non-Hispanic African American Patients Research Articles

Racial differences in treatment and survival among older patients with multiple myeloma.

Treatments for multiple myeloma (MM) have evolved over time and improved MM survival. While racial differences in MM treatment and prognosis between non-Hispanic African American (NHAA) and non-Hispanic White (NHW) patients are well-established, it is unclear whether they have persisted after the introduction of novel agents. Using the Surveillance, Epidemiology, and End Results-Medicare linked database, our study investigated racial difference in the receipt of treatment within 1 year following diagnosis and assessed survival outcomes among Medicare beneficiaries (≥66 years) diagnosed with MM from 2007 to 2017. We applied multivariable Cox proportional hazards models to estimate the association between race and survival and presented hazard ratios (HRs). Of 2094 NHAA and 11,983 NHW older patients with MM, 59.5% and 64.8% received treatment during the first year, respectively. Discrepancy in the proportion of patients receiving treatment between the two groups increased from 2.9% in 2007 to 2009 to 6.9% in 2014-2017. After controlling for relevant factors, patients who received treatment within the first year had lower mortality than those who did not (HR = 0.90, 95% confidence interval [CI]: 0.86-0.94). NHAA patients had a lower probability to receive treatments during the first year than NHW patients (HR = 0.91, 95% CI: 0.85-0.97) but had lower mortality (HR = 0.94, 95% CI: 0.88-1.00). The lower mortality was only observed among patients who received no treatment (HR = 0.84, 95% CI: 0.77-0.93); NHAA and NHW patients who received treatment had similar survival (p = 0.63). The increasing racial disparity in treatment utilization over time is concerning. Efforts are needed to eliminate the barriers of receiving treatment.

ODP203 Health Questionnaires are a Positive Behavioral Modifier In Patients with Impaired Blood Sugar In the African American Population.

Abstract Type 2 diabetes and its complications have a higher incidence in African Americans as compared to other racial groups (1). As per the American Diabetes Association, the prevalence of diabetes in non-Hispanic African American patients is 11.7% compared to 7.5% in non-Hispanic white patients. However, few studies have explored what can be done to spark a positive behavioral change leading to lower blood sugar. The purpose of this study is to evaluate if a patient filling out a health questionnaire has any impact on his or her habits by enhancing self-management and awareness to reduce HbA1c. Methods In an outpatient urban clinic, a prospective randomized study was conducted with African American patients with prediabetes with HbA1c 5.6 to 6.7. Patients were randomly assigned to either a survey group or a control group who did not take a survey. The survey included demographic information, weight, diabetes mellitus complication awareness, exercise frequency 3-5 days/week, eating habits, and self-perception. The patients in the survey group filled a follow-up survey 3-6 months later. Results The survey group had 50 respondents and 46 respondents who took the post-survey compared to the control group for which there were 50 respondents with 47 respondents in the control follow-up. In the survey group, 54% were males with an average age of 57 years. In the survey group, on followup HbA1c decreased (6.1 vs 5.7 p<0. 021), BMI decreased (32 vs 29.1 p<0.562), exercise frequency 3-5 days/week increased (10% to 35% p=0. 041), awareness of diabetic complication improved (15 to 74% p=0. 029), willingness to see a dietician increased (28% to 60% p=0. 038), and probability of reading nutrition labels increased (16% to 38% p=0. 058). In the control group, 58% were males with an average age of 56 years. In the control group, on followup HbA1c increased (6.1 vs 6.2), BMI increased (32 vs 33), exercise frequency 3-5 days/week increased (13% to 19% p=0.820), awareness of diabetic complication improved (12%to 16% p=0.673), willingness to see a dietician increased (29% to 38% p=0.340), and probability of reading nutrition labels increased (14% to 19% p=0.646). Conclusion Health questionnaires served as a positive behavioral modifier and helped patients identify and correct their harmful lifestyle habits. Patients in the survey group showed larger amounts of positive change compared to patients in the control group. Reference: (1) Marshall MC Diabetes in African Americans. Postgraduate Medical Journal2005;81: 734-740. Presentation: No date and time listed

Differences in tumor sequencing across ethnic groups in the treatment of endometrial cancer

<h3>Objectives:</h3> We aimed to identify ethnic differences in genetic mutations associated endometrial cancer (EC), as well as differences in the utilization of sequencing results to direct disease treatment based on actionable mutations among different ethnic groups. <h3>Methods:</h3> Patients of interest were identified using the EMERSE program. Inclusion criteria included patients with endometrial cancer who underwent solid tumor genomic sequencing between the dates of April 2014 and January 2019 at our institution. Patients meeting the inclusion criteria with verifiable tumor sequencing results were included in our retrospective cohort. Patients were excluded if they had synchronous cancers and germline or non-solid tumor testing only. Clinical information was abstracted from the medical record. Differences between groups were calculated using descriptive statistics. <h3>Results:</h3> 287 patients met inclusion criteria. The majority of patients who underwent genomic sequencing of their tumors were non-Hispanic Caucasian (n=212, 73.9%), followed by non-Hispanic African American (n=55, 19.2%) and Hispanic (n=6, 2.1%), a distribution that accurately reflects the ethnic makeup of our state population. Among patients who underwent tumor sequencing, non-Hispanic Caucasian patients had an 82% likelihood (n=174) of having an actionable mutation, whereas non-Hispanic African American patients had a 60% likelihood (n=33) (p<0.001). PTEN (n=107, 80.5%, p<0.001) and FGFR2 (n=28, 95.8%, p=0.04) mutations were found at a higher rate in non-Hispanic Caucasian patients. When controlling for histological subtypes, however, ethnic variations in these mutations were no longer significant. FBXW7 mutations (n=4, 40%, p=0.03) were found to occur at a lower rate in non-Hispanic African American patients. No significant differences in the rates of genetic mutations were found in Hispanic, Asian, or American Indian/Native Alaskan patients. 21 patients received targeted treatments based on sequencing results. Among ethnic groups, 9.8% (n=17) of non-Hispanic Caucasian and 12.1% (n=4) of non-Hispanic African American patients were initiated on targeted treatments (p=0.68). The majority of patients receiving targeted therapy had endometrioid histology (n=11, 52.4%), followed by carcinosarcoma (n=5, 23.8%) and serous (n=4, 19.0%) histology. <h3>Conclusions:</h3> Genomic sequencing of solid tumors was utilized in a high percentage of patients with endometrial cancer. When examining ethnic groups, no disparate use of tumor sequencing was found. Similar actionable mutations were seen across ethnic groups when controlling for tumor histology. Overall, utilization of tumor sequencing results to personalize care was used at a low rate among patients with actionable mutations across ethnic groups. This underutilization highlights the need for the continued development of efficacious, targeted therapies for endometrial cancer.

Race, Ethnicity, and Insurance: the Association with Opioid Use in a Pediatric Hospital Setting.

This study examined the association between race/ethnicity and health insurance payer type with pediatric opioid and non-opioid ordering in an inpatient hospital setting. Cross-sectional inpatient encounter data from June 2013 to June 2018 was retrieved from a pediatric children's hospital in Southern California (N = 55,944), and statistical analyses were performed to determine associations with opioid ordering. There was a significant main effect of race/ethnicity on opioid and non-opioid orders. Physicians ordered significantly fewer opioid medications, but a greater number of non-opioid medications, for non-Hispanic African American children than non-Hispanic Asian, Hispanic/Latinx, and non-Hispanic White pediatric patients. There was also a main effect of health insurance payer type on non-opioid orders. Patients with government-sponsored plans (e.g., Medi-Cal, Medicare) received fewer non-opioid prescriptions compared with patients with both HMO and PPO coverage. Additionally, there was a significant race/ethnicity by insurance interaction on opioid orders. Non-Hispanic White patients with "other" insurance coverage received the greatest number of opioid orders. In non-Hispanic African American patients, children with PPO coverage received fewer opioids than those with government-sponsored and HMO insurance. For non-Hispanic Asian patients, children with PPO were prescribed more opioids than those with government-sponsored and HMO coverage. Findings suggest that the relationship between race/ethnicity, insurance type, and physician decisions opioid prescribing is complex and multifaceted. Given that consistency in opioid prescribing should be seen regardless of patient background characteristics, future studies should continue to assess and monitor unequitable differences in care.

Disparities In Outcomes Among COVID-19 Patients In A Large Health Care System In California.

As the novel coronavirus disease (COVID-19) pandemic spreads throughout the United States, evidence is mounting that racial and ethnic minorities and socioeconomically disadvantaged groups are bearing a disproportionate burden of illness and death. We conducted a retrospective cohort analysis of COVID-19 patients at Sutter Health, a large integrated health system in northern California, to measure potential disparities. We used Sutter's integrated electronic health record to identify adults with suspected and confirmed COVID-19, and we used multivariable logistic regression to assess risk of hospitalization, adjusting for known risk factors, such as race/ethnicity, sex, age, health, and socioeconomic variables. We analyzed 1,052 confirmed cases of COVID-19 from the period January1-April8, 2020. Among our findings, we observed that compared with non-Hispanic white patients, non-Hispanic African American patients had 2.7 times the odds of hospitalization, after adjustment for age, sex, comorbidities, and income. We explore possible explanations for this, including societal factors that either result in barriers to timely access to care or create circumstances in which patients view delaying care as the most sensible option. Our study provides real-world evidence of racial and ethnic disparities in the presentation of COVID-19.

Quality of life differences between African Americans and Hispanic Americans with multiple sclerosis

BackgroundIn comparison to non-minority patients with multiple sclerosis, minority research in multiple sclerosis continues to be only a few percent of the literature. Often, the comparator group is with the Caucasian populations of the world, who themselves comprise of non-ubiquitous groups. Comparisons between minority groups have not been done as they relate to quality of life, partly because the populations are smaller. Our study will compare the quality life differences between two minority populations living in the same geographic and urban area.MethodsThis study utilized cross-sectional data from an observational prospective cohort study. A total of 28 minority patients were included in this study. All patients were on a disease modifying therapy. Demographic information was obtained. The primary outcome measure was the MSQLI and all scores were derived from the MSQLI user’s manual.ResultsThe MSQLI scores of the Mental Health Index were lower in all areas for Hispanic White MS patients as compared to Non-Hispanic African American patients, but 3 of 5 were statistically significant: MHI total score, MHI anxiety, and MHI behavioral control subscores (all p < 0.05). When investigating if EDSS associated with MSQLI measures, independent of minority group, the only noted difference was between the mild (EDSS< or = 3) and the moderate group (EDSS 3.5–5.5) in the Physical Components Score and Health Transition Score (p = 0.028 and p < 0.05).ConclusionThe study begins to elucidate differences in quality life measures between minorities with multiple sclerosis potentially leading to culturally competent care.

Effect of a Positive Psychological Intervention on Pain and Functional Difficulty Among Adults With Osteoarthritis

Positive psychological interventions for improving health have received increasing attention recently. Evidence on the impact of such interventions on pain, and racial disparities in pain, is limited. To assess the effects of a positive psychological intervention on pain and functional difficulty in veterans with knee osteoarthritis. The Staying Positive With Arthritis Study is a large, double-blinded randomized clinical trial powered to detect race differences in self-reported pain in response to a positive psychological intervention compared with a neutral control intervention. Data were collected from 2 urban Veterans Affairs medical centers. Participants included non-Hispanic white and non-Hispanic African American patients aged 50 years or older with a diagnosis of osteoarthritis. Mailings were sent to 5111 patients meeting these criteria, of whom 839 were fully screened, 488 were eligible, and 360 were randomized. Enrollment lasted from July 8, 2015, to February 1, 2017, with follow-up through September 6, 2017. The intervention comprised a 6-week series of evidence-based activities to build positive psychological skills (eg, gratitude and kindness). The control program comprised similarly structured neutral activities. Programs were delivered via workbook and weekly telephone calls with interventionists. The primary outcomes were self-reported pain and functional difficulty measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC; range 0-100). Secondary outcomes included affect balance and life satisfaction. The sample included 180 non-Hispanic white patients and 180 non-Hispanic African American patients (mean [SD] age, 64.2 [8.8] years; 76.4% were male). Mean (SD) baseline scores for WOMAC pain and functional difficulty were 48.8 (17.6) and 46.8 (18.1), respectively. Although both decreased significantly over time (pain: χ23 = 49.50, P < .001; functional difficulty: χ23 = 22.11, P < .001), differences were small and did not vary by treatment group or race. Exploratory analyses suggested that the intervention had counterintuitive effects on secondary outcomes. The results of this randomized clinical trial do not support the use of positive psychological interventions as a stand-alone treatment for pain among white or African American veterans with knee osteoarthritis. Adaptations are needed to identify intervention components that resonate with this population, and the additive effect of incorporating positive psychological interventions into more comprehensive pain treatment regimens should be considered. ClinicalTrials.gov Identifier: NCT02223858.

Determinants of Survival for Adolescents and Young Adults with Urothelial Bladder Cancer: Results from the California Cancer Registry

Bladder cancer is a common malignancy often diagnosed in older adults. Previous studies have reported racial/ethnic disparities in bladder cancer survival outcomes but have not focused on younger patients. We identified whether factors influencing cause specific survival in adolescents and young adults (ages 15 to 39) differed from older adults, and defined prognostic factors specifically in adolescents and young adults using the California Cancer Registry. Patients diagnosed with bladder cancer between 1988 through 2012 were included in the study. The primary outcome measure was cause specific survival. A multivariable Cox proportional hazards regression model was used to evaluate predictors of cause specific survival in patients of all ages and in adolescents/young adults. Interactions of age and other variables between younger and older adult patients were assessed. Of 104,974 patients with bladder cancer we identified 1,688 adolescent and young adult patients (1.6%). Compared to older patients these patients had a 58% reduced risk of bladder cancer death (HR 0.42, p <0.001). Significant age interactions were identified involving race/ethnicity and histology. Among adolescents and young adults, nonHispanic African-American patients with low socioeconomic status had poor cause specific (HR 7.1, p <0.001) and overall (HR5.02, p <0.001) survival. Racial/ethnic and socioeconomic disparities exist in adolescent and young adult patients with bladder cancer in California. Further studies are warranted to identify the underlying causes in order to overcome these disparities.

Intrinsic Genomic Differences Between African American and White Patients With Clear Cell Renal Cell Carcinoma.

There are well-documented racial disparities in outcomes for African American patients with clear cell renal cell carcinoma (ccRCC). Despite a dramatic improvement in overall survival in white patients since the advent of targeted therapy, survival for African Americans with advanced ccRCC has not changed. There is little known about potential racial differences in tumor biology of ccRCC. To determine if there are racial differences in the somatic mutation rate and gene expression of ccRCC tumors from white and African American patients. Overall, 438 patients with ccRCC were identified through The Cancer Genome Atlas (TCGA) clear cell kidney (KIRC) dataset (419 white and 19 African American patients). The GSE25540 dataset containing 135 patients (125 white and 10 African American patients) was used for validation. Tumor samples were collected from numerous cancer centers and were examined for racial differences in somatic mutation rates and RNA expression. Racial differences in somatic mutation rates and RNA expression were examined. The comparison of somatic mutation rates and differences in RNA expression in white and African American patients with ccRCC. Overall, 419 ccRCC tumor data sets from non-Hispanic white patients and 19 from non-Hispanic African American patients were identified through the publically available TCGA KIRC data set, and a validation set of 125 white and 10 African American ccRCC patient tumors was identified from the publicly available GSE25540 data set. African American patients were significantly less likely than white patients to have VHL mutations (2 of 12 [17%] vs 175 of 351 [50%], respectively; P = .04) and were enriched in the ccB molecular subtype (79% in African American vs 45% in white patients ; P = .005), a molecular subtype that carries a worse prognosis. It was found that RNA expression analysis revealed relative down-regulation of hypoxia-inducible factor (HIF) and vascular endothelial growth factor (VEGF)-associated pathways in African American patients compared with white patients. African American patients have less frequent VHL inactivation, are enriched in the ccB molecular subtype, and have decreased up-regulation of HIF-associated gene signatures than white patients. These genomic differences would predict decreased responsiveness to VEGF-targeted therapy and are a biologically plausible contributing factor to the worse survival of African American patients with ccRCC, even in the targeted therapy era.

Age at diagnosis predicts deterioration in glycaemic control among children and adolescents with type 1 diabetes

BackgroundPoor glycemic control early in the course of type 1 diabetes mellitus (T1DM) increases the risk for microvascular complications. However, predictors of deteriorating control after diagnosis have not been described,...

Eye Care Use Among a High-Risk Diabetic Population Seen in a Public Hospital's Clinics

Little is known regarding eye care use among low-income persons with diabetes mellitus, especially African Americans. To investigate eye care use among patients with diabetes who were seen in a county hospital clinic that primarily serves high-risk, low-income, non-Hispanic African American patients. A retrospective cohort study with 2 years of follow-up examined eye care use among adult patients with diabetes seen in 2007 in an outpatient medical clinic of a large, urban county hospital that primarily serves low-income, non-Hispanic African American patients. Patients with a history of retinopathy and macular edema or a current diagnosis indicating ophthalmic complications were excluded. Eye care use was defined dichotomously as whether or not patients had a visit to the eye clinic for any eye care examination or procedure. We estimated crude and adjusted rate ratios (aRRs) and 95% CIs for the association between eye care use and selected clinical and demographic characteristics. There were 867 patients with diabetes identified: 61.9% were women, 76.2% were non-Hispanic African American, and 61.4% were indigent, with a mean age of 51.8 years. Eye care utilization rates were 33.2% within 1 and 45.0% within 2 years. For patients aged 19 to 39 years compared with those aged 65 years or older, significantly decreased eye care utilization rates were observed within 1 year (aRR, 0.48; 95% CI, 0.27-0.84) and within 2 years (aRR, 0.61; 95% CI, 0.38-0.99). Overall eye care utilization rates were low. Additional education efforts to increase the perception of need among urban minority populations may be enhanced if focused on younger persons with diabetes.

Effects of health insurance and race on colorectal cancer treatments and outcomes.

We hypothesized that health insurance payer and race might influence the care and outcomes of patients with colorectal cancer. We examined treatments received for all incident cases of colorectal cancer occurring in Florida in 1994 (n = 9551), using state tumor registry data. We also estimated the adjusted risk of death (through 1997), using proportional hazards regression analysis controlling for other predictors of mortality. Treatments received by patients varied considerably according to their insurance payer. Among non-Medicare patients, those in the following groups had higher adjusted risks of death relative to commercial fee-for-service insurance: commercial HMO (risk ratio [RR] = 1.40; 95% confidence interval [CI] = 1.18, 1.67; P = .0001), Medicaid (RR = 1.44; 95% CI = 1.06, 1.97; P = .02), and uninsured (RR = 1.41; 95% CI = 1.12, 1.77; P = .003). Non-Hispanic African Americans had higher mortality rates (RR = 1.18; 95% CI = 1.01, 1.37; P = .04) than non-Hispanic Whites. Patients with colorectal cancer who were uninsured or insured by Medicaid or commercial HMOs had higher mortality rates than patients with commercial fee-for-service insurance. Mortality was also higher among non-Hispanic African American patients.

Effects of health insurance and race on early detection of cancer.

The presence and type of health insurance may be an important determinant of cancer stage at diagnosis. To determine whether previously observed racial differences in stage of cancer at diagnosis may be explained partly by differences in insurance coverage, we studied all patients with incident cases of melanoma or colorectal, breast, or prostate cancer in Florida in 1994 for whom the stage at diagnosis and insurance status were known. The effects of insurance and race on the odds of a late stage (regional or distant) diagnosis were examined by adjusting for an individual's age, sex, marital status, education, income, and comorbidity. All P values are two-sided. Data from 28 237 patients were analyzed. Persons who were uninsured were more likely diagnosed at a late stage (colorectal cancer odds ratio [OR] = 1.67, P =.004; melanoma OR = 2.59, P =.004; breast cancer OR = 1.43, P =.001; prostate cancer OR = 1.47, P =.02) than were persons with commercial indemnity insurance. Patients insured by Medicaid were more likely diagnosed at a late stage of breast cancer (OR = 1.87, P<.001) and melanoma (OR = 4.69, P<.001). Non-Hispanic African-American patients were more likely diagnosed with late stage breast and prostate cancers than were non-Hispanic whites. Hispanic patients were more likely to be diagnosed with late stage breast cancer but less likely to be diagnosed with late stage prostate cancer. Persons lacking health insurance and persons insured by Medicaid are more likely diagnosed with late stage cancer at diverse sites, and efforts to improve access to cancer-screening services are warranted for these groups. Racial differences in stage at diagnosis are not explained by insurance coverage or socioeconomic status.