Outcomes In African Americans Research Articles

Race Adjustment of Pulmonary Function Tests in the Diagnosis and Management of COPD: A Scoping Review.

Increasing evidence suggests that the inclusion of self-identified race in clinical decision algorithms may perpetuate longstanding inequities. Until recently, most pulmonary function tests utilized separate reference equations that are race/ethnicity based. We assess the magnitude and scope of the available literature on the negative impact of race-based pulmonary function prediction equations on relevant outcomes in African Americans with COPD. We performed a scoping review utilizing an English language search on PubMed/Medline, Embase, Scopus, and Web of Science in September 2022 and updated it in December 2023. We searched for publications regarding the effect of race-specific vs race-neutral, race-free, or race-reversed lung function testing algorithms on the diagnosis of COPD and COPD-related physiologic and functional measures. Joanna Briggs Institute (JBI) guidelines were utilized for this scoping review. Eligibility criteria: The search was restricted to adults with COPD. We excluded publications on other lung disorders, non-English language publications, or studies that did not include African Americans. The search identified publications. Ultimately, six peer-reviewed publications and four conference abstracts were selected for this review. Removal of race from lung function prediction equations often had opposite effects in African Americans and Whites, specifically regarding the severity of lung function impairment. Symptoms and objective findings were better aligned when race-specific reference values were not used. Race-neutral prediction algorithms uniformly resulted in reclassifying severity in the African Americans studied. The limited literature does not support the use of race-based lung function prediction equations. However, this assertion does not provide guidance for every specific clinical situation. For African Americans with COPD, the use of race-based prediction equations appears to fall short in enhancing diagnostic accuracy, classifying severity of impairment, or predicting subsequent clinical events. We do not have information comparing race-neutral vs race-based algorithms on prediction of progression of COPD. We conclude that the elimination of race-based reference values potentially reduces underestimation of disease severity in African Americans with COPD.

Assessing disparities in pancreatic cancer outcomes in African Americans.

612 Background: Pancreatic Adenocarcinoma (PA) is a leading cause of cancer-related death across the world, with poorer outcomes noted in minority populations. The observed variation in outcomes has been attributed to delayed diagnosis, barriers to optimal treatment and health care related disparities. We evaluated the impact of race on clinical presentation and outcomes in pancreatic cancer at a large academic teaching center. Methods: We performed a retrospective review of patients with pancreatic adenocarcinoma diagnosed between January 2016 to December 2021. The demographic characteristics (age, tobacco use, alcohol use, BMI); comorbidities (diabetes, acute/chronic pancreatitis); pathology, treatment (chemotherapy regimen, radiation, surgery) and recurrence free survival (RFS) and overall survival based on race were analyzed. Results: The cohort (N=947) consisted of 147 (16%) African Americans (AA) and 775 (82%) Non-Hispanic Whites (NHW). The mean age at diagnosis was 68 years (±10) among AA and 70 years (±11) in NHW. Thirty-seven (26%) of AA and 104 (14%) of NHW were current smokers; 46 (33%) of AA and 323 (45%) of NHW consumed alcohol regularly. Among AA, 32 (22%) were obese (BMI>30), compared to 194 (25%) in NHW. Other comorbidities included diabetes (35% in AA vs. 32% in NHW) and acute/chronic pancreatitis (11% among AA vs. 9% among NHW). Eighteen percent (18%) of AA and 17% of NHW had stage II disease, 16% and 12% had stage III and 48% in both had stage IV disease respectively. The treatment modality consisted of chemotherapy (63% in AA vs. 66% in NHW), surgery (25% in AA vs. 26% in NHW) and radiation (10% in AA vs. 12% in NHW). The median time to treatment initiation was 30 (17, 41) months for AA and 26 (16, 40) months for NHW. On univariate analysis, AA race was associated with younger age at diagnosis (p 0.043), higher current tobacco use (p 0.001), lower alcohol use (p 0.012), lower rates of obesity (p 0.024) and higher rate of acute pancreatitis (p 0.037) in pancreatic cancer. On multivariate analysis, race was not associated with difference in recurrence free survival (12 months in AA vs. 14 months in NHW; p 0.96) when adjusted for age, sex, alcohol use, tobacco use, cancer stage and chemotherapy. High mean age, clinical stage II, III and IV, current alcohol use, underweight and BMI>30 and cerebrovascular accident as a comorbidity was associated with worse overall survival when adjusted for other variables. Conclusions: Our study revealed that pancreatic cancer in AA was diagnosed at a younger age, associated with active smoking and pancreatitis. We observe there was no difference in treatment initiation among AA and NHW. There was no significant difference in recurrence free survival and overall survival compared to NHW when adjusted for other variables. Future studies incorporating germline mutations, novel biomarkers are needed to determine impact of racial health disparities on outcomes in pancreatic cancer.

Care delivery team composition effect on hospitalization risk in African Americans with congestive heart failure.

The care delivery team (CDT) is critical to providing care access and equity to patients who are disproportionately impacted by congestive heart failure (CHF). However, the specific clinical roles that are associated with care outcomes are unknown. The objective of this study was to examine the extent to which specific clinical roles within CDTs were associated with care outcomes in African Americans (AA) with CHF. Deidentified electronic medical record data were collected on 5,962 patients, representing 80,921 care encounters with 3,284 clinicians between January 1, 2014 and December 31, 2021. Binomial logistic regression assessed associations of specific clinical roles and the Mann Whitney-U assessed racial differences in outcomes. AAs accounted for only 26% of the study population but generated 48% of total care encounters, the same percentage of care encounters generated by the largest racial group (i.e., Caucasian Americans; 69% of the study population). AAs had a significantly higher number of hospitalizations and readmissions than Caucasian Americans. However, AAs had a significantly higher number of days at home and significantly lower care charges than Caucasian Americans. Among all CHF patients, patients with a Registered Nurse on their CDT were less likely to have a hospitalization (i.e. 30%) and a high number of readmissions (i.e., 31%) during the 7-year study period. When stratified by heart failure phenotype, the most severe patients who had a Registered Nurse on their CDT were 88% less likely to have a hospitalization and 50% less likely to have a high number of readmissions. Similar decreases in the likelihood of hospitalization and readmission were also found in less severe cases of heart failure. Specific clinical roles are associated with CHF care outcomes. Consideration must be given to developing and testing the efficacy of more specialized, empirical models of CDT composition to reduce the disproportionate impact of CHF.

Evaluating disparities in pancreatic cancer outcomes in African Americans.

e18657 Background: Pancreatic Adenocarcinoma (PA) is a leading cause of cancer-related death across the world, with poorer outcomes observed in minority populations. The observed variation in outcomes has been attributed to delayed diagnosis, barriers to optimal treatment and health care related disparities. We sought to evaluate the impact of race on clinical presentation and outcomes in pancreatic cancer at a large academic teaching center. Methods: We performed a retrospective review of patients with pancreatic adenocarcinoma diagnosed between January 2016 to December 2021. The demographic characteristics (age, tobacco use, alcohol use, BMI); comorbidities (diabetes, acute/chronic pancreatitis); pathology, treatment (chemotherapy regimen, radiation, surgery) and progression free survival (PFS) based on race were analyzed. Results: The cohort (N = 983) consisted of 154 (16%) African Americans (AA) and 803 (82%) Non-Hispanic Whites (NHW). The median age at diagnosis was 65 years (60, 70) among AA and 71 years (64, 78) in NHW. Thirty-seven (26%) of AA and 104 (14%) of NHW were current smokers; 46 (33%) of AA and 323 (45%) of NHW consumed alcohol regularly. Among AA, 32 (22%) were obese (BMI > 30), compared to 194 (25%) in NHW. Other comorbidities included diabetes (35% in AA vs. 32% in NHW) and acute/chronic pancreatitis (11% among AA vs. 9% among NHW). The treatment modality consisted of chemotherapy (57% in AA vs. 61% in NHW), surgery (26% in AA vs. 27% in NHW) and radiation (10% in AA vs. 12% in NHW). The median time to treatment initiation was 24 (16, 41) months for AA and 34 (20, 56) months for NHW. On univariate analysis, AA race was associated with younger age at diagnosis (p 0.043), higher current tobacco use (p 0.001), lower alcohol use (p 0.012), lower rates of obesity (p 0.024) and higher rate of acute pancreatitis (p 0.037) in pancreatic cancer. On multivariate analysis, race was not associated with difference in progression free survival (12 months in AA vs. 14 months in NHW; p 0.96) when adjusted for age, sex, alcohol use, tobacco use, cancer stage and chemotherapy. Conclusions: Our study revealed that pancreatic cancer in AA was diagnosed at a younger age, associated with active smoking and pancreatitis. Although there was a shorter time to treatment initiation among AA, there was no significant difference in progression free survival compared to NHW when adjusted for other variables. Future studies incorporating novel biomarkers are needed to determine impact of racial health disparities on outcomes in pancreatic cancer.

Lipidomic Profiling Reveals Biological Differences between Tumors of Self-Identified African Americans and Non-Hispanic Whites with Cancer.

In the US, the incidence and mortality of many cancers are disproportionately higher in African Americans (AA). Yet, AA remain poorly represented in molecular studies investigating the roles that biological factors might play in the development, progression, and outcomes of many cancers. Given that sphingolipids, key components of mammalian cellular membranes, have well-established roles in the etiology of cancer progression, malignancy, and responses to therapy, we conducted a robust mass spectrometry analysis of sphingolipids in normal adjacent uninvolved tissues and tumors of self-identified AA and non-Hispanic White (NHW) males with cancers of the lung, colon, liver, and head and neck and of self-identified AA and NHW females with endometrial cancer. In these cancers, AA have worse outcomes than NHW. The goal of our study was to identify biological candidates to be evaluated in future preclinical studies targeting race-specific alterations in the cancers of AA. We have identified that various sphingolipids are altered in race-specific patterns, but more importantly, the ratios of 24- to 16-carbon fatty acyl chain-length ceramides and glucosylceramides are higher in the tumors of AA. As there is evidence that ceramides with 24-carbon fatty acid chain length promote cellular survival and proliferation, whereas 16-carbon chain length promote apoptosis, these results provide important support for future studies tailored to evaluate the potential roles these differences may play in the outcomes of AA with cancer.

Influence of TRPM4 rs8104571 genotype on intracranial pressure and outcomes in African Americans with traumatic brain injury

The TRPM4 gene codes for a membrane ion channel subunit related to inflammation in the central nervous system. Recent investigation has identified an association between TRPM4 single nucleotide polymorphisms (SNPs) rs8104571 and rs150391806 and increased intracranial (ICP) pressure following traumatic brain injury (TBI). We assessed the influence of these genotypes on clinical outcomes and ICP in TBI patients. We included 292 trauma patients with TBI. DNA extraction and real-time PCR were used for TRPM4 rs8104571 and rs150391806 allele discrimination. Five participants were determined to have the rs8104571 homozygous variant genotype, and 20 participants were identified as heterozygotes; 24 of these 25 participants were African American. No participants had rs150391806 variant alleles, preventing further analysis of this SNP. Genotypes containing the rs8104571 variant allele were associated with decreased Glasgow outcome scale-extended (GOSE) score (P = 0.0231), which was also consistent within our African-American subpopulation (P = 0.0324). Regression analysis identified an association between rs8104571 variant homozygotes and mortality within our overall population (P = 0.0230) and among African Americans (P = 0.0244). Participants with rs8104571 variant genotypes exhibited an overall increase in ICP (P = 0.0077), although a greater frequency of ICP measurements > 25 mmHg was observed in wild-type participants (P = < 0.0001). We report an association between the TRPM4 rs8104571 variant allele and poor outcomes following TBI. These findings can potentially be translated into a precision medicine approach for African Americans following TBI utilizing TRPM4-specific pharmaceutical interventions. Validation through larger cohorts is warranted.

Uncovering Ethnic Genomic Disparities Associated with Inferior Outcome in African Americans Diagnosed with Acute Myelogenous Leukemia

Background: African Americans (AA) have higher cancer-associated mortality than other ethnicities. AA with AML exhibit inferior overall survival (OS) to non-AA subgroups (OS=162 d vs 709 d, respectively, p=0.0001, HR=7.8) Fig 1A. In other cancers, higher genomic instability (GI) and differential oncogenic addiction contribute to AA worse outcomes; however, in AML, genetic causes of inferior outcomes are uncharacterized. In this study, we seek to investigate differential AML mut and other factors that contribute to inferior AA OS. Methods: After IRB approval, 92/250 (36.8%) available AML patients (pt) had next generation sequencing (NGS) data and were included. Mut frequencies were annotated by ethnicity [White (W) vs AA vs Hispanic (H) vs Asians (A)] and prioritized by European Leukemia Network (ELN) 2017 classification. Numeric chromosomic alterations (NCA) were extracted from metaphase karyotyping at diagnosis. Deleteriousness of mutations to protein function was calculated with sorting intolerant from tolerant (SIFT) prediction method. Chi-square and t-test evaluated differences in categorical and continuous variables respectively. Logistic binary regression was used to detect predictors for racial induced survival. SAS software was used. Results: Whites (W), AA, Hispanics (H) and Asians (A) represented 57/91 (62%), 14/91 (15%), 20/91 and (22%), 5/91 (5.4%) of the cohort, respectively. Median age was 63 (W) , 57.5 (AA) , 53 (H), 62 (A), p=NS. 60/92 (65%) were male. Median number of mut were 2.04 (W), 1.8 (AA), 2.2 (H) and 1.8 (A), p=NS. Distribution for adverse ELN-2017 defects were equivalent among AA vs non-AA except RUNX1, p=0.05. Lack of favorable mut was observed among AA. Only AA demonstrated CUX1, previously associated with DNA repair defects, and FBXW7 mut. A non-significant trend for higher NCA in AA (2.7 [W], 6.4 [AA], 3 [H] and 0.8 [A], p=0.09) was observed. Age correlated with NCA and number of mut in AML genome, p=0.02 and p=0.004. Interestingly, correlation effect was mostly driven only by AA, p=0.02 and p=0.003, respectively. SIFT score was 0.01 (W), 0.09 (AA), 0.02 (H), and 0.01 (A). These SIFT results suggest that AA mut are functionally tolerated. After adjusting for multiple factors, only canonical ELN-2017 mut, p=0.02 (OR 0.37, CI 0.16-0.8), and AA race, p=0.005 (OR 0.25, CI 0.1-0.67) increased risk of death (c-statistics=0.66) Fig.1B. Conclusions: In AA, frequency of Adverse ELN-2017 mut is similar to other races, but favorable mutations were lacking. NCA and number of AML genome mut strongly correlate with aging in AA, but not other ethnic groups. Surprisingly, SIFT score failed to demonstrate functional deleteriousness for AA mut, which suggests alternative genomic defects as a culprit for poor outcome. Acknowledging the small number of mut in our cohort, our study advances our understanding of racial disparity in AML survival. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Perspectives on a Novel Culturally Tailored Diabetes Self-Management Program for African Americans: A Qualitative Study of Healthcare Professionals and Organizational Leaders.

Background: There is an urgent need for culturally tailored diabetes self-management education to improve health outcomes in African Americans, especially given the disproportionate prevalence of diabetes and medication non-adherence. Stakeholder engagement can guide and enrich the development of these interventions by integrating content directly addressing barriers to African Americans’ adherence with existing community-based diabetes self-management education programs. The aim of this study is to explore stakeholder perspectives on a novel culturally tailored diabetes self-management program for African Americans. Methods: Thirteen semi-structured individual interviews were conducted in a large Midwestern U.S. city with healthcare professionals and organizational leaders serving African American communities and/or providing diabetes education. Transcripts were analyzed using directed content analysis with the Consolidated Framework for Implementation Research and inductive content analysis. Results: Five overarching themes were identified: (1) fulfill needs among stakeholders, (2) creating a supportive and trusting environment to address distrust, (3) building relationships and empowering peers, (4) logistical organization barriers to program implementation and (5) challenges to program acceptance by participants. Conclusion: Stakeholders delineated how the new culturally tailored diabetes self-management program aligned with the needs of African American patients. Perceived challenges and corresponding strategies to address barriers to participation were identified to inform program implementation and sustainability.

Molecular and pathological subtypes related to prostate cancer disparities and disease outcomes in African American and European American patients.

Prostate cancer (PCa) disproportionately affects African American (AA) men, yet present biomarkers do not address the observed racial disparity. The objective of this study was to identify biomarkers with potential benefits to AA PCa patients. Differentially expressed genes (DEG) analysis coupled with gene set enrichment analysis (GSEA) and leading-edge genes analysis showed that the keratin family of genes, including KRT8, KRT15, KRT19, KRT34, and KRT80, constituted the single most prominent family of genes enriched in AA compared to European American (EA) PCa cell lines. In PCa patients (TCGA and MSKCC patient cohorts), KRT8, KRT15, and KRT19 expression were relatively higher in AA than in EA patients. The differences in the expression of KRT15 and KRT19, but not KRT8, were enhanced by Gleason score and ERG fusion status; in low Gleason (Gleason ≤ 6 [TCGA cohort] and Gleason ≤ 7 [MSKCC cohort]), the expression of KRT15 and KRT19 was significantly (p ≤ 0.05) higher in AA than in EA patients. Survival analysis revealed that high expression of KRT15 and KRT19 was associated with increased risk of biochemical recurrence in low Gleason category patients in the TCGA patient cohort. Interestingly, KRT15 and KRT19 expression were also associated with an increased risk of death in the metastatic prostate adenocarcinoma cohort, suggesting the potential to predict the risks of disease recurrence and death in the low Gleason category and advanced disease conditions respectively. Gene set enrichment analysis revealed known oncogenic gene signatures, including KRAS and ERBB2, to be enriched in patients expressing high KRT15 and KRT19. Furthermore, high KRT15 and KRT19 were linked to the basal and LumA PCa subtypes, which are associated with poor postoperative androgen deprivation therapy (ADT) response compared to the LumB subtype. Taken together, the present study identifies genes with high expression in AA than in EA PCa. The identified genes are linked to oncogenic gene signatures, including KRAS and ERBB2, and to basal and LumA PCa subtypes that are associated with poor postoperative ADT response. This study, therefore, reveals biomarkers with the potential to address biomarker bias in PCa risk stratification and/or prognosis.

Abstract 510: Molecular subtypes related to prostate cancer disparities and disease outcome in African American and European American patients

Abstract Prostate cancer disproportionately affects African American (AAM) men, yet present biomarkers do not factor in prostate cancer racial disparity. The objective of this study was to identify biomarkers with potential benefits to AAM prostate cancer patients. Differentially expressed genes (DEG) analysis coupled with gene set enrichment analysis (GSEA) and leading-edge genes analysis showed that the keratin family of genes, including KRT8, KRT15, KRT19, KRT34, and KRT80, constituted the single most prominent family of genes enriched in AAM compared to European American (EAM) prostate cancer cell lines. In prostate cancer patients (TCGA and MSKCC patient cohorts), only KRT8, KRT15, and KRT19 expression were relatively higher in AAM than in EAM. The differences in the expression of KRT15 and KRT19, but not KRT8, were enhanced by Gleason score and ERG fusion status; in low Gleason (Gleason ≤ 6 [TCGA cohort] and Gleason ≤ 7 [MSKCC cohort]), the expression of KRT15 and KRT19 was significantly (p ≤ 0.05) higher in AAM than in EAM patients. Survival analysis revealed that high expression of KRT15 and KRT19 was associated with increased risk of biochemical recurrence in low Gleason category patients in the TCGA patient cohort. Interestingly, KRT15 and KRT19 expression was associated with an increased risk of death in the metastatic prostate adenocarcinoma (SU2C/PCF Dream Team, PNAS 2019) cohort, suggesting the potential to predict the risks of disease recurrence and death in the low Gleason category and advanced disease conditions respectively. Gene set enrichment analysis revealed known oncogenic gene signatures, including KRAS and ERBB2, to be enriched in patients expressing high KRT15 and KRT19. Furthermore, high KRT15 and KRT19 were linked to the basal and LumA prostate cancer subtypes associated with poor postoperative androgen deprivation therapy (ADT) response compared to the LumB subtype. Taken together, the present study identifies genes with high expression in AAM than in EAM prostate cancer. The identified genes are linked to oncogenic gene signatures, including KRAS and ERBB2, and to basal and LumA prostate cancer subtypes that are associated with poor postoperative ADT response. The study, therefore, reveals biomarkers with the potential to address biomarker bias in prostate cancer diagnosis and/or prognosis. Future studies would explore the diagnostic and/or prognostic potential of identified markers in prostate cancer tissue samples. Citation Format: Joakin Opeli Mori, Jason White, Balasubramanyam Karanam, Clayton Yates, Honghe Wang. Molecular subtypes related to prostate cancer disparities and disease outcome in African American and European American patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 510.

Abstract 518: Association of CC chemokines with breast cancer disparity

Abstract Despite recent advances, breast cancer (BrCa) still affects many women, and the impact is disproportional in African Americans (AA) and European Americans (EA). Addressing socioeconomic and behavioral status has not been enough to reduce disparity, suggesting racial difference in BrCa biology. Our laboratory was the first to show the involvement of CC chemokines in BrCa. In this study, using ONCOMINE, TCGA, bc-GenExMiner, KMplotter, and antibody microarray, we examined the association of CC chemokines in BrCa outcomes and disparity. We show over-expression of CCL5, CCL7, CCL11, CCL17, CCL20, CCL22, and CCL25 in BrCa tissues. High mRNA levels of CCL7, CCL8, CCL17, CCL20, and CCL25 predicted a decrease in overall survival (OS). CCL7 and CCL8 were associated with decreased relapse-free survival. Expression of CCL17 and CCL25 was associated with decreased OS in AA. In EA, CCL8 was associated with decreased OS. Expression of CCL5, CCL7, CLC8, CCL17, CCL20, and CCL25 was highest in TNBC. The expression of CCL11 and CCL22 was associated with HER2 expression. CCL7, CCL8, CCL17, CCL20, and CCL25 were elevated in AAs. Since CCL25 showed a significant association with decreased OS in AA, we examined the expression of CCR9, which is the only receptor for CCL25, and CCR9-mediated signaling in BrCa cell lines derived from AA and EA. Our data show higher expression of CCR9 in AA than EA and distinct molecular cascade in cells derived from AA than EA. Furthermore, higher CCR9 expressing cells showed poor response to Carboplatin upon CCR9 activation. In conclusion, our data suggest the association of distinct CC-chemokines in BrCa progression, OS, and disparate disease outcome in AA compared to EA patients implying CCR9 signaling to be a potential target for improving chemotherapeutic response. Citation Format: Hina Mir, Briana A. Brock, Rajeev Samant, Shailesh Singh. Association of CC chemokines with breast cancer disparity [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 518.

Comparison of demographics, disease characteristics, and outcomes between African American patients and White patients with myelodysplastic syndrome: A population-based study.

7051 Background: Myelodysplastic syndrome (MDS) consists of a heterogeneous group of clonal myeloid neoplasms, classified as a malignancy since 2001. Previous studies have described inferior outcomes for African Americans (AA) versus Whites (W) in several solid tumors and hematological malignancies, including AML. We performed an analysis of the Survival, Epidemiology, and End Results (SEER) cancer registry to analyze baseline characteristics and various outcomes. Methods: Using SEER (18 Registries, 2000-2018, Nov 2020 submission), we included 37,564 patients (pts) with microscopically confirmed MDS, age &gt; = 20, diagnosed between 2000-2013 based on ICO-O3 codes. MDS sub-types were grouped into low, intermediate, and high-risk disease. We compared baseline characteristics, mortality rates per attributed cause of death (COD) and overall survival (OS). Multivariate Cox regression and Propensity Score analyses were conducted to reduce effect of confounding due to imbalance in baseline covariates. Results: We included 34,543 W (92%) and 3021 AA (8%) pts; There were more males (58%) among W vs AA (49%). At diagnosis the median age was 71 and 76 in AA and W subjects, respectively. Low and high risk MDS comprised 22.8% and 14.5% of cases among AA and 21.5% and 16.3% among W pts, respectively. 66.8% of AA were living in large metropolitan areas vs 60.2% for W pts. mOS was 33 months for AA and 26 months for W; HR for OS comparing W vs AA using a univariate Cox PH model was: 0. 79 (0.76- 0.82), p &lt; 0.001. In a multivariate Cox-PH model, HR for OS after adjusting for sex, age at diagnosis, histology, urban-rural continuum, income group was: 0.90 (95%CI 0.86-0.94), p &lt; 0.001. HRs after stratified cox PH model and propensity score matching model for age, sex, histology and income group were 0.92 (0.88-0.96), p &lt; 0.001 and 0.93(0.88-0.98), p = 0.01 respectively. Analysis by histology shows statistically significant association between race and OS for refractory anemia and MDS-unclassifiable while not significant for refractory anemia with ringed sideroblasts, refractory anemia with excess blasts and MDS with del(5q). Incidence rate ratio for AA vs W for death attributed to the two most frequent CODs were: MDS/Leukemia: 0.74 (0.69-0.81, p &lt; 0.001); CVD: 1.07 (0.94-1.21, ns). Conclusions: In this large study of MDS cases reported to the SEER registry, we observed differences in age, sex, disease subtype, socio-economic factors, mortality rate per attributed COD, survival outcomes between AA and W. The finding of AA having better OS outcomes than W pts is unexpected and needs to be further investigated, specifically the contribution of the less well-defined low-grade risk forms of MDS. Although caution in the interpretation is necessary due to multiple limitations inherent to the SEER dataset, this data does raise intriguing questions for future study.

Race and ethnicity define disparate clinical outcomes in chronic rhinosinusitis

BackgroundChronic rhinosinusitis (CRS) is a common upper airways inflammatory disease requiring multidisciplinary care. ObjectiveTo evaluate if African Americans (AA), Latinxs, and nonLatinx White (White) patients have different chronic rhinosinusitis outcomes and to identify associated factors impacting these outcomes. MethodsWe conducted a large prospective cohort study of CRS patients who were evaluated and followed for several clinical variables at the initial encounter and after continuous management of CRS for a mean of 40 months. The Sinonasal Outcome Test (SNOT-22) and Lund-MacKay scores were measured on initial visits, and SNOT-22 was repeated at the end of follow-up. Logistic regression was used to compare outcomes between the different groups adjusted for comorbidities and demographics. ResultsAmong the 977 enrolled CRS cases, 615 (63.0%), 235 (24.1%) and 138 (13.0%) were White, AA and Latinx respectively. There was no difference in severity of CRS based on Lund-MacKay scores and SNOT-22 scores, and frequency of other comorbidities at presentation among the 3 groups. During the follow-up period, compared with Whites, AA and Latinx were less frequently evaluated by an allergist. AAs had less frequent CRS related visits and lower final SNOT-22 score compared with Whites. ConclusionAlthough our enrolled patients from the 3 ethnic groups had similar clinical characteristics and disease burden at baseline, AAs had less frequent follow-up visits and worse final SNOT-22 after 40 months of follow-up. The observed poorer outcomes in AAs are likely owing to inequity in healthcare access evidenced by differences in insurance and suboptimal management of CRS.

Improving Heart Transplant Outcomes in the African American Population? Are We There Yet?

<h3>Purpose</h3> Heart failure (HF) related deaths in Southern United States (SUS), where majority of the African American (AA) population lives, is 202.5/100,000 of population, and is significantly higher than median of 189.5 deaths for rest of US. We sought to investigate the heart transplant (HTX) trends and post-transplant outcomes in the AA population over the years. <h3>Methods</h3> United Network for Organ Sharing (UNOS) registry was analyzed for all adult HTX recipients (HTR) from 1999 to 2018. Two groups were evaluated (Group 1: AA, Group 2: All others) over 5 year intervals (Time A:1998-2003, B:2003-2008, C:2008-2013, D:2013-2018) and organ allocation regions (south: region 3&11 vs Other (rest of US)). Chi-square, trend test and Kaplan- Meier survival analysis were applied to analyze HTX trends over time, and long-term survival and hazard ratios were analyzed by cox regression modeling. <h3>Results</h3> 35,566 patients received HTX, with 6,737 (18%) being AA with mean age of 52.9±12.5 years. In AA HTR 2224 (33%) were female. Of 8464 HTR in SUS, 2635 (31%) were AA with progressive increase in HTX in every 5 year time interval (Time A-20%, B-26%, C-30%, D-33%)(p<0.0001) and demonstrated statistical significance after adjusting for confounding variables (p<0.0001). KM survival analysis in HTR-AA during the four-time intervals showed progressive increase in survival (Fig). However, HTR-AA had increased risk of death in all time periods (Time A: 27%, B: 36%, C: 25%) from 1999-2013 in comparison to rest of population. <h3>Conclusion</h3> Burden of heart failure is higher in SUS, and resources are needed to improve HF management, improve access to HF therapies including HTX, and devise new strategies to improve HTX outcomes in AA.

Abstract P028: Do Increased Cardiovascular Comorbidities Explain Excess Covid-19 Morbidity And Mortality In African Americans?

Introduction: Racial disparities in COVID-19 incidence, severity and mortality have been widely reported, with African Americans (AA) suffering disproportionately compared to White Americans (WA), but the epidemiological basis for these observations remains poorly understood. We hypothesize that AA have an excess of comorbid cardiovascular conditions compared to WA, accounting for the disparity in COVID-19 infection and death. Methods: We examined 63545 laboratory-confirmed COVID-19 cases from the One Florida Research Consortium’s sample of recipients of healthcare in Florida from January 2020 to April 2021. We assessed the prevalence of preexisting comorbid conditions, behavioral risk factors, and outcomes of AA, WA, and Hispanic patients testing positive for COVID-19. Outcomes were defined as admission to ICU or all-cause death in the index admission. Associations between risk factors and outcomes were evaluated using multivariate logistic regression analysis. Results: Compared to WA, Hispanic and AA COVID-19 patients were younger, more females, and more uninsured. AA patients with COVID-19 had the highest burden of comorbidities (especially cardiovascular), and worse combined comorbidity scores. They also had a higher rate of ICU admission and death. After adjustment for multiple variables, AA patients continued to have the highest adverse outcomes risk (OR=1.44; P &lt; 0.001; Figure 1). Other significant predictors in the model included age, sex, poverty, cardiovascular comorbidities, cancer, and mental health disorders. Conclusions: Excess comorbidities from cardio-metabolic diseases exist in AA patients with COVID-19, who also suffer excess COVID-19 outcomes. However, these cardiovascular comorbidities did not account for all the risk of adverse COVID-19 outcomes. Reasons for the excess residual risk of in AA even after adjusting for comorbidities and other risk factors require further investigation, such as mediation analyses.

Disparities in Cancer Specific and Overall Survival Outcomes in African Americans With Renal Cell Carcinoma: Analysis From the International Marker Consortium for Renal Cancer (INMARC)

ObjectiveTo investigate association of African-American race and survival in Renal Cell Carcinoma (RCC). Patients and MethodsWe queried the International Marker Consortium for Renal Cancer database for patients who underwent partial or radical (RN) nephrectomy. The cohort was divided into African American (AA) and non-African American (NAA) patients. Primary outcome was all-cause mortality. Secondary outcome was cancer-specific mortality. Multivariable Analysis and Kaplan-Meier Analysis were used to elucidate predictive factors and survival outcomes. ResultsThree thousand eight hundred and ninety-three patients were analyzed (AA, n = 564/NAA, n = 3329). AA had greater Stage I (73.8% vs 63.9%, P <.001) and papillary RCC (29.8% vs 8.5%, P <.001). Multivariable Analysis revealed increasing age (HR = 1.03, P <.001), AA (HR = 1.24, P = .027), higher stage (HR = 1.30-3.19, P <.001), RN (HR = 2.45, P <.001), clear cell (HR = 1.23, P <.001), positive margin (HR = 1.34, P .004), and high-grade (HR = 1.58, P <.001) to be associated with worsened all-cause mortality. Increasing age (HR = 1.02, P <.001), AA (HR = 1.48, P = .025), RN (HR = 2.98, P <.001), high-grade (HR = 3.11, P <.001), and higher stage (HR = 3.03-13.2, P <.001) were predictive for cancer-specific mortality. Kaplan-Meier Analysis revealed worsened 5-year overall survival for AA in stage I (80% vs 88%, P = .001), stage III (26% vs 70%, P = .001), and stage IV (23% vs 44%, P = .009). Five-year cancer-specific survival was worse for AA in stage III (36% vs 81%, P <.001) and stage IV (30% vs 49%, P = .007). ConclusionDespite presenting with more indolent histology and lower stage, African-Americans were at greater risk for diminished survival, faring worse in overall survival for all stages and cancer-specific survival in for stage III/IV RCC. Further investigation into factors associated with these disparities is warranted.

Disparities Research at the Deep South Alzheimer’s Disease Center of the University of Alabama at Birmingham

Residents of the US Deep South (Alabama, Georgia, Louisiana, Mississippi, and South Carolina) have a 20–30% higher risk of developing Alzheimer’s disease or related dementia (ADRD). Moreover, >20% of African Americans, who are at higher ADRD risk than whites, live in this region. Therefore, one important goals of the Deep South Alzheimer’s Disease Center (DS-ADC) of the University of Alabama at Birmingham is to spearhead research to address these disparities. This panel presents current DS-ADC research, with two presentations focusing on the local patient population and the last two on the Deep South population compared to the rest of the nation. Addressing the challenge of recruiting representative samples in clinical research, the first paper is part of a research program to understand difference that may exist between African American and white research participants. The second paper examines patients with multiple conditions, in particular dementia and cancer, showing a marked disadvantage in cognition outcomes for African Americans. The next two papers take a broader perspective to better understand the population of older adults with ADRD in the Deep South and in the rest of the US. The third paper examines socioeconomic and medical contexts of African American and white older Medicare beneficiaries with ADRD, and the fourth paper examines differences in utilization of specialists, ADRD drugs, and hospitalizations in the two regions taking these contexts into account. The discussant will close the session by placing these studies in the larger context of the disparities research at the DS-ADC.

SToRytelling to Improve Disease outcomes in Gout (STRIDE-GO): a multicenter, randomized controlled trial in African American veterans with gout

BackgroundUrate-lowering therapy (ULT) adherence is low in gout, and few, if any, effective, low-cost, interventions are available. Our objective was to assess if a culturally appropriate gout-storytelling intervention is superior to an attention control for improving gout outcomes in African-Americans (AAs).MethodsIn a 1-year, multicenter, randomized controlled trial, AA veterans with gout were randomized to gout-storytelling intervention vs. a stress reduction video (attention control group; 1:1 ratio). The primary outcome was ULT adherence measured with MEMSCap™, an electronic monitoring system that objectively measured ULT medication adherence.ResultsThe 306 male AA veterans with gout who met the eligibility criteria were randomized to the gout-storytelling intervention (n = 152) or stress reduction video (n = 154); 261/306 (85%) completed the 1-year study. The mean age was 64 years, body mass index was 33 kg/m2, and gout disease duration was 3 years. ULT adherence was similar in the intervention vs. control groups: 3 months, 73% versus 70%; 6 months, 69% versus 69%; 9 months, 66% versus 67%; and 12 months, 61% versus 64% (p > 0.05 each). Secondary outcomes (gout flares, serum urate and gout-specific health-related quality of life [HRQOL]) in the intervention versus control groups were similar at all time points except intervention group outcomes were better for the following: (1) number of gout flares at 9 months were fewer, 0.7 versus 1.3 in the previous month (p = 0.03); (2) lower/better scores on two gout specific HRQOL subscales: gout medication side effects at 3 months, 32.8 vs. 39.6 (p = 0.02); and unmet gout treatment need at 3 months, 30.9 vs. 38.2 (p = 0.003), and 6 months, 29.5 vs. 34.5 (p = 0.03), respectively.ConclusionsA culturally appropriate gout-storytelling intervention was not superior to attention control for improving gout outcomes in AAs with gout.Trial registrationRegistered at ClinicalTrials.gov NCT02741700

DELAYED DIAGNOSIS OF METASTATIC INVASIVE DUCTAL CARCINOMA DUE TO THE COVID-19 PANDEMIC

TOPIC: Imaging TYPE: Medical Student/Resident Case Reports INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has drastically changed access to medical care. In an attempt to decrease the breakout of COVID-19, quarantine protocols and strict restrictions led to brief closures of primary care offices leading to delays in preventative care. The combination of primary care closures and public fear led to an interruption in the continuity of care. The consequences can be dire and include delays in serious and time sensitive diagnoses, like cancer. CASE PRESENTATION: Our patient is a 59-year-old woman with a history of heart failure with reduced ejection fraction, hypertension, and type-2 diabetes mellitus, who presented to the emergency room with acute-onset dyspnea and a right-sided breast mass. She first noticed a golf ball sized breast lump in March of 2020. She was not able to see her primary care physician due to the lockdown and her own fear of exposure to COVID-19. By June of 2020, the patient stated the mass had grown to be the size of a baseball.She decided to come to the hospital in March of 2021 when her symptoms progressed to include dyspnea with minimal exertion. She described increasing shortness of breath over a few days and denied orthopnea, fever, chills, chest pain, nausea, and vomiting. CT angiogram was negative for a pulmonary embolism; however, it revealed numerous bilateral lung nodules, a moderate-sized left pleural effusion, and a 11.5 x 9.7 cm low-density focus in the right breast with enhancing rim and septa. She was admitted to the hospital and subsequent thoracentesis revealed exudative fluid without malignant cells. A bedside breast biopsy would later reveal triple-negative, aggressive metastatic invasive ductal carcinoma of the right breast. The patient died two weeks after admission to the hospital. DISCUSSION: Breast cancer is the most common cancer in women in the United States and the second most common cause of mortality secondary to cancer. Triple-negative breast cancer is an aggressive malignancy that is defined by the absence of estrogen receptor, tyrosine kinase human epidermal growth factor receptor 2, and progesterone receptor. This cancer has a high mortality rate, but early intervention can lead to better outcomes including prolonged life and improved quality of life. Early intervention may have led to a better outcome for our patient. CONCLUSIONS: COVID-19 pandemic protocols overshadowed and briefly suspended routine screening. The impact of this delay in the diagnosis and treatment of invasive or preventative cancer will be evident in the coming years. REFERENCE #1: Mitchell EP. Declines in Cancer Screening During COVID-19 Pandemic. J Natl Med Assoc. 2020;112(6):563-564. doi:10.1016/j.jnma.2020.12.004 REFERENCE #2: Chen Y, Susick L, Davis M, et al. Evaluation of Triple-Negative Breast Cancer Early Detection via Mammography Screening and Outcomes in African American and White American Patients. JAMA Surg. 2020;155(5):440–442. doi:10.1001/jamasurg.2019.6032 REFERENCE #3: Chen Y, Susick L, Davis M, et al. Evaluation of Triple-Negative Breast Cancer Early Detection via Mammography Screening and Outcomes in African American and White American Patients. JAMA Surgery. 2020;155(5):440. doi:10.1001/jamasurg.2019.6032? DISCLOSURES: No relevant relationships by Kendall Creed, source=Web Response No relevant relationships by Kenneth Nugent, source=Web Response No relevant relationships by Navkiran Randhawa, source=Web Response No relevant relationships by Sukhbir Randhawa, source=Web Response

MP43-18 INCREASED PROSTATE CANCER UPGRADING RATE IS ASSOCIATED WITH POSITIVE FAMILY HISTORY IN CAUCASIANS BUT NOT IN AFRICAN AMERICANS

You have accessJournal of UrologyProstate Cancer: Detection & Screening IV (MP43)1 Sep 2021MP43-18 INCREASED PROSTATE CANCER UPGRADING RATE IS ASSOCIATED WITH POSITIVE FAMILY HISTORY IN CAUCASIANS BUT NOT IN AFRICAN AMERICANS Aaron Bradshaw, Ram Pathak, Adam Cohen, Bridget Krol, Justin Refugia, Parth Thakker, Shuo Liu, and Ashok Hemal Aaron BradshawAaron Bradshaw More articles by this author , Ram PathakRam Pathak More articles by this author , Adam CohenAdam Cohen More articles by this author , Bridget KrolBridget Krol More articles by this author , Justin RefugiaJustin Refugia More articles by this author , Parth ThakkerParth Thakker More articles by this author , Shuo LiuShuo Liu More articles by this author , and Ashok HemalAshok Hemal More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002064.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: While the pathology and outcomes of prostate cancer (PCa) have been shown to differ between the Caucasian and African American (AA) population, the impact of family history has not yet been comparatively assessed between the two. We sought to separately evaluate the impact of family history on PCa outcomes in AA and Caucasian men. METHODS: We performed a retrospective analysis of consecutive AA with clinically localized PCa who underwent robotic radical prostatectomy (RRP). For comparison, we abstracted 250 consecutive Caucasian patients who also underwent RRP. The cohorts were further subdivided for analysis into those with or without a family history of PCa. Family history was classified as a first degree relative with PCa and was determined and recorded at time of diagnosis. Clinical and demographic variables were obtained via chart review and compared between those with or without family history of PCa. Primary outcomes were impact on post-operative PSA and rate of upgrading/upstaging for each race. RESULTS: A similar proportion of both Caucasian (65/250) and AA (63/246) groups were found to have significant family history of PCa. Within each cohort, there was no significant difference in median follow-up length, age, BMI, or prostate volume between positive or negative family history groups. At the time of diagnosis, mean PSA was lower in Caucasians with positive history (6.34 vs. 8.27, p=0.042) but not in AA (p=0.64). The distribution of disease risk was not significantly different between family history groups within either cohort. Pathologic upgrading and upstaging rates were also not significantly different based on family history, with exception for Caucasians where an increased rate of upgrading in those men with positive family history (31% vs. 17%, p=0.012). There was ultimately no difference in the first post-operative PSA. CONCLUSIONS: Positive family history does not appear to be associated with adverse oncologic outcomes in AA men, but is associated with increased risk of upgrading in Caucasians. Further study may help understand whether this is due to an intrinsic difference in disease biology or related to other aspects of screening, diagnosis, and treatment. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e789-e789 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aaron Bradshaw More articles by this author Ram Pathak More articles by this author Adam Cohen More articles by this author Bridget Krol More articles by this author Justin Refugia More articles by this author Parth Thakker More articles by this author Shuo Liu More articles by this author Ashok Hemal More articles by this author Expand All Advertisement Loading ...