National Database Study Research Articles

1433-P: Protective Effect of GLP-1 Receptor Agonists (GLP-1 RA) and SGLT2 Inhibitors (SGLT2i) against Adverse Cardiovascular (CV) Events in HIV and Type 2 Diabetes Mellitus (T2DM) When Compared with Metformin Alone: A National Database Study

Introduction: T2DM and HIV independently confer an increased risk of CV adverse events. We aimed to evaluate the effect of newer oral antidiabetic medications (GLP-1 RA/SGLT2i) on CV outcomes in adults with HIV and T2DM. Methods: Using a national database (IBM Explorys Solutions, IBM, Inc.), we searched for cases (HIV + T2DM patients on GLP-1 RA/SGLT2i and metformin) and controls (HIV + T2DM patients on metformin alone). We calculated comparative odds ratios (OR) and 95% confidence interval (CI) for the risk of association of GLP-1 RA/SGLT2i use and incident CV adverse events, namely myocardial infarction (MI) and acute heart failure (AHF). Results: Out of a total of 61,917,780 patients in Explorys, 29,920 had both HIV and T2DM. Patients on GLP-1 RA or SGLT2i were significantly less likely to experience an incident adverse CV event when compared to controls (Table 1). When stratified by individual drug classes (either GLP-1 RA or SGLT2i), patients on the newer antidiabetic medications were still significantly less likely to experience an adverse CV event in comparison to metformin alone (Table 1). Conclusion: GLP-1 RA and SGLT2i seem to confer a protective effect against major adverse CV events such as MI and AHF in patients with both HIV and T2DM. Disclosure O.A. Alaber: None. A.K. Chandar: None. B.A. Dahash: None. A.C. Zuzek: None. A. Rajpal: None.

161-OR: Association of Frequency of Hypoglycemic Episodes with Incident Cardiovascular Events in Adults with Type 2 Diabetes Mellitus: A National Database Study

Introduction: Hypoglycemia has been linked to increased cardiovascular (CV) events, however there is limited data about frequency of hypoglycemic episodes and CV outcomes. We aimed to evaluate the association of frequent hypoglycemic episodes (> 5/year) with incident CV events in adults with type 2 diabetes mellitus (T2DM). Methods: We queried a national database (IBM Explorys Solutions, IBM, Inc.) for adults with T2DM who had >5 hypoglycemic episodes (cases) vs. 1 to 5 hypoglycemic episodes (controls) in one year. Primary outcomes were overall CV adverse events, acute myocardial infarction (MI), cerebrovascular accident (CVA) and cardiac arrhythmias. Odds ratios (OR) and 95% confidence interval (CI) for the OR were calculated for the risk of association between number of hypoglycemic episodes and incident CV events. Results: Out of a total of 61,917,780 patients in Explorys, 4,882,710 had T2DM. Patients with >5 hypoglycemic episodes in 1 year (cases) had a higher incident risk of overall CV adverse events when compared to controls (OR: 1.61, 95% CI: 1.558, 1.663). In the stratified analysis, patients with frequent hypoglycemic episodes had a significantly higher incidence of cardiac arrhythmias, acute MI, and CVA (Table 1). Conclusion: Adults with T2DM with frequent hypoglycemic episodes (>5/year) tend to have higher incidence of adverse CV events. Disclosure O.A. Alaber: None. A.K. Chandar: None. B.A. Dahash: None. A.C. Zuzek: None. A. Rajpal: None.

Pneumonia risk and its associated factors in Parkinson's disease: A National Database Study

BackgroundDespite pneumonia being an emerging burden on Parkinson's disease patients, there is essentially nothing known on whether they are at an increased risk of pneumonia occurrence and their associated factors. ObjectivesTo determine whether Parkinson's disease is associated with the risk of pneumonia and its associated factors. MethodsUsing nationwide database that covers the whole population in South Korea from 2002 to 2017, we identified newly diagnosed Parkinson's disease patients in 2004–2006, and selected four age- and sex-matched controls for each patient from the general population. From these patients and controls, we identified pneumonia occurrence until the end of the study period, and plotted Kaplan-Meier curves and Cox proportional hazards model to determine its risk. ResultsWe identified 10,159 Parkinson's disease patients and matched 39,574 controls. These patients showed a higher incidence rate than controls (11.21 vs. 3.61 events/1000 person-years) throughout the study period, and were at an increased risk of pneumonia (hazard ratio = 2.26; 95% CI, 2.17–2.36) even after adjusting for confounders. Old age, male sex, region of residence, diabetes mellitus, congestive heart failure, tuberculosis, atrial fibrillation, chronic kidney disease, cerebrovascular disease, dementia, chronic obstructive pulmonary disease, seizure disorder and antidiabetic drug usage were all associated with a higher risk of pneumonia, while dyslipidemia and antihypertensive medication usage lowered the risk. ConclusionsParkinson's disease patients may be more likely to experience pneumonia compared to the general population throughout the disease course from diagnosis. Therefore, physicians should focus on the modifiable risk factors of pneumonia in such patients.

Short- and long-term survival after laparoscopic versus open total gastrectomy for gastric adenocarcinoma: a National database study.

The use of laparoscopic total gastrectomy for gastric cancer remains controversial. Our objective was to compare outcomes of laparoscopic total gastrectomy (LTG) vs. open total gastrectomy (OTG) for gastric adenocarcinoma using a national cancer database. The National Cancer Database (2010-2014) was analyzed for total gastrectomy cases performed for gastric adenocarcinoma. Patient demographics and surgical outcomes were stratified by stage and compared based on laparoscopic vs. open surgical approach. Primary outcome measures included 30-day and 90-day mortality and Kaplan-Meier curves to estimate long-term survival. There were 2584 cases analyzed, including 592 (22.9%) stage I, 710 (27.5%) stage II, and 1282 (49.6%) stage III cases. The distribution of LTG vs. OTG cases was 156 (26.4%) vs. 436 (73.6%) for stage I, 163 (23.0%) vs. 547 (77.0%) for stage II, and 241 (18.8%) vs. 1041 (81.2%) for stage III. For all stages analyzed, there was no difference between laparoscopic vs. open approach for adjusted 30-day mortality (stage I: adjusted odds ratio (AOR) 0.52, p = 0.75; stage II: AOR 1.36, p > 0.99; stage III: AOR 0.46, p = 0.29) or 90-day mortality (stage I: AOR 0.46, p = 0.99; stage II: AOR 1.17, p = 0.99; stage III: 0.57, p = 0.29). There was no difference between LTG vs. OTG 5-year Kaplan-Meier estimated survival curves for any stage (stage I: p = 0.20; stage II: p = 0.83; stage III: p = 0.46). When compared to OTG, LTG had a similar hazard ratio (HR) for mortality (HR 0.89 p = 0.20). Laparoscopic total gastrectomy and OTG have comparable 30-day mortality, 90-day mortality, and long-term survival.

Association of demographic, clinical, and hospital-related factors with use of robotic hysterectomy for benign indications: A national database study.

We examined the association of patient factors, gynecologic diagnoses, and hospital characteristics with utilization of the robotic approach for benign hysterectomy. We performed cross-sectional study of women (n = 725 050) undergoing hysterectomies in the 2012 to 2014 National Inpatient Sample. A total of 725 050 women underwent inpatient hysterectomy for benign indications: 70345 (10%) were performed robotically. Women were more likely to receive robotic hysterectomy at teaching hospitals (RR 1.60 [95% CI 1.54-1.66]) after adjustment for other patient factors, gynecologic diagnoses, and hospital characteristics. They were more likely to undergo robotic hysterectomy at large (RR 1.34 [95% CI 1.29-1.39]) and for-profit hospitals (RR 1.16 [95% CI 1.11-1.22]). Women were less likely to undergo robotic hysterectomy if they were rural (RR 0.68 [95% CI 0.64-0.72]), African-American (RR 0.78 [95% CI 0.74-0.82]), or publicly insured or uninsured (RR 0.55 [95% CI 0.53-0.57]) women. Significant geographic and hospital-level disparities exist in access to robotic hysterectomy in the United States.

Stent as a bridge to surgery or immediate colectomy for malignant right colonic obstruction: propensity-scored, national database study.

The aim of this study was to compare perioperative outcomes of urgent colectomy and placement of a self-expanding metallic stent followed by colectomy for patients with malignant right colonic obstruction. Right-sided malignant obstruction is less common than left-sided. Stenting for malignant left colonic obstruction has been reported to reduce postoperative complications. However, the impact of stenting for malignant right colonic obstruction remains undefined. The study included patients with right-sided malignant obstruction or stenosis undergoing colectomy between April 2012 and March 2017 identified from a nationwide database. Propensity score matching analysis was used to compare mortality and morbidity rates, proportion receiving a stoma and postoperative stay between urgent colectomy and stent groups. From 9572 patients, 1500 pairs were generated by propensity score matching. There was no significant difference in in-hospital mortality between the urgent colostomy and stent groups (1·6 versus 0·9 per cent respectively; P = 0·069). Complications were more common after urgent colectomy than stenting (22·1 versus 19·1 per cent; P = 0·042). Surgical-site infection was more likely with urgent colectomy (7·1 versus 4·4 per cent; P = 0·001). There was no significant difference between the two groups in anastomotic leakage (3·8 versus 2·6 per cent; P = 0·062). The proportion of patients needing a stoma was higher with urgent colectomy than primary treatment with stents (5·1 versus 1·7 per cent; P < 0·001). Postoperative stay was longer after urgent colectomy (15 versus 13 days; P < 0·001). Stenting followed by colectomy in patients with malignant right colonic obstruction may provide more favourable perioperative outcomes than urgent colectomy.

Proportion and risk factors of cholesterol crystal embolization after cardiovascular procedures: a retrospective national database study.

Cholesterol crystal embolization (CCE) is a rare, mainly iatrogenic condition. The proportion of CCE after cardiovascular procedures has not been fully elucidated. The purpose of this study was to determine the proportion of CCE diagnosed after cardiovascular procedures and to identify risk factors for CCE occurrence. Data on patients aged older than 40years who underwent cardiovascular procedures between July 2010 and March 2017 were extracted from the Japanese Diagnosis Procedure Combination database. Inpatients diagnosed with CCE within 1year after procedures in the same hospital were identified. Logistic regression analysis was performed to identify factors associated with the occurrence of CCE. There were 962 patients with CCE in 2,190,300 patients who underwent cardiovascular procedures. The overall proportion of CCE after cardiovascular procedures was 4.4 per 10,000 patients (95% confidence interval 4.1-4.7). The overall in-hospital mortality among patients with CCE was 11% (107/962). Older age, male sex, smoking, heart failure, peripheral vascular disease, cerebrovascular disease, renal insufficiency, diabetes mellitus, hypertension, and aortic aneurism and dissection were significantly associated with the higher occurrence of CCE. Compared with cardioangiography, several procedures were significantly associated with higher occurrence of CCE, including intra-aortic balloon pumping, percutaneous transluminal angioplasty of the renal artery, and transcatheter aortic valve implantation or balloon aortic valvuloplasty. CCE is rare but remains a severe complication of cardiovascular procedures. Atherosclerotic risk factors and certain cardiovascular procedures were associated with CCE.

Second primary malignancies in blastic plasmacytoid dendritic cell neoplasm: A national database study

Second primary malignancies in blastic plasmacytoid dendritic cell neoplasm: A national database study

25 Social Integration in the First 2 Years After Moderate to Severe Burn Injury: A Burn Model System National Database Study

Abstract Introduction Feeling a part of community and participating in social life are important aspects of overall quality of life. Burn survivors consider community reintegration one of the most important issues affecting their recovery. Integration, including social integration, has been studied in this population, but longitudinal analyses to examine factors associated with successful integration are lacking. The current study aims to assess variables associated with social integration during the first two years post-burn. Methods Adult (18+ years) burn survivors enrolled in the Burn Model System national longitudinal database responded to questionnaires at hospital discharge and 6-, 12-, and 24-months postburn. Social integration was assessed at all follow-up timepoints using the Community Integration Questionnaire Social Integration Component Scale, which has a possible range of scores from 0 (no community integration) to 12 (excellent community integration). To examine variables associated with social integration over time, linear mixed effect models utilizing generalized least squares with maximum likelihood and robust standard errors were used. Independent variables in the model included age, sex, % total body surface area (TBSA) burned, race/ethnicity, living status at time of injury, facial burn, history of psychiatric treatment preburn, employment at follow-up assessment, and SF-12 or VR-12 mental health component scores at the time of each follow-up assessment. Results Data from 1,848 adult burn survivors were included in the analyses. Average age of the survivors was 42.9 years, 74.0% were male, 77.7% were white, 47.0% were married or living common-law with a partner, and mean total body surface area burned was 18.2%. Factors associated with better social integration over time included younger age, female sex, lower TBSA (&amp;lt; 40%) burn size, white/non-Hispanic race, no preburn psychiatric treatment, postburn employment, and better mental health. Time was not a significant predictor, indicating that social integration scores remain relatively stable over the 24-month follow-up period. Conclusions We identified several factors that contribute to greater social integration including age, gender, burn size, race/ethnicity, employment, and mental health, with the association between age, gender, and employment status and community integration a novel finding in this population. Applicability of Research to Practice This study suggests that while most factors associated with social integration are not modifiable, interventions aimed at improving mental health and helping burn survivors return to work could also improve self-reported social integration.

81 Inhalation Injury Is Associated with Long-term Physical, Satisfaction with Life, and Employment Outcomes: A Longitudinal National Database Study

Abstract Introduction The effects of inhalation injury on mortality are well established. However, little is known about the long-term impacts of inhalation injuries on survivors. This study aims to describe the inhalation injury population and examine differences in long-term physical, mental, employment, and satisfaction with life outcomes between adult burn survivors with and without inhalation injury. Methods Data from the Burn Model System National Database (1993–2019) were analyzed. Demographic and clinical characteristics of those with and without inhalation injury were assessed. The Physical Health Composite Scale (PCS) and Mental Health Composite Scale (MCS) of the Short Form-12 Health Survey, Employment Status, and Satisfaction with Life Scale (SWLS) were analyzed at 24 months post-injury. Regression analyses assessed whether inhalation injury was associated with each outcome, which were adjusted for age, gender, race, ethnicity, and burn size. Results The analysis included 4,045 individuals (452 with inhalation injury, 3,593 without inhalation injury). Those with inhalation injury had larger burn size, longer hospital lengths of stay, and more operations; they were less likely to be employed at injury and injured at work, and took longer to gain employment after injury (Table 1). Two years after injury, individuals with inhalation injury were half as likely to be working (OR = 0.49, p&amp;lt; 0.001), and had worse PCS (β=-2.51, p=0.021) and SWL scores (β=-2.35, p=0.006) compared to those without inhalation injury. MCS scores did not differ between groups. Conclusions Burn survivors with inhalation injuries experience lower rates of employment, worse physical functioning, and worse satisfaction with life outcomes at 24 months post-injury compared to those without inhalation injuries. Applicability of Research to Practice Burn survivors with an inhalation injury may require supplementary resources and treatment as well as monitoring of sequelae long-term.

The effects of methylphenidate on stress fractures in patients' ages 10–29: a national database study

ABSTRACT Objectives: Current literature is divided on the effect of methylphenidate (MP) on stress fracture development and if this medication increases fracture, or is actually protective for it. This study further investigates this effect utilizing a large national database. We hypothesized that individuals on MP would have a reduced risk of SF compared against controls. Methods: This study utilized the Humana insurance data set within the PearlDiver Patient Records Database (PearlDiver Inc, Fort Wayne, Indiana). All patients’ ages 10–29 were included and patients were identified without ADHD, with ADHD not on MP, and with ADHD on MP. ADHD and stress fracture diagnoses were identified by International Classification of Disease, Tenth Revision codes. Bivariate analysis of stress fracture occurrence was conducted using chi-square analysis. Multivariate logistic regression was used to calculate odds ratios, controlling for age, sex, race, and Charlson Comorbidity Index (CCI). Statistical analysis was performed using the PearlDiver software, which runs R, Version 1.1.442. An α value of .05 was set as the level of significance. Results: The study included 29,590 patients on MP and 831,439 patients not on MP from ages 10–29. The highest proportions of patients who filled MP prescriptions were in the age range 10 to 14 years old (51.2%), followed by 15 to 19 (41.0%). Patients rarely continue MP from years 20 to 24 (16.5%) or 25 to 29 (9.6%). ADHD patients on MP had the lowest calculated risk of stress fractures (0.45%) compared to patients without ADHD (0.54%) and ADHD patients not on methylphenidate (0.58%). In all three patient groups, most stress fractures occurred in 15 to 19-year olds. Patients with ADHD on MP conferred lower odds of stress fracture than ADHD patients not on MP and patients without ADHD (aOR = 0.64, p = 0.0002). The older age groups 20–24 and 25–29 involved less risk of stress fracture compared to the youngest age group 10–14 (p < 0.0001; p < 0.0001), as well as did male gender (p < 0.0001). Conclusions: This database-based study of the effect of MP on SF adds to the growing body of literature providing evidence that MP may offer protective benefit for stress fracture.

Geographic Variation in Outcomes After Burn Injury: A Burn Model System National Database Study.

Geography is an important yet underexplored factor that may influence the care and outcomes of burn survivors. This study aims to examine the impact of geography on physical and psychosocial function after burn injury. Data from the Burn Model Systems National Database (1997-2015) were analyzed. Individuals 18 years and older who were alive at discharge were included. Physical and psychosocial functions were assessed at 6, 12, and 24 months postinjury using the following patient-reported outcome measures: Community Integration Questionnaire, Physical Composite Scale and Mental Composite Scale of the 12-Item Short Form Health Survey, Satisfaction with Appearance Scale, and Satisfaction with Life Scale. Descriptive statistics were generated for demographic and medical data, and mixed regression models were used to assess the impact of geography on long-term outcomes. The study included 469 burn survivors from the Centers for Medicare and Medicaid Services regions 10, 31 from region 8, 477 from region 6, 267 from region 3, and 41 from region 1. Participants differed significantly by region in terms of race/ethnicity, burn size, burn etiology, and acute care length of stay (P < 0.001). In adjusted mixed model regression analyses, scores of all 5 evaluated outcome measures were found to differ significantly by region (P < 0.05). Several long-term physical and psychosocial outcomes of burn survivors vary significantly by region. This variation is not completely explained by differences in population characteristics. Understanding these geographical differences may improve care for burn survivors and inform future policy and resource allocation.

Association of Gender with Survival in Melanoma In Situ of the Head and Neck: A National Database Study.

IntroductionWhile prior studies have addressed the gender-specific survival of malignant melanoma, such investigation is lacking for melanoma in situ (MIS) and for the sun-exposed head and neck areas. Understanding the role of patient characteristics on disease prognosis is essential in determining optimal patient treatment and follow-up. We conducted a retrospective cohort study of patients diagnosed with MIS of the head and neck to assess the association of gender with long-term survival.MethodsFirst primary cases of MIS diagnosed between 1998 and 2015 were extracted from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database. Cox regression analysis adjusting for demographic, tumor, and treatment characteristics was used to evaluate all-cause and cancer-specific mortality risks.ResultsAfter adjusting for demographic, tumor, and treatment data, males demonstrated significantly poorer overall survival (hazard ratio [HR] 1.484; 95% confidence interval [CI] 1.332, 1.653; P<0.001) and cancer-specific survival (HR 1.571; 95% CI 1.056, 2.338; P=0.026) compared to their female counterparts.ConclusionProposed reasons for these findings include gender-based hormonal influence on cancer growth and development, gender-specific health utilization behaviors, and gender-based cosmetic impact of cutaneous malignancies. These findings do have limitations, including its retrospective nature, possible upgrading of MIS diagnoses during the study period, miscoding, and inability to account of lifestyle/modifiable/environmental risk factors. Nevertheless, it suggests a gender-specific survival difference, which may be further investigated and considered as part of clinician awareness, influence patient counseling, and screening for such patients.

Hospital admission for complicated diverticulitis is increasing in Italy, especially in younger patients: a national database study

Epidemiological studies show an increasing trend of hospitalization for acute diverticulitis (AD), but data regarding the trend in hospitalization for complicated AD in Italy are scarce. The aim of this study was to analyze the Italian trend in hospitalization for complicated AD, from 2008 to 2015. Using the Italian Hospital Information System, we identified all patients with complicated colonic AD as a discharge diagnosis. Age- and sex-specific rates for AD as well as type of hospital admission (emergency/elective), type of complication (peritonitis, obstruction, bleeding, abscess, fistula, perforation, sepsis) and type of treatment (medical/surgical), were analyzed. A total of 41,622 patients with a discharge diagnosis of complicated AD were identified. Over the study period the admission rate grew from 8.8 to 11.8 per 100,000 inhabitants. The hospitalization rate was highest for patients ≥ 70years, but the increase in the admission rate was higher among patients aged ≤ 60years. There were more males in the group < 60years and more females in the group ≥ 60years old. The rate of emergency admissions associated with surgery showed a significant mean annual increase (+ 3.9% per year) in the rate of emergency admissions associated with surgery, whereas elective admissions for surgery remained stable. Peritonitis was the most frequent complication (35.5%). The rate of surgery increased in AD complicated by peritonitis (+ 5.1% per year), abscess (+ 5.8% per year) and decreased for obstruction (-1.8% per year). From 2008 to 2015, we documented an increasing rate of hospitalization for complicated AD, especially for younger patients, with an increase in surgery for peritonitis and abscess. Further studies are needed to clearly assess the risk factors for complications and risk of surgery.

National database study on the use of long-acting antipsychotic injections and hospital readmission proportions in patients with schizophrenia in Japan.

AimIt is important to investigate the current prescription status and clinical outcomes of patients with schizophrenia receiving long‐acting antipsychotic injections. We aimed to determine the prescription proportion of long‐acting antipsychotic injections and hospital readmission proportions of patients with schizophrenia in Japan.MethodsAn open dataset was created using data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan. Patient records with the term ‘schizophrenia’ were included. In Analysis 1, antipsychotic prescription proportions were determined for outpatients who had visited psychiatric facilities between 1 February 2015 and 31 March 2017. In Analysis 2, patients who had been discharged from a psychiatric facility and had received a long‐acting antipsychotic injection prescription within 90 days after initial discharge were selected; then, their readmission proportion was examined for 365 days after the initial discharge.ResultsThe long‐acting antipsychotic injection prescription proportion was 3.5% for outpatients with schizophrenia receiving antipsychotics. The readmission proportion was 41.0% in the entire patient population, 36.2% in patients receiving typical long‐acting antipsychotic injections alone, and 23.5% in patients receiving atypical long‐acting antipsychotic injections alone.ConclusionLong‐acting antipsychotic injections are not yet widely used in Japan. The readmission proportion was lower in the patients receiving atypical than typical long‐acting antipsychotics injections. The results may provide important basic information to develop new future research questions but should be interpreted with caution because generalizability may be limited by the use of aggregated data and the data structure of the database used.

Direct medical costs of diabetes and its complications in Vietnam: A national health insurance database study

AimTo estimate the direct medical cost of type 2 diabetes mellitus (T2DM) and its complications in Vietnam. MethodsUsing the public payer perspective, the direct medical cost was estimated using routine data in the national claims database in Vietnam in 2017. People were identified as being diagnosed with T2DM if they were aged ≥ 30 years and who either (1) had at least one ICD-10 code E11 or (2) had been prescribed with oral antihyperglycemic medication on two separate visit records. The Diabetes Severity Complications Index was used to assess the presence of diabetes-related complications. All costs were standardized to 2017 United States dollars (USD). ResultsOf the 1,395,204 people identified with T2DM, 55% had diabetes-related complications. The most common complication was cardiovascular diseases (34%). The total direct medical cost was USD 435 million, of which 24% was spent on hospitalization, 20% on outpatient care, 7% on emergency care, 36% on non-diabetes-related medication, and 13% on antihyperglycemic medication. About 70% of the total direct medical costs were attributed to diabetes-related complications. ConclusionThe high proportion of hospitalization and complications costs in Vietnam suggests that the possibility exists to make economic savings through better preventative care.

Disparities in Liver Cancer Screening Among People with Disabilities: A National Database Study in Korea

Background: Using the linked administrative database in Korea, we sought to investigate 1) whether there are disparities in liver cancer screening according to degree and type of disability and 2) temporal trends in liver cancer screening among people with disabilities. Methods: We linked national disability registration data with national cancer screening data. We analyzed age-standardized participation rates for each year during the 2006-2015 period according to presence, type, and severity of disability. We also examined factors associated with liver cancer screening by multivariate logistic regression using the most current data (2014-2015). Findings: The age- and sex-adjusted screening rate for liver cancer in people with disabilities increased from 25.7% in 2006 to 49.6% in 2015 (change: +23.9%); however, during the same period, screening rate among people without disabilities increased from 24.9 to 54.5% (change: +29.6%). As a result, disparities in liver cancer screening increased over time. The screening participation rate among people with disabilities was 12% lower than among people without disabilities (adjusted OR [aOR] 0.88, 95% confidence interval [CI], 0.87-0.89). Screening rates were markedly lower among people with severe disabilities (aOR 0.71, 95% CI 0.70-0.72) and people with renal disease (aOR 0.43, 95% CI 0.41-0.45), brain injuries (aOR 0.60, 95% CI 0.58-0.62), ostomy problems (aOR 0.60, 95% CI 0.53-0.68), and intellectual disabilities (aOR 0.69, 95% CI 0.66-0.73). Interpretation: Despite the availability of a national liver cancer screening program, a marked disparity was found in liver cancer screening participation, especially among people with severe disabilities, renal disease, or brain-related or mental disabilities. Funding Statement: This work was supported by the R&D grant (No. 2016007) on rehabilitation by Korea National Rehabilitation Center Research Institute, Ministry of Health & Welfare, and the National Research Foundation of Korea(NRF) grant funded by the Ministry of Education (No.2016R1D1A3B03931142) and by the Korea government(MSIT) (No. 2019R1H1A2080180, 2019R1A2C1087507) and by the Ministry of Science, ICT, & Future Planning (No. 2016R1A2B4011045). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: Our study was approved by the Institutional Review Board of Chungbuk National University (CBNU-201708-BM-501-01).

Breast cancer screening disparities between women with and without disabilities: A national database study in South Korea.

Health disparities among individuals with disabilities remain underrecognized. The objective of the current study was to investigate: 1) whether disparities exist in breast cancer screening rates among women with disabilities compared with women without disabilities; 2) whether breast cancer screening rates vary according to the type and severity of disabilities; and 3) trends in breast cancer screening disparities according to disability status over time. Using national administrative databases concerning disability status and national cancer screening programs in Korea, age-standardized participation rates were calculated according to the type and severity of disabilities. The age-standardized rate for breast cancer screening in individuals with disabilities increased from 30.2% in 2006 to 53.7% in 2015 (change of +23.5%), whereas that among those without a disability increased from 29.3% to 60.1% (change of +30.8%). In general, disability was associated with slightly lower breast cancer screening rates (adjusted odds ratio [aOR], 0.824; 95% CI, 0.820-0.828). However, screening rates were especially low in women with severe disabilities (aOR, 0.465; 95% CI, 0.461-0.469) and among women with autism (aOR, 0.235; 95% CI, 0.143-0.388), renal failure (aOR, 0.342; 95% CI, 0.337-0.348), brain injury (aOR, 0.349; 95% CI, 0.346-0.352), intellectual disabilities (aOR, 0.403; 95% CI, 0.397-0.410), mental disorders (aOR, 0.494; 95% CI, 0.488-0.501), or ostomies (aOR, 0.529; 95% CI, 0.512-0.546). Even without a cost barrier, significant disparities were found in breast cancer screening participation, especially in women with severe disabilities and brain-related and/or mental disabilities. Policy efforts, such as ensuring the accessibility of information and equipment, transportation support, and access to a usual source of care, should be made to decrease this disparity.

Mortality rate associated with carbon monoxide poisoning in Turkey: a national database study

Mortality rate associated with carbon monoxide poisoning in Turkey: a national database study

Impact of timing of chemotherapy for pancreatic cancer in the elderly: A national cancer database study

Presenter: Neha Lad MD | Miami Cancer Institute Background: Recent reports have confirmed that chemotherapy improves overall survival in patients with pancreatic cancer. The aim of this study is to specifically evaluate the effect of timing of chemotherapy on overall survival of elderly patients undergoing pancreatic surgery for pancreatic adenocarcinoma (PDAC). Methods: The NCDB was reviewed from 2004 to 2016. The effect of chemotherapy in elderly patients (≥75) was studied. Three major groups were analysed: adjuvant (ADJ), neoadjuvant (NEO) and neoadjuvant with adjuvant (BOTH). Chi-square test was used to find differences in patient characteristics between groups. Log rank test and multivariable Cox proportional regression models were used to find factors associated with survival. Results: A total of 380,524 patients were diagnosed with pancreatic adenocarcinoma during the study period. Of these, 130,039 were ≥75 years of age, which included 18,291 patients (7.1%) who underwent surgical treatment. Chemotherapy was provided as follows: 5,640 underwent adjuvant chemotherapy (ADJ), 888 neoadjuvant chemotherapy (NEO) and 345 received at least 2 cycles before, but also received chemotherapy after (BOTH). There was a significant difference in the proportion of patients with Stage I to IV between groups, with a majority being diagnosed at stage II patients in NEO (48%) and BOTH (53%) . Demographics and Charlson-Deyo comorbidity score were similar across the groups. The 3 year survival rate was 31.9% in BOTH (95% CI: 26.4 - 38.6), 24.7% in NEO (95% CI: 21.6 - 28.3) and 25.0% in ADJ (95% CI: 23.8-26.3). Univariate Cox regression shows a significantly improved survival in BOTH in comparison to ADJ (p=0.0081) and a trend in improvement in comparison to NEO (p=0.079). There was a non significant tendency to improved survival when comparing elderly patients that received only neoadjuvant vs those that received only adjuvant (p=0.23). On multivariate analysis comorbidities were identified as an independent factor negatively impacting survival. Chemotherapy given as BOTH was independently associated with improved survival (figure 1). Conclusion: Elderly surgical patients undergoing BOTH neoadjuvant and adjuvant chemotherapy had improved survival when compared to patients receiving chemotherapy only in an adjuvant setting. Therefore, BOTH should not be withheld in elderly patients just because of their age.