Hispanic Research Articles

Risk Factors for Pediatric Intracranial Neoplasms in the Kids’ Inpatient Database

Introduction: In children and adolescents, brain and central nervous system (CNS) tumors are the leading types of cancers. Past studies have found differing rates of intracranial cancers among races and identified additional cancer risk factors. This study aimed to see if these differences can be substantiated with further investigation of the latest version (2019) of the Kids’ Inpatient Database (KID). Methods: A total of 7,818 pediatric patients <21 years old in KID with ICD-10 codes consisting of malignant neoplasms of the brain, brainstem, and cerebral meninges (C700, C709–C719) were queried. Modifiable risk factors evaluated include: hospital region, insurance type, hospital city size, the average income of patient zip code, and location/teaching status of a hospital. Non-modifiable risk factors were race and sex at birth. Dependent variables were tested in Excel and GraphPad Prism 9 using a χ2 test with Yates’ continuity correction and Tukey’s one-way and two-way ANOVAs. Results: Mortality rates of females (2.88%) compared to males (1.99%) were significant (p < 0.05). Mortality was (4.17%) in black patients compared to (1.68%) for white (p < 0.0001), Hispanic mortality (2.95%) compared to white (p < 0.01), and mortality of Asian/Pacific Islander (3.86%) compared to white (p < 0.01). Black patients had significantly higher mortality than white, Hispanic, Asian/Pacific Islander, Native American, and other races overall (p < 0.01). There was no significant difference in the mortality rates between children’s hospitals and large hospitals for any race. After accounting for patient race, mortality was still not significantly different for patients with Medicaid insurance compared to non-Medicaid insurance types. Of the children treated at children’s hospitals, the most transferred in from outside hospitals were Native American (20.00%) followed by Asian/Pacific Islander (15.09%) then Hispanic patients (13.67%). A significant difference between races was also seen regarding length of stay (p < 0.001) and number of charges (p < 0.001). Conclusion: These findings confirm prior studies suggesting gender and race are significant factors in mortality rates for children with intracranial neoplasms. However, the findings do not identify the root causes of these discrepancies but may serve as an impetus for clinicians, healthcare administrators, and governmental leaders to improve national resource allocation to better care for pediatric patients with intracranial neoplasms.

Solidifying the minority high school student pathway: evidence from the health professions recruitment and exposure program.

The objective of this report is to provide longitudinal insights on the impact of a health professions exposure program for high school students of underrepresented backgrounds in medicine. Medical students at the University of Chicago reviewed data from their chapter of the Health Profession Recruitment and Exposure Program (HPREP) from 2016-2021 to discover trends in enrollment. This data is documented in the context of the program's mission to increase awareness of health disparities, the success of prominent alumni, and recent community efforts post-COVID-19 pandemic. Two hundred and ninety-nine high school students participated in the University of Chicago HPREP program between 2016 and 2021. Participants ranged in age from 12 to 18 years (mean = 16, SD = 1) and 74% (n = 222) were female students. Of 252 respondents, 58% (n = 147) identified as Black or African American, 31% (n = 77) identified as Latinx or of Hispanic origin, and 10% (n = 24) identified as another race or as bi-racial. Ten or fewer black male students participated in the program every year, including the 2020-2021 year in which 61 students participated. HPREP has played an important role in shaping the face of health care, especially in Chicago. The data suggests significant increases in the number of underrepresented minority women becoming physicians and serving Chicago communities in the next decade. Pathway programs for underrepresented students in medicine should be strategic in recruiting and educating future health professionals based on future workforce needs.

Hypertension Prevalence and Related Risk Factors Among Mexican American Adults Are Increasing: National Health and Nutrition Examination Survey 1999 to 2018.

Acculturation affects hypertension prevalence among Hispanic people, but there have been no recent analyses specifically focused on Mexican American (MA) people. We sought to determine age-adjusted hypertension prevalence, abdominal obesity, and acculturation trends among MA adults and non-Hispanic White adults. Data from the NHANES (National Health and Nutrition Examination Survey) were analyzed in 2-year increments to observe trends in hypertension and risk factors (age, sex, body mass index, smoking status, abdominal obesity, waist-to-height ratio (WHtR), education, and income). Acculturation was based on three commonly used measures. The sample included 30 920 adults. Age-adjusted hypertension prevalence is higher in MA adults (52.7%) than White adults (48.3%). Hypertension risk factors-age, obesity prevalence, WHtR, acculturation-all significantly increased among MA adults, while smoking declined. Higher acculturation scores increased hypertension likelihood (odds ratio [OR], 1.44 [95% CI, 0.91-1.97]) for MA adults compared with those with lower acculturation scores. White adults with elevated WHtR >0.5 had a 40% higher risk of hypertension than those with WHtR <0.5, but among MA adults, elevated WHtR did not increase risk for hypertension. There was a significant increase in hypertension prevalence among MA adults from 2003 to 2018 at an average biennial rate of 2.23%. There was no change in hypertension prevalence among White adults from 1999 to 2018. Over 20 years of NHANES, more highly acculturated MA adults were at greater risk for hypertension, despite declines in smoking and controlling for age, sex, obesity status, education, and income. Finding ways to promote more traditional lifestyle and eating habits for MA adults could be a beneficial approach to reducing hypertension risk factors in this population.

Barriers to resection following neoadjuvant chemotherapy for resectable pancreatic adenocarcinoma: A national and local perspective.

Neoadjuvant chemotherapy (NAC) use for pancreatic ductal adenocarcinoma (PDAC) has increased, but some patients never get resection following NAC. Data from January 2012 to December 2019 for all clinically resectable patients across two health networks were utilized, as well as data from the ACS NCDB registry. Univariate testing, multivariable logistic regression, and survival analyses were employed to evaluate failure to resection after neo-adjuvant chemotherapy. Of the 10 007 registry patients eligible for resection, the resected group was younger (64.6 vs. 69.5 years; p < 0.001) and had a slightly lower mean comorbidity index (0.41 vs. 0.45; p < 0.001) than the nonsurgical group. The nonsurgical group was composed of a higher percentage of Black and Hispanic patients (17.5 vs. 13.1%; p < 0.001). After adjusting for age and comorbidities, the factors associated with decreased probability of resection after NAC were evaluation at a community hospital (OR 2.4), Black or Hispanic race (OR 1.6), areas of increased high school drop-out rates (OR 1.4), and lack of private health insurance (OR 1.3). The median overall survival for nonsurgery was markedly worse than the surgical cohort (10.6 vs. 26.6 months; p < 0.001). The most frequent reasons for a lack of definitive resection were operative upstaging to unresectable (39.6%), patient preference (14.5%), progression on NAC (13.2%), deconditioning or comorbidity severity (12.5%), and nonreferral to a surgeon (8.8%). Racial, economic, and educational disparities have a considerable influence on the successful completion of a neoadjuvant approach for resectable PDAC. A comprehensive closed or highly collaborative/communicative multidisciplinary neoadjuvant program is optimal for treatment success and completion.

Cervical Cancer Screening Rates Among Rural and Urban Females, From 2019 to 2022

Little nationally representative research has examined Papanicolaou testing rates from before the pandemic in 2019 through the COVID-19 pandemic in 2022. Papanicolaou testing rates among rural females are a concern as they have historically had lower screening rates than their urban counterparts. To examine the receipt of a Papanicolaou test in the past year among US females overall and females residing in rural and urban areas in 2019, 2020, and 2022. This repeated cross-sectional study used data from 3 years of the Health Information National Trends Survey (HINTS), a nationally representative survey that asks respondents about cancer screenings, sources of health information, and health and health care technologies. Study participants were females aged 21 to 65 years. Individuals who received a Papanicolaou test more than 1 to 3 years prior to a HINTS interview were excluded as they were likely not due for a Papanicolaou test. Survey year (2019, 2020, and 2022) and rural or urban residence were the main exposure variables. Self-reported receipt of a Papanicolaou test within the past year. Among the 188 243 531 (weighted; 3706 unweighted) females included in the analysis, 12.5% lived in rural areas and 87.5% in urban areas. Participants had a mean (SE) age of 43.7 (0.27) years and were of Hispanic (18.8%), non-Hispanic Asian (5.2%), non-Hispanic Black (12.2%), non-Hispanic White (59.6%), or non-Hispanic other (4.1%) race and ethnicity. In 2022, unadjusted past-year Papanicolaou testing rates were significantly lower among rural vs urban residents (48.6% [95% CI, 39.2%-58.1%] vs 64.0% [95% CI, 60.0%-68.0%]; P < .001). Adjusted odds of past-year Papanicolaou testing were lower in 2022 than 2019 (odds ratio, 0.70; 95% CI, 0.52-0.95; P = .02). This repeated cross-sectional study found that past-year Papanicolaou testing rates were lower in 2022 than 2019, pointing to a need to increase access to screenings to prevent an uptick in cervical cancer incidence. Rural-vs-urban differences in 2022 indicate a need to specifically target rural females.

Impact of cardiac arrhythmias on in-hospital mortality in patients with cytokine release syndrome: Insights from National Inpatient Sample.

e24017 Background: Cytokine release syndrome (CSR) is a pervasive inflammatory response characterized by elevated body temperature and multi-organ dysfunction. This syndrome is linked to chimeric antigen receptor (CAR)-T cell therapy, various immunotherapies, or haploidentical hematopoietic cell transplantation (HCT). It can manifest as a fever, fatigue, headache, rash, diarrhea, arthralgia, and myalgia. In some cases, it can progress to hypotension, hypoxia, and an uncontrolled systemic inflammatory response leading to circulatory collapse, pulmonary edema, renal damage, and multi-organ failure. Cardiac evaluation in the context of CSR is crucial for assessing these manifestations, but little is known about the arrhythmias associated with this therapy, and there is limited information in the literature. Methods: A retrospective study using the National Inpatient Sample to identify patients diagnosed with CRS, and the arrhythmias they experienced during their hospitalizations between January and December 2020. The primary endpoint was the incidence of various arrhythmias. Furthermore, Independent predictors of in-hospital mortality were analyzed, with p values, adjusted odds ratios (aOR) and confidence intervals (CI) calculated for each variable. Results: A total of 4675 patients were diagnosed with CRS in 2020, 39% of whom were females. The mortality rate of patients with CRS was 22%. In addition, the mortality rate of patients who developed arrhythmias was 43% while that of patients who did not was 17% (p &lt; 0.01). The mean age was higher in the arrhythmia cohort compared with the non-arrhythmia cohort (70 vs 60.7 years, p &lt; 0.01). Predictive factors associated with increased mortality included development of arrhythmias, age, hispanic race, asian or pacific islander race, obesity, previous myocardial infarction, and electrolyte abnormalities with an aOR of 2.22 (P &lt; 0.01, CI 1.51-3.28), 1.03 (P &lt; 0.01, CI 1.01-1.05), 1.85 (P = 0.04, CI 1.02-3.34), 2.57 (P = 0.014, CI 1.02-3.34), 1.72 (P = 0.018, CI 1.09-2.69), 3.26 (P = 0.008, CI 1.36-7.8), and 4.19 (P &lt; 0.01, CI 2.7-6.4) respectively. Female sex was found to be protective against mortality with an aOR of 0.5 (P = 0.004, CI 0.31-0.8). Conclusions: Our study reveals that developing arrhythmias is more common in older patients with CRS. Patients diagnosed with arrhythmias during their hospitalization experienced poorer outcomes. Adjusted predictors of mortality include the development of arrhythmias during hospitalization, age, hispanic race, asian or pacific islander race, obesity, previous myocardial infarction, and electrolyte imbalances. Additionally, female sex was found to be a protective against mortality. Given these findings, physicians should strive to be more vigilant when treating patients with CRS who have any of these predictors of mortality until further data is available.

The impact of COVID-19 and missed diagnosis of breast cancer.

1118 Background: To evaluate the impact of COVID-19 pandemic on breast cancer diagnosis based on age, race, and regions within the US. Methods: Data on breast cancer incidence were obtained from the United States Cancer Statistics (USCS) program from 2001-2020. SEER*Stat 8.4.1.2 and Joinpoint regression program 5.0.2 were used to calculate estimated and actual incidence rates per 100,000 females. Rates were age-adjusted as appropriate. We compared actual breast cancer incidence rates in the year 2020 to estimated rates based on trends from 2001-2019 with sub-analyses for age, race, and region. Results: From 2001 to 2019, there were 4,005,763 identified cases of breast cancer in the United States. In 2019, prior to the pandemic, the incidence rate of breast cancer was 162.87 per 100,000 in females in the US. Based on the data from 2001 to 2019, breast cancer increased by 1.32% per year (p&lt;0.001). Using these prior trends, it was expected that the incidence of breast cancer to be 165.02 per 100,000 adults (265,206 total cases) in 2020. However, the reported incidence was only 147.77 per 100,000 (237,471). Thus, there were 10.46% (27,735) less breast cancer cases than expected. The missed diagnosis rate was more pronounced in older age groups with 15.89%, 14.75%, and 13.27% cases missed for the age groups 85+, 80-84, and 70-74 respectively. Based on racial and ethnic groups, we found that Hispanic females had the greatest number of missed cases at 13.04% compared to 12.68%, 10.57%, and 8.94% of Non-Hispanic Asians and Pacific Islander (NHAPI), Non-Hispanic White (NHW), and Non-Hispanic Black (NHB) females respectively. The discrepancy between expected and actual number of cases by U.S. region ranged from the highest in the Northeast (11.90%) followed by 11.83%, 10.60%, and 9.49% in the West, South, and Midwest regions respectively. An intersectionality analysis showed that 40–44-year-old Hispanic females residing in the Midwest region had the largest discrepancy at 27.01%. Conclusions: The reported breast cancer cases significantly declined during the pandemic. Older age, Hispanic race and ethnicity, and those residing in the Northeast region had the greatest number of missing cases. As breast cancer is the most common cancer in the United States, more mitigating factors are needed to improve the access to care for patients in these at-risk groups to improve detection of breast cancer and its associated mortality.

Pulmonary blastoma: An NCDB analysis of demographic and socioeconomic factors.

e20069 Background: Pulmonary blastoma (PB) is a rare sarcomatoid carcinoma classified as a non-small cell lung cancer with a poor prognosis and no standard treatment. This malignancy exhibits glandular proliferation with a morular component resembling embryonic development. Leading PB treatment favors surgical resection with concurrent chemotherapy. However, radiation is recommended for inoperable tumors. Further analysis of diagnostic trends may provide information about the epidemiology of PB. The National Cancer Database (NCDB) was analyzed to establish the demographic factors in diagnosed patients. Methods: A retrospective cohort study from 2004 to 2020 was conducted using the NCDB. 146 patients were identified with a histologically confirmed diagnosis of PB (ICD-O-3 code 8972). Race, gender, Hispanic origin, urban/rural residence, insurance coverage, treatment approaches, and mean survival rates were analyzed via descriptive statistics. Regression analysis was performed to examine incidence trends. Results: 146 patients diagnosed with PB were identified in the NCDB, where the incidence rate of diagnoses strongly declined annually (R² = 0.079). The average age of diagnosis was 50 years (SD = 26, range = 1-90 years), with women (56%) more likely to be affected than men (44%). The majority of patients identified as White (80%) and non-Hispanic (88%), lived in metropolitan counties with a population greater than 1 million (58%), and were privately insured (45%). The top primary sites of diagnoses were the upper (38%) and lower (28%) lobe of the bronchus or lung. For patients who did not receive palliative care (93%), many received surgery (75%) as their primary treatment. Within this group, chemotherapy and radiation therapy were also chosen as treatment options (48% and 27%, respectively). The majority of individuals (66%) had a Charlson-Deyo comorbidity score of 0. The survival rates were 58% at two years, 49% at five years, and 34% at ten years. The mean survival was also found to be 86 months. Conclusions: To the best of our knowledge, this is the first NCDB analysis on pulmonary blastoma and helps provide insight on a previously understudied topic. Results demonstrated that the majority of PB patients are non-Hispanic White females, who were primarily diagnosed at the upper lobe of the bronchus or lung. These findings confirmed similar descriptions from other databases and earlier case reports. This is the first time the socioeconomic factors of PB patients have been described in the literature: PB patients typically do not receive palliative care and choose to undergo surgery as their primary treatment. Further research is indicated to provide a greater insight on the effects of demographic/socioeconomic factors on diagnostic criteria, chosen treatments, and overall survival rates of patients with PB.

Clinical factors associated with response to neoadjuvant chemotherapy in women of Hispanic origin diagnosed with early-stage TNBC or HER2+ breast cancer in the United States.

e12535 Background: Neoadjuvant chemotherapy (NACT) has been strongly recommended for patients diagnosed with TNBC or HER2+ breast cancer. Hispanic populations are composed of a heterogenous group that include different racial and national backgrounds. This may account for differences in response to NACT. The aim of this study is to explore the factors associated with chemosensitivity among Hispanic women with early-stage TNBC or HER2+ breast cancer in the United States. Methods: This retrospective cohort study queried data from the National Cancer Database between 2010 and 2020 for women diagnosed with early-stage TNBC or HER2+ breast cancer who received NACT and identify as Hispanic (Mexican, Puerto Rican, Cuban, South or Central American and Dominican Republic). Patients were divided into two groups based on their response to NACT: sensitive (pTNM stage &lt; cTNM, including ypT0N0) and refractory (pTNM stage ≥ cTNM stage). Using chi-square, socio-demographic and clinical factors associated with response to NACT were identified. Significant variables (p&lt;0.05) were included in the multivariate logistic regression model predicting their response to NACT. Results: This study included N= 1,225 Hispanic women who met the inclusion criteria, 48.8% were Mexican, and 30.5% were from the Caribbean (Cuba, Puerto Rico, and Dominican Republic and 20.7% were from Central or South America). Within the overall group, n=769 (62.8%) were deemed sensitive to NACT, while n=456 (37.2%) were considered refractory. Significant variables associated with chemosensitivity at the multivariate level included age, tumor subtype, cN stage, and the use of multiagent NACT. Hispanic patients &gt;70 years were less likely to respond to NACT (OR 0.57 95% CI 0.35-0.94, p-value=0.027). Meanwhile, patients diagnosed with TNBC were more likely to respond to NACT compared to HER2+ tumors (OR 2.0 95%CI 1.6-2.6, p-value&lt;0.001). Patients with negative lymph nodes were 1.6 times more likely to have chemosensitive response compared to those with positive lymph nodes who tend to have more refractory disease (95%CI 1.6-2.6, p-value&lt;0.001). Patients receiving single agent were 63% less likely to respond than multiagent NACT (95%CI 0.23-0.61, p-value&lt;0.001). No major chemosensitive differences were found between individual Hispanic origin. Conclusions: In our nationwide Hispanic cohort, youngerage, TNBC, and cN0 were found to be significant predictors of neoadjuvant chemosensitive response in early-stage Breast Cancer. Further prospective inclusive studies are warranted to better delineate the heterogeneity in response to NACT among individual self-reported Hispanic ethnicities within the United States.

Mixed liposarcoma: A study of socioeconomic and demographic factors.

e23527 Background: Mixed Liposarcoma (LS) is an extremely rare subtype of LS, with characteristics often spanning 2 or more of the other LS subtypes such as myxoid, round cell, or well-differentiated LS. To date, the cytologic features of this uncommon tumor has yet to be described. Analyzing trends in diagnoses may produce valuable information about its epidemiology. The National Cancer Database (NCDB) was analyzed to uncover the demographic factors in patients diagnosed with mixed LS. Methods: A retrospective cohort study from 2004 to 2020 was conducted using the NCDB. 199 patients were found with a histologically confirmed diagnosis of mixed LS (ICD-8855-3). Race, gender, Hispanic origin, type of treatment facility, insurance coverage, and distance from patient residence to treatment facility were analyzed via descriptive statistics, and trends in incidence were interpreted using regression analysis. Results: The majority of patients were white (89%) and non-Hispanic (83%) with a relatively equal split of males (56%) and females (44%). The most common primary site of mixed LS was the retroperitoneum (72%), and the frequency of diagnosis decreased from 2004 to 2020 (R2 = 0.4568). Patients were treated at academic/research programs (45%), comprehensive community cancer programs (25%) and integrated network cancer programs (18%) that were generally located in the Middle Atlantic (19%), South Atlantic (18%), and East North Central (16%). The two primary payers at diagnosis include private insurance/managed care (45%) and Medicare (43%). Most patients were from counties in metro areas with a population of at least 1 million (57%) followed by metro counties with a population of 250,000 to 1 million (18%). The largest median household income quartile was $74,063 or more (38%), followed by $46,227 - $57,856 (22%). Most patients had a Charlson-Deyo Score of 0 (83%) with a NCDB analytic stage of either I (28%), III (26%), or not applicable (21%). Conclusions: To the best of our knowledge this NCDB analysis on mixed LS is the first of its kind and therefore addresses a significant knowledge gap. Most patients tend to be white and non-Hispanic. Mixed LS most commonly is found in the retroperitoneum, which is similar to case reports. We found that mixed LS patients have a relatively high household income, most often live in high populated metro areas, and are most frequently treated at academic/research programs. These findings are significant because these socioeconomic factors have not been noted before in literature. Further examination of these demographic and socioeconomic factors is required to understand how they impact treatment, diagnosis of, and survival of patients with mixed LS.

Analysis of demographic and socioeconomic factors in biphasic synovial sarcoma using data from the National Cancer Database.

e23524 Background: Synovial sarcoma, a rare type of soft tissue sarcoma, can be classified into two subtypes - biphasic and spindle cell. Of the two, biphasic synovial sarcoma (BSS) has a better 5-year survivorship; however, 35% of patients diagnosed with BSS die within 5 years. Despite past controversy, adjuvant chemotherapy has been found to improve overall survival for patients with stage III BSS. The National Cancer Database (NCDB) was examined to discover the demographics of individuals diagnosed with BSS. Methods: The 2004-2020 NCDB was analyzed to conduct a retrospective cohort analysis. Patients with a histologically confirmed diagnosis of BSS (ICD-O-3 code 9043) were included (N = 92). Demographic factors like age, sex, race, Hispanic origin, insurance status, educational attainment, distance from facility, facility type, and Charles/Deyo score were evaluated using descriptive statistics and incidence trends were interpreted with regression analysis. Results: Ninety-two biphasic synovial sarcoma cases sampled between 2004 and 2020 revealed an average age at diagnosis of 47.3 years (SD = 19.9, range = 5–87), with males being more likely to be diagnosed (58%). The patients reside at an average of 42 miles from treatment facilities (SD = 108.56, range = 0.3–800.6). Primary disease sites varied, including the lower lobe of the bronchus or lung (12%), upper lobe (11%), and long bones (11%). Diagnosis frequency (2004–2020) showed minimal variation (R^2 = 0.007). Palliative care was not received in 95% of cases, and 41% of patients did not undergo a surgical procedure at the primary site. In patients who received surgery, residual tumor absence post-resection was noted in 56% of patients. Primary treatments included chemotherapy (48%) and radiation therapy (42%), with an average tumor size of 65.2 mm (SD = 42.8, range = 9–195 mm). Notably, 74% survived beyond 90 days post-surgery, with a thirty-day mortality rate of 2%. Patients survived an average of 8.5 years post-diagnosis. Facility-wise, 37% were in academic/research programs. Privately insured patients constituted 60%, with 51% of all patients residing in metropolitan areas of 1 million or more. Conclusions: This analysis addresses a critical knowledge gap, offering insights into the demographics and socioeconomic factors affecting the diagnosis and treatment of Biphasic Synovial Sarcoma (BSS). The average age of BSS diagnosis is 47.3 years with males being predominantly affected, consistent with earlier case reports. BSS patients showed diverse geographic distribution. Survival beyond 90 days post-surgery was high. Chemotherapy and radiation therapy were common treatments. Unique findings include a majority residing in metropolitan areas, and non-academic program treatments. This study underscores the necessity for further research to grasp the impact of these factors on BSS diagnosis, treatment, and overall survival.

The demographics of Sertoli cell carcinoma: A National Cancer Database analysis.

e17012 Background: Sertoli cell tumors (SCTs) are an extremely rare and lethal diagnosis responsible for roughly 1% of all testicular and ovarian carcinomas. No uniform treatment regimen with sufficient results has been established. Current combination of retroperitoneal lymph node dissection, chemotherapy, and radiation therapy provides the best known outcome. Analyzing trends in diagnosis may provide valuable information about its epidemiology. The National Cancer Database (NCDB) was analyzed to establish the demographic factors in diagnosed patients. Methods: A retrospective cohort study from 2004 to 2020 was conducted using the NCDB. 159 patients were found with a histologically confirmed diagnosis of SCTs (ICD-8640-3). Race, gender, Hispanic origin, type of treatment facility, insurance coverage, and distance from patient residence to treatment facility were analyzed via descriptive statistics, and trends in incidence were interpreted using regression analysis. Results: The number of patients diagnosed with SCTs has remained relatively consistent since 2004 (R^2 = 0.07), with approximately 9 diagnoses per year. Of the 159 patients found, the average age of diagnosis was 44.6 years (SD = 19.1, range = 2 – 89 years). A majority of patients were male (67%), while the remaining third were female (33%). Most of the patients were White (73%). Patient Hispanic status could not be reliably determined due to limited data. More patients were in the top income quartile (31%) than the second (24%), third (18%), or fourth (14%) quartiles, with 13% having unknown income status. Most patients were privately insured (59%), followed by coverage under Medicare/Medicaid (28%). More patients lived in metropolitan counties with a population of 250,000 or more (76%) compared to less-populated urban or rural regions (24%). The majority received treatment at comprehensive community cancer programs or academic/research programs (43%). Patients traveled an average of 30.2 miles (SD = 64.0, range = 0.5 – 474.9) to reach the treatment facility. Conclusions: SCTs remains a rare diagnosis. This study pursues a significant gap in existing knowledge on patient characteristics that may present with SCTs. Most patients were White, privately insured, in the top income quartile, and lived in metropolitan areas. This novel study may contribute data towards understanding the relationship between patient socioeconomic status and access to diagnosis. Further research is required to uncover the role of socioeconomic status in SCTs.

Origin associated with heterogeneity amongst Hispanic patients with breast cancer in the United States.

e23077 Background: There are over 50 million self-identifying Hispanics in the United States. This, however, represents a heterogenous population variably affected by an array of determinants of health, including race and insurance status. We used a national registry to investigate for significant differences in outcomes of Hispanic patients with breast cancer in the United States by country of origin. Methods: We identified a cohort of Hispanic patients in the United States with breast cancer for which origin was documented using the 2004-2019 National Cancer Database (NCDB) dataset. The NCDB delineates the following specific origins: Puerto Rico, Mexico, Cuba, South or Central America (excluding Brazil), or the Dominican Republic. We performed multivariate logistic regression modeling to identify whether origin was a significant predictor of advanced cancer staging at diagnosis (AJCC stage III or IV), adjusting for age, race, receptor subtype, histology, grade, insurance status, and facility type. Consequently, we used Cox Regression survival modeling to investigate whether overall survival (OS) differed by Hispanic origin after adjusting for stage at diagnosis and other confounders of survival: age, race, stage at diagnosis, receptor subtype, and systemic therapy received. Results: Of the identified n = 60,438 Hispanic patients with breast cancer in the United States: n = 26,800 (44.3%) had Mexican, n = 9,792 (16.2%) had Puerto Rican, n = 5,283 (8.8%) had Cuban, n = 14,381 (23.8%) had South/Central American, and n = 4,172 (6.9%) had Dominican Republic origins. After adjusting for the aforementioned covariates, we found that origin was a significant predictor of staging at diagnosis (p &lt; 0.001). Patients originally from Mexico were more likely to be diagnosed at advanced stages compared to patients from Puerto Rico (OR 1.31; 95% CI, 1.18-1.46; p &lt; 0.001). We also identified that origin was a significant predictor of overall survival in this cohort even when controlling for various confounders, including stage at diagnosis. Compared to patients from Puerto Rico, patients from Central/South America (HR 0.78, 95% CI 0.70-0.88, p &lt; 0.001) and patients from the Dominican Republic (HR 0.77, 95% CI 0.65-0.92, p = 0.003) exhibited significantly improved overall survival. There was no statistically-significant survival difference between patients from Mexico and patients from Puerto Rico. Conclusions: This real-world analysis showed that, for Hispanic individuals living in the US with breast cancer, origin is significantly associated with outcomes even after accounting for other known determinants of health. We suggest that region of origin should be studied further as a potential determinant of outcomes in patients with cancer.

Impact of frailty on hospitalized patients with prostate cancer: A retrospective analysis.

e23054 Background: The impact of Hospital frailty risk score on outcomes in hospitalized patients with prostate cancer has not been previously studied. This research aimed to examine the association between frailty and prostate cancer outcomes. Methods: This retrospective study utilized hospitalization data from the National Inpatient Sample (NIS) between January 1, 2020, and December 31, 2020. Data of patients with a primary or secondary discharge diagnosis of prostate cancer (ICD10-CM codes C61.0, D07.5, and Z85.46) were obtained. The objective was to evaluate the correlation between frailty and prostate cancer. Multivariate analysis was performed, stratified by race, age, Charlson index, median annual income in the patient's zip code, hospital bed size, teaching status, and census division of the hospital. Results: A total of 51,980 hospitalizations for prostate cancer were identified, with 72.7% in the intermediate to high frailty score (IHFS) group and 27.3% in the low frailty score (LFS) group. The IHFS group had a higher unadjusted in-hospital mortality rate than the LFS group (5.85% vs. 1.2%). Patients with IHFS had increased odds of adjusted mortality compared to those with LFS (adjusted odds ratio [aOR] = 4.45, 95% Cl [3.80-5.22], P &lt; 0.01). Hispanic and Black race patients also had increased odds of adjusted mortality compared to Caucasian race patients (aOR = 1.42, 95%CI [1.19-1.70], P &lt; 0.01); aOR = 1.16, 95%CI [1.00-1.32], P = 0.037, respectively). Additionally, the IHFS group had longer lengths of stay (5.65 ± 0.038 vs. 3.26 ± 0.28 days) and higher adjusted total costs ($66,107 ± 850 vs. $64,308 ± 1066) compared to the LFS group. Conclusions: Patients with prostate cancer and a high hospital frailty risk score exhibited significantly higher mortality rates, longer lengths of stay, and increased total adjusted costs. Frailty assessment plays a crucial role in predicting outcomes in patients with prostate cancer. Physicians can use frailty assessment to stratify patients based on risk and improve their ability to anticipate consequences.

In Patients With Rotator Cuff Tears, Female, Hispanic, African American, Asian, Socially Deprived, Federally Insured, and Uninsured Patients Are Less Commonly Treated Surgically

The purpose of the current study was to evaluate socioeconomic factors affecting whether a patient undergoes rotator cuff repair after a diagnosis of a rotator cuff tear. From 2009 through 2018, claims for adult (≥18 years of age) patients who were diagnosed with a primary rotator cuff injury were identified in the New York Statewide Planning and Research Cooperative System (SPARCS) database via International Classification of Diseases (ICD)-9th Revision-Clinical Modification (CM) and ICD-10-CM diagnostic codes. SPARCS is a comprehensive all-payer database collecting all inpatient and outpatient pre-adjudicated claims in New York. ICD-9-CM and ICD-10-CM codes were used to identify the initial diagnosis for each patient. Current Procedural Terminology codes were used to identify subsequent rotator cuff surgery. The procedures identified were linked with the initial diagnosis, and patients were noted as either having or not having rotator cuff surgery. Logistic regression analysis was performed for variables including age, sex, race, Social Deprivation Index (SDI), Charlson Comorbidity Index, and primary insurance type to determine the effect of patient factors on the likelihood of having surgery after a diagnosis of rotator cuff injury. Of the 67,584 rotator cuff patients included in the analysis, 19,770 (29.3%) of the patients underwent surgical intervention. From the logistic regression, females relative to males (odds ratio [OR]= 0.798, P < .0001), increased SDI (OR= 0.994, p < .0001), African American compared with White race (OR= 0.694, P < .0001), Asian compared with White (OR= 0.832, P < .0001), Hispanic compared with White (OR= 0.693, P < .0001), other race (OR= 0.58, P < .0001), those with Medicare (OR= 0.601, P < .0001) or Medicaid (OR= 0.614, P < .0001) relative to private insurance, and self-pay relative to private insurance (OR= 0.727, P < .0001) were all associated with decreased odds of undergoing rotator cuff surgery. Older patients (OR= 1.012, P < .0001) and Workers' Compensation relative to private insurance (OR= 1.664, P < .0001) had increased odds of undergoing surgery. The results of the current study identified disparities in the likelihood of undergoing rotator cuff repair after a diagnosis of a rotator cuff tear based on patient demographic and socioeconomic factors. Individuals with higher SDI; African American, Asian, Hispanic, or other non-White races; and those with Medicare, Medicaid, or self-pay insurance had decreased odds of surgery, whereas older age and Workers' Compensation insurance were associated with increased odds of undergoing surgery. Level IV, retrospective case series.

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

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

Youth and Young Adult Awareness of and Perceptions About Tobacco Marketing as a Social Justice Issue.

Systemic racism and tobacco-industry targeting contribute to disparities in communities of color. However, understanding tobacco as a social justice issue and the industry's role in perpetuating inequities remains limited. This study explored youth and young adult awareness of tobacco marketing and perceptions of tobacco marketing as a social justice issue. Focus groups were conducted with youth and young adults in 2020 and 2021, including individuals who used tobacco and e-cigarettes and those who did not use either. Online surveys were conducted in 2021 with youth (n = 1227) and young adults (n = 2643) using AmeriSpeak's nationally representative panel, oversampling for black and Hispanic Americans and people who smoke. Perceptions of flavor bans, social justice, and industry marketing were assessed. Most (>80%) survey respondents agreed that tobacco companies target youth. However, only 20% saw tobacco as a social justice issue. Focus group participants regardless of their tobacco or e-cigarette use, reported higher prevalence of tobacco advertising in their communities relative to survey respondents but did not view it as targeting communities of color. Black non-Hispanic (20.9%) and Hispanic (21.4%) survey respondents perceived tobacco as a social justice issue more than white non-Hispanic (16.1%) respondents. The majority (>60%) of survey respondents supported bans on menthol and flavored tobacco, regardless of race or ethnicity. Respondents broadly supported menthol and flavored tobacco bans and recognized tobacco-industry influence on youth. Low awareness of tobacco as a social justice issue highlights the need to raise awareness of the underlying factors driving tobacco-related disparities. The majority of young people see the tobacco industry as targeting them. Most young people support bans on menthol and flavored tobacco bans, with support across racial and ethnic groups. While few young respondents perceived tobacco as a social justice issue, some perceived tobacco companies as targeting low-income and communities of color. Black non-Hispanic and Hispanic respondents were more likely to perceive tobacco as a social justice issue than white non-Hispanic respondents. Efforts to raise awareness among young people of tobacco as a social justice issue may be key in addressing tobacco disparities and advancing support for flavor tobacco bans.

Inequities in naloxone administration among fatal overdose decedents by race and ethnicity in Pennsylvania, 2019-21.

The aim of this study was to characterize the circumstances of drug overdose deaths and determine whether naloxone administration differed by overdose decedent race and ethnicity. Analysis of data on unintentional and undetermined intent drug overdose deaths in Pennsylvania (2019-21) was collected from death certificates and the State Unintentional Drug Overdose Reporting System. Multivariable logistic regression models were adjusted for overdose death circumstances and the odds of naloxone administration were estimated by race/ethnicity and year. The analytical sample included 3386 fatal overdose decedents in 2019, 3864 in 2020 and 3816 in 2021. Evidence of naloxone administration (yes/no) was defined using scene evidence and toxicology reports from coroner and medical examiner records, while race/ethnicity (Hispanic, non-Hispanic Black, non-Hispanic White) was based on the death certificate. In the analytic sample, overdose death rates were the highest among Black people and increased over time (rate per 10 000 population, 2019: 4.3; 2020: 6.1; 2021: 6.5); rates were lowest among White people and remained constant over time (rate per 10 000 population, 2019: 2.6; 2020: 2.7; 2021: 2.6). Throughout all years, Black decedents had approximately 40-50% lower odds of naloxone administration compared with White decedents as referent [2019: odds ratio (OR) = 0.7, 95% confidence interval (CI) = 0.5-0.9; 2020: OR = 0.5, 95% CI = 0.4-0.7; 2021: OR = 0.6, 95% CI = 0.5-0.8], while Hispanic decedents had similar odds of naloxone administration to that of White decedents. After controlling for overdose circumstances in drug overdose deaths in Pennsylvania, USA, from 2019 to 2021, Black people had lower odds of naloxone administration compared with White people, while there were no differences between Hispanic and White people.

Demographic and Systemic Risk Factors for Persistent Corneal Edema Following Cataract Surgery in Patients With and Without Diabetes

PurposeTo identify risk factors associated with the development of corneal edema (CE) and the need for corneal transplantation following cataract surgery. DesignRetrospective cohort study. MethodsSetting: Nation-wide sample of Medicare beneficiaries from 2011-2015. Study PopulationMedicare beneficiaries aged over 65 years who received cataract surgery between 2011-2014 with at least 1 year of continuous follow-up. Data was retrieved from the Denominator and Physician Supplier Part B file from the Center for Medicare and Medicaid Services. Main Outcome(s) and Measure(s)The main outcome was the association between demographic characteristics (e.g. age, sex, race/ethnicity) and systemic factors including diabetes status, hypertension, and tobacco use on the incidence of CE and the subsequent need for corneal transplantation following cataract surgery. ResultsAmong 187,746 beneficiaries, 67,734 had diabetes and 120,012 did not. Beneficiaries with diabetes were more likely to develop CE compared to those without (Odds ratio [OR] 1.19, 95% Confidence Interval [CI] [1.02-1.40]). Compared to those aged 65-74, beneficiaries aged 75-84 and over 85 were more likely to develop CE (OR 1.29 [1.09-1.52]) and OR 1.96 [1.55-2.46], respectively). Asian (OR 2.42 [1.66-3.40]), Hispanic (OR 2.60 [1.73-3.74]), and North American Native (OR 3.59 [1.78-6.39]) race was associated with increased likelihood of developing CE. North American Native beneficiaries had higher risk of requiring corneal transplantation compared to White beneficiaries (OR 9.30 [2.26-25.31]). Female sex decreased likelihood of requiring corneal transplantation post-operatively (OR 0.56 [0.36-0.87]). Amongst those with diabetes, the presence of proliferative diabetic retinopathy increased the likelihood of developing CE (OR 1.94 [1.05-3.39]). ConclusionOlder age, diabetes, and non-White race elevate the risk of CE following cataract surgery, with race incurring the highest risk. Further research is needed to understand the factors underlying the significantly increased risk of CE in racial and ethnic minorities within the United States.

Breastfeeding Perceptions and Decisions among Hispanic Participants in the Special Supplemental Nutrition Program for Women, Infants, and Children: A Qualitative Study.

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a nutrition assistance program in the U.S. WIC served 2.5 million eligible Hispanic women, infants, and children under the age of five in 2021, which is WIC's largest racial/ethnic group. However, limited research has been conducted to understand Hispanic WIC participants' perceptions of WIC breastfeeding recommendations and their breastfeeding decisions. For this qualitative study, we interviewed 18 of these pregnant and postpartum WIC participants on their experiences and decision-making processes related to breastfeeding. Hispanic cultures and home country norms were identified as prominent influences on breastfeeding decisions, along with perceptions of WIC's breastfeeding support. These results can help the WIC program to refine its breastfeeding education to better meet the needs of Hispanic participants.