Median Household Income Quartile Research Articles

Differential Survival Among Patients With Cancer by COVID-19 Vaccination Status: An Analysis of the ASCO COVID-19 Registry

PURPOSE We evaluated our hypotheses that vaccine exposure before infection with SARS-CoV-2 in patients with cancer would be associated with overall survival and vaccine exposure would differ by patient demographics, area-level social determinants of health, and clinical features. METHODS Our cohort study includes patients with cancer 18 years and older who tested positive for SARS-CoV-2 infection on or after April 1, 2021, and had information on receipt (or not) of at least one COVID-19 vaccine dose. We analyzed three vaccine exposure categories reflecting recency of last dose before SARS-CoV-2 infection was defined: No dose, any recent dose (1-6 months), and last dose in >6 months. Patients with last dose in <1 month were categorized on the basis of previous dose (if present) or as no dose. RESULTS This cohort analysis included 1,765 patients with cancer diagnosed with COVID-19 disease between April 2021 and July 2023 (57% female, 68% non-Hispanic White, and 51% age <65 years). The following patient characteristics were associated with vaccination status: age, rurality, Eastern Cooperative Oncology Group performance status, cancer type, and COVID-19 diagnosis window, as well as quartiles of area-level median household income, percent unemployed, and percent high school-only graduates age >24 years. After adjusting for covariates, the hazard ratio for death was 1.60 times among patients with no dose (95% CI, 1.26 to 2.04) and 1.32 times among those with last dose in >6 months (95% CI, 1.03 to 1.69) compared with those with a dose 1-6 months before infection. CONCLUSION Our findings underscore the need for oncology-specific guidance on COVID-19 vaccination schedules and suggest that more frequent than annual administration of vaccination may be appropriate for patients with cancer.

Abstract A054 Liver cancer mortality by structural disadvantage and race: An analysis of U.S. area-level factors

Abstract Introduction: Racial/ethnic and sex disparities in liver cancer (LC) mortality are well established; yet little is known about the contributions of county-level social risks on these disparities. Methods: We used U.S. national death certificate data from the National Center for Health Statistics (2018-2022) for LC mortality. County-level estimates of income inequality (ratio of household income at the 80th and 20th percentile), and median household income were obtained using the American Community Survey. Severe housing problems (percentage of households with 1 of 4 housing problems: overcrowding, high housing costs, lack of kitchen facilities, or lack of plumbing facilities) were abstracted from the U.S. Department of Housing and Urban Development (HUD) and U.S. Census Bureau. We estimated age-adjusted mortality rates (MR) and MR rate ratios (aRR) across metrics of county-level social risk grouped in quartiles overall and by race/ethnicity. Results: There were 101,088 liver cancer (LC) deaths from 2018-2022 (MR=6.16 per 100,000). Areas of highest county-level income inequality had 31% higher LC mortality compared to areas within the lowest quartile (aRR=1.31). LC MRs were 45% higher in counties with the lowest vs. highest median household income (aRR=1.45). Men and women in the highest quartile of severe housing problems had 29% and 22% higher LC MR (aRR=1.29 and 1.22, respectively), than those in the lowest quartiles. Men and women in the lowest quartile of median household income had 43% and 49% higher LC mortality than those in the highest median income quartiles (aRR=1.43 and 1.49, respectively). Within the highest quartile of income inequality, American Indian/Alaskan Native (AI/AN) persons had the highest LC mortality rates (MR=7.07), followed by Hispanic (MR=6.75), Black (MR=6.48), and Asian (MR=5.83) individuals. Similarly, in the highest quartile of severe housing problems, AI/AN persons had the highest LC mortality rate (MR 7.74), while Hispanic persons had 58% higher MR (MR 7.01), followed by Black (MR=6.19), Asian (MR=5.85) and White (MR=4.07) individuals. In the lowest median household income quartile, compared to White persons (MR=5.91), AI/AN persons had the highest MR (MR=8.86), and Hispanic persons had a 70% increase in mortality (MR=8.48). Among counties with the highest income inequality, compared to White persons (aRR=1.15), Black persons had an 80% increase in mortality (aRR=1.43). For those in the most concentrated quartile of severe housing problems, compared to White persons (aRR=1.07), AI/AN persons had an 80% increase in mortality (MR=1.34).Conclusion: All county-level indicators of highest social risk were associated with greater liver cancer mortality, but do not appear to fully account for racial and ethnic disparities in mortality. Therefore, place- based interventions are needed to address the role of county-level economic attributes in liver cancer mortality disparities. Citation Format: Jennifer K. McGee-Avila, Wayne R. Lawrence, Natalie Joe, Cameron B. Haas, Meredith S Shiels. Liver cancer mortality by structural disadvantage and race: An analysis of U.S. area-level factors [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 A054.

Abstract C037: Inflammatory breast cancer by metastatic status: Racial and ethnic and socioeconomic disparities in receipt of treatment

Abstract Background: Inflammatory breast cancer (IBC) is a relatively rare but aggressive type of breast cancer. Racial and ethnic minority patients are disproportionately affected by IBC and often face barriers to accessing cancer care and services. However, racial and ethnic disparities in receipt of treatment are not well defined among patients with IBC by metastatic status. Methods: We analyzed data from patients with IBC in the 2004-2020 U.S. National Cancer Database. Five treatment modalities were assessed: hormone therapy, chemotherapy, radiotherapy, surgery, and trimodal therapy. Metastatic status was dichotomous as “metastatic/non-metastatic.” Racial and ethnic groups included Asian or Pacific Islander, American Indian, Alaska Native, or Other, Black, Hispanic, and White. Separate logistic regression models were fit, adjusting for sociodemographic and clinicopathological characteristics, stratified by metastatic status. Adjusted odds ratios (aOR) and 95% CIs were calculated. Results: Of 33,376 patients with IBC (mean age 58 years [SD=14]), most (70.6%) identified as White, followed by 18.1% as Black, 7.0% as Hispanic, 2.5% as Asian or Pacific Islander, 1.8% as American Indian, Alaska Native, or Other; and 32.5% were metastatic. In the non-metastatic cohort, Black (72.7%; aOR 0.79, 95% CI: 0.63-0.98) or Asian or Pacific Islander (74.8%; aOR 0.59, 95% CI: 0.38-0.90) patients had lower odds of receiving hormone therapy than White patients (78.0%). Compared with White patients, Black patients had a lower likelihood of receiving chemotherapy (89.1% vs. 89.5%; aOR 0.67, 95% CI: 0.53-0.86), surgery (78.4% vs. 85.3%; aOR 0.65, 95% CI: 0.55-0.77), or trimodal therapy (81.5% vs. 87.3%; aOR 0.61, 95% CI: 0.49-0.76). American Indian, Alaska Native, or Other (65.0%; aOR 0.64, 95% CI: 0.42-0.97) and Black (63.6%; aOR 0.71, 95% CI: 0.61-0.82) patients had lower odds of receipt of radiotherapy than White patients (70.6%). In the metastatic cohort, Black patients had a lower likelihood of receiving hormone therapy (55.2% vs. 63.5%; aOR 0.61, 95% CI: 0.48-0.78), chemotherapy (78.7% vs. 78.2%; aOR 0.75, 95% CI: 0.60-0.95), surgery (28.2% vs. 35.1%; aOR 0.68, 95% CI: 0.56-0.82), or trimodal therapy (30.4% vs. 40.4%; aOR 0.63, 95% CI: 0.48-0.82) than White patients. There were no statistically significant differences in receipt of treatment between White and other racial and ethnic patients with metastatic IBC. Furthermore, we observed significantly differential rates of treatment receipts by socioeconomic factors including median household income quartile, insurance coverage, and facility type. Conclusions: In this study of a large U.S. national IBC patient cohort, racial and ethnic minority patients were less likely than White patients to have received treatment for IBC, with Black patients being the most affected. Our findings highlight racial and ethnic disparities and socioeconomic inequities in treatment receipts, suggesting the need for oncology programs to improve equitable care access and reduce these disparities in the IBC population. Citation Format: Jincong Q. Freeman, Jared H. Hara, Olasubomi J. Omoleye. Inflammatory breast cancer by metastatic status: Racial and ethnic and socioeconomic disparities in receipt of treatment [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 C037.

Comparative analysis of patient demographics, perioperative outcomes, and adverse events after lumbar spinal fusion between urban and rural hospitals: an analysis of the National Inpatient Sample (NIS) database

ObjectiveRural location of a patient’s primary residence has been associated with worse clinical and surgical outcomes due to limited resource availability in these parts of the US. However, there is a paucity of literature investigating the effect that a rural hospital location may have on these outcomes specific to lumbar spine fusions. MethodsUsing the National Inpatient Sample (NIS) database, we identified all patients who underwent primary lumbar spinal fusion in the years between 2009 and 2020. Patients were separated according to whether the operative hospital was considered rural or urban. Univariable and multivariable regression models were used for data analysis. ResultsOf 2,863,816 patients identified, 120,298 (4.2 %) had their operation at a rural hospital, with the remaining in an urban hospital. Patients in the urban cohort were younger (P < .001), more likely to have private insurance (39.81 % vs 31.95 %, P < .001), and fewer of them were in the first (22.52 % vs 43.00 %, P < .001) and second (25.96 % vs 38.90 %, P < .001) quartiles of median household income compared to the rural cohort. The urban cohort had significantly increased rates of respiratory (4.49 % vs 3.37 %), urinary (5.25 % vs 4.15 %), infectious (0.49 % vs 0.32 %), venous thrombotic (0.57 % vs 0.24 %, P < .001), and neurological (0.79 % vs 0.36 %) (all P < .001) perioperative complications. On multivariable analysis, the urban cohort had significantly increased odds of the same perioperative complications: respiratory (odds ratio[OR] = 1.48; 95 % confidence interval [CI], 1.26–1.74), urinary (OR = 1.34; 95 %CI, 1.20–1.50), infection (OR = 1.63; 95 %CI, 1.23–2.17), venous thrombotic (OR = 1.79; 95 %CI, 1.32–2.41), neurological injury (OR = 1.92; 95 %CI, 1.46–2.53), and localized infection (OR = 1.65; 95 %CI, 1.25–2.17) (all P < .001). ConclusionsPatients undergoing lumbar fusions experience significantly different outcomes based on the rural or urban location of the operative hospital.

Adenocarcinoma in multiple adenomatous polyps: An analysis of demographic and socioeconomic factors.

e15619 Background: Adenocarcinoma in multiple adenomatous polyps (AMAP) is a form of gastrointestinal cancer characterized by adenomatous polyps in the gastrointestinal mucosa and distinct lesions found outside the intestines. A rare form of cancer, AMAP can be traced back to mutations in the APC gene, with higher rates of mutation correlating with worse prognosis. There is an association with familial adenomatous polyposis, which can lead to colorectal cancer in patients as young as 15. Examining demographic statistics on AMAP from the National Cancer Database (NCDB) sheds light on this rare form of colorectal cancer, unlocking new possibilities for diagnostics and treatment. Methods: A retrospective cohort analysis identified 193 patients with AMAP from the 2004-2020 NCDB using ICD-O-3 Code 8221 to identify them. Demographic factors such as age, sex, treatment type, and Charles/Deyo score were explored with descriptive statistics. Linear regression analysis was utilized to study incidence trends. Results: A total of 193 cases of histologically confirmed AMAP were retrieved from the 2004-2020 NCDB with a slight decline in incidence rates during this time (R² = 0.39). The majority of patients were male (55%), White (86%), privately insured (46%), and resided in metropolitan areas with a population size of at least one million (60%). Most patients also comprised the top two income quartiles based on median household income (64%). The mean age at diagnosis was 56.5 years (SD = 19.15, range = 15 - 90). The top primary sites affected were the Colon (26%), Sigmoid Colon (16%), and Rectum (11%). Furthermore, most patients were treated surgically (88%) with the average tumor size of 35.3 mm (SD = 20.5, range = 5.0 - 77.0). More patients received chemotherapy (28%) than radiation therapy (10.4%), with few patients receiving hormone therapy (0.5%) and none receiving immunotherapy. Over half (51%) of the patients were categorized as experiencing Stage 0 and Stage 1 cancer according to the NCDB Analytic Stage Group. The vast majority of patients (74%) had no comorbidities (Charlson-Deyo = 0) and did not receive any palliative care (97%). Conclusions: Our NCDB analysis on AMAP is a novel examination that provides insight into various demographics to better understand the disease. The majority of patients were males with adenocarcinoma lesions most commonly diagnosed in the colon and rectal areas, consistent with previous studies on multiple adenomatous polyps. Our analysis revealed that the majority of patients diagnosed with AMAP tend to be White, privately insured, reside in metropolitan areas, and hail from the top two quartiles of median household income. Additional research is required to gain a greater understanding of the demographic and socioeconomic factors that are important for accurate diagnosis, effective treatments, and improved outcomes.

Demographic and socioeconomic analysis of patients with glucagonoma: Insights from the National Cancer Database.

e16319 Background: Glucagonoma is a rare glucagon-producing alpha islet cell tumor primarily of the pancreas, and a type of pancreatic neuroendocrine tumor. These types of cancers have a 10-year survival rate of about 38%. Metastasis may be found in approximately 50% of glucagonoma cases. As a result of the low incidence of glucagonoma, analysis of the diagnostic patterns may provide more insight into the disease’s epidemiology. This study analyzed the National Cancer Database (NCDB) to examine demographic factors of individuals diagnosed with glucagonoma. Methods: ICD-8152-3 Data from the NCDB between 2004-2020 was gathered to perform a retrospective cohort analysis on patients diagnosed with glucagonoma (N = 88). Descriptive statistics were used to investigate demographic factors such as age, sex, race, Hispanic status, years of education, insurance, facility type, distance from facility, and Charlson-Deyo score. Regression analysis was utilized to evaluate incidence trends. Results: We found that patients had an average age of 61 years (SD = 13, range = 23-90), with an average tumor size of 53 mm (SD = 39, range = 12-140), and the majority were male (61%) and White (90%). The majority of patients (97%) did not receive palliative care, with surgery (57%) and chemotherapy (28%) being the primary treatments. Post-surgery, 90% had no residual tumor, and survival rates were 98% after thirty days and 96% after ninety days. Most were treated in academic/research facilities (43%) and had private insurance (59%) or Medicare (34%). The largest median household income quartile of these patients was $74,063 or more (39%).The study noted a 2-year survival rate of 74%, a 5-year rate of 54%, and a 10-year rate of 31%, with a mean survival of 89.3 months. The primary disease sites were the tail of the pancreas (32%) and pancreas, NOS (22%). The distribution across NCDB Analytic Stage Groups was 19% for Stage I, 11% for Stage II, 2% for Stage III, and 23% for Stage IV. Conclusions: This study represents the first analysis of glucagonoma patients using the National Cancer Database, filling a gap in our understanding of the disease. The findings indicate that the majority of glucagonoma patients were non-Hispanic, White, and had tumors primarily located in the tail of the pancreas, aligning with earlier case report descriptions. Socioeconomically, patients most likely had earnings above the median income quartile, resided in densely populated metropolitan areas, and received treatment in academic facilities. Further investigation is necessary to have a more thorough grasp of the impact of demographic and socioeconomic characteristics on glucagonoma patients' diagnosis, course of treatment, and overall survival rates.

Mixed liposarcoma: A study of socioeconomic and demographic factors.

e23527 Background: Mixed Liposarcoma (LS) is an extremely rare subtype of LS, with characteristics often spanning 2 or more of the other LS subtypes such as myxoid, round cell, or well-differentiated LS. To date, the cytologic features of this uncommon tumor has yet to be described. Analyzing trends in diagnoses may produce valuable information about its epidemiology. The National Cancer Database (NCDB) was analyzed to uncover the demographic factors in patients diagnosed with mixed LS. Methods: A retrospective cohort study from 2004 to 2020 was conducted using the NCDB. 199 patients were found with a histologically confirmed diagnosis of mixed LS (ICD-8855-3). Race, gender, Hispanic origin, type of treatment facility, insurance coverage, and distance from patient residence to treatment facility were analyzed via descriptive statistics, and trends in incidence were interpreted using regression analysis. Results: The majority of patients were white (89%) and non-Hispanic (83%) with a relatively equal split of males (56%) and females (44%). The most common primary site of mixed LS was the retroperitoneum (72%), and the frequency of diagnosis decreased from 2004 to 2020 (R2 = 0.4568). Patients were treated at academic/research programs (45%), comprehensive community cancer programs (25%) and integrated network cancer programs (18%) that were generally located in the Middle Atlantic (19%), South Atlantic (18%), and East North Central (16%). The two primary payers at diagnosis include private insurance/managed care (45%) and Medicare (43%). Most patients were from counties in metro areas with a population of at least 1 million (57%) followed by metro counties with a population of 250,000 to 1 million (18%). The largest median household income quartile was $74,063 or more (38%), followed by $46,227 - $57,856 (22%). Most patients had a Charlson-Deyo Score of 0 (83%) with a NCDB analytic stage of either I (28%), III (26%), or not applicable (21%). Conclusions: To the best of our knowledge this NCDB analysis on mixed LS is the first of its kind and therefore addresses a significant knowledge gap. Most patients tend to be white and non-Hispanic. Mixed LS most commonly is found in the retroperitoneum, which is similar to case reports. We found that mixed LS patients have a relatively high household income, most often live in high populated metro areas, and are most frequently treated at academic/research programs. These findings are significant because these socioeconomic factors have not been noted before in literature. Further examination of these demographic and socioeconomic factors is required to understand how they impact treatment, diagnosis of, and survival of patients with mixed LS.

Pagetic osteosarcoma: An analysis of the National Cancer Database.

e23503 Background: Pagetic osteosarcoma (Pagetic OS) is a rare cancer typically originating at bones affected by Paget disease. Pagetic OS may present as metachronous multifocal lesions primarily affecting the pelvis, proximal femur, and proximal humerus. There are currently no available sociodemographic descriptions of patients with Pagetic OS. Analyzing sociodemographic factors through the National Cancer Database may unveil important information about its epidemiology and guide future treatment. Methods: A retrospective cohort analysis utilizing the 2004–2020 National Cancer Database (NCDB) included patients with a histologically-confirmed diagnosis of Pagetic osteosarcoma (N = 128) using ICD-O-3 code 9184. Demographic factors (age, sex, race, Hispanic status, educational attainment, insurance status, facility type, distance from facility, and Charles/Deyo score) were analyzed by descriptive statistics. Incidence trends were interpreted in regression analysis. Results: In the NCDB, 128 patients were identified with a confirmed diagnosis of Pagetic osteosarcoma (Pagetic OS) between 2004 and 2020, with a steady incidence of diagnoses per year (R2 = 0.0). The average age of diagnosis was 68.9 years (SD = 13.4, range = 11-90 years). Men were more likely to be diagnosed than women (57% and 43%, respectively). Most patients were non-Hispanic White (71%), insured by Medicare (56%), and lived in a metropolitan area (85%). When compared individually, more patients were in the top median household income quartile (31%). The top two primary sites were the long bones of the lower limb including their associated joints (27%) and the pelvic bones excluding the sacrum, coccyx, and symphysis pubis (27%). Within the cohort, 31 patients received chemotherapy as primary treatment (24%) while 28 patients received primary radiation therapy (22%). Most patients (63%) did not undergo primary site surgery while 39 patients (31%) did receive surgery as primary treatment. The 90-day mortality included 15% of patients, who died 90 or fewer days after surgery was performed. The 2-year survival was 82% while the 5-year survival was 53% and the 10-year survival was significantly lower at approximately 11%. Most individuals (76%) had Charlson-Deyo comorbidity scores of 0. Conclusions: To the best of our knowledge, this NCDB analysis on Pagetic osteosarcoma (Pagetic OS) is the first of its kind on this specific subset of osteosarcoma. Previous research suggests the broader osteosarcoma occurs most frequently in adolescents. This data reveals that Pagetic OS is primarily diagnosed later in life (68.9 years), while still affecting a significantly wide age range (range = 11-90 years). Most patients were non-Hispanic White (71.1%), lived in a metropolitan area (85.2%), and belonged to the top median household income quartile (31.3%). Further research could unveil additional guidance on best practice in diagnosing and treating this cancer.

Craniofacial Assault Against Women: A National Evaluation Defining At-risk Populations and Outcomes.

Few studies have analyzed epidemiologic factor associated with female patients presenting to the emergency department from facial fractures because of assault. Clearly understanding these factors may assist in developing effective strategies to decrease the incidence and sequelae of these injuries. To determine the epidemiology of facial fractures because of assault in the female population. All female facial fracture visits were queried in the 2019 Nationwide Emergency Department (ED) Sample database. The likelihood of a facial fracture encounter resulting from assault was modeled using logistic regression adjusting for demographics, insurance status, geographic region, location of patient residence, and income. Secondary outcomes analyzed hospitalization costs and adverse events. Of all facial fractures 12.4% of female encounters were due to assault were due to assault. Of assaulted females, 72.8% were between the ages of 20 and 40, and Black women experienced a disproportionate share of assault encounters (odds ratio [OR]=2.55; CI, 2.29-2.84). A large portion (46.4%) of encounters occurred in patients living in the lowest quartile of median household income, and 22.8% of patients were uninsured (OR=1.34; CI, 1.09-1.66). Assaulted patients were more likely to have fractures in nasal bone (58.1% vs. 42.5%), orbit (16.8% vs. 10.9%), zygoma (4.1% vs 3.6%), and mandible (8.7% vs. 4.8%) compared with their nonassaulted counterparts. Facial fractures were especially common in lower income, uninsured, urban, and Black populations. Examining the patterns of injury and presentation are critical to improve prevention strategies and screening tools, identifying critical patients, and develop a more efficient and effective system to treat and support female patients suffering facial fractures secondary to assault.

Socioeconomic and racial disparities in revisits, indication, and readmission or reoperation in pediatric tonsillectomy

IntroductionPediatric tonsillectomy is a frequent otolaryngologic procedure. This study aimed to characterize disparities in post-tonsillectomy revisits, including emergency department evaluation, readmission, or reoperation as well as indication for revisit. MethodsCases of inpatient and ambulatory pediatric tonsillectomy in New York and Florida in 2016 constituted the analytic sample. Patients were extracted from the State Ambulatory Surgery Databases (SASD) and State Inpatient Databases (SID) and linked to the SID and State Emergency Department Database (SEDD) and SASD. Outcomes include 3 types of revisits within 30 days: ED visits, hospital readmissions, and reoperation. Indication for revisit was also analyzed. Multivariable analysis determined the association of each outcome with gender, age, race/ethnicity, primary payer, urbanicity, and zip code median household income quartile. The Holm Bonferroni test was used to correct for multiple hypothesis testing. Results15,264 pediatric tonsillectomies were included. The revisit rate was 6.77% (N = 1,034, 49.1% female; 6 years median age [interquartile range: 5]). The 30-day ED revisit rate was 4.85%, readmission rate was 1.27%, and reoperation rate was 0.65%. On multivariate analysis, Latinx patients (OR = 3.042, 95% CI = 1.393–6.803) and those who identify as other race/ethnicity (OR = 6.116, 95% CI = 1.989–19.245) have greater odds of requiring inpatient care for indications including pain, dehydration, nausea, and vomiting compared to white patients. No significant differences in tier of care for the management of post-tonsillectomy hemorrhage were identified. ConclusionDisparities in pediatric post-tonsillectomy ED presentation, readmission and reoperation demonstrate opportunities to improve patient safety and equity.

Race and socioeconomic disparities persist in treatment and outcomes of patients with cervical spinal cord injuries: An analysis of the national inpatient sample from 2016 - 2020

ObjectivePrevious literature has described race and socioeconomic disparities in both treatment and outcomes following cervical spinal cord injuries (SCI). The goal of this study is to investigate the current state of parity in management and outcomes following SCI. MethodsWe surveyed the National Inpatient Sample database (NIS) for patients admitted with primary diagnosis of cervical SCI. 49,320 patients were identified. Univariate and multivariate analyses were performed to evaluate racial and socioeconomic differences in SCI care and outcomes. ResultsCompared to white patients, minority race was associated with a longer time from presentation to operative intervention (p < 0.001) and longer length of stay following admission for cervical SCI (16 vs 13 days, p < 0.001). Minority patients were more likely to have an unfavorable discharge (skilled nursing facility, against medical advice, death) status than white patients (p < 0.001). Patients in the bottom quartile of median household income were associated with more unfavorable discharges than the top two quartiles (p < 0.001). Patients with the lowest median household income quartile also had higher total costs than those in the top quartiles ($221,654 vs 191,723, p < 0.001). Black, Hispanic, and Asian/Pacific Islander incurred higher treatment costs than White patients. ConclusionMinority and lower socioeconomic status are independently associated with unfavorable discharge and LOS in cervical SCI. Furthermore, racial and economically disadvantaged groups have longer wait times from admission to surgical intervention. These disparities persist despite being highlighted by previous publications and increased societal awareness of healthcare inequities, necessitating further work to reach parity.

Socioeconomic and Racial Disparities Affect Access to High-Volume Centers During Meningioma Treatment

Studies examining the relationship between hospital case volume, socioeconomic determinants of health, and patient outcomes are lacking. We sought to evaluate these associations in the surgical management of intracranial meningiomas. We queried the National Inpatient Sample (NIS) database for patients who underwent craniotomy for the resection of meningioma in 2013. We categorized hospitals into high (HVC) or low (LVC) volume centers. We compared outcomes in 2016 to assess the potential impact of the Affordable Care Act (ACA) on healthcare equity. Primary outcome measures included hospital mortality, length of stay (LOS), complications, and disposition. A total of 10270 encounters were studied (LVC: n=5730 [55.8%], HVC n=4340 [44.2%]). 62.9% of LVC patients identified as white compared to 70.2% at HVC (p<0.01). A higher percentage of patients at LVC came from the lower two quartiles of median household income than HVC (49.9% vs 44.2% p<0.001). Higher mortality (1.3% vs 0.9% p = 0.041) was in LVCs. Multivariable regression analysis showed LVCs were significantly associated with increased complication (OR 1.36, 95% CI 1.30-1.426, p<0.001) and longer hospital LOS (OR -0.05, 95% CI -0.92,-0.45, p=<0.001). There was a higher proportion of white patients at HVCs in 2016 compared to 2013 (67.9% vs. 72.3%). More patients from top income quartiles (24.2% vs. 40.5%) were treated at HVC in 2016 compared to 2013. This study demonstrated notable racial and socioeconomic disparities in LVC as well as access to HVCs over time. Disparities in meningioma treatment may persistent and require further study.

Demographic differences in early vs. late-stage laryngeal squamous cell carcinoma

PurposeThis study aims to evaluate how various demographic factors impact the stage at diagnosis and, therefore, prognosis of laryngeal cancer. Materials and methodsUsing the National Cancer Database, 96,409 patients were diagnosed with laryngeal squamous cell carcinoma between 2004 and 2020. Early (stage 0 or I) vs. late-stage (stage IV) cancers were compared based on demographic variables utilizing Chi-square and multivariate analysis with a significance of p < 0.05. ResultsFemale, Black, and generally older patients were more likely to have late-stage cancer than their counterparts. When compared with a community cancer program, patients treated at other facility types were more likely to be diagnosed late. Patients with private insurance, Medicare, or other government insurance were all less likely to have late-stage cancer compared to patients without insurance. Compared to patients in the lowest median household income quartile, patients in the third quartile and fourth quartile were diagnosed earlier. Patients living in an area with the lowest level of high school degree attainment were most likely to be diagnosed late. Living in a more populous area was associated with a lower chance of being diagnosed late. Increasing Charlson-Deyo Score was associated with a stronger likelihood of being diagnosed at a later stage. ConclusionPatients who are female, Black, uninsured, have a low household income, live in less populated and less educated areas, are treated at non-community cancer programs, and have more comorbid conditions have later stage diagnoses. This data contributes to understanding inequities in healthcare.

Race, gender, and income negatively impact patient-reported outcomes following total shoulder arthroplasty

BackgroundSocial determinants of health (SDOH) refer to social and economic factors that influence a patient’s health status. The purpose of this study was to investigate the impact of SDOH on preoperative and postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores and postoperative resource utilization following primary shoulder arthroplasty (SA). MethodsThis retrospective chart review evaluated data from all patients who underwent primary SA (including anatomic, reverse, and hemiarthroplasty) at a single health system between May 2020 and May 2022. Patients without at least 6-month postoperative PROMIS questionnaires and those undergoing revision surgeries were excluded. The electronic medical record was used to identify SDOH for each patient, and PROMIS scores for Upper Extremity (PROMIS-UE), Pain Interference (PROMIS-PI), and Depression (PROMIS-D) were completed electronically at respective preoperative and postoperative visits. Univariate analysis using independent 2-group t-tests and Chi-squared tests were used to analyze the mean difference between patient groups based on SDOH. Multivariate linear regressions were performed with all predictors used in the univariate model using the least squares method. ResultsThe study included 248 patients who underwent SA, with a mean age of 67.9 years. Caucasian patients were over-represented in the highest quartile of median household income (MHI) compared to Black patients (35.1% vs. 17.2%) who were over-represented in the lowest MHI quartile (37.9% vs. 8.3%). At 6-month postoperative, black patients had significantly lower UE (33.8 ± 6.2 vs. 38.1 ± 9.0; P = .03) and greater PI scores (59.1 ± 6.1 vs. 55.6 ± 8.6; P = .145) compared to Caucasian patients. Similarly, at 6-month follow-up, the lowest MHI quartile had lower UE (33.8 ± 7.7 vs. 39.6 ± 8.8; P = .01) and higher PI scores (58.7 ± 6.5 vs. 54.3 ± 8.2; P < .01) compared to the highest MHI quartile, and females demonstrated lower UE (36.3 ± 7.9 vs. 38.6 ± 9.8; P = .04) and higher D scores (46.2 ± 9.1 vs. 42.0 ± 8.6; P = .046) compared to males. Government/public insurance demonstrated lower UE (36.8 ± 8.0 vs. 39.8 ± 10.4; P = .03) and higher D scores (45.9 ± 9.2 vs. 40.6 ± 7.6; P = .03) compared to private insurance. At 12-month follow-up, females demonstrated lower UE scores compared to males (36.0 ± 10.2 vs. 40.1 ± 11.3; P = .03). Black patients harbored lower UE, PI, and D scores compared to Caucasian patients, although not statistically significant. ConclusionSeveral socioeconomic factors such as race, gender, and insurance status are associated with differential outcomes after SA. Patients who are Black, female, current smokers, and from the lowest income quartile are associated with inferior PROMIS function, pain, and depression outcomes following SA.

Demographic and prognostic factors in papillary transitional cell carcinoma: An analysis of the National Cancer Database.

541 Background: Transitional cell carcinomas account for the majority of bladder cancers, with the papillary subtype comprising most of these cases. The role of race in bladder cancers has been investigated in the past, but there have been no studies that collectively investigated the role of different demographic factors in survival and mortality in papillary transitional cell carcinoma (PTCC). This study analyzes the effects of demographic factors on overall mortality (OM) in patients with PTCC. Methods: A retrospective cohort analysis was conducted using National Cancer Database data from 2004-2019, including 12,300 patients with histologically confirmed PTCC (ICD-O-3=8130). Sex, race (Black, White, and Other), insurance status, and median household income quartile (based on 2016-2020 American Community Survey data) were examined. Kaplan-Meier curves were used to calculate 2, 5, and 10 year survival (2-5-10 YS). Multivariable Cox regression was used to calculate hazard ratios (HR) to identify independent prognostic factors. Statistical significance was set at α=0.05. Results: Females had higher 2-5-10 YS and decreased OM compared to males (HR=0.85, P&lt;.001). White patient survival was higher at 2 years compared to Black patients, but Black patient survival was higher at 5 and 10 years. There was no significant difference in OM between Black and White patients (HR=1.07, P=0.260). Patients of other races had higher 2-5-10 YS and decreased OM compared to White (HR=0.85, P=0.023) and Black patients (HR=0.80, P=0.011). Patients on Medicaid had lower 2-5-10 YS and increased OM compared to patients on private insurance (HR=1.19, P=0.036). Patients on Medicaid had higher 2-5-10 YS than patients on Medicare, but no significant difference in OM (HR=0.87, P=0.091). Patients on private insurance (HR=0.70, P&lt;.001) and Medicare (HR=0.73, P=0.003) had decreased OM compared to uninsured patients. Patients in the fourth income quartile had decreased OM compared to patients in the first (HR=0.82, P&lt;.001), second (HR=0.87, P&lt;.001), and third quartiles (HR=0.90, P=0.003). Conclusions: Male sex, uninsured status, and lower income were associated with increased OM. Black patients and White patients had increased OM compared to patients of other races. Future research should investigate the reasons for these disparities and how to minimize them. [Table: see text]

Rising Incidence of Syphilitic Uveitis–Related Hospitalizations in the US

The number of syphilis cases continues to increase in the US every year since 2001 with a 74% increase observed since 2017. In addition, there remains a national shortage of injectable penicillin G. Despite the increase in reported cases, to the authors' knowledge, there has been no recent nationwide study investigating the trends in incidence of syphilitic uveitis. To evaluate the national and regional incidence of syphilitic uveitis-related hospitalizations in the US. This was a retrospective, cross-sectional study. The Nationwide Inpatient Sample was queried to identify all inpatient admissions with a diagnosis of syphilitic uveitis in the US between the years 2010 and 2019. Analyses were performed to determine baseline sociodemographic characteristics and identify national and regional trends in incidence. All patients hospitalized with a diagnosis of syphilis, uveitis, and/or syphilitic uveitis were eligible for inclusion. Statistical analysis of study data took place in June 2023. Diagnosis of syphilis, uveitis, and/or syphilitic uveitis on inpatient admissions during the years 2010 to 2019 in the Nationwide Inpatient Sample. The primary outcome was to determine trends in the national and regional incidence of syphilitic uveitis-related hospitalizations in the US. Secondary outcome measures included sociodemographic characteristics of patients with syphilitic uveitis, incidence stratified by sex and race and ethnicity, and median charge per syphilitic uveitis hospital admission. From the Nationwide Inpatient Sample, inpatient data from 444 674 patients (median [IQR] age, 53 [37-67] years; 54.8% male) were analyzed. There were an estimated 5581 syphilitic uveitis-related hospitalizations during the 10-year study period. The median (IQR) age of individuals with syphilitic uveitis was 45 (35-55) years, and 4395 patients (78.9%) were male. Syphilitic uveitis disproportionately affected African American individuals (1787 patients [32%], although they compose 13.6% of the population) and those belonging to the lowest median household income quartile (2163 [38.8%]). The national incidence was 0.15 per 100 000 population and showed an increasing trend over the years, with the lowest incidence in 2011 (0.08 per 100 000 population) and the highest incidence in 2019 (0.23 per 100 000 population; P = .04). Regional analysis showed an increase in incidence across all 4 US geographical regions. A total of 1293 patients (23.2%) had comorbid AIDS. Although this cross-sectional study only captured inpatient diagnosis, an increasing incidence of syphilitic uveitis-related hospitalizations was observed in the US between 2010 and 2019. Given the concomitant national shortage of injectable penicillin G, results suggest that clinicians should maintain a high index of suspicion for syphilis when evaluating patients with intraocular inflammation.

Disparities in Ultrasound Use for Diagnosing Pediatric Appendicitis Across United States Emergency Departments

IntroductionAn ultrasound (US)-first approach for evaluating appendicitis is recommended by the American College of Radiology. We sought to assess the access to and utilization of an US-first approach for children with acute appendicitis in United States Emergency Departments. MethodsUtilizing the 2019 Nationwide Emergency Department Sample, we performed a retrospective cohort study of patients <18 y with a primary diagnosis of acute appendicitis based on International Classification of Disease 10th Edition Diagnosis codes. Our primary outcome was the presentation to a hospital that does not perform US for children with acute appendicitis. Our secondary outcome was the receipt of a US at US-capable hospital. We developed generalized linear models with inverse-probability weighting to determine the association between patient characteristics and outcomes. ResultsOf 49,703 total children, 24,102 (48%) received a US evaluation. The odds of presenting at a hospital with no US use were significantly higher for patients aged 11-17 compared to patients <6 y (adjusted odds ratio [aOR] [95% confidence interval (CI)]: 1.59, [1.19- 2.13], P = 0.002); lowest median household income quartile compared to highest (aOR [95% CI]: 2.50, [1.52-4.10], P < 0.001); rural locations compared to metropolitan (aOR [95% CI]: 8.36 [5.54-12.6], P < 0.001), and Hispanic compared to non-Hispanic White (aOR [95% CI]: 0.63 [0.45-0.90], P = 0.01). The odds of receiving a US at US-capable hospitals were significantly lower for patients >6 y, lowest median household income quartiles, and rural locations (P < 0.05). ConclusionsRural, older, and poorer children are more likely to present to hospitals that do not utilize US in the diagnosis of acute appendicitis and are less likely to undergo US at US-capable hospitals.

Trends in Utilization of Charcot Reconstruction

Category: Ankle; Diabetes Introduction/Purpose: Charcot arthropathy of the foot and ankle is a challenging complication of peripheral neuropathy with a 0.1% and 5.0% incidence in the diabetic population. The purpose of this study is to assess rates of foot or ankle reconstructions (fusions) for Charcot arthropathy, describe the associated patient demographics and hospital settings, and project the volume of Charcot reconstructions anticipated to be performed in 2030. Methods: The National Inpatient Sample database was queried from 2016-2019 using International Classification of Diseases (ICD) codes for foot or ankle fusion (midfoot, hindfoot, or ankle) and a diagnosis of Charcot arthropathy, ultimately identifying 1,343 patients undergoing surgical procedures. Patient information collected included age, sex, race, primary payer status, year of surgery, length of hospital stays, and median household income quartile. Hospital information included bed size, census region, teaching status, and ownership. Results: Between 2016-2019, there were approximately 1,343 patients treated surgically with midfoot, hindfoot, or ankle arthrodesis for Charcot arthropathy, and the number of cases increased by 12.11% annually. Between 2019-2030, there is projected to be a 121.41% increase in the frequency of Charcot reconstruction procedures from 383 to 848 total annual cases. Patients undergoing these procedures are predominantly white, male, and in their 50s. The most common payers were Medicare and private insurance. The mean hospital length of stay was 5.80 days. The procedures performed were predominantly large, urban teaching hospitals in the south with a private, non-profit ownership structure. Conclusion: Surgical reconstruction of Charcot arthropathy of the foot and ankle is steadily increasing in prevalence. These patients are predominantly white, male, and in their 50s. It is important for orthopaedic foot and ankle surgeons to be trained in the surgical management and reconstruction of Charcot arthropathy to meet the expected growing surgical need, which is projected to be 848 procedures annually by 2030.

Trends in Geographic Utilization of Total Ankle Arthroplasty and Ankle Arthrodesis

Category: Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) and ankle arthrodesis (AA) are common surgical treatment options for end-stage ankle arthritis. Previous studies of trends in TAA utilization have shown a rapid increase in use from 2000-2010, likely due to improvements in implants and surgical techniques. The purpose of this study is to assess relative rates of TAA and AA utilization, investigate these trends in across populations and hospital settings, and project these trends in 2030. Methods: The National Inpatient Sample database was queried from 2016-2019 using International Classification of Diseases codes for TAA and AA to identify 8,787 patients (TAA=4,664, AA=4,123). Patient information collected included age, sex, race, primary payer status, year of surgery, length of hospital stay, and median household income quartile. The latter was determined by the NIS database using patient zip code, with the first quartile being the poorest and fourth quartile the richest. Hospital information included bed size, census region, teaching status, and ownership. Results: The ratio of TAA to AA increased from 0.90 in 2016 to 1.33 in 2019. Compared to AA patients, TAA patients were more significantly likely to be male (p=.004), white (p &lt;.001), older (p &lt;.001), and have higher income (p &lt;.001). TAA was more likely to be performed over AA at hospitals which were either smaller (p &lt;.001), urban non-teaching (p &lt;.001), in the western U.S. (p &lt;.001) or with a private, for-profit ownership structure (p=.002). The overall highest volume of both TAAs and AAs were performed in large (TAA=45.6%, AA=55.6%), southern (TAA=31.5%, AA=34.9%), urban-teaching (TAA=75.9%, AA=78.9%) hospitals with private, non-profit ownership (TAA=75.8%, AA=75.0%). TAA utilization is estimated to increase by 79.5% and AA to decline by 63.8%. (Table 1) Conclusion: TAA has continued to grow in utilization from 2016-2019 and is projected to continue this growth to 2030, while AA is expected to decrease in use. Furthermore, patients more likely to receive a TAA than AA are disproportionally white, male, and have a higher income and hospitals more likely to preform TAA are small, urban, for-profit hospitals in the western United States.

Association Between Demographic and Socioeconomic Factors and Diagnosis of Advanced Non-small Cell Lung Cancer: An Analysis of the National Cancer Database.

Introduction Lung cancer is a prevalent and potentially lethal cancer. The stage at initial presentation for diagnosis predicts mortality and helps to guide treatment options. Thus, it is critical to determine what factors impact the stage of cancer at diagnosis. This study sought to determine if certain socioeconomic and demographic factors are associated with receiving an early (Stage 0-I) or advanced (Stage IV) diagnosis of non-small cell lung cancer (NSCLC). Methods Using the National Cancer Database (NCDB), 1,149,539 patients were identified as having an NCDB Analytic Stage Group diagnosis of Stage 0-I (early) versus Stage IV (advanced) NSCLCbetween 2004 and 2018. Patients with early and delayed diagnoses were comparedbased on specific characteristics including sex, race, ethnicity, number of comorbid conditions, insurance status, median annual income, level of education, geographic location, and reporting facility. Using IBMSPSSStatistics for Windows, Version 28 (Released 2021; IBM Corp., Armonk, New York, United States), the data underwent analysis using binary multivariate logistic regression, chi-square analyses, and one-way ANOVA. Results Factors associated with an advanced diagnosis of NSCLC include being male, Black, Native American, or Hispanic. Compared to patients with at least one comorbid condition, those without comorbid conditions are more likely to present with advanced disease. Patients with private insurance, Medicaid, Medicare, or other government insurance are all less likely to present with advanced-stage cancer than patients without insurance. Compared to patients in the lowest median household income quartile, those in the second and fourth quartiles are diagnosed earlier. Patients living in areas where a higher proportion of residents lack a high school diploma are more likely to present with advanced NSCLC. Additionally, living in the Midwest and Western United States and presenting to Community Cancer programs are associated with advanced disease at initial presentation. Conclusions Factors that were associated with the advanced presentation of NSCLC included being male, Black, Native American, or Hispanic, having a lack of comorbid conditions or insurance, earning a lower median annual income, and living in a zip code where a higher proportion of residents lack a high school diploma. Additionally, residing in the Midwest and Western United States and seeking care at Community Cancer programs were associated with advanced disease at initial presentation. Understanding that certain socioeconomic and demographic factors impact the stage at initial diagnosis of NSCLC can allow for targeted intervention strategies aimed at the most at-risk individuals, areas, and facilities.