Lack Of Insurance Research Articles

Impact of Health Education Programme on Adherence to Treatment in Knee Osteoarthritis: An Interventional Study on Egyptian Patients.

To measure the level of adherence of patients with primary knee osteoarthritis (KOA) to an interventional therapeutic and rehabilitation programme and investigate factors that hinder patients' adherence. A total of 154 participants with primary knee osteoarthritis (KOA) were divided into intervention and control groups. The intervention protocol included patient education on the nature and treatment of KOA, therapeutic exercise, a weight loss programme for overweight patients, and a physical therapy programme. Participants were followed for 3months. The Visual Analog Scale for Pain (VAS-p), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and knee Kellgren-Lawrence OA grading were measured before and after the intervention. Additionally, the Morisky adherence questionnaire and the WHO Multidimensional Framework for factors affecting adherence were assessed. One fifty four participants with KOA were randomly allocated into intervention and control groups. A low level of adherence was detected in both groups (68.8% in the intervention group vs. 84.4% in the control group). Patients who followed the interventional programme were more adherent. Adherence to therapy was associated with a reduction in the Visual Analog Scale for Pain (VAS-p) (p=0.016) and improved function as measured by WOMAC (p=0.018). Factors primarily associated with patient non-adherence included unemployment (67.8%), low income (59.3%), no previous response to therapy (58.5%), less frequent follow-up visits (55.1%), lack of insurance (66.9%), difficult access to services (59.3%), and high cost of services (55.1%). Adherence to treatment in OA patients is a significant concern and a common problem, appearing to be associated more with socioeconomic factors than with pain and function.

Structural discrimination and HIV-related health outcomes among Black transgender populations in the Southern United States: a scoping review

Background Transgender populations are disproportionately impacted by HIV with an overall HIV rate of 13.7%. Non-Hispanic Black/African Americans (44.2%) have the highest transgender HIV prevalence compared to Hispanics (25.8%) and White (6.7%). Moreover, Black transgender populations face debilitating structural level factors including: racism and discrimination, stigma, poverty, unemployment or underemployment, high rates of food insecurity, unstable housing, lack of insurance, criminalization, incarceration, and violence that negatively impact their health and well-being. Methods In this article, we conducted a scoping review to analyze the impact of structural discrimination on HIV prevention, care, and treatment among Black transgender people in the Southern United States. Results Of the 397 articles identified, twelve manuscripts eligible for full-text review were assessed based on the inclusion/exclusion criteria. A total of five articles with a combined total of 341 study participants met the eligibility criteria. All five studies included in this scoping review reported different yet interrelated structural discrimination factors. These were grouped into three categories: (a) socioeconomic factors, (b) access to healthcare, and (c) stigma and discrimination. Conclusions Black transgender populations face extreme structural discrimination creating barriers to access and adherence to HIV prevention, care, and treatment programs. There is an urgent need for additional research and the implementation of tailored, culturally-appropriate, multi-level interventions to address structural discrimination-related factors that increase HIV vulnerability for Black transgender populations.

Patients with symptomatic cholelithiasis at a safety net hospital: Early surgeon involvement matters.

Gallstones are a common diagnosis in the United States; though many patients remain asymptomatic, others develop symptoms. Standard of care for symptomatic cholelithiasis is cholecystectomy, but many do not undergo surgery. The purpose of this study is to identify factors that influence receipt of cholecystectomy for symptomatic cholelithiasis at a safety net hospital. This is a retrospective study performed at a large, academic, tertiary care and safety net state hospital. Patients who presented with symptomatic cholelithiasis were included. Same admission cholecystectomy and elective outpatient cholecystectomy were considered success/standard of care, and readmission cholecystectomy or no cholecystectomy were considered failures/not standard of care. Of 376 patients, a substantial minority were Spanish speaking, and almost half had public insurance. 23.7% were successfully treated, and 76.3% had failure in management. A larger number of patients in the group that had successful treatment had surgery consultation, 67.4%. Only 28.5% of patients saw a surgeon as an outpatient within 30days of their visit. On multivariable analysis, patients who were provided a surgery consultation were more likely to receive standard of care. Age, sex, language, smoking status, lack of insurance, and alcohol use were not associated. Surgery consultation during presentation for symptomatic cholelithiasis was associated with receipt of same admission, or outpatient elective cholecystectomy, or successful management. There should be a low threshold to involve a surgeon for symptomatic cholelithiasis.

Health care transition rates and associated factors for adolescents with asthma

BackgroundAdolescents and young adults (AYAs) with asthma, face increased risks during healthcare transition (HCT) from pediatric to adult care. Despite guidelines advocating for more HCT preparedness, this does not consistently occur in clinical practice. The rates of transition preparation exposure in adolescents with asthma are unknown. Objective(s)Our goal was to understand the rates of HCT exposure among adolescents with asthma in the United States along with predictive characteristics associated with receiving HCT exposure using data from a nationally representative survey. MethodsWe studied adolescents aged 12-17 years old with asthma in the 2020-2021 National Survey of Children’s Health (NSCH) dataset. Associations were explored between sociodemographic, health-related and provider practice-related variables and HCT exposure through univariate analysis and multivariable logistic regression. ResultsOnly 19% of adolescents with asthma from this cohort met criteria indicating they received HCT exposure. In our multivariable analysis, older age, female gender, having a provider actively work with the child to make positive choices about health, a written care plan addressing transition, routine preventive care visits, and a caregiver had someone discuss about health insurance into adulthood were associated with higher odds of HCT exposure. Hispanic ethnicity, lack of insurance, and living in a metropolitan area were associated with lower odds of receiving transitional care preparation but were not significant in the multivariable model. ConclusionsOur findings underscore the need to improve transitional care preparation for adolescents with asthma, with attention needed to address disparities based on sociodemographic factors, including healthcare access.

Abstract C126: Disparities in time-to-treat insured patients with newly diagnosed cancer in a vertically integrated healthcare system

Abstract Purpose. After a cancer diagnosis, delays in initiating treatment may impact treatment response, disease progression, adverse health events, and overall survival. Race and socioeconomic status (SES) may be factors in initiating cancer treatment. Complicating this issue is the lack of insurance or underinsurance. Thus, the purpose of this study was to assess the influence of race/ethnicity and SES on time to treatments for insured patients diagnosed with cancer in a vertically integrated healthcare system. Methods. We conducted a cross-sectional nested study within a cohort of patients diagnosed with cancer between 2010 and 2018 from Kaiser Permanente Southern California (KPSC), a vertically integrated healthcare system. Patients of all ages and all cancer anatomical sites were included. Patients with in-situ cancers were excluded, with no other exclusion criteria. The main independent variables are race/ethnicity and SES, and the dependent variable is time to initial treatment. All information was pulled from the KPSC Cancer Registry, including race/ethnicity, and treatments (surgical; radiation; chemotherapy; immunotherapy; hormonal). SES was categorized into quintiles based on geocoded expected income using home addresses from census tract data. For each patient, we calculated days from diagnosis to first treatment. Results. We identified 153,270 patients of all ages with cancers of all anatomical sites diagnosed between 2010 and 2018, of which 125,943 received treatment. When examining racial groups, the mean time to treatment for White, Black, Hispanic, Asian/PI, and other patients was 42.5, 52.6, 44.3, 44.1, and 41.2 days, respectively. For White patients, mean time to treatment was 42.4 days in the lower 20% income quintile and 42.7 days in the top 20% income quintile. For Black patients, mean time to treat was 53.9 days in the lower 20% income quintile and 52.8 days in the top 20% income quintile. For Hispanic patients, mean time to treat was 45.8 days in the lower 20% income quintile and 42.1 days in the top 20% income quintile. For Asian/PI patients, mean time to treat was 44.1 days in the lower 20% income quintile and 43.5 days in the top 20% income quintile. For other patients, mean time to treat was 51.4 days in the lower 20% income quintile and 39.2 days in the top 20% income quintile. Within each SES quintile, Black patients consistently started cancer treatment later than other racial/ethnic groups. Conclusion. We found minimal disparities in time to initial treatment based on SES in this vertically integrated system of care. Within each of the White, Black, and Asian racial groups, the difference in time to treatment between the highest and lowest SES groups was less than 2%. This difference was closer to 7% in Hispanic patients. Additional work is necessary to elucidate reasons why Black patients initiate cancer treatments later than other racial groups and if this affects recurrence or survival. Citation Format: Robert Cooper, Reina Haque, Andrea Young, Zimin Zhuang. Disparities in time-to-treat insured patients with newly diagnosed cancer in a vertically integrated healthcare system [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C126.

Unmet healthcare needs among older people in South Korea

ABSTRACT This paper explores the multiple factors that determine unmet healthcare needs among older people in South Korea using the data from the 2018 Korea Health Panel Study (KHPS). 4137 participants aged 65+ were identified. To analyse group differences in categorical variables, the Rao-Scott Chi-square test was used. Logistic regression analysis was further conducted to assess factors associated with unmet healthcare needs. The prevalence of unmet healthcare needs was 14.4%. Of these, a key reason was financial difficulties (4.4%). Key factors associated with unmet needs include living in rural areas, low education, unemployment, lack of insurance, low income, smoking, chronic conditions, depressive symptoms, visual and memory impairments, and poor self-rated health. The findings indicate that it is important to identify the barriers that impede healthcare accessibility and the relationship between health-related factors, socioeconomic factors, and unmet healthcare needs among older people because medical needs of older people are more varied compared to other age groups. As the ageing population is increasing rapidly, it is important to provide preventive services for older people so that it can reduce the chronic diseases in an aged society.

Diabetes Disparities: Addressing Health Inequities and Improving Outcomes in Underserved Populations

Diabetes mellitus, characterized by high blood sugar levels due to insulin deficiency or resistance, is a global public health crisis with significant disparities in prevalence, management, and outcomes, particularly among underserved populations such as racial and ethnic minorities, low-income groups, and rural residents. These populations faced higher rates of diabetes and complications due to social determinants of health, including economic instability, inadequate education, and limited access to healthcare. Barriers such as lack of insurance, transportation challenges, and cultural and linguistic differences further hindered effective diabetes management. Lifestyle and behavioral factors, including diet, physical activity, medication adherence, and mental health, play critical roles in diabetes outcomes. Policy and system-level interventions, such as expanding healthcare coverage, improving access to care, and addressing social determinants of health, are essential to reducing disparities. Technological innovations like telehealth, mobile health applications, wearable devices, and data analytics offered significant potential to enhance diabetes management in underserved populations. This review was conducted using a comprehensive analysis of current literature and existing studies to provide insights into the multifaceted nature of diabetes disparities and to highlight successful interventions and necessary policy changes to improve health outcomes for underserved populations. Addressing these inequities required a multifaceted approach, including community-based interventions, policy reforms, and technological advancements to ensure equitable diabetes care for all. Keywords: Diabetes disparities, Underserved populations, social determinants of health, Healthcare access, Technological innovations.

Impact of Social Needs and Identity Experiences on the Burden of Illness in Patients with Multiple Myeloma: A Mixed-Methods Study.

Multiple myeloma (MM) is a common hematologic malignancy, but due to its incurable nature, patients experience many relapses in their lifetime and hence face unique challenges. This mixed-methods study consisting of an online survey and subsequent focus groups aimed to understand how social and identity experiences affected the diagnostic, treatment, and care journey for patients with MM. Twenty-three adult patients with MM participated in this study. The survey participants identified common determinants negatively impacting their health, including mental health concerns (experienced by 90.5% of respondents), worries about food shortage (42.9%), and transportation concerns (28.6%). Focus group participants described high physical and mental health burdens associated with MM. Frequent monitoring, fear of a relapse, and unpredictable side effects contributed to high anxiety. Participants indicated that MM differed from other types of cancer and chronic health conditions in many ways, particularly how and where the diagnosis was made, disease progression and relapse, treatments and side effects, and financial concerns. Most participants (65.0%) reported ≥1 social need that negatively impacted health outcomes including lack of knowledge about MM, financial instability, and lack of insurance, transportation, and social support. The findings reveal that patients with MM continually experience patient-specific mental and physical health burdens indicating high unmet needs throughout the disease journey.

Closing the gap in access to child mental health care: provider feedback from the Wisconsin Child Psychiatry Consultation Program

BackgroundMental illnesses are common among children and negatively impact wellbeing during childhood as well as later in life. However, many children with these conditions are not able to access needed mental health care. The Wisconsin Child Psychiatry Consultation Program (WI CPCP) was created to reduce gaps in access to care by providing primary care providers with referral resources, access to behavioral health consultations, and training on mental health topics.ObjectivesThe purpose of this study was 1) to assess the effectiveness of the WI CPCP in Milwaukee County, providing specific insights into provider’s ability to care for child mental health, and 2) identify challenges Milwaukee PCPs faced in providing mental health care to child patients and contextualize these challenges in a conceptual framework of access to health care.MethodsA cross-sectional mixed-methods secondary data analysis was conducted using data collected from online baseline and nine-month follow-up surveys completed by providers participating in the program practicing in Milwaukee County from 2014 to 2022. Provider confidence and skill in providing mental health care was analyzed quantitatively using Two-sample Wilcoxon rank-sum (Mann–Whitney) tests (baseline vs. follow-up survey responses) and descriptive statistics (follow-up survey only). Provider challenges to providing mental health care were analyzed qualitatively using a thematic analysis research approach.ResultsResults from quantitative analyses showed that provider confidence and skill in treating childhood anxiety and depression improved from baseline to follow-up. Results from qualitative analyses were categorized by factors within and beyond the scope of WI CPCP. Within the scope of WI CPCP, providers reported a lack of knowledge of referral options and a lack of training in mental health care as well as a lack of knowledge in assessing and treating mental disorders. Still, many barriers to mental healthcare access persist that are beyond the scope of WI CPCP, such as long wait times and a lack of insurance coverage.ConclusionsThis study supports the effectiveness of the program to improve access to care for children. However, there is a need for additional solutions such as better reimbursement for mental health professionals and expanded insurance coverage.

Barriers to Adherence to Overactive Bladder Treatment for Hispanic Women.

Adherence to overactive bladder (OAB) therapy is low among the general population. Prior studies suggest that OAB is more prevalent among Hispanic women compared with other ethnicities. The aims of this study were to analyze nonadherence to OAB therapy among Hispanic compared with non-Hispanic women and identify potential barriers to treatment to reduce disparities in care. All patients who received treatment for OAB between 2018 and 2022 were included in this retrospective study. Race and ethnicity were self-reported. Nonadherence was defined as failure to initiate therapy within 1 year. Non-Hispanic women were selected at random to form a control group. The study was powered to detect a 50% difference in treatment nonadherence. Comparisons were made using the Fisher exact test or χ2 test as appropriate for nominal variables, and the Mann-Whitney test for continuous variables. The analysis included 126 Hispanic and 126 non-Hispanic women. Both cohorts were similar in demographics. Nonadherence to OAB therapy was more frequent among Hispanic women (44.0 vs 20.9%, P < 0.0001). After adjusting for age, body mass index, primary language, parity, insurance type, and treatment offered, Hispanic women were at a 2.54-fold increased risk of nonadherence (P = 0.007). A subanalysis of only Hispanic women found that younger age (P = 0.033), higher parity (P = 0.035) underinsured status (P = 0.027), and fewer office visits (P = 0.0002) were associated with nonadherence. Nonadherence to OAB therapy was greater among Hispanic women despite no difference in treatment patterns. Younger age, greater parity, lack of insurance, and fewer office visits may be barriers for Hispanic women.

Towards an understanding of the biopsychosocial determinants of CVD in SLE: a scoping review

ObjectiveSystemic lupus erythematosus (SLE) is a chronic autoimmune condition with significant physical, mental, psychosocial and economic impacts. A main driver of SLE morbidity and mortality is cardiovascular disease (CVD). Both...

Barriers to and Benefits of Mental Health Services in College Students with and without Depression, Anxiety, and Hazardous Alcohol Use

ABSTRACT College students are at risk for mental health concerns and hazardous alcohol use, yet few access services. We examined perceived barriers to and benefits of mental health services utilization (MHSU) among college students with and without symptoms of depression, anxiety, and/or hazardous alcohol use. Second-year students (n = 756; 63.4% female, 76.3% White non-Hispanic) were asked about depression, anxiety, alcohol use, and perceived barriers to and benefits of MHSU. Approximately 20% of students reported depression symptoms, anxiety symptoms, and/or hazardous alcohol use. About 40% of students with mental health symptoms and 25% of students engaging in hazardous alcohol use reported MHSU. Cost was the most cited barrier (89.1%), while improved mental health was the most cited benefit (97.7%). Compared to males, females had greater odds of reporting cost, lack of insurance, and not knowing where to go for help as barriers and increased communication as a benefit. Students reporting depression or anxiety symptoms endorsed more barriers than students without symptoms, specifically discomfort sharing feelings with another person, wanting to handle problems on one’s own, and lack of insurance. Campus administrators and counseling centers may benefit from understanding specific perceived benefits and barriers among students to develop strategies for outreach.

Association between Insurance Status and Outcomes of Hospitalizations for Necrotizing Soft Tissue Infections.

Background: Lack of insurance is associated with poorer outcomes in hospitalized patients. However, few studies have explored this association in hospitalizations for necrotizing soft tissue infections (NSTIs). This study examined the impact of insurance status on the outcome of NSTI admissions. Methods: All adult hospitalizations for necrotizing fasciitis, gas gangrene, and Fournier gangrene between 2016 and 2018 were examined using the Nationwide Inpatient Sample database. Insurance status was categorized as insured (including Medicare, Medicaid, and Private, including Health maintenance organization (HMO) or uninsured (Self-pay). Outcome measures included mortality rates, limb loss, length of hospital stay, prolonged hospital stay, and critical care admissions. Statistical analysis included weighted sample analysis, chi-square tests, multivariate regression analysis, and negative binomial regression modeling. Results: Approximately 29,705 adult hospitalizations for NSTIs were analyzed. Of these, 57.4% (17,065) were due to necrotizing fasciitis, 22% (6,545) to gas gangrene, and 20.5% (6,095) to Fournier gangrene. Approximately 9.7% (2,875) were uninsured, whereas 70% (26,780) had insurance coverage. Among the insured, Medicare covered 39.6% (10,605), Medicaid 29% (7,775), and private insurance 31.4% (8,400). After adjustments, Medicare insurance was associated with greater odds of mortality (adjusted odds ratio [aOR]: 1.81; 95% confidence interval [CI]: 1.33-2.47; p = 0.001). Medicaid insurance was associated with increased odds of amputation (aOR: 1.81; 95% CI: 1.33-2.47; p < 0.001), whereas private insurance was associated with lower odds of amputation (aOR: 0.70; 95% CI: 0.51-0.97; p = 0.030). Medicaid insurance was associated with greater odds of prolonged hospital stay (aOR: 1.34; 95% CI: 1.09-1.64; p < 0.001). No significant association was observed between the lack of insurance or self-pay and the odds of primary or secondary outcomes. Conclusion: Medicare insurance was correlated with greater odds of mortality, whereas Medicaid insurance was associated with increased odds of amputation and longer hospital stay. Uninsured status was not associated with significant differences in NSTI outcomes.

Identification of Priorities for Colorectal Cancer Screening Interventions Among US Hispanic/Latino Populations.

Objectives. To identify nationwide census tract‒level areas where improving colorectal cancer (CRC) screening uptake via targeted local preventive intervention may benefit Hispanic or Latino/a (H/L) groups defined by region or country of origin. Methods. Using 2021 Centers for Disease Control and Prevention PLACES and American Community Survey data, we applied geographically weighted regression and Getis-Ord Gi* hot spot procedures to identify CRC screening priority zones for H/L groups in the United States. Priority zones can be conceptualized as census tracts with strong inverse associations between percentage of a particular H/L group in the population and CRC screening rate, after adjusting for socioeconomic deprivation and lack of insurance. Results. We identified 6519, 3477, 3522, 1069, and 1424 census tract CRC screening priority zones for H/L communities of Mexican, Puerto Rican, Central/South American, Dominican, and Cuban heritage, respectively. Priority zones for H/L groups had strong spatial heterogeneity, and overlap of geographic patterns among H/L groups varied by region. Conclusions. Our findings and interactive web map may serve as a translational tool for public health authorities, policymakers, clinicians, and other stakeholders to target investment and interventions to increase guideline-concordant CRC screening uptake benefitting specific H/L communities in the United States. (Am J Public Health. 2024;114(S6):S515-S524. https://doi.org/10.2105/AJPH.2024.307733) [Formula: see text].

Mapping disparities in head and neck cancer care: Geospatial analysis of social vulnerability and healthcare access in the US.

e23112 Background: Ensuring equitable access to head and neck (H&amp;N) cancer care across the US is vital for optimal patient outcomes. This study explores the impact of social vulnerability on disparities in access to H&amp;N multidisciplinary specialist care by US region and metro status. Methods: Oncologists and a subset of H&amp;N cancer specialist practice locations were extracted from the National Provider Index, American Society of Clinical Oncology, and US News and World Report. Travel time using the fastest transportation mode from population-weighted county centroids to the nearest H&amp;N cancer specialist (surgical, radiation, or medical oncologist) was computed using Travel Time API. Cancer data were obtained from United States Cancer Statistics and Surveillance, Epidemiology, and End Results (SEER). Regression analysis assessed impact of aspects of social vulnerability from the Social Vulnerability Index (SVI) on travel time. A disparity index incorporating travel time, county-level H&amp;N cancer incidence, and SVI was developed to quantify disparities at the county-level. Results: In total, 18,241 medical, 6,387 radiation, and 2,564 surgical oncologists were identified, of which 346 medical, 308 radiation, and 453 surgical oncologists self-identified as H&amp;N specialists. Regression analysis indicated that low household income and lack of insurance within counties significantly increased travel time ( p &lt; .001) after controlling for US region, metro status, cancer rate, and other county-level factors. The disparity index identified counties with highest and lowest disparity (Table 1). Conclusions: Key findings highlight specific counties with higher vulnerability, primarily rural counties in the West and Southeast, and underscores the influence of social vulnerability on access to care. After accounting for US region and metro status, aspects of social vulnerability still predict travel time, with low household income and lack of insurance being the most impactful. Identified disparities in care may provide targets for interventions and policies aimed at reducing access inequalities, such as outreach programs and allocation of resources to underserved areas. [Table: see text]

Identifying objective risk factors of financial toxicity in patients with cancer.

e24116 Background: Current financial toxicity (FT) screening tools rely on patient-reported risk factors (RF)1. Underrepresented populations may not be forthcoming about FT fears due to cultural concerns of treatment withholding or migratory repercussions, if applicable1–4. Identifying objective RF, such as social determinants of health (SDH) and disease-specific factors (DSF), could reduce FT in cancer patients and healthcare systems. Methods: This was a multi-center retrospective study evaluating SDH and DSF associated with FT (defined as ≥$15,000 owed) related to cancer treatment. Inferential statistics were used to evaluate differences between the FT cohort and those who owed &lt; $15,000. Continuous data were compared with a Student’s t or Mann-Whitney U test, depending on distribution. Categorical outcomes were compared with a chi square test. A logistic regression model was used to evaluate multivariate associations with FT, using p &lt; 0.05 to define significant results. Results: The sample comprised 162 records, 81 in each group. Univariate analyses demonstrated differences in age, lack of PCP, non-US country of origin, lack of insurance, lower education levels, need for an English interpreter, stage 4 at diagnosis, recurrent or metastatic disease, use of immune checkpoint inhibitors (ICI), and use of targeted molecular therapy (TMT) (Table 1). Employment status and marital status were not statistically different. The logistic regression model showed that lack of insurance and stage 4 at diagnosis were significantly associated with FT (p = 0.001 and p = 0.0495, resp.). Conclusions: Objective FT screening can minimize response bias and incidence in those at increased risk. Non-US country of origin and lack of English proficiency suggests that first-generation Hispanics may not be appropriately navigated for FT. These findings identify specific subpopulations at risk for FT and will guide prospective interventions looking to minimize FT. Healthcare systems should analyze objective measures of FT while considering loco-regional and subcultural SDH/DSF in order to overcome response bias. Ref. Witte J et al. Methods for measuring financial toxicity after cancer diagnosis and treatment. Annals of Oncology. 2019;30(7) Strasser-Weippl K et al. Progress and remaining challenges for cancer control in Latin America and the Caribbean. Lancet Oncol. 2015;16(14) Zhu Z et al. Cancer survivors’ experiences with financial toxicity. Psychooncology. 2020;29(6) Chebli P et al. Multilevel determinants of financial toxicity in breast cancer care. Supportive Care in Cancer. 2020;28(7). [Table: see text]

Educating a diverse group of women in Los Angeles County on ovarian and uterine cancers and clinical trials.

e23105 Background: Ovarian and uterine cancers are among the deadliest cancers for women and due to vague symptoms, diagnosis is often delayed. In addition, there are ethnic disparities in time to diagnosis, treatment, and outcome for these cancers. The purpose of this study was to assess a diverse group of Los Angeles (LA) County women’s understanding of both ovarian and uterine cancers and assess the impact of intervention by community health organizations. Methods: A Qualtrics survey was administered online and in-person to 185 women aged 18 and older in LA County between May 3rd and July 15th 2023. The survey aimed to investigate participants’ knowledge, awareness, and attitudes on women’s cancers’ risk factors, symptoms, screening, treatment options, and clinical trials. Information on participant demographics was also collected. Chi-square analysis, descriptive statistics, filtering and sub-setting, correlation analysis were utilized using R-Studio. MiOra Health Educators provided face-to-face education on ovarian and uterine cancers as well as clinical trials to this sample of participants. Results: Out of 185 respondents, 117 (63.2%) were Hispanic or Latina and 65 (35.1%) reported completing 4 year of college education. 137 (74.0%) reported attending their annual women’s wellness visit. Women with insurance (143, 77.0%) were more likely to report having women’s cancer screening compared to those who were uninsured (71, 38.0%). 93 women (50.3%) reported going to their primary physicians for advice on sexual and/or genital organ health rather than visiting a gynecologist; however older women (aged 41-50) reported seeing their gynecologist more often than the women in younger groups. Moreover, 127 women (68.6%) were aware of clinical trials (the majority being college-educated) however, a majority of the total participants (154, 83.2%) did not know where to locate clinical trials or that one may leave a clinical trial at any time (123, 66.5 %). Prior to educational intervention, only 104 women (56.2%) reported being “somewhat knowledgeable” about women’s cancers’ risk factors and symptoms. Following educational intervention, 143 (77.7%) reported feeling more knowledgeable about women’s cancers’ risk factors and symptoms and 122 (66.6%) reported feeling more knowledgeable about clinical trials and comfortable participating in one. Conclusions: In this pilot study we found that a majority of diverse LA County women attend their annual wellness visits; however, only a small portion receive women’s cancer screening. Lack of insurance appears to be a significant barrier for access to screening tests. In addition to awareness of clinical trials, the ability to locate a clinical trial appears to influence participation in one. Although primary care providers and obstetricians are the most trusted health resources, community health educators may be effective in educating women to close these gaps.

Preparing Vulnerable Communities: Disaster Mitigation Strategies for Economically Depressed Areas in Oklahoma

When disasters strike, vulnerable areas that are economically disadvantaged are adversely affected economically, culturally, and healthily, as the lack of resources and vulnerabilities amplify their problems. This research focuses on the population specifics of disaster vulnerabilities and targeted policies for economically depressed neighborhoods in Oklahoma. Relative to less susceptible entities, poor people are likelier to take damage from tornados, winter storms, wildland fires, and flooding because they lack the resources required for preparation, response, and recovery. Through an equity-focused lens, the study examines four key factors amplifying disaster risk: those due to aging critical infrastructure, lack of insurance and savings, health disparities, or the failure to plan adequately. Collapsed stormwater drainage systems, roads, bridges, and water pipes in financially deprived communities experience cracks in a hurry during duresses. With little or no funds, families earning every paycheck cannot afford to purchase rescue insurance or, in the case of names, save money to build an emergency fund, including money to cover repair costs, temporary housing, and other costs. This is, of course, made even worse by any previously existing medical, disability, or mental health issues as well, with poorer health outcomes than might usually be expected since access to healthcare services, treatments, and medications is also disrupted. Lastly, language and education barriers lead to the lower development of disaster plans; the delays include access to early warning systems and a need for more awareness of risks among vulnerable groups. Given these weaknesses, the study offers policymakers, funders, and resilience practitioner’s implementable policy, investment, and community-oriented intervention recommendations. The hazards can be lessened by prioritizing infrastructure upgrades, insurance reduction, and commitment to spread-out shelters and relief supplies. Long-term recovery programs financed specifically by equal aid promote program equity of rebuilding. Regarding inclusive messaging on public preparation and early warnings, local trusted institutions should be appropriated to reach a diverse population. Collaborative networks among government agencies, relief organizations, businesses, and grassroots associations can bolster response capacity. Their unified efforts on localized resilience initiatives advance strategic plans for the state's most economically fragile neighborhoods. Implementation should focus on those with the highest vulnerability markers and the least ability to prepare, respond, and recover independently— metrics assessing community functionality, equity factors, and recovering spending offer evidence-based progress milestones. With climate change projected to increase disaster severity in Oklahoma, research-driven and equitable resilience policies for marginalized communities can reduce prolonged suffering. Tailored preparation, outreach, critical system backups, and financial support lessen acute shocks and accelerate recovery. However, sustainable policy change relies on addressing root socioeconomic inequalities through systemic interventions beyond immediate disaster management.

Racial and survival disparities in inflammatory breast cancer (IBC) and non-IBC: a population-based study focused on Native Hawaiians and other Pacific Islanders.

It is well known that race is an independent predictor of breast cancer mortality and advanced stage at diagnosis. Inflammatory breast cancer (IBC) is the most aggressive type of breast cancer and has distinct clinical and biological features. Previous studies have shown that Blacks have a higher incidence of IBC than Whites. However, the proportion of IBC and the role of race on prognosis in Native Hawaiian and other Pacific Islander (NH/PI) populations with breast cancer are poorly understood. In this study, we aimed to examine the proportion of IBC to non-IBC in NH/PIs and to identify the clinicopathological, biological, and socioeconomic factors associated with the overall survival of NH/PIs compared to other races. Utilizing a comprehensive cancer registry from the largest hospital in Hawaii, newly diagnosed primary invasive breast cancer patients diagnosed between 2000 and 2018 were identified. Univariate and multivariate Cox proportional hazards models were used to test the association between race and clinical outcomes. Variables with P-values <0.05 in the univariate analysis and race (variable of interest) were included in a multivariate analysis. The cohort included 3691 patients, 60 of whom had IBC. NH/PI race had the highest proportion of IBC compared to other races (3.44%) but was not found to be an independent poor prognostic factor in IBC (HR 1.17 [95%CI 0.26-5.22]). Conversely, NH/PI race was associated with worse survival outcomes in patients with non-IBC (HR 1.65 [95%CI, 1.14-2.39]) along with other factors such as lack of insurance, underinsured status, triple-negative breast cancer (TNBC) subtype, age, and advanced clinical stage. The findings of this study highlight that NH/PIs had higher rates of IBC and inferior survival in non-IBC compared to other races but not in IBC. It is essential to disaggregate NH/PI race from Asians in future population-based research studies. Further research is needed to understand the factors contributing to higher rates of IBC and poor survival outcomes in NH/PIs with non-IBC as well as targeted interventions to improve breast cancer outcomes in this population to ultimately help improve survival rates and reduce health inequities in NH/PIs with breast cancer.

Discharge of Acute Coronary Syndrome Patients on Sub-Optimal Dual Anti-Platelet Therapy: A Single Center Experience.

To identify and quantify the reasons why acute coronary syndrome (ACS) patients undergoing stenting at the University of New Mexico Hospital (UNMH) were prescribed sub-optimal dual antiplatelet therapy (DAPT) at discharge, and to identify practice patterns that could potentially lead to improved DAPT treatment for these patients. We reviewed electronic medical records and cardiac catheterization records of 326 patients who underwent percutaneous coronary intervention (PCI) at UNMH between January 1, 2021, and June 30, 2022 and identified 229 ACS patients who survived until discharge. Demographic and clinical characteristics relevant to P2Y12 inhibitor selection were obtained from a review of medical records. Pharmacists' notes documenting their efforts to secure appropriate insurance coverage and reasons for discharging patients on clopidogrel rather than ticagrelor/prasugrel were reviewed. Patients discharged on aspirin and clopidogrel underwent review of medical records and cardiac catheterization lab records to determine if the discharge P2Y12 drug was appropriate. Reasons for inappropriate discharge on clopidogrel were categorized as cost/insurance, patient preference, concern for daily adherence to a twice-daily medication, and maintenance of pre-hospital clopidogrel therapy rather than switch to ticagrelor after PCI. The 229 ACS patients included 87 (38.0%) appropriately discharged on ticagrelor/prasugrel, 63 (27.5%) appropriately discharged on clopidogrel, 75 (32.8%) discharged on sub-optimal clopidogrel, and 4 (1.7%) not discharged on a P2Y12 inhibitor. For patients inappropriately discharged on clopidogrel (n = 75), the most common reasons were cost or lack of insurance (n = 56) and clinical inertia (taking clopidogrel before PCI and maintained on it afterward) (n = 17). Sub-optimal P2Y12 therapy at discharge was significantly associated with lack of insurance (odds ratio 21.5, 95% confidence interval 5.33-156,p < 0.001) but not with ethnicity, age, sex, or diabetes. At the University of New Mexico, a safety-net hospital, increasing financially restricted access to ticagrelor/prasugrel could help up to 24.5% of ACS patients reduce their risk of ischemic events. For patients admitted on clopidogrel DAPT, escalating to ticagrelor/prasugrel could reduce ischemic risk in 7.4%. Expanding and improving healthcare insurance coverage might reduce the frequency of discharge on sub-optimal P2Y12 therapy.