Hispanic White Research Articles

Federal Nursing Home Policies on Antipsychotics had Similar Impacts by Race and Ethnicity for Residents With Dementia.

Federal initiatives have been successful in reducing antipsychotic exposure in nursing home residents with dementia. We assessed if these initiatives were implemented equally across racial and ethnic minority groups. Retrospective, cross-sectional trends study. National long-stay nursing home residents with dementia from 2011 to2017. We examined trends in psychotropic drug class exposures from the Minimum Data Set assessments for non-Hispanic Black (NHB), Hispanic, and non-Hispanic White (NHW) residents using interrupted time-series analyses with age-sex standardized quarterly outcomes and time points to denote the National Partnership (2012) and Five Star Rating changes (2015). Initially, antipsychotic (33.0%) and sedative (6.8%) exposure was highest for Hispanic residents; antidepressant (59.8%) and anxiolytic (23.4%) exposure was highest for NHW residents; NHB residents had the lowest use of each. Antipsychotic use dropped at the time of the Partnership (β=-0.8807, P=.0023) and the slope declined further after the Partnership (β=-0.6611, P < .0001) for NHW. In comparison to NHW, the level and slope changes for NHB and Hispanics were not significantly different. The Five Star Rating change did not impact the level of antipsychotic use (β= 0.027, P= .9467), but the slope changed to indicate a slowed rate of decline (β= 0.1317, P= .4075) for NHW. As to the other psychotropic drug classes, there were few significant differences between trends seen in the racial and ethnic subgroups. The following exceptions were noted: antidepressant use decreased at a faster rate for NHB residents post-Partnership (β=-0.1485, P= .0371), and after the Five Star Rating change, NHB residents (β=-0.0428, P= .0312) and Hispanic residents (β=-0.0834, P < .0001) saw antidepressant use decrease faster than NHW. Sedative use in slope post-Partnership period (β=-0.086, P= .0275) and post-Five Star Rating (β=-0.0775, P < .0001) declined faster among Hispanic residents. We found little evidence of clinically meaningful differences in changes to 4 classes of psychotropic medication use among racial and ethnic minority nursing home residents with dementia following 2 major federal initiatives.

The COVID-19 Pandemic and Associated Inequities in Acute Myocardial Infarction Treatment and Outcomes

The COVID-19 pandemic disrupted usual care for emergent conditions, such as acute myocardial infarction (AMI). Understanding whether Black and Hispanic individuals experiencing AMI had greater increases in poor outcomes compared with White individuals during the pandemic has important equity implications. To investigate whether the COVID-19 pandemic was associated with increased disparities in treatment and outcomes among Medicare patients hospitalized with AMI. This cross-sectional study used Medicare data for patients hospitalized with AMI between January 2016 and November 2020. Patients were categorized as Hispanic, non-Hispanic Black, and non-Hispanic White. The association between race and ethnicity and outcomes as a function of the proportion of hospitalized patients with COVID-19 was evaluated using interrupted time series. Data were analyzed from October 2022 to June 2023. The main exposure was a hospital's proportion of hospitalized patients with COVID-19 on a weekly basis as a proxy for care disruption during the pandemic. Revascularization, 30-day mortality, 30-day readmission, and nonhome discharges. A total of 1 319 273 admissions for AMI (579 817 females [44.0%]; 122 972 Black [9.3%], 117 668 Hispanic [8.9%], and 1 078 633 White [81.8%]; mean [SD] age, 77 [8.4] years) were included. For patients with non-ST segment elevation MI (NSTEMI) overall, the adjusted odds of mortality and nonhome discharges increased by 51% (adjusted odds ratio [aOR], 1.51; 95% CI, 1.29-1.76; P < .001) and 32% (aOR, 1.32; 95% CI, 1.15-1.52; P < .001), respectively, and the odds of revascularization decreased by 27% (aOR, 0.73; 95% CI, 0.64-0.83; P < .001) among patients hospitalized during weeks with a high hospital COVID-19 burden (>30%) vs patients hospitalized prior to the pandemic. Black individuals with NSTEMI experienced a clinically insignificant 7% greater increase in the odds of mortality (aOR, 1.07; 95% CI, 1.00-1.15; P = .04) for each 10% increase in the COVID-19 hospital burden but no increases in readmissions or nonhome discharges or reductions in revascularization rates compared with White individuals. There were no differential increases in adverse outcomes among Hispanic compared with White patients with NSTEMI based on hospital COVID-19 burden. Increases in hospital COVID-19 burden were not associated with changes in outcomes or the use of revascularization in STEMI overall or by racial or ethnic group. This study found that while hospital COVID-19 burden was associated with worse treatment and outcomes for NSTEMI, race and ethnicity-associated inequities did not increase significantly during the pandemic. These findings suggest the need for additional efforts to mitigate outcomes associated with the COVID-19 pandemic for patients admitted with AMI when the hospital COVID-19 burden is substantially increased.

Genetic Architecture of Dilated Cardiomyopathy in Individuals of African and European Ancestry

Black patients with dilated cardiomyopathy (DCM) have increased familial risk and worse outcomes than White patients, but most DCM genetic data are from White patients. To compare the rare variant genetic architecture of DCM by genomic ancestry within a diverse population of patients with DCM. Cross-sectional study enrolling patients with DCM who self-identified as non-Hispanic Black, Hispanic, or non-Hispanic White from June 7, 2016, to March 15, 2020, at 25 US advanced heart failure programs. Variants in 36 DCM genes were adjudicated as pathogenic, likely pathogenic, or of uncertain significance. Presence of DCM. Variants in DCM genes classified as pathogenic/likely pathogenic/uncertain significance and clinically actionable (pathogenic/likely pathogenic). A total of 505, 667, and 26 patients with DCM of predominantly African, European, or Native American genomic ancestry, respectively, were included. Compared with patients of European ancestry, a lower percentage of patients of African ancestry had clinically actionable variants (8.2% [95% CI, 5.2%-11.1%] vs 25.5% [95% CI, 21.3%-29.6%]), reflecting the lower odds of a clinically actionable variant for those with any pathogenic variant/likely pathogenic variant/variant of uncertain significance (odds ratio, 0.25 [95% CI, 0.17-0.37]). On average, patients of African ancestry had fewer clinically actionable variants in TTN (difference, -0.09 [95% CI, -0.14 to -0.05]) and other genes with predicted loss of function as a disease-causing mechanism (difference, -0.06 [95% CI, -0.11 to -0.02]). However, the number of pathogenic variants/likely pathogenic variants/variants of uncertain significance was more comparable between ancestry groups (difference, -0.07 [95% CI, -0.22 to 0.09]) due to a larger number of non-TTN non-predicted loss of function variants of uncertain significance, mostly missense, in patients of African ancestry (difference, 0.15 [95% CI, 0.00-0.30]). Published clinical case-based evidence supporting pathogenicity was less available for variants found only in patients of African ancestry (P < .001). Patients of African ancestry with DCM were less likely to have clinically actionable variants in DCM genes than those of European ancestry due to differences in genetic architecture and a lack of representation of African ancestry in clinical data sets.

High sustained virologic response rates, regardless of race or socioeconomic class, in patients treated with chronic hepatitis C in community practice using a specialized pharmacy team.

Approved direct-acting antiviral (DAA) regimens against hepatitis C virus (HCV) can cure nearly all patients; however, socioeconomic disparities may impact access and outcome. This study assesses socioeconomic factors, differences in insurance coverage and the drug prior authorization process in HCV-infected patients managed in community practices partnered with a dedicated pharmacy team with expertise in liver disease. This Institutional Review Board-approved, ongoing study captures data on a cohort of 2480 patients from community practices. Patients had chronic hepatitis C and were treated with DAA regimens selected by their physician. The HCV Health Outcomes Centers Network provides comprehensive patient management including a dedicated pharmacy support team with expertise in the prior authorization process. In this cohort, 60.1% were male, 49% were Hispanic Whites (HW), 37% were Non-Hispanic Whites (NHW), and 14% were Black/African American (BAA). Eighty-seven percent of patients were treatment-naïve, 74% were infected with genotype 1 virus and 63% had advanced fibrosis/cirrhosis (F3/F4 = 68.2% HW, 65.6% BAA, 55.4% NHW). Forty percent of patients were on disability with the highest percentage in the BAA group and less than one-third were employed full time, regardless of race/ethnicity. Medicare covered 42% of BAA patients versus 32% of HW and NHW. The vast majority of HW (80%) and BAA (75%) had a median income below the median income of Texas residents. Additionally, 75% of HW and 71% of BAA had median income below the poverty level in Texas. Despite the above socioeconomic factors, 92% of all prior authorizations were approved upon first submission and patients received DAAs an average of 17 days from prescription. DAA therapy resulted in cure in 95.3% of patients (sustained virologic response = 94.8% HW, 94.0% BAA, 96.5% NHW). Despite having more advanced diseases and more negative socioeconomic factors, >94% of HW and BAA patients were cured. Continued patient education and communication with the healthcare team can lead to high adherence and > 94% HCV cure rates regardless of race/ethnicity or underlying socioeconomic factors in the community setting.

Designing a Digital Culinary Education Intervention for Parents With Low Income

ObjectiveTo examine cooking practices, online information-seeking habits, and intervention preferences among parents with low income to inform the development of a digital cooking intervention on the basis of the Healthy Cooking Index. MethodsThis formative research study included a brief survey followed by in-depth interviews (from February to April, 2021) with parents of a child aged 6–11 years with low income (n = 20; 100% female, 70% African American or Hispanic White). Interview transcripts were analyzed using a semistructured hybrid coding approach. ResultsThree main themes were identified to inform the development of the intervention: (1) current Healthy Cooking Index behaviors, (2) preferences for digital cooking intervention content, and (3) design and delivery preferences. A 7-step process was used to develop the intervention and integrate qualitative findings. Conclusions and ImplicationsOnline culinary programs targeting parents with low income may consider short, mobile-friendly video formats and focus on easy-to-prepare recipes adaptable to family preferences.

Risk Factors for SARS-CoV-2 Infection and Severe Outcomes Among People With Human Immunodeficiency Virus: Cohort Study.

Studies on COVID-19 in people with HIV (PWH) have had limitations. Further investigations on risk factors and outcomes of SARS-CoV-2 infection among PWH are needed. This retrospective cohort study leveraged the national OPTUM COVID-19 data set to investigate factors associated with SARS-CoV-2 positivity among PWH and risk factors for severe outcomes, including hospitalization, intensive care unit stays, and death. A subset analysis was conducted to examine HIV-specific variables. Multiple variable logistic regression was used to adjust for covariates. Of 43 173 PWH included in this study, 6472 had a positive SARS-CoV-2 result based on a polymerase chain reaction test or antigen test. For PWH with SARS-CoV-2 positivity, higher odds were found for those who were younger (18-49 years), Hispanic White, African American, from the US South, uninsured, and a noncurrent smoker and had a higher body mass index and higher Charlson Comorbidity Index. For PWH with severe outcomes, higher odds were identified for those who were SARS-CoV-2 positive, older, from the US South, receiving Medicaid/Medicare or uninsured, a current smoker, and underweight and had a higher Charlson Comorbidity Index. In a subset analysis including PWH with HIV care variables (n = 5098), those with unsuppressed HIV viral load, a low CD4 count, and no antiretroviral therapy had higher odds of severe outcomes. This large US study found significant ethnic, racial, and geographic differences in SARS-CoV-2 infection among PWH. Chronic comorbidities, older age, lower body mass index, and smoking were associated with severe outcomes among PWH during the COVID-19 pandemic. SARS-CoV-2 infection was associated with severe outcomes, but once we adjusted for HIV care variables, SARS-CoV-2 was no longer significant; however, low CD4 count, high viral load, and lack of antiretroviral therapy had higher odds of severe outcomes.

Race-Based Differences in ST-Segment-Elevation Myocardial Infarction Process Metrics and Mortality From 2015 Through 2021: An Analysis of 178 062 Patients From the American Heart Association Get With The Guidelines-Coronary Artery Disease Registry.

Systems of care have been developed across the United States to standardize care processes and improve outcomes in patients with ST-segment-elevation myocardial infarction (STEMI). The effect of contemporary STEMI systems of care on racial and ethnic disparities in achievement of time-to-treatment goals and mortality in STEMI is uncertain. We analyzed 178 062 patients with STEMI (52 293 women and 125 769 men) enrolled in the American Heart Association Get With The Guidelines-Coronary Artery Disease registry between January 1, 2015, and December 31, 2021. Patients were stratified into and outcomes compared among 3 racial and ethnic groups: non-Hispanic White, Hispanic White, and Black. The primary outcomes were the proportions of patients achieving the following STEMI process metrics: prehospital ECG obtained by emergency medical services; hospital arrival to ECG obtained within 10 minutes for patients not transported by emergency medical services; arrival-to-percutaneous coronary intervention time within 90 minutes; and first medical contact-to-device time within 90 minutes. A secondary outcome was in-hospital mortality. Analyses were performed separately in women and men, and all outcomes were adjusted for age, comorbidities, acuity of presentation, insurance status, and socioeconomic status measured by social vulnerability index based on patients' county of residence. Compared with non-Hispanic White patients with STEMI, Hispanic White patients and Black patients had lower odds of receiving a prehospital ECG and achieving targets for door-to-ECG, door-to-device, and first medical contact-to-device times. These racial disparities in treatment goals were observed in both women and men, and persisted in most cases after multivariable adjustment. Compared with non-Hispanic White women, Hispanic White women had higher adjusted in-hospital mortality (odds ratio, 1.39 [95% CI, 1.12-1.72]), whereas Black women did not (odds ratio, 0.88 [95% CI, 0.74-1.03]). Compared with non-Hispanic White men, adjusted in-hospital mortality was similar in Hispanic White men (odds ratio, 0.99 [95% CI, 0.82-1.18]) and Black men (odds ratio, 0.96 [95% CI, 0.85-1.09]). Race- or ethnicity-based disparities persist in STEMI process metrics in both women and men, and mortality differences are observed in Hispanic White compared with non-Hispanic White women. Further research is essential to evolve systems of care to mitigate racial differences in STEMI outcomes.

“I don't just say, Hi! I'm gay”: Sexual Orientation Disclosures in Oncology Clinic Settings Among Sexual Minority Women Treated for Breast Cancer in the U.S. South

ObjectivesFew studies examine sexual orientation disclosures (SODs) among women with breast cancer; fewer examine the impact of culture and geography on disclosure processes. This study explores how sexual minority women (SMW) in the Southern United States engage in SODs with oncology clinicians. Data SourcesWe conducted in-depth interviews with SMW (eg, lesbian, bisexual) treated for early-stage (stages I–III), hormone receptor–positive breast cancer (N = 12), using a semistructured interview guide. Participants completed an online survey prior to the 60-minute interview. Data was analyzed using an adapted pile sorting approach and thematic analysis conventions. ConclusionAverage age of participants was 49.5 years (range: 30–69), all self-identified as cisgender; 83.3% as lesbian, 58.3% were married, 91.7% had completed a 4-year college degree or higher, 66.7% identified as non–Hispanic White, 16.7% as Black, and 16.7% as Hispanic/Latina. Half of the sample had not engaged in SODs with an oncology clinician. Key themes were: (1) religious and political conservatism in the South create SOD barriers; (2) oncologist-specific barriers to SODs; (3) “straight passing” as a discrimination mitigation strategy; and (4) SOD facilitators in oncology settings (ie, strategic disclosures, medical privilege, and lesbian, gay, bisexual, and transgender–friendly branding of oncology centers). Implications for Nursing PracticeSMW with breast cancer living in the U.S. South navigate unique interpersonal barriers to SODs in oncology settings. Clinicians could encourage SODs by fostering inclusive environments via nonheteronormative language, inclusive intake forms, and respect for SMW's SOD navigation processes. Oncology clinicians require culturally relevant, geographic-specific communication training to facilitate SODs among SMW.

Self-Efficacy Buffers Against Belonging Loss for Hispanic Students During the First Semester of College

&lt;p style="text-align: justify;"&gt;Hispanic college students typically report a lower sense of belonging than their White peers, citing challenges related to first generation student status, low-income family backgrounds, and academic underpreparedness. The present study asked whether Hispanic students would have a lower sense of belonging than non-Hispanic White students and whether academic self-efficacy would be able to provide a greater buffer against belonging loss for Hispanic students compared to their non-Hispanic White peers. The participants of this study were Hispanic (n = 68) and non-Hispanic White (n = 420) first year students at a predominantly White small liberal arts college. Academic self-efficacy was a significant predictor of change in belonging for Hispanic students but not for non-Hispanic White students. These results suggest academic self-efficacy is a worthwhile target of belonging interventions for Hispanic students. &lt;/p&gt;

Prostate cancer genetic alterations in Hispanic men.

Differences in DNA alterations in prostate cancer among White, Black, and Asian men have been widely described. This is the first description of the frequency of DNA alterations in primary and metastatic prostate cancer samples of self-reported Hispanic men. We utilized targeted next-generation sequencing tumor genomic profiles from prostate cancer tissues that underwent clinical sequencing at academic centers (GENIE 11th). We decided to restrict our analysis to the samples from Memorial Sloan Kettering Cancer Center as it was by far the main contributor of Hispanic samples. The numbers of men by self-reported ethnicity and racial categories were analyzed via Fisher's exact test between Hispanic-White versus non-Hispanic White. Our cohort consisted of 1412 primary and 818 metastatic adenocarcinomas. In primary adenocarcinomas, TMPRSS2 and ERG gene alterations were less common in non-Hispanic White men than Hispanic White (31.86% vs. 51.28%, p = 0.0007, odds ratio [OR] = 0.44 [0.27-0.72] and 25.34% vs. 42.31%, p = 0.002, OR = 0.46 [0.28-0.76]). In metastatic tumors, KRAS and CCNE1 alterations were less prevalent in non-Hispanic White men (1.03% vs. 7.50%, p = 0.014, OR = 0.13 [0.03, 0.78] and 1.29% vs. 10.00%, p = 0.003, OR = 0.12 [0.03, 0.54]). No significant differences were found in actionable alterations and androgen receptor mutations between the groups. Due to the lack of clinical characteristics and genetic ancestry in this dataset, correlation with these could not be explored. DNA alteration frequencies in primary and metastatic prostate cancer tumors differ among Hispanic-White and non-Hispanic White men. Notably, we found no significant differences in the prevalence of actionable genetic alterations between the groups, suggesting that a significant number of Hispanic men could benefit from the development of targeted therapies.

Trends in Racial, Ethnic, and Gender Diversity in Orthopaedic Surgery Adult Reconstruction Fellowships From 2007 to 2021

BackgroundOrthopaedic surgery has seen improvement in its representation of women, whereas the representation of racial/ethnic minorities has remained stagnant over the past decade. Overall, the surgical field lags behind other specialties in sex and racial/ethnic parity. Although demographic disparities within orthopaedics have been analyzed for both residents and faculty members, information for adult reconstruction fellows remains limited. MethodsSex and race/ethnicity demographics for adult reconstruction orthopaedic fellowship matriculants were collected via a database published by the Accreditation Council for Graduate Medical Education (ACGME) from 2007 to 2021. Statistical analyses, including descriptive statistics and significance testing, were performed. ResultsDuring the 14-year time frame, men trainees remained high with an overall average percentage of 88% and demonstrated increasing representation (P trend = .012). White non-Hispanics, Asians, Blacks, and Hispanics represented on average 54%, 11%, 3%, and 4%, respectively. White non-Hispanics (P trend = .039) and Asians (P trend = .030) saw increasing and decreasing representation, respectively. Women, Blacks, and Hispanics remained relatively stagnant throughout the observation period as no trends were appreciable (P trend >.05, each). ConclusionUsing publicly available demographic data from the Accreditation Council for Graduate Medical Education (ACGME) from 2007 to 2021, we found relatively limited progress in the representation of women and those from traditionally marginalized groups seeking additional training in adult reconstruction. Our findings mark an initial step in measuring the demographic diversity among adult reconstruction fellows. Further research is needed to ascertain specific factors likely to attract and retain members from minoritized groups into orthopaedics.

Racial/ethnic differences in 21-gene recurrence score and survival among estrogen receptor-positive breast cancer patients.

511 Background: Despite studies on racial/ethnic disparities in breast cancer patients, there is limited literature evaluating association of racial/ethnic differences with 21-gene recurrence score (RS) and survival differences stratified by RS risk categories. We performed an observational cohort study to evaluate such disparities in context of RS. Methods: The National Cancer Database (NCDB) was queried for patients with ER-positive, pT1-3N0-1aM0 breast cancer who received surgery followed by adjuvant endocrine therapy with available RS from 2006 to 2018. Racial/ethnic groups were stratified by non-Hispanic White (NHW), Hispanic White (HW), Black, and Asian/Pacific Islander (API). Our primary endpoint was overall survival (OS). Logistic multivariable analysis (MVA) was built upon baseline patient and tumor characteristics to evaluate variables associated with RS &gt; 25. Cox MVA was used to evaluate OS. Interaction term analysis was used to identify heterogeneous association of racial/ethnic groups and RS; if significant, subgroup analyses compared magnitude of racial/ethnic differences stratified by RS. To address immortal time bias, Cox MVA analyses were repeated after excluding patients with post-diagnosis survival &lt; 6 months. P values were two-sided. Bonferroni correction was used for multiple comparisons (NHW vs HW women, NHW vs Black women, and NHW vs API women) with p values less than 0.017 being statistically significant. Results: A total of 140,133 women (median [interquartile range (IQR)] age, 60 [52-67] years) were included for analysis. 115,651 (82.5%), 8,213 (5.9%), 10,814 (7.7%), and 5,455 (3.9%) were NHW, Hispanic, Black, and API women respectively. Median (IQR) follow up was 66.2 mo. (48.0-89.8). Logistic MVA showed compared to NHW women, Black women were associated with higher RS (26 or higher vs &lt; 26: adjusted odds ratio [aOR] 1.19, 95% confidence interval [CI] 1.12-1.26, p &lt; 0.001), while HW (aOR 0.93, 95% CI 0.86-1.00, p = 0.04) and API (aOR 1.03, 95% CI 0.95-1.13, p = 0.45) were not. Cox MVA showed compared to NHW, Black women were associated with worse OS (adjusted hazards ratio [aHR] 1.10, 95% CI 1.02-1.19, p = 0.012) while HW (aHR 0.85, 95% CI 0.77-0.94, p = 0.001) and API (aHR 0.66, 95% CI 0.56-0.77, p &lt; 0.001) were not. There was significant interaction between race/ethnicity and RS (interaction p = 0.006). Subgroup analysis found similarities in those with RS &lt; 26, while only API women were associated with improved OS among those with RS ≥ 26. After excluding those with post-diagnosis survival &lt; 6 mo., our findings remained comparable. Conclusions: To our knowledge, this is the largest nationwide oncology database study to suggest that Black women are associated with higher RS, while HW and API are not. It also suggests that Black women are associated with worse OS among those with RS &lt; 26, while API are associated with improved OS regardless of RS compared to NHW women.

SpotCheck: A skin cancer diagnostic clinical trial comparing dermoscopy-enhanced telemedicine to in-person evaluation.

1604 Background: Low socioeconomic status and long distances to a diagnosing provider are factors associated with poor melanoma outcomes, including advanced stage at presentation. Telemedicine offers improved access to diagnostic services for patients in medically underserved communities. Dermoscopy is an established skin imaging method with greater diagnostic accuracy for skin cancers compared to naked eye examination alone. We evaluated the safety and efficacy of a dermoscopy-enhanced, store-and-forward telemedicine-based skin cancer diagnostic platform in a prospective clinical trial. Methods: Participants were recruited primarily through advertisements in local newspapers. Subjects with self-identified skin lesions concerning for malignancy could have up to three lesions evaluated. Clinical and dermoscopic images of each lesion were captured, and were stored-and-forwarded to a team of three dermatologists (TeleTeam) working remotely, and independently. Participants were also evaluated face-to-face by a dermatologist (F2F). Participants were offered biopsies by the F2F (if needed) at the time of the visit, or at a follow up visit if the biopsy was only recommended by one or more members of the TeleTeam. The TeleTeam was blinded to the F2F recommendations. Results: We enrolled 146 subjects with 375 lesions of concern for skin cancer between September 2020 and December 2022. Baseline characteristics: 94 (64%) female; median age 65 years (range: 25-90 years); 92 (63%) non-Hispanic White; 22 (15%) Black; 11 (7%) Hispanic White; 8 (6%) Asian; 13 (9%) other or preferred not to say. Nineteen participants (13%) had a prior skin cancer including 2 with melanoma (one also with basal cell carcinoma (BCC)), and 17 with keratinocyte cancers (BCC and/or squamous cell carcinoma (SCC)). Overall, 363/375 (97%) skin lesions were clinically or histopathologically benign; 14/146 (10%) patients had a malignant or atypical skin growth. These included 12 skin cancers: 1 stage IA melanoma (0.5mm in thickness); 1 in-situ melanoma; 8 BCC; 2 in-situ SCC; and 2 moderately or severely atypical nevi. F2F recommended biopsy for both melanomas, 7 BCC and 1 SCC. TeleTeam recommended biopsy for both melanomas, 7 BCC, 2 SCC, and both moderately or severely atypical nevi. F2F identified 10/14 malignant or atypical skin growths; the TeleTeam identified 13/14. The benign:malignant ratio of the F2F and TeleTeam recommended biopsies were 2.7:1 and 5.8:1, respectively. The TeleTeam benign:malignant ratio decreased to 4.5:1 after the first 35 subjects were evaluated. Conclusions: Dermoscopy-enhanced teledermatology evaluation appears to be a safe and effective method to triage skin lesions for in-person medical evaluation and biopsy to diagnose skin cancer. Deployment of this diagnostic modality may help reduce melanoma health disparities arising in communities lacking dermatologists. Clinical trial information: NCT04411810 .

Ethnic disparities in biomarker testing and targeted therapy use in metastatic lung adenocarcinoma: A 2014-2021 analysis.

e21216 Background: Racial and ethnic disparities have been demonstrated to be widespread in lung cancer, including in the US. Despite insurance coverage for standard biomarker testing, testing rates remain low in minority populations. This work sought to analyze institutional data to assess whether there existed ethnic disparities in biomarker testing rates and receipt of targeted therapy between Hispanic/Latino and non-Hispanic/Latino patients of metastatic lung adenocarcinoma (mAdenoCa). Methods: A retrospective study was conducted and reported following ‘strengthening the reporting of observational studies in epidemiology’ (STROBE) guidelines. All Hispanic white and non-Hispanic white patients of mAdenoCa seen at our tertiary care institution in South Florida from 01/2014 to 12/2021 were identified and included through Guardian Research Network (GRN) platform. Socio-demographic, clinicopathological, and tumor molecular features along with treatment-related characteristics were analyzed via descriptive and comparative statistics. Results: A total of 268 mAdenoCa patients were included, of which 179 patients were Hispanic or Latino and 89 were not Hispanic or Latino. Biomarker testing data is reported in the table. Data of MET, KRASG12C, VKIRAS, and HER3 was not available in all cases. The unadjusted product-limit survival analysis indicated worse outcomes for Hispanic whites as compared to non-Hispanic counterparts. There were no differences found regarding targeted therapy use in either population. Conclusions: While metastatic lung adenocarcinoma patients at our center showed no differences in biomarker testing or targeted therapy use, the non-availability of data regarding several key mutations indicates a major dearth of testing. Future studies need to evaluate actionable strategies for improving the existing low testing rates in patients with mAdenoCa, particularly in racial and ethnic minorities. [Table: see text]

Health disparities among patients with Ewing sarcoma in Florida.

e18549 Background: Ewing sarcoma (ES) is the second most common malignant bone tumor in children and young adults. Although usually localized, subclinical metastatic disease is often present. Treatment includes multi-agent chemotherapy with surgery or radiation for local control. Though overall survival (OS) has improved to 70% for localized disease, mortality from recurrent or metastatic disease remains high. Although, ES is most common among Non-Hispanic White adolescent males, prior population-based ES studies utilizing Surveillance, Epidemiology, and End Results (SEER) have shown increased mortality among White Hispanics, Blacks, and those of low socioeconomic status (SES). Florida is not part of SEER but is home to a unique population with high proportions of immigrants and Hispanics of distinct backgrounds including Cubans, Puerto Ricans, and South Americans that contrasts to the Mexican Hispanic majority in other US states. As there are no prior population-based studies examining ES in Florida, the role of racial/ethnic disparities on outcomes among this diverse patient population remains unknown. By utilizing the Florida Cancer Data System (FCDS) for ES patients, this study will assess overall racial/ethnic disparities, evaluate the impact of racial/ethnic disparities on OS, and compare ES incidence rates in Florida with national SEER-21 rates to assess risk. Methods: This retrospective secondary analysis examined all patients diagnosed with ES (2005-2018) in Florida (n = 411) and SEER-21 (n = 1,513). Age-adjusted incidence (AAI) with 95% confidence interval (95%CI) was analyzed for the entire group and OS was estimated using Kaplan-Meier survival analysis. Univariable and multivariable analyses using Cox regression models were performed for variables of interest—race/ethnicity, age, sex, year of diagnosis, site of disease, staging, SES, and insurance type. Adjusted hazard ratio (aHR) with 95%CI were calculated. Results: Per the FCDS, there was a higher incidence of ES in Hispanic males (AAI 2.6; 95%CI: 2.0-3.2 per 1,000,000; n = 84) as compared to the SEER (1.2; 1.1-1.4; n = 250). Among non-metastatic ES, Hispanics had an increased risk for cancer-related mortality compared to Non-Hispanic Whites (aHR 2.9; 95%CI: 1.46-5.74; p =0.002), after adjusting for all other variables. In the full model (all cases regardless of stage at diagnosis), older age and distant metastasis were statistically significant factors for poor OS while SES and insurance status were not. Conclusions: Hispanics in Florida are of interest for ES with a higher-than-expected incidence compared to the US and remarkably worse survival for non-metastatic disease compared to Non-Hispanic Whites. Further in-depth studies are needed to examine why this disparity exists, but it is potentially multifactorial. This is the first known study for ES health disparities in Florida and provides updated national data for comparison.

Identifying racial and ethnic disparities in patients diagnosed with mycosis fungoides/Sezary syndrome in the United States: A contemporary SEER analysis.

7544 Background: Mycosis fungoides (MF) and Sezary syndrome (SS) are rare cutaneous T-cell lymphomas. In this study, we compare demographics, treatment, and survival patterns in Hispanic (HI) vs. Non-Hispanic (NH) patients diagnosed with MF and SS. Methods: Data were analyzed on MF and SS patients in the US reported to SEER 18 database between 2000 and 2018. SEER 18 contains the most comprehensive population-based cancer information in the US, covering approximately 27% of the total US population, and up to 36% of HI. Racial groups analyzed included NH whites, HI whites, blacks, and Asians/Pacific Islanders. Patient characteristics, age-adjusted incidence rate, and survival rate were compared across ethnic groups, HI vs NH. Stratification by age, gender, and stage at diagnosis were considered. Kaplan-Meier and Cox regression analyses were used to compare overall survival (OS) between HI and NH. Multivariate analysis and propensity score matching were performed with adjustment for age, stage, and B-symptoms. Results: 8578 patients with MF and 275 patients with SS were identified. Of patients with MF, 11% were HI and 89% were NH; of patients with SS, 12% were HI and 88% were NH. In NH patients with MF, most patients were male (58%); for HI patients with MF, a male predominance was not observed (p &lt; 0.001). In patients with SS, most patients were male in both NH and HI (56% NH, 56% HI; p = 0.989). In both MF and SS, HI were diagnosed at younger ages compared to NH, 49 y.o vs 60 y.o (p &lt; 0.001) and 59 y.o vs 71 y.o (p = 0.009) respectively. Most HI and NH with MF and SS did not receive radiotherapy (91% of NH and 92% of HI for MF; 92% of NH and 91% of HI for SS; p values 0.166 and 0.760, respectively). On survival analysis, for patients with MF, the survival probability (SP) at 2, 5, and 10 years for HI vs NH were 94%, 87%, and 77% vs. 91%, 81%, and 69%, respectively. The survival difference observed favored HI (p &lt; 0.001). For patients with SS, there was no statistically significant survival difference between HI and NH with 2, 5, and 10 year SP at 65%, 42%, and 17% for HI and 62%, 36%, and 16% for NH, respectively (p = 0.99). In patients with SS, the median survival time in years was 3.3 and 3.2 in NH and HI patients, respectively. In patients with MF, the median survival time was not reached. On multivariate analysis, when adjusted for age, those patients with MF and SS who were older than 80 y.o and between 60 to 80 y.o, had worse OS compared to those younger than 60 y.o, with HR 17.6 (95%: 13.8 – 22.3 ) and 4.2 (95 % CI: 3.6 – 5) respectively for MF; and HR 1.8 (95% CI: 0.9 – 3.7) and 1.64 (CI 95% 1 – 2.8) respectively for SS. Conclusions: We identified ethnic differences in incidence, age at diagnosis, sex, and survival outcomes in patients with MF and SS. Notably, we identified a survival advantage in patients with MF that favored HI. In patients with SS, there was no ethnic difference in survival.

A nationwide population based primary CNS lymphoma (PCNSL) analysis: Do Hispanics have better outcomes?

10560 Background: Over the last decade, overall survival (OS) of PCNSL patients has increased from 12.5 months to 26 months (N. Oncol, PMID 30418592). One study examined the incidence of PCNSL in the Hispanic (HI) population in Texas (Cureus, PMID: 33042676), but a national study is needed to understand ethnic disparities, as many HI face barriers to health care access (Natl Cance Inst Monogr, PMIDL 8562207). This study aims to understand demographics, treatment patterns, and outcomes of HI and Non-Hispanic (NH) patients with PCNSL nationally. Methods: Data analyzed on PCNSL patients in the United States (US) was reported to the Surveillance, Epidemiology, End Results (SEER) 18 database between 2000 and 2018. Racial groups analyzed included NH whites, HI whites, Blacks, and Asian/Pacific Islanders (PI). Patient characteristics, age-adjusted incidence rate, and survival rate were compared across ethnic groups (HI vs. NH). Stratification by age, gender, and stage at diagnosis was considered. Data was stratified using Kaplan-Meier and Cox regression analyses to compare OS between HI and NH. Multivariate analysis and propensity score matching was performed with adjustment for age, stage, and B-symptoms. Results: Of 5819 PCNSL patients, 15% were HI, and 85% NH. 57% were male compared to 51% of NH. As compared to NH at diagnosis, HI patients were younger, 59 years vs. 66 years(y) (p&lt;0.001); the majority of HI (42%) were diagnosed in the age bracket of 60-80y (p&lt;0.001). Approximately 30% of HI were diagnosed in 2015-2018, while most of NH (29%) were diagnosed in 2010-2014 (p=0.054). With 52% of HI being diagnosed at &lt;60y, only 32% in NH. As for race, most of HI and NH were White (97% vs. 79%), followed by Black (1% vs. 8%). On survival analysis, the survival probability at 2, 5, and 10y of HI vs. NH were (0.507 vs. 0.441), (0.395 vs. 0.322), and (0.237 vs. 0.225), respectively. The median survival time was 2.1y for HI vs. 1.2y for NH. There was an OS difference favoring HI (p=0.0009). On multivariate analysis, when adjusted for age, patients with PCNSL between 60-80y and above have 3.4 times more likely to die from disease after diagnosis with HR 3.4 (95% CI:2.9-4) and 1.7 (95% CI: 1.6-1.9). Conclusions: Our study demonstrates statistically longer median survival and OS favoring the HI population. The younger age of diagnosis in HI patients could be a factor in their survival probability for PCNSL, given that both HI and NH received similar treatment and had a similar staging. However, additional studies would be needed to validate this observation and determine other biological or socioeconomic factors that may play a role. [Table: see text]

Racial Disparities in the Ascertainment of Cancer Recurrence in Electronic Health Records.

There is growing interest in using computable phenotypes or proxies to identify important clinical outcomes, such as cancer recurrence, in rich electronic health records data. However, the race/ethnicity-specific accuracies of these proxies remain unclear. We examined whether the accuracy of a proxy for colorectal cancer (CRC) recurrence differed by race/ethnicity and the possible mechanisms that drove the differences. Using data from a large integrated health care system, we identified a stratified random sample of 282 Black/African American (AA), Hispanic, and non-Hispanic White (NHW) patients with CRC who received primary treatment. Patient 5-year recurrence status was estimated using a utilization-based proxy and evaluated against the true recurrence status obtained using detailed chart review and by race/ethnicity. We used covariate-adjusted probit regression models to estimate the associations between race/ethnicity and misclassification. The recurrence proxy had excellent overall accuracy (positive predictive value [PPV] 89.4%; negative predictive value 96.5%; mean difference in timing 1.96 months); however, accuracy varied by race/ethnicity. Compared with NHW patients, PPV was 14.9% lower (95% CI, 2.53 to 28.6) among Hispanic patients and 4.3% lower (95% CI, -4.8 to 14.8) among Black/AA patients. The proxy disproportionately inflated the 5-year recurrence incidence for Hispanic patients by 10.6% (95% CI, 4.2 to 18.2). Compared with NHW patients, proxy recurrences for Hispanic patients were almost three times as likely to have been misclassified as positive (adjusted risk ratio 2.91 [95% CI, 1.21 to 8.31]). Higher false positives among racial/ethnic minorities may be related to higher prevalence of noncancerous lung-related problems and substantial delays in primary treatment because of insufficient patient-provider communication and abnormal treatment patterns. Using a proxy with worse accuracy among racial/ethnic minority patients to estimate population health may misdirect resources and support erroneous conclusions around treatment benefit for these patients.

SA42 Innovative Methods for Integrating Social Determinants of Health Data with Administrative Claims to Facilitate Health Equity Research

The Covid-19 pandemic highlighted the importance of considering Social Determinants of Health (SDoH) in healthcare research. Administrative claims databases are widely used for research, but often lack SDoH data or sufficient transparency in how these data were obtained. This study describes innovative methods for integrating SDoH data with administrative claims to facilitate health equity research. The HealthCore Integrated Research Database (HIRD) contains medical and pharmacy claims from a large, national US payer starting in 2006 and includes commercial (Comm), Medicare Advantage (MCare), and Medicaid (MCaid) populations. The HIRD includes individually identifiable information, which was used for linking with SDoH data from the following sources: national neighborhood-level data from the American Community Survey, the Food Access Research Atlas, and the National Center for Health Statistics’ urbanicity classification; and member-level data on race/ethnicity from enrollment files, medical records, self-attestation, and imputation algorithms. We examined SDoH metrics for members enrolled as of 05-July-2022 and compared them to the respective US national data using descriptive statistics. We also examined telehealth utilization in 2022. SDoH data were available for ∼95% of currently active members in the HIRD (Comm/MCare/MCaid 12.5m/1m/7.6m). Socioeconomic characteristics at the neighborhood-level differed by membership type and vs. national data: % of members with at least a high-school education (90/88/84 vs. 87); median family income ($98k/$76k/$70k vs. $82k); % of members living in low-income low-food-access tracts (9/14/18 vs. 13); urban (57/52/47 vs. 61). At the member-level, the % of White Non-Hispanics, Black Non-Hispanics, Asian Non-Hispanics, and Hispanics were 61/6/5/6 (Comm), 76/12/2/2 (MCare), and 45/26/5/19 (MCaid). Imputation contributed 15-60% of race/ethnicity values across membership types. Telehealth utilization increased with socioeconomic status. We successfully integrated SDoH data from a variety of sources with administrative claims. SDoH characteristics differed by type of insurance coverage and were associated with differences in telehealth utilization.

Racial disparities in hospitalization outcomes among patients with cholangiocarcinoma.

6631 Background: Studies have reported on the rising incidence and mortality outcomes among patients diagnosed with cholangiocarcinoma (CCA) but racial disparities in outcomes among inpatients have not been explored in this population. We examined the racial disparities in outcomes among adult hospitalized patients with a diagnosis of CCA. Methods: Retrospective cohort analyses were conducted using data from the National Inpatient Sample (NIS), 2016-2020. Multivariate logistic and linear regression models were used to examine the association between race/ethnicity and patient disposition, length of stay, elective admissions, and total hospital charges. Results: In the adjusted analyses, while Black patients had 14% higher odds (95% Confidence Interval (CI): 1.04–1.25) of being discharged to a facility/home with home health care versus routine discharge when compared to their White counterparts, Hispanics had 14% lower odds (95% CI: 0.79–0.95). Black patients had 39% higher risk (95% CI: 1.19–1.63) of death versus routine discharge relative to the White patients. Compared to White patients, Blacks (AOR: 1.23; 95% CI: 1.13–1.34), Hispanics (AOR: 1.15; 1.06–1.25) and other race/ethnicities (AOR: 1.20; 1.10–1.31) were more likely to have a length of hospital stay greater than 5 days relative to 5 days or less. Hispanics (β: $16,789; 95% CI: $11,480–$22,099) were found to have higher total hospital charges when compared to the White CCA patients. Additionally, Black (AOR: 0.68; 95% CI: 0.60–0.78) and Hispanic patients (AOR: 0.87; 95% CI: 0.77–0.99) were less likely to be admitted electively to the hospital. Conclusions: Despite advances made in treatment of patients with CCA, the prognosis remains poor. We report disparities in various hospitalization outcomes among adult patients with a diagnosis of CCA. Health care providers need to be aware that these disparities exist and health policies should be implemented to narrow the gap in existing disparities. [Table: see text]