nH Black Patients Research Articles

Socio-demographic determinants of myelofibrosis outcomes in an underserved center and the SEER national database

The influence of demographic characteristics and social determinants on cancer outcomes is widely recognized in various malignancies but remains understudied in myelofibrosis (MF). This study aims to investigate social and demographic variables associated with MF survival. We retrospectively reviewed data of biopsy-proven MF patients from the Surveillance, Epidemiology and End Results (SEER) database (2000–2021) and Montefiore Medical Center (2000–2023), an underserved inner-city hospital. The SEER cohort included 5,403 MF patients and was predominantly Non-Hispanic (NH) White (82%) with a median age of 69 years. The age-adjusted incidence rate of MF was 0.32 cases per 100,000 person-years, increasing annually by 1.3% from 2000 to 2021. Two- and five- year overall survival rates were 69% and 42%, respectively. Worse cause-specific survival was associated with older age, male sex, and diagnosis before 2011 (year of Ruxolitinib approval). NH-Black ethnicity, unmarried status and lower median income were independent predictors of worse overall survival. The single-center analysis included 84 cases, with a median age of 66 years. NH-White patients comprised 37% of the sample, followed by NH-Black (28.5%). Two- and five- year overall survival rates were 90% and 61%, respectively, with NH-Black patients exhibiting the lowest median survival, although the difference was not statistically significant. Age was a significant predictor of worse survival in this cohort. NH-Black and Hispanic patients lived in areas with higher socioeconomic and demographic stress compared to NH-White patients. Overall, this study highlights the association of social and demographic factors with MF survival and emphasizes the need for equitable healthcare and further exploration of social-demographic factors affecting MF survival.

A joinpoint analysis examining trends in firearm injuries at six us trauma centers from 2016 to 2022

BackgroundThere is an epidemic of firearm injuries in the United States since the mid-2000s. Thus, we sought to examine whether hospitalization from firearm injuries have increased over time, and to examine temporal changes in patient demographics, firearm injury intent, and injury severity.MethodsThis was a multicenter, retrospective, observational cohort study of patients hospitalized with a traumatic injury to six US level I trauma centers between 1/1/2016 and 6/30/2022. ICD-10-CM cause codes were used to identify and describe firearm injuries. Temporal trends were compared for demographics (age, sex, race, insured status), intent (assault, unintentional, self-harm, legal intervention, and undetermined), and severity (death, ICU admission, severe injury (injury severity score ≥ 16), receipt of blood transfusion, mechanical ventilation, and hospital and ICU LOS (days). Temporal trends were examined over 13 six-month intervals (H1, January–June; H2, July–December) using joinpoint regression and reported as semi-annual percent change (SPC); significance was p < 0.05.ResultsFirearm injuries accounted for 2.6% (1908 of 72,474) of trauma hospitalizations. The rate of firearm injuries initially declined from 2016-H1 to 2018-H2 (SPC = − 4.0%, p = 0.002), followed by increased rates from 2018-H2 to 2020-H1 (SPC = 9.0%, p = 0.005), before stabilizing from 2020-H1 to 2022-H1 (0.5%, p = 0.73). NH black patients had the greatest hospitalization rate from firearm injuries (14.0%) and were the only group to demonstrate a temporal increase (SPC = 6.3%, p < 0.001). The proportion of uninsured patients increased (SPC = 2.3%, p = 0.02) but there were no temporal changes by age or sex. ICU admission rates declined (SPC = − 2.2%, p < 0.001), but ICU LOS increased (SPC = 2.8%, p = 0.04). There were no significant changes over time in rates of death (SPC = 0.3%), severe injury (SPC = 1.6%), blood transfusion (SPC = 0.6%), and mechanical ventilation (SPC = 0.6%). When examined by intent, self-harm injuries declined over time (SPC = − 4.1%, p < 0.001), assaults declined through 2019-H2 (SPC = − 5.6%, p = 0.01) before increasing through 2022-H1 (SPC = 6.5%, p = 0.01), while undetermined injuries increased through 2019-H1 (SPC = 24.1%, p = 0.01) then stabilized (SPC = − 4.5%, p = 0.39); there were no temporal changes in unintentional injuries or legal intervention.ConclusionsHospitalizations from firearm injuries are increasing following a period of declines, driven by increases among NH Black patients. Trauma systems need to consider these changing trends to best address the needs of the injured population.

Lipoprotein(a) Levels in Disaggregated Racial and Ethnic Subgroups Across Atherosclerotic Cardiovascular Disease Risk Levels

BackgroundLipoprotein(a) [Lp(a)] is a causal risk factor for atherosclerotic cardiovascular disease (ASCVD). ObjectivesThe authors assessed differences in Lp(a) testing and levels by disaggregated race, ethnicity, and ASCVD risk. MethodsThis was a retrospective cohort study of patients from a large California health care system from 2010 to 2021. Eligible individuals were ≥18 years old, with ≥2 primary care visits, and complete race and ethnicity data who underwent Lp(a) testing. Race and ethnicity were self-reported and categorized as follows: non-Hispanic (NH) White, NH-Black, Hispanic (Mexican, Puerto Rican, other), NH-Asian (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, other). Logistic regression models tested associations between elevated Lp(a) (≥50 mg/dL) and race, ethnicity, and ASCVD risk. Results13,689 (0.9%) individuals underwent Lp(a) testing with a mean age of 54.6 ± 13.8 years, 49% female, 28.8% NH Asian. Over one-third of those tested had Lp(a) levels ≥50 mg/dL, ranging from 30.7% of Mexican patients to 62.6% of NH-Black patients. The ASCVD risk of those tested varied by race: 73.6% of Asian Indian individuals had <5% 10-year risk, whereas 27.2% of NH-Black had established ASCVD. Lp(a) prevalence ≥50 mg/dL increased across the ASCVD risk spectrum. After adjustment, Hispanic (OR: 0.76 [95% CI: 0.66-0.88]) and Asian (OR: 0.88 [95% CI: 0.81-0.96]) had lower odds of Lp(a) ≥50 mg/dL, whereas Black individuals had higher odds (OR: 2.46 [95% CI: 1.97-3.07]). ConclusionsLp(a) testing is performed infrequently. Of those tested, Lp(a) levels were frequently elevated and differed significantly across disaggregated race and ethnicity groups. The prevalence of elevated Lp(a) increased with increasing ASCVD risk, with significant variation by race and ethnicity.

Differences in real-world outcomes by risk classification for localized prostate cancer patients after radiation therapy.

Limited real-world evidence exists on the long-term clinical outcomes of patients with localized prostate cancer (LPC) who received external beam radiation therapy (EBRT) as the initial treatment. This study evaluated clinical outcomes of US patients with high-risk LPC (HR-LPC) and low/intermediate-risk LPC (LIR-LPC) who received EBRT. This retrospective study using Surveillance, Epidemiology, and End Results-Medicare linked data from 2012 to 2019 included patients ≥ 65 years old who received EBRT as initial therapy. Baseline patient characteristics were summarized, metastasis-free survival (MFS), overall survival, and time to initiation of advanced prostate cancer treatment were compared using Kaplan-Meier (KM) and adjusted Cox proportional hazard (PH) models. 5-year survival probabilities stratified by race/ethnicity (non-Hispanic [NH] White, NH Black, NH Asian, and Hispanic) were assessed. Of 11,313 eligible patients, 41% (n = 4600) had HR-LPC and 59% (n = 6713) had LIR-LPC. Patient characteristics for both groups were comparable, with mean age at EBRT initiation > 70 years, 86% white, and mean follow-up time >40 months. More patients in the HR-LPC than LIR-LPC groups (78% vs 34%) had concurrent androgen deprivation therapy use and for a longer duration (median 10.4 months vs. 7.4 months). A higher proportion of HR-LPC patients developed metastasis, died, or received advanced prostate cancer treatment. Adjusted Cox PH survival analyses showed significantly (p < 0.0001) higher risk of mortality (hazard ratios[HR], 1.57 [1.38, 2.34]), metastasis or death (HR, 1.97 [1.78, 2.17]), and advanced prostate cancer therapy use (HR, 2.57 [2.11, 3.14]) for HR-LPC than LIR-LPC patients. Within 5 years after the initial EBRT treatment, 18%-26% of patients with HR-LPC are expected to have died or developed metastasis. The 5-year MFS rate in the HR-LPC group was lower than the LIR-LPC group across all racial/ethnic subgroups. NH Black patients with HR-LPC had the highest all-cause mortality rate and lowest rate of receiving advanced prostate cancer treatment, compared to other racial/ethnic subgroups. This real-world study of clinical outcomes in patients with LPC treated with EBRT suggests substantial disease burden in patients with HR-LPC and highlights the need for additional treatment strategies to improve clinical outcomes in patients with HR-LPC.

Abstract 4812: Evaluating racial and ethnic differences in advanced-stage laryngeal cancer treatment and outcomes in Florida: Unmasking the inequities

Abstract Purpose: To evaluate the association between race/ethnicity, treatment, and mortality among individuals with advanced-stage laryngeal cancer in Florida. Methods: We obtained data from the Florida Cancer Data System (FCDS) on non-Hispanic (NH)-White (the reference group), Hispanic, and NH-Black patients with advanced-stage (regional and distant) laryngeal cancer from 2009 to 2020. Sociodemographic factors were obtained from FCDS (age, marital status, and insurance) and the United States Census at the county level (education, household income, and rurality). Treatment strategies included chemoradiation, surgery followed by chemoradiation, chemotherapy, radiation, surgery, and surgery followed by chemotherapy. The primary outcome was overall mortality. Multivariable Cox proportional hazard models were used to calculate hazard ratios (HR) and 95% confidence intervals (95% CI) and to examine the association of race/ethnicity with treatment and survival, while adjusting for sociodemographic factors. Results: There were 4,522 participants with advanced-stage laryngeal cancer (57.9% &amp;lt;65 years, 79.5% male, 75.4% NH-White, 13.1% Hispanic, and 11.5% NH-Black) included in the analysis. Compared to NH-White patients, NH-Black patients were less likely to be married, have private insurance, and live in an urban county. Moreover, NH-Black individuals were less likely to receive chemoradiation alone and were more likely to receive surgery followed by chemoradiation. Government insurance was highly associated with chemoradiation receipt. In age-adjusted models, NH-Black patients with advanced-stage laryngeal cancer had a higher risk of death compared to NH-White patients (HR: 1.19; 95% CI: 1.06, 1.32), while Hispanic patients had a lower risk of death compared to NH-White patients (HR: 0.80; 95% CI: 0.71, 0.89). After adjusting for sociodemographic factors, there was no statistically significant difference in overall mortality in NH-Black patients compared to NH-White patients (HR: 1.07; 95% CI: 0.96, 1.20). However, among individuals who received chemoradiation, NH-Black patients had a higher risk of mortality, even after adjusting for sociodemographic factors, compared to NH-White patients (HR: 1.27; 95% CI: 1.04, 1.55). Conclusions: Among patients with advanced-stage laryngeal cancer in Florida, NH-Black patients experienced a higher risk of overall mortality compared to other racial and ethnic groups, but this discrepancy was primarily among those who received chemoradiation, even after accounting for sociodemographic factors. This study emphasizes the urgency of expanding laryngeal cancer care access for NH-Black individuals and investigating possible biological variations in their response to chemoradiation and subsequent survival outcomes. Citation Format: Caretia J. Washington, Chayil Lattimore, Dejana Braithwaite, Kristianna Fredenburg, Shama Karanth. Evaluating racial and ethnic differences in advanced-stage laryngeal cancer treatment and outcomes in Florida: Unmasking the inequities [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4812.

Racial differences in body composition and survival among older adults with gastrointestinal malignancies

IntroductionMuscle and adipose tissue measures can be quantified from routinely obtained computed tomography (CT) images and are predictors of chemotherapy-related toxicities and survival among patients with gastrointestinal (GI) malignancies. Most studies to date have consisted of predominantly White patients, and the role of body composition among minoritized racial groups is unknown. We examined racial differences in body composition and survival among patients with GI malignancies. Materials and MethodsThis was a prospective cohort study of patients with GI malignancies. Single slices of axial CT images from L3 segments were analyzed using Slice-O-Matic software. The skeletal muscle area (cm2) was divided by height to obtain the skeletal muscle index (SMI, cm2/m2). Skeletal muscle radiodensity (SMD) in Hounsfield units (HU) was used for muscle composition. We compared body composition parameters between non-Hispanic (NH)-White and NH-Black participants. Cox models were used to examine the impact of body composition on survival. We proposed new race-specific cutoffs for body composition using optimal stratification. ResultsFive hundred forty patients were included, of which 24% were NH-Black. In Cox models stratified by race, each 5 cm2/m2 decrease in SMI was associated with increase in risk of all-cause mortality in NH-Black patients (hazard ratio [HR] 1.25; 95% confidence interval [CI] 1.04–1.49 p = 0.02). With the existing cut points, neither sarcopenia nor myosteatosis was associated with worse survival. Using a new cutoff for sarcopenia in NH-Black patients, NH-Black patients with sarcopenia (HR 2.31 95%CI 1.10–4.88 p = 0.03) and myosteatosis (HR 2.63 95% CI 1.25–5.53 p = 0.01) had worse survival. DiscussionNH-Black older patients with GI cancers and sarcopenia or myosteatosis have worse overall survival.

Racial Disparities and Other Socioeconomic Predictors of Mortality in Acute Pulmonary Embolism Treatment from the National Inpatient Sample

PurposeTo explore the significance of socioeconomic factors such as race and ethnicity as predictors of mortality in submassive and massive acute pulmonary embolism (PE). Materials and MethodsHospitalizations of patients aged >18 years with acute, nonseptic PE from 2016 to 2019 were identified from the National Inpatient Sample and divided into interventional radiology (IR) (catheter-directed thrombolysis and thrombectomy) and non-IR (tissue plasminogen activator) treatments. Statistical analyses calculated significant odds ratios (ORs) via 95% confidence intervals (CIs). The primary outcome of interest was mortality rate. Comorbidities affecting mortality were examined secondarily. ResultsNon-Hispanic (NH) Black, Hispanic, and Asian/Pacific Islander patients were significantly less likely to undergo an IR procedure for acute, nonseptic PE compared with White patients (NH Black, OR, 0.83 [95% CI, 0.76–0.90], P < .05; Hispanic, 0.78 [0.68–0.89], P = .06; Asian/Pacific Islander, 0.71 [0.51–0.98], P = .72); however, these differences were eliminated when propensity score matching was performed for age, biological sex, and primary insurance type or for primary insurance type alone. NH Black patients were significantly more likely to die than White patients, regardless of undergoing non-IR or IR treatment. Overall risk of death was 41% higher for NH Black patients than for White patients (relative risk, 1.41 [95% CI, 1.24–1.60]; P < .001). ConclusionsNH Black patients have a higher risk of mortality from acute, nonseptic PE than White patients. Independent of race, undergoing IR management for acute, nonseptic PEs was associated with a lower mortality rate. Matching for primary insurance type eliminates differences in mortality between races, suggesting that socioeconomic status may determine outcomes in acute PE.

Recent racial/ethnic disparities in cancer-specific mortality among patients diagnosed with rectal cancer.

African American patients frequently receive nonstandard treatment and demonstrate poorer overall survival (OS) outcomes compared to White patients. Our objective was to analysis whether racial/ethnic disparities in rectal cancer-specific mortality remain after accounting for clinical characteristics, treatment, and access-to-care-related factors. Individuals diagnosed with rectal cancer between 2011 and 2020 were identified using the Surveillance, Epidemiology, and End Results Database. The cumulative incidence of rectal cancer-specific mortality was computed. Sub-distribution hazard ratios (sdHRs) and 95% confidence intervals (CIs) for rectal cancer-specific mortality associated with race/ethnicity were estimated using Fine and Gray model with stepwise adjustments for clinical characteristics, treatment modalities, and factors related to access-to-care. Among 54,370 patients, non-Hispanic (NH) Black individuals exhibited the highest cumulative incidence of rectal cancer-specific mortality (39%), followed by American Indian/Alaska Native (AI/AN) (35%), Hispanics (32%), NH-White (31%), and Asian/Pacific Islander (API) (30%). After adjusting for clinical characteristics, NH-Black patients had a 28% increased risk of rectal cancer mortality (sdHR, 1.28; 95% CI: 1.20-1.35) compared to NH-White patients. In contrast, mortality disparities between Hispanic-White, AI/AN-White, and API-White groups were not significant. The Black-White mortality differences persisted even after adjustments for treatment and access-to-care-related factors. In stratified analyses, among patients with a median household income below $59,999, AI/AN patients showed higher mortality than NH-Whites when adjusted for clinical characteristics (sdHR, 1.32; 95% CI: 1.03-1.70). Overall, the racial/ethnic disparities in rectal cancer-specific mortality were largely attributable to differences in clinical characteristics, treatment modalities, and factors related to access-to-care. These findings emphasize the critical need for equitable healthcare to effectively address and reduce the significant racial/ethnic disparities in rectal cancer outcomes.

Abstract B108: Racial disparities in survival among oral cavity and pharynx cancer patients treated with immunotherapy: Insights from the US National Cancer Database (NCDB)

Abstract Purpose: Survival rates for oral cavity and oropharynx cancers vary by race, with Non-Hispanic(NH)-Black patients experiencing relatively lower survival rates compared to NH-White patients. While the potential for improving survival with immunotherapy has been demonstrated in clinical trials, it remains unclear whether racial disparities persist in patients treated with this novel approach. We aimed to evaluate the association between race and all-cause mortality among oral and pharynx cancer patients who received immunotherapy. Methods: This study utilized the National Cancer Database (NCDB) to investigate racial disparities in survival after immunotherapy among patients diagnosed with oral cavity and pharynx cancers between 2013 and 2017. Multivariable Cox proportional hazards models were employed to calculate hazard ratios (HR) and 95% confidence intervals (95% CI) by race/ethnicity. Results: The study cohort included 7,714 patients, consisting of 7,011 NH-White patients and 703 NH-Black patients. During the follow-up period, mortality occurred in 45.5% of NH-White patients and 59.5% of NH-Black patients. After adjusting for sociodemographic, clinical, and treatment factors, NH-Black patients had a higher risk of death compared to NH-White patients (HR: 1.24; 95% CI: 1.11, 1.38). Additionally, the study found no significant differences in the interaction between race and Charlson-Deyo comorbidity score or race and area-level median income. Conclusion: This study suggests that urgent action is needed to address these disparities to improve outcomes for NH-Black patients with oral cavity and pharynx cancers. Citation Format: Danting Yang, Shama Karanth. Racial disparities in survival among oral cavity and pharynx cancer patients treated with immunotherapy: Insights from the US National Cancer Database (NCDB) [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B108.

Abstract B137: Examining racial disparities in the association between food swamps, liquor store density, and colorectal cancer mortality among Georgia cancer patients

Abstract Introduction: Colorectal cancer (CRC) is the third-most common cancer in the United States (U.S.) and racial/ethnic disparities regarding CRC death continue to persist. Increased healthy food consumption and decreased processed food consumption are key factors in reducing CRC mortality. However, living in geographical areas with no access to healthy food options and more pro-inflammatory foods (i.e. food swamps) decreases healthy food access. The influx of liquor stores, or businesses that advertise and sell unhealthy food products including processed foods and alcohol, may contribute to elevated CRC death. We investigated whether liquor store density modified the association between residing in food swamps with risk of CRC death among a multiethnic sample of cancer patients in Georgia. Methods: We conducted a retrospective cohort analysis utilizing 2012, 2014, 2015, 2017, and 2020 data from the U.S. Department of Agriculture Food Environment Atlas along, U.S. Census County Health Patterns data, and linked them via county FIPS codes with patient data years 2010 – 2020 from the Surveillance, Epidemiology, and End Results (SEER) Program. Food swamp score (FS) was calculated as the ratio of fast-food and convenience stores to grocery stores and farmer’s markets. Liquor store density was calculated as the proportion of beer, wine, and liquor stores to Georgia county populations per 100,000. We categorized FS and liquor store density to low or high; higher scores indicated patients living in counties with poorer healthy food resources. Multilevel Cox proportional hazard models were used to estimate the association between FS, liquor store density and CRC death. Results: Among 56,861 SEER patients in Georgia, majority of CRC death was in high liquor store density counties. NH-Black and Other patients at both levels of FS counties had an increased risk of CRC death (low: adjusted hazard ratio (aHR) = 1.21, 95% CI = 1.16 – 1.26; high: aHR = 1.06, 95% CI = 1.01 – 1.12) when compared to NH-white patients-low-FS counties. In sub-analyses by liquor store density, NH-Black and Other patients-low-FS counties had an increased risk of CRC death among high (aHR = 1.24, 95% CI = 1.19 – 1.31) and low (aHR = 1.12, 95% CI = 1.03 – 1.21) liquor store density counties. Conclusions: NH-Black patients living in the worst food environments, including effect modification by liquor store density, had increased risk of CRC death. We strongly recommend local and state representatives and community stakeholders create and implement sustainable approaches at combating CRC in underserved racial communities by increasing access to healthier food sources (e.g. building more community gardens, fixing barriers to walkability). Citation Format: Malcolm S. Bevel, April Parham, Aashka Sheth, Meng-Han Tsai, Sydney E. Andrzejak, Samantha R. Jones, Justin X. Moore. Examining racial disparities in the association between food swamps, liquor store density, and colorectal cancer mortality among Georgia cancer patients [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B137.

Assessing Epidemiological Differences in Myelofibrosis: A Comparative Study of a Single-Center Cohort and the SEER National Database

Background Myelofibrosis (MF) is a rare class of BCR-ABL negative myeloproliferative neoplasms characterized by clonal proliferation of hematopoietic stem cells and progressive fibrosis of the bone marrow. This study attempts to elucidate epidemiological discrepancies in survival outcomes between MF patients at a single tertiary care center from an underserved population in the Bronx (which ranks last in health outcomes amongst 62 New York state counties) versus the Survival, Epidemiology, and End Results (SEER) national cancer registry by analyzing different population parameters. Methods Our retrospectively constructed single center database included 96 patients with biopsy confirmed primary or secondary MF who were age ≥20 diagnosed after 2000. 75 remained for analysis after excluding subjects without known race or date of diagnosis. The SEER [SEER research plus data, 17 registries, Nov 2022 Sub (2000-2020)] dataset comprised of 5254 patients with microscopically confirmed primary MF (ICD code: 9661.3) diagnosed between 2000 and 2015, had age of diagnosis ≥20, and whose deaths were attributable to MF diagnosis. Both cohorts were independently analyzed via log-rank testing and/or cox proportional hazards (cox-PH) regression with death as event outcome. Results Mean age of our single-center cohort was 65.87 years. Males [37 (49.3%)] and females [38 (50.7%)] were approximately evenly distributed. Races included non-hispanic white (NHW) [26 (34.7%)], NH black (NHB) [20 (26.7%)], NH asian and pacific islanders (NH-API) [6 (8.0%)], and hispanics of all races [23 (30.7%)]. Primary [40 (53.3%)] and secondary [35 (46.7%)] MF were approximately even. Log rank testing detected significance in race (p=.05) but not sex (p=.2) or type (p=.7). Significant univariate cox-PH findings include increased mortality within the NHB group [hazard ratio (HR) 2.69, p=.04] and increased mortality with age (HR 1.07, p=.005) (Table 1). Low event size precluded multivariate analysis. In the SEER cohort, age was grouped into 4 categories: ≤44 years old [214 (4.1%)], 45-64 [1,590 (30.3%)], 65-84 [3,051 (58.1%)], and ≥85 [399 (7.6%)]. There were more females [3,159 (60.1%)] than males [2,095 (39.9%)]. NHW [3,995 (76.0%)] comprised the overwhelming majority of races reported, followed by NHB [441 (8.4%)], hispanic [420 (8.0%)], and NH-API [398 (7.6%)]. Median household income (MHI) data (inflation adjusted to 2021) was divided into &amp;lt;$70,000 and ≥$70,000 (table 2). Univariate cox-PH noted improved survival in NH-APIs (HR .75, p&amp;lt;.001) and MHI ≥$70K (HR .92, p=.05). However this significance disappeared upon adjustment for age and race. In multivariate cox-PH, age demonstrated significance for each category (45-64 HR 2.20; 65-84 HR 4.45; ≥85 HR 6.59, p &amp;lt; .001). Female patients had better survival compared to males (HR .73, p&amp;lt;.001) (Table 2). Conclusion In this comparison study of MF cohorts from an underserved tertiary center and SEER, we found differences in demographic features and their impact on disease mortality. NHW patients constitute the overwhelming majority of subjects in the SEER dataset while the tertiary cohort has nearly equal distribution of NHW, NHB, and hispanic patients. NHB patients from the single-center cohort tended to do worse while SEER showed no differential survival based on race. Possible explanations for this include differences in racial distribution, healthcare accessibility, and other socioeconomic factors. Median income in the Bronx is 36% lower than the national average and the poverty rate is 2.3x higher. Unexpectedly, no significant association was found between MHI and survival in SEER when adjusted for age and race. Also notable is that improved survival in NH-APIs per SEER data disappeared upon adjustment for age, which may suggest that the NH-API group tends to be younger at diagnosis given that age serves as a negative prognostic marker. Further research is warranted. Regarding sex, SEER data suggests that female patients have a decreased mortality risk compared to males which is consistent with literature. Caution in interpretation is necessary given the low tertiary center sample size and the inherent limitations of the SEER dataset.

Disparities Among Adolescent and Young Adult Patients with Acute Lymphoblastic Leukemia

Introduction: Acute lymphoblastic leukemia (ALL) in the pediatric population has a 5-year overall survival that exceeds 90%, however, the survival rate drops significantly in the adolescent and young adult (AYA) population. Notably, the AYA contribute to 80% of ALL mortality despite representing less than one-fourth of total ALL cases. The challenges related to caring for adolescents and young adults with malignancies have become increasingly well recognized and the impacts of racial, socioeconomic, and psychosocial disparities as potential contributors to AYA ALL survival rates are only recently being characterized. Methods: We conducted a retrospective cohort study using the Nationwide Inpatient Sample (NIS), the largest all-payer database of hospital admissions in the United States, from January 1, 2011 through December 31, 2020. The study sample consisted of AYA patients 15-39 years of age, as defined by the National Cancer Institute. ALL-related hospitalizations were captured using ICD-9 and 10 codes indicative of ALL. We performed temporal trends analysis to assess inpatient death among ALL hospitalizations by race/ethnicity using joinpoint regression. We used adjusted survey logistic regression analyses to assess associations between race/ethnicity and in-hospital mortality among ALL hospitalizations. Results: Our data captured 138,923 ALL-related hospital encounters of AYA patients from 2011 to 2020. In our cohort, 73.1% of ALL hospitalizations were in patients younger than 30, and 26.9% were in patients between the ages of 30 and 39. AYA NH-Black patients with ALL had twice the odds of inpatient mortality as compared to NH-White patients [odds ratio (OR), 95% confidence interval: 1.75 (1.34-2.29)] (Table 1). While the rate of inpatient mortality improved in the overall AYA population over our 10-year study period, strikingly, the rate of inpatient mortality instead increased in NH-Black patients (Figure 1). In contrast, NH-White patients saw the lowest rate of inpatient mortality, both at the start and at the end of our study period (Figure 1). Although the inpatient mortality rate in Hispanic patients improved over time, these patients remained at an increased likelihood of inpatient mortality compared to their NH-White counterparts [OR 1.32 (1.08-1.61)] (Table 1). Conclusion: Survival gains in the AYA population have improved only modestly compared to that of their pediatric and adult counterparts, and here we report that these survival gains are even further stratified and disparate depending on patient race/ethnicity with worse outcomes in NH-Black patients. It is important to better understand the disparities that impact the AYA population, which is particularly vulnerable to social factors impacting their care. Study limitations include lack of data pertaining to treatment received, including pediatric versus adult treatment protocol or bone marrow transplant status. Disparate access to centers of excellence, stem cell transplant and blinatumomab may certainly be contributors to the disparate outcomes described herein.

Healthcare access dimensions and uterine cancer survival: a national cancer database study.

Disparities exist throughout diagnosis, treatment, and survival for Black patients with uterine cancer. There is limited data on how several healthcare access (HCA) dimensions contribute to these disparities in patients with advanced stage uterine cancer. Using the National Cancer Database (NCDB), we identified patients aged 40-89 years with Stage III-IV uterine cancer between 2004-2015 who received chemotherapy and/or radiotherapy. Race/ethnicity were classified as non-Hispanic (NH)-Black, Hispanic, and NH-White. Variables defined in the NCDB were used to assess HCA affordability, availability, and accessibility. Kaplan-Meier estimates, log-rank test, and multivariable Cox proportional hazards models were used to analyze overall survival. Of 43,134 patients, 78.8% of the cohort identified as NH-White, 15.3% NH-Black, and 5.9% Hispanic. NH-Black patients were the most likely to have type II (75.6% vs. 53.9% and 55.4%) and stage IV (40.8% vs. 30.7% and 32.3%) disease compared to NH-White and Hispanic patients. NH-Black patients were more likely than NH-White and Hispanic patients to have government funded insurance (58.6% vs. 50.3% and 50.4%), live in low-income areas (46.4% vs. 14.2% and 29.9%), and receive only chemotherapy (53.5% vs. 43.1% and 46.2%). Having private insurance and receiving treatment at an academic facility were positive predictors of survival. NH-Black patients had worse survival than NH-White patients after adjusting for clinical characteristics and healthcare access dimensions (HR 1.29; 95% CI 1.24, 1.34). While HCA affordability and availability predicted survival in patients with advanced stage uterine cancer, additional factors contribute to racial disparities. Compared to NH-White patients, NH-Black patients had more aggressive disease, received only chemotherapy rather than combined therapy, and had worse survival regardless of cancer subtype. Additional dimensions of healthcare access must be explored to remedy uterine cancer disparities.

Racial Disparities in Plasma Cell Leukemia Outcomes Among Hospitalized Patients in the United States.

Plasma cell leukemia (PCL) is a rare, aggressive subtype of multiple myeloma (MM) with a poor prognosis. Prior studies have shown that racial disparities affect MM patients in various ways, which may affect patients' outcomes. In this study, we aimed to investigate racial differences in hospitalization outcomes for PCL using Nationwide Inpatient Sample data. Overall, hospitalization rates for PCL tended to decrease over the past decade. Among hospitalized patients with a primary diagnosis of PCL, there was no statistically significant association between race/ethnicity and hospitalization rates, between NH-White patients and NH-Black patients (OR 1.94; 95%CI 0.3-3.54, p 0.95), and Hispanic patients (OR 0.47; 95% CI 0.05-4.23, p 0.5). Additionally, there was no significant association between race/ethnicity and inpatient mortality. The overall lower incidence of PCL, more significant disease burden, and poor prognosis across all groups may contribute to our findings. With increasing evidence that PCL is cytogenetically distinct from MM, more investigation into biological and sociodemographic factors that affect healthcare utilization and treatment outcomes should be carried out.

Healthcare access dimensions and uterine cancer survival: A National Cancer Database study.

5594 Background: Racial disparities persist throughout the continuum of care for Black patients with uterine cancer. Few studies have evaluated how multiple dimensions of healthcare access (HCA) contribute to these disparities in patients who present at an advanced stage and meet criteria for adjuvant therapy. Methods: Patients with Stage III-IV uterine cancer between 2004-2015 who received adjuvant therapy with complete sociodemographic and other relevant covariate data were identified in the National Cancer Database (NCDB). Race and ethnicity were defined as non-Hispanic (NH)-Black, Hispanic, and NH-White. Healthcare access dimensions of affordability, availability and accessibility were measured using variables defined in the NCDB. Overall survival was analyzed using Kaplan-Meier curves, log-rank test, and multivariable Cox proportional hazard models. Results: The study cohort included 43,134 patients: 78.8% NH-White, 15.3% NH-Black, and 5.9% Hispanic. Compared to NH-White and Hispanic patients, NH-Black patients were more likely to have Type II (75.6% vs. 53.9% and 55.4%) and Stage IV disease (40.8% vs. 30.7% and 32.3%). NH-Black patients were more likely to receive chemotherapy alone (53.5% vs. 43.1% and 46.2%) compared to NH-White and Hispanic patients. NH-Black patients were the most likely to have government funded insurance (58.6% vs. 50.3% and 50.4%) and live in the lowest income quartile (46.4% vs. 14.2% and 29.9%) compared to NH-White and Hispanic patients. NH-Black patients had a significantly higher risk of death than NH-White patients when adjusting for demographic/clinical characteristics and all three healthcare access dimensions (HR 1.29; 95% CI 1.24, 1.34). Conclusions: Healthcare access affordability predicts survival but does not fully explain racial disparities in survival rates of patients with advanced stage uterine cancer. NH-Black patients are more likely to have aggressive disease, receive chemotherapy alone, and have worse survival than NH-White patients regardless of pathogenic subtype. Investigating additional healthcare access dimensions may be critical to addressing disparities in uterine cancer.

Socioeconomic disparities in immunotherapy use among advanced-stage non-small cell lung cancer patients: analysis of the National Cancer Database

Socioeconomic and racial disparities exist in access to care among patients with non-small cell lung cancer (NSCLC) in the United States. Immunotherapy is a widely established treatment modality for patients with advanced-stage NSCLC (aNSCLC). We examined associations of area-level socioeconomic status with receipt of immunotherapy for aNSCLC patients by race/ethnicity and cancer facility type (academic and non-academic). We used the National Cancer Database (2015–2016), and included patients aged 40–89 years who were diagnosed with stage III-IV NSCLC. Area-level income was defined as the median household income in the patient’s zip code, and area-level education was defined as the proportion of adults aged ≥ 25 years in the patient’s zip code without a high school degree. We calculated adjusted odds ratios (aOR) with 95% confidence intervals (95% CI) using multi-level multivariable logistic regression. Among 100,298 aNSCLC patients, lower area-level education and income were associated with lower odds of immunotherapy treatment (education: aOR 0.71; 95% CI 0.65, 0.76 and income: aOR 0.71; 95% CI 0.66, 0.77). These associations persisted for NH-White patients. However, among NH-Black patients, we only observed an association with lower education (aOR 0.74; 95% CI 0.57, 0.97). Across all cancer facility types, lower education and income were associated with lower immunotherapy receipt among NH-White patients. However, among NH-Black patients, this association only persisted with education for patients treated at non-academic facilities (aOR 0.70; 95% CI 0.49, 0.99). In conclusion, aNSCLC patients residing in areas of lower educational and economic wealth were less likely to receive immunotherapy.

Selected Articles from This Issue

Highlights| April 03 2023 Selected Articles from This Issue Author & Article Information Online ISSN: 1538-7755 Print ISSN: 1055-9965 ©2023 American Association for Cancer Research2023American Association for Cancer Research Cancer Epidemiol Biomarkers Prev (2023) 32 (4): 463. https://doi.org/10.1158/1055-9965.EPI-32-4-HI Related Content A commentary has been published: Risk of Renal or Urinary Related Hospitalization in Survivors of Childhood Cancer: Results from the French Childhood Cancer Survivor Study A commentary has been published: Serum Lipid Profiles and Cholesterol-Lowering Medication Use in Relation to Subsequent Risk of Colorectal Cancer in the UK Biobank Cohort A commentary has been published: The Intersectionality between Race, Ethnicity, and Residential-Level Socioeconomic Status in Disparities of Head and Neck Cancer Outcomes: A SEER Study View more A commentary has been published: Methylation Signature Implicated in Immuno-Suppressive Activities in Tubo-Ovarian High-Grade Serous Carcinoma View less Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Article Versions Icon Versions Version of Record April 3 2023 Citation Selected Articles from This Issue. Cancer Epidemiol Biomarkers Prev 1 April 2023; 32 (4): 463. https://doi.org/10.1158/1055-9965.EPI-32-4-HI Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest Search Advanced Search Head and Neck cancer mortality differs by race/ethnicity and socioeconomic status (SES). In this study of 76,095 patients, Karanth and colleagues examined the joint association of race/ethnicity and census-tract-level SES with relative survival rates, all-cause and cause-specific mortality. The five-year survival rates differed by race/ethnicity and SES, with non-Hispanic (NH)-Black patients having the lowest. Compared to NH-White patients, NH-Black patients had a higher risk of all-cause and cause-specific mortality, regardless of the SES group. NH-Asian/Pacific Islander and Hispanic patients had higher risk of cause-specific mortality in some SES groups. More research is needed to understand the causes of persistent disparities in head and neck cancer mortalities Most previous epidemiologic studies evaluating the associations of blood lipids with colorectal cancer risk did not consider the use of cholesterol-lowering medications at the time of lipid measurements, which could bias findings. Leveraging data from the UK Biobank, Yuan and colleagues showed that high... You do not currently have access to this content.

Racial Disparities in Opioid Administration Practices Among Undifferentiated Abdominal Pain Patients in the Emergency Department.

The purpose of this study was to examine racial disparities in opioid prescribing practices for patients presenting to the emergency department (ED) with a common chief complaint of abdominal pain. Treatment outcomes were compared for non-Hispanic White (NH White), non-Hispanic Black (NH Black), and Hispanic patients seen over 12months in three emergency departments in the Minneapolis/St. Paul metropolitan area. Multivariable logistic regression models were used to estimate odds ratios (OR) with 95% confidence intervals (CI) to measure the associations between race/ethnicity and outcomes of opioid administration during ED visits and discharge opioid prescriptions. A total of 7309 encounters were included in the analysis. NH Black (n = 1988) and Hispanic patients (n = 602) were more likely than NH White patients (n = 4179) to be in the 18-39 age group (p < 0. 001). NH Black patients were more likely to report public insurance than NH White or Hispanic patients (p < 0.001). After adjusting for confounders, patients who identified as NH Black (OR: 0.64, 95% CI: 0.56-0.74) or Hispanic (OR: 0.78, 95% CI: 0.61-0.98) were less likely to be given opioids during their ED encounter when compared to NH White patients. Similarly, NH Black patients (OR: 0.62, 95% CI: 0.52-0.75) and Hispanic patients (OR: 0.66, 95% CI: 0.49-0.88) were less likely to receive a discharge opioid prescription. These results confirm that racial disparities exist in the ED opioid administration within the department as well as at discharge. Future studies should continue to examine systemic racism as well as interventions to alleviate these health inequities.

The Intersectionality between Race, Ethnicity, and Residential-Level Socioeconomic Status in Disparities of Head and Neck Cancer Outcomes: A SEER Study.

Head and neck cancer (HNC) mortality differs by race, ethnicity, and socioeconomic status (SES). However, it is unclear whether the relationship between race/ethnicity and HNC-specific mortality varies according to the residence-level SES. Data from the Surveillance Epidemiology and End Results database included participants with primary HNC between 2006 and 2017 (followed through 2018) to assess the joint association of race/ethnicity and census-tract level SES Yost-index groups (quintiles) with all-cause and HNC-specific mortalities. Relative survival rates at 1, 5, and 10 years were calculated. Multivariable Cox proportional hazard regression models estimated hazard-ratios and 95% confidence intervals for all-cause mortality, and Fine-Gray subdistribution hazard models for HNC-specific mortality. Cumulative incidence curves for HNC-specific deaths were estimated. 76,095 patients were included in the analysis: 63.2% were <65 years, 73.4% male, and 11.3% non-Hispanic (NH) Black. Most patients (58.3%) were diagnosed at regional or distant stages and 20.6% died of HNC. The five-year relative survival rate increased with SES group, with 51.6% in the lowest SES group, and 74.1% in the highest SES group. NH-Black patients had higher risk of all-cause and HNC-specific mortality than NH-White patients, regardless of the SES group. NH-Asian/Pacific Islander and Hispanic patients had higher risk of HNC-specific mortality in some SES groups. NH-Black patients of all SES strata had significantly worse outcomes. Other factors, such as healthcare quality, may be associated with persistent disparities. The study highlights the persistence of significant racial disparities in HNC survival across socioeconomic categories. There is need to consider additional factors underlying these disparities.

Impact of maternal early warning system and safety bundle on timely treatment of severe hypertension

To evaluate the impact of quality improvement (QI) and patient safety (PS) initiatives on timely treatment of severe hypertension (SHTN) in pregnancy. Retrospective chart review of all hospital deliveries between January 1, 2016 through June 30, 2022 with an episode of SHTN. During the study time period, our hospital implemented a maternal early warning system (MEWS), which mandated provider bedside evaluation for SHTN, and a patient safety bundle on SHTN in pregnancy that included team-based simulations around a new hospital guideline. Timely treatment of severe hypertension was defined as the percent of patients during their delivery hospitalization who received an antihypertensive agent within 60 minutes of the first documented severe blood pressure if it persisted for at least 15 minutes. Acceptable antihypertensive agents included intravenous labetalol or hydralazine or immediate release oral nifedipine. All deliveries ≥ 20 0/7 weeks were included. Data was analyzed using chi-square analysis. During the study period, there were 464 patients that met inclusion criteria prior to MEWS (phase 1), 1009 after MEWS (phase 2), and 375 with MEWS+bundle (phase 3). There was a statistically significant improvement in the rate of timely treatment of SHTN with implementation of MEWS (25.9% in phase 1 vs 44.0% in phase 2, p< .001) and then again with the bundle (61.3% in phase 3, p< .001 compared to phase 2). When looking at the data by race and ethnicity, non-Hispanic (NH) White patients were less likely to receive timely treatment as compared to NH-Black patients during phases 1 and 2, with elimination of this disparity in phase 3 (p < .001, p = .04, p = .42, respectively). Compared to NH-White patients, Hispanic patients were less likely to receive timely treatment during phase 2 only (p = .04). QI/PS efforts that standardize response to and treatment of SHTN can lead to improvement in timely treatment and elimination of disparities, which may in turn reduce severe maternal morbidity and mortality from hypertensive disorders of pregnancy.