Native Hawaiian Pacific Islander Research Articles

Racial and Ethnic Composition of Departments of Health Policy, Management, Education, and Behavioral Sciences.

The diversity of racial/ethnic representation in the health services and policy research (HSPR) workforce plays a crucial role in addressing the health needs of underserved populations. We assessed changes (between 2012 and 2022) in the racial/ethnic composition of students and faculty from departments of Health Policy & Management (HPM) and Health Education & Behavioral Sciences (HEBS) among the Association of Schools and Programs of Public Health member institutions. We analyzed annual data from over 40 institutions that reported student and faculty data in 2012 and 2022 within each department. Racial/ethnic populations included American Indian/Alaska Native (AI/AN), Asian, Hispanic, Native Hawaiian/Pacific Islander (NH/PI), Black, White, Unknown, and Multiracial. We conducted analyses by department and examined racial/ethnic composition by student status, degree level, faculty rank, and tenure status. We found statistically significant increases in Black assistant professors (HPM and HEBS) and tenured faculty (HPM), Hispanic graduates and tenure-track faculty (HPM), Asian professors (HPM: full and tenured, HEBS: associate and tenured), and Multiracial students and graduates (HPM and HEBS). Statistically significant decreases were observed in White professors (HPM: assistant and full, HEBS: all ranks) and tenure-track faculty (HPM and HEBS), AI/AN associate professors and tenured faculty (HEBS), Hispanic associate professors (HPM), Asian assistant professors (HEBS), and NH/PI students (HPM and HEBS). Our findings highlight the importance of increasing racial/ethnic representation. Strategies to achieve this include facilitating workshops to raise awareness about the structural barriers encountered by Hispanic faculty, providing research support, evaluating promotion processes, establishing more pathway programs, and fostering interdisciplinary academic environments studying AI/AN or NH/PI populations.

Racial and ethnic differences in epithelial ovarian cancer risk: an analysis from the Ovarian Cancer Association Consortium.

Limited estimates exist on risk factors for epithelial ovarian cancer (EOC) in Asian, Hispanic, and Native Hawaiian/Pacific Islander (NHPI) women. Participants included 1734 Asian (785 cases, 949 controls), 266 NHPI (99 cases, 167 controls), 1149 Hispanic (505 cases, 644 controls), and 24,189 White (9,981 cases, 14,208 controls) women from 11 studies in the Ovarian Cancer Association Consortium. Logistic regression models estimated odds ratios (ORs) and 95% confidence intervals (CIs) for risk associations by race and ethnicity. Heterogeneity in EOC risk associations by race and ethnicity (p ≤ 0.02) was observed for oral contraceptive (OC) use, parity, tubal ligation and smoking. We observed inverse associations with EOC risk for OC use and parity across all groups; associations were strongest in NHPI and Asian women. The inverse association for tubal ligation with risk was most pronounced for NHPI participants (OR=0.25, 95% CI 0.13-0.48), versus Asian and White participants, respectively (OR=0.68, 95% CI 0.51-0.90; OR=0.78, 95% CI 0.73-0.85). Differences in EOC risk factor associations were observed across racial and ethnic groups, which could in part be due to varying prevalence of EOC histotypes. Inclusion of greater diversity in future studies is essential to inform prevention strategies.

Examining racial disparities in utilization rate and perioperative outcomes following knee and hip arthroplasty.

Previous arthroplasty utilization research predominantly examined Black and White populations within the US. This is the first known study to examine utilization and complications in poorly studied minority racial groups such as Asians and Native Hawaiian/Pacific-Islanders (NHPI) as compared to Whites. Data from 3304 primary total hip and knee arthroplasty patients (2011 to 2019) were retrospectively collected, involving 1789 Asians (52.2%), 1164 Whites (34%) and 320 Native Hawaiians/Pacific Islanders (NHPI) (9.3%). The 2012 arthroplasty utilization rates for Asian, White, and NHPI increased by 32.5%, 11.2%, and 86.5%, respectively, by 2019. Compared to Asians, Whites more often underwent hip arthroplasty compared to knee arthroplasty (odds ratio (OR) 1.755; p < 0.001). Compared to Asians, Whites and NHPI more often received total knee compared to unicompartmental knee arthroplasty (White: OR 1.499; NHPI: OR 2.013; p < 0.001). White patients had longer hospitalizations (2.66days) compared to Asians (2.19days) (p = 0.005) following bilateral procedures. Medicare was the most common insurance for Asians (66.2%) and Whites (54.2%) while private insurance was most common for NHPI (49.4%). Compared to Asians, economic status was higher for Whites (White OR 0.695; p < 0.001) but lower for NHPI (OR 1.456; p < 0.001). After controlling for bilateral procedures, NHPI had a lower risk of transfusion compared to Asians (OR 0.478; p < 0.001) and Whites had increased risk of wound or systemic complications compared to Asians (OR 2.086; p = 0.045). Despite NHPI demonstrating a significantly poorer health profile and lower socioeconomic status, contrary to previous literature involving minority racial groups, no significant overall differences in arthroplasty utilization rates or perioperative complications could be demonstrated amongst the racial groups examined.

Extended offset stems are infrequently required in anterior approach total hip arthroplasty and low usage does not compromise stability.

Extended offset (EO) stems are commonly used in posterior approach (PA) total hip arthroplasty (THA), but usage rates and complications are not well studied with anterior approach (AA) THA. This study evaluated usage rates, radiographic outcomes and complications following AA THA between patients receiving EO stems and a matched cohort receiving standard offset (SO) stems. This retrospective review evaluated 1515 consecutive AA THA performed between 2014 and 2021. The recent 100 EO were included in radiographic and complication analysis and were matched to 100 SO stems based on stem size, procedure (unilateral/bilateral), sex, body mass index (BMI), and age. Data collection included patient demographics; pre- and postoperative radiographic measurements of leg length difference (LLD) and global hip offset difference (GHOD); and complications within 1year. Independent t-tests and Chi-squared analyses compared EO and SO groups. EO was utilized in 8% of all AA THA. Despite matching procedures, the distribution of racial groups was different between EO and SO groups, respectively: Caucasian (75% vs. 43%), Asian (12% vs. 35%), Native Hawaiian/Pacific Islander (NHPI) (9% vs. 13%), and other (4% vs. 9%) (p < 0.001). No fractures, dislocations, or revisions occurred within 1year after surgery in either group. One deep infection was noted in the SO group. The proportions of patients following surgery who had a GHOD < 6mm (76% vs. 82%; p = 0.193) and LLD < 6mm (81% vs. 86%; p = 0.223) were not significantly different between EO and SO groups, respectively. Prioritizing hip symmetry over stability results in a high proportion of patients achieving hip symmetry without high usage of EO stems in AA THA. Furthermore, low use of EO stems did not result in increased dislocations. Due to racial anatomical differences, Caucasian patients required EO stems to achieve hip symmetry more frequently than Asian and NHPI patients.

Abstract 66: US Asian and Pacific Islander Adolescents With Obesity Have Triple the Risk of Prediabetes When Compared to Non Hispanic White Children

Introduction: Race and ethnicity and elevated body mass index (BMI) are risk factors for pre-diabetes (preDM) among adolescents. We recently observed high preDM prevalence among aggregated US Asian and Pacific Islander (API) children with obesity, but data pertaining to disaggregated API subgroups remain limited. Aim: To examine the risk of preDM among API subgroups compared to non-Hispanic White (NHW) adolescents with obesity. Methods: This retrospective study included 3233 API and 4150 NHW children age 13-17y with obesity and without DM who were identified at preventive health well-child visits in 2016-2019 and had hemoglobin A1c (HA1c) measured within 1 year of the visit. Visit data included self-reported diet/lifestyle behaviors and BMI measurement. PreDM (outcome) was defined by HA1c 5.7-6.4%. Obesity was categorized as Class 1-3 based on BMI percent of the 95th BMI percentile (obesity threshold). Four obesogenic behaviors were ascertained from clinic data: Fruit/vegetable consumption &lt;5 servings/day; juice/sugary beverage intake &gt;12 ounces/day; exercising &lt;60 minutes/day; and screen time 2+ hours/day. A neighborhood deprivation index (NDI) was calculated using area of residence and 2010 US Census data. Log binomial regression was used to examine the association of API ethnicity and preDM, reporting relative risk (RR) and 95% confidence intervals [CI]. Results: The cohort included 210 Chinese, 900 Filipino, 200 South Asian, 132 Southeast Asian, 283 Native Hawaiian/Pacific Islander (NHPI), 1508 other/unspecified API ethnicity, and 4150 NHW children. Overall, 22.4% of API vs 9.4% NHW (p&lt;0.001) children had preDM. PreDM prevalence ranged from 19.1% for Chinese, 21.7% for Filipino, 22.5% for South Asian, 24.2% for Southeast Asian, to 26.5% for NHPI subgroups. After adjusting for age, sex, NDI, obesity class, and obesogenic health behaviors, risk of preDM was about 3-fold higher (RR 2.9 [2.6-3.4] for API compared to NHW adolescents, ranging from RR 2.5 [1.8-3.6] for Chinese, RR 2.8 [2.3-3.4] for Filipino, RR 3.1 [2.2- 4.4] for South Asian, RR 3.2 [2.1-4.9] for Southeast Asian, RR 3.3 [2.5-4.4] for NHPI, and RR 3.0 [2.5-3.5] for other/unspecified API children. Obesity severity (RR 1.4 [1.2-1.6] for Class 2 and RR 2.1 [1.7-2.6] for Class 3 compared to Class 1 obesity) was also associated with preDM risk. Conclusion: PreDM risk was about 3-fold higher for API compared to NHW children with obesity even after adjusting for sociodemographic, lifestyle, and BMI differences. The risk of preDM ranged from 2.5-fold to 3.3-fold higher for the major API subgroups, especially Southeast Asian and Filipino groups compared to NHW children. These findings highlight the importance of preDM screening among API children and demonstrate heterogeneity of risk among API subgroups. Future efforts should focus on effective screening and monitoring of at-risk populations to prevent progression to Type 2 DM.

Racial and Ethnic Minorities Underrepresented in Pain Management Guidelines for Total Joint Arthroplasty: A Meta-analysis.

Total joint arthroplasty aims to improve quality of life and functional outcomes for all patients, primarily by reducing their pain. This goal requires clinical practice guidelines (CPGs) that equitably represent and enroll patients from all racial/ethnic groups. To our knowledge, there has been no formal evaluation of the racial/ethnic composition of the patient population in the studies that informed the leading CPGs on the topic of pain management after arthroplasty surgery. Using papers included in the 2021 Anesthesia and Analgesia in Total Joint Arthroplasty Clinical Practice Guidelines and comparing them with US National census data, we asked: (1) What is the representation of racial/ethnic groups in randomized controlled trials compared with their representation in the US national population? (2) Is there a relationship between the reporting of racial/ethnic groups and year of data collection/publication, location of study, funding source, or guideline section? Participant demographic data (study year published, study type, guideline section, year of data collection, study site, study funding, study size, gender, age, and race/ethnicity) were collected from articles cited by this guideline. Studies were included if they were full text, were primary research articles conducted primarily within the United States, and if they reported racial and ethnic characteristics of the participants. The exclusion criteria included duplicate articles, articles that included the same participant population (only the latest dated article was included), and the following article types: systematic reviews, nonsystematic reviews, terminology reports, professional guidelines, expert opinions, population-based studies, surgical trials, retrospective cohort observational studies, prospective cohort observational studies, cost-effectiveness studies, and meta-analyses. Eighty-two percent (223 of 271) of articles met inclusion criteria. Our original literature search yielded 27 papers reporting the race/ethnicity of participants, including 24 US-based studies and three studies conducted in other countries; only US-based studies were utilized as the focus of this study. We defined race/ethnicity reporting as the listing of participants' race or ethnicity in the body, tables, figures, or supplemental data of a study. National census information from 2000 to 2019 was then used to generate a representation quotient (RQ), which compared the representation of racial/ethnic groups within study populations to their respective demographic representation in the national population. An RQ value greater than 1 indicates an overrepresented group and an RQ value less than 1 indicates an underrepresented group, relative to the US population. Primary outcome measures of RQ value versus time of publication for each racial/ethnic group were evaluated with linear regression analysis, and race reporting and manuscript parameters were analyzed with chi-square analyses. Two US-based studies reported race and ethnicity independently. Among the 24 US-based studies reporting race/ethnicity, the overall RQ was 0.70 for Black participants, 0.09 for Hispanic participants, 0.1 for American Indian/Alaska Natives, 0 for Native Hawaiian/Pacific Islanders, 0.08 for Asian participants, and 1.37 for White participants, meaning White participants were overrepresented by 37%, Black participants were underrepresented by 30%, Hispanic participants were underrepresented by 91%, Asian participants were underrepresented by 92%, American Indian/Alaska Natives were 90% underrepresented, and Native Hawaiian Pacific Islanders were virtually not represented compared with the US national population. On chi-square analysis, there were differences between race/ethnicity reporting among studies with academic, industry, and dual-supported funding sources (χ2 = 7.449; p = 0.02). Differences were also found between race/ethnicity reporting among US-based and non-US-based studies (χ2 = 36.506; p < 0.001), with 93% (25 of 27) of US-based studies reporting race as opposed to only 7% (2 of 27) of non-US-based studies. Finally, there was no relationship between race/ethnicity reporting and the year of data collection or guideline section referenced. The 2021 Anesthesia and Analgesia in Total Joint Arthroplasty Clinical Practice Guidelines provide evidence-based recommendations that reflect the current standards in orthopaedic surgery, but the studies upon which they are based overwhelmingly underenroll and underreport racial/ethnic minorities relative to their proportions in the US population. As these factors impact analgesic administration, their continued neglect may perpetuate inequities in outcomes after TJA. Our study demonstrates that all non-White racial/ethnic groups were underrepresented relative to their proportion of the US population in the 2021 Anesthesia and Analgesia in Total Joint Arthroplasty Clinical Practice Guidelines, underscoring a weakness in the orthopaedic surgery evidence base and questioning the overall external validity and generalizability of these combined CPGs. An effort should be made to equitably enroll and report outcomes for all racial/ethnic groups in any updated CPGs.

Asian American and Native Hawaiian/Pacific Islander Substance Use and Disparities: Review of Current Evidence and Recommendations for the Field

Abstract Purpose of Review This study aimed to describe the current state of the science on Asian American (AA) and Native Hawaiian/Pacific Islander (NH/PI) substance use, covering extant research and treatment knowledge and gaps. Recent Findings Despite literature gaps, epidemiological studies revealed sizable population-level differences between AAs, who have among the lowest rates of US substance use, and NH/PIs, who have among the highest. Targeted studies identified key challenges affecting NH/PI communities and some AA subgroups, particularly for alcohol, cigarette, and e-cigarette use. Of major concern, both AAs and NH/PIs demonstrate significant treatment disparities. Summary There is a scarcity of substance use research and interventions specifically targeted for AAs and NH/PIs. Promisingly, a growing body of research is focused on developing/testing culturally targeted interventions for these populations, but more is needed. Recommendations for improving substance use data and intervention research with AAs and NH/PIs—including disaggregating both racial groups and their subgroups—are discussed.

Abstract A003: Decomposing racial and ethnic disparities in endometrial cancer survival

Abstract Background: Black-White mortality disparities are well-established and continue to widen over time among women diagnosed with endometrial cancer (EC). Yet, few studies have explored the existence or sources of racial/ethnic disparities in EC survival among Hispanic, American Indian/Alaska Native (AI/AN), Asian, and Native-Hawaiian/Pacific Islander (NH/PI) women. EC survival disparities across racial and ethnic groups have been suggested to be linked to differences in sociodemographic, clinical, and access to care characteristics. We examined how these individual- and area-level factors influence the presence of racial/ethnic disparities among women with EC. Methods: Participants were diagnosed between 2004 and 2019 with stages 1A through 4B endometroid and non-endometroid EC in the National Cancer Database (NCDB). Race was categorized as non-Hispanic white (NHW), non-Hispanic black (NHB), Hispanic, Asian, NH/PI, and AI/AN. We performed Oaxaca-Blinder decompositions of the log overall survival (OS) time assuming an accelerated failure time model with Weibull error, which decomposes observed differences in log survival time into parts potentially explained by differences in measured prognostic factors and differences not explained by measured variables. We examined the following classes of prognostic factors: age at diagnosis, zip code-level demographics (educational attainment, average income, and rurality), access to care (insurance status, facility type and location, treatment delay), Charlson comorbidity score, tumor characteristics (stage and histology), and guideline-concordant treatment (GCT). White women were the comparison group in all decompositions. Results: Compared with NHW women (N=121,069; estimated overall survival for average covariates values (eOS)=19.7 years) eOS was significantly shorter among NHB women (N=15,855; eOS=9.9 years); longer among Asian women (N=5,098; eOS=42.7 years); longer among Hispanic women (N=9,671; eOS=25.9 years); and not significantly different in NH/PI (N=536; eOS=24.8 years) or AI/AN women (N=551; eOS=17.0 years). Measured covariates explained 76.7% of the difference for NHB women (p&amp;lt;0.001); 19.7% for Asian women (p&amp;lt;0.001); and did not significantly explain the difference for Hispanic women (8.4%; p=0.14). Factors significantly contributing to the observed differences for NHB women were tumor characteristics (61.5%); access to care (6.6%); zip code-level demographics (5.1%); comorbidity (3.9%); age (-1.8%); and GCT (1.5%). Significant factors for Asian women were age (16.6%); tumor characteristics (-6.0%); zip code-level demographics (4.7%); access to care (3.0%); and comorbidity (1.6%). Significant factors for Hispanic women were age (45.2%); tumor characteristics (-17.9%); access to care (-13.4%); comorbidity (-2.0%); and GCT (-1.0%). Conclusions: Contributors to EC survival disparities vary by race/ethnicity and strongly implicate the need for research to identify how disparities arise to tailor interventions to reduce survival gaps. Citation Format: Jordyn A. Brown, Jennifer A. Sinnott, Ziyu Gao, Caitlin E. Meade, Macarius M. Donneyong, Tasleem J. Padamsee, Ashley S. Felix. Decomposing racial and ethnic disparities in endometrial cancer survival [abstract]. In: Proceedings of the AACR Special Conference on Endometrial Cancer: Transforming Care through Science; 2023 Nov 16-18; Boston, Massachusetts. Philadelphia (PA): AACR; Clin Cancer Res 2024;30(5_Suppl):Abstract nr A003.

Racial and Ethnic Disparities in Tuberculosis Incidence, Arkansas, USA, 2010-2021.

We conducted an epidemiologic assessment of disease distribution by race/ethnicity to identify subpopulation-specific drivers of tuberculosis (TB). We used detailed racial/ethnic categorizations for the 932 TB cases diagnosed in Arkansas, USA, during 2010-2021. After adjusting for age and sex, racial/ethnic disparities persisted; the Native Hawaiian/Pacific Islander (NHPI) group had the highest risk for TB (risk ratio173.6, 95% CI 140.6-214.2) compared with the non-Hispanic White group, followed by Asian, Hispanic, and non-Hispanic Black. Notable racial/ethnic disparities existed across all age groups; NHPI persons 0-14 years of age were at a particularly increased risk for TB (risk ratio888, 95% CI 403-1,962). The risks for sputum smear-positive pulmonary TB and extrapulmonary TB were both significantly higher for racial/ethnic minority groups. Our findings suggest that TB control in Arkansas can benefit from a targeted focus on subpopulations at increased risk for TB.

Abstract 13354: Higher Severe Maternal Morbidity Rates at Delivery Hospitalization Among Racial and Ethnic Groups Related to Chronic Hypertension and Hypertensive Disorders of Pregnancy

Severe maternal morbidity (SMM) affects 0.5-3% of pregnancies in the United States, with risk varying for racial and ethnic groups. Studies have rarely evaluated how chronic hypertension (cHTN) and hypertensive disorders of pregnancy (HDP) affect differences in SMM risk. This study sought to evaluate cHTN and HDP as contributors to racial disparities in SMM rates. Retrospective cohort study of 263,518 patients aged 18-46 years who received prenatal care ≤14 weeks' gestation and delivered a stillborn or live singleton birth ≥20 weeks’ gestation at a Kaiser Permanente Northern California hospital (2009-2019). We evaluated the relation of cHTN and HDP [preeclampsia (PE), gestational hypertension (GH) and superimposed preeclampsia (s_PE)] to SMM at delivery hospitalization, defined as the presence of at least 1 of 21 conditions meeting CDC criteria. Modified Poisson regression models estimated the adjusted relative risk (aRR) of SMM associated with cHTN and HDP among self-reported racial and ethnic groups [Asian, Black, Hispanic, Native Hawaiian Pacific Islander (NHPI), White] adjusted for covariables. There were 13,626 women (5.2%) with cHTN, in whom 4297 (31.5%) developed s_PE. For patients with no cHTN, 11,744 (4.7%) developed PE and 11,514 (4.6%) developed GH. The overall SMM rate (number of cases/10,000 births) was 219.7. SMM rates were higher for patients with cHTN vs no cHTN (417.6 vs. 208.9, p&lt;.0001), and for PE (934.3) and s_PE (898.3) vs no cHTN + no HDP (165.9), p&lt;0.001. SMM rates differed for racial and ethnic groups. Compared to White patients with No cHTN or HDP, aRRs of SMM associated with PE and s_PE increased in order for White, Asian, Hispanic, Black, and NHPI groups (Table 1). Preeclampsia was 6 times more prevalent among those with cHTN than no cHTN. Preeclampsia was strongly associated with higher SMM rates in both women with cHTN and without cHTN, especially among NHPI and Black groups. Preeclampsia may contribute substantially to racial disparities in SMM.

B - 43 Case Study: Native Hawaiian/Pacific Islander Female Veteran with Dementia with Lewy Bodies.

Recent research suggests there is a lack of consensus regarding current data on the racial/ethnic profiles of cognitively impaired persons with dementia with Lewy bodies (DLB) despite DLB being among the most common neurodegenerative dementias. This case study reviews a Native Hawaiian/Pacific Islander (NHPI) with probable DLB and discusses challenges encountered to emphasize the importance of appropriate normative data to help detect DLB in diverse populations. A 78-year-old NHPI female veteran presented for repeat neuropsychological evaluation to track her cognitive symptoms. Chief complaints included concurrent cognitive and motor difficulties, fully formed visual hallucinations, nighttime confusion, and reduplicative paramnesias which have significantly impacted her instrumental activities of daily living. Neuropsychological testing is suggestive of progressive decline in several cognitive domains, including visuospatial ability, executive functioning, semantic fluency, and verbal and visual learning and memory. Consistent with a DLB diagnosis, her cognitive symptoms emerged concurrently with motor symptom onset. There is also evidence of significant visuospatial and executive difficulties, as well as previously reported reduplicative paramnesia, confusion, and weekly fully-formed hallucinations. Additionally, there is evidence of concurrent parkinsonism's such as bradykinesia, rigidity, hypophonia, and tremor. The constellation of symptoms reported by the patient, combined with the results of neuropsychological assessment, was highly congruent with prototypical DLB; however, lack of proper normative data to accurately assess for decline in her scores led to significant caution in interpretation of her neuropsychological performance. This case demonstrates the importance of proper normative data in diverse populations and the role of neuropsychological evaluations in specific cultural contexts.

Finding the Potholes in Academic Career Pathways for Underrepresented Groups in Otolaryngology.

To assess inequities in representation among ranks and odds of promotion by race in academic otolaryngology. Cross-sectional study. USacademic medical centers. Demographic data was collected for medical students, residents, and faculty in the Association of American Medical Colleges and Accreditation Council for Graduate Medical Education databases for the academic year 2020 to 2021. The rank equity index (REI) was used to make pairwise comparisons between ranks to determine groups' representation between levels. Odds ratios (ORs) and 95% confidence intervals (CIs) demonstrating the likelihood that an individual of a particular rank/race would advance in their academic career were determined. Representation comparing medical students with full professors for black, Latine, and Asian otolaryngologists was below parity (REI: 0.27, 0.85, 0.85, respectively). Black (OR: 0.20, CI: 0.15, 0.26), Latine (OR: 0.61, CI: 0.50, 0.75), and Asian (OR: 0.62, CI: 0.55, 0.71) medical students all faced lower odds of becoming otolaryngology residents compared to their white counterparts. Similar findings occurred when comparing resident and assistant professor representation. American Indian/Alaskan Native (AIAN) and Native Hawaiian/Pacific Islander (NHPI) REIs and ORs could not be assessed as only 1 self-reported AIAN and no NHPI faculty are present in the studied data. Underrepresented in Medicine and Asian physicians faced worsening representation at each rung of the academic otolaryngology ladder. The greatest losses occurred when medical students transitioned to residents and residents transitioned to assistant professors. AIAN and NH faculty were absent in otolaryngology, indicating vital targets for recruitment efforts.

Risk Factors and Survival Impact Associated With Documentation of Radiation Therapy Refusal in Patients With Gynecologic Cancer

Radiation therapy (RT) refusal is known to have deleterious effects on survival for multiple cancer types. Factors associated with RT refusal by patients with gynecologic malignancies have not been well described. This study aimed to examine factors associated with and the survival impact of documented RT refusal among patients with gynecologic cancers. This study analyzed data from the National Cancer Database (NCDB) of patients with gynecologic cancers diagnosed between 2004 and 2020. Patients were included if they had complete survival data and a documented RT recommendation by their treating physician in the NCDB. Patients coded as received RT were compared with those coded as refused RT in the NCDB using a multivariate log binomial regression with robust variance to yield incidence rate ratios (IRR). Overall survival was analyzed using a multivariate (MV) Cox proportional hazards model to yield hazard ratios. This study identified 209,976 patients. A total of 5.75% (n=12,081) patients were coded as refusing RT. Multivariable IRR showed that documentation of RT refusal was positively associated with older age (MV IRR, 1.04; 95% CI, 1.041-1.045), Native Hawaiian Pacific Islander race (1.72 [1.27-2.32]), and increased morbidity (score=1: 1.06 [1.02-1.11]; score=2: 1.20 [1.12-1.29]; score ≥3: 1.26 [1.14-1.38]). Negative associations were seen with Hispanic ethnicity (0.74 [0.67-0.80]), having insurance (0.58 [0.53-0.63]), and annual income >$74,063 (0.85 [0.81-0.90]). During the 16-year period, a statistically significant test for trend (P=.001) for increasing RT refusal was noted. RT refusal was associated with a significantly higher risk of death (MV hazard ratio, 1.59 [1.55-1.63]). For patients with gynecologic malignancies diagnosed from 2004 to 2020, an increase in documented RT refusal is associated with decreased overall survival in all disease types. Targeted interventions aimed at mitigating potential sociodemographic barriers to receipt of RT are warranted.

Assessing the validity of race and ethnicity coding in administrative Medicare data for reporting outcomes among Medicare advantage beneficiaries from 2015 to 2017.

To assess the validity of race/ethnicity coding in Medicare data and whether misclassification errors lead to biased outcome reporting by race/ethnicity among Medicare Advantage beneficiaries. In this national study of Medicare Advantage beneficiaries, we analyzed individual-level data from the Health Outcomes Survey (HOS) and the Consumer Assessment of Healthcare Providers and Systems (CAHPS), race/ethnicity codes from the Medicare Master Beneficiary Summary File (MBSF), and outcomes from the Medicare Provider Analysis and Review (MedPAR) files from 2015 to 2017. We used self-reported beneficiary race/ethnicity to validate the Medicare Enrollment Database (EDB) and Research Triangle Institute (RTI) race/ethnicity codes. We measured the sensitivity, specificity, and positive and negative predictive values of the Medicare EDB and RTI codes compared to self-report. For outcomes, we compared annualized hospital admission, 30-day, and 90-day readmission rates. Data for Medicare Advantage beneficiaries who completed either the HOS or CAHPS survey were linked to MBSF and MedPAR files. Validity was assessed for both self-reported multiracial and single-race beneficiaries. For beneficiaries enrolled in Medicare Advantage, the EDB and RTI race/ethnicity codes have high validity for identifying non-Hispanic White or Black beneficiaries, but lower sensitivity for beneficiaries self-reported Hispanic any race (EDB: 28.3%, RTI: 85.9%) or non-Hispanic Asian American or Native Hawaiian Pacific Islander (EDB: 56.1%, RTI: 72.1%). Only 8.7% of beneficiaries self-reported non-Hispanic American Indian Alaska Native are correctly identified by either Medicare code, resulting in underreported annualized hospitalization rates (EDB: 31.5%, RTI: 31.6% vs. self-report: 34.6%). We find variation in 30-day readmission rates for Hispanic beneficiaries across race categories, which is not measured by Medicare race/ethnicity coding. Current Medicare race/ethnicity codes misclassify and bias outcomes for non-Hispanic AIAN beneficiaries, who are more likely to select multiple racial identities. Revisions to race/ethnicity categories are needed to better represent multiracial/ethnic identities among Medicare Advantage beneficiaries.

0930 What explains high self-reports of poor sleep quality in Native Hawaiian/Pacific Islanders?

Abstract Introduction High rates of poor sleep quality have been reported among patients of Native Hawaiian/Pacific Islander (NHPI) race. Unrestful sleep might be attributable to short sleep times or to elevated rates of obstructive sleep apnea among NHPIs. We aimed to evaluate factors associated with self-reported poor sleep quality among NHPIs in a nationwide, representative community sample. Methods Using the 2014 National Health Interview Survey (NHIS), we used logistic regression to model the odds of individuals reporting that they did not awake feeling rested at least two out of the prior seven days. NHPIs from the NHPI-NHIS and non-NHPIs from the general sample were compared. Age, sex, BMI, smoking status, report of heavy drinking, employment status, marital status, and reported average hours of sleep time were evaluated in terms of their effects on self-reported sleep quality. Results Data from 36,697 non-NHPI and 2,590 NHPI individuals was available for analysis. There were significant differences in age, BMI, marital and current employment status between NHPIs vs. non-NHPIs. NHPI patients reported less sleep (mean 6.86±1.41 hours) in contrast to non-NHPIs (mean 7.12±1.42 hours) (P&amp;lt; 0.001). NHPIs were more likely to report two or more days awakening not feeling rested (Odds Ratio (OR) 1.22, 95% confidence interval (95CI) 1.12–1.32) as compared to non-NHPIs. After adjusting for demographics, BMI, alcohol, smoking, and marital and employment status, the relationship persisted (OR 1.17, 95CI 1.07-1.28). When additionally controlling for sleep time, which was strongly associated with the likelihood of awakening unrested (OR 3.1 95CI 2.9-3.2 for six or fewer average hours of sleep), there was no significant relationship between race and likelihood of awakening unrested (OR 1.02, 95CI 0.93-1.13). Findings were similar when evaluating different thresholds of unrestful nights per week. Conclusion NHPIs are more likely to awake feeling unrested than non-NHPIs. The higher rate of unrestful sleep is associated with higher reports of short (6 hours or less) sleep time. Therefore, future research to improve sleep quality in NHPIs should also investigate the cultural and social factors leading to short sleep time. Support (if any) BWL: NIH Ruth L. Kirschstein National Research Service Award 5T32HL105321 and the ATS ASPIRE Fellowship

Different Experiences in Chronic Migraine Etiology, Treatment and Comorbidities of Hawaii’s Ethnic Groups (P14-12.006)

<h3>Objective:</h3> To determine racial disparities in CM treatment and comorbidities of patients in Hawaii, a state characterized by its a majority-minority patient population. We hypothesize that minority populations are under-treated. <h3>Background:</h3> Chronic migraine (CM) is a debilitating condition with negative repercussions on the socioeconomic status of patients; compounded by under-diagnosis and treatment in minority populations. Identifying treatment and comorbidity characteristics of CM patients in Hawaii will guide treatment of migraines. <h3>Design/Methods:</h3> We performed a retrospective chart review on patients diagnosed with CM at a headache and facial pain center in Honolulu, Hawaii. 743 patients with a clinic visit from January 27, 2022 to April 27, 2022 were retrieved from <i>eClinicalWorks</i>. Patients without sufficient data were excluded, yielding 298 patients fulfilling inclusion criteria of a) ICD-10 code diagnosis of CM b) lack of secondary migraine etiology and c) fulfilling IHCD-3 standards of CM. Socioeconomic demographic variables were collected including self-reported race, age, obesity, number of medications and public/private health insurance. Patient treatment modalities were recorded: botulinum toxin (BoNT), pharmacologic treatment, monoclonal antibodies, and physical therapy. <h3>Results:</h3> Native Hawaiian/Pacific Islander (NHPI) patients reported the highest prevalence of obesity (60.9%) at &gt;30% compared to other race groups (p&lt;0.001). History of diabetes was low across all race groups (7.7%). However, NHPI patients had a higher history of diabetes (14.5%) (p= 0.004), hypertension (37.7%), &gt;13% higher than other race groups (p= 0.01). Significantly more white patients received BoNT as therapy (73.9%), &gt;25% compared to other race groups (p= 0.02). Public insurance was significantly more common in NHPI patients (59.4%) followed by other minorities (57.1%), with a 9–11% difference compared to other race groups. (p=0.02) <h3>Conclusions:</h3> Our findings suggest barriers to BoNT treatment in minority patients. Comorbidities in NHPI patients, such as obesity, diabetes and hypertension, differ from other ethnic groups. <b>Disclosure:</b> Miss Lu has nothing to disclose. Ms. Yamane has nothing to disclose. Mr. Keahi has nothing to disclose. Mr. Tong has nothing to disclose. Mr. Goo has nothing to disclose. The institution of an immediate family member of Ms. Prabhudesai has received research support from National Eye Institute. An immediate family member of Ms. Prabhudesai has received intellectual property interests from a discovery or technology relating to health care. The institution of Dr. Chen has received research support from NIH. Dr. Vajjala has nothing to disclose. Enrique Carrazana has received personal compensation for serving as an employee of Neurelis. Enrique Carrazana has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Neurelis, Alexza, Zogenix. Enrique Carrazana has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Hawaii-Biotech, CND Life Sciences. Enrique Carrazana has stock in Neurelis, Marinus, . Dr. Viereck has nothing to disclose. The institution of Dr. Liow has received research support from UCB. The institution of Dr. Liow has received research support from Livanova. The institution of Dr. Liow has received research support from Biogen. The institution of Dr. Liow has received research support from Novartis. The institution of Dr. Liow has received research support from Eisai. The institution of Dr. Liow has received research support from Engage Therapeutics. The institution of Dr. Liow has received research support from SK Lifescience. The institution of Dr. Liow has received research support from Cerevel. The institution of Dr. Liow has received research support from Xenon. The institution of Dr. Liow has received research support from NeuroDerm. The institution of Dr. Liow has received research support from Avanir. The institution of Dr. Liow has received research support from Annovis. The institution of Dr. Liow has received research support from Acadia.

77 METHODS FOR IDENTIFYING FILIPINO GENDER MINORITIES AND MENTAL HEALTH RISKS IN ELECTRONIC HEALTH RECORDS

OBJECTIVES/GOALS: Aim 1: To explore methodologies to identify gender minorities, and Filipinos, separately, in an electronic health record system. Aim 2: To characterize the similarities and differences in demographic, socioeconomic, and mental health of Filipinos gender minorities compared to Native Hawaiian Pacific Islanders, and White/ European Americans. METHODS/STUDY POPULATION: This study was approved by the University of Hawaii Institutional Review Board. Cross-sectional retrospective data were obtained from a collaborative community clinic’s electronic health record system. Patients were age 18 and older with a clinical diagnosis for gender dysphoria and from Native Hawaiian Pacific Islander, White/ European American, and Filipino backgrounds. RESULTS/ANTICIPATED RESULTS: Preliminary data revealed that 11% of the clinical population were diagnosed with gender dysphoria (N=373) with 57.6% (n=215) who met the inclusion criteria with complete health registration forms. Patients were from Filipino (21.8%), Native Hawaiian Pacific Islander (23.3%), White/ European American (31.6%), and multiethnic (23.3%) backgrounds. Most patients reported mental health (e.g., depression) conditions (50.6%-64.7%). Further statistical analyses will reveal if Filipinos have higher or lower levels of anxiety, depression, and suicide risks than Native Hawaiian Pacific Islander, and White/ European American gender minority individuals. DISCUSSION/SIGNIFICANCE: In Hawaii, one person dies by suicide every two days; suicide is the lead cause of fatal injuries. Study findings can inform future methodology studies to identify gender minorities and develop culturally relevant gender affirming mental health programs for gender minorities.

The Mental Health, Substance Use, Physical Health, and Mental Health Treatment Need of Community Individuals Experiencing Homelessness in Hawai'i.

Limited research has examined the mental health of individuals experiencing homelessness in Hawai'i, which bears the nation's second highest homelessness rate. Mental health, substance use, treatment need, and health data were collected from 162 unhoused individuals in Hawai'i County by visiting community locations where they congregate (e.g., beaches, vacant buildings). 77% of participants were Native Hawaiian/Pacific Islander (NH/PI) with participants demonstrating severe rates of mental and substance use disorders including 57% experiencing major depressive disorder (MDD), 56% experiencing generalized anxiety disorder (GAD), and 64%, 74%, and 12% experiencing alcohol, methamphetamine, and opioid use disorders, respectively-heightening overdose risk. Treatment need was high (62%) but health was poor (85% reporting fair/poor health), with MDD and GAD predicting reduced general health (p < 0.05). Study findings indicate Hawai'i unhoused individuals are disproportionately Indigenous NH/PI, enduring striking mental and physical health disparities that may be reduced by increasing access/utilization of community mental health programs/services.

Building an Equitable Future Through Data Disaggregation.

Building an Equitable Future Through Data Disaggregation.

Abstract Number ‐ 27: VARIANCE: Variability of Assessed BP Readings In Acute Neuro‐intervention Cases and its Effect on outcomes

Introduction Blood pressure variability (BPV) following endovascular thrombectomy (EVT) in acute ischemic strokes is associated with poor functional outcomes both in the short and long term. Patient variables which may predict high BPV must be examined to improve outcomes. The purpose of this study is to analyze the affect of BPV on outcomes in patients with good recanalization with EVT and examine potential predictors of BPV. Methods We conducted a retrospective analysis of prospectively collected data from an IRB approved Stroke Registry of two academic Comprehensive Stroke Centers in Southern California between 2017 and 2022. Patients were included if they had 1) anterior circulation ischemic stroke due to large vessel occlusions (LVO) and 2) successful EVT with TICI 2b‐3. All BPs were recorded as immediate pre‐op SBP and DBP (one minute prior to procedure start time), immediate post‐op SBP and DBP (at time of recanalization), and 24 hours post revascularization. Variables examined include age, sex, Hispanic ethnicity, initial NIHSS, history of HTN, current antihypertensive use, symptom onset to groin puncture time, door to groin puncture time, and symptomatic ICH (sICH). Outcome was assessed via hospital discharge disposition and modified Rankin Scale at 90 days. Good short‐term outcome was disposition to home or rehab. Good long‐term outcome was mRS of 0–2. BPV was defined by the average real variability (ARV) calculated as the absolute value of the average of the differences between consecutive BP measurements divided by the number of measurements. A correlation matrix was used to identify both continuous and categorical variables with a significant correlation with ARV (p≤0.10). A stepwise logistic regression model for good versus poor outcome was created by including all significant variable from the correlation matrix. A significance level of p≤0.05 was included for all non‐correlational analysis. Results We identified 253 patients (mean age 70±14 years, 51.4% female). 49% were white, 6.3% asian, 5.5% black, 1.6% native Hawaiian pacific islander, and 37.5% are unspecified. 30.4% were Hispanic. The median NIHSS was 17±8. Mean BMI was 27±8. Mean symptom onset to groin puncture time was 478±326 mins. Mean door to groin puncture time was 86±110 mins. 34.8% of patients received tPA (100% of those eligible as our population included patients in the extended window who qualified per DAWN/DEFUSE‐3). 57.2% had cardioembolic etiology. 4.7% had sICH. 58.9% of patients had a good discharge disposition. ARVAB as defined as the average SBP variability as an absolute value was 30.6±25.6. ARVAB was associated with sex, home antihypertensive use, and immediate pre‐op and post‐op SBPs. ARVAB was not associated with age, initial NIHSS, Hispanic ethnicity, HTN, rate of sICH, or short or long term outcome. Conclusions There was a significant correlation with female sex and home use of antihypertensives and higher BPV. These variables can potentially be used as predictors of BPV. BPV was not correlated with discharge disposition or 90 day mRS in our population. While our study did not show a positive correlation between BPV and outcome, our ARVAB was lower than prior populations likely due to more accurate BP monitoring and control.