Impact Of Geographic Region Research Articles

Impact of geographic region on racial disparities in gynecologic oncology clinical trial enrollment

Impact of geographic region on racial disparities in gynecologic oncology clinical trial enrollment

Discrimination of Turkish Gemlik virgin olive oils by growing regions and environmental conditions

AbstractGeographic origins together with environmental conditions (temperature, rainfall, humidity, altitude) during harvest, could alter the olive oil quality, nutritional value, and traceability. The impact of geographic region (Bursa PDO, Hatay, Mersin, and Izmir NPDO) and conditions at harvest years (2016 and 2017) on the quality and traceability of Gemlik virgin olive oils were investigated. Environmental conditions (high temperature and relative humidity, low rainfall) resulted in low quality due to increase in FFA, linoleic acid, PUFA, Δ7‐stigmastenol, stigmasterol and total sterols in oils obtained from southeast (Hatay and Mersin) NPDO regions. Bursa PDO and Izmir NPDO Gemlik virgin olive oils were high in oleic acid, MUFA, hydroxtytyrsol, tyrosol, antioxidant activity and, ∆5‐avenesterol and discriminated by 99% accuracy with discriminant analysis. PCA and DA can easily detect and distinguish differences in virgin olive oils quality and purity coming from different growing regions and subjected to inverse environmental conditions. Bursa PDO and Izmir NPDO growing regions have better conditions for Gemlik olives cultivation to obtain high quality and oxidative resistant Gemlik virgin olive oils.

Growing Old in the Bible Belt: Resources for Aging LGBT Adults Living in the South

ABSTRACT There has been an increase in the literature about LGBT older adults in recent years; however, there is a need for further sociological quantitative research examining the impact of geographic region on LGBT aging. Utilizing data from a nationwide survey, this study focuses on the availability of LGBT-specific resources for LGBT aging adults living in the South. We examine the effects of community type and sociodemographics on the availability of LGBT-specific resources as well as the type of resources available. Findings reveal that in the South, community type, having a partner, household income, and education affect the LGBT-specific resources available. Of particular interest, LGBT-affirming faith organizations are identified as the resource most frequently available for LGBT aging adults in this region often referred to as the Bible Belt. Overall, this study sheds light on the LGBT-specific resources that are available to provide social support and help meet the unique needs of LGBT adults aging in the South.

Impact of Geographic Region on the COMMANDER-HF Trial

ObjectivesThis study sought to compare patient characteristics, outcomes, and treatment effects among regions in the COMMANDER-HF trial. BackgroundGlobalization of cardiovascular trials increases generalizability. However, regional differences may also introduce heterogeneity in results. MethodsIncidence rates and interactions with treatment were recorded in pre-specified regions: Eastern Europe, Western Europe and South Africa, North America, Asia-Pacific, and Latin America. ResultsMost patients (n = 3,224; 64.2%) were from Eastern Europe; 458 (9.1%) were from Western Europe and South Africa; 149 (3.0%) were from North America; 733 (14.6%) were from Asia-Pacific; and 458 (9.1%) were from Latin America. Compared with patients from Eastern Europe, patients from Western Europe and South Africa, North America, and Asia-Pacific were older and more likely to have coronary interventions and cardiac devices. Patients from Eastern Europe had the lowest event rates. For the primary outcome of myocardial infarction (MI), stroke, or all-cause death, event rates (100/year) were 11.6 in Eastern Europe (10.8 to 12.5); 19.5 (16.5 to 23.0) in Western Europe and South Africa; 14.2 (10.5 to 19.2) in North America; 17.7 (15.4 to 20.3) in Asia-Pacific; and 18.6 (15.6 to 22.1) in Latin America. There was a lower incidence of bleeding in Eastern Europe. Blood concentrations of rivaroxaban (Xarelto, Titusville, New Jersey) at 4 weeks were undetectable in 21% patients from Eastern Europe (n = 128) compared to 5% in other regions (n = 42). There was no evidence of treatment-by-region heterogeneity for the primary outcome (interactionp = 0.14), but a favorable effect on the secondary outcome of MI, stroke, or cardiovascular death was observed in Western Europe and South Africa, North America, and Latin America but not in Eastern Europe and Asia-Pacific (interactionp = 0.017). ConclusionsIn the COMMANDER-HF study, patients from Eastern Europe had a lower risk profile and fewer cardiovascular and bleeding events, possibly related to lower treatment adherence. Those differences might have influenced the effect of rivaroxaban therapy. (A Study to Assess the Effectiveness and Safety of Rivaroxaban in Reducing the Risk of Death, Myocardial Infarction or Stroke in Participants With Heart Failure and Coronary Artery Disease Following an Episode of Decompensated Heart Failure [COMMANDER HF]; NCT01877915)

AS121 - The impact of geographical region on outcomes of patients with primary biliary cholangitis from western Europe

AS121 - The impact of geographical region on outcomes of patients with primary biliary cholangitis from western Europe

Rural-urban disparities in colorectal cancer screening: An insight from a statewide database.

69 Background: The Healthy People 2020 initiative aims to increase colorectal cancer (CRC) screening. The common CRC screening options are FIT, FOBT, sigmoidoscopy, and colonoscopy. Colonoscopy allows visualization of the entire colon and offers therapeutic benefit whereas stool tests are less invasive, cost-effective and are easily available. Inequities exist in CRC screening among rural residents which may be contributed to a lower level of education, income, health insurance and access to health care. The purpose of the study is to identify the impact of geographic region on the preference of CRC screening modality among Louisiana adults. Methods: We performed a retrospective cohort study among age-eligible Louisiana adults who had CRC screening either with colonoscopy or stool-based tests using the 2016 Behavioral Risk Factor Surveillance System database (n = 1372). We examined demographic characteristics among participants who had CRC screening with colonoscopy versus who had a stool-based test. Multivariable logistic regression analysis evaluated the association of geographic region and the preference of CRC screening. Results: Participants age 65-75 years old were 36% less likely to have a colonoscopy as compared to age 50-64 years (p = 0.0008). African Americans and Hispanic Americans were 34% (p < 0.006) and 55% (p = 0.057) less likely to have a colonoscopy as compared to Caucasian Americans, respectively. Medicaid and Medicare participants were 82% (p < 0.0001) and 52% (p < 0.0001) less likely to have a colonoscopy compared to participants with private insurance, respectively. After adjusting for age, race/ethnicity, education, income, and insurance the odds of screening colonoscopy was 29% lower for rural residents compared to urban residents of Louisiana (OR 0.71 95% CI 0.53 - 0.94). Conclusions: Individuals residing in rural parishes of Louisiana were more likely to have a stool-based test for CRC screening. Health care providers while considering the reliability and feasibility of CRC screening modality should also incorporate patient’s preferences while offering the screening tests to increase the rate of CRC screening.

EPR19-075: Geographic Region and Race/Ethnicity Are Associated With Treatment and Survival for Gastric Cancer

Introduction: Gastric adenocarcinoma (GAC) remains a lethal disease. Evidence suggests that there is increased incidence of gastric cancer among ethnic minorities as compared to whites. In addition, survival and treatment recommendations may vary based on geographic regions. Objectives: We sought to assess the impact of geographic region and race/ethnicity on treatment and survival for GAC. Methods: Data from SEER registry was used to identify patients with potentially resectable gastric adenocarcinoma (AJCC I–III) diagnosed 2004 to 2015. Exposures of interest were geographic region of diagnosis: Western (West), Midwestern (MW), Southern (SO) or North Eastern (NE), and race. The endpoints were: (1) recommendation of no surgery by the provider, (2) utilization of surgery, and (3) gastric cancer-specific survival (GCS). Multivariable logistic and Cox regression models were used to identify associations. Results: 15,991 patients were included in the analysis (West, 56.3%; NE, 16.3%; MW, 7.8%; and SO, 19.7%). On univariate analysis, the likelihood of no recommendation for surgery was highest in SO (OR: 1.35; P<.001;] West, referent). In adjusted analysis, it was lowest in NE and MW (NE aOR: 0.78; P<.001; MW aOR: 0.78; P=.002). The likelihood of no recommendation for surgery was lowest in Asians (AS) on univariate analysis (OR: AS, 0.47; P<.001); American Indian (AI) 0.59 (P=.027); Hispanic (HS) 0.85 (P=.018); whites (W) 1.01 (P=.884); Black (B) ref]. The adjusted analysis for W is (aOR: 0.86; P=.029; B-ref) and persisted for the rest of ethnicity. Patients diagnosed in NE were independently more likely to undergo surgery as compared to those in other regions (aOR: 1.25; P<.001); black individuals were less likely to undergo surgery as compared to whites, Asians, and Hispanics (P<.05 for all). Overall, a diagnosis of gastric cancer in the NE region was independently associated with superior GCS (HR=0.85; P<.001) (Table 1). Among patients who underwent surgery, those in the NE (HR=0.85; P=.001) exhibited superior GCS, but poor GCS in SO (HR=1.17; P=.001; West-ref). AS who underwent surgical intervention demonstrated superior GCS as compared to all other ethnic groups (HR=0.76; P<.001). Conclusion: There is significant difference in treatment and survival for GAC based on geographic region and race/ethnicity. Adherence to treatment guidelines and recommendations is essential to optimize outcomes for all patients.

Drivers of change in Toronto Western Spasmodic Rating Scale (TWSTRS) scores following botulinum toxin treatment: Impact of geographical region (P5.042)

Drivers of change in Toronto Western Spasmodic Rating Scale (TWSTRS) scores following botulinum toxin treatment: Impact of geographical region (P5.042)

Geographic disparities in surgical treatment recommendation patterns and survival for pancreatic adenocarcinoma

BackgroundPrevious studies have described pessimistic attitudes of physicians toward recommending surgery for early-stage pancreatic adenocarcinoma. However, the impact of geographic region on recommendation patterns of surgical treatment for potentially resectable pancreatic cancer is unknown. MethodsThe SEER registry was used to identify patients with early-stage pancreatic adenocarcinoma (AJCC I-II) [2004–2013]. The exposure of interest was geographic region of diagnosis: Midwest, West, Southeast or Northeast. The endpoints of interest were recommendation of no surgery, and overall survival. ResultsA total of 24,408 patients were identified [Midwest – 10.6%, West – 50.1%, Southeast – 21.7% and Northeast – 17.6%]. Overall, 38% of patients had a recommendation of no surgery by their provider. On univariate analysis, the likelihood of having a recommendation of no surgery was lowest in the NE [OR: Northeast (0.8), West (1.6), Southeast (1.3), and Midwest (Ref); p < 0.05 for all]. This association persisted following risk adjustment. Geographic region was an independent predictor of mortality, irrespective of resection status. ConclusionSignificant disparities in surgical treatment recommendation patterns and survival for early-stage pancreatic cancer exist based on geographic location. Improved adherence to guideline-driven treatment recommendations, standardization of care processes, and regionalization may help stem the existing variability in care and outcomes.

Impact of geographic region on overall survival (OS) in patients with metastatic renal cell carcinoma (mRCC): Results from a pooled clinical trials database.

4583 Background: Health determinants vary according to the geographic region and may impact the outcomes of mRCC patients treated on clinical trials of targeted therapy. We investigate the OS by geographic region of mRCC patients treated in the targeted therapy era. Methods: We conducted a pooled analysis of mRCC patients treated on phase II and III clinical trials. Clinical characteristics and survival data were collected. Statistical analyses were performed using the Kaplan-Meier method and log-rank test in univariate analysis. Results: Overall, 4736 patients were included in the analysis. Patient characteristics differed according to geographic region (table). No statistically significant differences in OS were observed when comparing US/Canada (USC, reference) to other regions: Latin America (LA), Asia/Oceania/Africa (AOA), and Eastern Europe (EE). OS differed among patients enrolled on trials in the USC compared to Western Europe (WE) (20.3 vs.17.4 months, respectively; HR: 1.15; 95%CI 1.03-1.3 p = 0.015). All grade treatment-related adverse events (AE) were reported more frequently in USC. There were no significant differences in grade 3-5 AEs between groups. Conclusions: We highlight that despite differing baseline characteristics, OS was similar among most geographic regions. Factors such as disease biology, access to care, AE reporting, and quality of care that may contribute to potential differences in outcomes among regions need to be further characterized. [Table: see text]

The Geographic Impact on Hospitalization in Patients with Cystic Fibrosis

To assess whether geographic location influences hospitalizations for pulmonary exacerbations for patients with cystic fibrosis (CF) in the US, as there is no existing literature regarding this subject. The CF Foundation Patient Registry was analyzed during the years 2007-2012 via geographic grouping of states. The impact of geographic region on recovery from hospitalization, hospitalization length, and time to next hospitalization were analyzed using multivariate models. Posthospitalization lung function and nutritional measures were similar among regions for 1 year following hospitalization. The West region was associated with risk of longer hospital stays (OR 1.60, CI 1.45-1.77), however, dornase alfa use (OR 3.85, CI 1.15-12.92) was the only specific factor. History of allergic bronchopulmonary aspergillosis (OR 1.58, CI 1.11-2.25) and adult age (OR 2.48, CI 1.17-5.25) in the Northeast, chronic macrolide use in the South (OR 1.36, CI 1.03-1.79), and infection with Candida albicans (OR 1.47, CI 1.18-1.82) and Pseudomonas aeruginosa (OR 1.44, CI 1.02-2.04) in the Midwest were associated with increased hospitalization length. There was a significantly decreased risk for subsequent hospitalizations in the Northeast compared with other regions (P = .038). Sociodemographic analysis identified Caucasians in the South having a significantly lower risk of future hospitalization compared with African Americans (hazard ratio 0.79, CI 0.69-0.91, P = .0009). There is significant regional variability in hospitalization length and risks for subsequent hospitalizations for patients with CF in the US. Regional variation should be subject to further study to determine if benchmarking standards can be achieved nationally.

Impact of Geographic Region on Benefit of Approved Anticancer Drugs Evaluated in International Phase III Clinical Trials

AimsInternational collaboration allows for enhanced accrual and more generalisable results of phase III randomised controlled trials (RCTs). The impact of geographic region on the outcomes of new anticancer agents is unclear. Materials and methodsInternational RCTs evaluating approved systemic therapy for advanced solid tumours that reported efficacy of new anticancer drugs based on geographic regions were eligible. Data for overall (OS) or progression-free survival (PFS) were pooled in a meta-analysis. The primary analysis was the comparison of developed versus developing countries. A meta-regression analysis explored the impact of differences in gross national income (GNI) per capita on the hazard ratio comparing developed and developing countries. Secondary analyses compared geographic regions irrespective of GNI. ResultsOf the 63 identified studies, 12 independent RCTs were eligible; five reported data for OS and nine for PFS. Improvements in overall survival were greater in developed as compared with developing countries (hazard ratio 0.82, 95% confidence interval 0.68–0.99, P = 0.04). This effect was seen only among studies of cytotoxic chemotherapy and not among those of targeted agents. No difference was seen for PFS (hazard ratio 0.93, 95% confidence interval 0.79–1.09, P = 0.36). Meta-regression showed a significant negative association between GNI per capita and overall survival, but a non-significant negative association with PFS (β = –0.774, P = 0.05 and β = –0.211, P = 0.29, respectively). No differences were observed in PFS between Asian and non-Asian countries or North America and Western Europe. ConclusionCompared with patients from developing countries, those from developed countries derive greater improvement in overall survival from cytotoxic chemotherapy, but similar benefit from targeted drugs.

Impact of Geographic Region on Benefit of Anticancer Agents Evaluated in International Phase III Clinical Trials

ABSTRACT Aim: International collaboration is important for contemporary phase III randomized controlled trials (RCTs). Such collaboration allows for enhanced patient accrual and more generalizable results. The impact of geographic region on the outcomes of new anticancer agents is unclear. Here we analyze the impact of geographic region on the efficacy of newly approved anticancer agents. We hypothesized that compared to developed countries; the magnitude of benefit will be lower in developing countries. Methods: RCTs evaluating agents for treatment of advanced solid tumors approved by the US Food and Drug Administration between January 2000 and June 2013 were identified. Eligible studies explicitly documented an international, multicenter design and reported outcomes of the primary endpoint based on geographic regions. Hazard ratios (HR) and 95% confidence intervals (CI) for overall (OS) or progression free survival (PFS) were extracted or estimated and pooled in a meta-analysis. The primary analysis was the comParison of developed vs. developing countries as defined by the World Bank, 2012. Secondary analyses included the comparison of Asian vs any non-Asian countries, Asian vs developed non-Asian countries, and Western Europe vs North America. Results: A total of 14 RCTs were eligible; 5 reported data for OS and 11 for PFS. Improvements in OS and PFS were significantly greater in developed compared to developing countries (see Table). No differences were observed in PFS between Asian and Non-Asian countries (subgroup difference P = 0.94); Asian and developed non-Asian countries (subgroup difference P = 0.09); or North America and Western Europe (Subgroup difference P = 0.57). Secondary analyses for OS were not possible due to lack of data. Outcome Pooled HR [95% CI] Developed Countries Pooled HR [95% CI] Developing Countries Subgroup difference P OS 0.73 [0.65-0.83] 0.94 [0.83-1.06] 0.005 PFS 0.54 [0.49-0.59] 0.69 [0.62-0.78] Conclusions: Patients from developed countries derive more benefit from new drugs than those from developing countries. This difference likely occurs due to differences in health systems or quality of supportive and palliative care or due to other undefined factors. Disclosure: All authors have declared no conflicts of interest.

A joint United Kingdom (UK) and Hong Kong (HK) study to determine prognostic factors for hepatocellular carcinoma (HCC) undergoing curative and palliative treatment.

181 Background: There have been few international studies that systematically evaluate the impact of geographical region on the prognosis of HCC. Methods: Prospective cohorts of patients (pt) were accrued in UK (n=567; 2006-2011) and HK (n=517; 2007-2012). Clinical data were documented at baseline; treatments were decided by multidisciplinary teams at both centers. Results: The median follow-up time of the UK and HK cohort was 27.9 and 29.8 months, respectively. The median overall survival (OS) of the whole UK and HK cohort was 22.9 months and 8.6 months. In the HK cohort, 425 underwent palliative treatment (TACE, systemic agents or supportive care) and 92 had curative treatment (surgery and locoablation); in the UK cohort, 338 had palliative treatment and 228 underwent curative treatment. In the curative group, the median OS was 54.8 months in the UK cohort but has not yet been achieved in the HK cohort. For the palliative group, the median OS was 12.7 and 5.5 months in the UK and HK cohort respectively. In the palliative group, geographical difference was an independent prognostic factor (HK vs. UK, HR=2.0; p&lt;0.0001). Other prognostic factors were mainly tumorous features and Child’s liver function (Table). In the curative group, neither geographical difference nor Child’s score were prognostic factors. Conclusions: Separate prognostic factors exist for curative and palliative treatment. Geographical differences need to be considered during design of clinical trials on novel agents where palliative treatments are investigated but not for surgery or locoablation. [Table: see text]

Impact of geographical region on urinary metabolomic and plasma fatty acid profiles in subjects with the metabolic syndrome across Europe: the LIPGENE study

The application of metabolomics in multi-centre studies is increasing. The aim of the present study was to assess the effects of geographical location on the metabolic profiles of individuals with the metabolic syndrome. Blood and urine samples were collected from 219 adults from seven European centres participating in the LIPGENE project (Diet, genomics and the metabolic syndrome: an integrated nutrition, agro-food, social and economic analysis). Nutrient intakes, BMI, waist:hip ratio, blood pressure, and plasma glucose, insulin and blood lipid levels were assessed. Plasma fatty acid levels and urine were assessed using a metabolomic technique. The separation of three European geographical groups (NW, northwest; NE, northeast; SW, southwest) was identified using partial least-squares discriminant analysis models for urine (R² X: 0·33, Q²: 0·39) and plasma fatty acid (R² X: 0·32, Q²: 0·60) data. The NW group was characterised by higher levels of urinary hippurate and N-methylnicotinate. The NE group was characterised by higher levels of urinary creatine and citrate and plasma EPA (20 : 5 n-3). The SW group was characterised by higher levels of urinary trimethylamine oxide and lower levels of plasma EPA. The indicators of metabolic health appeared to be consistent across the groups. The SW group had higher intakes of total fat and MUFA compared with both the NW and NE groups (P≤ 0·001). The NE group had higher intakes of fibre and n-3 and n-6 fatty acids compared with both the NW and SW groups (all P< 0·001). It is likely that differences in dietary intakes contributed to the separation of the three groups. Evaluation of geographical factors including diet should be considered in the interpretation of metabolomic data from multi-centre studies.

Regional Variation in Smoking among African Americans

Background. The impact of geographic region and metropolitan residence on smoking prevalence among African Americans has not been adequately examined.Methods. This study analyzed 5 years of data from the National Health Interview Survey (1990–1994) on current smoking and regional variation among 16,738 African Americans.Results. Respondents in the West had the lowest unadjusted smoking prevalence rates and Midwest residents had the highest. Current smoking was lower among African Americans living in noncentral cities than in central cities even after adjusting for several sociodemographic covariates. Multivariate logistic regression analysis revealed that black women in the South were significantly less likely to be smokers compared with any other gender/region group.Conclusions. These findings suggest the significance of gender and regional factors such as the social history of migration, social stress and racism, exposure to tobacco advertisement, variations in cultural influences, community structures, and coping strategies in under standing African American smoking behavior.