Low Socioeconomic Status Patients Research Articles

Association of cleft lip and palate with predisposing factors

BACKGROUND: The cleft lip (CL) and palate are common orofacial congenital abnormalities observed in Indian population. Various predisposing factors contribute to this condition. PURPOSE: The purpose is to assess the most common type of CL and palate and to study predisposing factors associated with its development. MATERIAL AND METHODS: This cross-sectional prospective study was carried in 80 patients with CL and palate. A detailed history was recorded in predesigned pro forma. The occurrence of different types of CL and palate with predisposing factors were assessed. RESULTS: Out of 80 patients, 18.8% of patients had only CL, 46.2% had unilateral CL with palate (UCLP), and 35% had a bilateral CL with palate (BCLP). CL and palate were observed more in males. The left side of the lip was more affected than the right side. Low socioeconomic status patients had more incidences. Advanced maternal age, more than 35 years, was the most common predisposing factor 62.5%. Consanguineous marriage of parents was the second-most predisposing factor observed in 40% of cases. Breastfeeding habit was observed in 73.3% of CL patients, 25% in UCLP patients, and 17.2% in BCLP patients. CONCLUSIONS: Males were more commonly affected by CL and palate with the left side predominance. Advanced maternal age above 35 years was the most predisposing factor followed by consanguineous marriage of the parents.

Influence of socioeconomic status on the incidence of aneurysmal subarachnoid haemorrhage and clinical recovery

BackgroundThe relevance of socioeconomic status (SES) on the incidence of aneurysmal subarachnoid haemorrhage (aSAH) and discharge functional outcomes following treatment is not clear. MethodsA retrospective cross-sectional study was performed on data retrieved from the Nationwide Hospital Morbidity Database for all aSAH cases in Australia between 2012 and 2018. Information on patient characteristics, procedures performed, discharge disposition and SES were extracted. SES data was derived from classifications by the Australian Bureau of Statistics. Putative risk factors were evaluated with univariate and multivariate logistic regression analysis to identify independent predictor of unfavourable discharge outcomes (defined as death or dependency). ResultsA total of 3,591 low SES patients (49.8%) were identified in our study cohort. Average crude incidence of aSAH was persistently higher among the SES disadvantaged (6.6 cases per 100,000 person-years, 95% CI 6.3 – 6.8), compared to the SES advantaged group (4.1 cases per 100,000 person-years, 95% CI 4.0–4.2) (p < 0.0001). Patients in the Low SES group were more likely to be active smokers, have type 2 diabetes mellitus, or live in non-metropolitan residence, and have overall worse discharge functional outcomes (27.7% versus 24.5%, p = 0.0015). Adjusting for well-established risk factors such as older age, and intracranial bleed (ICH and/or IVH), disadvantaged SES remained a significant predictor of poor discharge outcome following aSAH (p = 0.0003). ConclusionaSAH occurs more frequently among low SES communities, and once ruptured, there is a greater risk of poor recovery..

Underdiagnosis bias of artificial intelligence algorithms applied to chest radiographs in under-served patient populations

Artificial intelligence (AI) systems have increasingly achieved expert-level performance in medical imaging applications. However, there is growing concern that such AI systems may reflect and amplify human bias, and reduce the quality of their performance in historically under-served populations such as female patients, Black patients, or patients of low socioeconomic status. Such biases are especially troubling in the context of underdiagnosis, whereby the AI algorithm would inaccurately label an individual with a disease as healthy, potentially delaying access to care. Here, we examine algorithmic underdiagnosis in chest X-ray pathology classification across three large chest X-ray datasets, as well as one multi-source dataset. We find that classifiers produced using state-of-the-art computer vision techniques consistently and selectively underdiagnosed under-served patient populations and that the underdiagnosis rate was higher for intersectional under-served subpopulations, for example, Hispanic female patients. Deployment of AI systems using medical imaging for disease diagnosis with such biases risks exacerbation of existing care biases and can potentially lead to unequal access to medical treatment, thereby raising ethical concerns for the use of these models in the clinic.

Association of clinical features of typhoid fever with socioeconomic status in Pakistan.

Typhoid fever is spread by ingestion of contaminated food or water, which is linked to infrastructure; specifically, sewage and sanitation. In developing countries, infrastructure varies according to socioeconomic status (SES). Balochistan is the least developed province of Pakistan. To analyse the association between the clinical features of typhoid fever and socioeconomic status. A quantitative, cross-sectional study was conducted in Quetta, Balochistan, Pakistan. Between May and October 2017, 143 patients presented to tertiary care hospitals and private clinics with a complaint of fever lasting ~3 days, along with a clinical history of headache, malaise, diarrhoea or constipation, abdominal pain, dry cough, and anorexia. All patients had a positive blood culture for Salmonella enterica serotype Typhi. Eighteen patients dropped out of the study, leaving 125. Seventy (56%) participants had low socioeconomic status (SES), 40 (32%) middle SES and 15 (12%) high SES. The strongest predictors of presenting with typhoid fever were patients' clinical condition when presenting to health facilities, followed by SES. Most respondents had a treatment duration of 1-2 weeks. SES had a high impact on source of drinking water supply. The strongest predictor of reporting typhoid fever was the current clinical condition of the patients, followed closely by SES. The incidence of typhoid fever in the low SES patients was almost the same as in the middle and high SES patients. Patients with low SES were more susceptible to contracting typhoid fever due to poor health status and facilities.

Ethnic Minorities and Low Socioeconomic Status Patients With Chronic Liver Disease Are at Greatest Risk of Being Uninsured

BackgroundChronic liver disease (CLD) predominantly affects ethnic minorities and socially vulnerable populations, who have high prevalence of risk factors (e.g., suboptimal insurance coverage) predisposing to healthcare disparities. We evaluate prevalence and predictors of uninsured status among CLD adults, and secondarily, how this affects documented immunity or vaccination for hepatitis A virus (HAV) and hepatitis B virus (HBV).MethodsUsing 2011 - 2018 National Health and Nutrition Examination Survey data, self-reported insurance status was determined among adults with CLD. Prevalence of uninsured status was stratified by patient characteristics and evaluated using multivariable logistic regression models. Prevalence of self-reported completion of vaccination as well as laboratory value-based documented immunity to HAV and HBV was stratified by insurance status.ResultsOverall, 19.0% of adults with CLD reported having no insurance, which was highest among individuals of Hispanic ethnicity (33.5%), less than high school education (33.7%), and below poverty status (35.3%). On multivariable analyses, significantly lower odds of having any insurance coverage was observed in men, Hispanics, and individuals with lower education and lower household income. Prevalence of documented immunity or vaccination for HAV was low across all insurance categories, ranging from 46.5% to 54.0%. Prevalence of documented immunity or vaccination for HBV was similarly low across all insurance categories, ranging from 24.3% to 40.8%.ConclusionPrevalence of uninsured status among CLD was more than twice the US adult population, and lack of insurance particularly impacted Hispanics and individuals with low education and low household income. Low prevalence of documented immunity or vaccination for HAV and HBV across all insurance categories is concerning.

The Association of Patient Educational Attainment With Cardiac Rehabilitation Adherence and Health Outcomes.

Participating in cardiac rehabilitation (CR) after a cardiac event provides many clinical benefits. Patients of lower socioeconomic status (SES) are less likely to attend CR. It is unclear whether they attain similar clinical benefits as patients with higher SES. This study examines how educational attainment (one measure of SES) predicts both adherence to and improvements during CR. This was a prospective observational study of 1407 patients enrolled between January 2016 and December 2019 in a CR program located in Burlington, VT. Years of education, smoking status (self-reported and objectively measured), depression symptom level (Patient Health Questionnaire), self-reported physical function (Medical Outcomes Survey), level of fitness (peak metabolic equivalent, peak oxygen uptake, and handgrip strength), and body composition (body mass index and waist circumference) were obtained at entry to, and for a subset (n = 917), at exit from CR. Associations of educational attainment with baseline characteristics were examined using Kruskal-Wallis or Pearson's χ 2 tests as appropriate. Associations of educational attainment with improvements during CR were examined using analysis of covariance or logistic regression as appropriate. Educational attainment was significantly associated with most patient characteristics examined at intake and was a significant predictor of the number of CR sessions completed. Lower educational attainment was associated with less improvement in cardiorespiratory fitness, even when controlling for other variables. Patients with lower SES attend fewer sessions of CR than their higher SES counterparts and may not attain the same level of benefit from attending. Programs need to increase attendance within this population and consider program modifications that further support behavioral changes during CR.

Abstract 10354: Socioeconomic Status and Differences in Trends of Atrial Fibrillation Hospitalizations Among Black and Non-Black Adults in the United States

Introduction: Socioeconomic status (SES) and race is closely interlinked. There is limited data regarding trends of atrial fibrillation (AF) hospitalizations in black and non-black adults based on SES. Methods: We queried the National Inpatient Sample database from January 2004 to December 2018 to identify patients admitted with AF. We used ICD-9-CM and ICD-10-CM diagnosis codes to identify all patients who were ≥18 years of age and hospitalized with a primary discharge diagnosis of AF. Our cohort was categorized into black and non-black groups, and SES using median household income (MHI) as a surrogate, into low SES (MHI 0-50) and high SES (MHI 51-100). AF hospitalizations per 1 million US population were calculated using US census population ≥18 years of age for each year. We estimated AF hospitalizations per 1 million blacks and non-blacks and trends in AF hospitalizations of black and non-black adults stratified by SES utilizing MHI. Cochran Armitage Test was utilized to estimate temporal trends. Results: Total admissions for AF per 1 million adults in the US population has increased (Figure 1). Among patients hospitalized with AF, the proportion of black adults is increasing. In those of low SES, both black and non-black patients have had increases in AF hospitalizations. However, in those of high SES, non-black patients have had steady improvement while black patients have remained at about the same rate of hospitalizations from 2004 to 2018 (Figure 2). Conclusions: Trends of AF hospitalizations have increased or not improved in low and high MHI-SES black adults, respectively. Identifying causes of these health disparities can improve healthcare quality in black adults with AF.

Disparities in Obstetric Readmissions: A Multistate Analysis, 2007-2014.

Hospital readmissions are generally higher among racial-ethnic minorities and patients of lower socioeconomic status. However, this has not been widely studied in obstetrics. The aim of the study is to determine 30-day postpartum readmission rates by patient-level social determinants of health: race ethnicity, primary insurance payer, and median income, independently and as effect modifiers. Using state inpatient databases from the health care cost and utilization project from 2007 to 2014, we queried all deliveries. To produce accurate estimates of the effects of parturients' social determinants of health on readmission odds while controlling for confounders, generalized linear mixed models (GLMMs) were used. Additional models were generated with interaction terms to highlight any associations and their effect on the outcome. Adjusted odds ratios (aOR) with 95% confidence intervals are reported. There were 5,129,867 deliveries with 79,260 (1.5%) 30-day readmissions. Of these, 947 (1.2%) were missing race ethnicity. Black and Hispanic patients were more likely to be readmitted within 30 days of delivery, as compared with White patients (p < 0.001 and p < 0.05, respectively). Patients with government insurance were more likely to be readmitted than those with private insurance (p < 0.001). Patients living in the second quartile of median income were also more likely to be readmitted than those living in other quartiles (p < 0.05). Using GLMMs, we observed that Black patients with Medicare were significantly more likely to get readmitted as compared with White patients with private insurance (aOR 2.78, 95% CI 2.50-3.09, p < 0.001). Similarly, Black patients living in the fourth (richest) quartile of median income were more likely to get readmitted, even when compared with White patients living in the first (poorest) quartile of median income (aOR 1.48, 95% CI 1.40-1.57, p < 0.001). Significant racial-ethnic disparities in obstetric readmissions were observed, particularly in Black patients with government insurance and even in Black patients living in the richest quartile of median income. · Using generalized linear mixed models, we observed significant interactions.. · Government-insured Black patients were 2.78X more likely to be readmitted.. · The wealthiest Black patients were still 1.48X more likely to be readmitted..

Socioeconomic Status and Medical Assistance in Dying: A Regional Descriptive Study.

Objective: Concerns that medical assistance in dying (MAiD) may harm vulnerable groups unable to access medical treatments and social supports have arisen since the legalization of MAiD on June 17, 2016; however, there is little research on the topic. The purpose of this study is to investigate the socioeconomic status (SES) of patients who request MAiD at the London Health Sciences Centre (LHSC). Methods: A retrospective analysis of patients from the LHSC MAiD database between June 6, 2016 and December 20, 2019 was conducted. Patients were linked to income data from the 2016 Canadian Census, and their corresponding income quintile was a proxy for SES. Geographic information system (GIS) mapping software was used to visualize the distribution of income and MAiD requests. Results: 39.4% of the LHSC catchment area was classified as low SES. Two hundred thirty-seven (58.1%) MAiD requests came from low SES patients and 171 (41.9%) requests came from high SES patients. Two hundred fifty-nine (63.5%) patients who requested a MAiD assessment did not receive MAiD following their request. Of the 237 lower SES patients, 150 (63.3% [95% CI 57.2-69.3]) did not receive MAiD. Of the 171 higher SES patients, 109 (63.7% [95% CI 56.5-70.9]) did not receive MAiD. Conclusion: A disproportionate number of requests for a MAiD assessment at LHSC came from lower SES patients; however, similar proportions of patients who requested MAiD from each SES group received aid in dying. Future research should explore why a disproportionately high number of low SES patients request MAiD at LHSC.

Decomposition of socioeconomic inequality in COVID-19 mortality in Iran: A retrospective cohort study.

This study aimed to investigate the relationship between socioeconomic status and COVID‐19 mortality in Iran. We performed a retrospective cohort study on data from the hospitalised COVID‐19 patients in Qazvin. We collected data on education, self‐reported socioeconomic status, and location of residence as a proxy for socioeconomic status (SES). We applied the Blinder‐Oaxaca decomposition approach to assess the role of socioeconomic inequality in COVID‐19 mortality and determine the main contributors to the observed inequality. Overall, 941 patients (48.96%) had low SES, while only 24.87% (n = 478) were classified in the high SES category. The mortality rate was significantly higher in the low SES group, and we spotted a 17.13% gap in COVID‐19 mortality between the high and low SES patients (p < 0.001). Age was the main contributor to the observed inequality, responsible for 6.91% of the gap (p < 0.001). Having co‐morbidities (1.53%) and longer length of stay (LOS) in hospitals (0.95%) in the low SES group were other main determinants of the inequality in COVID‐19 mortality (p < 0.05). In the unexplained part of our model, the effect of increased age (10.61%) and a positive RT‐PCR test result (3.43%) were more substantial in the low SES group compared to the high SES patients (p < 0.05).The low SES people had an increased risk of getting COVID‐19, and the disease has been more severe and fatal among them. Increased age, co‐morbidities, and LOS were identified as the main drivers of this inequality.

Access to CAR-T Cell Therapy in Underrepresented Populations: A Multicenter Cohort Study of Pediatric and Young Adult ALL Patients

Introduction: Social determinants of health such as race, ethnicity, and socioeconomic status (SES) are associated with inferior outcomes in patients with B-cell acute lymphoblastic leukemia (B-ALL). Latinx patients have worse event-free survival and are at increased risk of relapse when compared to non-Latinx peers; given that low SES is also an independent predictor of relapse, some of this disparity is likely the result of structural racism. Chimeric antigen receptor T-cell therapy (CAR-T) is a promising approach to improve survival for patients with relapsed/refractory (r/r) B-ALL. However, given the limited number of cellular therapy centers, these therapies may not be equally accessible to patients of low SES or patients from historically disadvantaged populations. The sociodemographic characteristics of pediatric and young adult patients referred for CAR-T have not been well-described. We aimed to evaluate how sociodemographic characteristics of patients referred for CAR-T from outside institutions (referred CAR-T) differed from r/r patients referred for CAR-T at their home institution (local CAR-T), r/r patients not referred for CAR-T at their home institution (other relapse), and patients without r/r disease (without relapse). We hypothesized that there would be a higher proportion of non-Latinx White patients and patients with higher SES among referred CAR-T patients.Methods: We conducted a multicenter, retrospective cohort study of children and young adults with B-ALL treated at five large pediatric hospitals between 2012-2018. Patients diagnosed with B-ALL between age 0 and 29 were included. Clinical and demographic data (including race/ethnicity, insurance, and primary language) were collected from the electronic health record and analyzed using descriptive statistics. For patients residing within the United States, ArcGIS NSES Index software was used to assign SES score by census tract (0-100, with 50 as the national average).Results: Our cohort included 1374 patients with B-ALL, of which 372 (27%) had r/r disease (Table 1). Among 372 r/r patients, 142 were referred CAR-T patients and 230 were treated for r/r leukemia at their home institution (35% local CAR-T and 65% other relapse). Median distance traveled to CAR-T therapy was 824 miles among referred patients and 20.5 miles among local CAR-T patients. The majority of patients (76% of the overall cohort and 79% of those receiving CAR-T) were either White or Latinx.A higher proportion of local CAR-T patients were Latinx compared to referred CAR-T patients (56% vs. 29%; p<0.01). Conversely, fewer local CAR-T patients were non-Latinx White compared to referred CAR-T patients (28% vs. 47%; p<0.01). A higher proportion of local CAR-T patients had public insurance compared to referred CAR-T patients (65% vs. 31%; p<0.001). A higher proportion of local CAR-T patients identified Spanish as their primary language compared to referred CAR-T patients (24% vs. 6%; p<0.001). Mean SES scores were similar across all groups.Conclusions: In a large multicenter cohort of B-ALL pediatric and young adult patients, the demographics of referred CAR-T patients were notably different than local CAR-T patients. Latinx patients are at increased risk of relapse, making access to CAR-T all the more essential; however, we found less than one-third of patients referred from outside institutions for CAR-T cell therapy were Latinx, while a majority of patients receiving CAR-T cell therapy locally were Latinx. This association suggests that barriers to access such as distance and need for travel may differentially impact Latinx patients due to structural racism. Spanish-speaking patients and patients with public insurance were also underrepresented in referrals from outside institutions. However, these observational differences may be in part due to regional variations in the demographics of the population. Preliminary analysis by site is underway and indicates that center level demographic variation may be driving some of the observed differences. Very few Black and Asian patients received CAR-T within our cohort making any assessments of patterns of care difficult. Future work will involve additional analysis to identify non-clinical factors that may influence referral and enrollment rates on CAR-T clinical trials as well as qualitative work to understand these factors from the patient and provider perspectives. [Display omitted] DisclosuresWalters: AllCells, Inc: Consultancy; BioLabs, Inc: Consultancy; Vertex pharmaceuticals: Consultancy; Ensoma, Inc.: Consultancy. Ramsey: Vertex Pharmaceuticals: Consultancy; Cystetics Medicines: Consultancy.

DEMOGRAPHIC, SOCIOECONOMIC AND CLINICAL PROFILE OF OCULAR CHEMICAL INJURIES IN TERTIARY CARE CENTRE IN CENTRAL INDIA

PURPOSE: To identify risk factors of Ocular chemical injuries by studying demographic, socio-economic and clinical characteristics of patients and suggest preventive measures. DESIGN: Prospective hospital-based study. PARTICIPANTS: Patients who presented to tertiary care hospital in central India with ocular chemical burns during February 2019-2020.METHODS:In this study a total of 41 patients (49 eyes) were included.Patient data recorded were Age, Gender, Occupation, Education, socio-economic status, location and mode of injury, type of chemical, use and awareness of Personal Protective Equipment (PPE) and first aid.Clinical characteristics studied were initial and final Best corrected visual acuity (BCVA), grade of injury, Intra- ocular pressure (IOP) at presentation, management and complications.The variables were evaluated for potential relationships with visual outcome.RESULTS:Average age was 32.05+15.1 years with Male:Female ratio of 1.9:1.Total of 13 patients (31.7%) were illiterate,belonged to Upper Lower IV socio-economic class (n=20, 48.8%). Most were semi-skilled workers (n=19, 46.3%) and 61% of the total injuries occurred at workplace.Accidental mode of injury was more prevalent (n=38,92.7%),most common causative chemical was alkali (n=27 eyes,55.1%).Low grade burns (Grade 1,2 and 3) were most observed (n=34,69.38%).Majority of eyes (n=39,79.6%) were medically managed.Risk factors for poor final BCVA using multivariate logistic regression analysis was poor initial BCVA (p =0.011) and grade of chemical injury (p =0.007).Conclusion:Chemical injuries are commonly encountered by patients of low Socio-Economic Status (SES), who are mostly illiterate. Most sustained injury at workplace and were not using PPE.These findings identify need for awareness programs with audio-visual components that are easily understood.It also highlights need for safer workplace practices.

S1130 Ethnic Minorities and Low Socioeconomic Status Patients With Chronic Liver Disease Are at Greatest Risk of Being Uninsured and Receiving Suboptimal Vaccination Care

S1130 Ethnic Minorities and Low Socioeconomic Status Patients With Chronic Liver Disease Are at Greatest Risk of Being Uninsured and Receiving Suboptimal Vaccination Care

Cognition and Exercise: GENERAL OVERVIEW AND IMPLICATIONS FOR CARDIAC REHABILITATION.

Performance of endurance exercise is associated with a broad range of cognitive benefits, with notable improvements shown across a wide variety of populations including healthy populations as well as those with impaired cognition. By examining the effects of exercise in general populations, as well in populations where cognitive deficits are pronounced, and critical to self-care, we can learn more about using exercise to ameliorate cognitive issues and apply that knowledge to other patient populations, such as those eligible for cardiac rehabilitation (CR). Cognitive challenges are a concern within CR, as management of a chronic disease is cognitively taxing, and, as expected, deficits in cognition predict worse outcomes, including lower attendance at CR. Some subsets of patients within CR may be particularly at high risk for cognitive challenges including those with heart failure with low ejection fraction, recent coronary bypass surgery, multiple chronic conditions, and patients of lower socioeconomic status. Attendance at CR is associated with cognitive gains, likely through the progressive exercise component, with larger amounts of exercise over longer periods having greater benefits. Programs should identify at-risk patients, who could gain the most from completing CR, and provide additional support to keep those patients engaged. While engaged in CR, patients should be encouraged to exercise, at least at moderate intensity, and transitioned to a long-term exercise regimen. Overall, CR programs are well-positioned to support these patients and make significant contributions to their long-term well-being.

Translating Access to Outcomes: The Impact of Socioeconomic Status on Completion of Breast Reconstruction at a National Cancer Institute (NCI)-Designated Cancer Center: Impact of SES on Completion

The purpose of this study was to determine the impact of socioeconomic status (SES) on the completion of breast reconstruction, as defined by the percent of patients undergoing NAC reconstruction. Patients (n=949) who underwent primary breast reconstruction following a mastectomy recorded from 2007 to 2017 were divided into groups based on the median household income of their residential zip code (>/< $67,640). A three-step protocol was designed to (1) broadly compare between patients of low and high SES who were stratified by race and reconstruction type, (2) compare a smaller subset of low SES and high SES patients via propensity matching for demographic, baseline health, and oncologic factors, and (3) elucidate the strongest predictors of non-completion and delayed completion among low SES patients. Patients of lower SES appear less likely to complete NAC reconstruction, especially following staged reconstruction. That this finding presents in staged, but not immediate reconstruction, and disappears with propensity matching for oncologic factors suggests that reduced completion in patients of low SES may be attributable to advanced cancer staging and aggressive adjuvant therapy. Furthermore, expander conversion to autologous reconstruction significantly increased the likelihood of NAC reconstruction in multivariable analysis, and adjuvant radiation therapy significantly increased the time to NAC reconstruction. Further investigation will solidify the relationship between SES, cancer staging, and completion of reconstruction in a multi-site patient population. Larger multivariable analyses may also uncover other factors that can be modified or addressed to increase completion and optimize reconstruction for patients at risk of discontinuation.

Assessment of 2-Year Mortality With Use of Drug-Coated Devices in Femoropopliteal Disease: A Real World Experience from The Bronx, New York

We sought to compare the 2-year mortality outcome in patients with femoropopliteal arterial disease treated with drug-coated devices (DCDs) vs those treated with non-drug-coated devices (nDCDs) in an inner-city public hospital that mainly serves patients of lower socioeconomic status.

The Differential Impact of Medicaid Expansion on Racial Disparities Following Peripheral Vascular Intervention

Peripheral artery disease (PAD) disproportionately affects Black and low socioeconomic status patients, who are less likely to have health insurance and routine health care visits. Medicaid expansion (ME) has improved insurance rates and access to care, potentially benefitting these patients. We sought to assess the impact of ME on racial disparities in peripheral vascular intervention (PVI) for PAD.

Quality and Location of the Surgical Episode Mediate a Large Proportion of Socioeconomic-Based Survival Disparities in Patients with Resected Stage I-III Colon Cancer.

Lower socioeconomic status (SES) is associated with shorter overall survival (OS) in patients with locoregional colon cancer. We aimed to estimate: (1) the proportion of SES-based OS disparities mediated by disparities in the quality and location of surgical treatment in patients with resected stage I-III colon cancer and (2) the relative importance of components of surgical quality. We examined patients ages 18-80 years with resected stage I-III colon adenocarcinoma using the 2010-2016 National Cancer Database. SES was defined at the zip code level. Inverse odds weighting mediation analysis was used to estimate the proportion mediated (PM) for nine treatment quality-related and facility-related factors and composite PMs in models including all nine mediators. Models compared high SES patients with each lower SES stratum. Among 171,009 patients, 5-year OS increased from 70.4% in low SES patients to 78.1% in high SES. When high SES patients were compared with low, lower-middle, and upper-middle SES patients, PM ranges among lower SES strata were: minimally invasive surgery 16.0-16.6%, lymph nodes examined 7.7-9.6%, positive margins 3.8-6.5%, length of stay 16.7-28.1%, readmissions insignificant to 3.7%, treatment at > 1 CoC facility 2.7-3.1%, facility type insignificant to 7.3%, facility volume 2.9-8.2%, and adjusted facility 90-day mortality rates 33.2-42.8%. Composite PMs were 76.9% (95% CI 61.3%, 92.4%) for low SES, 68.7% (95% CI 56.4%, 81.1%) for lower-middle SES, and 60.9% (95% CI 43.1%, 78.6%) for upper-middle SES. These data suggest that improving the quality of the surgical episode for disadvantaged patients undergoing resection for locoregional colon cancer could decrease SES-based survival disparities by over half.

Long-term outcomes after out-of-hospital cardiac arrest in relation to socioeconomic status

AimsThis study aimed to examine whether socioeconomic differences exist in long-term outcomes after out-of-hospital cardiac arrest (OHCA). MethodsWe included 2309 30-day OHCA survivors ≥ 30 years of age from the Danish Cardiac Arrest Registry, 2001–2014, divided in tertiles of household income (low, medium, high). Absolute probabilities were estimated using logistic regression for 1-year outcomes and cause-specific Cox regression for 5-year outcomes. Differences between income-groups were standardized with respect to age, sex, education and comorbidities. ResultsHigh-income compared to low-income patients had highest 1-year (96.4% vs. 84.2%) and 5-year (87.6% vs. 64.1%) survival, and lowest 1-year (11.3% vs. 7.4%) and 5-year (13.7% vs. 8.6%) risk of anoxic brain damage/nursing home admission. The corresponding standardized probability differences were 8.2% (95%CI 4.7–11.6%) and 13.9% (95%CI 8.2–19.7%) for 1- and 5-year survival, respectively; and −4.5% (95%CI −8.2 to −1.2%) and −5.1% (95%CI −9.3 to −0.9%) for 1- and 5-year risk of anoxic brain damage/nursing home admission, respectively. Among 831 patients < 66 years working prior to OHCA, 72.1% returned to work within 1 year and 80.8% within 5 years. High-income compared to low-income patients had the highest chance of 1-year (76.4% vs. 58.8%) and 5-year (85.3% vs. 70.6%) return to work with the corresponding absolute probability difference of 18.0% (95%CI 3.8–32.7%) for 1-year and 9.4% (95%CI −3.4 to 22.3%) for 5-year. ConclusionPatients of high socioeconomic status had higher probability of long-term survival and return to work, and lower risk of anoxic brain damage/nursing home admission after OHCA compared to patients of low socioeconomic status.

Institutions Treating Breast Cancer Patients of a Low Socioeconomic Status Achieve Multidisciplinary Quality Standards at Lower Rates.

The National Accreditation Program of Breast Centers (NAPBC) certifies institutions that provide quality breast care. Whereas low socioeconomic status (SES) has a negative impact on patient outcomes, it is unknown whether an institution's patient SES mix is associated with meeting NAPBC standards. All institutions submitting at least 100 breast cancer patients to the National Cancer Database (2006-2017) were ranked based on the patients' insurance status, income, and education. The 10% treating the largest proportion of low-SES patients were termed low-SES institutions (LSES). Patient cohorts were created based on the 2018 NAPBC standards. Uni- and multivariate comparisons of patient, tumor, and treatment factors were made to calculate adjusted odds of meeting each standard between low- and non-low-SES institutions. The analysis included 1319 institutions. Both the LSES and non-LSES reached the benchmark rate of 50% lumpectomies (61.2 vs 62.9%; p < 0.001), but the unadjusted and adjusted rates of lumpectomy were lower in LSES. The rate for sentinel lymphadenectomy was lower for LSES (49.2 vs 53.7%; p < 0.001). Similarly, the unadjusted and adjusted rates of adjuvant chemotherapy and endocrine therapy were lower at LSES. Although the unadjusted rate of adjuvant radiation was higher at LSES, adjusted odds demonstrated that patients treated at LSES were less likely to undergo adjuvant radiation when appropriate. Small but significant differences in achieving multidisciplinary standards for quality breast cancer care exist between LSES and non-LSES and may exacerbate disparities already faced by patients of low SES.