.03) were more likely to use telehealth; patients who had unhealthy behaviors such as smoking and alcohol consumption were less likely to use telehealth (P<.001). Male patients were less likely than female patients to use telehealth among patients aged 65 years and older (OR 0.94, 95% CI 0.93-0.95; P<.001), while male patients aged between 18 and 44 years were more likely to use telehealth (OR 1.05, 95% CI 1.03-1.07; P<.001). Among patients younger than 65 years, full-time employment was positively associated with telehealth use (P<.001). Patients aged between 18 and 44 years with high school or less education were 2% less likely to use telehealth (OR 0.98, 95% CI 0.97-0.99; P=.005). Results also revealed a positive association with using WebMD (WebMD LLC) among patients aged older than 44 years (P<.001), while there was a negative association with electronic prescriptions among those who were aged between 18 and 44 years (P=.009) and aged between 45 and 64 years (P=.004). This study demonstrates that telehealth use among Hispanic communities is dependent upon factors such as age, gender, education, socioeconomic status, current health care engagement, and health behaviors. To address these challenges, we advocate for interdisciplinary approaches that involve medical professionals, insurance providers, and community-based services actively engaging with Hispanic communities and promoting telehealth use. We propose the following recommendations: enhance access to health insurance, improve access to primary care providers, and allocate fiscal and educational resources to support telehealth use. As telehealth increasingly shapes health care delivery, it is vital for professionals to facilitate the use of all available avenues for accessing care.

Socioeconomic and Demographic Disparities in Immunotherapy Utilization for Advanced Kidney and Bladder Cancer

ObjectivesImmunotherapy (IO) drugs have been increasingly utilized in locally advanced or metastatic clear cell renal cell carcinoma (ccRCC) and urothelial carcinoma of the bladder (UC). Multiple trials have demonstrated clear survival benefit, however, there are often barriers to access for these advanced therapies which has been demonstrated in other non-urologic malignancies. The goal of this study was to assess socioeconomic and demographic factors associated with the receipt of IO for advanced ccRCC and UC. Materials and methodsWe queried the National Cancer Database (NCDB) for patients with stage IV ccRCC and UC. The study period was 2015 to 2020 for ccRCC (FDA approval date of IO) and 2017 to 2020 for UC (FDA approval date of broadened indication for IO, initial limited approval in 2016). The primary outcome of interest was receipt of IO therapy using multivariable logistic regression, adjusting for relevant socioeconomic and demographic variables. ResultsWe identified 15,926 patients with stage IV ccRCC and 10,380 patients with stage IV UC of which 5,419 (34.0%) and 2,231 (21.5%) received IO therapy, respectively. IO utilization increased with each successive year. In both malignancies, treatment at a non-academic facility, education level, income, and insurance were independently associated with IO utilization. For ccRCC, black (OR = 0.77, 95% CI, 0.64–0.93, P = 0.009) and Hispanic race (OR = 0.73, 95% CI, 0.61–0.86, P = 0.006) were each associated with decreased IO utilization but there were no independent associations between race and receipt of IO in patients with UC. ConclusionsIn the era of FDA-approved IO therapy for advanced ccRCC and UC, this national cohort analysis suggests that IO utilization is increasing over time, but significant disparities exist based on income, education, and insurance status in both malignancies. Additionally, patients treated at non-academic facilities were less likely to receive IO therapy for these specific genitourinary malignancies. In ccRCC, additional disparities were seen black and Hispanic races which each were associated with lower odds of IO receipt. Identifying strategies to mitigate these differences and provide equitable access to IO therapy is of imperative need.

Perceived Social and Emotional Support Among Teenagers: United States, July 2021-December 2022.

This report uses data from the National Health Interview Survey and National Health Interview Survey-Teen to estimate the prevalence of self-reported social and emotional support among teenagers ages 12-17 years, describe differences in health and well-being outcomes by level of support received, and compare teen- and parent-reported estimates for social and emotional support overall and by selected teen and family characteristics. The percentage of teenagers who self-reported always or usually receiving social and emotional support by selected demographic characteristics, and potential differences in health outcomes by level of support, were estimated using data from the National Health Interview Survey-Teen collected from July 2021 through December 2022. In addition, data from the same time period from the National Health Interview Survey were used to compare parent-reported estimates of their teenager's social and emotional supports with the teenager's self-reported estimates. In 2021-2022, 58.5% of teenagers reported always or usually receiving the social and emotional support they needed. Differences were seen by several demographic characteristics including sex, race and Hispanic origin, sexual or gender minority status, highest parental education level, and family income level. Teenagers who always or usually received support were less likely to report poor or fair health, anxiety or depression symptoms, very low life satisfaction, and poor sleep quality. Parents consistently reported higher perceived levels of their teenager's social and emotional support compared with the teenager's self-report.

The Effects of Stigma Against HIV and Tuberculosis on Healthcare-Seeking Behavior Among Tibetan Refugees in Dharamshala, India

Patients who experience more severe symptoms of Ulcerative Colitis are associated with having greater socioeconomic challenges or higher social barrier scores (SBS). Inflammatory Bowel Disease describes two conditions, Ulcerative Colitis and Crohn's Disease, characterized by gastrointestinal (GI) tract inflammation. Ulcerative Colitis is a type of Inflammatory Bowel Disease (IBD) characterized by large intestine inflammation. Research has shown that multiple social determinants of health (SDOH) hinder achieving desirable health outcomes in the Inflammatory Bowel Disease community. These include financial strains, poor health literacy, and lack of access to education. Additionally, social barriers disproportionately affect non-Hispanic Black and Hispanic people.

The Effect of Socioeconomic Barriers on Health Outcomes in Patients with Inflammatory Bowel Disease

Patients who experience more severe symptoms of Ulcerative Colitis are associated with having greater socioeconomic challenges or higher social barrier scores (SBS). Inflammatory Bowel Disease describes two conditions, Ulcerative Colitis and Crohn's Disease, characterized by gastrointestinal (GI) tract inflammation. Ulcerative Colitis is a type of Inflammatory Bowel Disease (IBD) characterized by large intestine inflammation. Research has shown that multiple social determinants of health (SDOH) hinder achieving desirable health outcomes in the Inflammatory Bowel Disease community. These include financial strains, poor health literacy, and lack of access to education. Additionally, social barriers disproportionately affect non-Hispanic Black and Hispanic people.

The Impact of Race and Socioeconomic Status on Transplant Accessibility and Outcomes: A Literature Review

Due to the high demand but low supply of donor organs, issues of organ allocation arise as patients on the waitlist are prioritized to determine who gets the next available organ. This literature review will review articles related to the racial and socioeconomic disparities in organ transplants and how they affect transplant access and outcomes. Patients of Black and minority (Hispanic and Native American) races had significantly lower rates of organ transplants as well as worse transplant outcomes including graft failure and post-operative complications (Bryce et al., 2009). Similarly, patients from lower socioeconomic status (SES) backgrounds (i.e. poverty or lack of private/commercial insurance) had lower rates of organ transplant surgeries but there has been no significant research done on the effect that SES specifically has on transplant outcomes. Further directions for future research should be investigating the role of SES on transplant outcomes. The findings of this literature review highlight the need for measures to make organ allocation more equitable; this can be done by factoring in the social determinants of health (SDOH) when prioritizing potential organ recipients to compensate for race and SES decreasing accessibility to transplants.

Urology HEIRS: A Feasibility and Acceptability Study for Video-Based Research on Physician-Family Communication in Pediatric Urology Visits.

Patient- and family-centered communication is essential to health care equity. However, less is known about how urologists implement evidence-based communication and dynamics involved in caring for diverse pediatric patients and caregivers. We sought to evaluate the feasibility and acceptability using video-based research to characterize physician-family communication in pediatric urology. We assembled a multidisciplinary team to conduct a multiphase learning health systems project and establish the Urology HEIRS (Health Experiences and Interactions in Real-Time Studies) corpus for research and interventions. This paper reports the first phase, evaluating feasibility and acceptability based on consent rate, patient diversity, and qualitative identification of verbal and paraverbal features of physician-family communication. We used applied conversation analysis methodology to identify salient practices across 8 pediatric urologists. We recruited 111 families at 2 clinic sites; of these 82 families (N = 85 patients, ages 0-20 years) participated in the study with a consent rate of 73.9%. The racial/ethnic composition of the sample was 45.9% non-Hispanic White, 30.6% any race of Hispanic origin, 16.5% non-Hispanic Black/African American, 4.7% any ethnicity of Asian/Asian American, and 2.3% some other race/ethnicity; 24.7% of families used interpreters. We identified 11 verbal and paraverbal communication practices that impacted physician-family dynamics, including unique challenges with technology-mediated interpreters. Video-based research is feasible and acceptable with diverse families in pediatric urology settings. The Urology HEIRS corpus will enable future systematic studies of physician-family communication in pediatric urology and provides an empirical basis for specialty-specific training in patient- and family-centered communication.

Associations between mental health & substance use treatment and alcohol use progression and recovery among US women drinkers.

Alcohol use has profound public health impact on women; however, modifiable factors that may influence alcohol use progression/recovery, including health service utilization, are understudied in women. To investigate the association between mental health (MH) and substance use (SU) treatment with alcohol use progression and recovery among women who currently use alcohol or have in the past. This study is a secondary data analysis of prospective data from waves 1 (2001-2002) and 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; a US-nationally representative sample of adults). The analytic sample was limited to women who reported past or current alcohol use at wave 1 (N = 15,515). Latent transition analysis (LTA) examined whether receiving SU/MH treatment in the year prior to wave 1 was associated with transitioning between three empirically-derived stages of alcohol involvement (no, moderate, and severe problems classes), between Waves 1 and 2 adjusting for possible confounders using propensity score weight. Compared to White female drinkers, female drinkers who were from Black, Hispanic, or other races were less likely to receive SU/MH treatment (p-values ≤. 001). SU/MH treatment in the year prior to wave 1 was associated with transitioning from the moderate problems class to the no problems class between Waves 1 and 2 (p-value = .04). Receipt of SU or MH treatment among women, was associated with a higher likelihood of remission from moderate alcohol use problems to no problems over time. Future research, including investigation into treatment characteristics (e.g., frequency, duration, type) should further explore why women initially experiencing severe alcohol use problems did not experience similar remission.

Patient characteristics associated with delayed time to adjuvant chemotherapy among women treated for stage I-IIIA breast cancer.

For patients with breast cancer, delays in chemotherapy initiation have been adversely associated with recurrence and survival. We evaluated patient-level factors associated with delayed chemotherapy initiation, from both diagnosis and surgery, in a community-based cohort of women with early-stage breast cancer. For the Optimal Breast Cancer Chemotherapy Dosing study, we identified a cohort of 34,109 women diagnosed with stage I-IIIA breast cancer at two U.S. integrated healthcare delivery systems between 2004 and 2019. We used logistic regression to calculate odds ratios (OR) and 95% confidence intervals (CI) to identify patient factors associated with delays in chemotherapy initiation after diagnosis (≥90 days) and surgery (≥60 days). Among 10,968 women receiving adjuvant chemotherapy, 21.1% experienced delays in chemotherapy initiation after diagnosis and 21.3% after surgery. Older age, non-Hispanic Black and Hispanic race and ethnicity, and ER+ and/or PR+ disease were associated with increased likelihood of delays to chemotherapy initiation after diagnosis and surgery. People diagnosed in 2012-2019 (vs. 2005-2011), with a higher grade and larger tumor size were less likely to experience delays. Other factors were associated with a higher likelihood of delays specifically from diagnosis (earlier stage, mastectomy vs. breast-conserving surgery), or surgery (higher comorbidity, increased nodal number). Women diagnosed with breast cancer who were at highest risk of progression and recurrence were less likely to experience delays in chemotherapy initiation after diagnosis and surgery. Understanding reasons for chemotherapy delays beyond patient factors may be potentially important to reduce risk of breast cancer recurrence and progression.

Assessing national trends in indications for pediatric total thyroidectomy

PurposeThe most common indications for total thyroidectomy (TT) in children are malignancy and thyrotoxicosis due to Graves' disease (GD). However, the incidence of patients with GD among patients undergoing TT is unknown. This study aims to examine trends in pediatric TT. Materials and methodsThe US Agency for Health Research and Quality Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID) was queried to identify patients who underwent TT between 1997 and 2019. Weighted national estimates were obtained. Statistical analysis was completed using univariate logistic regression and one-sided Mann-Kendall Test. ResultsAn estimated 4803 pediatric patients underwent TT within the study years. GD was the indication in 25 % of cases. Mann-Kendall testing showed a trend toward an increasing proportion of TT for GD without reaching statistical significance (z = 1.3609, S = 12, p = 0.0688). Statistically significant univariate associations were found among those who underwent thyroidectomy for GD compared to other indications, as they were more likely to be female (β = 0.286, 95 % CI [0.058, 0.514], p = 0.014), Black, or Hispanic (β = 1.392 [1.064, 1.721], p < 0.001; and β = 0.562 [0.311, 0.814], p < 0.001, respectively). Additionally, they were less likely to have private insurance (β = −0.308 [−1.076, −0.753], p = 0.002) and more likely to live in a ZIP code associated with a median household income below the 50th percentile (β = 0.190 [0.012, 0.369], p = 0.036). The associations with the female sex, Black race, and Hispanic race persisted in multivariate analysis. ConclusionGD appears to be an increasingly prevalent indication for TT. Patient characteristics differ from those who undergo TT for other diagnoses.

Using Microeconomic Spending Traits to Inform Trends in Utilization of Cosmetic Procedures by Race and Ethnicity.

Cosmetic plastic surgery in the United States is underutilized by African American and Hispanic populations compared with their White and Asian counterparts. This study evaluated whether microeconomic spending traits as a representation of financial stability can inform trends in cosmetic procedure volumes by racial group. Annual volumes for the top five cosmetic surgical and cosmetic minimally invasive procedures by racial/ethnic group from 2012 to 2020 were collected from the American Society of Plastic Surgeons' annual reports. Factor analysis was used to calculate inflexible and flexible consumer spending by racial/ethnic groupings from the US Bureau of Labor Statistics' consumer expenditure data. All four factors were calculated across US Bureau of Labor Statistics-defined racial/ethnic groupings and standardized so they could be interpreted relative to each other. Compared with the other groupings, the White/Asian/other grouping spent significantly more on average for inflexible consumer spending (P = 0.0097), flexible consumer spending (P < 0.0001), cosmetic surgical procedures (P < 0.0001), and cosmetic minimally invasive procedures (P = 0.0006). In contrast, African American people spent significantly less on average for all four factors (all P < 0.01). For Hispanic people, values were significantly less on average for flexible consumer spending (P = 0.0023), cosmetic surgical procedures (P < 0.0001), and cosmetic minimally invasive procedures (P = 0.0002). This study demonstrates that inflexible and flexible consumer spending follow trends in utilization of cosmetic surgical and minimally invasive procedures by racial/ethnic groups. These microeconomic spending inequities may help further contextualize the racial/ethnic variation in access to cosmetic surgery.