Hispanic Outcomes Research Articles

Two‐year longitudinal outcomes of subjective cognitive decline in Hispanics compared to non‐Hispanic Whites

AbstractBackgroundHispanics are at higher risk for Alzheimer disease (AD) than non‐Hispanic Whites (NHW), motivating further study of differences and risk factors at the preclinical level. Subjective cognitive decline (SCD) is considered a preclinical AD stage, but its features and outcomes in Hispanics are less studied. We investigated the differences in longitudinal change in SCD phenotype, cognition, and function among Hispanics compared to NHW.MethodLongitudinal analyses were performed on consecutive participants with SCD who were evaluated at the NYU Alzheimer’s Disease Research Center. Inclusion criteria were self‐identification as Hispanic (n = 23) or NWH (n = 165) and a 2‐year follow‐up visit. Demographics, conversion rate to mild cognitive impairment (MCI), SCD characteristics, and psychometric performance were analyzed by t‐test, multiple linear regression models, or Cox models as appropriate. Models were adjusted for age, sex, education, depression, and baseline values.ResultHispanics were at higher risk for conversion to MCI (HR: 6.57, 95% CI 1.25‐34.47, p = 0.02596). Hispanic ethnicity was associated with increased SCD severity in time as measured via the total Brief Cognitive Rating Scale (BCRS) score (OR: 4.28, 95% CI 1.42‐12.83, p = 0.0094), and in specific BCRS domains: mood and behavior (OR: 0.18, 95% CI 0.03‐0.89, p = 0.0355) and calculation (OR: 29.68, 95% CI 4.02‐219.18, p = 0.0009). Global cognitive function by Mini‐Mental State Examination had a higher risk of declining in time in Hispanics (HR: 2.83, CI 1.09‐7.35, p = 0.0320). Likelihood of decline in domain‐specific tests associated with Hispanic ethnicity for Trails A (HR: 4.05, 95% CI 1.93‐8.47, p = 0.0002), Trails B (HR: 3.16, 95% CI 1.62‐6.14, p = 0.0007), and delayed paragraph recall (HR: 2.08, 95% CI 1.01‐4.24, p = 0.0444).ConclusionHispanics present a higher risk of conversion from SCD to MCI than NHW. Apart from stage conversion, subjective and objective measure of cognition worsen more in Hispanics, but in a domain‐specific manner. These findings suggests that Hispanics not only decline at a faster rate, but that this decline is expressed with a different phenotype. This should be considered when studying this population in preclinical investigations.

A contemporary national population-based analysis of demographics and outcomes of Hispanics with adult T-cell leukemia/lymphoma in the US.

e18771 Background: Adult T-cell Leukemia/Lymphoma (ATL) is a malignancy caused by the human T-cell leukemia virus type I with heterogenous clinical course (Blood Adv PMID29545256 J Clin Exp Hematop PMID34937829). There are endemic regions, but emigration has increased its incidence in the United States (US) (Hematol Oncol Clin North AmPMID2834087). There is a need to recognize trends and ethnic patterns to better understand this malignancy (J Oncol Pract PMID28796966 Blood Adv PMID29545256). This is the first national population-based analysis evaluating ethnic differences for HI diagnosed with ATL in the US. Methods: Data were analyzed on ATL patients in the US reported to the Surveillance, Epidemiology, and End Results (SEER) database between 2000-2018. Demographic, clinical and survival patterns were analyzed. Kaplan-Meier and Cox regression analyses were used when appropriate. Multivariate analysis and propensity score matching were performed with adjustment for age, stage and B-symptoms. Results: 598 patients (HI=65, NH=533) were diagnosed with ATL. Male sex predominated in in both. HI were diagnosed at a younger median age, 52 years (y) vs 63y for NH [p<0.001]. Most of HI presented in the age bracket of 40-60y, while NH were identified between 60-80y [p <0.001]. Regarding race, most of HI and NH were whites 82% vs 52% respectively, however, for NH Blacks and Asian/Pacific Islander were noted to be representative in the sample [p <0.001]. The majority of HI were diagnosed between 2010-2014, however for NH, same incidence was reported from 2005-2009 and 2010-2014 [p = 0.107]. For both group the presence of B symptoms was predominantly unknown. The median survival for HI was 1.5y vs 0.8y for NH. The survival probability at 2, 5 and 10y for HI corresponded to 0.474, 0.341 and 0.238, while for NH it was 0.347, 0.244 and 0.153, respectively. The OS probability at 10y had no statistically significant difference but a tendency favoring HI [p = 0.053]. On multivariate analysis, when adjusted for age, those patients who were older than 80y and between 60-80 y, had worse OS compared to those younger than 60y, with Hazard Ratio of 3.9 (95% CI: 2.7 – 5.6) and 1.7 (95% CI: 1.2 – 2.2), respectively. Conclusions: This national population-based study identified similar OS in HI diagnosed with ATL in the US. The median survival time was noted to be higher for HI and the OS had a tendency favoring this group; however, findings are not yet significant. This association should be further analyzed as there may be unique oncologic response in this ethnic minority. HI may have remarkable immunologic reaction to infection due to oncogenic viruses plus the creation of a distinct tumor microenvironment. Recognizing clinical trends and identifying genetic predictors may assist in constructing more accurate prognostic indices to deliver targeted therapy.

Abstract 1913: Population-based analysis of primary mediastinal B-cell lymphoma: a look at Hispanic outcomes

Abstract Background: Primary Mediastinal B-cell Lymphoma (PMBL) is a rare, aggressive Non-Hodgkin Lymphoma (NHL) accounting for approximately 2-5% of all NHL (PMID: 34330673). Due to its rarity, there is scarce literature on the demographic features of PMBL. Moreover, there is little to no research on outcomes of ethnic minority groups, particularly in Hispanics (HI) (PMID: 27399089.) Thus, there is a need for further investigation of disease characteristics to advance treatment options for the future. This is a national scale population-based analysis examining disparities in HI vs Non-Hispanics (NH) and its impact on survival outcomes in patients with PMBL. Material and Methods: Data was analyzed on PBML patients in the United States reported to the Surveillance, Epidemiology, and End Results (SEER) database between 2000 and 2018. SEER contains the most comprehensive population-based cancer information in the U.S., covering approximately 27% of the total US population, and up to 36% of Hispanics alone. Racial groups analyzed included non-Hispanic whites, Hispanic whites, blacks, and Asians/PIs (Pacific Islanders). Patient characteristics, age-adjusted incidence rate, and survival rate were compared across ethnic groups, Hispanics (HI) vs Non-Hispanics (NH). Stratification by age, gender, and stage at diagnosis was considered. Kaplan-Meier and Cox regression analyses were used to compare overall survival (OS) between HI and NH. Multivariate analysis and propensity score matching were performed with adjustment for age, stage and B-symptoms. Results: Of 1,014 PMBL patients, 15% were HI, and 85% were NH. PMBL affects mostly women in both HI and NH (66% and 60% p=0.215). HI were diagnosed at a younger median age, 30 y.o vs 36 y.o (p=0.001), compared to NH. The majority of HI and NH were diagnosed under 40 years old (p=0.010). Both groups were mostly diagnosed between 2015-2018 (44% vs 41%) (p=0.768). The majority of both groups did not receive radiation, however it was noted that HI received less radiation compared to NH (72% vs 66%) (p=0.180). The median survival time was not reached indicating a favorable prognosis. On survival analysis; the survival probability of HI vs NH at 2 years was 0.87 vs 0.86, at 5 years 0.85 vs 0.85, and 10 years 0.83 vs 0.82. and there was not an OS difference favoring HI/NH (p = 0.94). On multivariate analysis, when adjusting for age, those who were older than 80 y.o and between 60 to 80 y.o, had worse OS compared to those younger than 60 y.o with HR 9.3 (95% CI: 4.3 - 20) and 8.8 (95% CI: 4 - 19). Conclusions: Our study analysis shows that the demographic variables between HI and NH were generally homogenous. In patients with PMBL, HI were diagnosed younger compared to their NH counterparts, however this did not affect OS. In conclusion, HI and NH patients with PMBL had similar treatment and outcomes showing that, when there is equity in health, favorable prognosis is possible with the current standard of care. Citation Format: Lauren Diaz Boyle, Esteban Toro-Velez, Adolfo Enrique Diaz Duque. Population-based analysis of primary mediastinal B-cell lymphoma: a look at Hispanic outcomes [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1913.

Risk profiles, access to care, and outcomes in Hispanics hospitalized for lower extremity peripheral artery disease.

Previous studies have shown that Hispanics have worse clinical outcomes for lower extremity peripheral artery disease (PAD) than non-Hispanic White (NHWs). Using a national database, this study aimed to document the contemporary burden of PAD in Hispanics by evaluating their risk profiles, access to care, and outcomes compared with NHWs. Hospitalizations of Hispanics and NHWs with a primary diagnosis of PAD were identified using 2011-2017 National Inpatient Sample data. Patient sociodemographic characteristics, comorbidities, whether the admission was through the emergency department (ED) or elective, length of stay, and costs accrued were compared by ethnicity. Temporal trends in revascularizations, amputations, and ED admissions by year were evaluated with the Cochran-Mantel-Haenszel test and stratified by ethnicity. Data were combined across years and multivariable logistic regression was used to evaluate the association of ethnicity with inpatient revascularization, amputation, and mortality, adjusting for sociodemographic and cardiovascular risk factors. From 2011 to 2017, there were a total of 1,018,220 PAD hospitalizations among Hispanics (13.9%) and NHWs (86.1%) between 2011 and 2017. Hispanics were more often low income and uninsured and presented with higher burden of comorbidities including diabetes, renal failure, prior amputations, and chronic limb-threatening ischemia compared with NHWs. Most Hispanics were admitted via the ED compared with NHWs (58.0% vs 36.7%; d= 0.48), and median length of stay was almost a day longer (4.5days vs 3.7days). Hispanic ethnicity was associated with lower odds of surgical (odds ratio [OR], 0.62; 95% confidence interval [CI], 0.57-0.67) and endovascular revascularization (OR, 0.94; 95% CI, 0.89-0.996) and mortality (OR, 0.83; 95% CI, 0.75-0.93), but higher odds of minor (OR, 1.25; 95% CI, 1.20-1.31) and major (OR, 1.08; 95% CI, 1.03-1.14) amputation. Two tiers of health care consumption for inpatient PAD care and outcomes manifested among Hispanics and NHWs. First, Hispanics with PAD had a more vulnerable socioeconomic profile and presented with more severe PAD than NHWs. Second, they sought care more disproportionately through the ED and underwent more amputations than NHWs. To eradicate these inequities in PAD care and risk, strategies that improve access to outpatient care and expand health care coverage, as well as targeted management of risk factors in these vulnerable minority groups are needed.

Prostate cancer upgrading and adverse pathology in Hispanic men undergoing radical prostatectomy.

Radical prostatectomy (RP) outcomes in Hispanic men with prostate cancer are not well-described. Prior studies showed varying results regarding the rate of upgrading and upstaging, and these studies included limited pathologic data and lack of central pathology review. We characterized the rate of upgrading, adverse pathology, and oncologic outcomes in Hispanics after prostatectomy using a large institutional database. We included Hispanic white (HW), non-Hispanic white (NHW), and black men who underwent (RP) between 2010 and 2021 at a single institution. We recorded differences in grade group between biopsy and prostatectomy and performed multivariable analyses for odds of upgrading and adverse pathologic findings. The primary outcome was rate of upgrading in HWs. Using a sub-cohort with follow-up data, we assessed race/ethnicity and upgrading as a predictor of biochemical recurrence (BCR)-free survival. Our cohort included 1877 men: 36.7% were NHW, 40.6% were HW, and 22.7% were black. Rates of upgrading were not different between NHW, NHW, and black men at 34.0, 33.8, and 37.3%, respectively (p = 0.4). In the multivariable analysis for upgrading, significant predictors for upgrading were older age (p = 0.002), higher PSA (p < 0.001), and lower prostate weight (p = 0.02), but race/ethnicity did not predict upgrading. In patients with available follow-up (1083, 58%), upgrading predicted worse BCR-free survival (HR 2.17, CI 1.46-3.22, p < 0.0001) but race/ethnicity did not. HW men undergoing RP had similar rates of upgrading and adverse pathologic outcomes as NHW men. Race/ethnicity does not independently predict upgrading or worse oncologic outcomes after RP.

A two statewide population based study evaluating ethnic patterns, differences in treatment and survival between Hispanics and non-Hispanics with peripheral T cell lymphoma.

e19567 Background: Peripheral T-cell lymphomas (PCTLs) are an aggressive group of lymphomas that comprise less than 15% of all non-Hodgkin lymphomas in adults. There is limited literature regarding differences in outcomes for Hispanics (H). Some studies indicate worse outcomes in H compared to non-Hispanics (NH), whereas others have shown comparable outcomes. The purpose of this study is to evaluate demographics, treatment patterns and survival outcomes of PCTLs among H vs. NH in Texas (TX) and Florida (FL). Methods: This is a retrospective analysis of patients with PTCLs from the Texas Cancer Registry (TCR) and the Florida Cancer Data System (FCDS), from 2006-2017. Inclusion criteria was histopathologic proven PTCLs. Patients were divided into H and NH for comparison. Standard demographic, socioeconomic, clinical, and survival variables were reviewed. All statistical testing was determined using Fisher’s Exact test, Pearson’s Chi-square test, T-test or Wilcoxon test, as appropriate. Survival time was measured using the day of diagnosis to last date of follow up or death. Survival distributions were calculated based on Kaplan-Meier curves. Results: We identified 3358 patients. In TX 51% were H, and 49% were NH. In FL 27% were H, and 73% were NH. Median age at diagnosis of H was 70-79 years (y) (19%) and NH was 60-69 (23%) in TX (p &lt; 0.001). Median age at diagnosis of H was 50-59 y (26%) and NH was 70-7 y (26%) in FL (p &lt; 0.001). Most frequent poverty index was 20-100% for H vs 10-19.9% for NH (p &lt; 0.001) in TX and 10-19% for both H and NH (p &lt; 0.001) in FL. Government-sponsored insurance (GSI) was 40% in H vs 46% in NH (p &lt; 0.001) in TX and 35% vs 31% in NH (p &lt; 0.001) in FL. Most common stage at diagnosis for both groups was III/IV with 50% in H vs 49% in NH (p = 0.01) in TX; and stage I with 53% H vs 42% in NH (p = 0.05) in FL. Median overall survival (MOS) in TX for H was 1.4 years vs 1.5 in NH; survival probability (SP) for H vs NH at 2 y was 0.42 vs 0.44, at 5 y 0.32 vs 0.31, and at 10 y 0.21 vs 0.14 with no statistically significant difference in overall survival (OS). MOS in FL for H was 1.9 y vs 1.8 y in NH; SP for H vs NH at 2 y was 0.48 vs 0.47, at 5 y 0.36 vs 0.33, and at 10 y 0.24 vs 0.20 with no statistically significant difference in OS. Conclusions: Amongst the population of TX and FL, H with PTCLs have similar outcomes when compared to NH. There were no statistically significant differences in MOS or SP at 2, 5, and 10 y among the H cohorts. There were statistically significant differences between H and NH patients in median age of diagnosis, poverty index, and insurance status at diagnosis. These disparities were observed in both states and may be a direct reflection of the significantly higher rates of poverty and lack of insurance among H. Within the context of healthcare equality, we ascertained similar outcomes amongst groups, which agrees with previous reports claiming homogeneity of medical care.

Race/ethnicity and outcomes in hematopoietic stem cell transplantation (HCT) in myeloproliferative neoplasms (MPN): A single institutional study.

e19083 Background: Previous studies have demonstrated racial disparities in MPN outcomes, but there is no data regarding impact of race on outcomes of HCT in MPN. This is a retrospective study evaluating transplant related outcomes in Hispanics undergoing allogeneic HCT for MPN/MF in a large hospital in South Texas. Methods: A total of 45 patients who underwent HCT for MPN disorders from January 2008 to December 2020 at the Methodist Hospital, San Antonio were included. Race was self-reported by patients and obtained from electronic medical record along with other variables. Significance of variation in categorical outcomes were assessed with Chi-square tests. OS was estimated using the Kaplan-Meier method and compared between races using the log rank test. Results: This study analyzed 19 Non-Hispanic White (NHW) and 19 Hispanic (H) patients (7 patients were excluded due to unknown or other race). Patients primarily underwent transplantation for Myelofibrosis (n=19) followed by CMML (n=12) and MDS-MPN-U (n=7). There were no significant differences between NHW and H patients with regards to performance status, conditioning regimen, stem cell source and GvHD prophylaxis. However, H were younger at transplant with a median of 52 years (range 42-71) compared with 62 years (41-76) in NHW (p=0.50) and were more likely to have a haploidentical donor (47% vs 11%, p &lt; 0.001). There were no significant differences in time to neutrophil (median 22 days (range 15-560) versus 25 days (range 8-48 days), p=0.7) or platelet recovery (median 24 days (range 15-636) versus 25 days (range 6-102), p=0.9) in NHW vs H patients. There were no significant differences in cumulative incidence of grade 1-2 and grade 3-4 acute GvHD between NHW (50 and 50%) vs H (40 and 60%) patients (p=0.4 and p=0.5, respectively). There was significant difference in the cumulative incidence of chronic GvHD (68% NHW compared to 37% H, p=0.03). Median OS was 6.75 years in NHW and 2.67 years in H (p=0.08). The cumulative incidence of Relapse Mortality (RM) and non-RM were not statistically significant between NHW and H, however H had higher percentage of relapse related mortality at 5 years (5.3% vs 17.5%)(Table). Among the 5 NHW and 8 H non-relapse deaths, causes of death were similar among the two groups – the most common being infection (20% and 38%, respectively), acute and chronic (40% and 25%) GvHD and graft failure (0% and 25%). Conclusions: NHW and H had comparable relapse, non-relapse and survival rates likely due to similar access to treatment and follow-up within a single institution. Larger and prospective studies are needed to further elucidate this important topic.[Table: see text]

PH Roundtable: Disparities in PH

PH Roundtable: Disparities in PH

"I Felt Defeated. I Felt Helpless": Social Determinants of Health Influencing the Cancer Survivorship of a Young Latina Mother.

Social determinants of health (SDOH) contribute to cancer disparities among young Latina women (<50 years) residing in the counties along the US-Mexico border. These SDOH are particularly burdensome to young Latina mothers diagnosed with cancer while they are raising school-age children. Conexiones, a culturally adapted program designed to improve mother and child adjustment to maternal cancer, was piloted with diagnosed Latina mothers residing in border counties in New Mexico and Texas. The purpose of this case analysis was to highlight the SDOH affecting a young Latina mother's cancer survivorship in the U.S.-Mexico border region. The participant's Conexiones education sessions were recorded, transcribed, translated to English, back translated to Spanish to establish accuracy, and inductively coded. The participant's baseline survey indicated she was a young (<50 years), married, Spanish-speaking Latina mother diagnosed with breast cancer while raising a teenage daughter. Seventeen SDOH themes affecting the participant's cancer experience were identified in the cancer-related emotional triggers she reported across five Conexiones sessions. These themes were organized using Yanez's conceptual model of determinants of cancer outcomes in Hispanics (i.e., socioeconomic, healthcare, cultural context, and psychosocial). Findings provide direction for cultural adaptations of evidence-based programs.

Abstract 9489: Echocardiographic Characteristics, Cardiovascular Factors, and Disease-Directed Therapy Do Not Explain Differences in Covid-19 Related Hispanic Outcomes

Introduction: Severe coronavirus disease 2019 (COVID-19) is associated with cardiovascular injury and disparate outcomes in different ethnic groups. However, the reason for this difference has not been elucidated. Methods: A retrospective cross-sectional study was done on adult COVID-19 patients at a single center from April 2020 to January 2021. Mortality, length of stay, mechanical ventilation use, and intensive care unit (ICU) status were compared across demographic groups, echocardiographic indices, and COVID-19-specific treatments. Results: One hundred fifty patients were included. In univariate analysis, elevated cardiac biomarkers, COVID-19 directed therapies, and elevated right-sided pressures were associated with higher mortality, mechanical ventilation use, length of stay, and ICU admission. Multivariable logistic regression predicted higher mortality for Hispanic ethnicity (odds ratio, OR, 6.7) even when adjusting for advanced age (OR 5.3), mechanical ventilation use (OR 18), and right ventricular systolic pressure (OR 1.1 per 1mmHg). There were no differences in underlying comorbidities, echocardiographic indices, cardiac biomarkers, or treatments between Hispanic and non-Hispanic patients. Conclusions: Despite being a younger cohort, Hispanic patients had a higher rate of mortality even when controlling for age, biomarkers, and echocardiographic indices. This suggests Hispanic ethnicity is an independent risk factor for mortality in COVID-19 infection, highlighting an important health inequity that warrants further investigation.

Quadruple and Truncated MEK3 Mutants Identified from Acute Lymphoblastic Leukemia Promote Degradation and Enhance Proliferation.

Compared to other ethnicities, Hispanic children incur the highest rates of leukemia, and most cases are diagnosed as Acute Lymphoblastic Leukemia (ALL). Despite improved treatment and survival for ALL, disproportionate health outcomes in Hispanics persist. Thus, it is essential to identify oncogenic mutations within this demographic to aid in the development of new strategies to diagnose and treat ALL. Using whole-exome sequencing, five single nucleotide polymorphisms within mitogen-activated protein kinase 3 (MAP2K3) were identified in an ALL cancer patient library from the U.S./Mexico border. MAP2K3 R26T and P11T are located near the substrate-binding site, while R65L and R67W localized to the kinase domain. Truncated-MAP2K3 mutant Q73* was also identified. Transfection in HEK293 cells showed that the quadruple-MEK3 mutant (4M-MEK3) impacted protein stability, inducing degradation and reducing expression. The expression of 4M-MEK3 could be rescued by cysteine/serine protease inhibition, and proteasomal degradation of truncated-MEK3 occurred in a ubiquitin-independent manner. MEK3 mutants displayed reduced auto-phosphorylation and enzymatic activity, as seen by decreases in p38 phosphorylation. Furthermore, uncoupling of the MEK3/p38 signaling pathway resulted in less suppressive activity on HEK293 cell viability. Thus, disruption of MEK3 activation may promote proliferative signals in ALL. These findings suggest that MEK3 represents a potential therapeutic target for treating ALL.

Disparities in Mantle Cell Lymphoma Outcomes in Hispanics: A Population Based Analysis in Texas and Florida

Disparities in Mantle Cell Lymphoma Outcomes in Hispanics: A Population Based Analysis in Texas and Florida

Primary Language and Participation Outcomes in Hispanics With Traumatic Brain Injury: A Traumatic Brain Injury Model Systems Study.

To examine the relationship between primary language and participation outcomes in English- and Spanish-speaking persons with complicated mild to severe traumatic brain injury (TBI) at 1 year post-injury. Community following discharge from inpatient rehabilitation. A total of 998 Hispanic participants with outcomes available at year 1 follow-up; 492 (49%) indicated English as their primary language and 506 (51%) indicated Spanish as their primary language. Prospective, multicenter, cross-sectional, observational cohort study. Community participation at 1 year post-injury was assessed by 3 domains of the Participation Assessment with Recombined Tools-Objective (PART-O): Out and About, Productivity, and Social Relations. Unadjusted group comparisons showed better participation outcomes for English versus Spanish speakers for all PART-O domains and for the Balanced Total score. After controlling for relevant covariates, English-speaking participants had significantly better PART-O Balanced Total scores and better scores on the Social Relations domain, although effect sizes were small. Hispanic persons with TBI whose primary language is Spanish may require greater assistance integrating socially back into their communities after TBI. However, potential cultural differences in value placed on various social activities must be considered. Potential cultural bias inherent in existing measures of participation should be investigated in future studies.

Survival and Outcomes for T-Cell Lymphomas in a Ubiquitous Hispanic Community: A Texas Cancer Registry Retrospective Study

BACKGROUND Non-Hodgkin Lymphomas (NHL) represent one of the most common cancers in the United States, accounting for about 4% of all cancers and it is estimated over 77,000 people (including children and adults) will be diagnosed with NHL in the United States in 2020. Depending on the data, it is estimated T-cell lymphomas make up anywhere from 7 to 15% of all NHLs. Given their relative rarity compared to other sub-types of lymphomas (and malignancies at large), there is a scarce literature regarding their outcomes in ethnic minority groups. Retrospective reviews of cancer registries and SEER databases have demonstrated conflicting evidence regarding outcomes in Hispanics (HI) with some studies suggesting worse overall survival (OS) in this group (Clin Lymphoma Myeloma Leuk. PMID: 26198444), while others suggest comparable outcomes in the setting of healthcare homogeneity (Leuk Lymphoma. PMID: 25012944). MATERIALS/METHODS This is a retrospective study of a cohort of patients diagnosed with T-cell NHL from the Texas Cancer Registry (2006-2016). Patients were identified by the International Classification of Diseases for Oncology Third Edition (ICD-O-3) code list. Data was provided to us completely de-identified. Key variables collected included gender, ethnicity, dates at diagnosis and death, payer, stage, treatment, and poverty index. Categorical outcomes were summarized with frequencies and percentages and age, the only continuously distributed outcome, with the mean and standard deviation. The significance of variation in distribution of categorical outcomes with ethnicity [HI, non-Hispanic (NH)] was assessed with Fisher's Exact tests or Pearson's Chi-square as appropriate; age was assessed with T-test or Wilcoxon. Survival time was measured in years from date of primary diagnosis to date of death. Survival distributions were described with Kaplan-Meier curves and significance of variation in median survival with ethnicity was assessed with log rank testing. At risk tables were computed based on the Kaplan-Meier estimate of the survival curve. All statistical testing was two-sided with a significance level of 5%. Corrections for multiple testing were not applied. The R language was used throughout. RESULTS We identified 2074 patients with T-cell NHL (n= 902 Peripheral T Cell, NOS; 295 Angioimmunoblastic T Cell; 577 Anaplastic Large T Cell; 120 NK/T-cell; and 180 Adult T-cell Leukemia/Lymphoma). 553 were HI (26%), 1521 NH (74%). Median age of diagnosis in HI was 50.1 vs 57.4 in NH (p = &amp;lt;0.001). Males were more frequently affected, 63.8% in HI vs 58.9% in NH (p = 0.048). Most frequent poverty index was 20-100% for HI vs 10-19.9% for NH (p &amp;lt; 0.001). Most frequent payor for both groups were Medicare with 24.3% in HI vs 35.3% in NH (p &amp;lt; 0.001). Most common stage at diagnosis in both groups was III/IV with 50.3% in HI vs 49.7% in NH (p = 0.031). Most frequent chemotherapy included multiple agents for both, 55.7% in HI vs 44.2% in NH (p &amp;lt; 0.001). Majority in both groups had neither hematologic transplant 90.2% in HI vs 85.3% in NH (p = 0.073) nor radiation, 84.4% in HI vs 82.9% in NH (p = 0.076). Median overall survival (OS) in HI was 1.7 years vs 1.9 in NH; survival probability for HI vs NH at 2 years was 0.46 vs 0.49, at 5 years 0.37 vs 0.35, and at 10 years 0.24 vs 0.23 with no statistically significant difference in OS probability (p=0.89). CONCLUSION Our study demonstrates that amongst the population of Texas, HI with T-cell NHL have similar outcomes when compared to their NH counterparts. Breakdown of our cohort demonstrated similar healthcare utilization, as well as diagnostic and treatment modalities amongst both groups. Within the context of healthcare equality, we ascertained similar outcomes amongst groups, which is in agreement with previous reports claiming homogeneity of medical care helps overcome ethnic disparities. Figure Disclosures Diaz Duque: ADCT Therapeutics: Research Funding; Molecular Templates: Research Funding; AstraZeneca: Research Funding; Hutchinson Pharmaceuticals: Research Funding; Seattle Genetics: Speakers Bureau; Verastem: Speakers Bureau; AbbVie: Speakers Bureau.

Ethnic Disparities in Hodgkin's Lymphoma (HL): A Large-Scale Population Based Analysis of Hispanics with HL in Texas

BACKGROUND: It is estimated that 8480 persons in USA will be diagnosed with Hodgkin Lymphoma (HL) in 2020 accounting to approximately 0.5% of all new cancer diagnoses. The advent of new treatment options has improved the outcomes of this disease and 5-year relative survival rate is 87.4% currently. However, studies have shown that outcomes of HL have been worse in Hispanics (Annals of Oncology, PMID: 22241896) especially in late stage disease and HI experience up to a 35% higher risk of HL specific mortality than whites (AACR,PMID: 26826029). There is an unmet need in the field and dossiers on underrepresented ethnic minorities need to be carefully considered, compared to existing data. Our study aims to compare survival outcomes in Hispanics (HI) vs Non-Hispanics (NH) with HL and to our knowledge this is the largest cohort of patients from an area that represents a large proportion of HI population in the USA. METHODS: This is a retrospective study that examines HL patients obtained from Texas Cancer Registry (TCR) database between 2006-2016 and identified by the International Classification of Diseases for Oncology Third Edition (ICD-O-3) code list. All patient data was provided to us de-identified. Standard demographic variables collected include gender, race, ethnicity, dates at diagnosis and death, primary payer at diagnosis, subtype of lymphoma, stage, treatment modality, poverty index among others. Categorical outcomes were summarized with frequencies and percentages while age (years), the only continuously distributed outcome was summarized with the mean and standard deviation. The significance of variation in the distribution of categorical outcomes with ethnicity (HI vs NH) was assessed with Fisher's Exact tests or Pearson's Chi-square tests as appropriate; age was assessed with T-tests or Wilcoxon tests as appropriate. Survival time (years) was measured from date of primary diagnosis to death. Patients not coded as dead were considered censored on survival time at the date last seen. Survival distributions were described with Kaplan-Meier curves and significance of variation in median survival with ethnicity was assessed with log rank testing. At risk tables were computed based on the Kaplan-Meier estimate of the survival curve. All statistical testing was two-sided with a significance level of 5%. Corrections for multiple testing were not applied. The R language [R Core Team (2013). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria] was used throughout. RESULTS: We identified 6353 patients with HL, of which 1843 were HI (29%), 4510 NH (71%). Median age of diagnosis in HI was 41.3 vs 42.3 in NH (p = 0.084). Males were more frequently affected, 56.5% in HI vs 54.8 in NH (p = 0.213). Most frequent poverty index bracket for HI was between 20-100% vs 10-19.9% for NH (p &amp;lt; 0.001). Most frequent payment model amongst both groups was private insurance with 28.1% in HI vs 45.1% in NH (p &amp;lt; 0.001). Metro/non-border most frequent locality amongst both groups (p value n/a) with Harris county accounting to 15.7% of HL in HI vs 16.5% of HL in NH. Bexar county accounted for 12.5% of HL in HI vs 5.2% of HL in NH. Most common stage at diagnosis in both groups was III/IV with 43% in HI vs 33.7% in NH (p &amp;lt; 0.001). In both groups most frequent chemotherapy included multiple agents, 57.1% in HI vs 48.8% in NH (p &amp;lt; 0.001). Majority in both groups neither got any radiation, 77% in HI vs 76.5% in NH (p = 0.208) nor hematologic transplant, 92% in HI vs 88.6% in NH (p = 0.01). We found the median overall survival time in HI was 10.5 years vs 10.8 years in NH; the overall survival probability for HI vs NH at 2 years was 0.8 [CI 0.771-0.811] vs 0.85 [CI 0.83-0.853], at 5 years was 0.72 [CI 0.694-0.743] vs 0.77 [CI 0.753-0.782] and at 10 years was 0.60 [CI 0.544-0.646] vs 0.65 [CI 0.615-0.679]. CONCLUSION: Our study demonstrates that amongst the population of Texas, HI patients with HL have a statistically significant worse overall survival probability (p value &amp;lt; 0.0001) when compared to NH patients with HL. It is of paramount importance that outcomes for all racial and ethnic groups continue to improve but very little is known about the basis for these differences. This warrants a deeper investigation into the biological and non-biological determinants for these differences. Figure Disclosures Diaz Duque: ADCT Therapeutics: Research Funding; Molecular Templates: Research Funding; AstraZeneca: Research Funding; Hutchinson Pharmaceuticals: Research Funding; Seattle Genetics: Speakers Bureau; Verastem: Speakers Bureau; AbbVie: Speakers Bureau.

Outcomes in Hispanics With COVID-19 Are Similar to Those of Caucasian Patients in Suburban New York.

BackgroundDespite reported higher rates and worse outcomes due to COVID‐19 in certain racial and ethnic groups, much remains unknown. We explored the association between Hispanic ethnicity and outcomes in COVID‐19 patients in Long Island, New York.MethodsWe conducted a retrospective cohort study of 2,039 Hispanic and non‐Hispanic Caucasian patients testing positive for SARS‐CoV‐2 between March 7 and May 23, 2020, at a large suburban academic tertiary care hospital near New York City. We explored the association of ethnicity with need for intensive care unit (ICU), invasive mechanical ventilation (IMV), and mortality.ResultsOf all patients, 1,079 (53%) were non‐Hispanic Caucasians and 960 (47%) were Hispanic. Hispanic patients presented in higher numbers than expected for our catchment area. Compared with Caucasians, Hispanics were younger (45 years vs. 59 years), had fewer comorbidities (66% with no comorbidities vs. 40%), were less likely to have commercial insurance (35% vs. 59%), or were less likely to come from a nursing home (2% vs. 10%). In univariate comparisons, Hispanics were less likely to be admitted (37% vs. 59%) or to die (3% vs. 10%). Age, shortness of breath, congestive heart failure (CHF), coronary artery disease (CAD), hypoxemia, and presentation from nursing homes were associated with admission. Male sex and hypoxemia were associated with ICU admission. Male sex, chronic obstructive pulmonary disease, and hypoxemia were associated with IMV. Male sex, CHF, CAD, and hypoxemia were associated with mortality. After other factors were adjusted for, Hispanics were less likely to be admitted (odds ratio = 0.62, 95% confidence interval = 0.52 to 0.92) but Hispanic ethnicity was not associated with ICU admission, IMV, or mortality.ConclusionsHispanics presented at higher rates than average for our population but outcomes among Hispanic patients with COVID‐19 were similar to those of Caucasian patients.

Outcomes for Hispanics after Liver Transplantation are Comparable to Non-Hispanic Whites, Despite a Greater Burden of Disease: Parsing the Hispanic Paradox

Outcomes for Hispanics after Liver Transplantation are Comparable to Non-Hispanic Whites, Despite a Greater Burden of Disease: Parsing the Hispanic Paradox

Superior Outcomes for Hispanics after Kidney Transplantation Overshadow Access Obstacles: Understanding the Hispanic Paradox

Superior Outcomes for Hispanics after Kidney Transplantation Overshadow Access Obstacles: Understanding the Hispanic Paradox

Implementing a pharmacogenetic-driven algorithm to guide dual antiplatelet therapy (DAPT) in Caribbean Hispanics: protocol for a non-randomised clinical trial

IntroductionMinority populations in the USA are disproportionately affected by cardiovascular conditions. Reduced responsiveness to clopidogrel among carriers of CYP2C19 variants has been reported in patients with either coronary artery disease...

Abstract A035: The influence of patient-provider language concordance in cancer care: Results of the Hispanic Outcomes by Language Approach (HOLA) randomized trial

Abstract Purpose: Delivering linguistically competent care is critical to serving limited English proficiency patients, and represents a key national strategy to reduce health disparities. Current acceptable standards of communication with non-English speaking patients include providers communicating through professional interpretive services, or bilingual providers speaking patients’ non-English languages directly. This study tests the impact of patient-provider language concordance on patient satisfaction through the conduct of a randomized clinical trial. Methods and Materials: Eighty-three adult Spanish-speaking cancer patients were randomized to receive care from either 1) a bilingual physician speaking to a patient directly in Spanish or 2) from the same physician speaking English and using a professional interpreter service. Validated questionnaires were administered to assess patient-reported satisfaction with both provider communication and overall care. Audio recordings of initial consultations with oncologists were transcribed and analyzed for content variations. Results: Compared to using professional interpretive services, patients cared for in direct Spanish reported significantly improved general satisfaction, technical quality of care, care team interpersonal manner, communication, and time spent with patient. Specific to physician communication, patients rated direct Spanish care more highly in perceived opportunity to disclose concerns, physician empathy, confidence in physician abilities, and general satisfaction with their physician. Analyzing the content of consultation encounters revealed differences between study arms, with the direct Spanish arm having more physician speech related to patient history verification and partnering activities. Additionally, patients in the direct-Spanish arm were more likely to initiate unprompted speech, and ask their providers questions. Conclusions: This study demonstrates improved patient-reported satisfaction among Spanish-speaking cancer patients cared for in direct Spanish compared to patients cared for with interpreter-based communication. Further research into interventions to mitigate this patient-provider language barrier is necessary to optimize care for this minority population. Citation Format: Daniel M Seible, Souma Kundu, Alexa Azuara, Daniel Cherry, Steven Arias, Vinit Nalawade, Jonathan Cruz, Rolando Arreola, Elena M Martinez, Jesse Nodora, Douglas A Rahn, James D Murphy. The influence of patient-provider language concordance in cancer care: Results of the Hispanic Outcomes by Language Approach (HOLA) randomized trial [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A035.