non-Hispanic White Counterparts Research Articles

Racial and Ethnic and Sex Differences in At-Home Estimates of Obstructive Sleep Apnea Parameters among Diverse Adults.

Racial and ethnic and sex differences in sleep may exist, but limited data directly compare objective estimates of obstructive sleep apnea (OSA), particularly in rapid eye movement (REM) versus non-rapid eye movement (NREM) sleep, among Black, Mexican American and non-Hispanic White adults. To determine whether OSA parameters during REM and NREM sleep differ by race, ethnicity or sex in community-dwelling adults. The Dormir Study conducted a comprehensive sleep examination among Black, Mexican American, and non-Hispanic White adults aged 50 years and older enrolled in the ongoing Health and Aging Brain Study-Health Disparities cohort (2020-4). Here we characterize racial, ethnic, and sex differences in OSA indices assessed by an FDA-approved Peripheral Arterial Tonometry (PAT)-based home sleep testing system. We examined 821 participants (mean age=66.6±8.5 years), including 543 (66.1%) females, and 284 (34.6%) Mexican American and 174 (21.2%) Black individuals. Around half (50.5%) had moderate-to-severe OSA as defined by the respiratory event index (REI based on 3% desaturations of ≥15/hour), 72.7% with REM-REI≥15/hour and 39.5% with NREM-REI≥15/hour. Significant racial, ethnic, and sex differences were observed for REM-specific but not overall OSA metrics. Black females had the highest REM-REI, and NHW males had the lowest REM-REI. After controlling for demographics, socioeconomic factors, comorbidities, and sleep medication use, Black participants had a REM-REI 3 events/hour higher than NHW adults, while NREM-REI were similar. Mexican American individuals had similar REM or NREM OSA parameters compared to non-Hispanic White adults but exhibited higher average blood oxygen levels. In this new, diverse cohort, PAT-based measures of in-home sleep indicate greater REM-stage respiratory events in Black adults, particularly Black females, compared to their non-Hispanic White counterparts. Given the link between REM OSA and adverse health outcomes, clinicians should pay more attention to this sleep apnea phenotype, especially in minoritized populations. Primary Source of Funding: National Institute on Aging.

Cardiac autonomic function in young, healthy adults: Influence of race and sex.

Non-Hispanic Black (BL) adults living in the United States are more likely to develop cardiovascular disease (CVD) compared with their non-Hispanic White (WH) counterparts. Although measures of cardiac autonomic function [i.e., spontaneous cardiac baroreflex sensitivity (BRS) and heart rate variability (HRV)] have a predictive value for CVD, studies investigating racial differences in cardiac autonomic function are limited and have reported conflicting results. Furthermore, sex differences are often not considered despite BL women having a high prevalence of CVD. We hypothesized that young BL men and women would exhibit lower cardiac BRS and HRV compared with their WH counterparts. Heart rate and beat-to-beat blood pressure were continuously recorded during 5 min of supine rest in 145 young (18-33 yr), healthy, BL (37 men, 38 women) and WH (39 men, 31 women) adults to assess cardiac BRS and HRV. Overall cardiac BRS (sequence method) was higher in BL adults compared with WH adults (P < 0.001), which was mainly driven by differences between BL and WH men (BL men: 34 ± 16 vs. WH men: 21 ± 9 ms/mmHg, P < 0.001) compared with women (BL women: 27 ± 12 vs. WH women: 24 ± 11 ms/mmHg; P > 0.05). Likewise, greater HRV in BL adults, indexed by root mean square of successive differences, was primarily driven by BL men (BL men: 109 ± 59 vs. WH men: 64 ± 33 ms; P < 0.001) rather than BL women (P > 0.05). Thus, contrary to our hypothesis, these results support that reduced cardiac autonomic function does not manifest early in life among young BL adults.NEW & NOTEWORTHY Herein, we demonstrated that BL adults do not have lower cardiac autonomic function compared with WH adults. Rather BL men had greater spontaneous cardiac baroreflex sensitivity and heart rate variability compared with WH men while no differences were found among BL and WH women. These findings suggest that reduced cardiac autonomic function, which could increase the risk of cardiovascular disease, does not appear early in life in healthy BL adults.

Discrimination and Wellbeing are Differentially Related to Pain Severity for the Racially Marginalized.

This study examines the relationship between racial discrimination and physical pain outcomes. A geographically representative sample of 887 individuals was recruited online through CloudResearch from diverse racial backgrounds, including Black/African American, Latine/Hispanic American, Asian American, and White/European American adults. Participants completed measures on racial and ethnic discrimination, racial microaggressions, pain severity, depression symptoms, and coping styles. Statistical analyses included multiple regression and mediation models. Our findings indicate that racialized participants experienced greater ethnic discrimination and racial microaggressions compared to their non-Hispanic White counterparts. Hispanic/Latine participants also reported greater pain severity than other groups. Lifetime experiences of discrimination, depression symptoms, avoidant coping style, and age emerged as significant predictors of pain severity, while mediation analyses revealed that lifetime discrimination partially mediated the relationship between race/ethnicity and pain severity for racially marginalized participants, compared to non-Hispanic White participants. Further, greater reliance on avoidant coping combined with greater lifetime discrimination experiences was associated with increased severity of pain. The findings indicate how racism may result in worse pain outcomes in people of color, with potentially amplified adverse effects for those who engage in avoidant coping. While therapeutic interventions targeting avoidance may benefit racialized individuals, ultimately, the results highlight the critical need for large-scale policy interventions targeting racial discrimination to improve health equity and reduce the burden of pain among racialized populations.

Differences in barriers to specialty alcohol treatment between Latino and White adults with an alcohol use disorder.

Differences in barriers to specialty alcohol treatment between Latino and White adults with an alcohol use disorder.

Effects of the Part D Senior Savings Model on racial and ethnic disparities in healthcare costs

Objective The Centers for Medicare & Medicaid Services tested the Part D Senior Savings Model (“PDSS Model”) in 2021, capping monthly out-of-pocket (OOP) insulin costs at $35. Diabetes disproportionately affects racial/ethnic minorities compared to their non-Hispanic White (White) counterparts, so this study compared the changes in racial/ethnic disparities in healthcare costs among insulin users between Medicare and non-Medicare populations in 2021. Methods This study analyzed the Medical Expenditure Panel Survey (2020–2021). The intervention group comprised Medicare beneficiaries aged ≥65, while the comparison group included a near-elderly non-Medicare population. The study outcomes included annual OOP/total costs in 2021 dollars for insulin, medication, health services (medical), and overall healthcare. A difference-in-differences-in-differences approach was employed to assess the PDSS Model’s effects between White and each racial/ethnic minority group. Results The weighted sample included 1,056,386 insulin users (53.89% intervention). In 2020, among the intervention group, non-Hispanic Black (Black) and Hispanic had similar or higher insulin costs than White patients. Black–White differences in OOP insulin costs were lowered more among the intervention group (cost ratio [CR] = 0.12, 95% confidence interval = 0.06–0.22) than the comparison group. Black–White differences in OOP costs for medication, health services, and overall healthcare widened more among the intervention group by 61–64%. These patterns were not seen for other racial/ethnic disparities. Conclusions Among insulin users, Black may have benefited more from the PDSS Model than White patients, which may be associated with enhanced insulin access and lower needs for other healthcare. Future studies should examine the long-term and heterogeneous impact of the PDSS Model.

National treatment utilization among racially and ethnically diverse patients with PTSD

Research suggests that racial/ethnic minoritized individuals have elevated risk for experiencing trauma and developing posttraumatic stress disorder (PTSD) but are less likely to utilize mental health treatment compared to their non-Hispanic White counterparts. However, possessing health insurance may mitigate these disparities. We investigated this issue using a subsample of data obtained from the National Epidemiologic Survey on Alcohol and Related Conditions-III (N = 2,339), to estimate the likelihood of utilizing PTSD-specific and general mental health treatment among a racially/ethnically diverse sample of individuals diagnosed with PTSD. Insurance status was included as a moderating factor. Across racial/ethnic groups, insured individuals had more than twice the odds of utilizing PTSD-specific and general treatment than those without insurance. Black, Hispanic, and Asian/Native Hawaiian/Pacific Islander participants were significantly less likely to utilize PTSD-specific and general mental health treatment regardless of insurance status. These findings can inform targeted public health interventions to address mental health care disparities.

Informal Care Receiving among Older Adults: The Role of Multimorbidity and Intersectional Social Position.

Older adults with distinct multimorbidity combinations may require varying intensities of informal care and these needs may vary in important ways by race/ethnicity and sex. This study aims to examine informal care-receiving characteristics among older adults with varying multimorbidity patterns and race/ethnicity-sex characteristics. 4,875 participants from the National Health and Aging Trends Study were included. Five clinically-informed multimorbidity categories (no condition(s), somatic-only, depression without cognitive impairment, cognitive impairment without depression, both depression and cognitive impairment) and six intersectional groups (non-Hispanic White female, non-Hispanic White male, non-Hispanic Black female, non-Hispanic Black male, Hispanic female, Hispanic male) were assessed. Negative binomial regression was applied to explore the associations between multimorbidity groups, race/ethnicity and sex combinations, and informal care-receiving characteristics. Compared with the somatic-only multimorbidity group, individuals with no condition(s) received assistance with fewer ADL/IADL activities, whereas the cognitive impairment multimorbidity group received assistance with more ADL/IADL activities. Across race/ethnicity-sex groups, non-Hispanic White and Black males received assistance with fewer ADL/IADL activities, and no statistical significance was found for non-Hispanic Black female or Hispanics compared to non-Hispanic White female counterparts. Sensitivity analysis examining assistance with only ADL activities revealed the same pattern. The study highlighted the complexities of informal care-receiving characteristics among older adults, particularly among those with cognitive difficulties, and the ways in which race/ethnicity and sex are associated with care-receiving patterns. The findings highlight a need for person- and family-centered interventions sensitive to the diverse needs of care-recipients and caregivers.

Predictors of Mortality in Acute Myocardial Infarction Patients With Systemic Lupus Erythematosus.

Introduction Acute myocardial infarction (AMI) remains a leading cause of mortality globally, with systemic lupus erythematosus (SLE) posing additional risks for adverse outcomes. Methods This retrospective cohort study utilized data from the Healthcare Cost and Utilization Project National Inpatient Sample from 2016 to 2020 to investigate predictors of mortality among hospitalized AMI patients, stratified by SLE status. Results A total of 81,935 patients were included, with variables analyzed using multivariate logistic regression. Among SLE patients, being female, aged ≥65 years, and having a prolonged hospital stay >5 days were associated with higher mortality. Elective admissions were protectivewhile non-Hispanic Black SLE patients showed reduced odds of mortality compared to their non-Hispanic White counterparts. Among non-SLE patients, predictors of increased mortality included being non-Hispanic Black and having prolonged hospital stays. Private insurance coverage was associated with lower mortality in this group. Conclusion These findings highlight critical patient- and hospital-related factors influencing mortality in AMI patients with and without SLE. Targeted strategies focusing on early recognition, effective interventions, and reducing healthcare disparities are essential to improve outcomes in this population.

Social and Financial Costs of Neonatal Intestinal Failure

Neonatal short bowel syndrome with intestinal failure is rare, and observational studies are limited to small cohorts. Health disparities exist in long-term management with little known about the initial hospitalization. To identify children with neonatal short bowel syndrome with intestinal failure and to determine whether race, ethnicity, and neighborhood opportunity are associated with length of stay during their initial hospitalizations. This cross-sectional study of children with neonatal short bowel syndrome and intestinal failure was conducted between 2004 and 2020, with validation and analysis performed from July 2022 to April 2024. Children were identified from the Pediatric Health Information System database, which included administrative data from 50 freestanding US children's hospitals. Children were included on the basis of a diagnosis code of postsurgical malabsorption and billed charges for a neonatal intensive care unit stay and sustained parenteral nutrition use. Race and ethnicity were included as a single variable with categories of Hispanic, non-Hispanic Black, non-Hispanic White, other (Asian and multiracial, combined because of low numbers), and unknown according to hospital report. Child Opportunity Index quintile ranged from very low (lowest quintile) to very high (highest quintile). The primary outcome was length of stay measured in number of days from admission to discharge. The χ2 analysis was used to examine unadjusted associations between categorical variables, and Wilcoxon rank-sum test was used for continuous variables. A total of 2267 children with neonatal short bowel syndrome with intestinal failure were identified (997 female [44%]; 410 Hispanic [18%]; 481 non-Hispanic Black [21%]; 690 non-Hispanic White [30%]; 231 other [10%]; 455 unknown [20%]), with 629 (28%) living in areas with very low Child Opportunity Index. The median (IQR) length of stay for the initial admission was 150 (112-200) days, with a median (IQR) cost of $528 628 ($374 040-$766 446). In multivariable analysis, non-Hispanic Black children remained in the hospital for 16 days longer than their non-Hispanic White counterparts (95% CI, 7-25 days; P < .001). Child Opportunity Index was not significantly associated with length of stay when controlling for race and ethnicity. In this cross-sectional study, children with neonatal short bowel syndrome with intestinal failure experienced long initial hospital stays, incurring high costs, with non-Hispanic Black children disproportionately affected. Interventions targeting safe and efficient transition to home are needed to address both efficacy and equity for these children.

Returning to work after breast cancer: a longitudinal analysis of employment and financial hardship.

This study explored changes in employment and financial hardship following breast cancer diagnosis. We used data from a single-institution, longitudinal study of women with newly diagnosed breast cancer who received curative intent chemotherapy. The primary outcomes of interest in this analysis were breaks in active employment, defined as being out of work for the four weeks prior, and patient-reported acute financial burden during chemotherapy and up to 24months following chemotherapy completion. Mixed-effects logistic regression models were used to identify factors associated with breaks in employment and financial burden. The cohort consisted of 104 women who were employed at time of breast cancer diagnosis. The mean age was 49.6years and 86% were non-Hispanic White, 11% African American or Black, and 4% another race or ethnicity. In multivariable models, African-American women were 168% more likely to report a break from active employment than their non-Hispanic white counterparts (adjusted odds ration [aOR] 2.68; p = 0.026). A break from active employment was not statistically associated with greater self-reported acute financial burden, but patients from the lowest socioeconomic status tertile were 173% more likely to report financial burden than those in the highest tertile (aOR 2.73; p = 0.022). African-American breast cancer survivors were more likely to report breaks from active employment than their White peers, even after adjusting for type of work and socioeconomic status. African-American and Black breast cancer survivors may face greater challenges returning to work.

Assessing Attitudes and Perceptions of High-Risk, Low-Resource Communities Towards Cardiopulmonary Resuscitation and Public-Access Defibrillation.

Background: Layperson cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use are vital for improving survival rates after out-of-hospital cardiac arrest (OHCA), yet their application varies by community demographics. We evaluated the concerns and factors influencing willingness to perform CPR and use AEDs among laypersons in high-risk, low-resource communities. Methods: From April 2022 to March 2024, laypersons in Northern Manhattan's Community District 12 completed surveys assessing their attitudes toward CPR and AED use before attending Hands-Only CPR training. Fisher's Exact Test assessed differences in concerns and willingness to perform CPR and AED use across racial-ethnic groups and compared low-resource communities with high-resource groups consisting of non-clinical staff across eight ambulatory sites. Results: Among 669 participants from low-resource communities, 64% identified as Hispanic, 58% were under 40 years of age, and 67% were female. Significant knowledge gaps were identified: 62% had never learned CPR, and 77% were unfamiliar with AEDs. Top concerns about giving CPR included fear of incorrect performance (67%), causing harm (56%), and legal repercussions (53%). Willingness to perform CPR was most influenced by familiarity with the victim. The primary barrier to AED use was a lack of operational knowledge (66%). Non-Hispanic Black participants expressed significantly greater concerns than their Non-Hispanic White counterparts. Participants in high-resource settings (n = 309) showed higher training rates, albeit with similar apprehensions about CPR and AED use. Conclusions: Concerns regarding CPR and AED use stem from a lack of confidence and training, particularly predominant in certain racial-ethnic groups. Targeted, culturally sensitive community interventions could potentially address these barriers, enhance preparedness, and improve OHCA survival rates.

ESPO AND BEHAVIORAL AND SOCIAL SCIENCES SECTION SYMPOSIUM: DEFYING THE ODDS: HOW MINORITIZED OLDER ADULTS USE PSYCHOSOCIAL AND ENVIRONMENTAL FORTITUDE TO ENHANCE AGING HEALTH

Abstract Minoritized older adults report worse health outcomes compared to their non-Hispanic White counterparts. However, existing research often focuses on the role of risk factors rather than sources of resilience among minoritized older adults. In this symposium, we will highlight ways in which racially and ethnically minoritized older adults use different facets of fortitude to ameliorate disparities and promote resilience. Our first two presentation will examine psychosocial fortitude in relation to cognitive health. Dr. Alexandra Clark will examine how belonging to a resilient psychosocial-behavioral phenotype buffers risk for Alzheimer’s disease and how bilingualism protects cognitive health variably among Latinx older adults. Dr. Ruijia Chen will address racial/ethnic disparities in Alzheimer’s disease and related dementias by focusing on the interplay of life course stressors, resilience factors, and sleep health across the life span. Our last two presentations will examine environmental factors in relation to cognitive and physical health. Dr. Talha Ali will provide insights on resilience mechanisms by exploring the moderating role of individual-level race/ethnicity in the relationship between structural racism and increased risk for subjective cognitive decline. Dr. Kyle Moored will explore ways in which neighborhood walkability buffers the negative impact of neighborhood socioeconomic disadvantage on step activity among Black older persons. Dr. Laura Zahodne, as discussant, will provide summative comments identifying synergies across presentations and promoting strategies for advancing the field of minority aging research.

CONCEPTUALIZING THE HEALTH CARE WORKFORCE AS A SOCIAL DETERMINANT OF HEALTH IN LONG-TERM CARE SETTINGS

Abstract The social determinants of health include environmental conditions where: individuals reside and age that affect their health, functioning, quality of life, and risks. We propose a conceptual model of how the health workforce becomes a social determinant of health resulting from the sustained person-clinician relationship. To illustrate the application of this proposed model, we examine the case of long-stay residents in long-term care settings. These residents spend ≥101 days, oftentimes until death in these facilities and have prolonged healthcare staff interactions which impact their health outcomes. Evidence suggests that sustained contact between residents and the healthcare workforce does impact their quality of life, health outcomes, and risks. We posit that the health workforce can be a contributing factor in inequitable outcomes in long-term care settings, thus becomes a social determinant of health. Their interactions and practices with residents may explain disparities in Black and Hispanic residents who typically have significantly higher rates of pain, falls, antipsychotic use, and pressure injuries relative to their Non-Hispanic White counterparts. Additionally, Black and Hispanic residents receive care in geographically segregated nursing homes. Through multi-level exemplars, we will illustrate how as a social determinant the workforce characteristics like racial and ethnic concordance, skill mix, and hours per resident impact health outcomes. Therefore, studies that conceptualize and operationalize the healthcare workforce as a social determinant of health at the individual, interpersonal and organizational levels are needed to improve staffing interventions to mitigate health disparities across in long-term care settings.

Mental Health Care Disparities Among US Pregnant Individuals in 2020-2021: A Cross-Sectional Study.

To examine maternal characteristics associated with perceived unmet mental health needs and mental health care settings, focusing on residential rurality and race/ethnicity. This cross-sectional study analyzed self-reported unmet mental health needs and mental health care settings among 1097 pregnant respondents in the 2020-2021 National Survey on Drug Use and Health, incorporating the complex sampling weights for national representativeness. Non-Hispanic Black pregnant individuals and those living in nonmetro rural areas reported lower odds of unmet mental health needs compared to those in large metro areas and non-Hispanic White individuals. Pregnant individuals in nonmetro rural areas and non-Hispanic other pregnant individuals also reported lower odds of utilizing virtual mental care services, while non-Hispanic other pregnant individuals were less likely to receive prescription medication than their non-Hispanic White counterparts. Disparities in mental health care access by rurality and race/ethnicity reveal increased barriers for nonmetro rural and minority pregnant populations, particularly regarding virtual and prescription-based care. The lower unmet health needs among Black pregnant individuals and those living in nonmetro rural areas may reflect adjusted expectations or reliance on informal support systems, emphasizing the need to understand these perceptions. COVID-19's impact on access patterns further highlights the need for more research on barriers to maternal mental health treatment. Tailored mental health interventions and policy reforms are needed to enhance accessible, culturally sensitive maternal mental health services across diverse communities.

The Influence of Racial/Ethnic and Gender Concordance on Care Among Non-Pregnant Women of Childbearing Age with Diabetes Mellitus: an Analysis of the Medical Expenditure Panel Survey, 2010-2019.

This study examined associations between patient-provider race/ethnicity concordance and gender concordance on overall healthcare ratings, self-efficacy, and diabetes care monitoring in non-pregnant women of childbearing age with diabetes mellitus before and after adjusting for sociodemographic factors. We analyzed longitudinal data from the 2010-2019 Medical Expenditure Panel Survey. The sample was limited to non-pregnant women of childbearing age (18-45years) diagnosed with diabetes (unweighted n = 327; weighted n = 566,504). Bivariate analysis, logistic regression, and latent variable modeling were performed. Few racially minoritized women reported racial/ethnic and gender concordance with their healthcare provider. Only 2.9% of Hispanic women reported having a Hispanic provider and 12.1% of non-Hispanic Black women reported seeing a non-Hispanic Black provider compared to 81.1% of non-Hispanic White women who reported seeing a non-Hispanic White provider (p < .0001). Among Hispanic women, 15.3% reported seeing a female provider compared to 25.2% of non-Hispanic Black and 53.5% of non-Hispanic White women. Patient-provider race/ethnicity and gender concordance were not statistically significantly associated with overall healthcare ratings, self-efficacy, or diabetes care monitoring. This study revealed a large disparity in race/ethnicity and gender concordance among minority women of reproductive age with diabetes compared to their non-Hispanic White counterparts. There is a need for larger, more robust studies to examine the influence of provider and other healthcare characteristics on diabetes-related outcomes in this understudied population.

Self-Management Interventions for Black Women at Risk for Cardiovascular Disease: A Systematic Literature Review.

Cardiovascular disease (CVD) is the leading cause of death among Black women. When compared with their non-Hispanic White counterparts, Black women are about 50% more likely to have uncontrolled high blood pressure (BP). The disproportionate burden of CVD in Black women highlights the need for CVD prevention programs in this population. The present systematic literature review examined the updated literature on the efficacy of primary prevention self-management interventions for Black women with CVD risk factors. Searches were run on PubMed, Cochrane, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO databases based on the following inclusion criteria: papers published from September 22, 2018; English language; U.S. studies only; original research reports; prospective clinical trials; cardiovascular health promotion/self-management interventions that target at least two health practices for primary prevention; comorbid conditions without a cardiovascular event; at least one patient-level outcome; and Black women at least 18 years of age. Twelve papers met the inclusion criteria. Health practices targeted included physical activity, nutrition, weight loss, health knowledge, and BP control. Nine of the 12 papers reported statistically significant improvements on at least one CVD risk factor including weight loss, physical activity, BP control, waist circumference, and depression. Culturally tailored self-management interventions appear to be feasible with weak to moderately high evidence of efficacy for reducing CVD risk factors in Black women. Further research should focus on the influence that social determinants of health, including mental health, may have on self-management and CVD risk in this population.

Worse Clinical and Survival Outcomes in Breast Cancer Patients Living in Puerto Rico Compared to Hispanics, Non-Hispanic Blacks, and Non-Hispanic Whites from Florida.

Herein, we report the characterization of four cohorts of breast cancer patients including (1) non-Hispanic Whites in Florida, (2) non-Hispanic Blacks in Florida, (3) Hispanics in Florida, and (4) Hispanics in Puerto Rico. Data from female breast cancer patients were collected from cancer registry (n = 9361) and self-reported patient questionnaires (n = 4324). Several statistical tests were applied to identify significant group differences. Breast cancer patients from Puerto Rico were least frequently employed and had the lowest rates of college education among the groups. They also reported more live births and less breastfeeding. Both Hispanic groups reported a higher fraction experiencing menstruation at age 11 or younger (Floridian Hispanics [38%] and Puerto Ricans [36%]) compared to non-Hispanic Whites (20%) and non-Hispanic Blacks (22%). Non-Hispanic Black and Puerto Rican women were significantly older at breast cancer diagnosis than their non-Hispanic White and Floridian Hispanic counterparts. The Puerto Rican and non-Hispanic Black groups more frequently had pathology stage T2 or higher primary breast tumors at diagnosis (non-Hispanic Whites [29%], non-Hispanic Blacks [39%], Floridian Hispanics [33%], Puerto Ricans [46%]). The Puerto Rican (73%, 95% CI [66, 82]) and non-Hispanic Black (79%, 95% CI [75, 84]) groups demonstrate reduced 5-year survival compared to non-Hispanic Whites (89%, 95% CI [86, 92]) and Floridian Hispanics (89%, 95% CI [86, 90]). These findings demonstrate that Puerto Rican breast cancer patients suffer significant breast cancer health disparities relative to non-Hispanic Whites and Hispanics from Florida similar to the disparities observed for non-Hispanic Blacks. Future work must seek to better understand and address these disparities.

Abstract 4145236: Predictors of Mortality Among Hospitalized Patients with Acute Myocardial Infarction by Systemic Lupus Erythematosus Diagnosis

Introduction: Studies have reported on the prevalence, and associations between acute myocardial infarction (AMI) and systemic lupus erythematosus (SLE), but there is limited data on the predictors of mortality and whether these differ among patients with a diagnosis of SLE. We examined the factors associated with mortality among hospitalized patients with a diagnosis of AMI with or without SLE. Hypothesis: Patient and hospital associated factors can predict mortality among hospitalized patients with AMI and these predictors differ by SLE diagnosis Methods: The National Inpatient Sample (NIS) data collected from 2016 – 2020 was utilized to conduct retrospective cohort analyses. Multivariate logistic regression models were used to examine the factors associated with mortality among hospitalized patients with AMI by SLE diagnosis. Results: Among SLE patients with a diagnosis of AMI, being female (AOR: 1.53; 95% CI: 1.02-1.86) and 65 years and above (AOR: 1.65; 95% CI: 1.20-2.74) was associated with higher odds of mortality compared to being male and younger than 65 years. Elective admission (AOR: 0.59; 95% CI: 0.39-0.85) was associated with lower risk of mortality relative to non-elective admission. Of note, non-Hispanic blacks (AOR: 0.68; 95% CI: 0.39-0.98) had lower odds of mortality than non-Hispanic whites. Patients with length of stay greater than 5 days (AOR: 1.75; 95% CI: 1.18-2.59) were more likely to die than those with hospital stay 5 days or less. Higher comorbidity scores were also associated with higher odds of mortality. Among patients without SLE, non-Hispanic blacks (AOR: 1.68; 95% CI: 1.07–2.48) reported higher mortality compared to their non-Hispanic white counterparts. Additionally, being on private insurance (AOR: 0.75; 95% CI: 0.32–0.99) was associated with lower odds of mortality relative to Medicare insurance. Conclusion: Our study highlights patients and hospital related factors that can predict mortality among patients hospitalized with AMI by SLE. Further studies are needed to explore these factors as it will help physicians identify patients that need closer monitoring.

Disparities in Treatment for Alcohol Use Disorder Among All of Us Participants.

The authors examined racial/ethnic and socioeconomic disparities in receiving treatment for alcohol use disorder (AUD). A retrospective cohort study was conducted that included adults (≥18 years) with AUD from the All of Us Controlled Tier database v7. Outcomes were lifetime receipt of FDA-approved medications (disulfiram, acamprosate, and naltrexone), psychotherapy (individual, family, and group-based session), and combination treatment (medication and psychotherapy). The study examined treatment receipt by race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, other), insurance (private, Medicare, Medicare and Medicaid, Medicaid, Veteran Affairs [VA], none), income (<$10K, $10-<$50K, $50-$100K, >$100K), and area deprivation index (ADI) quintiles. Multivariable logistic and multinomial logistic regressions were used to assess the association between patient characteristics and treatment receipt. The cohort consisted of 18,692 patients (mean age=57.1 years; 60.7% were male; 47.1% were non-Hispanic White). Almost 70% received no treatment, 11.4% received medication, 24.0% received psychotherapy, and 4.9% received combination treatment. In adjusted analysis, non-Hispanic Black (aOR=0.78, 95% CI=0.69-0.89) and Hispanic (aOR=0.75, 95% CI=0.64-0.88) individuals were less likely to receive medication than non-Hispanic White counterparts. There was no association between race/ethnicity and receipt of psychotherapy or combination treatment. Compared with private insurance, dual eligibility was associated with less use of medication, Medicare and Medicaid with less use of medication and combination treatment, and VA and no insurance with more use of psychotherapy and combination treatment. Higher income and lower ADI were positively associated with all treatment types. There are disparities in AUD treatment by race/ethnicity, socioeconomic status, and insurance. Systematic approaches are required to improve equitable access to effective treatment.

Assessment of poor cardiovascular health metrics and related disparities among cancer patients in the United States: a nationwide analysis of over 1.5 million individuals

Abstract Background Cancer, a major health challenge and a leading cause of mortality in the United States, significantly impacts cardiovascular health (CVH). The American Heart Association (AHA) emphasizes several CVH metrics to improve health outcomes, yet disparities in CVH persist nationwide. The specific impact of these disparities on the CVH of individuals with cancer, however, has yet to be fully explored. Purpose This study aims to utilize a detailed and nationally representative dataset from the U.S. to assess the prevalence of poor CVH among adults with a cancer diagnosis, focusing on uncovering sociodemographic disparities. Methods We utilized self-reported data from the Behavioral Risk Factor Surveillance System (2011 to 2019). This system, a state-based telephone survey, gathering data on cancer diagnoses, CVH metrics, and sociodemographic characteristics. We measured CVH through a composite score (0-7) based on the AHA’s seven CVH indicators: hypertension, high cholesterol, smoking, body mass index, diabetes, physical activity, and fruits and vegetables consumption. Individuals scoring between 0 and 2 were defined as having poor CVH. Multivariable generalized linear models within a binomial framework was applied to estimate adjusted prevalence ratios (aPRs) for poor CVH among cancer patients. Results Of 1,575,187 U.S. adults (representing an estimated 154.5 million; 50.7% female, 10.9% non-Hispanic black), 7.8% reported a cancer diagnosis between 2011 and 2019. Adjusted* findings show that having cancer (vs without) associated with a 16% higher prevalence of poor CVH (aPR=1.16; 95% CI [1.12-1.19]). Age-specific analysis revealed increased prevalence of poor CVH in middle-aged (45-64; aPR=3.55) and elderly (≥65; aPR=3.58) cancer patients, indicating a 255% and 358% rise, respectively, with p_interaction &amp;lt;0.001. Female cancer patients experienced a 22% lower prevalence of poor CVH than males (aPR=0.78; p_interaction &amp;lt;0.001). Non-Hispanic black cancer patients faced a 42% higher prevalence of poor CVH than their non-Hispanic white counterparts (aPR=1.42; p_interaction=0.001). Higher-income and education levels associated with 52% and 53% reduced prevalence of poor CVH, respectively (p_interaction &amp;lt;0.001; Table). Conclusions Our research identifies a strong correlation between cancer and deteriorating CVH metrics across U.S. adults, with pronounced variations based on sociodemographic factors. Specifically, the prevalence of poor CVH is substantially higher among cancer patients who are middle-aged, elderly, or identify as non-Hispanic Black, compared to other groups. Conversely, female cancer patients and those with a higher socioeconomic status appear to have a reduced risk of poor CVH. These outcomes stress the critical need for targeted, equitable public health initiatives that address both the cardiovascular and broader health needs of cancer patients, particularly among those most vulnerable.Table1