Median Household Research Articles

Barriers and Opportunities to Improve Healthcare Access for Uninsured Patients at a Student-Run Free Clinic in New Haven, Connecticut.

Uninsured patients have limited options to pay for necessary medical services. Most United States hospitals offer financial assistance programs (FAPs) to help patients pay for care, but the challenges of accessing these programs demonstrate a need for more solutions. This study was a retrospective review of 200 randomly sampled HAVEN Free Clinic patients from September 2022 to September 2023. Patients were eligible to be seen at HAVEN if 18-65 years old, without health insurance, and living in New Haven County, Connecticut. Application histories to Medicaid and hospital FAP at a non-profit tertiary care center in Connecticut were assessed. In the 200-patient sample, average age was 43.4 ± 11.2 years old, 61.0% were female, and 86.5% were Hispanic or Latino. 68% were employed with a median household yearly income of $18,200 [$7,293-$26,741]. 80% had applied for a hospital FAP-71.1% were currently approved for Free Care or Discounted Care. 6% were approved for Medicaid; 2.5% were approved for Emergency Medicaid. Of those who applied for a hospital FAP, 28.3% received ≥ 1 application denial. Most common hospital FAP denial reasons were missing, wrong, or outdated proof of income (93.9%), and incomplete application (6.1%). Hospital FAPs and Medicaid provide important access to care for uninsured patients, but are not without barriers and should not be viewed as the only solution. Improving hospital FAP access involves assessing eligibility at presentation, extending approval duration, and advocating for more funding. Addressing these barriers can advance equitable care for all.

Evolution of Inequality in Nigeria: a Tale of Falling Inequality, Rising Poverty, and Regional Heterogeneity

AbstractRecent research on Nigeria indicates declining income inequality. In contrast, anecdotal evidence suggests that only the upper class has benefited from economic growth in Nigeria over time. The disconnect between these findings and anecdotal evidence, and the limitation in how inequality was estimated in the past literature are the motivation for our research. First, we consider if inequality decreased in Nigeria between 2010 and 2018. We then examine how changes in inequality relate to changes in consumption and poverty. In addition, we examine whether there has been convergence in inequality and consumption across geopolitical regions over this period? Leveraging data from the four waves of the Nigeria General Household Panel Survey (GHS) and carefully measuring inequality in consumption expenditure using Gini, our results suggest that between 2010 and 2018, inequality decreased and median consumption expenditure increased. At the same time, poverty incidence and severity increased precipitously. Our findings also suggest convergence across regions over time in estimated within region Gini. In contrast, we find evidence of divergence across regions over time in median households’ consumption.

Pediatric and Adolescent Obstetric and Gynecologic Encounters in US Emergency Departments: A Cross-Sectional Study.

To describe pediatric and adolescent obstetric and gynecologic diagnoses presenting at emergency departments (EDs) in the United States. This was a retrospective, cross-sectional study design that utilized the Nationwide Emergency Department Sample (NEDS), which comprised hospital-owned EDs throughout the United States in 2018. The participants included a sample set of female patients from birth to 18 years old. All obstetric and gynecologic (OB/GYN) International Classification of Disease (ICD-10) codes were categorized. Descriptive, bivariate, and multivariate analyses were used to assess diagnoses by age group, hospital type, ED disposition (eg, admission and transfer), payer, and median household income. In 2018, there were 518,244 OB/GYN ED visits by female patients aged less than or equal to 18 years. Vulvovaginal disorders and abnormal uterine bleeding were among the top 5 presentations in all age groups. The top diagnoses varied by age group. Diagnoses with higher morbidity and mortality (ovarian torsion and ectopic pregnancy) had higher admission and transfer rates compared with diagnoses that can be commonly managed in the outpatient setting (vulvar or vaginal disorders). This is the first study that evaluated OB/GYN diagnoses in pediatric and adolescent patients presenting to the ED. Educational and referral efforts should focus on not only emergency diagnoses, such as ovarian torsion, adnexal masses, and ectopic pregnancy, but also common presentations that can often be managed in the outpatient setting, such as vulvovaginal disorders and abnormal uterine bleeding.

Examining the association between California tobacco licensed retail density and public support or opposition to state anti-tobacco legislation.

The state of California has enacted progressive anti-tobacco policies, including Proposition 56 in 2016. In response, the alternative and emerging tobacco product (ATP) industry has increased its political activity. This study explores the association between the proportion of people voting against Proposition 56 and tobacco/ATP retail density. We conducted a retrospective analysis using data on licensed California tobacco retailers, which were then cross-referenced for categorization using Yelp. Proportion voting against Proposition 56 was obtained from the Secretary of State's website. A series of linear regression tests were performed between population-normalized retailer density and voting proportion at the county level before and after adjusting for covariates such as age, gender, race/ethnicity and median household income. The total number of licensed tobacco retailers increased by 29.31% from 2015 to 2019. Association between proportion voting against Proposition 56 and retail density was significant during voting and during periods of policy implementation and post-implementation (2016-2018) for non-specialized tobacco retailers. For specialized/ATP retailers, significance was only detected during the post-implementation period (2018-2019) after normalization. Proportion voting against Proposition 56 was also a significant predictor of increase in total number of non-specific (β=0.48, p=0.008) as well as specialized tobacco and/or ATP retail storefronts (β=0.21, p=0.001) from 2016 to 2018. This study provides initial evidence of the association between tobacco retail density and voting patterns for anti-tobacco policy. Future research should examine the role of tobacco retail density on variation in local support for state tobacco control initiatives, including tailoring outreach to specific voting census blocks in communities with heavy retail presence.

Financial Capability and Performance: Assessing Trends Among North Carolina Utilities

Key TakeawaysOf 301 analyzed utilities in North Carolina, 51% reported operating revenues less than operating expenditures—operating ratios (ORs) less than 1.Affordability burden and OR were both affected by utilities’ respective population size, population growth or loss rate, and median household income.Annual supplemental funding would be needed to provide all 301 utilities with sufficient revenue to cover operating expenses to ensure ORs are greater than 1.When evaluating consolidation of the utilities into a collective entity, the cumulative revenue of the 301 utilities well exceeded the sum of operating expenses.

Catastrophic health expenditure on chronic non-communicable diseases among elder population: A cross-sectional study from a sub-metropolitan city of Eastern Nepal.

This study was conducted with the objective to analyze the out-of-pocket (OOP) healthcare expenditure and catastrophic healthcare expenditure (CHE) on chronic non-communicable diseases (CNCD) among the elderly population, and the association of CHE on CNCD with associated factors among the same population. We collected data from the elderly population of Dharan Sub-metropolitan city of the Eastern Nepal via door-to-door survey and face-to-face interview. The ten wards out of twenty were chosen by lottery method, and the equal proportion out of 280 samples was purposively chosen from each of ten wards (28 participants from each selected ward). The data were entered in Microsoft Excel 2019 v16.0 and statistical analysis was performed by using statistical package for social sciences, IBM SPSS® v21. The chi-square test was used to test the group differences. Multivariable logistic regression was used to determine independent factors associated with CHE (all variables with P < 0.20), and adjusted odds ratios (AOR) were calculated at 95% confidence interval (CI). The median household, food and health expenditures were 95325 (72112.50-126262.50), 45000 (33000-60000) and 2100 (885.00-6107.50) NPR respectively. The proportion of the participants with CHE was 14.6%. The single living participants had 3.4 times higher odds of catastrophic health expenditure (AOR = 3.4, 95% CI = 1.2-9.6, P-value = 0.022) than those who are married. Similarly, those who had cancer had 0.1 times lower odds of CHE (AOR = 0.1, 95% CI = 0.0-0.2, P-value = <0.001) than those without cancer. The elder population had significant financial health shocks due to chronic health ailments. There should be the provision of mandatory health insurance programmes for elderly to cut down the catastrophic healthcare expenditure. Similarly, there should be the provision of exemption scheme for vulnerable elderly who are more likely to face catastrophic expenditure from all available health facilities.

The Financial Toxicity of FDA-Drugs Approved for Malignant Hematology

Background: Many Food and Drug Administration (FDA) drugs (FDADs) are available now for patients with malignant hematology (MH). Still,the high prices of FDADs for MH affect the care of these patients and our health care system. Here, we estimated one monthly supply price (OMSP) for FDADs for MH approved between 2011 and 2021. Also, we reported the total cost (TC) of FDADs by multiplying OMSP times the assumed duration of therapy based on the available overall survival (OS) (OMSP x OS (months)). Methods: We performed a retrospective review of clinical trials (CTs) published from January 2011 to May 2021 that led to FDA approval of hematological malignancy drugs (Leukemias, lymphomas, Multiple Myeloma (MM), Myelodysplastic Syndrome (MDS), and Myeloproliferative Neoplasm (MPN)). The drugs investigated were selected using FDA Databases, 'Oncology (Cancer) / Hematologic Malignancies Approval Notifications' and 'Novel Drug Approvals'. CTs were also reviewed for demographic data on ClinicalTrials.gov (CT.gov) and Primary Literature on drug approval. FDADs were divided into disease groups: acute myeloid leukemia (AML), chronic myeloid leukemia (CML), acute lymphoblastic leukemia (ALL), chronic lymphocytic leukemia (CLL), MDS+MPN, MM, and lymphoma. We compared prices between drug.com and UpToDate using the lowest price for each drug (the percentage change was low 0.18). We calculated the median of OMSP for each group, compared the median of OMSP between oral (PO), subcutaneous (SQ), and intravenous (IV) FDADs, and calculated TC for each group. For non-reached OS, we used 60 months to calculate TC. Results: Sixty-one FDADs were identified; 9,4,4,7 and 4 for AML, CML, ALL, CLL, and MDS+MPN, respectively. For MM and lymphoma, we identified 11 and 22, FDADs, respectively. The median of PO, SQ, and IV FDADs were 29, 4, and 30, respectively (some drugs were approved for more than one group). The median of OMSP for AML, CML, ALL, CLL, and MDS+MPN were $30,923 [range, $5,989-36,099], $19,343 [range, $20,834-22,570], $75,839 [range, $48,917-93,660] (excluding chimeric antigen receptor-T cell (CAR-T) therapy), $15,263 [range, $3,532- 23,091], and $15,284 [range, $8,060- 24,157], respectively. The median of OMSP for MM and lymphoma excluding CAR-T were $20,514 [range, $2,090-35,276 ] and $18,434 [range, $6,834-34,351], respectively. The median of OMSP for PO, SQ, and IV FDADs were $18,291 [range, $2,628-31,686], $18,370 [range, $6,934-22,583] and $24,691 [range, $2,090-93,660] (excluding CAR-T cell therapy), respectively. All FDADs for ALL patients were IV. The median OMSP for FDADs approved from (2011 to 2016) and (2016 to 2021) were $22,233 (range, $8,300-23,091) and $24,517 (range, $2,352-86,253), respectively. The median TC for AML, CML, ALL, CLL, and MDS+MPN were $351,327 (range, $196,380-791,041), $1,160,597 (range, $1,097,482-1,354,993), $547,091 (range, $244,587-$985,915), $971,160 (range, $564,720-3,456,000), and $1,114,038 (range, $255,502-1,449,447), respectively. OS was not reached for all CML drugs, in 5/7 (71%) of CLL drugs and 12/61 (34%) of all FDADs. The median TC for MM and lymphoma were $607,031 [range, $18,813-1,743,706 ] and $884,900 [range, $183,817-9,116,360], respectively. Excluding CAR-T drugs, The highest OMSP was for ALL but not TC due to the short median OS (10 months) (Figure 1). There were 5 CAR-T products approved between August 2017 and March 2021 (tisagenlecleucel, axicabtagene ciloleucel, lisocabtagene maraleucel, brexucabtagene autoleucel and idecabtagene vicleucel). The median cost was $432,055 (range, $373,000-475,000), and the estimated OMSP was $21,635 (range,$6,216-39,583). The median household monthly income was $6,558 in 2020 in the United States (US). In 2020, 8.6% of US population (28 million) did not have helath insurance at any point during the year. There are currently no generic drug products of these FDADs available in the US. Conclusion: The cost-effectiveness of CAR-T products is relatively similar to other FDADs. Patients with malignant hematologic disorders are affected by treatment-related financial harm. Although the costs used for this analyses may be modulated by many factors where the actual cost may not be what is reported in the sources used, the financial impact is still significant for many patients. There is a need for strategies to lower the costs. The value of drugs should be considered in formulating treatment guidelines. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

IBCL-015 The Financial Toxicity of FDA-Drugs Approved for Malignant Hematology

The high prices of cancer drugs affect the care of cancer patients and our health care system. Many Food and Drug Administration (FDA) drugs (FDADs) are available now for patients with malignant hematology (MH). We reviewed one monthly supply price (OMSP) for FDADs for MH approved between 2011 and 2021. We performed a retrospective review of randomized clinical trials that led to FDAs approval for MH. Sixty-three FDADs were identified. FDADs were divided into disease groups: acute myeloid leukemia (AML), chronic myeloid leukemia (CML), acute lymphoblastic leukemia (ALL), chronic lymphocytic leukemia (CLL), multiple myeloma (MM), myelodysplastic syndrome + myeloproliferative neoplasms (MDS+MPN), and lymphoma. We compared prices between drug.com and UpToDate. The percentage change was low (0.18). We calculated the median of OMSP for FDADs for each group. We compared the median of OMSP between oral (PO), subcutaneous (SQ), and intravenous (IV) FDADs. The median of OMSP for AML, CML, ALL, CLL, and MDS+MPN were $30923 [range, 5989 to 36099], $19343 [range, 20834 to 22570], $84749 [range, 75839 to 373000], $15263 [range, 3532 to 23091], and $15284 [range, 8060 to 24157], respectively. All FDADs for ALL patients were IV. The median of OMSP for MM and lymphoma were $20982 [range, 12054 to 441,743] and $23091 [range, 6834 to 475000], respectively. The median of OMSP for PO, SQ, and IV FDADs were $18291 [range, 2628 to 31,686], $18370 [range, 6934 to 22583] and $24691 [range, 2090 to 93660] (discounting CAR-T cell therapy), respectively. The median of OMSP for FDADs approved from (2011 to 2016) and (2016 to 2021) were $22233 (range, 8300 to 23091) and $24517 (range, 2352 to 475000), respectively. The median household monthly income was $6,558 in 2020 in the United States (US). There are currently no generic drug products of FDADs available in the US. MH patients are affected by treatment-related financial harm. The need for generic versions to lower the price is urgent. IV FDADs are more expensive than PO or SQ. The value of drugs should be considered in formulating treatment guidelines.

A mixed-methods study of minority patients treated on a cancer clinical trial at a tertiary referral center.

e18543 Background: Representation of minority patients (pts) in cancer clinical trials (CCTs) is low and contributes to health disparities. Our study sought to understand the beliefs and motivations of minority patients and to identify barriers and facilitators of CCT enrollment. Methods: 270 minority pts treated on CCT were identified from the medical record from 2018-2021. Of the 138 of pts alive, 13 (9.4%) consented. Semi-structured qualitative interviews were conducted exploring motivations, barriers, and facilitators to CCT participation. Surveys collected demographics and explored beliefs towards cancer and factors that influenced participation. Results: Of the 13 participants, 9 were female (69%), 4 Hispanic (30%), 3 Black (23%), 3 multiple races (23%), 2 Asian (15%), 2 Native American (15%), and 1 Native Hawaiian (8%). Two pts had a high school education (15%), 7 ≥ 4-year college (54%), 4 ≥ 2-year college (30%). Eight pts were married, 3 divorced, 1 widowed, and 1 single. Employment status was: employed (4 pts, 30%), unemployed (1 pt, 8%), disabled (5 pts, 38%), retired (3 pts, 23%). All pts were insured. Median household was 3 people (range 1 to &gt; 5); 3 pts had dependents. 9 pts had their own vehicle; 4 used public or subsidized transport. 2 pts had trouble finding transportation. Income was: 3 pts &lt; 25K, 4 pts 25-35K, 1 pts 35-50 K, 1 pts 50-75K, and 4 pts &gt; 75K. 4 pts received emotional support from religion. All pts had heard of CCTs and 6 (46%) had known other CT participants. Direct communication from healthcare provider was the most common way of hearing about CCT. 9 pts (69%) had trust or strong trust in experimental therapy/CCT; 4 pts (30%) were neutral. 8 pts (61%) believed standard therapy was needed to cure cancer. 5 pts (38%) believed God would decide if they die from cancer. 7 pts (54%) believed that worry makes cancer worse. Key themes about patients’ motivation to participate: chance for cure, staying positive, giving back to others, having representation in research, and advancing science. Key themes about facilitators to participation: supportive family, cost coverage for treatment, and limited treatment options. Key themes on participation: minimizing logistical barriers, decentralizing CCTs, increasing awareness via patient narratives, diversifying research staff, minimizing cost, and being clear on purpose and benefit of CCT. Factors from survey that influenced participation are summarized in Table. Conclusions: Understanding minority pts experience through in-depth interviews is valuable and may help with recruitment.[Table: see text]

Abstract 185: Income Status And Receipt Of Sacubitril/valsartan For The Treatment Of Heart Failure

Background: Outcomes in heart failure with reduced ejection fraction (HFrEF), are influenced by access and adherence to guideline directed medical therapy. Objective: To study the association between median annual household income and: (1) odds of receiving sacubitril/valsartan, a novel angiotensin receptor/neprilysin inhibitor (ARNI) therapy among insured patients with heart failure with reduced ejection fraction (HFrEF) and (2) medication adherence (measured as the proportion of days covered (PDC)). Hypothesis: lower income is associated with lower odds of receiving and adhering to ARNI among patients with HFrEF. Methods: Using Optum’s deidentified Clinformatics® Data Mart, patients with ≥ 2 diagnoses of HFrEF and ≥ 6 months of enrollment for follow up (2016-2020) were included. Covariates included age, race, ethnicity, sex, educational attainment, household net worth, geographical region and Elixhauser comorbidity index. Prescription for ARNI was defined by presence of a claim within 180 days. Adherence was defined as PDC ≥80%. We fit multivariable-adjusted logistic regression models and hierarchical logistic regression accounting for covariates. We also assessed for race-income interaction. Results: Among 322007 individuals with HFrEF diagnosis, 136,613 had ≥6 months of complete data. Of the patients eligible for ARNI, only 5.4% (7409/136613) received a claim within 180 days of HFrEF diagnosis. After adjusting for social and clinical factors, the odds were elevated for ARNI claim within 180 days of HFrEF diagnosis (OR=1.38, 95% CI: 1.27, 1.49) for the highest income category (&gt;$100K) compared with the lowest (&lt;$40K). After adjustment, income &lt;$40k) was associated with a 47% higher odds of PDC&lt;80% compared with income &gt;$100K. Conclusions: Higher patient income is associated with increased likelihood of an ARNI claim within 180 days of HFrEF diagnosis, even after adjusting for socioeconomic and clinical factors. Future analyses are needed to determine other social factors associated with delay in ARNI initiation and long-term adherence.

Sources of inertia in the individual health insurance market

Consumers in private health insurance markets are highly inertial. The literature has repeatedly found consumers are willing to pay thousands of dollars to keep their health plan. However, the causes of inertia are not well understood, despite their importance in determining whether welfare can be improved by reducing inertia and which types of policies would be effective in doing so. Using administrative data from California’s Health Insurance Marketplace, we separately identify three sources of inertia—tastes for provider continuity, inattention, and hassle costs—using two-stage models of inattention and health plan choice. We find that eliminating inattention and hassle costs would reduce repeated health plan choice by 53 percentage points and that interventions to reduce inattention and hassle costs are complements. Inattention and hassle costs cost consumers over a billion dollars in foregone consumer surplus in 2018, roughly $1,790 per household per year or half the annual premium paid by the median household, with inattention accounting for the largest source of forgone surplus. We conclude that interventions to reduce inertial plan choice should jointly focus on hassle costs and particularly inattention, but not tastes for provider continuity.

Modeling factors contributing to dockless e-scooter injury accidents in Austin, Texas

Objective Over the past few years, increased e-scooter ridership has raised concerns about the growing number of injury accidents involving e-scooters. Additionally, given the lack of appropriate e-scooter accident data, the extent to which built environment and socioeconomic factors affect e-scooter safety is unclear. In consideration of these issues, this study was aimed at identifying the factors contributing to the number of e-scooter injury accidents in Austin. Methods We developed zero-inflated Poisson (ZIP) and zero-inflated negative binomial (ZINB) models on the basis of 2018 dockless e-scooter injury accident data collected from the Patch platform. The results indicated that the ZIP model better fit the accident data. Results Significant variables included the ratio of 18- to 34-year-old males to their female counterparts, the median annual household income (in thousands), the ratio of public transport users to private transport users, the land use entropy index, the percentage of restaurants, and the percentage of educational centers in the study site. Conclusions As e-scooter accidents are likely to occur in dense urban settings, a critical initiative is to develop new infrastructure, such as bike lanes, and/or extend sidewalks beyond core urban areas. Another highly recommended measure is to implement a demerit point system for the suspension of riders who engage in unsafe behaviors. Lastly, launching educational campaigns by e-scooter operators and law enforcement agencies will raise riders’ awareness about road and personal safety.

Abstract 10809: Socioeconomic Factors Affect Prescription Patterns of the Newer Anti-Diabetic Medications

Introduction: Sodium-glucose Cotransporter-2 inhibitors (SGLT2) and Glucagon-like Peptide-1 receptor agonist (GLP-1) medications are known to reduce cardiovascular mortality through their insulin-independent mechanisms. The prescription pattern of these medications among diabetes patients is unknown. We sought to classify prescription patterns within our healthcare system and identify factors which influence these patterns. Hypothesis: We predicted that socioeconomic factors would influence the likelihood of SGLT2 or GLP-1 prescription for diabetes care. Methods: Unique encounters for diabetes care in the outpatient and inpatient setting from January 1, 2020, to December 31, 2020, were identified through a systematic query of our healthcare system’s database. We included patients &gt;18 years old who had an A1C of ≥8%. We abstracted demographic data, SGLT2 or GLP-1 prescription status, diabetes complications and assessed the relationship between these and the likelihood of being prescribed one of the medications of interest. Results: Of the 2,746 patients included, 24.4% were prescribed either an SGLT2 or a GLP-1. Prescription status did not differ by sex. Users were more likely to be younger (mean age: 65.1 ± 9.4 years vs. 66.4 ± 9.9 years, p = 0.005); non-Hispanic (86.3%), White (77.9%), likely to live in a middle-income level zip code, and likely to have private insurance. Logistic regression of the predictors of prescription status is shown in table 1. Conclusion: Race, age, ethnicity, insurance type, and median annual household income are associated with the likelihood that a diabetes patient would be prescribed either an SGLT2 or GLP-1. Further work is warranted to identify resources and strategies to limit the disparities in prescription patterns

Park environment and moderate-to-vigorous physical activity in parks among adolescents in a high-density city: the moderating role of neighbourhood income

BackgroundUrban parks are critical environmental resources in which adolescents engage in physical activity (PA). Evidence on the associations between park environmental characteristics and park-based PA in adolescents is mixed, particularly for high-density cities. Evidence is also lacking concerning the moderating role of neighbourhood socioeconomic status on the park-PA relationships. The current study aimed to examine the associations between park environmental characteristics and moderate-to-vigorous physical activity (MVPA) in parks among adolescents in Hong Kong and the moderating effect of neighbourhood income on these associations.MethodsA cross-sectional study involving direct observations of adolescents was conducted in 32 randomly selected urban parks in Hong Kong. Park environmental characteristics were measured using the Community Park Audit Tool. Park-based MVPA among adolescents was measured using the System for Observation Play and Recreation in Communities. Neighbourhood income was extracted from the 2011 Hong Kong Population Census data on median household income.ResultsThere was a significant positive association between the quality of amenities and park-based MVPA (metabolic equivalents per observation) in adolescents. However, the associations between the diversity of active facilities, greenness and adolescents’ park-based MVPA were not significant. Neighbourhood income moderated the association between adolescents’ park-based MVPA and park safety, where the relationship between park safety and park-based MVPA was significantly positive in low-income neighbourhoods but not significant in high-income neighbourhoods. An income-by-environment interaction was also observed concerning park aesthetics, with a negative relationship between park aesthetics and park-based MVPA in high-income neighbourhoods but not in low-income neighbourhoods.ConclusionOur findings provide evidence regarding how park environment and neighbourhood income impact adolescents’ park-based MVPA in Hong Kong. These findings can inform urban planning and policymakers who seek to improve urban park development in high-density cities.

The Care Children Deserve

The Care Children Deserve

1011-P: Major Depressive Disorder Is Associated with Higher Risk of Readmission following DKA

Introduction: Diabetic ketoacidosis (DKA) is a medical emergency associated with significant patient mortality and morbidity. Studies have shown that the presence of Major Depressive Disorder (MDD) is associated with an increased incidence of DKA. We aimed to assess whether MDD was associated with increased risk of readmission following DKA. Methods: We utilized the National Readmission Database for 2016 to identify hospitalized adult patients with a principal diagnosis of DKA and a secondary diagnosis of MDD from January 1 to November 30, 2016. We excluded patients with elective and traumatic admissions. We utilized a multivariate cox regression model to identify independent predictors of readmission. Results: Of 15,981 patients with MDD and DKA who were discharged, 23.2%(n=3710) were readmitted within 30-days. The most common reason for readmission was DKA (63.9%, n=2371). In the multivariate cox regression model, MDD was associated with higher risk of readmission (HR: 1.17, 95% CI: 1.1 - 1.26, p=0.04) when adjusted for comorbidities and hospital characteristics. Of those MDD patients with DKA who were readmitted, type 1 DM (HR: 1.14, 95% CI: 1 - 1.3, p=0.04), CHF (HR: 1.40, 95% CI: 1.1 - 1.78, p=0.006), and CKD (HR: 1.44, 95% CI: 1.17 - 1.79, p=0.001) were associated with higher risk of readmission. Obesity (HR: 0.75, 95% CI: 0.59 - 0.97, p=0.025), private insurance (HR: 0.64, 95% CI: 0.53 - 0.79, p&amp;lt;0.001), median patient household income between $54,000-$70,999 (HR: 0.73, 95% CI: 0.63 - 0.85, p&amp;lt;0.001) and $71,000 or more (HR: 0.74, 95% CI: 0.62- 0.89, p=0.002) were associated with lower risk of readmission. Conclusion: In this study, we found that patients with MDD admitted for DKA had a 17% increased risk of readmission within 30 days of discharge in comparison to those without MDD. This could be explained by their propensity for poor adherence to diet, exercise, and recommended pharmacological therapy. Further studies need to be done to assess and target the exact precipitants of readmission. Disclosure M. Ramirez: None. M. Murthi: None. B. Sharma: None. R. Atluri: None. H. Shaka: None. G. Velazquez: None.

Treatment patterns, and survival of patients with metastatic undifferentiated pleomorphic sarcoma: A National Cancer Database (NCDB) study.

11561 Background: Undifferentiated Pleomorphic Sarcoma (UPS) is regarded as one of the most common types of soft tissue sarcoma. Although prior studies have highlighted its metastatic potential, there have been no database studies that delineate the clinical/social characteristics and outcomes in UPS patients with metastatic disease. Utilizing the National Cancer Database (NCDB), we want to observe the complex interplay between treatment approaches and non-biologic modifiers. Methods: 737 patients diagnosed with metastatic UPS above the age of 17 years between 2004 and 2015 were identified utilizing the NCDB. Patients were identified with ICD-O-3 morphologic code 8830/3. Demographic factors (Race/ethnicity, biological sex, Median household income/education at zip code level, facility type, insurance) were studied in relation to the type of treatment they received: No treatment; chemotherapy only; chemotherapy and radiation therapy; chemotherapy and surgery; chemotherapy, surgery, and radiation; radiation therapy and/or surgery; and other treatments. Survival tables were utilized to generate 1-year and 3-year survival rates, and Kaplan-Meier method with associated log-rank list was used to examine the differences in unadjusted survival. Results: Approximately 17% of our cohort were left untreated, whereas 83% received treatment. Patients who were untreated were likely to be older, on Medicare, and had a Charlson-Deyo (CD) score of 2 or above. Patients who were more likely to receive treatment were younger educated males with private insurance, residing in areas of higher income, and receiving care at an academic program. Patients who only received chemotherapy were more likely to belong to areas with lower income and had a CD score of 0. Patients who received a combination of chemotherapy, surgery, and radiation therapy were more likely to belong to areas of high income, private insurance owners, and received care at an academic facility. Patients who received chemotherapy with surgery and without radiation therapy were more likely to be younger males from areas of highest income, and received care at an academic facility. Patients who had better unadjusted survival were younger educated patients on private insurance or Medicaid, with distant lymph nodes metastases at diagnosis, who received a combination of chemotherapy, radiation therapy and surgery at an academic program. Patients who had poorer unadjusted survival were untreated older patients on Medicare, and with bone metastases. Conclusions: This is one of the most comprehensive studies involving patients with metastatic UPS that analyzes demographic variables in relation to the treatment approach. Some of the major determinants that influence outcomes in these patients included age, insurance status, treatment at academic facility, CD score, and type of metastases at diagnoses.

Ties in Tough Times: How Social Capital Helps Lower-Income Jewish Parents Weather the Economic Hardship of COVID-19.

In this exploratory study, we examined how social ties helped lower-income Jewish parents in the Greater Philadelphia area weather the COVID-19 pandemic. We interviewed 36 parents who self-identified as Jewish, had at least one school-age child, and earned less than the median Jewish household income in the Philadelphia area. We analyzed the data through the lens of social capital, focusing on three forms: bonding, bridging, and linking social capital. Unlike in weather-related disasters, where social capital yields crucial physical help, the social distancing requirements of the COVID-19 pandemic changed how social capital functions. Parents with strong social ties in the Jewish community were able to connect to people and institutions of power, such as rabbis and Jewish organizations, who provided valuable material resources while families sheltered in place. We describe how people develop relational ties by doing something with and for a social group, and discuss how extended periods of social distancing can threaten the flow of social capital.

Healthcare disparities in cardio oncology: patients receive same level of surveillance regardless of race at a safety net hospital

BackgroundCardiotoxicity remains a dreaded complication for patients undergoing chemotherapy with human epidermal growth factor (HER)-2 receptor antagonists and anthracyclines. Though many studies have looked at racial disparities in heart failure patients, minimal data is present for the cardio-oncology population.MethodsWe queried the echocardiogram database at a safety net hospital, defined by a high proportion of patients with Medicaid or no insurance, for patients who received HER2 receptor antagonists and/or anthracyclines from January 2016 to December 2018. Patient demographics, clinical characteristics, and treatment outcomes were collected. Based on US census data in 2019, home ZIP codes were used to group patients into quartiles based on median annual household income. The primary end point studied was referral rate to cardiology for patients undergoing chemotherapy.ResultsWe identified 149 patients who had echocardiograms and also underwent treatment with HER2 receptor antagonists and/or anthracyclines, of which 70 (47.0%) were referred to the cardio-oncology program at our institution. Basic demographics were similar, but white patients were more likely to live in ZIP codes with higher income quartiles (p < 0.00001). Comparing between racial groups, there was no statistical difference in the percentage of patients that had a reduction in ejection fraction (EF) (p = 0.75). There was no statistical difference between racial groups in the number of cardiology or oncology appointments attended, number of appointments cancelled, average number of echocardiograms received, additional cardiac imaging received. Black patients were more likely to receive ACEI/ARB post chemotherapy (p = 0.047). A logistic regression model was created using race, age, gender, insurance, income quartile by home ZIP code, comorbidities (hypertension, hyperlipidemia, coronary artery disease, arrhythmia, diabetes mellitus, smoking, family history, age > 65), procedures (coronary stents, cardiac surgery), medications pre-chemotherapy, cancer type, cancer stage, and chemotherapy. This model found that there was an increased referral rate among patients from higher income quartiles (p = 0.017 for quartile 3, p = 0.049 for quartile 4), patients with a history of hypertension (p < 0.0001), and patients with breast cancer (p = 0.02).ConclusionsThe results of this study suggest that patients of our cardio-oncology population at a safety net hospital receive the same level of surveillance and treatment, and develop drop in ejection fraction at similar rates regardless of their race. However, patients that reside in ZIP codes associated with higher income quartiles, with hypertension, and with breast cancer, are associated with increased rate of referral.

A Cluster Randomized Controlled Trial of a Home-Delivered Food Box on Food Security in Chickasaw Nation

BackgroundThe 2010 Child Nutrition reauthorization called for the independent evaluation of innovative strategies to reduce the risk of childhood hunger or improve the food security status of households with children. ObjectiveThe research question was whether the Packed Promise intervention reduces child food insecurity (FI-C) among low-income households with children. DesignThis study was a cluster randomized controlled trial of 40 school districts and 4,750 eligible, consented households within treatment and control schools. Participants/settingData were collected at baseline (n = 2,859) and 2 follow-ups (n = 2,852; n = 2,790) from households with children eligible for free school meals in participating schools in 12 rural counties within the Chickasaw Nation territory in south central Oklahoma in 2016 to 2018. InterventionEach month of the 25-month intervention, for each eligible child, enrolled households could choose from 5 types of food boxes that contained shelf-stable, nutritious foods ($38 food value) and a $15 check for purchasing fruits and vegetables. Main outcome measuresThe primary outcome was FI-C. Other outcomes included household and adult food security, very low food security among children, and food expenditures. Statistical analyses performedDifferences between the treatment and control groups were estimated by a regression model controlling for baseline characteristics. ResultsThe Packed Promise project did not significantly reduce FI-C at 12 months (29.3% prevalence in the treatment group compared with 30.1% in the control group; P = 0.123) or at 18 months (28.2% vs 28.7%; P = 0.276), but reduced food insecurity for adults by 3 percentage points at 12 months (P = 0.002) but not at 18 months (P = 0.354). The intervention led to a $27 and a $16 decline in median household monthly out-of-pocket food expenditures at 12 and 18 months, respectively. ConclusionsAn innovative intervention successfully delivered nutritious food boxes to low-income households with children in rural Oklahoma, but did not significantly reduce FI-C. Improving economic conditions in the demonstration area and participation in other nutrition assistance programs among treatment and control groups might explain the lack of impact.ClinicalTrials.gov ID: NCT04316819 (http://www.clinicaltrials.gov). Funding/SupportThis article is published as part of a supplement supported by the US Department of Agriculture, Food and Nutrition Service.