Large Racial Disparities Research Articles

Racialized police use of force and maternal health

IntroductionThere are large racial disparities in maternal health that cannot be explained by education, income, or other individual-level risk factors. This cross-sectional study estimated associations between racial inequity in police use of force (PUOF) at the community level and health outcomes of Black and White women. MethodsBirth records were linked to maternal hospital discharge records and municipal police department data for 326,240 births occurring between 1/1/2012 and 12/31/2016 to Black and White women in New Jersey. Outcomes, identified using diagnosis and procedure codes, were substance use (any/tobacco/alcohol/other), mental health disorders (any/depression/anxiety/ other), asthma, obesity, hypertension (preexisting/gestational), diabetes (preexisting/gestational), severe maternal morbidity, other cardiovascular diseases, and preterm labor. Data were analyzed in 2024. ResultsFor Black women, living in a community with 1% greater racially-disproportionate PUOF was associated with higher odds of any mental health disorder [by 0.18%; 95% CI: 0.08-0.28], depression [0.19%; 95% CI: 0.05-0.33], anxiety [0.25%; 95% CI: 0.09-0.41], other mental health disorder [0.17%; 95% CI: 0.07-0.27], any substance use [0.26%; 95% CI: 0.14-0.38], tobacco use [0.31%; 95% CI: 0.16-0.46], other substance use [0.17%; 95% CI: 0.04-0.30], asthma [0.12%; 95% CI: 0.04-0.21], and preterm labor [0.17%; 95% CI: 0.05-0.29] in adjusted models. There were no robust associations with the other outcomes for Black women or with any of the outcomes for White women. ConclusionsRacially-disproportionate PUOF was significantly associated with mental illness, substance use, asthma, and preterm labor of Black women. Results underscore the potential importance of institutionalized racism as a fundamental cause of health disparities.

Abstract B083: Community-based knowledge-to-action translation to improve early detection of prostate cancer among Black individuals

Abstract Introduction: Black individuals have 70-80% higher incidence and 120% higher mortality from prostate cancer when compared to all other groups in the US. This is the largest racial disparity in cancer-related mortality in the US and has persisted over the last five decades despite improvements in the diagnosis and treatment of prostate cancer. Our previous work demonstrated that intensified screening practices could reduce prostate cancer mortality among Black individuals. Challenges impede the translation of these findings into real-world interventions and practices. The objective of this study was to design a patient-centered and culturally tailored knowledge toolkit to improve the knowledge and awareness of prostate-specific antigen (PSA) testing in Black individuals to facilitate informed shared-decision making between Black patients and primary care providers. Methods: Using a community-partnered participatory research approach, we convened a working group of Black prostate cancer survivors and community advocates, and clinicians, researchers, and health communications specialists. During monthly meetings, the working group followed Graham’s Knowledge-to-Action framework to synthesize information from: 1) peer-reviewed literature on the use of shared decision-making aids; 2) interviews conducted by our research team with Black individuals regarding barriers and facilitators to access PSA testing; and 3) community input on PSA testing and prostate cancer early detection. We then facilitated four iterative design sessions with the working group to develop recommendations for toolkit content, framing, and format. Results: With the working group, we designed a comprehensive set of resources to increase knowledge and awareness of PSA testing for early detection of prostate cancer among Black individuals. The design framework includes detailed recommendations on the content, framing, and format for resources contained in the toolkit. Recommendations encompass: 1) interactive web-based documents that cover comprehensive information about prostate cancer risk and screening; 2) printable shared decision-making documents that present evidence-based information about the use of PSA testing to guide conversations between Black individuals and their primary care providers; and 3) educational videos focused on prostate cancer fundamentals and dispelling common misconceptions about prostate cancer risk and screening, with content delivered by Black prostate cancer survivors and interviews with Black providers and prostate cancer researchers. Conclusion: This study addressed the need for a community-developed approach to increasing knowledge and awareness about prostate cancer screening and early detection in an accessible, culturally tailored, and accurate manner. We used a collaborative process that centered the experiences of Black prostate cancer survivors and advocates in the design of a toolkit that can facilitate decision-making discussions between Black individuals and their care providers for use of PSA testing for prostate cancer screening. Citation Format: Jenney R. Lee, Sung Min Kim, Yohali Burrola- Mendez, Dante' Morehead, Marty Chakoian, Michael Ware, Kojo Ward, Floyd Gossett, Vida Henderson, Patricia Egwuatu, Burcu Darst, John Masembe, Erika M. Wolff, Yaw A Nyame. Community-based knowledge-to-action translation to improve early detection of prostate cancer among Black individuals [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 B083.

Suspect race affects defense attorney evaluations of preidentification evidence.

When an officer places a suspect in an identification procedure and the witness identifies the suspect, it falls on attorneys to make decisions that reflect the strength of that identification. The factor that most affects the strength of identification evidence is the likelihood that the suspect is guilty before being subjected to the procedure, which scholars refer to as the prior probability of guilt. Given large racial disparities in exonerations based on eyewitness misidentifications, the current work examined whether defense attorneys are less sensitive to prior evidence of guilt when the defendant is Black as opposed to White. We predicted that when the defendant's race was described as White rather than Black, attorneys' judgments would be more sensitive to variations in the evidence that would influence the base rate of guilt. We also predicted that attorneys would rate the case as stronger when the victim's race was described as White rather than Black. We gave 316 defense attorneys case files (modeled after the New York Police Department's style) that varied the strength of the preidentification evidence (strong vs. weak), the race of the defendant (Black vs. White), and the race of the victim (Black vs. White). Attorneys made judgments that were sensitive to the base rate of guilt, but self-report measures demonstrated that they did not understand the extent to which the base rate of guilt influences the reliability of eyewitness evidence. Participants also rated the strength of the preidentification evidence as stronger for Black than for White defendants. Although attorneys are intuitively sensitive to the strength of preidentification evidence, they lack conscious awareness of how a suspect's prior probability of guilt affects likelihood of a mistaken identification, which may have implications for their ability to make race-neutral evaluations of preidentification evidence. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Factors predicting primary and booster COVID-19 vaccination in a community sample of African American men and women in the United States Midwest

COVID-19 has disproportionately burdened impoverished minority communities. This study recruited an age- and gender-diverse community sample of 541 Black adults in a United States Midwestern city with large racial health disparities, with the aim of examining factors associated with COVID-19 vaccination. All participants completed measures assessing their COVID-19 vaccination status (unvaccinated, received primary vaccination, or received primary plus booster vaccination) as well as demographic characteristics, socioeconomic factors, health and health system factors, and health behavior theory constructs related to vaccination. In this predominantly low-income sample, 55% of participants had received primary COVID-19 vaccination and 31% of the sample had received a booster dose. Multiple regression analyses established that having primary vaccination was significantly predicted by older age, political identification as Democrat, education beyond high school, barriers to accessing health care, as well as higher trust of vaccine benefits, less preference for natural immunity, stronger social norms favoring vaccination, and perceiving higher levels of collective responsibility. Surprisingly, higher global medical mistrust and difficulty with healthcare access were associated with vaccination. The model explained 76% of the variance in primary COVID-19 vaccination. Having received a COVID-19 booster was predicted by older age, previous COVID-19 infection, higher trust in vaccine benefits, and fewer worries about unforeseen future effects of vaccination. Study findings identified factors associated with COVID-19 vaccine uptake in racial minority communities, and support the benefits of interventions that harness social network supports for vaccination, address community vaccine concerns, and appeal to collective responsibility to promote vaccine uptake.

Intersectional disparities in outpatient alcohol treatment completion by gender and race and ethnicity.

Untreated alcohol use disorder (AUD) can have negative outcomes, including premature death. Completing specialty treatment for AUD can improve economic and educational outcomes. However, there are large racial and ethnic disparities in treatment completion, and how these disparities vary intersectionally (e.g., by gender and race and ethnicity) is unknown. Recent studies suggest that not using an intersectional approach can mask important disparities. We estimated disparities in AUD nonintensive outpatient treatment completion by gender alone, race and ethnicity alone, and intersectionally in a gender-by-race-and-ethnicity model. Accurately quantifying treatment completion disparities is critical not only for understanding healthcare disparities but reducing them to advance health equity. Data are from SAMHSA's 2017 to 2019 Treatment Episode Dataset-Discharges for adults aged 18+ who entered nonintensive outpatient treatment primarily for alcohol (n = 559,447 episodes; 30.3% women; 63.7% White, 18.0% Black, 14.4% Hispanic/Latinx, 2.1% American Indian/Alaska Native [AIAN], 1.0% Asian/Pacific Islander). Using the rank-and-replace method, treatment completion disparities were estimated by gender, race and ethnicity, and gender-by-race-and-ethnicity due to any reason other than differences in need for treatment, consistent with the Institute of Medicine's definition of a healthcare disparity. The intersectional gender-by-race-and-ethnicity model identified the widest range of disparities among all models tested. Using this model, the largest disparities were identified for minoritized women's treatment episodes. Compared to White men whose completion rate was 60.79% (95% confidence interval [CI]: 60.06, 60.98), Black, Hispanic/Latina, AIAN, and Asian-American/Pacific Islander women had treatment episode completion rates that were 12.35 (CI: 12.33, 12.37), 9.08 (CI: 9.06, 9.11), 10.27 (CI: 10.22, 10.32), and 4.87 (CI: 4.78, 4.95) percentage points lower, respectively. In the United States, treatment completion rates for non-intensive outpatient alcohol treatment episodes are significantly lower for minoritized women than White men. The extent of the disparity is not apparent in univariate models, highlighting the importance of an intersectional approach to understanding disparities in the completion of non-intensive outpatient treatment for AUD.

Racial Disparities in Childhood Vaccination Rates

Background: Despite the high efficacy and safety of routine vaccinations, most of the United States is currently falling well short of the Healthy People 2020 goals for childhood vaccination rates. A large racial disparity exists within the IU Health (IUH) system, with about a 26% difference between Black/African American (BAA) and white patient vaccination rates as of 2022. Within IUH, the most commonly missed appointment is the 4-month well child check, a critical appointment for staying up to date on vaccinations. In response to this disparity, a pilot program was launched to assist BAA patients in scheduling, attending visits, and getting vaccinated. This study also investigates the roles of insurance, race, ethnicity, and gender in racial disparities of routine vaccination rates among IU Health pediatric patients at the Riley Pediatric Care Center (PCC).
 Project Methods: A cohort of patients at the PCC clinic who were not meeting vaccination recommendations were compared to the PCC patient population as a whole to identify drivers of under-vaccination. These patients were also compared to patients within the pilot vaccination program to assess program efficacy in scheduling and attending 4-month well child checks.
 Results: The largest differences between the cohort not meeting the vaccination measure and the PCC patient population were race and insurance status. Patients not meeting vaccination recommendations were more likely to be BAA and to use Medicaid. The pilot program patient population had much higher rates of attendance at 4-month well child checks and vaccination rates for rotavirus among BAA patients than the IUH BAA patient population as a whole.
 Conclusions: The data from this study will help identify drivers of racial disparities in vaccination rates and guide data-driven and community-informed interventions to ameliorate the disparity. The pilot program has shown great success and warrants strong consideration for increased investment and expansion.

The role of suspect development practices in eyewitness identification accuracy and racial disparities in wrongful conviction

AbstractThis article reviews the three previously studied categories of variables that are related to eyewitness identification accuracy: estimator (characteristics of the witnessing conditions), system (characteristics of the identification procedure that are under the control of the criminal legal system), and reflector (variables that reflect the likely accuracy of a witness). Although eyewitness scholars frequently turn to these variables and models of memory to explain why eyewitnesses make mistakes, none of these variables provides a reasonable explanation for the large racial disparities in wrongful convictions based on mistaken identifications, yet problematic policing practices might. The policies and practices guiding police efforts to develop suspects as well as the decisions of officers to place a suspect at risk of misidentification determine the base‐rate of innocent suspects that appear in identification procedures. Current police practices—from developing suspects based on hunches, through facial recognition technology, or by pressuring reluctant witnesses to make identifications—increase the likelihood that innocent suspects will be placed in lineups. An increase in lineups with innocent suspects increases the ratio of mistaken to correct identifications without changes in witness performance. Requirements for evidence‐based suspicion, video recording identification procedures, and prohibiting coercive interviewing techniques with reluctant witnesses are recommended for reducing the effect of unreliable suspect development methods on eyewitness evidence.

COVID-19 Case, Death, and Vaccination Rate Disparities by Race and Ethnicity in Virginia.

This paper tracks trends in COVID-19 case, death, and vaccination rate disparities by race and ethnicity in Virginia during the COVID-19 pandemic. COVID-19 case, death, and vaccination rates were obtained from electronic state health department records from March 2020 to February 2022. Rate ratios were then utilized to quantify racial and ethnic disparities for several time periods during the pandemic. The Hispanic population had the highest COVID-19 case and age-adjusted death rates, and the lowest vaccination rates at the beginning of the pandemic in Virginia. These disparities resolved later in the pandemic. COVID-19 case and death rates among the Black population were also higher than those of the White population and these disparities remained throughout the pandemic. Racial and ethnic disparities changed over time in Virginia as vaccination coverage and public health policies evolved. Year 2 of the analysis saw lower case and death rates, and higher vaccination rates for non-White populations in Virginia. Public health strategies need to be addressed during the pandemic and developed before the next pandemic to ensure that large racial and ethnic disparities are not again present at the outset.

Death by the minute: Inequities in trauma care for victims of firearm violence.

Gunshot wounds (GSWs) remain a significant source of mortality in the United States. Timely delivery of trauma care is known to be critical for survival. We sought to understand the relationship of predicted transport time and death after GSW. Given large racial disparities in firearm violence, we also sought to understand disparities in transport times and death by victim race, an unstudied phenomenon. Firearm mortality data were obtained from the Boston Police Department 2005 to 2023. Firearm incidents were mapped using ArcGIS. Predicted transport times for each incident to the closest trauma center were calculated in ArcGIS. Spatial autoregressive models were used to understand the relationship between victim race, transport time to a trauma center, and mortality associated with the shooting incidents. There were 4,545 shooting victims with 758 deaths. Among those who lived, the median transport time was 9.4 minutes (interquartile range, 5.8-13.8) and 10.5 minutes (interquartile range, 6.4-14.6; p = 0.003) for those who died. In the multivariable logistic regression, increased transport time to the nearest trauma center (odds ratio, 1.024; 95% confidence interval, 1.01-1.04) and age (odds ratio, 1.016; 95% confidence interval, 1.01-1.02) were associated with mortality. There was a modest difference in median transport time to the nearest trauma center by race with non-Hispanic Black at 10.1 minutes, Black Hispanic 9.2 minutes, White Hispanic 8.5 minutes, and non-Hispanic White 8.3 minutes ( p < 0.001). Our results highlight the relationship of transport time to a trauma center and death after a GSW. Non-White individuals had significantly longer transport times to a trauma center and predicted mortality would have been lower with White victim transport times. These data underscore the importance of timely trauma care for GSW victims and can be used to direct more equitable trauma systems. Prognostic/Epidemiological; Level III.

Exercise to enhance cardiovascular health among Black patients with prostate cancer with androgen deprivation therapy: The POWER trial.

TPS5120 Background: Large racial disparities persist in prostate cancer (PCa) incidence and mortality in the US. Among all races, Black men have the highest rates of PCa incidence and mortality, where they are 1.7 and 2.1 times more likely to develop and die of PCa compared to non-Hispanic White men, respectively. Androgen deprivation therapy (ADT) is one of the most recommended treatments for intermediate and advanced PCa. However, men receiving ADT have a higher risk of developing cardiovascular disease (CVD) by 65% compared to patients not receiving ADT, which is likely linked to ADT-induced cardiovascular and metabolic toxicity. Moreover, Black men with PCa receiving ADT have a higher risk of CVD-related death and a higher prevalence of comorbid conditions. Therefore, prevention and management of CVD risk factors in this population is an important unmet clinical need. Exercise is an effective way to lower CVD risk factors in many clinical settings; however, Black men with cancer are underrepresented in exercise oncology research, and no studies to date have focused on Black men with PCa on ADT. We designed a randomized controlled trial, entitled “Exercise to Enhance Cardiovascular Health among Black Prostate Cancer Patients with Androgen Deprivation Therapy: POWER Trial.” The objective of the POWER Trial is to examine the effects of a tailored exercise intervention on CVD risk factors in Black men with PCa undergoing ADT. Methods: The POWER trial is a two-arm, multi-center, randomized controlled trial, recruiting 62 Black men with localized or metastatic PCa who are receiving ADT at Dana-Farber Cancer Institute or Beth Israel Deaconess Medical Center, Boston, MA. Participants are randomly assigned to either exercise training or usual care at a 1:1 ratio. Participants in the intervention group are asked to complete a culturally tailored, home-based, virtually supervised exercise training program thrice weekly for 16 weeks. Aerobic exercise is high-intensity interval training and performed on a stationary bike, alternating 1-min high-intensity (75-95% of VO2peak) and 1-min recovery (40% of VO2peak) intervals. Resistance exercises are performed on large muscle groups using dumbbells with 2-3 sets of 15-20 repetitions at 60-75% of the 1-repetition maximum. Participants in the usual care group are asked not to change their baseline exercise behavior and then may cross over to the exercise program after the initial 16 weeks. The primary outcome is the CVD risk assessed by the Framingham Risk Score (i.e., age, sex, blood cholesterol, blood pressure, and smoking). The secondary and exploratory outcomes include cardiorespiratory fitness, muscular strength, body composition, patient-reported outcomes, and treatment-related symptoms. To date, five out of the planned 62 patients have been enrolled. This trial is registered in clinicaltrials.gov (NCT05327465). Clinical trial information: NCT05327465 .

Neighborhood Walkability as a Risk Factor for Preterm Birth Phenotypes in Two Philadelphia Hospitals from 2013-2016.

A total of one in ten infants is born preterm in the U.S. with large racial disparities. Recent data suggest that neighborhood exposures may play a role. Walkability-how easily individuals can walk to amenities-may encourage physical activity. We hypothesized that walkability would be associated with a decreased risk of preterm birth (PTB) and that associations would vary by PTB phenotype. PTB can be spontaneous (sPTB) from conditions such as preterm labor and preterm premature rupture of membranes, or medically indicated (mPTB) from conditions such as poor fetal growth and preeclampsia. We analyzed associations of neighborhood walkability (quantified by their Walk Score® ranking) with sPTB and mPTB in a Philadelphia birth cohort (n = 19,203). Given racial residential segregation, we also examined associations in race-stratified models. Walkability (per 10 points of Walk Score ranking) was associated with decreased odds of mPTB (aOR 0.90, 95% CI: 0.83, 0.98), but not sPTB (aOR 1.04, 95% CI: 0.97, 1.12). Walkability was not protective for mPTB for all patients; there was a non-significant protective effect for White (aOR 0.87, 95% CI: 0.75, 1.01), but not Black patients (aOR 1.05, 95% CI: 0.92, 1.21) (interaction p = 0.03). Measuring health effects of neighborhood characteristics across populations is key for urban planning efforts focused on health equity.

Examining Twitter-Derived Negative Racial Sentiment as Indicators of Cultural Racism: Observational Associations With Preterm Birth and Low Birth Weight Among a Multiracial Sample of Mothers, 2011-2021.

Large racial and ethnic disparities in adverse birth outcomes persist. Increasing evidence points to the potential role of racism in creating and perpetuating these disparities. Valid measures of area-level racial attitudes and bias remain elusive, but capture an important and underexplored form of racism that may help explain these disparities. Cultural values and attitudes expressed through social media reflect and shape public norms and subsequent behaviors. Few studies have quantified attitudes toward different racial groups using social media with the aim of examining associations with birth outcomes. We used Twitter data to measure state-level racial sentiments and investigate associations with preterm birth (PTB) and low birth weight (LBW) in a multiracial or ethnic sample of mothers in the United States. A random 1% sample of publicly available tweets from January 1, 2011, to December 31, 2021, was collected using Twitter's Academic Application Programming Interface (N=56,400,097). Analyses were on English-language tweets from the United States that used one or more race-related keywords. We assessed the sentiment of each tweet using support vector machine, a supervised machine learning model. We used 5-fold cross-validation to assess model performance and achieved high accuracy for negative sentiment classification (91%) and a high F1 score (84%). For each year, the state-level racial sentiment was merged with birth data during that year (~3 million births per year). We estimated incidence ratios for LBW and PTB using log binomial regression models, among all mothers, Black mothers, racially minoritized mothers (Asian, Black, or Latina mothers), and White mothers. Models were controlled for individual-level maternal characteristics and state-level demographics. Mothers living in states in the highest tertile of negative racial sentiment for tweets referencing racial and ethnic minoritized groups had an 8% higher (95% CI 3%-13%) incidence of LBW and 5% higher (95% CI 0%-11%) incidence of PTB compared to mothers living in the lowest tertile. Negative racial sentiment referencing racially minoritized groups was associated with adverse birth outcomes in the total population, among minoritized mothers, and White mothers. Black mothers living in states in the highest tertile of negative Black sentiment had 6% (95% CI 1%-11%) and 7% (95% CI 2%-13%) higher incidence of LBW and PTB, respectively, compared to mothers living in the lowest tertile. Negative Latinx sentiment was associated with a 6% (95% CI 1%-11%) and 3% (95% CI 0%-6%) higher incidence of LBW and PTB among Latina mothers, respectively. Twitter-derived negative state-level racial sentiment toward racially minoritized groups was associated with a higher risk of adverse birth outcomes among the total population and racially minoritized groups. Policies and supports establishing an inclusive environment accepting of all races and cultures may decrease the overall risk of adverse birth outcomes and reduce racial birth outcome disparities.

P9 Mixed endometrial cancer a rare histology with the largest racial disparity in survival

P9 Mixed endometrial cancer a rare histology with the largest racial disparity in survival

DGAT2 Inhibition Potentiates Lipid Droplet Formation To Reduce Cytotoxicity in APOL1 Kidney Risk Variants.

Two variants in the gene encoding apolipoprotein L1 (APOL1) that are highly associated with African ancestry are major contributors to the large racial disparity in rates of human kidney disease. We previously demonstrated that recruitment of APOL1 risk variants G1 and G2 from the endoplasmic reticulum to lipid droplets leads to reduced APOL1-mediated cytotoxicity in human podocytes. We used CRISPR-Cas9 gene editing of induced pluripotent stem cells to develop human-derived APOL1G0/G0 and APOL1G2/G2 kidney organoids on an isogenic background, and performed bulk RNA sequencing of organoids before and after treatment with IFN-γ. We examined the number and distribution of lipid droplets in response to treatment with inhibitors of diacylglycerol O-acyltransferases 1 and 2 (DGAT1 and DGAT2) in kidney cells and organoids. APOL1 was highly upregulated in response to IFN-γ in human kidney organoids, with greater increases in organoids of high-risk G1 and G2 genotypes compared with wild-type (G0) organoids. RNA sequencing of organoids revealed that high-risk APOL1G2/G2 organoids exhibited downregulation of a number of genes involved in lipogenesis and lipid droplet biogenesis, as well as upregulation of genes involved in fatty acid oxidation. There were fewer lipid droplets in unstimulated high-risk APOL1G2/G2 kidney organoids than in wild-type APOL1G0/G0 organoids. Whereas DGAT1 inhibition reduced kidney organoid lipid droplet number, DGAT2 inhibition unexpectedly increased organoid lipid droplet number. DGAT2 inhibition promoted the recruitment of APOL1 to lipid droplets, with associated reduction in cytotoxicity. Lipogenesis and lipid droplet formation are important modulators of APOL1-associated cytotoxicity. Inhibition of DGAT2 may offer a potential therapeutic strategy to attenuate cytotoxic effects of APOL1 risk variants.

Student Discipline Disparities in Virginia

Large racial disparities in student discipline are thought to be directly contributing to disproportionate minority contact in the juvenile justice system. Little has been done to learn about what acts as a predictor of and gives rise to these disparities. The current research aims to add to this conversation by examining the relationship between racial disparities in reported student offenders, measured using risk ratio, and two budget variables: the proportion of budget going towards diversity inclusion and per-pupil expenditures. Specifically, the research asks: How does spending on specific diversity programs and overall spending on students affect racial disparities in student discipline? A meta-analysis was utilized to answer this question. Data on Black, Hispanic, and White male students with no disabilities were collected from 314 public high schools across 126 school districts in Virginia. To find the correlation between racial disparities in reported student offenders and specific diversity programs as well as overall spending on students, a Pearson’s r test for correlation was conducted. Disparities in student discipline were positively correlated with the proportion of budget going toward diversity inclusion, but this correlation was not statistically significant. On the other hand, disparities in student discipline had a statistically significant positive correlation with per-pupil expenditures. This positive correlation indicates that the wealth of a district acts as a predictor of levels of racial disparity in student discipline. This suggests that the demographics of a district or segregation within a district could contribute to or exacerbate the existence of such disparities.

Maternal Mortality in the United States: Recent Trends, Current Status, and Future Considerations.

Rigorous studies carried out by the National Center for Health Statistics show that previously reported increases in maternal mortality rates in the United States were an artifact of changes in surveillance. The pregnancy checkbox, introduced in the revised 2003 death certificate and implemented by the states in a staggered manner, resulted in increased identification of maternal deaths and in reported maternal mortality rates. This Commentary summarizes the findings of the National Center for Health Statistics reports, describes temporal trends and the current status of maternal mortality in the United States, and discusses future concerns. Although the National Center for Health Statistics studies, based on recoding of death certificate information (after excluding information from the pregnancy checkbox), showed that crude maternal mortality rates did not change significantly between 2002 and 2018, age-adjusted analyses show a temporal reduction in the maternal mortality rate (21% decline, 95% CI 13-28). Specific causes of maternal death, which were not affected by the pregnancy checkbox, such as preeclampsia, showed substantial temporal declines. However, large racial disparities continue to exist: Non-Hispanic Black women had a 2.5-fold higher maternal mortality rate compared with non-Hispanic White women in 2018. This overview of maternal mortality underscores the need for better surveillance and more accurate identification of maternal deaths, improved clinical care, and expanded public health initiatives to address social determinants of health. Challenges with ascertaining maternal deaths notwithstanding, several causes of maternal death (unaffected by surveillance artifacts) show significant temporal declines, even though there remains substantial scope for preventing avoidable maternal death and reducing disparities.

Trends and Social Inequalities in Maternal Mortality in the United States, 1969-2018.

Background:Despite the previous long-term decline and a recent increase in maternal mortality, detailed social inequalities in maternal mortality in the United States (US) have not been analyzed. This study examines trends and inequalities in US maternal mortality by maternal race/ethnicity, socioeconomic status, nativity/immigrant status, marital status, area deprivation, urbanization level, and cause of death.Methods:National vital statistics data from 1969 to 2018 were used to compute maternal mortality rates by sociodemographic factors. Mortality trends by deprivation level were analyzed by using census-based deprivation indices. Rate ratios and log-linear regression were used to model mortality trends and differentials.Results:Maternal mortality declined by 68% between 1969 and 1998. However, there was a recent upturn in maternal mortality, with the rate increasing from 9.9 deaths/100,000 live births in 1999 to 17.4 in 2018. The large racial disparity persisted over time; Black women in 2018 had a 2.4 times higher risk of maternal mortality than White women. During 2013-2017, the rate varied from 7.0 for Chinese women to 42.0 for non-Hispanic Black women. Unmarried status, US-born status, lower education, and rural residence were associated with 50-114% higher maternal mortality risks. Mothers in the most-deprived areas had a 120% higher risk of mortality than those in the most-affluent areas; both absolute and relative disparities in mortality by deprivation level widened between 2002 and 2018. Hemorrhage, pregnancy-related hypertension, embolism, infection, and chronic conditions were the leading causes of maternal death, with 31% of the deaths attributable to indirect obstetric causes.Conclusions and Global Health Implications:Despite the steep long-term decline in US maternal mortality, substantial racial/ethnic, socioeconomic, and rural-urban disparities remain. Monitoring disparities according to underlying social determinants is key to reducing maternal mortality as they give rise to inequalities in social conditions and health-risk factors that lead to maternal morbidity and mortality.

Trends and disparities in American Indian/Alaska Native unintentional injury mortality from 1999 to 2016

IntroductionAlcohol and drug use are significant problems in the US, and American Indian/Alaska Native (AI/AN) communities and individuals are known to be among the most affected. This study evaluates disparities...

Severe Acute Respiratory Syndrome Coronavirus 2 Surveillance in Decedents in a Large, Urban Medical Examiner’s Office

BackgroundSARS-CoV-2 has become a global pandemic. Given the challenges in implementing widespread SARS-CoV-2 testing, there is increasing interest in alternative surveillance strategies.MethodsWe tested nasopharyngeal swabs from 1094 decedents in the Wayne County Medical Examiner’s office for SARS-CoV-2. All decedents were assessed by a COVID-19 checklist, and decedents flagged by the checklist (298) were preferentially tested. A random sample of decedents not flagged by the checklist were also tested (796). We statistically analyzed the characteristics of decedents (age, sex, race, and manner of death), differentiating between those flagged by the checklist and not and between those SARS-CoV-2 positive and not.ResultsA larger percentage of decedents overall were male (70% vs 48%) and Black (55% vs 36%) compared to the catchment population. Seven-day average percent positivity among flagged decedents closely matched the trajectory of percent positivity in the catchment population, particularly during the peak of the outbreak (March and April). After a lull in May to mid-June, new positive tests in late June coincided with increased case detection in the catchment. We found large racial disparities in test results: despite no statistical difference in the racial distribution between those flagged and not, SARS-CoV-2 positive decedents were substantially more likely to be Black (82% vs 51%). SARS-CoV-2 positive decedents were also more likely to be older and to have died of natural causes, including of COVID-19 disease.ConclusionsDisease surveillance through medical examiners and coroners could supplement other forms of surveillance and may serve as a possible early outbreak warning sign.

Abstract C070: Social determinants of health disparities in triple-negative breast cancer in Louisiana

Abstract Introduction: Triple-negative breast cancer (TNBC) is an aggressive, heterogeneous subtype of breast cancer. TNBC patients have generally high risk of recurrence and metastasis, and treatment options remain limited, as there are no effective targeted therapies available. In USA, TNBC is diagnosed disproportionately more frequently in African American (AA) women than in European American (EA) women. We set out to investigate the role of social determinants in racial disparities in TNBC. Methods: TNBC patients diagnosed in Louisiana from 2010-2012 were identified from the Louisiana Tumor Registry. Patients were geocoded to census tract of residence at time of diagnosis. Census tract population and socioeconomic measures were obtained from the US Census American Community Survey. We used multilevel statistical models to analyze the role of neighborhood concentrated disadvantage index (CDI), a robust measure of physical and social environment, in racial disparities in TNBC incidence, stage at diagnosis, and stage-specific survival for the study population. CDI scores were calculated according to the PhenX Toolkit protocol. Results: We identified 1,216 women with TNBC for the study. Controlling for age, we found that AA women had a 2.21-fold risk of TNBC incidence compared to EA in Louisiana. Results from multivariate analyses indicated that the incidence of TNBC was independent of neighborhood CDI, as was the racial disparity. However, CDI did explain existing racial disparities in both stage at diagnosis and stage-specific survival. The odds of diagnosis at later stages were 42% higher for black women. A single standard deviation increase in CDI increased the hazard of breast cancer-related death by 19%. Overall, our results suggest that the increased incidence of TNBC in black women is independent of CDI, while neighborhood environment has a greater impact than race on the promotion and progression of the disease. The socioeconomic disadvantage experienced by black women coupled with increased biologic risk for TNBC contribute to the large racial disparity in breast cancer mortality in Louisiana. Further research is needed to determine the mechanisms through which social determinants affect the promotion and progression of this disease and guide efforts to improve overall survival. Citation Format: Fokhrul Hossain, Denise Danos, Aubrey Gilliland, Claudia Leonardi, Tekeda Ferguson, Neal Simonsen, Qingzhao Yu, Om Prakesh, Richard Scribner, Lucio Miele. Social determinants of health disparities in triple-negative breast cancer in Louisiana [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C070.