non-Hispanic Whites Research Articles

Pathology driven automation to improve updating documented follow up recommendations in the EHR after colonoscopy

Background: Failure to document colonoscopy follow-up needs post-polypectomy can lead to delayed detection of colorectal cancer (CRC). Automating the update of a unified follow-up date in the electronic health record (EHR) may increase the number of patients with guideline concordant CRC follow-up screening. Methods: Prospective pre-post design study of an automated rules-engine-based tool using colonoscopy pathology results to automate updates to documented CRC screening due dates was performed as an operational initiative, deployed enterprise-wide May 2023. Participants were aged 45-75 who received a colonoscopy November 2022 to November 2023. Primary outcome measure is rate of updates to screening due dates and proportion with recommended follow-up <10-years. Multivariable log-binomial regression was performed [relative risk (RR), 95% confidence intervals (95% CIs)]. Results: Study population included 9,824 standard care and 19,340 intervention participants. Participants had a mean age of 58.6±8.6 years and included 53.4% females, 69.6% non-Hispanic White, 13.5% non-Hispanic Black, 6.5% Asian, and 4.6% Hispanic. Post-intervention, 46.7% of follow-up recommendations were updated by the rules engine. The proportion of patients with a 10-year default follow-up frequency significantly decreased (88.7% to 42.8%, p<0.001). The mean follow-up frequency decreased by 1.9 years (9.3 to 7.4 years, p<0.001). Overall likelihood of an updated follow-up date significantly increased (RR 5.62, 95%CI: 5.30 – 5.95, p<0.001). Conclusion: An automated rules-engine-based tool has the potential to increase accuracy of colonoscopy follow-up dates recorded in patient EHR. The results emphasize the opportunity for more automated and integrated solutions for updating and maintaining EHR health maintenance activities.

Large‐scale deep proteomic analysis in Alzheimer's disease brain regions across race and ethnicity

AbstractINTRODUCTIONAlzheimer's disease (AD) is the most prevalent neurodegenerative disease, yet our comprehension predominantly relies on studies within non‐Hispanic White (NHW) populations. Here we provide an extensive survey of the proteomic landscape of AD across diverse racial/ethnic groups.METHODSTwo cortical regions, from multiple centers, were harmonized by uniform neuropathological diagnosis. Among 998 unique donors, 273 donors self‐identified as African American, 229 as Latino American, and 434 as NHW.RESULTSWhile amyloid precursor protein and the microtubule‐associated protein tau demonstrated higher abundance in AD brains, no significant race‐related differences were observed. Further proteome‐wide and focused analyses (specific amyloid beta [Aβ] species and the tau domains) supported the absence of racial differences in these AD pathologies within the brain proteome.DISCUSSIONOur findings indicate that the racial differences in AD risk and clinical presentation are not underpinned by dramatically divergent patterns in the brain proteome, suggesting that other determinants account for these clinical disparities.Highlights We present a large‐scale proteome (∼10,000 proteins) of DLPFC (998) and STG (244) across AD cases. About 50% of samples were from racially and ethnically diverse brain donors. Key AD proteins (amyloid and tau) correlated with CERAD and Braak stages. No significant race‐related differences in amyloid and tau protein levels were observed in AD brains. AD‐associated protein changes showed a strong correlation between the brain proteomes of African American and White individuals. This dataset advances understanding of ethnoracial‐specific AD pathways and potential therapies.

Abstract 4112716: The Trend In Racial Differences In Mortality Attributed To Congenital Heart Diseases In Infants In The United States From 2005 To 2019

Background: Deaths from congenital heart disease (CHD) in children have been decreasing in the United States. We examined the differences in mortality trends between Non-Hispanic Black (NHB) and Non-Hispanic White (NHW) infants. Methods: We retrospectively analyzed publicly available data from the Centers for Disease Control and Prevention’s Wide-ranging Online Data for Epidemiologic Research (CDC WONDER). The data was obtained from the linked birth/infant deaths from 2005 to 2019. We evaluated all infant deaths up to 1 year of age with the cause of death listed as CHD (International classification of diseases, 10 th revision (ICD-10) codes Q20-Q26 (except atrial septal defect, Q21.1 and patent ductus arteriosus, Q25. CHD infant mortality rate (IMR) was calculated per 100,000 live births. Race was ascertained based on death certificate reporting. Joinpoint regression was used to examine CHD-IMR by year, including stratification by NHB vs NHW, and neonatal vs postneonatal. The difference between NHB and NHW CHD-IMR was ascertained via the Mann-Whitney U test. P<0.05 was considered statistically significant. Results: Out of 60,243,988 live births, there were 19,004 CHD-related infant deaths. The characteristics of the study population are displayed in Table 1. The overall CHD-IMR declined from 36.1 to 27.0 per 100,000 live births (25.2%) with an average annual percentage change (AAPC) of -2.1 [95% CI -2.6, -1.572] (Figure 1). The CHD-IMR was significantly higher in NHB than in NHW (40 vs 29.3; P<0.0001) and this difference remained when the mortality rate was stratified by neonatal and post-neonatal periods. The CHD-IMR decreased significantly in NHW [AAPC: -2%; 95% CI: -2.5, -1.5%], but not in NHB [AAPC of -1.4%, 95% CI, -3.0, 0.3%]. The NHB-to-NHW CHD-IMR ratio, a measure of CHD-IMR disparity averaged 1.4 over the study period [AAPC: 0.8%; 95% CI: -0.2, 1.8%] (Figure 2). Conclusions: The CHD-IMR declined significantly for NHW, but not in NHB in the US from 2005 to 2019. The CHD-IMR was higher in NHB than in NHW. There was no significant change in the NHB-to-NHW CHD-IMR ratio, signifying no change in the disparity that exists between NHB and NHW IMR. These findings may have implications for patient care and public health policymaking. They lay the groundwork for additional studies to determine and understand the drivers behind these findings such as in prenatal diagnosis.

Abstract 4121359: Heart Disease and Heart Failure: Trends and Disparities in Mortality Rates in the United States from 2000 to 2020

Background: The remarkable decline in the overall prevalence and mortality rates of cardiovascular diseases (CVD) in the United States (US) over the past few decades has not been consistent across all age groups, sexes, races, and types of cardiovascular diseases. Heart disease (HD) and heart failure (HF) still pose a significant burden to the healthcare system. Objectives: This study sought to describe the age, sex and racial disparities in the trends in mortality rates for these two outcomes in the US over the past two decades. Methods: This was an ecological study with trend analysis of the mortality from heart disease and heart failure in the US between 2000 and 2020. Data on CVD was obtained from the National Centers for Disease Control and Prevention (CDC) surveillance databases and analyzed. Binomial regression models were used to evaluate trends in outcomes. Statistical significance was considered for p-values < 0.05. Results: There was a significant decrease in the age-standardized mortality for HD over the past two decades (from 343.5 per 100,000 cases to 215.1 per 100,000 cases (p<0.001)). Mortality rates were significantly higher in males (p<0.001, R2 = 0.92), non-Hispanic blacks (p<0.001) and non-Hispanic whites (p<0.001) compared to Hispanics, (R2 = 0.94) and in adults aged 65+ (p<0.001) and 75+ (p<0.001) (R2 = 0.98). There was no significant decrease in the age-standardized mortality for HF (from 26.9 per 100,000 cases to 25.7 per 100,000 cases (p=0.706)) due to a reversal in the trend after 2011. Though the rates were significantly lower in males overall (p=0.001, R2 = 0.27), these rates became higher in males and in non-Hispanic Blacks compared to non-Hispanic Whites beyond 2016. Mortality rates due to HF were highest in the 65+ and 75+ age groups. Conclusions: This study on national trends in heart disease and heart failure across age groups, sexes and races over the past two decades confirmed a significant reduction in heart disease mortality rates over this period, but with persistent disparities between males and females, non-Hispanic Blacks and other races and the older age groups. This study also highlights important reversals of heart failure mortality rates trends in more recent years in males and females, and non-Hispanic Blacks and Whites, the reasons for which are amenable to further research.

Abstract 4137928: Race-Dependent Association of Inflammation and Cholesterol with Cardiovascular Mortality in US Population

Background: Inflammation and cholesterol jointly contribute to cardiovascular disease and mortality. The relative contributions of inflammation and cholesterol to the risk of future cardiovascular events might shift according to pre-existing traits of each individual. Whether the association of inflammation and cholesterol with cardiovascular mortality differ by race remains unclear. Method: We sampled 12,726 participants from NHAENS III who were categorized as non-Hispanic White, non-Hispanic Black or Mexican Americans. In all race groups, we used the Cox proportional hazard regression model to relate log-transformed CRP and LDL-C levels to CVD deaths. All models simultaneously included CRP and LDL-C, and were adjusted for age, current smoking, hypertension, diabetes mellitus, body mass index, lipid-lowering medications, total cholesterol and family income. Results: 12,726 participants (53.4% female, mean age 46.8 ± 19.7 years) including 5648 non-Hispanic White (44.4%), 3484 non-Hispanic Black (27.4%) and 3594 Mexican-American (28.2%) were followed up for a median 26.3 years , and 1905 cardiovascular deaths were documented. After adjusting for cardiometabolic risk factors, per 1 SD increase in log-transformed CRP was associated with 14% (HR 1.14 [95% CI, 1.08-1.21], P < 0.001) and 13% (HR 1.13 [95% CI, 1.04-1.23], P = 0.001) higher risk of CVD mortality in non-Hispanic White and non-Hispanic Black respectively, while the association was neutral in Mexican American. Notably, per 1 SD increase in LDL-C was not associated with CVD mortality in all race groups (P > 0.05 for all). Conclusion: After a follow up of median 26.3 years, we found that, in non-Hispanic White and Black individuals, but not in Mexican American, inflammatory was a stronger predictor of cardiovascular mortality, compared to cholesterol.

Abstract 4144521: Racial disparities in heart transplantation: long term graft survival and non-mortality outcomes

Background: There is conflicting evidence on whether racial disparities still exist in heart transplant (HT) outcomes, with prior studies focusing primarily on differences in short-term mortality. We examined disparities in HT survival over a longer follow-up duration alongside a broader range of post-HT outcomes. Methods: Using the United Network for Organ Sharing (UNOS) database, we evaluated adult HT recipients between 2017 and 2022 and classified each according to race as either Black, non-Hispanic White and Other. The primary outcome was graft survival and secondary outcomes included rejection, renal dysfunction, and post-transplant diabetes. Chi-squared tests were used to compare baseline clinical factors and selected outcomes by racial group. Kaplan-Meier and Cox proportional hazards analyses were performed to compare risks of the primary outcome by race. Results: Among 15,873 recipients (63% non-Hispanic White, 23% Black, 14% Other), Black recipients were more often female, less often college educated, and more often had public (vs. private) insurance. Blacks had higher use of durable ventricular assist devices (VAD) and intra-aortic balloon pump (IABP) at the time of HT. Graft survival at one year did not differ by race (91.8% for Blacks vs. 91.1% for non-Blacks), but at three years was significantly lower for Blacks (83.4%) than non-Blacks (85.7%). Blacks had higher risk of graft failure after adjustment for baseline socioeconomic status (SES) and clinical variables (HR 1.28, CI 1.17 - 1.41). Blacks also had significantly higher prevalences of acute rejection (12.4% vs. 10.2%), diabetes (10.8% vs. 7.1%), and progression of renal dysfunction at 3-years post HT (40.9% vs. 37.1%; p < 0.05 for all). Conclusions: Racial disparities in graft survival after HT remain in the contemporary era but are only evident after longer-term follow-up. These survival disparities could be mediated by concurrent disparities in shorter term outcomes such as development of acute rejection, chronic kidney disease, and new onset diabetes.

Abstract Su703: Racial/Ethnic Disparities in Bystander Cardiopulmonary Resuscitation after Witnessed Out-of-Hospital Cardiac Arrest: A NEMSIS Database Study

Introduction: Out of hospital cardiac arrest (OHCA) is a leading cause of death in the United States, with upwards of 360,000 OHCAs annually. Receiving bystander cardiopulmonary resuscitation (CPR) almost doubles an individual’s odds of survival compared to those who don’t receive bystander CPR. Unfortunately, in the US, bystander application of CPR only occurs in 40% of OHCA. Improving the rate of bystander CPR and AED use will improve survival rates for OHCA. Minoritized populations experience worse outcomes from OHCA. Compared to non-Hispanic whites, they are less likely to survive to hospital discharge. A cross-sectional study of witnessed OHCA patients found that Black and Hispanic patients had lower rates of bystander CPR. Less is known about disparities in care for Asian American persons who experience OHCA. Studies using the Resuscitation Outcomes Consortium Epidemiologic Registry (ROC) and the Cardiac Arrest Registry to Enhance Survival (CARES) have concluded discrepant results, with ROC finding that Asian Americans were less likely to receive bystander CPR and CARES finding that they were just as likely to receive bystander CPR compared to non-Hispanic Whites. To that end, we sought to evaluate the association between bystander CPR and Asian race after witnessed OHCA. Objective: To evaluate the association between race/ethnicity and the odds of receiving bystander cardiopulmonary resuscitation (bCPR) after witnessed out-of-hospital cardiac arrest (OHCA). Methods: Data were obtained from the National Emergency Medical Services Information System (NEMSIS) database for adults (≥18 years) with a witnessed non-traumatic OHCA in the year 2022. Patients were separated into two groups: Non-Hispanic White and Asians. The primary outcome was the odds of receiving bCPR. Exclusions included traumatic etiology, do-not-resuscitate orders, and arrests witnessed by healthcare providers. Pearson’s chi-square test was used to test significance. Results: A total of 73,215 witnessed OHCA activations were included in this study. Overall, bystander CPR rates were lower for the Asian group (59.8%) compared to the Non-Hispanic White group (65.0%). Pearson’s chi-square test showed a statistically significant difference between the bCPR rates of the Asian group and Non-Hispanic White group, with a p-value of less than 0.001. Conclusion: Racial/ethnic disparities exist for Asian individuals in the odds of receiving bCPR after a witnessed non-traumatic OHCA.

Abstract 4133488: Persistent Disparities in Chronic Ischemic Heart Disease-Related Mortality across Age, Sex, Race/Ethnicity in the United States, 1999 - 2020

Background: Chronic Ischemic Heart Disease (CIHD) is a heterogeneous group of cardiac diseases that cause significant morbidity and mortality. Previous studies demonstrated a decline in CIHD mortality rate (MR) but there is paucity of data on contemporary trends across different demographics in the United States (US). We examined the national trends in age-adjusted CIHD-MR (overall and stratified by demographics) in the US from 1999 to 2020. Methods: We retrospectively analyzed national death certificate data from the CDC WONDER database from 1999 to 2020. The underlying cause of death from CIHD was identified with ICD-10 code I25 in adults aged ≥35 years and the age-adjusted mortality rate was calculated per 100,000 population. We categorized race/ethnicity as Non-Hispanic White (NHW), Non-Hispanic Black (NHB), Latino or Hispanic, and other non-Hispanic groups. Trends in age-adjusted CIHD-MR (AAMR) were analyzed by age, gender, race/ethnicity, and geographic region were evaluated with Joinpoint regression, and expressed as an average annual percentage change (AAPC) with a 95% confidence interval. For sensitivity analysis, we repeated the study with data from death certificates that had CIHD as a contributing cause of death. Results: Out of 3.55 billion people aged ≥ 35 years, 5,985,088 died of CIHD (AAMR: 158.2 per 100, 000) [53.9% male, 81.6% NHW, 38.8% ≥85 years]. The AAMR was highest in males, the Northeast region, and NHB (Table 1). The AAMR was highest in those aged ≥85 years and was directly related to age (35-44 years: 8.3 per 100,000; ≥85 years: 1,943 per 100,000). The CIHD AAMR declined significantly overall in males, all races/ethnicities, and geographical areas (Table 1). Reanalysis (Sensitivity analysis) with any mention of CIHD as a contributing cause of death showed similar trends. Conclusion: Over the 22 years, CIHD-related mortality in the US has declined overall and for almost all demographic groups. However, there are age, gender, and racial disparities in the CIHD AAMR. These findings highlight the need for further longitudinal studies to understand the drivers of these disparities and for focused public health interventions to improve CIHD mortality outcomes in these populations.

Abstract 4137810: Association of Sociodemographic Characteristics on Costs of Care in Patients with Obstructive Hypertrophic Cardiomyopathy

Introduction: No evidence exists on the impact of sociodemographic characteristics on costs of care for obstructive hypertrophic cardiomyopathy (oHCM). Therefore, we evaluated 5-year cumulative costs by age, sex, and race/ethnicity. Methods: Retrospective cohort study of adults diagnosed with oHCM (January 2013 to December 2021) using Optum claims and electronic medical record data. Patients with ≥2 claims for HCM (ICD-9 and-10) at least 30 days apart (index date = earliest oHCM claim) with ≥1 additional oHCM claim or septal reduction therapy, 6-months pre-index and 5-year post-index continuous enrollment were included. HCM-related cumulative costs (2022 CPI adjusted) were reported for medical (ambulatory [AB]: office [OV] visits, outpatient [OP] visits); emergency room [ER] visits; inpatient admissions (IP); and pharmacy (Rx). Results: Among 5,129 patients with oHCM, 52% were female (mean age 63.9 ± 14.3 years; 77.6% non-Hispanic White; 40% Medicare). Compared to females (Table), male patients had greater costs including total ($71,581 vs $63,710, p= 0.014), medical ($70,395 vs $62,455, p= 0.013), ambulatory ($16,024 vs $10,776, p<0.001), OV ($1,906 vs $1,573, p<0.001), and OP ($14,118 vs $9,202, p<0.001). Compared with White patients, Black patients had significantly greater IP costs ($54,572 vs $42,686, p= 0.01), Hispanic patients had greater ER costs ($1,724 vs $791, p<0.001), and Asian patients had greater OV costs ($2,094 vs $1,800, p<0.001). Patients aged 18-39 years had greater costs across all categories (p<0.001; IP=NS), except Rx. Patients aged 40-54 years had the highest Rx costs ($1,557, p<0.001), followed by 18-39, 55-64, 65-74, 75+ years ($1,528; $1,329; $1,197; $867), respectively. Conclusions: For oHCM patients , being male and age 18-39 years was associated with increased HCM-related healthcare costs. Differences in cost across race/ethnicity exist, including greater IP and ER costs for Black and Hispanic patients, respectively. Future research is required to understand the source of these differences among oHCM patients.

Abstract 4136977: Childhood Food Security and Cardiometabolic Health in Young Adulthood

Background: Food insecurity is associated with adverse cardiometabolic health in adults. To understand the early, long-term impact of food insecurity, we examined the associations of food insecurity in childhood with young adult cardiovascular-kidney-metabolic (CKM) syndrome stage and suboptimal cardiovascular health (CVH), and the modifying effects of participation during childhood in the Supplemental Nutrition Assistance Program (SNAP). Methods: In the Future of Families and Child Wellbeing Study of individuals enrolled at birth (1998-2000) and followed through age 22 years (2020-24) across 20 US cities, the associations of household food insecurity during childhood (age 3-5 years; score ≥1 on the US Household Food Security Survey) with CKM stage (0 [reference], 1, 2, or 3/4) and Life’s Essential 8 CVH score (high 80-100 [reference], intermediate 50-79, low 0-49) at age 22 years were evaluated with adjusted multinomial logistic regression. The interactions of food insecurity and SNAP participation, and food insecurity and race, were evaluated. Results: Among 1,071 participants, 53% were female; 53% non-Hispanic Black, 25% non-Hispanic White, 18% Hispanic; 39% lived in households with food insecurity, and 44% participated in SNAP. Food insecurity was associated with higher odds of being in CKM Stage 1 (aOR 1.41 [95% CI: 1.02-1.93]) and Stage 3/4 (aOR 1.78 [95% CI 1.11-2.83]) compared with Stage 0 at year 22 (Table). Food insecurity was also associated with having intermediate vs. high CVH in young adulthood (aOR 1.46 [95% CI 1.04-2.06]). SNAP participation modified the association of food insecurity and CVH; ffood insecurity was more strongly associated with intermediate vs. high CVH among those who did not participate in SNAP (aOR 2.37 [95% CI 1.39-4.04]) compared to those who were SNAP participants (aOR 0.79 [95% CI 0.46-1.35]) in childhood. There was no significant interaction of food insecurity and race for either outcome. Conclusions: Childhood food insecurity is associated with worse cardiometabolic health in young adulthood, especially among children whose families did not participate in SNAP. Policies to promote food security in children may promote cardiometabolic health across the life course.

Abstract 4125533: Demographic Trends and Disparities in Mortality Related to Coexisting Heart Failure and Diabetes Mellitus Among Older Adults in the United States: A Large Database Analysis from 1999 to 2020

Background: In the United States, over 38 million people have diabetes mellitus (DM) and more than 6 million have heart failure (HF). DM and HF often coexist, and each condition independently increases the likelihood of developing the other. Approximately 40% of individuals with HF also have DM, and this prevalence is even higher among older adults and hospitalized patients. While there has been concern regarding the increasing burden of disease for both conditions individually over the last decade, a comprehensive examination of mortality trends associated with their coexistence has not been thoroughly explored. Methods: This study analyzed death certificates from the CDC WONDER database, specifically focusing on mortality caused by the simultaneous presence of HF and DM among individuals aged 75 years and older. The data covers the period from 1999 to 2020. Age-adjusted mortality rates (AAMRs) per 100,000 individuals and annual percent change (APC) were computed and categorized based on year, gender, and race/ethnicity. Results: Between 1999 and 2020, a total of 663,016 deaths were reported in patients with coexisting HF and DM. Overall, AAMR increased from 154.1 to 186.1 per 100,000 population between 1999 and 2020, with an initial increase from 1999 to 2005 (APC: 0.80; 95% CI: -0.17 to 2.94), a significant decline from 2005 to 2011 (APC: -2.82; 95% confidence interval (CI): -5.47 to – 1.71), a subsequent increase from 2011 to 2018 (APC: 0.61; 95% CI: -0.59 to 2.18), and finally a steep increase from 2018 to 2020 (APC: 11.30; 95% CI: 6.98 to 14.11). Gender-based analysis revealed that older men had consistently higher AAMRs than older women (Men: 185; 95% CI: 184.3 to 185.6; vs Women: 135.4; 95% CI: 135 to 135.8). Furthermore, we found that AAMRs were the highest among non-Hispanic American Indian or Alaska natives (214.4; 95% CI: 207.5 to 221.4) followed by non-Hispanic African Americans (179.9; 95% CI: 178.5 to 181.4), Hispanics (159.5; 95% CI: 158 to 161.1), non-Hispanic White (152.9; 95% CI: 152.5 to 153.3), and non-Hispanic Asian or Pacific Islander populations (104.1; 95% CI 102.4 to 105.8) (Figure 1). Conclusion: The mortality rate due to coexisting HF and DM has increased in the elderly population over the past decade. Males and non-Hispanic American Indians or Alaskan Natives had the highest AAMRs in our study.

Abstract 4133161: Variation in Prevalence, Treatment, and Outcomes in Heart Failure with Improved Ejection Fraction by Race and Ethnicity

Background: Racial and ethnic disparities exist in heart failure with reduced ejection fraction (HFrEF), but little is known about how race and ethnicity relate to patients with HF with improved EF (HFimpEF). Research Question: Do the epidemiology, treatment, and outcomes vary by race and ethnicity in patients with HFimpEF? Aim: To describe the relationship between race and ethnicity and HFimpEF within a large, integrated health care delivery system. Methods: We identified adults aged ≥18 years with incident HFrEF (LVEF≤40%) from 2013-2018 within Kaiser Permanente Northern California. HFimpEF was defined as LVEF>40% within 12 months after incident HFrEF. Self-reported race and ethnicity were classified as non-Hispanic White, non-Hispanic Black, Asian American/Native Hawaiian/Pacific Islander (AANHPI), Hispanic, and other. Incidence rates of worsening HF (WHF) events (i.e., HF hospitalization, ED visit, or urgent outpatient WHF visits) or all-cause death were compared across patients with HFimpEF and persistent HFrEF using Cox proportional hazard models adjusted for age, sex, and LVEF at incident HFrEF, stratified by race and ethnicity. Results: Among 12,639 adults with incident HFrEF, 7,562 (59.8%) were White, 1,481 (11.7%) were AANHPI, 1,385 (11.0%) were Black, and 1,537 (12.2%) identified as Hispanic. Rates of HFimpEF following incident HFrEF was lowest among Black patients (26%), but similar among other race and ethnicities (36%, 34%, 30%, and 30% for AANHPI, White, Hispanic, and other, respectively, chi-squared p<0.01). Medication use was similar across groups at time of HFimpEF, but generally declined thereafter (Panel A) . Among patients with HFimpEF, Black and Hispanic patients had significantly higher crude rates of WHF or death compared to White patients (34 and 30 compared to 23 per 100 person-years, p<0.01 for each). Despite these differences in absolute rates, relative associations between HFimpEF (vs. persistent HFrEF) and WHF or death remained similar across all race and ethnicities (AANHPI: aHR=0.52 [95%CI 0.42-0.65], Black: aHR=0.70 [95%CI 0.56-0.87], Hispanic: aHR=0.60 [95%CI 0.49-0.73], White: aHR=0.53 [95%CI 0.48-0.58], p interaction =0.13) (Panel B) . Conclusions: HFimpEF is common within 12 months after incident HFrEF, and HF medication adherence declines in the years following. HFimpEF is associated with improved clinical outcomes across race and ethnicity, but occurs less frequently in Black patients despite similar HF medical therapy use.

Abstract 4134863: Major Cardiovascular Events Following Non-Cardiovascular Surgeries in Minority Patients Compared to White Patients

Introduction: Racial disparities are pervasive in cardiovascular outcomes. Although disparities following cardiovascular surgery have been extensively studied, fewer current, nationwide reports exist for postoperative outcomes in non-cardiovascular surgery. Research Aim: To investigate the incidence of 30-day post-operative major adverse cardiac, cerebral and thrombotic events (MACCTE) following non-cardiovascular surgeries in non-White patients as compared to White patients. Methods: This retrospective cohort study used the 2018-2022 National Surgical Quality Improvement Program database. Patients aged 18 or older who underwent non-cardiovascular surgeries (general, gynecology, neurosurgery, orthopedics, otolaryngology, plastics, thoracic, urology, obstetrics, and interventional radiology) were included. Race/ethnicity was categorized as non-Hispanic White (Whites), Hispanic, non-Hispanic Asian (Asians), non-Hispanic Black or African American (Blacks), and non-Hispanic Others. MACCTE was defined as a composite of death, MI, cardiac arrest, stroke, PE, or DVT. Five multivariable logistic regression models were used to hierarchically adjust for age, gender, ASA class, surgical subspecialty, operation time, transfer status, and all other comorbidities. Results: Among the 3,775,920 patients: 70.9% were Whites, 11.8% Hispanics, 4.1% Asians, 11.6% Blacks, 1.5% of Other race, 58.9% female, and 46.7% had an ASA classification of 3 or greater. The MACCTE incidence was 1.95% overall and 2.01% in Whites, 1.27% Hispanics, 1.48% Asians, 2.11% Blacks, and 1.69% Others. Compared to Whites, Blacks had higher incidences of cardiac arrest (0.40% vs. 0.23%), stroke (0.17% vs. 0.15%), PE (0.47% vs. 0.34%), and DVT (0.55% vs. 0.48%), and Asians (0.18% vs 0.15%) and Others (0.21% vs. 0.15%) had a higher incidence of stroke (p<0.001). With Whites as reference, the crude odds ratios, OR (95% CI) were 0.63 (0.61-0.65) in Hispanics, 0.73 (0.70-0.76) Asians, 1.05 (1.03-1.07) Blacks, and 0.84 (0.78-0.89) Others. The fully adjusted model odds ratios, OR (95% CI) were 0.88 (0.82-0.95) Hispanics, 0.89 (0.80-1.00) Asians, 1.11 (1.04-1.18) Blacks, and 0.80 (0.69-0.94) Others. Conclusion: Black patients experienced a higher MACCTE risk compared to Whites, even after adjustment for age, sex, ASA class, type of surgical procedure, and other comorbidities. These findings emphasize the importance of implementing comprehensive measures to prevent excess risk and promote equitable surgical care.

Abstract 4123530: Disparities in Hypertension Treatment Intensification among Adults in a Large United States Healthcare System

Background: There are racial/ethnic and socioeconomic status (SES) disparities in hypertension control, even in populations with regular care. It is unclear if clinical inertia by clinicians contributes to these disparities. Objectives: To quantify racial/ethnic and SES disparities in treatment intensification (TI) among adults with hypertension. Methods: We performed a retrospective cohort study using electronic health records from Johns Hopkins primary care practices from January 2018 to December 2022. We included non-Hispanic Black (Black) and non-Hispanic White (White) adults with at least 2 elevated blood pressure readings (>=140/90 mm Hg) in the 12 months prior to the index primary care visit and a diagnosis of essential hypertension. We excluded patients with diagnoses of end-stage renal disease, liver disease, dementia, and metastatic solid tumor. Patients could contribute multiple index visits. We measured SES using the national Area Deprivation Index, which comprises 17 neighborhood-level SES indicators, and dichotomized the population into high and low median SES groups. We defined TI as a change in antihypertensive class or dose increase within 14 days of the index visit. We balanced covariates reflecting clinical need at the index visit (age, sex, blood pressure readings, cardiometabolic comorbidities, body mass index) and the index visit’s calendar time across racial/ethnic and SES groups using inverse probability weighting. We estimated annual race/ethnic and SES specific TI rates and risk difference measures of disparity with 95% confidence intervals (CI) using a clustered bootstrap. Results: The cohort included 25,287 patients (11,800 Black, 13,487 White) with 79,898 eligible visits. Black patients were more often younger, female, and residing in low SES areas compared to White patients. In 2018, TI rates for Black patients (37%, 95% CI: 36-38%) were slightly lower than rates for White patients (39%, 95% CI: 38-40%). In 2022, the disparity persisted, with the Black patients’ TI rate lower by 3% (95% CI: -5%, -1%). Similarly, low SES patients had lower TI rates than high SES patients by 2% to 3% over the study period. Conclusion: Black patients and those from low SES consistently had modestly lower rates of TI compared to White patients and those from high SES. It will be important to identify the drivers and clinical implications of these treatment disparities.

Abstract 4137737: Demographics and Factors Influencing Mortality Among Cardiac Angiosarcoma Patients: An Analysis of the SEER Database

Background and Aims: Cardiac angiosarcoma is a rare and highly aggressive cancer originating from the endothelial cells lining the heart. It accounts for approximately 30% of all primary cardiac tumors. Given its aggressive nature and poor prognosis, it is critical to enhance our understanding of its epidemiology and the factors influencing mortality. Methods: The Surveillance, Epidemiology, and End Results (SEER) database was utilized to gather data spanning from 2000 to 2021 using the International Classification of Diseases for Oncology (ICD-O-3), anatomical codes (C38.0-Heart), and histological code 9120. Results: We identified 194 patients with cardiac angiosarcoma, of which 102 were males and 92 were females. The majority of patients were aged 50 years or younger (59%). Non-Hispanic whites constituted the largest group (56%), followed by non-Hispanic blacks (18%), and Hispanics (16%). Mortality data showed that 91% of the diagnosed patients died (n=176), with a mean survival period of 15 months after diagnosis. The overall survival rate at 1 year was 0.461 (95% CI: 0.39-0.53), at 3 years was 0.09 (95% CI: 0.05-0.14) and at 5 years was 0.052 (95% CI: 0.03-0.10). Advanced age (51-70 years) compared to the 0-50 year age group (HR: 0.57; 95% CI: 0.003-1.14; p=0.049), distant stage (HR: 0.91; 95% CI: 0.01-1.83; p=0.047), patients who did not receive therapeutic radiation therapy compared to those who did (HR: 2.69; 95% CI: 0.10-5.28; p=0.042), and patients who did not undergo surgical resection for angiosarcoma compared to those who did (HR=1.232; 95% CI: 0.69-1,77; p<0.001) were factors associated with increased mortality. Female gender (p=0.248, as compared to males), different races of non-Hispanic White (p=0.849), non-Hispanic Black (p=0.34), non-Hispanic Asian or Pacific Islander (p=0.24), as compared to Hispanics, tumor sizes of 6-10 cms (p=0.957), or more than 10 cm (p=0.273), as compared to < 5 cm, grade of tumor (III; p=0.682, and grade IV; p=0.281, as compared to grade I), median household income of more than 65000 USD (p=0.069) as compared to less than that, and no chemotherapy (p=0.851) compared to those that received chemotherapy, were not associated with a significant increase in mortality. Conclusions: Cardiac angiosarcoma is associated with a high mortality rate. Factors contributing to increased mortality include advanced age, distant stage of disease at diagnosis, not receiving radiation therapy, and not undergoing surgical resection.

Abstract 4127417: Trends in Atherosclerotic Cardiovascular Disease Related Mortality Among Older Adults in the United States From 1999-2021

Background: Atherosclerotic cardiovascular disease (ACVD) is the leading cause of mortality in the U.S, and increasing age is one of the greatest risk factors for the development and prognosis of ACVD. However, ACVD-related mortality trends in older adults have not yet been established. Aims: This study aims to highlight the annual trends and demographic differences in ACVD-related mortality among older adults in the U.S. from 1999 to 2021. Methods: The CDC WONDER multiple-cause of death database was examined from 1999 to 2021 for ACVD-related mortality in adults >65 years of age. Age-adjusted mortality rates (AAMRs) per 100,000 persons was calculated. Trends and annual percent changes (APCs) were calculated, and subsequently stratified by overall, sex, race/ethnicity, urbanization status, and census region. Results: Between 1999 and 2021, 9,307,495 ACVD-related deaths occurred among older adults in the U.S. AAMRs decreased from 1370.7 in 1999 to 803.5 in 2014 (APC, -3.64 [-3.89 to -3.46]), after which it gradually decreased to 741.3 in 2019 (APC, -1.24 [-2.54 to 0.19]), and then increased to 841.5 in 2021 (APC, 7.00 [3.92 to 9.18]). Men had consistently higher AAMRs than women from 1999 (AAMR men: 1754.1 vs women: 1122.2) to 2021 (AAMR men: 1169.6 vs women: 599.6). Non-Hispanic (NH) Black or African American older adults had the highest AAMR in 2020 (886.1), followed by NH White (849.4), NH American Indian/Alaska Native (752.5), Hispanics or Latino (718.3) and NH Asian or Pacific Islanders (494.4). AAMR also varied substantially by region (overall AAMR until 2020: Midwest 875.1; South 872.2; Northeast 801.0; West 789.2), and rural areas had higher ACVD-related mortality (993.5) than urban regions (954.7). Figure 1. Conclusion: Following a progressive decrease until 2019, ACVD-related mortality in U.S. older adults demonstrated a sharp increase in mortality in 2020 and 2021. The highest AAMRs were observed among Black or African American adults and men, and among patients living in the Midwestern and non-metropolitan areas. A targeted approach, with tailored strategies is required to counter the recent surge in ACVD-related mortality in older adults in the U.S.

Abstract 4128457: Trends in Hypertension-Related Mortality Among Younger Adults in the United States From 1999-2021

Background: The U.S. population has seen a dramatic increase in the burden of hypertension (HTN) among younger adults. However, HTN-related mortality trends among younger adults have not been investigated. Aim: We examined the trends and demographic differences in HTN-related mortality among younger adults in the U.S. Methods: Data from the CDC WONDER database was examined from 1999 to 2021 for HTN-related mortality in adults between 15 to 45 years of age. The International Statistical Classification of Diseases and Related Health Problems-10th Revision (ICD-10) codes employed were as follows: I10-I15 (hypertensive diseases). Age-adjusted mortality rates (AAMRs) per 100,000 persons and annual percent changes (APCs) with 95% confidence intervals (CIs) were calculated and stratified by year, sex, race/ethnicity, urbanization status and census region. Results: Between 1999 and 2021, 201,860 HTN-related mortalities occurred among younger adults in the U.S. The AAMR increased from 2.8 in 1999 to 5.0 in 2001 (APC, 35.3 [20.6 to 44.5]), after which it steadily increased to 9.4 in 2019 (APC 3.1, [2.7 to 3.5]), and sharply increased to 13.9 in 2021 (APC 22.3; 95% CI 15.1 to 26.4). Men had consistently higher AAMRs than women from 1999 (AAMR men: 3.6 vs women: 1.9) to 2021 (AAMR men: 18.9 vs women: 8.8). Non-Hispanic (NH) Black or African American young adults had the highest AAMR in 2020 (30.2), followed by NH American Indian/Alaska Natives (29.6), NH White (9.9), Hispanics or Latino (9.3) and NH Asian or Pacific Islanders (5.0). AAMR also varied substantially by region (overall AAMR: South 9.3; Midwest 6.4; West 5.8; Northeast 5.4), and rural areas had higher HTN-related mortality (8.5) than their urban counterparts (7.0). Figure 1. Conclusion: Following a steady increase until 2019, HTN-related mortality increased among young adults between 2020 and 2021. The highest AAMRs were observed among men and Black or African American young adults, and people residing in the Southern and non-metropolitan areas. This emphasizes the necessity of tailored interventions to mitigate the burden and reduce the current disparities in HTN-related mortality among young adults in the U.S.

Abstract 4120469: Racial and ethnic disparities in catheter based interventions vs. open heart surgery in congenital heart disease

Introduction: Transcatheter cardiac interventions have emerged as a viable alternative to open heart surgery for specific congenital heart disease lesions. There is literature to support racial and ethnic disparities in medicine, indicating that patients from racially and ethnically marginalized populations are less likely to receive advanced less invasive procedures. This study seeks to delve into the existence of such inequities between transcatheter and surgical interventions, shedding light on potential inequalities in access and outcomes. Methods: We analyzed California and Florida's State Inpatient and Ambulatory Surgery Databases from 2005 to 2017 to study patients under 18 admitted with diagnosis of atrial septal defect, pulmonary stenosis, aortic stenosis, and ventricular septal defects. Multivariable logistic regression, adjusted for patient characteristics, assessed race and ethnicity's influence on procedure type and in-hospital mortality. We also used log-transformed linear regression to examine associations with length of stay, hospitalization cost, and cost per day. Results: We identified 13,771 records who had open surgeries, and 2,045 records who had CBI. Compared to non-Hispanic White patients, Black patients were significantly more likely to undergo open surgical procedures (adjusted Odds Ratio [aOR] 1.49, p < .001). Additionally, Black, Hispanic, and other race patients had higher risks of in-hospital death (aOR 1.92, p = 0.016 for Black; aOR 1.93, p < 0.01 for Hispanic; aOR 2.37, p < 0.01 for other races). Black and Hispanic patients also experienced longer lengths of stay (Adjusted Means Ratio [aMR] 1.34, p < 0.01 for Black; aMR 1.16, p < 0.01 for Hispanic), and higher costs (aMR 1.12, p = .01 for Black; aMR 1.11, p = .01 for Hispanic), but Black patients had a lower cost per day (aMR 0.96, p = .02). Conclusion: Racial and ethnic gaps persist in pediatric cardiac care, with Black patients facing reduced access to less invasive procedures, higher mortality rates, longer hospital stays, and increased costs compared to non-Hispanic whites. However, the higher costs are likely attributed to longer hospital stays rather than expensive interventions. It is imperative to tackle these disparities to prioritize patient-centered care and streamline resource allocation in healthcare.

EPID-31. IMPACT OF THE COVID-19 PANDEMIC ON THE UTILIZATION OF STEREOTACTIC RADIOSURGERY AMONG RACIAL MINORITIES DIAGNOSED WITH BRAIN METASTASES

Abstract OBJECTIVES Brain metastases (BM) is the most common form of adult brain tumors and one of the devastating consequences of cancer. Stereotactic radiosurgery (SRS) is an established and effective treatment for oligometastatic BMs. We examined how COVID-19 pandemic impacted clinical utilization of SRS in BM treatment and generalize such impact to outpatient care for patients with all cancer types. METHODS Three national-scale datasets were used: National Cancer Database (NCDB,N=5,238), the National COVID Cohort Collaborative database (N3C, N=13,106 for BM, N=203,706 for all cancer types), and SEER. Multivariable logistic regression models were performed to determine whether the pandemic affected clinical utilization of SRS in BM treatment and chemotherapy initiation for all cancer types. RESULTS Prior to 2019 (pre-pandemic), we observed no racial disparity in the odds of receiving SRS between non-Hispanic white (NHWs) and non-Hispanic black (NHBs) BMs in both NCDB and N3C. Between 2020 and 2021 (pandemic), however, NHBs were significantly less likely to receive SRS comparing to NHWs in both NCDB (NHB:aOR-0.77,p=0.002) and N3C (NHB:aOR-0.78,p<0.001). In SEER, the age-adjusted incidence rate of BM remained unchanged when comparing pre- and post-pandemic periods. Further substantiating the impact of COVID-pandemic on racial disparity in outpatient care for all cancer patients, we showed that NHB patients were more likely to receive delayed chemotherapy (>60 days since diagnosis of cancer) compared to NHWs during the pandemic (aOR-1.10, p<0.001), but such association was not detected before pandemic. Ratio of odds ratio (ROR) analysis confirmed that NHB patients comparing to NHWs during pandemic experienced 1.11-fold difference in the odds of delayed chemotherapy between NHBs and NHWs before pandemic [ROR=1.11, p<0.001]. CONCLUSION Racial disparity in SRS-receipt for BM patients has been exacerbated during COVID-19 pandemic and such impact could be generalized to outpatient care for all cancer types. Understanding the determinants giving rise to this disparity should augment the readiness of our cancer care infrastructure in anticipation of future pandemics or other public health crises.

DISP-01. FACTORS AFFECTING POST-ABLATION OUTCOMES AND TRIAL ENROLLMENT IN DIVERSE PATIENTS UNDERGOING LASER INTERSTITIAL THERMAL THERAPY

Abstract BACKGROUND Laser interstitial thermal therapy (LITT) is a surgical treatment for progressive brain metastases (BM) following stereotactic radiosurgery (SRS). Although LITT has been increasingly accepted, little is known regarding factors influencing presentation and outcomes of patients with diverse backgrounds. METHODS Retrospective review of all patients receiving their index LITT treatment for BM at a single center from 2015 – 2023. Patient demographics and geospatial data was used to compare differences in receipt of LITT by race or ethnicity, survival outcomes, and clinical trial enrollment. RESULTS From 2015-2023, 137 patients presented for LITT to 146 intracranial lesions. One hundred and six patients (77.3%) were non-Hispanic White (NHW), while among Hispanic or non-White (HNW) patients, 25 (18.2%) were Black or African American, 5 (3.6%) were Asian American, and 1 (0.7%) was Hispanic/Latino. Among HNW patients, women more frequently received LITT (p = 0.022), with skin cancers being a more frequent indication among NHW patients (P = 0.019). NHW patients traveled a median of 62.0 (6.2 – 1045.9) miles to receive LITT vs 25.9 (1.31 – 238.3) miles for HNW patients (p = 0.001). Length of stay, discharge location, or readmission rates did not differ between groups. In multivariate analyses, probability of clinical trial enrollment was less among those of female sex (P = 0.049), HNW race/ethnicity (P = 0.041), or external referral status (P = 0.035), while post-LITT overall survival was predicted by pre-LITT KPS (P = 0.0007) and recurrent tumor on biopsy (P = 0.0002). CONCLUSIONS Differences in presentation for LITT by race or ethnicity may be influenced by underlying patient factors, including sex, systemic disease histology, and distance from a treating center, which do not influence post-LITT procedural outcomes or survival. Accordingly, clinical trial enrollment should be prioritized for vulnerable patient populations to realize the full benefits of laser ablation.