Outcomes In African American Patients Research Articles

Metabolic and Bariatric Surgery Outcomes in African American Patients: a Single Institution Experience.

The incidence of obesity in African Americans (AAs) is higher than in non-AA in the USA. Previous studies using large national databases report that AA patients have worse outcomes than non-AA patients. To assess perioperative outcomes among AA patients after MBS at a center of excellence (COE) that serves a large, diverse patient population. University Hospital METHODS: A retrospective analysis was performed on patients undergoing MBS between 2010 and 2020 at our two accredited MBSAQIP (Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program) COEs where the AA population makes up over 35% of the population. Preoperative variables were compared using unpaired t-test or chi-squared test where appropriate. Thirty-day outcomes were compared following propensity score matching (exact algorithm) of demographics and comorbidities. Overall, 5742 patients (AA = 2058, 36%) had Roux-en-Y gastric bypass (AA = 1028, 26%) or sleeve gastrectomy (AA = 1030, 27%). AA patients were more often female (90.2% vs. 80.2%, p < 0.001) and had higher rates of hypertension (56.3% vs. 47.8%, p < 0.001), while non-AA patients had higher rates of hyperlipidemia (27.3% vs. 20.7%, p < 0.001) and obstructive sleep apnea (41.2% vs. 37.1%, p = 0.0024). Matched data showed that AA patients had higher rates of pulmonary embolism (PE) (0.3% vs. 0.1%, p = 0.020) and more emergency department visits (7.0% vs. 5.1%, p = 0.012) but no differences in mortality, readmission, reintervention, or reoperation rates. In a diverse area, AA patients who underwent MBS had similar perioperative outcomes compared to non-AA patients except that they experienced higher rates of PE. They also experienced higher rates of emergency department visits but had similar readmission rates.

A novel role for KIFC1-MYH9 interaction in triple-negative breast cancer aggressiveness and racial disparity

African American (AA) women are twice as likely to develop triple-negative breast cancer (TNBC) as women of European descent. Additionally, AA women with TNBC present a much more aggressive disease course than their European American (EA) counterparts. Thus, there is an unmet clinical need to identify race-specific biomarkers and improve survival outcomes in AA patients with TNBC. The minus-end directed microtubule motor protein kinesin family member C1 (KIFC1) promotes centrosome clustering and chromosomal instability and is often overexpressed in TNBC. Previous findings suggest that KIFC1 plays a role in cell proliferation and migration in TNBC cells from AAs and that the levels of nuclear KIFC1 (nKIFC1) are particularly high in AA patients with TNBC. The nuclear localization of KIFC1 in interphase may underlie its previously unrecognized race-specific association. In this study, we found that in TNBC cells derived from AAs, nKIFC1 interacted with the tumor suppressor myosin heavy chain 9 (MYH9) over EA cells. Treatment of AA TNBC cells with commercial inhibitors of KIFC1 and MYH9 disrupted the interaction between KIFC1 and MYH9. To characterize the racial differences in the KIFC1-MYH9-MYC axis in TNBC, we established homozygous KIFC1 knockout (KO) TNBC cell lines. KIFC1 KO significantly inhibited proliferation, migration, and invasion in AA TNBC cells but not in EA TNBC cells. RNA sequencing analysis showed significant downregulation of genes involved in cell migration, invasion, and metastasis upon KIFC1 KO in TNBC cell lines from AAs compared to those from EAs. These data indicate that mechanistically, the role of nKIFC1 in driving TNBC progression and metastasis is stronger in AA patients than in EA patients, and that KIFC1 may be a critical therapeutic target for AA patients with TNBC.Graphical abstract

Choosing to End African American Health Disparities in Patients With Systemic Lupus Erythematosus.

Systemic lupus erythematosus (SLE) is three times more common and its manifestations are more severe in African American women compared to women of other races. It is not clear whether this is due to genetic differences or factors related to the physical or social environments, differences in health care, or a combination of these factors. Health disparities in patients with SLE between African American patients and persons of other races have been reported since the 1960s and are correlated with measures of lower socioeconomic status. Risk factors for these disparities have been demonstrated, but whether their mitigation improves outcomes for African American patients has not been tested except in self-efficacy. In 2002, the first true US population-based study of patients with SLE with death certificate records was conducted, which demonstrated a wide disparity between the number of African American women and White women dying from SLE. Five years ago, another study showed that SLE mortality rates in the United States had improved but that the African American patient mortality disparity persisted. Between 2014 and 2021, one study demonstrated racism's deleterious effects in patients with SLE. Racism may have been the unmeasured confounder, the proverbial "elephant in the room"-unnamed and unstudied. The etymology of "risk factor" has evolved from environmental risk factors to social determinants to now include structural injustice/structural racism. Racism in the United States has a centuries-long existence and is deeply ingrained in US society, making its detection and resolution difficult. However, racism being man made means Man can choose to change the it. Health disparities in patients with SLE should be addressed by viewing health care as a basic human right. We offer a conceptual framework and goals for both individual and national actions.

Dissemination and Implementation of a Community Health Worker Intervention for Disparities in Palliative Care (DeCIDE PC): a study protocol for a hybrid type 1 randomized controlled trial

BackgroundThere are persistent racial and ethnic health disparities in end-of-life health outcomes in the United States. African American patients are less likely than White patients to access palliative care, enroll in hospice care, have documented goals of care discussions with their healthcare providers, receive adequate symptom control, or die at home. We developed Community Health Worker Intervention for Disparities in Palliative Care (DeCIDE PC) to address these disparities. DeCIDE PC is an integrated community health worker (CHW) palliative care intervention that uses community health workers (CHWs) as care team members to enhance the receipt of palliative care for African Americans with advanced cancer. The overall objectives of this study are to (1) assess the effectiveness of the DeCIDE PC intervention in improving palliative care outcomes amongst African American patients with advanced solid organ malignancy and their informal caregivers, and (2) develop generalizable knowledge on how contextual factors influence implementation to facilitate dissemination, uptake, and sustainability of the intervention.MethodsWe will conduct a multicenter, randomized, assessor-blind, parallel-group, pragmatic, hybrid type 1 effectiveness-implementation trial at three cancer centers across the United States. The DeCIDE PC intervention will be delivered over 6 months with CHW support tailored to the individual needs of the patient and caregiver. The primary outcome will be advance care planning. The treatment effect will be modeled using logistic regression. The secondary outcomes are quality of life, quality of communication, hospice care utilization, and patient symptoms.DiscussionWe expect the DeCIDE PC intervention to improve integration of palliative care, reduce multilevel barriers to care, enhance clinic and patient linkage to resources, and ultimately improve palliative care outcomes for African American patients with advanced cancer. If found to be effective, the DeCIDE PC intervention may be a transformative model with the potential to guide large-scale adoption of promising strategies to improve palliative care use and decrease disparities in end-of-life care for African American patients with advanced cancer in the United States.Trial registrationRegistered on ClinicalTrials.gov (NCT05407844). First posted on June 7, 2022.

Abstract P4-07-52: Caloric Restriction for Oncology Research (CaReFOR): Assessing dietary adherence and outcomes in African American patients during breast cancer treatment

Abstract Purpose: Epidemiologic and clinical evidence have shown an association between obesity and increased risk for breast cancer (BC) incidence and mortality. Data from human and animal studies support a potential role for weight loss in counteracting tumor-promoting properties of obesity in BC. However, dietary intervention clinical trials often show low patient adherence, especially among African American (AA) women compared to Caucasian (CC) women. They also show that AA women are disproportionately obese and lose less weight during behavior lifestyle interventions compared to CC with similar risk factors. We evaluated the efficacy and feasibility of a 10-week caloric restricted diet in patients undergoing radiation and have performed analysis to determine if adherence to dietary alterations is feasible in underrepresented patients. Methods: In an IRB approved clinical trial, we determined the feasibility and toxicity of dietary intervention during radiation in breast cancer patients 18 years and older who were undergoing breast conservation therapy with T1-2N0 cancers. The dietary intervention consisted of caloric intake reduction of 25% from baseline for a total of 10 weeks during their six-week radiation treatment which was administered to the whole breast to a dose of 50Gy with a 10Gy boost to the tumor bed. To optimize adherence to caloric restriction (CR), patients received personalized counseling, maintained food diaries, and were educated on behavioral modifications at weekly visits. To characterize the effects of CR, baseline physiologic and blood parameters were collected and compared with post intervention measurements and samples. Biometric and biological data collected during the study comparing compliant participants before and after the CaReFOR intervention was stratified by race and analyzed via two-sample paired t-test. The difference between AA and CC study participants was determined to be significant if the calculated p-value was less than &amp;lt; 0.05 (CI 95%). Results: A total of 32 female patients were enrolled in the CaReFOR trial, 16 were AA and 16 were CC. Participant demographics were similar across age, primary tumor size (pT), nuclear grade, and hormone receptor status. Evaluation of patients’ baseline diet demonstrated similar macronutrients across races, with AA showing less fruit/vegetable and grains. AA patients were more overweight compared to their CC counterparts. They also showed a more inflamed state compared to CC patients. The baseline inflammatory biomarker levels for ESR and cholesterol were significantly higher while adiponectin was significantly lower in AA than that of CC patients. The trends for insulin, HbA1c, and leptin were also higher for AA compared to CC. Following the 10-week diet, AA patients (87.3%) were more compliant than CC’s (81.3%). Both AA and CC patients lost weight during the trial, with AA having a significant loss in body fat and gain in muscle mass compared to CC. Similarly, after completing the CR diet, biological inflammatory markers improved in AA and CC patients. Particularly, in AA, there was a significant decrease in cholesterol levels, while insulin, leptin, and ESR serum levels trended downwards, suggesting a decreased inflammatory state. Conclusions: Contrary to published studies, we found AA patients are successful in adhering to dietary alterations and have a benefit with respect to physiologic and biologic parameters. Our dietary intervention was able to positively affect our AA patients adverse baseline factors such as obesity and inflammation. Future studies should consider dietary alterations as a possible means to decrease AA patient disparate outcomes in breast cancer. Citation Format: Siani Harding, Adeseye Adekeye, Edith P. Mitchell, Nicole Simone. Caloric Restriction for Oncology Research (CaReFOR): Assessing dietary adherence and outcomes in African American patients during breast cancer treatment. [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-07-52.

Abstract 80: Teaching Students To Teach About Stroke

Background: Inadequate stroke prevention and stroke symptom identification delays contribute to higher stroke incidence and worse outcome in African American patients and those living in disadvantaged communities. It is not known how best to improve community stroke awareness. Studies have shown effectiveness of children teaching parents about stroke. Evidence regarding students teaching other students is lacking. Primary Objective: To increase awareness of stroke risk factors and stroke signs/symptoms/call 911 in an urban high school. Secondary Objectives: 1. Teach students the principles of teaching peers. 2. Assess effectiveness of a creative versus standard teaching method. Methods: Prospective, cross-over, community-based study in which 48 sophomore students from an urban high school were taught stroke risk factors and signs/symptoms/call 911. These Student Teachers then taught these topics to peers from the same school using a creative or standard method. Student Learners were blinded to the teaching method. Pre and post-tests were used to measure teaching effectiveness with possible scores ranging from 0 to 39. Results: Forty-four Student Learners took at least one of three tests (pre, post and one-month retention). Thirty-three Student Learners took pre and post-tests, while 17 took all three. Improvements in both mean post-test scores (4.8, p &lt; 0.001) and mean retention scores (3.4, p = 0.002), irrespective of teaching method, were observed. Thirteen Student Teachers took the retention test. There was no difference in scores relative to teaching method. Scores of Student Teachers who taught stroke risk factors, compared to those who taught signs/symptoms/call 911, were better (35.4 vs. 31.0, p = 0.049). Conclusion: Awareness of stroke risk factors and signs/symptoms/call 911 improved in high school students who were taught by peers regardless of the teaching method. Limitations which impacted the results include attendance, COVID restrictions, and scheduling challenges. We will mitigate limitations in the next phase of the project.

Exosomal miR-1304-3p promotes breast cancer progression in African Americans by activating cancer-associated adipocytes

Breast cancer displays disparities in mortality between African Americans and Caucasian Americans. However, the exact molecular mechanisms remain elusive. Here, we identify miR-1304-3p as the most upregulated microRNA in African American patients. Importantly, its expression significantly correlates with poor progression-free survival in African American patients. Ectopic expression of miR-1304 promotes tumor progression in vivo. Exosomal miR-1304-3p activates cancer-associated adipocytes that release lipids and enhance cancer cell growth. Moreover, we identify the anti-adipogenic gene GATA2 as the target of miR-1304-3p. Notably, a single nucleotide polymorphism (SNP) located in the miR-1304 stem-loop region shows a significant difference in frequencies of the G allele between African and Caucasian American groups, which promotes the maturation of miR-1304-3p. Therefore, our results reveal a mechanism of the disparity in breast cancer progression and suggest a potential utility of miR-1304-3p and the associated SNP as biomarkers for predicting the outcome of African American patients.

Impact of HIV Infection on Clinical Characteristics and Treatment Outcomes in African-American Patients with Multiple Myeloma: - a Retrospective Case-Control Study

Introduction: Although multiple myeloma (MM) is not considered an AIDS-defining malignancy such as certain types of non-Hodgkin lymphoma and Kaposi sarcoma, HIV infection can increase the risk of developing MM at a younger age. However, no robust data demonstrates that HIV infection could affect MM outcomes. Case reports or case series suggest that HIV positive MM has more aggressive biological features, clinical course, and shorter overall survival (Faure I et al, AIDS, 1999; Patra SK et al, J Clin Diagn Res, 2015). Other observational studies also reveal that HIV positive MM involves a younger population and has more extramedullary disease however survival data is yet to be explored (De Groot JJB et al, S Afr Med J, 2017; Giri S et al, Blood, 2018). NYC has only 3% of the US population but has reported nearly 16% of all AIDS cases and the Bronx carries the highest HIV infection rate among all the boroughs (NYC Department of Health and Mental Hygiene, 2021). Based on that, we initiated a retrospective study in a tertiary medical facility in the Bronx to investigate the relationship between HIV infection status and the outcome of MM. Methods: Using the electronic medical record data extraction software, we identified patients older than 18 diagnosed with HIV and MM between April 2009 and April 2022. HIV negative MM patients matched for age and ethnicity were included as control group. We conducted a retrospective chart review collecting demographic, laboratory and clinical characteristics and compared them between HIV positive and negative groups. Outcome data included response to initial therapy, presence of extramedullary disease, need for hospitalization during therapy, infectious complications, progression-free survival (PFS) and overall survival (OS). Statistical analysis was performed using chi-square testing for categorical variables and Mann-Whitney for continuous variables given the size of our sample. Results: A total of 14 patients were identified as HIV positive MM. 12 patients were on antiretroviral therapy, 2 patients were considered "long term non-progressor" who did not require treatment. In HIV positive group, mean CD4 count was 554 (71)cells/µl and mean viral load was 2477 (1634)copies/ml. The mean age on diagnosis was 61.5 years old (range 56-72), 57.1% patients were male (8/14), 100% of patients were African American. 9 had IgG subtype, 2 had IgA subtype, 2 had light chain subtype. International Staging System (ISS) stage 1, 2 and 3 were seen in 14.3% (2/14), 35.7% (5/14), 42.9% (6/14) patients, respectively. In one patient stage was unknown. Adverse risk cytogenetics were seen in 2 out of 13 patients at diagnosis (both were gain 1q). Cytogenetic information was not available in one patient. Mean number of lines of therapy was 2.1 and 8 out of 14 underwent autologous stem cell transplantation. Subsequently, 14 HIV positive patients were compared with 14 age/ethnicity-matched HIV negative patients with multiple myeloma. Median duration of follow up was 24 months (range 3-156) in HIV positive patients and 35 months (range 2-168) in HIV negative patients. No statistically significant differences were seen between the two groups in hemoglobin level, creatinine, calcium, lines of therapy, bone marrow plasma cell percentage, presence of bone lesions, number of lines of therapy, number of patients receiving autologous transplant, infectious complications, and OS (Table 1). HIV positive patients had significantly more extramedullary disease (71.4% vs. 21.7%, p=0.008), were hospitalized more often (78.6% vs 28.6%, p=0.008), had inferior response to induction therapy (21.4% vs 100%, p=0.001) (Table 1) and a shorter PFS (median 62.0 (95% CI, 22.8 to 101.9) months vs median 20.0 (95% CI, 0.0 to 42.3) months, p=0.038) (Figure 1). Conclusion: Our study is the first single-center retrospective study evaluating the outcomes and prognosis of MM in minority patients with HIV infection. Despite well-controlled HIV infection with preserved CD4 counts, suppressed viral load and low risk disease in most HIV positive patients, they had more aggressive clinical course with more extramedullary disease, higher hospitalization rate, inadequate response to induction therapy and a shorter PFS compared with age and ethnicity matched HIV negative controls with multiple myeloma. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Advancing Care and Outcomes for African American Patients With Multiple Sclerosis.

Multiple sclerosis (MS) has historically been underdiagnosed and undertreated among African Americans. Recent evidence suggests that African Americans with MS have a different clinical presentation, increased disease incidence and burden, and worse long-term outcomes vs their White counterparts. Due to limited data available for African Americans in MS clinical trials, it is difficult to make informed, generalizable conclusions about the natural history, prognosis, and therapeutic response in this population. In this narrative review, we highlight the nature and magnitude of the health disparities experienced by African Americans with MS and underscore the pressing need to increase knowledge about and understanding of MS disease manifestations in this group. In addition, we describe the mission and objectives of the recently established National African Americans with Multiple Sclerosis Registry, which is intended to be a platform to advance the care of African Americans with MS and address health disparities they may experience.

Abstract PO-096: Caloric restriction may decrease health disparity in AA breast cancer patients due to significant downregulation of the IGF-1R pathway in a window-of-opportunity clinical trial

Abstract Introduction: Health disparities in breast cancer outcomes exist for African American (AA) women who are noted to present with more aggressive cancer with worse survival. Although the underlying reason for this disparity is not apparent, it is likely multifactorial. Interestingly, type 1 insulin-like growth factor receptor (IGF-1R) expression, which plays a critical role in cell growth, survival, and migration, is higher in normal breast tissue in AA women as compared to Caucasian women. Although this has been well established, interventional studies to modulate this pathway have not been performed. We sought to determine if a dietary intervention of caloric restriction could play a role in modulating the IGF-1R pathway to help address the disparities seen in AA breast cancer patients. Methods: On an IRB approved clinical trial, patients were enrolled in a window-of-opportunity clinical trial to assess the effect of caloric restriction, or a 25% reduction of calories from the patients' baseline, on biomarkers in the tumor and blood. Patients recorded their baseline caloric intake for 3-5 days and were then instructed on a target calorie intake for the remainder of the diet. The patients remained on the dietary intervention for 2-12 weeks. Participants had anthropometric evaluation, blood draws to evaluate serum cytokines, tissue collection, and quality of life surveys collected at baseline and completion of diet which was the morning of surgery. Results: We enrolled 19 breast cancer patients between the years 2016 and 2018. The average age of the patients at the time of enrollment was 58 years old with 47% AA and 53% Caucasian. The patients were on the trial for an average of 19 days. Patients lost an average of 4.91 lbs during the trial, with AA patients losing an average of 5.18 lbs and Caucasians losing an average of 4.68 lbs. To determine the importance of IGF-1R in the disparities seen in AA women, we looked at two hundred cytokines from serum samples in patients who underwent caloric restriction. Analysis of the cytokine array data showed that nine cytokines involved in regulating or modulation by the IGF-1R pathway were significantly (p&amp;lt;0.05) downregulated in AA women post-diet. Compared to Caucasian women, AA women showed a significant decrease in IL-12p40 (~51%), VCAM1 (16.8%), IL-2 (28.72%), IL-2Rb (40.81%), CCL28 (36%), ERBB3 (26.6%), PAI-1 (9.4%), Axl (36%) and PDGF-AB (12%). Conclusion: These results demonstrate that caloric restriction significantly downregulated members of the IGF-1R pathway in the AA community. Since this pathway is notably dysregulated in AA patients, an integrated approach, one incorporating dietary changes to alter key pro-survival pathways, should be further investigated to narrow the disparity in breast cancer outcomes in AA patients. Citation Format: Samantha Okere, Anuradha A. Shastri, Kamryn Hines, Pramila Anne, Rita Murphy, Tiziana DeAngelis, Adam Berger, Alliric Willis, Melissa Lazar, Edith Mitchell, Nicole Simone. Caloric restriction may decrease health disparity in AA breast cancer patients due to significant downregulation of the IGF-1R pathway in a window-of-opportunity clinical trial [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-096.

Association of Health-Care System and Survival in African American and Non-Hispanic White Patients With Bladder Cancer.

African American patients with bladder cancer have inferior outcomes compared with non-Hispanic White (White) patients. We hypothesize that access to health care is a primary determinant of this disparity. We compared outcomes by race for patients with bladder cancer receiving care within the predominant hybrid-payer health-care model of the United States captured in the Surveillance, Epidemiology, and End Results (SEER) database with those receiving care within the equal-access model of the Veterans' Health Administration (VHA). African American and White patients diagnosed with bladder cancer were identified in SEER and VHA. Stage at presentation, bladder cancer-specific mortality (BCM), and overall survival (OS) were compared by race within each health-care system. The SEER cohort included 122 449 patients (93.7% White, 6.3% African American). The VHA cohort included 36 322 patients (91.0% White, 9.0% African American). In both cohorts, African American patients were more likely to present with muscle-invasive disease and metastases, but the differences between races were statistically significantly smaller in VHA. In SEER multivariable models, African American patients had worse BCM (hazard ratio [HR] = 1.22, 95% confidence interval [CI] = 1.15 to 1.29) and OS (HR = 1.26, 95% CI = 1.20 to 1.31). In contrast within the VHA, African American patients had similar BCM (HR = 0.97, 95% CI = 0.88 to 1.07) and OS (HR = 0.99, 95% CI = 0.93 to 1.05). In this study of contrasting health-care models, receiving medical care in an equal-access system was associated with reduced differences in stage at presentation and eliminated disparities in survival outcomes for African American patients with bladder cancer. Our findings highlight the importance of reducing financial barriers to care to notably improve health equity and oncologic outcomes for African American patients.

Clinical features and outcomes between African American and Caucasian patients with Takotsubo Syndrome.

Takotsubo syndrome (TS) is an acute, reversible form of heart failure, often mimicking an acute coronary syndrome (ACS). Data regarding racial differences in TS are inconsistent. The aim is to assess clinical features associated with unfavorable in-hospital outcomes between African American (AA) and Caucasian (CAU) patients. A retrospective electronic health record query identified 44 AA patients and 110 CAU patients with a diagnosis of TS. Our primary outcome was a composite of death, stroke, and cardiogenic shock during hospitalization. Variables associated with an increased risk of the primary composite outcomes were included in a logistic regression model. Compared to CAU patients, AA patients were a more comorbid population, and presented a higher prevalence of history of illicit drug use (27.3% vs. 13.6% P=0.044). There were no significant differences regarding in-hospital complication rates between AA and CAU patients. In the logistic regression model, infection was associated with greater risk of developing the primary outcome in AA patients (OR=7.26 [95% CI 1.22-43.17], P=0.029), whereas angina was a protective factor (OR=0.11 [95% CI 0.02-0.65], P=0.015). In CAU patients, severely depressed ejection fraction and worse peak creatinine during hospitalization increased risk of developing the primary outcome (OR=5.88 95% CI [2.01-17.17], P<0.001 and OR=1.64 [95% CI 1.15-2.58], P=0.031, respectively). Meanwhile, emotional stressors were protective (OR=0.16 [95% CI 0.03-0.88], P=0.004). Despite experiencing the same rate of in-hospital complications, the clinical profiles of AA patients are distinct from CAU patients admitted for TS, and clinical variables correlated with worse in-hospital outcomes also differ by race.

S64 Clinical Characteristics and Outcomes in African American Patients With Acute Pancreatitis

S64 Clinical Characteristics and Outcomes in African American Patients With Acute Pancreatitis

Destination LVAD Therapy in African American (AA) Recipients: A Single Center Experience

Purpose Despite the approval of LVADs as destination therapy (DT) nearly 2 decades ago, significant knowledge gaps remain regarding the characteristics and outcomes of AA patients (pts) who receive LVAD therapy as DT. The present analysis sought to assess the characteristics and outcomes of DT LVAD AA pts. Methods Single center retrospective review of DT LVAD pts from 1/1/2009 to 12/31/2019 was performed. We compared clinical characteristics of AAs to non-AAs. Survival and hemocompatibility-related adverse event (HRAE) rates for AA pts were determined. Uni- and multivariate predictors of mortality were identified. Results 256 pts underwent DT LVAD implantation, of which 180 (70%) were AA. 63 pts received a HMII, 54 HVAD, and 63 HM3. Compared to non-AAs, AA pts were younger (AA: 57 ± 12 vs non-AA: 67 ± 9), more likely to be female (33% vs 16%) have HTN (71% vs 57%), had a higher BMI (mean BMI 30 ± 8 vs 26 ± 5), a non-ischemic cardiomyopathy (76% vs 33%), and a history of stroke/TIA (19% vs 8%). There were no significant differences between the 2 groups in terms of INTERMACS profile. Post-operatively, the AA cohort required more days of vasopressor support (9.5 ± 14 vs. 6.0 ± 6) and had a higher postoperative length of stay (32.9 ± 21.0 vs. 26.2 ± 21.9 days). Among AAs, GI bleeding was the most common HRAE (44% of patients with events per patient year, EPPY 0.55) followed by stroke (22%, EPPY 0.13) and pump thrombosis (16%, EPPY 0.13). The HM3 was associated with lowest HRAE rates (EPPY) amongst the 3 devices (GIB 0.40, stroke 0.07, and no pump thrombosis events). Overall survival among AA DT pts was 81% and 69% at 1-year and 2-years. 5-year survival was 41%. On univariate analysis, history of prior sternotomy (HR 1.93, 95% CI 1.03-3.59, p=0.04) and total bilirubin (HR 1.21, 95% CI 1.04-1.40, p=0.01) were predictors of AA mortality while INTERMACS profile ≥3 (HR 0.67, 95% CI 0.49-0.93, p=0.02) was associated with improved survival. Total bilirubin was the only independent predictor of mortality in multivariate analysis (HR 1.18, 95% CI 1.0-1.4, p=0.05). Conclusion AA DT LVAD pts experienced excellent 1- and 2-year survival comparable to those demonstrated in large clinical studies. HM3 implantation was associated with lower rates of GIB, pump thrombosis, and stroke. Future research focused on barriers to LVAD therapy and the quality of life of AA LVAD pts is warranted.

Abstract PS7-53: Assessing racial differences in patients with metastatic triple-negative breast cancer: Real-world evidence from US community oncology practices

Abstract Background: Metastatic triple-negative breast cancer (mTNBC) is an aggressive tumor phenotype with a poor prognosis and few treatment options. The prevalence of mTNBC is disproportionately higher among African American (AA) women, compared with white women. Data identifying the drivers of racial differences in mTNBC or characterizations of treatment patterns and clinical outcomes in AA patients with mTNBC are limited. Methods: This retrospective study used the Flatiron Health electronic health record-derived de-identified database (January 2011-March 2020). Adult AA and white female patients with confirmed mTNBC treated in US community oncology practices were included. Differences in mTNBC prevalence among AA and white patients were assessed by age, health insurance coverage, geographic region and stage at initial diagnosis. Descriptive statistics were used to analyze clinical characteristics, treatment patterns and time to treatment initiation between AA and white patients. Racial differences in overall survival (OS) were examined using Kaplan-Meir analysis and a multivariate Cox regression model. Results: Of the 21,804 Flatiron patients diagnosed with metastatic breast cancer (mBC), 2116 eligible patients with mTNBC were identified; 383 (18%) were AA and 1155 (55%) were white. TNBC prevalence was twice as high among AA patients (23%) than white patients (12%). Racial differences in TNBC prevalence (AA vs white patients) were particularly higher among patients aged 45 to 65 y (26% vs 13%), patients in the Northeast (27% vs 11%) and those with initial diagnosis at Stage II (30% vs 13%) or Stage III (27% vs 15%). AA patients with TNBC were younger (mean age: 60 vs 63 y; P &amp;lt; 0.001) and more likely to have Medicaid at the time of diagnosis (10% vs 3%; P &amp;lt; 0.001) than white patients. Clinical characteristics were generally similar between AA and white patients, including the distribution of staging at initial diagnosis, disease recurrence, Eastern Cooperative Oncology Group performance status (ECOG PS), and sites and number of metastases. Regardless of race, 25% of all patients with mTNBC had no documentation of receiving anti-cancer treatment in the database. Untreated patients in both race groups were older, had poorer ECOG PS and were less likely to have visceral metastases than treated patients (all P &amp;lt; 0.001); they also had poorer survival than treated patients (median OS: 4.7 vs 13.1 months from diagnosis for all treated patients; unadjusted hazard ratio [HR], 0.51 [95% CI: 0.46, 0.57]). Among both AA and white treated patients, single-agent chemotherapy was the most prevalent first-line treatment (most common agent: capecitabine). More than half of treated patients initiated treatment in &amp;lt; 30 days, and median time-to-treatment initiation did not differ by race. Although OS was numerically lower in AA patients (median OS, 10.3 vs 11.9 months in white patients), the difference was not significant when adjusted for prognostic and treatment factors (adjusted HR, 1.09 [95% CI: 0.95, 1.25]). Conclusions: The prevalence of mTNBC was twice as high among AA compared with white patients in US community oncology practices. Unlike prior research, race did not show an association with OS in this population. Regardless of race, 1 in every 4 patients with mTNBC had not received documented anti-cancer treatment, potentially due to poor PS and concerns about treatment tolerance. OS was poor for both AA and white patients with mTNBC, particularly for untreated patients. Effective treatment remains a substantial unmet need for all patients with mTNBC. In light of the lack of racial differences in this patient cohort, prospective studies are needed to further elucidate underlying biological differences that may have predictive or prognostic significance for AA patients with TNBC. Citation Format: Amie Tan, Vincent Shen, Luciana Preger, Bann-mo Day, Edith P. Mitchell. Assessing racial differences in patients with metastatic triple-negative breast cancer: Real-world evidence from US community oncology practices [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-53.

Higher comorbidities and early death in hospitalized African-American patients with Covid-19

BackgroundAfrican-Americans/Blacks have suffered higher morbidity and mortality from COVID-19 than all other racial groups. This study aims to identify the causes of this health disparity, determine prognostic indicators, and assess efficacy of treatment interventions.MethodsWe performed a retrospective cohort study of clinical features and laboratory data of COVID-19 patients admitted over a 52-day period at the height of the pandemic in the United States. This study was performed at an urban academic medical center in New York City, declared a COVID-only facility, serving a majority Black population.ResultsOf the 1103 consecutive patients who tested positive for COVID-19, 529 required hospitalization and were included in the study. 88% of patients were Black; and a majority (52%) were 61–80 years old with a mean body mass index in the “obese” range. 98% had one or more comorbidities. Hypertension was the most common (79%) pre-existing condition followed by diabetes mellitus (56%) and chronic kidney disease (17%). Patients with chronic kidney disease who received hemodialysis were found to have lower mortality, than those who did not receive it, suggesting benefit from hemodialysis Age > 60 years and coronary artery disease were independent predictors of mortality in multivariate analysis. Cox proportional hazards modeling for time to death demonstrated a significantly high ratio for COPD/Asthma, and favorable effects on outcomes for pre-admission ACE inhibitors and ARBs. CRP (180, 283 mg/L), LDH (551, 638 U/L), glucose (182, 163 mg/dL), procalcitonin (1.03, 1.68 ng/mL), and neutrophil:lymphocyte ratio (8.3:10.0) were predictive of mortality on admission and at 48–96 h. Of the 529 inpatients 48% died, and one third of them died within the first 3 days of admission. 159/529patients received invasive mechanical ventilation, of which 86% died and of the remaining 370 patients, 30% died.ConclusionsCOVID-19 patients in our predominantly Black neighborhood had higher in-hospital mortality, likely due to higher prevalence of comorbidities. Early dialysis and pre-admission intake of ACE inhibitors/ARBs improved patient outcomes. Early escalation of care based on comorbidities and key laboratory indicators is critical for improving outcomes in African-American patients.

Clinical features and outcomes between African American and Caucasian patients with Takotsubo Syndrome

BACKGROUND Takotsubo syndrome (TS) is an acute, reversible form of heart failure, often mimicking an acute coronary syndrome (ACS). Data regarding racial differences in TS are inconsistent. The aim is to assess clinical features associated with unfavorable in-hospital outcomes between African American (AA) and Caucasian (CAU) patients. METHODS A retrospective electronic health record query identified 44 AA patients and 110 CAU patients with a diagnosis of TS. Our primary outcome was a composite of death, stroke, and cardiogenic shock during hospitalization. Variables associated with an increased risk of the primary composite outcomes were included in a logistic regression model. RESULTS Compared to CAU patients, AA patients were a more comorbid population, and presented a higher prevalence of history of illicit drug use (27.3% vs 13.6% p=0.044). There were no significant differences regarding in-hospital complication rates between AA and CAU patients. In the logistic regression model, infection was associated with greater risk of developing the primary outcome in AA patients (OR=7.26 95% CI [1.22-43.17], p=0.029), whereas angina was a protective factor (OR=0.11 95% CI [0.02-0.65], p=0.015). In CAU patients, severely depressed ejection fraction and worse peak creatinine during hospitalization increased risk of developing the primary outcome (OR=5.88 95% CI [2.01-17.17], p<0.001 and OR=1.64 95% CI [1.15-2.58], p=0.031, respectively). Meanwhile, emotional stressors were protective (OR=0.16 95% CI [0.03-0.88], p=0.004). CONCLUSIONS Despite experiencing the same rate of in-hospital complications, the clinical profiles of AA patients are distinct from CAU patients admitted for TS, and clinical variables correlated with worse in-hospital outcomes also differ by race.

No difference in clinical outcomes for African American and White patients hospitalized with SARS-CoV-2 pneumonia in Louisville, Kentucky

Introduction: Current literature indicates that African American individuals are at increased risk of becoming infected with the SARS-CoV-2 virus and suffer higher SARS-CoV-2-related mortality rates. However, there is a lack of consensus as to how the clinical outcomes of African American patients differ from those of other groups. The objective of this study was to define the clinical outcomes of African American and White hospitalized patients with SARS-CoV-2 community-acquired pneumonia (CAP) in Louisville, Kentucky.

Racial Disparities Among Pancreatic Adenocarcinoma Patients: A Retrospective Survival Analysis of Non-Metastatic Pancreatic Cancer Patients

It is predicted that in 2020, approximately 57,600 individuals will be diagnosed with pancreatic cancer (PaC). Based on SEER database analysis, there are conflicting opinions in literature about the overall treatment and outcomes in African-American patients with PaC. The purpose of this study was to determine if there was a racial disparity in overall survival rates between African Americans (AAs) and non-African Americans (non-AAs) diagnosed with PaC who received neoadjuvant radiation therapy (RT) in a tertiary-care cancer center with an established multi-disciplinary PaC tumor board and clinic. An IRB-approved retrospective chart analysis was completed on 100 patients who were diagnosed with pancreatic adenocarcinoma and treated with neoadjuvant RT between 2017-2019. Patients who were deemed resectable, borderline resectable (BR), or locally advanced/unresectable (LA) at initial diagnosis were included in the analysis. The following baseline characteristics were collected for each patient: staging, gender, age and ECOG score at initial diagnosis, tumor site and size, clinical T and N stage, CA19-9, and treatment variables (i.e., surgery, chemotherapy, and RT type). Overall survival was calculated from the RT start date. In order to identify any baseline differences among the AA group and the non-AA group, a two-sample t-test and Chi-square were employed. A log-rank test and Kaplan-Meier were used to determine any differences in overall survival among the two groups. Of the 100 patients included in the analysis, 25 were AA and 58 were female. There were 17 (68%) BR and 8 (32%) LA patients in the AA group. In the non-AA group, there were 2 (3%) resectable, 47 (63%) BR, and 26 (35%) LA patients. There were no statistically significant differences detected in any of the baseline characteristics except a trend for increased CA19-9 values of 399.8 U/mL for AAs and 229 U/mL for non-AAs. There was no statistically significant difference in receipt of chemotherapy and RT between the two groups. The estimated median survival rates were 11.5 months for non-AAs and 8.4 months for AAs. One-year overall survival was 45% for AAs versus 48% for non-AAs (p = 0.57). There was no difference in overall survival among AAs and non-AAs who received neoadjuvant RT+/- chemotherapy for PaC at our institution between 2017-2019. Contrary to previous publications based on large SEER database analysis, there does not appear to be any difference in overall survival based on race if patients receive treatment in a comprehensive multi-disciplinary collaborative center.

Effectiveness of mono antiplatelet therapy vs dual antiplatelet therapy in ischemic stroke or transient ischemic attack-Special subgroup consideration for the African-American Population.

The purpose of this study is to assess the effectiveness of mono antiplatelet therapy vs dual antiplatelet therapy in reducing recurrent stroke and mortality in patients with ischemic stroke or transient ischemic attack (TIA). A subgroup analysis was conducted to compare outcomes in African-American patients compared with non-African-American patients. This is a single-centre, retrospective, chart review, cohort study conducted at the University Medical Center New Orleans (UMCNO), New Orleans, Louisiana. This study includes all patients who are admitted to UMCNO with a diagnosis of ischemic stroke or TIA. The subjects were divided into two groups, patients who received mono antiplatelet therapy and patients who received dual antiplatelet therapy. A total of 762 stroke patients were included in the study. Of these, 499 (65.5%) received mono antiplatelet therapy and 263 (34.5%) patients received dual antiplatelet therapy. There was no statistical significant difference in the incidence of mortality and recurrent stroke in the mono antiplatelet therapy group compared with the dual antiplatelet therapy group. When comparing primary outcomes between African Americans and non-African Americans, there was no statistical significant difference in mortality rate and recurrent stroke rate between the two groups. This study found no statistical significant difference in the incidence of recurrent stroke and mortality between mono antiplatelet therapy and dual antiplatelet therapy among patients who had ischemic stroke or TIA; with similar findings in a subgroup analysis comparing outcomes in African-American patients compared with non-African-American patients.